Current concepts in teaching and learning in surgery

Modern surgical teaching is evolving at speed. The environment in which we learn and teach is subject to a number of extrinsic pressures. These are influencing ways in which medical students and trainees learn and are taught the discipline of surgery. As a surgical educator it is useful to understand the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.     

Detection of targeted perfluorocarbon nanoparticle binding using 19F diffusion weighted MR spectroscopy

Real‐time detection of targeted contrast agent binding is challenging due to background signal from unbound agent. ¹⁹F diffusion weighted MR spectroscopy (DWS) could selectively detect binding of angiogenesis‐targeted perfluorocarbon nanoparticles in vivo. Transgenic K14‐HPV16 mice with epidermal squamous carcinomas exhibiting up‐regulated neovasculature were used, with nontransgenic littermates as controls. Mice were treated with α_vβ₃‐integrin targeted perfluorocarbon nanoparticles. ¹⁹F DWS (b‐values from 0 to 16,000 s/mm²) was performed on mouse ears in vivo at 11.74 Tesla. Progressive decay of ¹⁹F signal with increased diffusion weighting at low b‐values (< 1500 s/mm²) was observed in ears of both K14‐HPV16 and control mice, demonstrating suppression of background ¹⁹F signal from unbound nanoparticles in the blood. Much of the ¹⁹F signal from ears of K14‐HPV16 mice persisted at high b‐values, indicating a stationary signal source, reflecting abundant nanoparticle binding to angiogenesis. ¹⁹F signal in controls decayed completely at high b‐values (> 1500 s/mm²), reflecting a moving signal source due to absence of angiogenesis (no binding sites). Estimated ADCs of nanoparticles in K14‐HPV16 and control mice were 33.1 ± 12.9 μm²/s and 19563 ± 5858 μm²/s (p < 0.01). In vivo ¹⁹F DWS can be used for specific detection of bound perfluorocarbon nanoparticles by selectively suppressing background ¹⁹F signal from nanoparticles flowing in blood. Magn Reson Med 60:1232–1236, 2008. © 2008 Wiley‐Liss, Inc.     

Supraventricular Tachycardia in the Pediatric Primary Care Setting: Age-related Presentation, Diagnosis, and Management

As many as 1 in 250 children experience supraventricular tachycardia (SVT), but its presentation is often vague and its symptoms mistakenly attributed to other common pediatric conditions. If SVT is correctly identified in a timely manner, most children will go on to live normal healthy lives. SVT is not covered in depth in most pediatric advanced practice nursing programs, but because of its prevalence, it should be familiar to all pediatric primary care providers. This article reviews common mechanisms of SVT and their age-related presentation, diagnosis, and management. A case study of an 8-year-old boy with SVT is presented.     

Extraocular muscle dystonia due to acquired (non‐Wilsonian) hepatocerebral degeneration

We present a video report of a patient with advanced non‐Wilsonian cirrhotic liver disease who developed extraocular muscle dystonia (oculogyric crisis) and severe orofaciolingual dyskinesias. Acquired hepatocerebral degeneration causes choreic movements, especially of cranial muscles, but dystonic ocular spasm is an infrequent manifestation of this disorder. This case illustrates that AHD should be considered in the differential diagnosis of extraocular muscle dystonia. © 2008 Movement Disorder Society     

Diagnostic yield and characteristic features in a series of decomposed bodies subject to coronial autopsy

A study was undertaken of 629 cases autopsied at Forensic Science SA, Adelaide, Australia over a 10-year period from 1994 to 2004 where significant decomposition had been documented. The age range of victims was 10 months to 92 years (mean 51.5 ± 18.1 years). There were 498 males (79%) and 131 females (21%) (M:F = 3.8:1). Deaths in 289 of the 629 cases (46%) were due to natural causes, with 179 suicides (28%), 83 accidents (13%), and 36 homicides (6%). The cause of death was ascertained in 89% of cases and the manner of death in 93% of cases. In 35 cases (6%) both the cause and manner could not be determined. Numbers of suicides were higher in younger age groups while deaths from organic illnesses predominated in later life. The number of cases in summer was significantly greater than in winter. Despite technical difficulties in handling decomposed bodies, and artifactual alteration of tissue structure and microscopic features, the autopsy was still a useful diagnostic exercise. While it is likely that more information may be gleaned from fresh bodies in perfectly preserved states, decomposed bodies may reveal significant anatomical and pathological features that enable both the cause and manner of death to be established.     

Effect of exercise on serum sex hormones in men: a 12-month randomized clinical trial.

PURPOSE: The effect of exercise on androgens in middle-aged to older men is poorly understood, and it could have implications for several aspects of health. This analysis was conducted to examine the effects of long-term aerobic exercise on serum sex hormones in middle-aged to older men. METHODS: One hundred two sedentary men, ages 40-75 yr, were randomly assigned to a 12-month exercise intervention or a control group (no change in activity). The combined facility- and home-based exercise program consisted of moderate/vigorous-intensity aerobic activity for 60 min.d(-1), 6 d.wk(-1). Serum concentrations of testosterone, free testosterone, dihydrotestosterone (DHT), 3alpha-androstanediol glucuronide (3alpha-Diol-G), estradiol, free estradiol, and sex hormone-binding globulin (SHBG) were measured at baseline, 3, and 12 months. RESULTS: Exercisers trained a mean of 370 min.wk(-1) (102% of goal), with only two dropouts. Cardiopulmonary fitness (.VO(2max)) increased 10.8% in exercisers and decreased by 1.8% in controls (P < 0.001). DHT increased 14.5% in exercisers versus 1.7% in controls at 3 months (P = 0.04); at 12 months, it remained 8.6% above baseline in exercisers versus a 3.1% decrease in controls (P = 0.03). SHBG increased 14.3% in exercisers versus 5.7% in controls at 3 months (P = 0.04); at 12 months, it remained 8.9% above baseline in exercisers versus 4.0% in controls (P = 0.13). There were significant trends toward increasing DHT and SHBG, with greater increases in .VO(2max) at 3 and 12 months in exercisers. No statistically significant differences were observed for testosterone, free testosterone, 3alpha-Diol-G, estradiol, or free estradiol in exercisers versus controls. CONCLUSIONS: A year-long, moderate-intensity aerobic exercise program increased DHT and SHBG, but it had no effect on other androgens in middle-aged to older men.     

Multi-organ failure in adult onset Still’s disease: a septic disguise

Juvenile dermatomyositis (JDM) is a rare disease, and Sjögren’s syndrome (SS) is unusual in adolescents. We report the first case of biopsy-proven JDM and SS with pulmonary involvement. A 15-year-old adolescent boy presented with recurrent parotid gland hypertrophy, severe muscle weakness, pronounced skin rash and widespread lymphadenopathy. JDM was diagnosed by clinical examination, elevated muscle enzymes, electromyography and muscle biopsy; SS was diagnosed by xerostomia, anti-Ro (SS-A) positivity and histopathological analysis of salivary gland tissue. This case illustrates a systematic approach which we feel is especially important in the younger patient with a more plastic immune system.