Treatment of Evan’s syndrome by leflunomide and desmopressin in a mixed-breed dog

A 9-year-old, male, mixed-breed dog was presented with severe lethargy, pale and icterus mucous membranes, gingival hemorrhage, and hematochezia. On physical examination, petechiae and echimosis on the penis were observed. The complete blood count revealed severe regenerative anemia and thrombocytopenia. Urinalysis indicated hemoglobinuria and bilirobinuria, and abdominal sonography showed splenomegaly. A series of diagnostic tests was performed based on the suspicion of Evan’s syndrome (concurrent immune-mediated anemia and thrombocytopenia). The therapeutic program was started with prednisolone combined with leflunomide followed by desmopressin and erythropoietin, lasted 1?month, and the animal showed progressive recovery. During 6?months follow-up, no complications were detected in the mentioned case.     

��Trick��, ��Manipulation�� and ��Farce��: Albert Moll��s Critique of Occultism

In July 1925, the psychiatrist Albert Moll appeared before the district court in Berlin-Schöneberg charged with having defamed the medium Maria Vollhardt (alias Rudloff) in his 1924 book Der Spiritismus [Spiritism]. Supported by some of Berlin’s most prominent occultists, the plaintiff – the medium’s husband – argued that Moll’s use of terms such as ‘trick’, ‘manipulation’ and ‘farce’ in reference to Vollhardt’s phenomena had been libellous. In the three-part trial that followed, however, Moll’s putative affront to the medium – of which he was eventually acquitted – was overshadowed, on the one hand, by a debate over the scientific status of parapsychology, and on the other, by the question of who – parapsychologists, occultists, psychiatrists or jurists – was entitled to claim epistemic authority over the occult. This paper will use the Rudloff–Moll trial as a means of examining Moll’s critique of occultism, not only as it stood in the mid-1920s, but also as it had developed since the 1880s. It will also provide insight into the views of Germany’s occultists and parapsychologists, who argued that their legitimate bid for scientific credibility was hindered by Dunkelmänner [obscurantists] such as Albert Moll.     

The dog’s meow: asymmetrical interaction in cross-modal object recognition

Little is known on cross-modal interaction in complex object recognition. The factors influencing this interaction were investigated using simultaneous presentation of pictures and vocalizations of animals. In separate blocks, the task was to identify either the visual or the auditory stimulus, ignoring the other modality. The pictures and the sounds were congruent (same animal), incongruent (different animals) or neutral (animal with meaningless stimulus). Performance in congruent trials was better than in incongruent trials, regardless of whether subjects attended the visual or the auditory stimuli, but the effect was larger in the latter case. This asymmetry persisted with addition of a long delay after the stimulus and before the response. Thus, the asymmetry cannot be explained by a lack of processing time for the auditory stimulus. However, the asymmetry was eliminated when low-contrast visual stimuli were used. These findings suggest that when visual stimulation is highly informative, it affects auditory recognition more than auditory stimulation affects visual recognition. Nevertheless, this modality dominance is not rigid; it is highly influenced by the quality of the presented information. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.

Medical physics in a DGH–a personal view

Medicine, from the point of view of its use of technological innovation, is considered by the author to be the most underdeveloped activity world-wide. Present-day engineering expertise can plan, design and construct a great variety of devices and techniques which increase the effectiveness of medical diagnosis and of treatment, of rehabilitation of the disabled, together with a range of‘spin-offs’-for example assisting in producing improved sports performance.

The difficulties in exploiting to the full the opportunities available to engineers in medicine are much the same as those which inhibit the exploitation of engineering in general to its full potential. These difficulties, according to Professor Kenedi, are not the result of the oft reputed ‘lack of liaison’ between technological education and industry (the latter incidentally being the health service for engineering in medicine) or of the apparent ‘lack of orientation’ of the UK's young people to engineering-these are only symptoms. The malaise is considered to be deeper seated and more subtle: although living in a characteristically multiprofessional world (this is particularly true of the health service) the British still attempt to guide the development of engineering on the bases of inapplicable, restrictive and inhibitive uni-professional concepts and principles.

