http://news.bbc.co.uk/1/hi/health/8261121.stm
An article caught my attention today on the BBC News website about Neurofibromatosis Type 1. It was particularly interesting because many of the family members affected by the condition weren't even aware that they had mild forms of the disease. The condition is caused by mutations on chromosome 17 and leads to growth of multiple tumours from nerve cells.
Medical Protection Society MPS Magazine.
Seems as though alot of the cases in the back of the magazine are to do with situations where doctors have failed to properly examine patients and have missed 'red flags' or signs as a result.
Saturday, 26 September 2009
Friday, 11 September 2009
Wanted to write about an interesting article which I read in the student BMJ, 'Shift Work and Cancer'. I had no idea before reading this that research has been published claiming to show a link between the two. Some of the underlying reasons cited include suppression of melatonin, sleep pattern disruption of the hypothalamic-pituitary axis and decreased vitamin D production.
Fritschi L. Shift Work and Cancer. BMJ. 2009 Jul 15;339:b2653. doi: 10.1136/bmj.b2653.
Fritschi L. Shift Work and Cancer. BMJ. 2009 Jul 15;339:b2653. doi: 10.1136/bmj.b2653.
Wednesday, 9 September 2009
Prolapse, Miscarriage and Ectopic Pregnancies
Yesterday was spent in the gynaecology out-patient department (Dr. Nicoll's teaching clinic) whilst today I was in the Early Pregnancy Assessment Clinic. I didn't realise until today that patients attending the teaching clinic are informed on their referral letter that they are coming to a teaching clinic and will be seen by students. I thought this was advantageous because it meant patients were willing to co-operate and I really appreciated the patients giving us their time and allowing us to observe with the examinations (bimanual, abdominal, speculum) and investigations (Pipelle biopsy).
I took a history from a 77 year old woman presenting with pelvic organ prolapse (dragging sensation), mixed incontinence and recurrent UTIs. It seems the cause of her problems may be bladder outlet obstruction as a result of failed TransVaginal Tape (TVT) surgery carried out in 2007 (a rare complication). Her prolapse was being managed presently with pessaries, however she was keen for surgery. Dr Nicoll councelled her against surgery (sacro-spinous fixation) due to her co-morbidites she had, and risk of the operation given her age. 2nd patient, interviewed by Jackie presented with prolapse after her partner told her after sex that it 'felt like the walls were caving in' (!). I learnt alot about pelvic organ prolapse (although maybe not quite enough to rival resident prolapse king Buchanan!), particularly the different ways in which prolapse can present ie.
anterior: urinary frequency, urgency, difficulty voiding, recurrent UTIs, stress incontinence. posterior: incomplete bowel emptying, digitation and other GI symptoms.
At the early pregnancy clinic 3 patients were seen; 1st was a very nervous, anxius woman and partner due to previous still birth (at term). Cannot even begin to imagine how awful that would be for the mother. In this unfortunate event, the woman is normally given an epidural and the fetus is delivered vaginally. 2nd patient was para 0+3 with bleeding at 11 weeks gestation but a viable (very bouncy) pregnancy was confirmed. The 3rd patient was para 0 + 2, very confused about dates of LMP and +ve pregnancy test. Based on the information, she would have been 10 weeks gestation, however on ultrasound scan there was only small gestational sac that would be more in keeping with approx 5 weeks. It is likely that this pregnancy had run into trouble and the patient was advised of this development. When the midwife left the room for a few minutes, I offered condolence and support to the patient and their partner but found this a difficult situation to manage. I think I coped quite well with the situation, and answered the couple's questions correctly.
Found out that numbers of ectopic pregnancies have shot up in recent years, ? due to chlamydia, gonorrhoea, increasing numbers of sexual partners and changes in contraceptive methods (less barrier).
Cervical screening tutorial offered alot of information this afternoon, such as aetiology, pathology, screening and treatment of CIN. Must remember that abnormal cells from a smear are NOT cancerous and patients must be councelled that it does not mean they have cancer. Hopefully what we covered today will be useful come visit to colposcopy on Friday.
England are going to South Africa 2010! Convincing 5-1 thrashing of Croatia, whilst Scotland are out, finishing third in the group and losing 0-1 on the night to the Netherlands. To top it off, the goal came 9 minutes from time on the 9th of the 9th, 2009. BlackBerry is on its way! Really looking forward to setting it up at the week - think I'm into a bit of a gadget fiend! Hopefully I'll be able to update this blog from my mobile - who knows!
