William The Coroner’s Forensic Files

Wednesday, 6, July, 2011

You Know You’re in Cereus Trouble

Filed under: Medicine — williamthecoroner @ 15:32

when your alcohol prep pads are giving people infections.  Like HERE.

Thursday, 2, June, 2011

Awright!

Filed under: Medicine,Teaching — williamthecoroner @ 17:38

I just learned that one of my little studentlets was accepted into the Navy Health Professions Scholarship Program.  So, she’s going to have her med school paid for (nothing to sneeze at, at 50K a year) and have some living expenses.  In return, it’s a three year active duty commitment after residency. Congrats!

Wednesday, 27, April, 2011

AΩΑ

Filed under: Medicine,Poetry,Science,Teaching — williamthecoroner @ 22:09

Just returned from the AΩΑ dinner, which was to honour the graduating medical students who had achieved honours in three or more of their core clerkships.  There were about twenty-one honourees.  The speaker was a neurosurgeon whose research on the effects of music on animal learning, particularly rodent spatial learning.  If you make rats listen to Mozart, they do better than control rats in the Morris Water Task.  His studies have shown increase in activity and increased dopamine in the hippocampi of rats exposed to music.

This effect seems to generalize to music and human learning.  If one sets material that one wishes to learn to music, one does better.  Of course, this information is not new.  The poets of ancient Greece and the Celtic lands sung their stores, just look at the Odyssey and the Story of Beowulf.  Rhythm and meter help the human brain organize information; it is interesting to see how it works on the cellular level.

Wednesday, 23, March, 2011

The Elephant Story–Part 1

Filed under: In Memoriam,Medicine,Natural History — williamthecoroner @ 16:13

Dr. John R. Carter was a well-respected director of the Institute of Pathology. Coming from Kansas, he was passionate about education and put in place many innovations during his tenure. I was impressed by his teaching, and wish I could have learned more from him. Dr. Carter’s particular interest was orthopedic pathology, and when one of the Zoo’s elephant’s died he jumped at the chance to help with an elephant autopsy. You don’t get to do one of those every day, and he wanted a chance to take some samples of the bones.

Well, how does one do an elephant autopsy? You start with a very delicate chainsaw, making a linear ventral midline incision. You do this while the elephant is lying on its side. You then take 2 x 4’s and knock together some cribbing, to support the weight of the elephant’s side, and people can work in the cavity. Elephants are large, and have a lot of blood. It is a good idea to tie the support structure to something sturdy, so it doesn’t slip. It is also a good idea to have someone outside the elephant, labeling samples, scribing, doing all that good stuff. Dr. Carter and the vet failed to observe these precautions, or so he told me.

As an aside, I would never doubt Dr. Carter’s veracity, but he did tell me this story at the Christmas party, and he had a couple of Manhattans in him when he told it. I was not witness to this, and I make no judgement, I merely report a good story. For he told me that the cribbing slipped on the bloody floor, and collapsed, dropping the side of the abdomen down and trapping the prosectors in the belly of the beast. Literally.

Post-mortem processes being what they are, the elephant was in full rigor, and was fairly large anyway. The people trapped inside were unable to lift the abdominal flap to get out. They were stuck, and shouting for help did not work. Not many people really want to hang around a dead elephant after all, and this was being done out of view of the public. So there they were, stuck.

But both prosectors were well-trained in anatomy, and new what to do. Using the spine as a landmark (and possibly a handrail, they followed the intestines all the way back to the posterior end of the carcass. Using their blades, they opened the colon and were able to escape via the anus, emerging slimy yet unbowed. After a long shower, and with some assistance, they rebuilt the structure and finished the post-mortem.

Saturday, 19, February, 2011

Over the Transom

Filed under: Haterade,Medicine — williamthecoroner @ 18:53

And you wonder why there is a medical malpractice problem in the United States?  I get this e-mail.

