One-year follow-up data from the Philadelphia low carbohydrate diet study has been published. (During weight-loss phase, lipids still were not adversely effected in the low-carb group. No difference seen in weight loss between groups. Longer term data yet to come.) [1]
A new six-month study in the Annals of Internal Medicine, funded by the Atkins Foundation, gave only the experimental low-carb group a fish oil supplement. [2]
Speaking of carbohydrates: The energy efficiency of a one-mile urban bike trip when the cyclist is fueled by bread is 300 miles per gallon (mpg). When fueled by beef it is 31 mpg. [3]
Bruno Bettelheim is quoted on human development in the Director's Notes for the CCM opera production of Engelbert Humperdinck's Hansel and Gretel, a Brothers Grimm story...
Growing up in Fairy Tales
"Fairy stories represent in imaginative form what the process of healthy human development consists of, and how the tales make such development attractive for the child to engage in. This growth process begins with the resistance against the parents and fear of growing up, and ends when youth has truly found itself, achieved psychological independence and moral maturity and no longer views the other sex as threatening or demonic but is able to relate positively to it."
(Bettelheim, B. The Meaning of Enchantment. From the introduction.)
Brother's Grimm stories are full-text free online at Project Gutenberg. [1, 2]
Growing up in America
Our bookclub recently read Updike's Rabbit Run. While not a fairy tale, throughout the series the main character is Rabbit. Harry Angstrom and others grow up.
Growing up in Greece
At the Cincinnati Art Museum vases, drinking vessels, and toys portray "Coming of Age in Ancient Greece." Complete with Zeus swallowing his wife and giving cephalic birth to Athena; Zeus disguised as a swan impregnating a goose (Nemesis in disguise), who hatches Helen; Zeus as an infant narrowly avoiding being swallowed by Kronos; Medea killing her own two sons to spite husband Jason; Perseus as a child, set to sea--abandoned in a chest; and Orestes killing his mother to avenge her murder of his father, Agamemnon.
Grown-ups in Opera
More tableaus of human development and trauma--opera. Images reinforced by sound. Sex and death. Pagliaci ends with dead bodies, as does Rigoletto and La Traviata. Each performed by local opera troupes in Middletown, Dayton and Cincinnati.
Dental radiation and risks is an old contentious story. [1,2] Hujoel et al from Washington state recently raise an association between low birth weight and dental x-rays. [3]
I have not yet found professional dental societies' recommendations on frequency of x-rays. The ADA does a good job of patient education. [4]
Here are links to electronic medical record proposals from the White House, Senate, House, and an open-source group. [1, 2, 3, 4]
Today my "I'm feeling lucky today" Google search on "web based medical record 2004" leads to an inaccessible private article from the Journal of Medical Internet Research? [5] It tries to link to: www.jmir.org/2004/2/e12/
A 39 year-old morbidly obese man with nonischemic cardiomyopathy had a sudden death at home. Two weeks later a similar 42 year-old obese man with nonischemic cardiomyopathy had dizziness that led to a holter monitor, that revealed runs of V-tach and SVT. This second gentleman had a defibrillator implanted.
This week the DEFINITE study of 458 patients (70% men) shows reduced arrhythmic death but no change in overall survival with defibrillators in nonischemic cardiomyopathy. Subgroup analysis raises the question that men with Class III heart failure may have increased overall survival with implanted defibrillators. [1] Devices are put in perspective in editorials. [2, 3,4]
Excellent "Clinical Practice" review from NEJM emphasizes value of suppressive therapy [1]...
"In a recent study, suppressive therapy with 500 mg of valacyclovir once daily for eight months decreased the rate of symptomatic HSV infection in the seronegative partner by 75 percent and reduced the likelihood of acquisition of genital HSV-2 infection (symptomatic or asymptomatic) by 48 percent." [2]
This Annals of Internal Medicine article reviews data on benefit & cost of computerized physician order entry (CPOE). [1] (See also the associated correspondence that again mentions Cedars-Sinai's negative experience.) [2]
Another good summary of data on the predictive value of D-dimer. [1]
"For excluding PE or DVT, a negative result on quantitative rapid ELISA is as diagnostically useful as a normal lung scan or negative duplex ultrasonography finding."
A constituent of the spice tumeric can unfold a mis-folded protein and correct a cystic fibrosis defect in this mouse model. [1]
Dr. Whittaker noticed precordial ST-elevation in a 45 year-old man with dyspea. Here are some of the possibilities from an excellent review by Dr. Marriott and others. [1]
And then there is "Brugada syndrome"...
"In 1992, Brugada and Brugada described eight patients with a history of cardiac arrest and electrocardiographic findings of right bundle-branch block and ST-segment elevation in the right precordial leads in the absence of long QT intervals and any structural heart disease. The disorder, known as the Brugada syndrome, accounts for 40 to 60 percent of all cases of idiopathic ventricular fibrillation."
Question from Grand Rounds: After a dose increase of opioids, how long does related nausea persist? This answer (without evidence) suggests 3-7 days. [1] An excellent review of opioids in general was recently published in the New England Journal of Medicine. [2]
This NEJM review talks about opioid-induced abnormal pain sensitivity:
"Long-term use of opioids may also be associated with the development of abnormal sensitivity to pain, and both preclinical and clinical studies suggest that opioid-induced abnormal pain sensitivity has much in common with the cellular mechanisms of neuropathic pain"
"...The possible use of NMDA antagonists in the treatment of neuropathic pain, opioid tolerance, and opioid-induced abnormal pain sensitivity is being investigated."