Archive | April 2012

Living will form (Medical humour)

LIVING WILL FORM

I, ______________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means.. Under no circumstances should my fate be put in the hands of pinhead partisan politicians who couldn’t pass ninth-grade biology, if their lives depended on it, or lawyers/doctors/hospitals interested in simply running up the bills.

If a reasonable amount of time passes, and I fail to ask for at least one of the following:
______ a Martini ______ a Margarita ____ a Scotch and soda ______ a Bloody Mary ______ a Gin and Tonic _______ a Cuppa ______ a Steak ______ Lobster or crab legs ______ the remote control ______ a bowl of ice cream ______ the sports page______ sex ______ or chocolate, it should be presumed that I won’t ever get any better.

 

When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes, and call it a day. At this point, it is time to call the Scots Highlander Bagpipe Band to come do their thing at my funeral and ask all of my friends to raise their glasses to toast the good times we have had.

 

 

Signature:__________________________ Date: _________________________

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Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is scarring or thickening of the lungs without a known cause.

Theories of Etiology:

There are genetic markers of susceptibility for the genetics and pathogenesis of familial IPF.

  • A central repository of DNA samples and lung biopsies of patients with familial IPF would be useful and may provide the genetic material for defining this important subset of patients with IPF.

Environmental factors contributing to the pathogenesis of IPF.

  • Case control studies with matched, well-defined cases of IPF to define environmental associations would be informative.

DNA viruses in the pathogenesis of IPF.

Pathogenesis:

Inflammatory and parenchymal cells affect fibroblasts. Fibroblasts also alter inflammatory and parenchymal cells. Stimulation of fibroblasts causes fibrosis of the lung tissue.

“In the normal lung, the interstitium of the alveolar wall is thin and the number of fibroblasts is limited. Most fibroblasts and collagen fibers occur along blood vessels and conducting airways. The balance of fibrogenic and antifibrogenic factors must be toward suppression of fibroblast proliferation and matrix production. However, we know little about the antifibrogenic factors that are present in the normal lung.”

Symptoms:

  • chest pain
  • cough, usually dry
  • Decreased exercise tolerance
  • dyspnea, upon exertion or in progressive cases also at rest)Diagnostics:
    • broncoscopy with transbronchial lung biopsy
    • chest CT
    • chest x-ray
    • SpO2, blood oxygen level
    • pulmonary function tests
  • Lung tissue biopsy

Treatment and management:

  • There is no cure.
  • corticosteroids and cytotoxic drugs may help reduce swelling (inflammation) in some cases
  • supplemental oxygen
  • lung physiotherapy to maintain exercise tolerance
  • lung transplant in severe advanced cases

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001134/

http://www.nhlbi.nih.gov/meetings/workshops/ipf-sum.htm

Whipple procedure

A surgical procedure  to treat cancer involving on the head of the pancreas, malignant tumors involving the common bile duct, duodenal papilla, or duodenum near the pancreas.

Pancreaticoduodenectomy:

en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.

The head of the pancreas and the duodenum share the same arterial blood supply (the gastroduodenal artery). These arteries run through the head of the pancreas, so that both organs must be removed if the single blood supply is severed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue necrosis.

Timeline:

1898 – procedure was originally described by Alessandro Codivilla, an Italian surgeon.

1909 – The first resection for a periampullary cancer was performed by Walther Kausch, a German surgeon.

1935 – improved version of the surgery performed by Allen Whipple, an American surgeon.

There after called the Whipple procedure.