My orthopedic surgeon made an incision on the outside of my knee during a partial knee replacement surgery by mistake. He sutured it up and then made an incision on the inside of my knee which was the correct area. He mentioned paying for cosmetic surgery at my 2 week check up, but never brought it up again. I don’t have to see him again for another nine months. Is this a common mistake and what if anything should I do about the extra 4″ scar on my knee?

My Response:
Ignore it and go about your business.

First off, one of the definitions of medical malpractice is a mistake that causes harm to a patient. An extra scar on a knee where you had surgery? I’m hard pressed to describe that as a harm. Granted, it’s not my leg, but on the other hand, I wear pants– you know what I mean.
C’mon. It was nice of the doctor to offer plastic surgery to make it less noticeable. Either take him up on it, or ignore it. If it were me, I’d ignore it.

Thursday, 20, January, 2011

What Is Cancer

Filed under: Medicine — williamthecoroner @ 12:04

Cancer is not one single disease. It was the height of silliness for the United States to talk about a “War on Cancer”. That’s like declaring war on mammals. There are so many kinds and types, that statement is meaningless. It is always amusing to hear people talk about cancer as a single entity, because it is obvious that they don’t know what they are talking about.

OK. So, what are we talking about? Let us start by defining out terms, so we are all on the same page. A tumor is a swelling or growth. A neoplasm is a new growth. A malignant tumor grows faster, and will invade, a benign tumor is relatively slow-growing, and does not invade. Malignant growths of epithelial tissues are carcinomas, malignant growths of connective tissues are called sarcomas. Finally, it is silly to say, as I saw in one bad TV show, that a person has “adenocarcinoma”. OK. we know that carcinomas are malignant growths of epithelial tissue, adeno is the prefix describing glandular tissue. So an adenocarcinoma is a malignant growth of epithelial glands.

But cancers are transformed tissue. They don’t arise spontaneously. They arise in some source tissue, and retain some characteristics of that source tissue. So, malignant tumor that arises in the glandular epithelium of the breast, is an adenocarcinoma of the breast. A malignant tumor that arises in the bronchi of the lung of a smoker is probably a squamous bronchogenic carcinoma. There are some hold overs, the adenocarcinoma of the liver used to be referred to as a hepatoma. The AFIP has books covering every tumor from every anatomic location, and a significant part of those books deals with the old nomenclature, so everyone can be on the same page.

What makes a cancer malignant? We don’t really know, and people have been asking that question since the 1890s. Breast cancer tends to go to liver and bone. Lung cancers tend to go to the brain. Cancers that make mucin have a tendency to be more invasive than those that don’t. The mucin pushes apart the tissues and helps make a channel.

I do know that if a person speaks of a tumor that was “invasive but not malignant.” that person does not know what they are talking about.

Thursday, 6, January, 2011

I Don’t Know What To Think About This One…

Filed under: Medicine,Politics,Social Commentary — williamthecoroner @ 13:37

In 1993 Gladys and Jamie Scott received double life sentences for planning a robbery in Forrest, Mississippi. The robbers weren’t that successful, the total take was low (under $200, and it was split five ways). On 29th December, the womens’ sentences were commuted by the governor of Mississippi on the condition that one donate a kidney to the other, who is on dialysis.

This bothers me on multiple levels. I have heard the original sentence decried as too harsh, because of the lack of criminal history of the Scotts and the low take. I’m not sure that the “one free bite” rule holds for people; but I don’t enough about the case for opine on it. If the crime is heinous enough, is it fair to say, “well, this person did X before, so we shouldn’t punish him too harshly”? I don’t think so. Put in “detonated an atomic device” or “Blew up a building” in for X and you’ll see how silly that is. The sisters were accused of planning a shotgun robbery with violence. That’s pretty bad–but it DOES seem excessive when murders walk free after seven years.

Having said all that. If the original sentence is justified–follow through with it. Being concerned about the costs of dialysis in the prison system is secondary. Prisoners don’t have the ability to make free and uncoerced decisions about when to get up or go to bed, let alone give up a vital organ. If it is unethical for free individuals to profit from selling their organs (which it is in the United States) shouldn’t it be unethical for these women to buy their freedom (by saving the state a lot of medical expenses, that’s exactly what they are doing.)

