Gastric epithelioid haemangioendothelioma: a rare cause of upper gastrointestinal bleeding

Vascular tumours of the stomach are rare, representing 0.9%-3.3% of all gastric neoplasms. A 58 year old man was admitted as an emergency with a one day history of haematemesis and melaena. He underwent an emergency laparotomy for a tumour in the lesser curve of the stomach. The tumour showed the characteristic histological and immunohistochemical features of epithelioid haemangioendothelioma. Surgery in the form of wide excision seems to be the treatment of choice for this rare neoplasm. This case highlights the difficulty in diagnosing this rare tumour preoperatively and emphasises the need for long term follow up in view of its uncertain metastatic potential.     

Paraneoplastic polyarthritis in association with metastatic neuroendocrince tumour of the adrenal gland

Paraneoplastic polyarthritis is a rare manifestation described in association with various solid tumours. We describe the clinical presentation, diagnostic evaluation, differential diagnosis, and management of a 28-year-old woman who presented with fever, weight loss, and symmetrical polyarthritis, subsequently diagnosed to have a metastatic neuroendocrine tumour of the adrenal gland with paraneoplastic polyarthritis. Paraneoplastic polyarthritis must be considered in polyarthritis unexplained by common aetiologies. The unusual presentation of this case, alerts us about the atypical presentation of these tumours. To the best of our knowledge, this is the first case study of a neuroendocrine tumour presenting as paraneoplastic polyarthritis.     

The Evaluation of Psychopharmacological Enhancers Beyond a Normative “Natural”–“Artificial” Dichotomy

The extra-therapeutic use of psychotropic drugs to improve cognition and to enhance mood has been the subject of controversial discussion in bioethics, in medicine but also in public for many years. Concerns over a liberal dealing with pharmacological enhancers are raised not only from a biomedical–pharmacological perspective, but particularly from an ethical one. Within these ethical concerns, there is one objection about the normative differentiation between “natural” and “artificial” enhancers, which is theoretically indeed widely discredited in bioethics, which has, however, entrenched itself in such a persistent way in everyday moral consciousness that it keeps a crucial influence on the assessment of pharmacological enhancers made by the public and medical professionals. This paper tries to first show why a normative differentiation between “natural” and “artificial” enhancers is highly problematic. In a second step, the resulting implications for our current dealing with pharmacological enhancers shall be examined. In a specific comparison of synthetic pharmaceuticals (modafinil, SSRIs) with phytopharmaceuticals (ginkgo biloba, St. John’s wort) and other already established enhancers (alcohol, caffeine), argumentative inconsistencies are pointed out which, at least partly, result from a rationally untenable preference for the “natural” over the “artificial”. Therefore, it is conclusively argued the case for an unprejudiced assessment of pharmacological enhancers beyond a “natural”–“artificial” dichotomy, which equally takes into account biomedical and ethical aspects. The goal is to reach a coherent dealing with pharmacological enhancement in the long run.     

Syphilis,psychiatry and offending behaviour: clinical cases from nineteenth-century Ireland

Background  Syphilis presented substantial challenges to nineteenth-century medical and psychiatric services. Aims  To illustrate the clinical course and diagnostic challenges associated with neurosyphilis in nineteenth-century Ireland. Method  This paper uses original archival material from the Central Criminal Lunatic Asylum, Dublin to present clinical cases and inform a discussion of related issues. Results  Mr A, a 34-year-old banker convicted of “felonious entry”, demonstrated many psychiatric and neurological features of neurosyphilis (“general paralysis of the insane”); he soon became “feeble”, “paralytic” and “demented”, and died within 2 years. The case of Mr B, a 38-year-old game-keeper convicted of “attempting to upset trains”, illustrates diagnostic dilemmas associated with neurosyphilis, especially when complicated by evidence of tuberculosis (“scrofulous diathesis”). Conclusions  The clinical and diagnostic challenges presented by syphilis have changed over the past century, but these cases, combined with recent evidence of syphilis outbreaks, highlight ongoing needs for clinical and epidemiological vigilance.     