I took a history from a 77 year old woman presenting with pelvic organ prolapse (dragging sensation), mixed incontinence and recurrent UTIs. It seems the cause of her problems may be bladder outlet obstruction as a result of failed TransVaginal Tape (TVT) surgery carried out in 2007 (a rare complication). Her prolapse was being managed presently with pessaries, however she was keen for surgery. Dr Nicoll councelled her against surgery (sacro-spinous fixation) due to her co-morbidites she had, and risk of the operation given her age. 2nd patient, interviewed by Jackie presented with prolapse after her partner told her after sex that it 'felt like the walls were caving in' (!). I learnt alot about pelvic organ prolapse (although maybe not quite enough to rival resident prolapse king Buchanan!), particularly the different ways in which prolapse can present ie.
anterior: urinary frequency, urgency, difficulty voiding, recurrent UTIs, stress incontinence. posterior: incomplete bowel emptying, digitation and other GI symptoms.
At the early pregnancy clinic 3 patients were seen; 1st was a very nervous, anxius woman and partner due to previous still birth (at term). Cannot even begin to imagine how awful that would be for the mother. In this unfortunate event, the woman is normally given an epidural and the fetus is delivered vaginally. 2nd patient was para 0+3 with bleeding at 11 weeks gestation but a viable (very bouncy) pregnancy was confirmed. The 3rd patient was para 0 + 2, very confused about dates of LMP and +ve pregnancy test. Based on the information, she would have been 10 weeks gestation, however on ultrasound scan there was only small gestational sac that would be more in keeping with approx 5 weeks. It is likely that this pregnancy had run into trouble and the patient was advised of this development. When the midwife left the room for a few minutes, I offered condolence and support to the patient and their partner but found this a difficult situation to manage. I think I coped quite well with the situation, and answered the couple's questions correctly.
Found out that numbers of ectopic pregnancies have shot up in recent years, ? due to chlamydia, gonorrhoea, increasing numbers of sexual partners and changes in contraceptive methods (less barrier).
Cervical screening tutorial offered alot of information this afternoon, such as aetiology, pathology, screening and treatment of CIN. Must remember that abnormal cells from a smear are NOT cancerous and patients must be councelled that it does not mean they have cancer. Hopefully what we covered today will be useful come visit to colposcopy on Friday.
England are going to South Africa 2010! Convincing 5-1 thrashing of Croatia, whilst Scotland are out, finishing third in the group and losing 0-1 on the night to the Netherlands. To top it off, the goal came 9 minutes from time on the 9th of the 9th, 2009. BlackBerry is on its way! Really looking forward to setting it up at the week - think I'm into a bit of a gadget fiend! Hopefully I'll be able to update this blog from my mobile - who knows!
Monday, 7 September 2009
An article in the BMA newsletter today says that 23% of the junior doctors in paediatrics in NHS Lothian are apparently on maternity leave at the same time. Same problem in Dundee's GUM clinic by the looks of things, yet another teaching session cancelled today, and it seems to be all of the important one's I'm missing too! Will need to catch up at a later date.
Sat in the gynaecology out-patient clinic today and saw three patients:
1) Investigations for ovarian cancer: CEA, Ca125. Follow up appointment, previous 'borderline' ovarian tumour. Found out that 15% of epithelial tumours are 'borderline', they show epithelial proliferation but no stromal invasion, tending to behave as a low grade malignancy. Removal of these tumours is ususally curative, as in this case.
2) Patient with a large anterior intramural fibroid in her uterus. Discussed with her and her partner the various surgical treatment options avalaible to her and talked about some of her concerns about having a hysterectomy. Found this really interesting and discussed it in greater detail in my RoCE.
3) 73 year old female patient complaining of faecal incontinence and bilateral leg oedema. This was a follow up appointment following wide local excision of a vulval carcinoma in '07. Unfortunately the patient was quite embarrassed by her problem, understandably so, and I felt quite awkward discussing it with her. Need to work on that because it probably doesn't leave a particularly good impression to the patient if the doctor finds talking about their problem awkward.
The registrar recommended a useful website to me, www.scan.scot.nhs.uk
It stands for the South-East Scotland Cancer Network and provides excellent guidelines in the management of not just gynae cancers but covers all specialities.... worth a look!