Researchers go through ethical training every couple of years to work with human subjects. I am working on studies describing how well our tutoring program runs, and I am required to take human subjects training to use the data. I’m not doing anything different with the students, and they would never know. Nevertheless, I am required to learn about the Tuskegee Syphilis Experiment and how children, students, prisoners, and the mentally retarded are protected populations, because they cannot freely consent. This isn’t a bad thing, thought the training is pretty simplistic. Be that as it may, I am just struck by the incongruity. I wonder if the Governor of Mississippi had to go through ethics training before he started playing God with prisoners’ lives and body parts?

Somehow, I don’t think so.

Monday, 29, November, 2010

Cranial Nerds #1.1

Filed under: Medicine,Teaching — williamthecoroner @ 12:02

I just started facilitating a group of medical students in their final basic science block, block 6–covering neurology, neuropathology, and psychiatry. They decided to call themselves the “Cranial Nerds”. They went through the first case slowly and thoroughly, we ran out of time sort of for the second case, but the differential diagnoses were similar.

In putting together a list of differential diagnoses, it is wise to lump them into aetological categories. Musculoskeletal, Neurological, Infectious, Neoplastic, Metabolic, Congenital, Developmental. etc.

Monday, 26, July, 2010

That’s Unpossible.

Filed under: Medicine — williamthecoroner @ 14:41

The National Health Service plans far-reaching cuts in response to the economic crisis.

Wow. Just, wow. Drastic cuts in services, terminally ill patients sent home to die and manage their conditions on their own, rationing care. Though this is public money, at least there people who are paying for it all had input into what is going to happen. Oh. This was all decided in secret. Man. That is terrible. It really makes me appreciate what the United States has…

er,

um.

Yeah.

Wednesday, 12, May, 2010

There Are No Words (Pathology Facebook)

Filed under: Group blogging,Japery,Medicine — williamthecoroner @ 22:43

ANS RAS proto-oncogenes are pretty cool. Unless you have a point mutation of one, that is. Then they are definitely NOT cool.

CB This is one malignant post. 🙂

SM Eh, it’s growing on me.

ANS S, you get extra points for that line. I should have expected that this crowd would break out the cancer humor…

SM That’s it, I’m going to Mass.

ANS OH MAN, that was bad… I’ll stop laughing as soon as I am bcr/abl.

SM Man, I bet you’re so glad we met

ANS My friend wanted me to buy a MAC, but I use APC

SM I don’t mean to be invasive, but did you use anaplastic when you bought it?

ANS I was going to, but I decided to use a cachexia. That was acute joke you just made.

SM Thanks. I’ve been using that joke since Grade 4. Well, I’m going to assume that your latency is a marker that this thread has reached its terminal. Thanks! It was a real vinblastine!

ANS I could repeat these jokes to my mom, but HER-2/NEU to pathology to get them.

ANS I know you’re a Libertarian, but did you vote for BRCA Obama?

SM Wow, kudos on the HER-2/NEU joke. I wish I could monoclonal your wit!

ANS This thread has gone on long enough. If we each post one more time, we’ll have made tumor jokes.

WZBG Oh My God.

SM Oh jesus vin-crist-ine

ANS Most of these claims have been Trousseau there’s no need to verifiy them
I guess this just goes to show you, in life, where there’s a Wilms, there’s a way!

SM It’ll benign or more comments until I’m done.
Also, all of your comments have been very well-circumscribed.

ANS You posted that joke about an Auer rod ago

SM All your jokes have a nice signet ring to them.

ANS Let me be perfectly clear cell carcinoma: A lot of people say I’m funny, but don’t believe the hypochlorhydria.

S, I think you move through life a little too FAS. Slow down, change your ways and turn over a new Li Fraumeni.

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