ENGLISH TRANSLATION OF CHINESE MEDICINE——Concerning the Use of Western Medical Terms to Represent Traditional Chinese Medical Concepts：Answer to Prof. XIE and His Colleagues

This paper strongly rejects the notion that the use of biomedical terms to represent traditional Chinese medical concepts is helpful to the internationalization of Chinese medicine. It further argues that this practice destroys the integrity and independence of Chinese medical concepts. Taking the term 风火眼 fěng huǒ yǎn as an example, it shows that the biomedical term ＂acute conjunctivitis＂ often suggested as the translation for this term is unsatisfactory, because （ 1 ） the clinical reference is not identical, （2） it introduces the concepts of ＂conjunctiva＂ and ＂inflammation＂, which are not Chinese medical concepts, and （3） destroys the Chinese medical concepts ＂wind＂ and ＂fire＂ expressed in the Chinese, which reflect the way the disease is traditionally diagnosed and treated. While for English readers not familiar with Chinese medicine, ＂acute conjunctivitis＂ may be immediately intelligible, for those seeking a deep understanding of the subject, the literal translation （loan translation） ＂wind-fire eye＂ is much more helpful. This paper supports these arguments with numerous other examples.     

Parotid gland carcinosarcoma with follicular dendritic cell sarcoma as mesenchymal component: a case report

The WHO has classified malignant mixed tumours of salivary glands into noninvasive carcinoma in pleomorphic adenoma, invasive carcinoma in pleomorphic adenoma, carcinosarcoma and metastasizing mixed tumour.Carcinosarcoma, or true malignant mixed tumour, is a tumour composed of both carcinomatous and sarcomatous elements.     

The Manipulated History of Manipulations of Spines and Joints? Rethinking Orthopaedic Medicine Through the 19th Century Discourse of European Mechanical Medicine

More than one single professional group deals with therapeutic manipulations of the spine and the joints. Osteopaths, Chiropractors, Naprapaths, Physical Therapists (and a contingent Physicians) all share this interest. Each profession is also very clear about where its bulk of knowledge stems from. The disciplines that are reckoned as the oldest are from the USA. A number of “inventors” are to be found, all without a formal university degree in Medicine. Andrew Taylor Still (1828–1917) came up with his system of Osteopathy in 1874. Daniel D. Palmer (1845–1913), the man behind Chiropractic, founded his system in 1894, and Palmer’s colleague and former student, Oakley Smith (1880–1967), developed Naprapathy in 1906/1907. Physical Therapists working with what is called Orthopaedic Manual Physical Therapy are on the other hand not claiming American ancestry, nor do their body of knowledge and clinical skills originate from outside the medical profession. It is an offspring of Orthopaedic Medicine (OM) which was an invention by Physicians. Date and place of birth is said to be 1929 in England. This article turns the above-mentioned chronology on its head. It will show that Orthopaedic Medicine likely is the oldest system. It will also unearth OM’s sturdy roots in a strong but forgotten, and even hidden, discourse of Mechanical Medicine found in 19th century Europe, which was ruled by Physical Therapists. Why “we” do not know about this “history” is analysed and explained from a variety of perspectives.     

Wilms’ tumour in adults: a case report and review of the literature

Background  

Wilms’ tumour is a very rare adult malignancy representing 1% of adult renal tumours. It is however the most common renal tumour of childhood, and adult patients are treated in accordance with paediatric protocols.     

The Adoption of Mobile Health Management Services: An Empirical Study

As their populations age, many countries are facing the increasing economic pressure of providing healthcare to their people. In Taiwan, this problem is exacerbated by an increasing rate of obesity and obesity-related conditions. Encouraging the adoption of personal health management services is one way to maintain current levels of personal health and to efficiently manage the distribution of healthcare resources. This study introduces Mobile Health Management Services (MHMS) and employs the Technology Acceptance Model (TAM) to explore the intention of students in Executive Master of Business Management programs to adopt mobile health management technology. Partial least squares (PLS) was used to analyze the collected data, and the results revealed that “perceived usefulness” and “attitude” significantly affected the behavioral intention of adopting MHMS. Both “perceived ease of use” and “perceived usefulness,” significantly affected “attitude,” and “perceived ease of use” significantly affected “perceived usefulness” as well. The results also show that the determinants of intention toward MHMS differed with age; young adults had higher intention to adopt MHMS to manage their personal health. Therefore, relevant governmental agencies may profitably promote the management of personal health among this population. Successful promotion of personal health management will contribute to increases in both the level of general health and the efficient management of healthcare resources.     

Water ballon-aided ultrasonography—Application in the diagnosis of rectal cancer

Summary Application of conventional ultrasonography in the diagnosis of rectal cancer is in itself very difficult. The authors have designed a new device called “Water Ballon-Aided Ultrasonography”. With the aid of the echofree zone and “acoustic window” effect formed by the water ballon, complete knowledge of the location, size and extension of the rectal cancer can be acquired, and the distance of the tumor from the the lower margin of the anus and the possibility of any infiltration to the adjacent organs can be detected, thereby enabling the surgeon to estimate the resectability of the tumor accurately and select suitable surgical approach. In this respect the water ballon-aided ultrasonography is much superior to other conventional examinations.     

