Medical briefings and expert medical opinion

A Tour around Parkinson's Disease
(Date of publication 28 November 2005)

The characteristic appearance and movement of a patient with advanced Parkinson's Disease are succinctly summed up in this drawing, which illustrates the stooped and rigid posture, shuffling gait, tremor, and constant movement of the thumb and forefinger described as 'pill-rolling'. The face often becomes expressionless and mask-like – just compare a photograph of Muhammad Ali in his prime with one taken earlier this year.

A Tour around Poliomyelitis
(Date of publication 14 November 2005)

In 2005, when there have been no outbreaks of poliomyelitis in the Western hemisphere for over a decade, it is difficult to appreciate the stark terror that accompanied epidemics in the 1950s. Of the known cases, one third developed paralysis and around 5% died. These recollections of a patient from the pre-vaccine era (just click on Listen) convey the helplessness of both victims and doctors, and the human cost is illustrated in this photograph of a child in an iron lung. For younger readers, the iron lung (or negative pressure ventilator) was essentially a metal cylinder whose internal pressure was varied so that a patient whose respiratory muscles were paralysed could breathe, and some polio victims remained in them for many years. More information on them is available here and the ward photograph gives an idea of the large numbers that were required.

A Tour around Imaging Techniques
(Date of publication 26 October 2005)

Pity the poor souls who required a head X-ray in the early part of the last century; the procedure could take up to 11 minutes, during which the unlucky patients had to hold themselves (and the not insubstantial film cassette!) motionless. They also received up to 50 times as much radiation as that produced by today's digital systems, which generate pictures with much greater definition in a matter of milliseconds. This page documents the history of medical imaging from the days of Roentgen onwards, giving a brief outline of how each method works.

A Tour around Multiple Sclerosis
(Date of publication 20 October 2005)

Here's a nugget of information for trivia addicts – St Lidwina of Schiedam, a Dutch nun who is the patron saint of skaters, was possibly the first recorded case of multiple sclerosis (MS). Apparently, she fell while skating and subsequently developed walking difficulties, headaches and violent pains in her teeth, her condition gradually deteriorating thereafter.

A Tour around Hydatid Cysts
(Date of publication 26 September 2005)

It is difficult to imagine that the Golden Retriever puppy in this toe-curlingly cute photograph could soon harbour a parasite capable of causing significant morbidity, even death, to its adoring owner. The potential culprit is Echinococcus granulosum, a tiny tapeworm only 3 to 6 mm long that is endemic in most regions of the world and has only three or four segments, as can be seen from this photograph.

MRSA – super bug or superstar?
(OnTarget Mag. Vol 4, issue 6 2005)

MRSA, or methicillin resistant Staphylococcus aureusto give it its full name, has never been so popular! Working in the devices industry we may forget that we also have a part to play in controlling this evasive disease. A typical day could mean accessing clinical areas in as many as five hospitals. This has to increase the risk.

A Tour around Dental Implants
(Date of publication 12 September 2005)

Attempts have been made to replace missing teeth with implants for thousands of years, originally with materials such as shells, animal bone and ivory. Have a look at this mandible from about 600 BC – treatment probably left something to be desired in the comfort department! Nowadays, dental implants are a well-established and successful therapy, capable of supporting extensive bridgework and full dentures. One wonders if the proud possessor of the restorations in this X-ray ever has difficulty in getting through airport security...

A Tour around Neurotransmitters
(Date of publication 31 August 2005)

Strange though it may seem, neurotransmission was being blocked by Amazonian Indians centuries before the concept even existed in the developed world; 16th century European explorers discovered tribes using curare as an arrow poison to paralyse their quarry, and Sir Walter Raleigh brought some back to Queen Elizabeth I in 1584. History does not record whether she found a use for it! Curare interferes with acetylcholine, the most abundant neurotransmitter, but there are many others with a wide range of functions.

A Tour around the Adrenal Gland
(Date of publication 15 August 2005)

In today's fervently age-conscious society, where maturity is widely regarded as a social handicap on a par with halitosis, why should women hoping to maintain their youthful good looks spend their days at sea level? And what could this possibly have to do with the adrenal gland? The answer is that women who live at high altitudes appear to age more quickly, because of lower levels of the adrenal hormones DHEA and DHEAS (dehydroepiandrosterone and dehydroepiandrosterone sulphate). However, a healthy adrenal gland does much more than act as endogenous botox...

A Tour around Heart Failure
(Date of publication 01 August 2005)

There is a widespread belief that heart failure is the sudden stopping of the heart as a result of sudden fright. Not so! It is the inability of the heart to pump sufficient blood, which usually develops over a period of time, and different symptoms are produced by the different sides of the heart. When the left ventricle fails to pump adequately, blood 'backs up' and fluid accumulates in the lungs, causing congestion, shortness of breath and reduced plasma oxygen levels, leading to fatigue. Deficiency of the right ventricle increases pressure in the venous vessels and fluid is forced out into the body tissues, producing oedema, particularly in the legs and feet. For those who prefer the multi-media approach, there is an interactive module with a simple explanation here.

