Medical history in the undergraduate medical curriculum

History has long played a role in the education of American physicians, but the uses of medicine's past have changed over time. In the late nineteenth century, some physicians taught medical history to their students to supply a sense of continuity with professional traditions in times of rapid and bewildering change. Other physicians believed that instruction in medical history would impart a sense of refinement to medical practitioners. In the late twentieth century, medical history is increasingly viewed as a significant dimension of the professional, intellectual, and humanistic development of medical students. Further, it is one of the principal means by which recent, radical changes in health care can be given needed perspective. The knowledge that medicine and the medical sciences are fundamentally social enterprises is an important lesson for medical students. Through exposure to the history of health care, students also learn that medical knowledge is itself subject to change and is acquired in specific contexts. In the 1990s, medical history is taught in a variety of settings. In some schools, history is integrated into the teaching of medical humanities. Where medical history is institutionally distinct from the humanities, courses in medical history may be either elective or required. In order to reach students at every stage of their medical education, historians and clinicians can join forces to teach history in innovative and flexible programs.     

Medical history from midcoast Maine

Previous studies have shown that in vitro thyroid peroxidase (TPO) iodide oxidation activity is decreased and thyroid T4-5'-deiodinase activity is increased 15 days after induction of experimental diabetes mellitus (DM). In the present study we used thyroid histoautoradiography, an indirect assay of in vivo TPO activity, to determine the possible parallelism between the in vitro and in vivo changes induced by experimental DM. DM was induced in male Wistar rats (about 250 g body weight) by a single i.p. streptozotocin injection (45 mg/kg), while control (C) animals received a single injection of the vehicle. Seven and 30 days after diabetes induction, each diabetic and control animal was given i.p. a tracer dose of 125I (2 microCi), 2.5 h before thyroid excision. The glands were counted, weighted, fixed in Bouin's solution, embedded in paraffin and cut. The sections were stained with HE and exposed to NTB-2 emulsion (Kodak). The autohistograms were developed and the quantitative distribution of silver grains was evaluated with a computerized image analyzer system. Thyroid radioiodine uptake was significantly decreased only after 30 days of DM (C: 0.38 +/- 0.05 vs DM: 0.20 +/- 0.04%/mg thyroid, P < 0.05) while in vivo TPO activity was significantly decreased 7 and 30 days after DM induction (C: 5.3 and 4.5 grains/100 micron 2 vs DM: 2.9 and 1.6 grains/100 micron 2, respectively, P < 0.05). These data suggest that insulin deficiency first reduces in vivo TPO activity during short-term experimental diabetes mellitus.     

Diseases of the skull in pre-Columbian South American mummies

OBJECTIVE: The majority of paleopathological investigations focus on the study of the skull. This is because the skull is the most frequently preserved part of the human body recovered from archaeological excavations. From studying the skull, a variety of information can be obtained regarding the individual, such as sex, age, nutritional status, and other disease processes, if present. METHODS: This study represents the examination of more than 700 human skulls recovered from archaeological excavations from the Andean region of southern Peru and northern Chile and dating back more than 8000 years. RESULTS: A variety of skull abnormalities were encountered. The nonmetric variables of Huschke's foramina and palatine tori were common. Cranial deformation was observed in more than 85% of the cases. There were two cases of sagittal synostosis. Iron deficiency anemia resulting in porotic hyperostosis of the skull was evident in certain cultures. Exostoses of the external auditory canal resulting from chronic otitis was evident only among coastal populations. One skull demonstrated a periostitis consistent with Treponema infection. Trephination was encountered only in the skulls from Peru. Fifty-four cases of skull fractures were observed, half of which showed evidence of healing. Finally, only two cases of neoplastic skull lesions were encountered. CONCLUSION: The study of the human skull alone provides a large amount of information regarding the health and diseases of ancient populations.     

The neuropathology of South American mummies

Few studies of intracranial mummified brain tissue have been undertaken. This is because of the infrequency in which preserved human central nervous system tissue is encountered and the scarcity of available mummies from different parts of the world. This study undertook a systematic analysis of 15 naturally mummified human brains from 1000 B.C. to 1500 A.D. excavated from the deserts of northern Chile. Gross examination revealed relatively well-preserved dura mater, cerebral hemispheres, cerebellum, and spinal cord in several cases. Five cases showed evidence of intracranial disease. Three cases had evidence of external injury. One case revealed subarachnoid and one case revealed intracerebral hemorrhage. Samples of central nervous system tissues were taken for further analysis. The samples were rehydrated and processed for structural analysis by light and electron microscopy. Light microscopy of the brain parenchyma revealed an eosinophilic staining background with vascular structures but few cellular elements present. The dura mater demonstrated normal dural architecture consisting of collagen fibrils. Electron microscopy did not clearly demonstrate individual neurons or axonal processes. Bundles of collagen fibrils with typical periodicity were clearly seen in the dura mater. The examination of ancient human central nervous system tissues reveals normal and abnormal neuroanatomy.     