For example Professor Kenedi suggests that the UK should start to register, statutorily, qualified engineers' pre-experience so as to compile a reliable data-base on which to plan manpower, and engineers should not be ‘chartered’ for life in a particular professional stream just because institutions are uni-professional. Individual career reorientations are now commonplace and an engineer's original ‘chartering’ is frequently inapplicable in later career. In this context, reaccreditation should be employed, firstly to make ‘chartering’ keep pace with career changes, and, secondly, (more importantly) to ensure periodic updating of competence. Industry is now acutely conscious of the increasingly frequent incidence of ‘skill obsolescence’, particularly in the ranks of its highly qualified staff.

In the UK's Engineering Council there is the organization to guide, encourge and, when necessary, push engineering out of its present ineffective morass. To do this with effect the Council will need to adopt a directly active altitude to the introduction of reforms that are so very much needed now.     

GPs' and pharmacists' experiences of managing multimorbidity: a ��Pandora's box��

Background

Multimorbidity is defined as the occurrence of two or more chronic diseases in one individual. Patients with multimorbidity generally have poorer health and functioning and higher rates of attendance in primary care and specialty settings.

Aim

To explore the views and attitudes of GPs and pharmacists managing patients with multimorbidity in primary care.

Design of study

Qualitative study using focus groups.

Setting

Primary care in Ireland.

Method

Three focus groups were held in total, involving 13 GPs and seven pharmacists. Focus groups were recorded, transcribed, and analysed using the ‘framework’ approach.

Results

The predominant themes to emerge from the focus groups were: 1) the concept of multimorbidity and the link to polypharmacy and ageing; 2) health systems issues relating to lack to time, inter-professional communication difficulties, and fragmentation of care; 3) individual issues from clinicians relating to professional roles, clinical uncertainty, and avoidance; 4) patient issues; and 5) potential management solutions.

Conclusion

This study provides information on the significant impact of multimorbidity from a professional perspective. It highlights potential elements of an intervention that could be designed and tested to achieve improvements in the management of multimorbidity, outcomes for individuals affected, and the experiences of those providing healthcare.     

Waldeyer��s fascia: anatomical location and relationship to neighboring fasciae in retrorectal space

Purpose  

The term Waldeyer’s fascia has caused confusion in surgery for rectal cancer. We have therefore dissected endopelvic fasciae to clarify the structure and location of Waldeyer’s fascia, and to determine its anatomical relationships with adjacent fasciae.     

��God��s Ethicist��: Albert Moll and His Medical Ethics in Theory and Practice

In 1902, Albert Moll, who at that time ran a private practice for nervous diseases in Berlin, published his comprehensive book on medical ethics, Ärztliche Ethik. Based on the concept of a contractual relationship between doctor and client, it gave more room to the self-determination of patients than the contemporary, usually rather paternalistic, works of this genre. In the first part of the present paper this is illustrated by examining Moll’s views and advice on matters such as truthfulness towards patients, euthanasia, and abortion. The second part of this article discusses how Moll engaged with the then publicly debated issues of experimentation on hospital patients and the ‘trade’ of foreign private patients between agents and medical consultants. In both matters Moll collected evidence of unethical practices and tried to use it to bring about change without damaging his or the profession’s reputation. However, with his tactical manoeuvres, Moll made no friends for himself among his colleagues or the authorities; his book on ethics also met with a generally cool response from the medical profession and seems to have been more appreciated by lawyers than by other doctors.     

Microcomputers in clinical psychology – a personal view

The applications of microcomputers in clinical psychology are discussed. The author illustrates the paper with examples drawn from his own experience and suggests some ways in which microcomputers might be of value to doctors in other areas of medicine.     

Deficits in inhibitory control and conflict resolution on cognitive and motor tasks in Parkinson��s disease

Recent imaging studies in healthy controls with a conditional stop signal reaction time (RT) task have implicated the subthalamic nucleus (STN) in response inhibition and the pre-supplementary motor area (pre-SMA) in conflict resolution. Parkinson's disease (PD) is characterized by striatal dopamine deficiency and overactivity of the STN and underactivation of the pre-SMA during movement. We used the conditional stop signal RT task to investigate whether PD produced similar or dissociable effects on response initiation, response inhibition and response initiation under conflict. In addition, we also examined inhibition of prepotent responses on three cognitive tasks: the Stroop, random number generation and Hayling sentence completion. PD patients were impaired on the conditional stop signal reaction time task, with response initiation both in situations with or without conflict and response inhibition all being significantly delayed, and had significantly greater difficulty in suppressing prepotent or habitual responses on the Stroop, Hayling and random number generation tasks relative to controls. These results demonstrate the existence of a generalized inhibitory deficit in PD, which suggest that PD is a disorder of inhibition as well as activation and that in situations of conflict, executive control over responses is compromised.     