A Tour around Migraine
(Date of publication 18 July 2005)

"My face feels like it’s splitting in two. I feel like barbed wire is going in and around my head with sharp points sticking in it." This description of a migraine attack by a 12 year-old girl makes it clear that she experiences something far more intense than a normal headache, and the sheer agony of migraine is graphically conveyed in this picture by the artist Sean McHone.

A Tour around Tennis Injuries
(Date of publication 01 July 2005)

Tennis enthusiasts who have focused their attention on Wimbledon over the past two weeks, for the annual orgy of British national disappointment, must have noticed that a high proportion of top class players suffer significant injuries. Could tennis be that dangerous? It would appear that the answer is yes; this tour demonstrates that the brutal reality is far removed from the decorous image of the game as a gentle accompaniment to tea on the vicarage lawn, so beloved by romantic novelists of a sensitive disposition.

A Tour around Stroke
(Date of publication 17 June 2005)

A 'stroke' is a fairly innocuous term for what can be a terrifying medical emergency – perhaps the American use of 'brain attack' is more appropriate. The condition can strike without warning, has a significant mortality and leaves many of its victims permanently disabled. It is caused by a sudden interruption of the blood supply to a part of the brain, the effects depending upon the region that is affected and the severity of the interruption.

A Tour around the Prostate Gland
(Date of publication 06 June 2005)

Although the prostate gland is modest in size, it is highly important to the adult male because the fluid it produces not only helps to nourish and protect sperm during intercourse, but also forms the main bulk of ejaculate. Comprised of 30 – 50 individual glands which are arranged in acini and empty into the urethra, the gland may be divided into a peripheral, transitional and central zone, although the function of these different zones is not clear. Here is a more detailed diagram and description of its anatomy, while this site for medical students incorporates a number of relevant photomicrographs and some humorous asides; for example, 'any student who calls this the "prostrate" gland will have her/his rubber glove confiscated.' The relevance of this remark will become crystal clear when we cover diagnosis.

A Tour around Alzheimer's Disease
(Date of publication 23 May 2005)

"It bothers me that I asked my daughter if she would take the clothes home with her to put them in her dryer. After she left I realised that I have my own dryer that I have been using for the past three years." "I confess to being unable to remember some conversations at all. Some, I can vaguely remember bits of." "I went shopping yesterday and left the keys in the car and the engine on. I've had to have my poor car broken into so many times that the door is practically wrecked."

A Tour around the Cerebral Cortex
(Date of publication 09 May 2005)

Question: why is the cerebral cortex, which comprises the external surface of the cerebral hemispheres, so highly convoluted and folded? Answer: because during the evolutionary process its volume increased more rapidly than the underlying tissue, producing grooves (sulci) and more elevated regions (gyri). Many areas of the cortex either process sensory information or co-ordinate motor output – these are divided into primary, secondary and tertiary sensory or motor areas, depending on their degree of involvement. For example, primary sensory areas receive information from peripheral receptors on the contralateral side of the body with only a few synapses between. There are also three large regions, called association areas, which make up the largest area of the cortex in primates. These are concerned with forming complex perceptions, planning voluntary movement, motivation, emotion and memory. If you are not sure of the precise location of the different functional areas described on this page, simply surf to this site and move your mouse over the interactive diagram.

A Tour around Tuberculosis
(Date of publication 25 April 2005)

If you had contracted tuberculosis (TB) in the first half of the last century, the most advanced treatment available was rest in a sanatorium and collapsing the lung; not surprisingly, the chances of survival were only around 50%. Cure rates soared in the developed world with the advent of antibiotics, but the latter years of the twentieth century saw a resurgence of the disease, with the emergence of multi-drug resistance and the deadly combination of tuberculosis and AIDS. Incidence rates have since generally declined, but the numbers involved are truly staggering.

A Tour around Hair Loss
(Date of publication 11 April 2005)

Hair loss or alopecia in men is widely regarded as a suitable topic for one-liners such as "I knew I was going bald when it took longer and longer to wash my face". This is hardly surprising considering the effort and ingenuity that goes into disguising follicular shortcomings. For example, in 1975 the American Patents Office registered a special way of combing hair for bald people! It is all to do with layering and hairspray, apparently. However, seeing handfuls of hair gather conspiratorially in the plughole after shampooing can be a very traumatic experience, which also affects women.