Sat in the gynaecology out-patient clinic today and saw three patients:
1) Investigations for ovarian cancer: CEA, Ca125. Follow up appointment, previous 'borderline' ovarian tumour. Found out that 15% of epithelial tumours are 'borderline', they show epithelial proliferation but no stromal invasion, tending to behave as a low grade malignancy. Removal of these tumours is ususally curative, as in this case.
2) Patient with a large anterior intramural fibroid in her uterus. Discussed with her and her partner the various surgical treatment options avalaible to her and talked about some of her concerns about having a hysterectomy. Found this really interesting and discussed it in greater detail in my RoCE.
3) 73 year old female patient complaining of faecal incontinence and bilateral leg oedema. This was a follow up appointment following wide local excision of a vulval carcinoma in '07. Unfortunately the patient was quite embarrassed by her problem, understandably so, and I felt quite awkward discussing it with her. Need to work on that because it probably doesn't leave a particularly good impression to the patient if the doctor finds talking about their problem awkward.
The registrar recommended a useful website to me, www.scan.scot.nhs.uk
It stands for the South-East Scotland Cancer Network and provides excellent guidelines in the management of not just gynae cancers but covers all specialities.... worth a look!
Thursday, 3 September 2009
Lung Transplantaiton, Spina Bifida, Oesophageal Cancer and Drive-Thru Medicine
Cystic fibrosis is the most prevalent serious genetically inherited disorder in Scotland, and it was really interesting tonight listening to the experiences of a Glasgow medical student with the condition who received a lung transplant one year ago. Having finished medical school against the recommendation of her doctors her condition worsened to the extent that she could not work. After waiting on the transplant list (for up to 2 years) she had the transplant and has made a remarkable return to health. The report on the Student BMJ podcast also talked about how half of the people on the waiting list never receive a transplant, and that the UK has significantly lower levels than, say, Spain which has the highest transplant rates in the world. The first organ transplant was successfully carried out in Boston in 1954. Sounds like the GMC are doing something about this:
GMC is to instruct all GPs to talk to dying patients about organ donation. BMJ 2009;339:b3578 2nd September 09
Found out today that the UK now has its first 'private' medical school, at the University of Buckingham. Hope this isn't just another step in the privatisation of health care, NHS doctors vs private trained doctors in a few years time maybe? Watched a really captivating programme on BBC iPlayer tonight about living with Alzheimers disease, good to re-visit these things from time to time.
Patients who I saw today in gynaecology: a woman in theatre for laparoscopic sterilisation, a second pateint with menorrhagia in theatre for endometrial biopsy, and a 76 y.o. woman with late-presentation of ovarian cancer. Ovarian cancer often presents with obscure symptoms, and often goes un-diagnosed. Some research is now being carried out to identify and refer patients with suspected ovarian cancer quicker from primary care.
Apparently one state in the US (Kentucky I think) has come up with an efficient way of vaccinating large volumes of people against flu in a short space of time: the drive-thru vaccination clinic! Not a bad idea but not quite sure about the safety! They tell people waiting in the queue, 'roll up your sleeves and roll down your windows!'.
Apparently the medical school has been issuing new dress code measures, and students should 'dress in a manner which inspires public confidence'. I'll try! Have recently found a couple of new tools for helping pass 4th year: Patient information leaflets, OnExamination.com and YouTube!
Amy gets back tomorrow!!!! Hope she brings back the Australian sun with her....
New music I need to download at some point: Fielding and The GoStation. Think the news about Chelsea's transfer ban is absolutely hilarious, puts Eduardo's two match ban (which will hopefully be overturned but doubt it will) into perspective!
Finally, saw an interesting research article on the BMJ today:
Now, for more Late Night Love courtesy of Wave 102........................or maybe another episode of The Office on BBC iPlayer, absolute comedy genius!!
GMC is to instruct all GPs to talk to dying patients about organ donation. BMJ 2009;339:b3578 2nd September 09
Found out today that the UK now has its first 'private' medical school, at the University of Buckingham. Hope this isn't just another step in the privatisation of health care, NHS doctors vs private trained doctors in a few years time maybe? Watched a really captivating programme on BBC iPlayer tonight about living with Alzheimers disease, good to re-visit these things from time to time.Patients who I saw today in gynaecology: a woman in theatre for laparoscopic sterilisation, a second pateint with menorrhagia in theatre for endometrial biopsy, and a 76 y.o. woman with late-presentation of ovarian cancer. Ovarian cancer often presents with obscure symptoms, and often goes un-diagnosed. Some research is now being carried out to identify and refer patients with suspected ovarian cancer quicker from primary care.
Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009;339:b2998. 25th August 09
In the news yesterday Scotland has the highest rates of spina bifida in the UK. Although the number of pregnancies affected by the condition are roughly equal, women in Scotland are less likely to terminate the pregnancy than their English counterparts. However this was hardly the impression I got having spent the afternoon in the Nairn clinic and hearing that Dundee has the highest rates of terminations of pregnancy in the UK. It was a real day of contrasts yesterday, with the morning spent on the infertility ward, and the afternoon the direct opposite. I wonder what the women on the infertility ward would feel about what goes on down in the basement of level 6... Spina bifida can be prevented by regular folic acid supplements, and can be detected on fetal ultrasound scanning by identifying the classic 'lemon and banana signs'.Apparently one state in the US (Kentucky I think) has come up with an efficient way of vaccinating large volumes of people against flu in a short space of time: the drive-thru vaccination clinic! Not a bad idea but not quite sure about the safety! They tell people waiting in the queue, 'roll up your sleeves and roll down your windows!'.
Apparently the medical school has been issuing new dress code measures, and students should 'dress in a manner which inspires public confidence'. I'll try! Have recently found a couple of new tools for helping pass 4th year: Patient information leaflets, OnExamination.com and YouTube!
Amy gets back tomorrow!!!! Hope she brings back the Australian sun with her....
New music I need to download at some point: Fielding and The GoStation. Think the news about Chelsea's transfer ban is absolutely hilarious, puts Eduardo's two match ban (which will hopefully be overturned but doubt it will) into perspective!
Finally, saw an interesting research article on the BMJ today:
Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ 2009;338:b929. 26th March 09
brought to my attention on the BMJ podcast this week.Now, for more Late Night Love courtesy of Wave 102........................or maybe another episode of The Office on BBC iPlayer, absolute comedy genius!!
Wednesday, 2 September 2009
Spent the morning today in Ward 35, ACU with Dr Kay and Dr Eid, witnessing two egg retrieval procedures and embryo transfer for IVF infertility treatment. The first patient was a self funding para 1 + 1 woman with previous failed cycle of IVF. Chance of success is increased with the following criteria: parous woman, young, absence of pelvic disease. 12 follicles approximately were drained, 3/4 of which contain eggs. 8 - 12 eggs are collected and approx 50% will become fertilised. The best two embryos are selected and re-implanted. The balance has to be weighed up between the risk of multiple pregnancy and the chance of a pregnancy occurring. Risks associated with IVF egg retrieval include infection, perforation of the bowel and haemorrhage although these complications are rare.
The second patient was Hep B +ve. I knew that due to her +ve status, it would be advisable to wear protective masks during the egg collection procedure however the theatre team had not done this. Therefore I went into the preparation room and collected masks to give to each of the members of staff. This should have been avoided with everyone wearing masks before entering the room with the patient. ICSI had been used for this patient, indicated due to severe male factor infertility. The long term results of ICSI are currently unavaliable. We discussed that patients wishing to have pre-implantation genetic diagnosis carried out can be referred to the regional centre in Edinburgh. I also discussed with the doctors some of the ethical implications of sperm donation, which has suffered a serious decline in numbers since new anonymity laws recently came into place.
The afternoon involved tutorials on Antepartum Haemorrhage (focusing particularly on placenta praevia & placental abruption), and Amenorrhoea, as well as a visit to the Nairn Suite to find out about councelling for termination of pregnancy. All in all an eventful day!
The second patient was Hep B +ve. I knew that due to her +ve status, it would be advisable to wear protective masks during the egg collection procedure however the theatre team had not done this. Therefore I went into the preparation room and collected masks to give to each of the members of staff. This should have been avoided with everyone wearing masks before entering the room with the patient. ICSI had been used for this patient, indicated due to severe male factor infertility. The long term results of ICSI are currently unavaliable. We discussed that patients wishing to have pre-implantation genetic diagnosis carried out can be referred to the regional centre in Edinburgh. I also discussed with the doctors some of the ethical implications of sperm donation, which has suffered a serious decline in numbers since new anonymity laws recently came into place.
The afternoon involved tutorials on Antepartum Haemorrhage (focusing particularly on placenta praevia & placental abruption), and Amenorrhoea, as well as a visit to the Nairn Suite to find out about councelling for termination of pregnancy. All in all an eventful day!
