Funtabulously Frivolous Friday Five 155

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 155

Question 1

Takotsubo syndrome from the Japanese word for an octopus trap has entered our common vernacular but what is moyamoya disease and what does it mean in Japanese?

  • Puff of smoke.
  • Moyamoya is a rare type of stroke. Arteries become blocked via constriction and thrombosis while a collateral circulation develops. These collateral vessels are weak and prone to aneurysm. On a conventional angiography these collateral vessels appear life a “puff of smoke”. [Reference]

moyamoya

Question 2

What is masque ecchymotic?

    • Craniocervical cyanosis
    • First described by Ollivier in 1837 at autopsy of a man trampled on by the crowds in Paris
    • Various hypotheses have been made about the pathophysiology.
    • One theory is the traumatic asphyxia is associated with a fear response in the accident victim just prior to injury. In this “moment of impending disaster”, the individual reflexly takes a deep breath, holds it, and braces himself. Since air cannot escape from the thoracic cavity during compression in the face of a closed glottis, the increased pressure is transmitted centrally to mediastinal veins, superior and inferior vena cave, and right atrium. The blood in these structures is squeezed from the chest into the valveless veins of the head, neck, and abdomen. [Reference]

masque ecchymotic

Question 3

How did warfarin acquire its name?

  • It was invented with the help of the Wisconsin Alumni Research Foundation (WARF) and -arin indicating the link with coumarin.
  • In 1933 a farmer from Deer Park showed up unannounced at the School of Agriculture and walked into a professor’s laboratory with a milk can full of blood which would not coagulate. In his truck, he had also brought a dead heifer and some spoiled clover hay. He wanted to know what had killed his cow. In 1941 Karl Paul Link gave him his answer and the rodent killer was born. [Reference]

Question 4

How did French gauge get it’s name, and how does it relate to diameter?

  • The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments.
  • In French-speaking countries the symbol for French gauge is Ch (for Charriere, its inventor) instead of Fr, Fg, Ga, FR or F seen in other countries.
  • It refers to the external diameter of catheters and is three times the diameter in millimetres. A 1 French has an external diameter of 1/3mm and a 9 French has a diameter of 3mm. D(mm) = Fr/3
  • Note that the higher the French gauge the larger the diameter of the catheter. This is contrary to needle-gauge size, where an increasing gauge corresponds to a smaller diameter catheter. [Reference]

Question 5

What is “penis captivus” and who described it?

  • It is an urban myth – that a couple can become “entwined” by a severe form of vaginismus which causes a “locking” of the penis within the vagina during intercourse. So why is it funny?
  • The original description was by Egerton Yorrick Davis in the Philadelphia Medical News.
  • EYD was the pseudonym of Sir William Osler – father of modern medicine. He is purported to have invented the syndrome and written an article upon it in 1884 in order to basically get up the nose of one of his fellow editorial board members!
  • Why is it funny today? Well if you enter penis captivus into a search engine – you get a lot off hits – the main forum is the cosmetic penis-enlargement market, seems a lot of men are worried if they have the op – they might end up with this problem. Seems the tongue inserted in the cheek is tougher to dislodge than the other member from its vessel! [Reference]
Image from wikipedia

Image source: wikipedia

Last update: Jul 22, 2016 @ 8:25 am

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Vortex Reloaded 2016

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Filed under: Online critical airway training Tagged: 2016, vortex

Interview with the Author: AfJEM: Douglas Wiebe on Economic development & road traffic fatalities in two neighbouring African nations

Series: “Interview with the Author…”

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The badEM crew interviewed Douglas J Wiebe regarding his newly released article in AfJEM Volume 6 Issue 2 entitled: “Economic development & road traffic fatalities in two neighbouring African nations” Original Research by Douglas J. Wiebe, Sunanda Ray, Titus Maswabi, Christina Kgathi, Charles C. Branas.

Link to open access article: Click here:

Corresponding Author: dwiebe@upenn.edu

Wiebe (image Charles Branas) Wiebe (image Sunanda Ray) Wiebe (image)

Tell us about yourself. How did you get involved in this research?

As injury epidemiologists, we – Doug Wiebe & Charlie Branas – are interested in many issues of injury & public policy.  Our work in Africa started when we visited the University of Botswana (UB) in 2010, where colleagues from our university have been collaborating with clinicians & researchers for years on HIV/AIDS treatment & prevention.  Of course road traffic crashes also create a large burden in terms of lives lost, disability, & the economy in Botswana & neighboring nations.  Groups at UB & other universities have been conducting important work to study, treat, & prevent road traffic crash injuries.  But this research field is relatively small, in terms of investigators & research funding that is dedicated to the topic, & needs to be expanded.  Since that visit we have been working to build upon infrastructure that is already in place, & create new partnerships including this collaboration with Sunanda Ray, Titus Maswabi, & Christina Kgathi. We also support trainees working to build capacity & help contribute to the evidence that can be used in strategic planning to make roadways & travel in Africa safer.

What were the key findings from this study?

Road crash fatalities increased in recent decades in both Zambia & Botswana. But the rapid economic development in Botswana over this time period appears to have driven proportionate road traffic fatality increases.  That is, we found that the road traffic fatality increases in Botswana resulted from, rather than just corresponded with, the especially rapid economic development that occurred there.  From a public health spandpoint the aspects of economic development that result in road traffic fatalities constitute risk factors that are modifiable.

