Dealing with dying patients: Difficulties and strategies in final-year medical students

The study reports on a questionnaire study of final-year medical students' self-reported attitudes to dealing with dying patients. All respondents had some direct clinical experience with dying patients, and reported that such encounters were largely unproblematic. Alleviating patient anxiety and counseling relatives were seen as important aspects of the doctor's role, along with diagnosis, and management of symptoms. “High fear” respondents were more likely to report difficulty in discussing the prognosis with the dying and to experience minor psychological problems.     

Placement of anterior cervical instrumentation without intraoperative radiography.

Adequate fixation with several commonly used anterior cervical plate systems requires that the screws penetrate both the anterior and posterior cortices of the vertebral bodies. This report emphasizes the shortcomings of plain film and fluoroscopic examinations in confirming screw position through the posterior vertebral cortex in three patients with lower cervical trauma or tumor. These cases and radiographs of isolated vertebrae from the cervicothoracic region demonstrate the inadequacy of plain film/fluoroscopy for determination of the position of anterior cervical plate screws in relation to the posterior cortex. Only axial images such as those obtained with computed tomography are able to show the exact relationship of the screws to the posterior cortical curvature in C7 and T1.     

Evaluation of a multifaceted "Resident-as-Teacher" educational intervention to improve morning report

Background  

Resident-led morning report is an integral part of most residency programs and is ranked among the most valuable of educational experiences. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the educational and teaching experience of morning report.     

Fluorescence in situ hybridization analysis of chromosome 12p in paraffin-embedded tissue is useful for establishing germ cell origin of metastatic tumors.

The over-representation of chromosome 12p sequences is crucial for the development of invasive testicular germ cell tumors. Testicular cancer patients may have metastatic tumors of diverse histologic types, including adenocarcinoma, undifferentiated carcinoma, sarcoma, or other malignancies that lack features of germ cell tumors. We sought to investigate the possible germ cell origin of such tumors using interphase fluorescence in situ hybridization. In all, 10 metastatic malignant somatic-type tumors from patients with histories of testicular cancer, as well as one malignant somatic-type tumor from a patient with primary mediastinal germ cell tumor were studied and included: adenocarcinoma (five cases), poorly differentiated carcinoma (one), sarcoma (four), and neuroendocrine carcinoma (one). The tumors were analyzed using fluorescence in situ hybridization using 12p spectrum green and 12 centromeric spectrum orange probes in paraffin sections. The patients ranged in age from 27 to 55 years (mean, 43). Colon and lung cancers from patients without germ cell tumors were used as controls. Adequate signals were observed in all tumors. Gain of chromosome 12p was seen in six tumors. None of the control tumors showed 12p amplification. Fluorescence in situ hybridization for 12p amplification in routinely processed surgical specimens is a useful adjuvant diagnostic tool in confirming the germ cell origin of metastatic tumors having the histologic appearance of somatic-type neoplasms.     

Dronabinol reduces signs and symptoms of idiopathic intracranial hypertension: a case report.

A case is presented in which a woman diagnosed with a longstanding history of idiopathic intracranial hypertension reported improvement of frontal headaches, photophobia, transient blindness, enlarged blind spots, and tinnitus after smoking marijuana. All these symptoms and signs were associated with increased intracranial pressure (220-425 mm of water). Treatment with dronabinol at a dose of 10 mg twice a day, then reduced to 5 mg twice a day, relieved all of her symptoms. Previously noted papilledema and enlargement of blind spots also resolved, and this, in the absence of psychoactive effect or weight gain.     

TOOTH WHITENING IN CHILDREN AND ADOLESCENTS

The popularity of vital tooth whitening has increased significantly over the past two decades. Professionally supervised "in-office" and "at-home" tooth whitening methods have been documented in the literature with evidence of safety and effectiveness. Although the literature includes considerable information about vital tooth whitening in adults, minimal information is available concerning vital tooth whitening in children and adolescents.
The need to provide vital tooth whitening for children might be infrequent owing to the natural whiteness of children's teeth. However, there are circumstances when tooth whitening can be desirable for children, such as fluorosis discoloration, generalized tooth darkening, post-traumatic injury discoloration, and postorthodontic tooth discoloration.
Few well-controlled clinical trials evaluating the safety and effectiveness of vital tooth whitening in children are available in the literature, Furthermore, these published clinical trials were carried out by the same principal investigator. This review examines these trials and offers recommendations accordingly.     

Gastric Barotrauma in a Scuba Diver: Report of a Case

Stomach rupture can occur as a consequence of the expansion of compressed air during rapid ascent after diving. We present the case of a middle-aged woman who suffered a gastric tear from surfacing too quickly after diving, and discuss the diagnosis and management of such patients by reviewing previously reported similar events. Gastric barotrauma should be suspected in divers who complain of abdominal pain, even in the absence of frank signs of peritoneal irritation. Although pneumoperitoneum is always present in these patients, it can also occur as a consequence of pulmonary barotrauma, making gastroscopy or radiological contrast studies, or both, essential for a definitive diagnosis. Surgical repair represents the treatment of choice for an active full-thickness tear and, if associated with arterial gas embolism or decompression sickness, should ideally be performed in a center where a category I (intensive care-capable) hyperbaric unit is available. Received: March 18, 2002 / Accepted: September 3, 2002 Reprint requests to: L.V. Titu