Advair on the chopping block

Experts to Consider Withdrawal of Asthma Drugs



anyone hear about this?
I t hink it is highly unlikely but i have not seen the studies.

Man Forced to Wear Sign for Animal Cruelty

Via Yahoo News:

Man Forced to Wear Sign for Animal Cruelty- HOPWOOD, Pa. - A western Pennsylvania man said he endured more than he expected when he agreed to an unusual sentence for an animal cruelty conviction...Complete Story.

Interns At work

The New Interns Work Arduously over a new admission. The details of this case to follow.

Had blister beetle dematitis yesterday, looked like this. 

Click the picture for the case from DermAtlas

Chilaiditi's sign/syndrome

Ok this is the case---the elderly female diabetic was admitted for "pneumonia". She had right upper quadrant pain and on chest x-ray "an infiltrate". She was treated for pneumonia. After reviewing the chest x-ray and lab tests, the diagnosis was in question.

On further questioning of the patient, there was a 1 year history of constipation and generalized mild abdominal pain possibly worse the right upper quadrant. A diangosis of "gall bladder disease" was considered, but the ultrasound was normal as was the PIPDA. There was a history of "retained food" on a recent EGD. The diagnosis of "diabetic gastroparesis" was considered; but since she was a diabetic for less than 10 years and was only treated with an oral hypoglycemic, the diagnosis was in doubt.

Before dismissal she had a colonscopy and the prep made her "feel much better", but the scope could only get to the splenic flexure due to a "large redundant colon".

A chest x-ray was done prior to dismissal to follow up on the "pneumonia". The film is the one shown above. NOW the diagnosis of Chilaiditi's syndrome (or hepatodiaphragmatic colon interposition) is apparent.

NOW, after reviewing the symptoms of the syndrome, the correct diagnosis is more apparent.
While it is uncommon this film shows the BEST example of Chilaiditi's I have ever seen.

-Posted by Clay for Joe

Blister Beetle strikes again

DermAtlas.org is a great resource for derm. pics.
BB had the opportunity to make the Dx but the old man had to clean it up.
The toxic substance is cantharidin, there are many of these beetles (2000) but if you look at their pictures on the net you will recognize some that you have seen in the yard.
They are so toxic that in Neb. this year they have infested hay and if horses eat enough of these critters(in the hay) they get sick and can even die.

Sambo, First Blood

Just now I have heard about a gun shooting expedition by our fellow blogger, Sam. Evidently he and one of our other esteemed coleagues decided to load up their weapon arsenal and travel 20 miles outside of town to a gravel pit. Sam, correct me if I'm wrong, but I heard that there were several impressive handgun specimens which you unleashed on various targets to satisfy your itchy trigger finger. Because of this recent event, I'm afraid you have picked up a couple of new nicknames: Sambo, and Tackleberry (from the Police Academy series). Although, I have learned from you that your partner in this bullet barrage might be more deserving of these new nicknames. Please set the story straight if there are any errors in this post.

Guns, Germs, and Steel

Nat. Geo. special on AETN Monday night at 900pm based on the book.

Chilaiditi's Rides Again

I have been accused of having " a favorite diagnosis or two" so here's the link --Chilaiditi's syndrome
or LearningRadiology.com search for Chilaiditi's syndrome.

We had a great case of Chilaiditi's this past week and our x-rays were the best I have been able to find(wish I knew how to put them on the blog--but will be happy to show you when you drop by).

It wasn't as much fun as spider in the ear but still you take fun where you can get it.

Case Reports and HIPPA Rules

Via Kevin MD:

Case Reports and HIPPA Rules-provided by Clinical Cases and Images Blog.

Arthropod in Ear Day Part II

After the insect in the kids ear one recent morning, I thought my day was complete and there would be no more excitement, but I was wrong.

A middle aged man came to the clinic late one recent afternoon with the following story. He was working above his head when he saw a spider descend upon him. It landed on his head and he felt it go in his ear. Somehow he was able to keep from jamming his finger in there to try to get it out. Instead, he calmly got in his vehicle and drove to the clinic. My nurse brought him back to an exam room where he told her the story. She took a look at his ear. This is a reenactment of her description of what she saw.

She was about to just grab it, but it backed its way in his ear just like that was his home. So she came and pulled me out of an exam room and told me about the spider in the ear. I shined a light and could just barely make out the spider and saw him backing in further. Keep in mind that the gentleman is standing very calmly, waiting for us to get it out. So I grabbed my otoscope and this is approximately what I saw.



I then grabbed the alligator clamp and took a couple of grabs at it but the thing kept moving away and further back. Finally I made an attempt and the spider scampered out of there and ran up the side of his head. My nurse very astutely started whacking this guy on the head trying to smash it, while I was lining up to thump it across the room. After 4 solid blows to the head she finally smashed it on his cap. Here is the actual dead spider. Its abdomen was much fuller but the contents were left behind on the cap. At first I though it might be a brown recluse because the thorax has what could be construed as a violin shape, but I wouldn't say for sure.


Since the spider finally went out voluntarily, there were no remaining parts, and no apparent injury, so all is well that ends well. I told my partners about this and they suggested next time I use lidocaine to both numb the ear and kill the animal. Next time I probably will go that route.

Arthropod in Ear Day Part I

The Phylum Arthropoda was well represented in my clinic recently. First I had a young kid come in with pus draining from his ear for 2-3 days. I thought this was going to be a run of the mill otitis, but no. I pulled out this insect in a piecemeal fashion along with a lot of stinky pus. I wasn’t able to get a thorough look at his TM because of all the pus and he had PE tubes which had been placed by our prestigious ENT blogger, so I sent the child over for Shane to get a second look. This is probably not a big deal to someone who does this all day long for a living, but it was a little unusual for me. I’m sorry for the poor pictures but it was the best I could do. Part II of Ear Arthropod Day is even more interesting.

Don't shoot these birds!!! 

Tomorrow night!!!!! 

This is what you get for befriending a sea gull. 

The Dullest Blog in the World

Although we do occasionally produce some exciting posts, such as pictures of baby crap and pictures of Joe's vacations (just to mention one genre), I'm sure there are plenty of people who find the content of this blog boring. Fortunately, this is not the dullest blog in the world. That Blog is here. The bad news is that this blog gets far more hits than we do.

And Now For Something Completely Different......

I'm just kidding of course. Here's more on Bowel movements and Bowels, at least this time there is little or no feces involved thanks to an apparent 4 star bowel prep. George would be proud.

Here is a photomontage of the artist's GI tract. Scroll to the right.