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Book Review For Neurosurgeons: Intraoperative MRI-Guided Neurosurgery

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Hall WA, Nimsky C, Truwit CL. Intraoperative MRI-Guided Neurosurgery. Thieme 2010, 272 pages, $159.95.

This book is a multiauthored text edited by three senior authors who have a tremendous experience in the use of intraoperative MRI technology. The book is divided into five sections that describe the various iterations of iMRIs that are available, its application for minor procedures, the resection of neoplastic lesions, and its role in the management of nonneoplastic disorders. The last section focuses on the future improvements in design that are likely to improve surgical access and utility of this burgeoning technology.

The first section describes the characteristics of iMRI machines that are available in the low, medium and high field strength. The reader gets a very good idea about the relative benefits and limitations of each of these machines. Hospitals that may be in the process of deciding which technology to go in for may use this information as a good guide. This section also highlights the optimal pulse sequences that may help differentiate tumor-brain interface, perform intraoperative fMRI and DTI tracking and detect complications related to brain ischemia and hematoma formation.  The chapters in this section are well illustrated and show both the technology and the images obtained with various units. The chapter on optimal pulse sequences is very well written and discusses the specific pulse sequences that can help obtain the maximum intraoperative information with the least amount of time. These sequences can be tailored to provide not only anatomical details but also to help obtain both DTI and functional activation data for intraoperative neuronavigation, thereby accounting for brain shifts and movement of eloquent tracts during surgery. The authors describe the challenges of this methodology. Specific anesthetic challenges that restrict the use of standard monitoring equipment have been outlined. These include patient access, length of operative procedure, influence of magnetic field and RF currents on the functioning of the equipments and the images obtained, and risk of migration of ferromagnetic instruments, among others. This has led to the development of MR compatible anesthesia and monitoring equipment. Safety issues and steps needed to ensure reliability of equipment have been described. Read more »

*This blog post was originally published at AJNR Blog*

Chronic Pain, Chocolate, and Vicodin

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Chocolate and vicodin? No, it’s not the latest Ben & Jerry’s flavor. “Chocolate & Vicodin: My Quest For Relief From the Headache That Wouldn’t Go Away” is the latest book by author, blogger, web designer, and busy woman Jennette Fulda.

I became acquainted with Jennette’s blog during BlogHer 2008, where I had purchased her first book, “Half-Assed: A Weight-Loss Memoir.” When she asked if I would like a copy of “Chocolate & Vicodin” to review, I jumped at the chance.

In “Half-Assed,” Jennette chronicled her journey to a near-200 pound weight loss. Just prior to that book’s release, she began another journey — one whose goal proved elusive. On February 17, 2008, Jennette went to bed with a headache. She still has the headache.

Name a diagnosis, she’s heard of it (brain tumor, dead twin in the brain, etc.) Name a treatment, she’s tried it (meds, massage, marijuana, mint chocolate chip ice cream, etc.) In “Chocolate & Vicodin,” Jennette is on a journey to find relief from chronic headache. Writing in a comfortable style, Jennette has a subtle humor that will have you laughing out loud. Trust me, her description of using marijuana “for medicinal purposes only” will have your beverage of choice coming out your nose! (Cover the book!)

But it will also choke you up. Under the humor, under the crazy e-mails from readers that suggest the crazy remedies, this is a serious story of chronic pain disrupting life. Persistent, excruciating pain and the work of coping with it takes a toll on Jennette, and when it becomes too much you find yourself sobbing with her. Read more »

*This blog post was originally published at Emergiblog*

Book Review: “Steeped In Blood: The Life And Times Of A Forensic Scientist”

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This post is a bit of a diversion from my usual posts, but I think it may still be worthwhile. You see, I want to promote a book.

I’ve just read the book, “Steeped in Blood: The Life and Times of a Forensic Scientist” by David Klatzow. What a stunning book. It really gives insight into the South Africa of old and possibly what South Africa of future may end up being like. I suggest that everyone get ahold of it and read it.