Acute liver failure following recreational use of psychotropic “head shop” compounds

The recreational use of the so-called “legal-highs” has been in both the medical and political arena over the last year as a result of the appearance of “head shops” in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.     

Sertoli-Leydig cell tumour in a postmenopausal woman showing all facets of the insulin resistance syndrome (IRS)

Sertoli-Leydig cell tumours are rare sex stromal tumours with an incidence of < 0.5% of all ovarian tumours. Most frequently this tumour occurs in young women with a history of amenorrhoea, hirsutism and lowered pitch. Here, we report on a woman with IRS, postmenopausal virilization and increased testosterone levels due to a Sertoli-Leydig cell tumour. This is the first case to suggest an association between IRS and Sertoli-Leydig cell tumours. Furthermore, we highlight the difficulties in detecting this ovarian tumour with sonography.     

Is simple nephrectomy truly simple? Comparison with the radical alternative

Background  

The Oxford English dictionary defines the term “simple” as “easily done” and “uncomplicated”. We tested the validity of this terminology in relation to open nephrectomy surgery.     

An experimental study of using “tendon bridge” or “tendon tunnel” as a conduit for nerve regeneration

In our experiments, a “tendon bridge” or a “tendon tunnel” was used as a conduit to repair the defect of a peripheral nerve in rabbits. A gap of about 1 cm was made on the deep peroneal nerve in each animal. In group 1, the tendon of anterior tibial muscle was isolated near the severed nerve, and a segment of half cross section of tendon was removed in ladder-shaped reversed fashion. The proximal and distal nerve stump were sutured respectively to the tendon by 11/0 atraumatic sutures under surgical microscope. In group 2, the nerve stumps were sutured to the tendon of anterior tibial muscle without cutting the tendon, but the tendon was dissected free and turned to form a tunnel wrapping the gap in between the nerve stumps. The results showed that a gap of 1 cm of the deep peroneal nerve might be repaired by both methods, but the results of using “tendon tunnel” in group 2 were much better than those of using “tendon bridge” in group 1.     

Characterizing Cancer Information Systems

The objective is to determine the extent to which information systems (IS) for cancer are unique and necessary. Via an analysis of Medical Subject Headings used to index relevant literature and other bibliometric techniques, cancer IS are compared and contrasted with IS of other specialties. Cancer IS are relatively little discussed and primarily connect radiation equipment with the radiation oncology staff. By contrast, clinical laboratory and radiology IS are frequently discussed and connect specialized equipment to the hospital. A “Specialty Need” model accounts for these patterns and says that the “need for a specialty IS” is proportional to the “uniqueness of the specialty tools” plus the “degree to which the information from those tools is needed throughout the particular health care entity.”     

A Proposed Instrument for the Assessment of Job Satisfaction in Greek Mental NHS Hospitals

Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform “Psychargos” introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the “retention” and the “motivation” variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically significant lower scores in comparison to the rest of the employees. Strong Pearson correlations were detected between GSI and “working conditions”, “interpersonal relations”, “organization”, “salary” and “supervision” factors. The retention factors presented stronger impact on GSI in comparison to the motivation ones. The results of the study indicate that the proposed instrument presents satisfactory validity and reliability for the assessment of job satisfaction in Greek mental NHS hospitals.     

Iconography and Wax Models in Italian Early Smallpox Vaccination

Luigi Sacco (1769–1863) was the main protagonist of early vaccination campaign in Italy. He found a native source of vaccine lymph: with that, he personally vaccinated more than 500,000 people and furnished all Italy and some Middle East countries too. Starting from the pictures of his books, Sacco proposed to create wax models of “real” and “spurious” smallpox pustules in human, cow, sheep and horse; just to permit, not only to doctors, but also to all other health operators, the identification of the right pustules from where to extract active lymph for vaccination. In the Museum of Pathological Anatomy of the Padua University Medical School, we have four anatomical waxes which corresponded exactly to the explicative pictures in 1809 Sacco’s treatise on Vaccine. We have found the same models also at the University of Milan, Pavia and Bologna—the main cities of “Cisalpine Republic”, the state of North Italy formed at the epoch of Sacco following the Napoleon conquest. The history of the diffusion of these models presented in this text will be a starting point to develop wider questions. In particular, this history could be useful to improve our understanding of the birth of scientific and experimental medicine through XIX and XX Century.