Showers, Sweating and Suing: Legionnaires�� Disease and ��New�� Infections in Britain, 1977�C90

Legionnaires’ disease is now routinely discussed as an ‘emerging infectious disease’ (EID) and is said to be one of the earliest such diseases to be recognised. It first appeared in 1976 and its cause was identified in 1977, the same year that Ebola fever, Hantaan virus and Campylobacter jejuni arrived. The designation of Legionnaires’ disease as an EID was retrospective; it was not and could not be otherwise as the category only gained currency in the early 1990s. In this article we reflect on the changing medical understanding and social profile of Legionnaires’ disease in the decade or so from its recognition to the creation of EIDs, especially its ambivalent position between public health and clinical medicine. However, we question any simple opposition, between public health experts who approached Legionnaires’ disease as a new and worrying environmental threat that could be prevented, and clinicians who saw it as another cause of pneumonia that could be managed by improved diagnosis and treatment. We argue that in the British context of public spending cuts and the reform of public health, the category of ‘new’ diseases, in which Legionnaires’ disease was central, was mobilised ahead of the EID lobby of the early 1990s, by interested groups in medicine to defend infectious diseases services.     

The Guyon��s canal in perspective: 3-T MRI assessment of the normal anatomy, the anatomical variations and the Guyon��s canal syndrome

Purposes

(1) To revisit the anatomical boundaries of the canal, its contents and its two channels, (2) to describe the anatomical variations of the canal??s borders and the variations of its contents, and (3) to discuss the clinical relevance of the Guyon??s canal syndrome.

Methods

Two hundred and fifty MR wrists examinations were reviewed. MR spin echo T1-weighted axial slices were used to analyze the Guyon??s canal. The anatomical boundaries, the cross-sectional area and length of the canal were calculated. The anatomical variations of the canal??s walls and contents and their prevalence were sought. Changes related to Guyon??s canal syndrome were also evaluated.

Results

From the 250 wrists, the anatomy of the Guyon??s canal was normal in 168 (67.2%) wrists; 73 (29.2%) wrists presented with anatomical variations; and 9 (3.6%) wrists had derangements causing Guyon??s canal syndrome. The cross-sectional area of the canal was 33?±?11?mm2 proximally and 45?±?19?mm2 distally. The canal??s length was approximately 40?±?4?mm. Among the 73 wrists with anatomical variations, there were aberrant muscles in 39 (53.4%) wrists, multiple ulnar nerve branching in 22 (30%) cases, increased amount of fat tissue inside the canal in 9 (12.3%) cases and hypoplastic hamulus in 3 (4.1%) cases. There were 9 (3.6%) symptomatic wrists with clinical and radiological features attributed to Guyon??s canal syndrome.

Conclusion

MRI is an excellent modality for the evaluation of the Guyon??s canal.     

Asymptomatic diffuse ��encephalitic�� cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia: case report and review of the literature

Opportunistic infections account for the majority of central nervous system lesions in adult immunosuppressed patients. In this setting, toxoplasmosis typically manifests as multiple abscesses readily seen on routine neuroimaging studies. Asymptomatic, widely disseminated Toxoplasma cysts without parenchymal reaction are also recognized. In contrast, widespread parasites in the brain parenchyma with an inflammatory “encephalitic” reaction and little or no necrosis have been reported in only four patients with acquired immune deficiency syndrome (AIDS). We describe a 70 year old male with stage IV chronic lymphocytic leukemia complicated by aplastic anemia. Neurological examination and imaging revealed no significant abnormalities. At autopsy, the brain revealed multifocal cysts and free tachyzoites of Toxoplasma gondii with diffuse microglial nodules and no necrosis. To the best of our knowledge, this case represents the first report of the “encephalitic” form of toxoplasmosis in a non-AIDS patient.