However, David, I do feel I must challenge you on one point. Towards the end of your book, you say one of your surgeon friends told you a story of one of our Cuban import surgeons who tried to do a tonsillectomy through the neck rather than through the mouth, the normal way of doing it. I know this story and have heard it often myself in the corridors in Pretoria. Unfortunately it’s urban legend and nothing more.

I have worked with the Cubans, and they aren’t too shabby. Don’t get me wrong — they aren’t a scratch on a South African specialist (although the standards are dropping as you rightly point out, and quite soon they may be far better than homegrown specialists), but the point is that they wouldn’t do something so bizarrely stupid. I even suspect I know who your surgeon friend might be, especially if he presently finds himself in Pretoria rather than Johannesburg, where you no doubt got to know him.

Anyway, still an absolutely brilliant read for anyone who wants to get a peek into the workings of the apartheid government of old. Go and buy it now.

*This blog post was originally published at other things amanzi*

A Thank You A Day…

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This is a guest post by Dr. John Schumann.

**********

I just read the book “365 Thank Yous” by John Kralik. I heard an interview with the author on NPR and it caught my attention.

Kralik had been down on his luck in 2007: Divorced twice, overweight, with a struggling law firm that he’d started, he was also failing in a new romantic relationship. He was worried about losing his seven-year-old daughter, too, in a custody dispute.

He made a momentous decision: Instead of feeling sorry for himself (easy to do given his predicaments), he decided to be grateful for what he had. To show it, he vowed to write a thank-you note every day for the next year. What do you think happened?

His life changed for the better. His relationship improved. His clients started paying their bills and his firm’s financial footing solidified. His health improved. He eventually achieved his lifelong dream of becoming a judge. To top it off, he turned his personal quest into a writing project. Within minutes of writing a book proposal, he received responses from agents who hoped to shepherd his project. Every writer’s dream.

I’ll grant you that it sounds hokey. But there are a couple of things the book demonstrated to me. Read more »

*This blog post was originally published at ACP Internist*

Book Review: “Tabloid Medicine: How The Internet Is Being Used To Hijack Medical Science For Fear And Profit”

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This was the Guest Blog at Scientific American on February 23rd, 2011. 

In his new book, “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit,” Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information. On the one hand, the Web can empower people with quality medical information that can help them make informed decisions. On the other hand, the Web is an unfiltered breeding ground for urban legends, fear-mongering and snake oil salesmen.

Goldberg uses case studies to expose the sinister side of health misinformation. Perhaps the most compelling example of a medical “manufactroversy” (defined as a manufactured controversy that is motivated by profit or extreme ideology to intentionally create public confusion about an issue that is not in dispute) is the anti-vaccine movement. Thanks to the efforts of corrupt scientists, personal injury lawyers, self-proclaimed medical experts, and Hollywood starlets, a false link between vaccines and autism has been promoted on a global scale via the Internet. The resulting panic, legal feeding frenzy, money-making alternative medicine sales, and reduction in childhood vaccination rates (causing countless preventable deaths), are sickening and tragic.

As Goldberg continues to explore the hyperbole behind specific “health threats,” a fascinating pattern emerges. Behind the most powerful manufactroversies, lies a predictable formula: First, a new problem is generated by redefining terminology. For example, an autism “epidemic” suddenly exists when a wide range of childhood mental health diagnoses are all reclassified as part of an autism spectrum. The reclassification creates the appearance of a surge in autism cases, and that sets the stage for cause-seeking.

Second, “instant experts” immediately proclaim that they have special insight into the cause. They enjoy the authority and attention that their unique “expertise” brings them and begin to position themselves as a “little guy” crusader against injustice. They also are likely to spin conspiracy theories about government cover-ups or pharmaceutical malfeasance to make their case more appealing to the media. In many cases the experts have a financial incentive in promoting their point of view (they sell treatments or promote their books, for example).

Third, because mainstream media craves David and Goliath stories and always wants to be the first to break news, they often report the information without thorough fact-checking. This results in the phenomenon of “Tabloid Medicine.” Read more »

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