A Tour around Toxoplasmosis
(Date of publication 24 March 2005 )

Has one of your male neighbours recently started driving recklessly, gambling wildly or become something of a delinquent? If so, one possible explanation is chronic infection with the parasitic protozoon Toxoplasma gondii. This condition is common all over the world and one effect in men is a personality change, so that the sufferer loses control, disregards rules and follows urges, whilst simultaneously becoming detached, critical and dogmatic. To find out why, we need to look at the organism's life cycle.

A Tour around the Ear
(Date of publication 14 March 2005)

The intensity range of the human ear is approximately 130 decibels. Doesn't sound very impressive, does it? But this means that the maximum tolerable volume is 10,000,000,000,000 times louder than the lowest audible sound, the energy of which is equivalent to that given off by a 50 watt light bulb 3,000 miles away! The displacement of the eardrum which results is about one-tenth the diameter of a hydrogen atom. Other statistics are almost as impressive; the ear can detect a difference of just 2 degrees in the direction of a sound source, and can recognise at least 400,000 different sounds.

A Tour around Periodontal Disease
(Date of publication 28 February 2005)

Which do you think is the most common disease in the world – heart disease, cancer, osteoarthritis? How about malaria or AIDS, which infect many millions every year? Well, the dubious honour goes to periodontal disease, which gradually destroys the supporting structures of the teeth and affects more than 70% of adults in the developed world. Unlike most medical problems, prevention and control depends upon the sufferer; without an effective oral hygiene routine, progression is inevitable. This Texas practitioner's site defines all the relevant terms and clearly illustrates the stages of the disease. More general information about risk factors, diagnosis and treatment is provided by the US National Institute of Dental and Craniofacial Research.

A Tour around Snake Bite
(Date of publication 14 February 2005)

We in the UK are lucky; our only poisonous snake is not much larger than an animated bootlace, and even a severe bite is very unlikely to prove fatal. Other countries, however, are not so fortunate. Seven thousand people are bitten every year in the US, although only 15 of those will die, putting the survival rate at something like 99.7%. India has the highest reported death rate (15,000-20,000 victims annually), although it is likely that many fatal bites, particularly in Third World countries, go unreported. Estimates have placed the true number as high as 5 million per year world-wide. The majority of bites occur during the late afternoon and evening, the snake’s time of peak activity, and most affect limbs or feet.

A Tour around Psoriasis
(Published: 29 January 2005)

Here is a nugget of information for the next pub quiz – the term 'psoriasis' comes from the Greek word for 'itch'. Many sufferers have only a few red, scaly patches causing mild discomfort, but virtually the entire skin surface can be affected, as well as the joints, nails and eyes. Dennis Potter, arguably Britain's greatest television playwright, described his condition as follows, "I would have these three month attacks in which I would literally look like a monster – 100% psoriasis – and you also lose control of your temperature, halfway between hallucination and whatever. But also you simply cannot operate, you cannot move, you cannot think".

Opinion Leader Editorial - Migraine
(Publication Date 20 January 2005)

For people with migraine, today's world is a better world than the one their parents knew. The last 15 years have seen major advances, giving us not only a much clearer understanding of the disorder but also considerably more effective therapies. Treatments exist that - if made available and used in the right way - can substantially relieve the majority of people affected by migraine.

A Tour around Malaria
(Published: 14 January 2005)

For fifty years scientists have been trying – and failing – to develop a vaccine against malaria, but last October the Lancet published details of the most effective candidate yet, which could be licensed in 2010. The research team tested the vaccine on 2,022 children aged between 1 and 4 in Mozambique, where each person receives an estimated 38 bites each year from malarial mosquitos. At the end of the trial the vaccine had reduced a child's risk of developing one episode of malaria by 30% and the risk of developing severe malaria by 58%, while extending the time to first infection by 45%.

Opinion Leader Editorial - Epilepsy
(Published: 12 January 2005)

Epilepsy is a common condition in the UK, with an incidence of approximately 80 cases per 100,000 population per year, and a prevalence of 5 - 10 cases per 1000. Yet, despite this high prevalence, it remains a stigmatising condition, with occupational and social disadvantages imposed on the individual. Epilepsy is difficult to diagnose, requiring a detailed history, and is complex to manage.

Opinion Leader Editorial - Lipid disorders
(Publication Date 10 January 2005)

Cardiovascular disease is the leading cause of morbidity and mortality for men and women in the United Kingdom, and diabetes alone is associated with a two- to four-fold increased risk of coronary disease and stroke.1 Dyslipidaemia is a major independent risk factor for cardiovascular disease but should not be managed in isolation from the other major risk factors such as hypertension, obesity, cigarette smoking and lack of exercise.2 As diabetics are particularly vulnerable to vascular disease they should now be considered as secondary prevention cases even in the absence of a cardiovascular history - being recognised as ‘cardiovascular equivalents’.

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Medical Briefings

Medical briefings and expert opinion for Medical Sales Professionals