What do these findings mean within the African context?

There are opportunities for newly emerging economies such as Zambia, Angola, & others to learn from the Botswana experience. Evidence-based investments in road safety interventions should be concomitant with economic development.

Check out the full-text open access article:  Click here

 

More about AfJEM (excerpt from their newsletter)

AFEMAfJEM is an open access publication in the spirit of bringing #FOAMed to Africa. This is an important consideration, especially in a low to middle income setting where prospective readers, that may benefit from published information, will most likely not be able to access subscription based journal content.  The AfJEM has no front end (author) or back end (reader) fees, and on top of that it offers a free Author Assist service that has been shown to reverse one in every four reject decisions (of manuscripts that fall within the journal’s scope) over the last five years.


More from AFEM:

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Support a delegate (Supadel) is a conference sponsorship program with a difference. Supadel is a peer-to-peer sponsorship scheme that enables prospective AfCEM2016 delegates from developed regions to financially support their peers from low and middle income countries.
For more information, to donate or to apply visit the:

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Do something for you today – reduce a pulled elbow

At least once a day, I like to think I have just simply fixed something.  Since I am not very good at DIY, that means finding some other way to scratch the itch.  Reducing a pulled elbow is hugely satisfying and anyone can do it if they know when and how to do so.

Pulled elbow (also called nursemaid's elbow) is not a true dislocation of the elbow but rather a subluxation of the radial head within the annular ligament of the elbow.


Based on empirical evidence, a pulled elbow hurts.  Additionally, there is often a second victim: the person who was involved in causing the pulled elbow (although there isn't always another person involved).  In fact, I was once hugged by a grateful relative after I reduced a child's pulled elbow.  What they don't know is that I already wanted to hug them for bringing me the elbow to fix.

Whatever specialty you work in, there are times when too much of what you do is intangible.  Sometimes I can see patient after patient and despite pouring my heart and soul into what I do, I don't get the feeling that I have really made anyone better.  These days are when I need a pulled elbow to shake that feeling off.  If you ever get the chance, I highly recommend doing it.  It is a fairly easy thing to do and, as I discovered recently, there are so many ways to do it.


When to attempt reduction of a pulled elbow

Before discussing technique, knowing how to do it isn't nearly as important as knowing when to do it.  There are some things that need to be considered before attempting a reduction.  Anyone can fix a pulled elbow, as long as they ask the right questions beforehand.

Is the child the right age?  There is bound to be a bell shaped curve for the age at which a child can get a pulled elbow. I would be sceptical about that diagnosis from the age of five up.

Does the mechanism fit with a pulled elbow?  Typical mechanisms include toddlers being swung around by fun uncles, toddlers being grabbed to keep them from running into the road etc.  A fall from a height is not likely to be a pulled elbow.

Are there signs that are inconsistent with a pulled elbow?  With distraction (not the anatomical kind), have a gentle feel of the elbow.  There shouldn't be any swelling.  There may be tenderness at the radial head but not in the distal humerus.  Feel all of the limb from the clavicle to the hand.  The two places that you are most likely to find point tenderness are the clavicle or the distal radius.

Often, children have had a previous episode.  If everything points towards a pulled elbow, there is no need to do an X-ray before attempting reduction.

How to reduce a pulled elbow

When I first did paediatric emergency medicine, I was taught to extend and supinate the elbow to reduce it.  That seemed to work most of the time.

Then, when I returned to work in a paediatric emergency department, I was told that flexing and pronating was better.  I have been doing it that way since then and it feels like it works more often.

 Of course the scientist in me is sceptical about the change.  Maybe something else affected  my success rate.  So what does the evidence say?  I was intrigued to find studies including other methods that I had not heard of, such as flexion with supination. (1)  I even found a Cochrane Review (2) which looked at the question.  It dodged the flexion vs extension question but concluded that pronation was probably successful more often than supination and possibly less painful.

So, I asked people on twitface which method they tend to use.

While finding it reassuring that two thirds of my colleagues were doing it 'my way', I was also interested to see that many will use a different method and that every possibility of twist and bend/ straighten is felt to be valid. 
I was pleased that nobody said anything about having to put firm pressure on the radial head.  I believe that all recommendations to do this are based in myth.  There is no logical reason why the radial head needs any guidance and I certainly don't press on the painful bit while applying my swift twist and bend.

I was also pleased that someone pointed out that if necessary, these can be left alone to resolve.  They always do, although it might take a day or two to finally slip back into place, during which time there will be discomfort.  I would still advocate reduction as success means that the resolution of pain is pretty much immediate.

Which brings me back to my original point.  How you do it is very much secondary to when you do it.  So, instead of worrying about technique, when the time is right, do something for you and fix a pulled elbow.

Edward Snelson
Notanosteopath
@sailordoctor

Disclaimer - I say that there are lots of methods, but my way is the right way.

For general principles of assessing children's injuries, follow this link.



References
  1. Macias CG et al, A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations, Pediatrics. 1998 Jul;102(1):e10
  2. Krul M et Al, Manipulative interventions for reducing pulled elbow in young children, Cochrane Library