Burns during pregnancy: a gloomy outcome

The effect of burns on fetal and maternal survival is known to be detrimental. This prospective study describes the performance of pregnant burned patients who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. During the 12-month period, 27 pregnant burned patients were managed. Fetal and maternal mortality correlated with the total body surface area (TBSA) burned, the mortality rate being 63 per cent for both mothers and fetuses in the 25-50 per cent TBSA group. A fetal loss of 56 per cent with no maternal loss were recorded in the 15-25 per cent TBSA group. Experience in dealing with pregnant burned patients proves that early surgical excision and skin grafting, with timely termination of pregnancy are the best lines of treatment. Prevention or minimizing the effects of the burns may be achieved by proper education and guidance of the pregnant woman.     

Burns of the hand and upper limb--a review

Previous research has demonstrated that only the two neurotrophins and their cognate receptors are necessary for the support of the inner ear innervation. However, detailed analyses of patterns of innervation in various combinations of neurotrophin receptor mutants are lacking. We provide here such an analysis of the distribution of afferent and efferent fibers to the ear in various combinations of neurotrophin receptor mutants using the lipophilic tracer Dil. In the vestibular system, trkC+/- heterozygosity aggravates the trkB-/- mutation effect and causes almost complete loss of vestibular neurons. In the cochlea innervation, various mutations are each characterized by specific topological absence of spiral neurons in Rosenthal's canal of the cochlea. trkC-/- mutation alone or in combination with trkB+/- heterozygosity causes absence of all basal turn spiral neurons and afferent fibers extend from the middle turn to the basal turn along inner hair cells with little or no contribution to outer hair cells. Both types of basal turn spiral neurons appear to develop and project via radial fibers to inner and, more sparingly, outer hair cells. Simple trkB-/- mutations show a reduction of fibers to outer hair cells in the apex and, less obvious, in the basal turn. Basal turn spiral neurons may be the only neurons present at birth in the cochlea of a trkB-/- mutant mouse combined with trkC+/- heterozygosity. In addition, the trkB-/- mutation combined with trkC+/- heterozygosity has a patchy and variable loss of middle turn spiral neurons in mice of different litters. Comparisons of patterns of innervation of afferent and efferent fibers show a striking similarity of absence of fibers to topologically corresponding areas. For example, in trkC-/- mutants afferents reach the basal turn, spiraling along the cochlea, rather than through radial fibers and efferent fibers follow the same pathway rather than emanating from intraganglionic spiral fibers. The data presented suggest that there are regional specific effects with some bias towards a specific spiral ganglion type: trkC is essential for support of basal turn spiral neurons whereas trkB appears to be more important for middle and apical turn spiral neurons.     

Bacteriological monitoring in the Prague Burns Center

The microbiological aspect of the prevention of nosocomial infections at the Burn Center consists primarily in the surveillance of bacterial flora and its antibiotical resistance. The Prague Burn Center is regularly monitoring the microbial flora. Patients are examined not only by the conventional methods of taking swabs of burned sites, but also by printing method, which allows a semiquantitative assessment of the colonization of burned areas. Simultaneously, investigation of bacterial contamination in the external environment of the department is carried out and the colonization of nursing staff is investigated. In all isolated strains the sensitivity to antibiotics is examined; this is significant from the point of view of current knowledge about therapeutic possibilities and for the antibiotic policy. The typing of bacterial strains makes possible to determine their epidemiological markers, and thus to investigate their spread within the department. The most frequent isolate is S. aureus and the prevalence of MRSA is relatively high. Among gramnegative rods the strains of P. aeruginosa, K. pneumoniae and E. cloacae are most often isolated. Various typing methods revealed endemic spread of particular strains of rarely isolated species (E. agglomerans, S. marcescens, A. baumannii, etc.).     

Medical manpower and public policy: a short history of P.L. 94-484

Twenty-three HLA antigens were investigated in 121 patients with clinical cancer as well as 188 male and 212 female controls. Patients with cervical carcinoma showed significant differences in some HLA frequencies from that of controls. Patients with cervical carcinoma showed significant differences in some HLA frequencies from that of controls. In the localized form of the neophasia HLA-A3 was decreased, HLA-A9 and B 12 were increased. In the disseminated form of cervical carcinoma HLA-A 1 were found decreased and AW 32 and B 12 increased. HLA antigens could be factors, together with others yet unknown, i.e. immune response genes, HSV-2-infection, which produce an increased susceptibility to the disease.     

Facial reconstruction: the history of a challenge

The temporal coordination of hand and foot actions in piano performance is an interesting instance of highly practiced, perceptually guided complex motor behavior. To gain some insight into the nature of this coordination, ten pianists were asked to play two excerpts from the piano literature that required repeated use of the damper pedal to connect successive chords. Each excerpt was played at three prescribed tempos on a Yamaha Disklavier and was recorded in MIDI format. The question of interest was whether and how changes in tempo would affect the timing of pedal releases and depressions within the periods defined by successive manual chord onsets. Theoretical possibilities ranged from absolute invariance (variable phase relationships) to relative invariance of pedal timing (constant phase relationships). The results show that, typically, the timing of pedal actions is neither absolutely nor relatively invariant: As the tempo increases, both pedal releases and depressions usually occur a little sooner and pedal changes (release-depression sequences) are executed a little more quickly, but these effects are proportionally smaller than the changes in manual (and pedal) period duration. Since this may be due to unequal changes in peripheral hand and foot kinematics with tempo, it remains possible that there is invariance of either kind at the level of central motor commands. However, it is the peripheral timing that produces the acoustic consequences musicians try to achieve.