Tuesday, 1 September 2009
Arctic Monkeys Headline Set Reading 09
- 1.My Propeller *
- 2.Red Right Hand (Nick Cave and The Bad Seeds cover)
- 3.Crying Lightning *
- 4.Brianstorm *
- 5.Still Take You Home
- 6.I Bet You Look Good On The Dancefloor *
- 7.Potion Approaching
- 8.Pretty Visitors
- 9.House Is A Circus
- 10.If You Were There, Beware
- 11.When The Sun Goes Down
- 12.Dangerous Animals
- 13.View From The Afternoon
- 14.Cornerstone *
- 15.Only Ones Who Know
- 16.Do Me A Favour
- 17.Fluorescent Adolescent *
- 18.Secret Door *
- 19.505
Looking at the BMA newsletter today I noticed an article about one particularly concerned doctor who was upset that junior doctors and medical students were missing out on interesting cases as they were being 'cherry-picked' by private institutions. I thought this was a good point, until I realised he was specifically referring to 'scrotal' cases, with the average medical student spending only 2 sessions in NHS urology clinics and possibly not seeing a single circumcision. Pity. http://web2.bma.org.uk/nrezine.nsf/wd/BSKN-7VBC85?OpenDocument&Login
The new Irish pub on Perth Road seems like one of the few places you can go out in Dundee, and feel like you're somewhere completely different! One of the highlights of the weekend has to have been Dominoes on Friday, particularly when theres 50% off courtesy of Andrew! Spent alot of time watching the highlights from Reading and Leeds festival, some bands I'm liking at the moment: The Gaslight Anthem, You Me at Six and Radiohead. Especially thought the performance by the latter, headlining the festival was astonishing, really need to get my hands on some Radiohead albums in the next few weeks.
I'm very disappointed Zane Lowe isn't coming to Dundee this year for Freshers Week! Vernon Kay is hardly a worthwhile substitution, he's not a DJ, he's just a celebrity face! Another night of top 40 hits then I'd imagine. Really looking forward to the next couple of weekends, Amy gets home on Friday so excited about seeing her again, then the following weekend; Fat Sams Live, Kirsten's leaving do and the tail end of Freshers week.
Interesting cases in the gynae theatre today. Particularly a woman who presented with bilateral peripheral oedema who was originally referred to a cardiologist on suspicion of a DVT (she had elevated D-dimers). However on abdominal examination she was found to have a raised pelvic mass, raising suspicions of a large abdominal tumour. CT scans revealed a large, complex abdominal cyst, highly suspicious of malignancy, compressing on the IVC and decreasing venous return. In theatre (Dr Mackenzie), laparoscopy confirmed these suspicions. Debulking of the tumour was carried out to remove some pressure on the IVC, however this patient will require chemotherapy and follow-up as metastases were seen on the abdominal wall.
The new Irish pub on Perth Road seems like one of the few places you can go out in Dundee, and feel like you're somewhere completely different! One of the highlights of the weekend has to have been Dominoes on Friday, particularly when theres 50% off courtesy of Andrew! Spent alot of time watching the highlights from Reading and Leeds festival, some bands I'm liking at the moment: The Gaslight Anthem, You Me at Six and Radiohead. Especially thought the performance by the latter, headlining the festival was astonishing, really need to get my hands on some Radiohead albums in the next few weeks.
I'm very disappointed Zane Lowe isn't coming to Dundee this year for Freshers Week! Vernon Kay is hardly a worthwhile substitution, he's not a DJ, he's just a celebrity face! Another night of top 40 hits then I'd imagine. Really looking forward to the next couple of weekends, Amy gets home on Friday so excited about seeing her again, then the following weekend; Fat Sams Live, Kirsten's leaving do and the tail end of Freshers week.
Interesting cases in the gynae theatre today. Particularly a woman who presented with bilateral peripheral oedema who was originally referred to a cardiologist on suspicion of a DVT (she had elevated D-dimers). However on abdominal examination she was found to have a raised pelvic mass, raising suspicions of a large abdominal tumour. CT scans revealed a large, complex abdominal cyst, highly suspicious of malignancy, compressing on the IVC and decreasing venous return. In theatre (Dr Mackenzie), laparoscopy confirmed these suspicions. Debulking of the tumour was carried out to remove some pressure on the IVC, however this patient will require chemotherapy and follow-up as metastases were seen on the abdominal wall.
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