RRP: AU$119.95

Snell, RS. Clinical Neuroanatomy, Seventh Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: AU$107.80

As stated by Sparks and colleagues [1] in their comparison of Clinically Oriented Anatomy and Gray’s Anatomy for Students, studying anatomy can be a challenging endeavour. This is true even more so for the study of neuroanatomy, which many students find particularly overwhelming. In the neuroanatomy textbook arena stand two ‘gold standard’ textbooks: Neuroanatomy through Clinical Cases, by Hal Blumenfeld, and Clinical Neuroanatomy, by Richard Snell. Inspired by the aforementioned comparative anatomy textbook review in the previous issue of the journal, I ponder the question: Which neuroanatomy textbook is superior, the more established Snell or the newer Blumenfeld?

I begin my comparison with a consideration of their similarities…

Figure 1. Baby hospitalised for suspected bacterial pneumonia.

Squeezing into our rusty mutatu (bus), we handed over the fare to the conductor, who returned to us less than expected change. In response to our indignant questioning, he defiantly stated, “You are mzungu (white person) and mzungu is money.” This was lesson one in a crash course we had inadvertently stumbled into: “Life in Kenya for the naïve tourist.” More unsettling than being scammed in day to day life, however, was the rampant corruption in the hospital and university setting.

We completed our placement at Kenyatta National Hospital, the largest referral centre in Kenya, with 1,800 beds, 50 wards and 24 operating theatres. I was based within the paediatric ward and paediatric emergency department…

Empathy and the medical student – Practice makes perfect?

The observation of another person in a particular emotional state has been shown to activate a similar autonomic and somatic response in the observer without the activation of the entire pain matrix, not requiring conscious processing, but able to be controlled or inhibited nonetheless. [2] This effectively means that when we see someone in physical or emotional distress, we too experience at least some aspect of that suffering without it even needing to be in the forefront of our consciousness. As medical students we are constantly told to “practice” being empathetic to patients and family members. What we are really practicing is consciously processing this suffering we unknowingly share with these people in order to develop rapport with them (if not just to impress medical school examiners).

We are taught an almost automated response to this distress, including a myriad of body language and particular phrases, such as “I imagine this must be very difficult for you,” to indicate to a patient that we are aware of the pain they are in. Surveys amongst critical care nurses have shown that gender, position, level of education and years of nursing experience have no significant relationship with the ability of a person to show empathy. [1] Thus it could be said that empathy is less of a skill which can be practiced until perfect, and more of a mindset that makes us as human as the people we treat…

During my elective term in early 2010 at the Royal Free Hospital, London, I was presented with a fantastic opportunity: to learn how to perform a laparoscopic gastric bypass procedure. The challenge was for myself, a medical student and complete novice in laparoscopic surgery, to use the hospital’s state-of-the-art screen-based simulation technology to become proficient in a specific operation within six weeks in this rapidly advancing area of surgery.

My training was to be undertaken using the Simbionix LAP Mentor (Simbionix, Cleveland, Ohio, USA): an advanced piece of technology made up of a computer with simulation software and accompanying hardware, consisting of ports and instruments. The difference between this and a video game is the presence of haptic feedback; when you hit something or pull it, you feel the corresponding tension, making it a highly realistic representation of surgery…

Prof. Alden H. Harken

As students of medicine, you will soon be educationally unique – with a body of knowledge that no one can ever take away from you.

When you receive your MBBS, the society and community in which you live is making a statement of trust in your abilities. With that trust you will be afforded extraordinary privileges and esteem. However, with the esteem and privilege comes the heavy responsibility of your patients’ well-being. You are all remarkably capable – and, remarkably fortunate to be so capable…

Figure 1. Population pyramid demonstrating the relative youth of Australia’s Indigenous population, 2009.

Surely we don’t need any more research? Surely we know what to do to improve Aboriginal health? Surely we know the best environments for healthy child development? In this article I provide a rationale for Aboriginal child health research, give a history of my own personal journey in Aboriginal child health from the 1970s to 2011, give examples of our research and its application to improve outcomes and how we have provided the environment to build the careers of Aboriginal researchers; and finally, end with several recommendations.

The aims of the Telethon Institute for Child Health Research (TICHR) are fourfold:

1. To conduct high quality research;
2. To apply research findings (not only our own) to improve the health and well being of children, adolescents and families;
3. To teach the next generation of health researchers; and
4. To be an advocate for children, for research and for social justice.

We do all this by…

Prof. Alan Trouson

Introduction

I have had the experience of working in two major areas of human medicine that have been challenging and rewarding, and have provided some of the most heated debate on medical ethics and disturbance of established social mores. In many respects this made the developments even more difficult because they were frequently and avidly opposed by entrenched religious, political and gender advocates. The medical developments have been extremely successful. In the first place, human in vitro fertilisation (IVF) whose genesis occurred in the 1970s and 1980s has resulted in more than five million births worldwide and can no longer be simply quantified. In some countries with liberal health support systems, more than 3% of all live births are by IVF. The second great quantum development resides in stem cell based therapies, whose influence will be even more pervasive and influential, and whose significance is only just being evaluated in preclinical and clinical trials. This work has evolved from discoveries in bone marrow transplantation in the 1980s and 1990s and embryonic stem cell discoveries between 1998 and 2000…

Figure 1. Contrast enhanced abdominal CT scan: coronal section. This image demonstrates the ovoid hypodense filling defect in the IVC distal to the renal veins. The thrombus is expanding the cava (red circle). Note also the hypodense metastatic deposit in the liver (green circle).

This case report identifies an IVC thrombosis in a patient with stage IV prostate cancer. The case demonstrates hypercoagulability as one of the many complications of malignancy. The patient presented clinically with bilateral pitting oedema to the groin and into the scrotum with dilated superficial abdominal veins. The prostate cancer was aggressive and unresponsive to anti-androgen therapy and brachytherapy. The latest staging CT and bone scans revealed diffuse disseminated disease and a caval thrombus. He is now receiving chemotherapy as an outpatient and unfortunately his prognosis is unfavourable.

Figure 1. Right fundus of Case One, eighteen months prior to the time of presentation with decreased left visual acuity. A vitelliform macular lesion typical of Best disease is present.

Juvenile Vitelliform Dystrophy (Best disease) is a degenerative macular condition that is genetically inherited. In recent years monoclonal antibodies have been employed to help prevent the decline in vision associated with macular fluid. This report documents the use of intra-vitreal bevacizumab in two siblings (aged thirteen and fifteen) with Best Disease. This work studies the changes observed in visual acuity and macular oedema over a 39 and nineteen week period respectively.