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Diverticulum
men alike. Six porters have failed to arrive and a mighty yak has dropped dead. 3.00 am. Awake dyspnoeic and very frightened. Angor animi? There is a severe weight on my chest-like a dead yak-and a pigeon fluttering within. Half-asleep, tired and hypoxic, I struggle unsuccessfully with self-diagnosis. The next day the other 15 physicians (and 3 professors) join in the diagnostic debate, giving at least 30 different opinions. An ECG resolves the problem-atrial flutter of 160/min with 2:1 a-v block, a touch of angina, and some LVF. Not real AMS. Disappointed, the doctors soon lose interest. The expedition leader decides to press on upwards to further suffering at Kala Pattar (19 000 ft) whilst I, with a sherpa and three yaks for company, slowly and ignominiously retreat towards Thyangboche. We reach a ridge. The clouds part and the sun lights up a massive mountain. "Look Sir," calls my sherpa, excitedly See-Nuptse!" I turn away, fearful and tachycardic. "Om mani padme hum", murmurs Nawang Sangay Sherpa to himself with each footfall. "See Nuptse and die" I respond as I stagger after him. "Did you have a good holiday?" asks the Medical Director on my return.
Rhetorical questions, however dramatic, :10 not for a moment call for burying one’s tiead in the sand-on the contrary, the gap between what we knew and what we could do had to be narrowed as soon as possible. We have devised a strategy along the lines of those given for chlorine by Baxter et al (Br J Ind Med 1989; 46: 277-85). However, we are aware that there still remain many unknowns in wartime chemical disasters particularly when fire effluents are mixing with toxic release. Our empathy for people terrified by such great perils will be long remembered after the "hurly-burly’s done, when the battle’s lost and won."
and
Diverticulum Diverticulum (Latin) A byway, bypath, deviation, wayside shelter or lodging. A smaller sidebranch of any cavity or passage; in anatomy applied usually to a blind tubular process, in pathology to a malformation having this quality. .
Oxford English Directory
Om Mani Padme Hum Thyanboche Monastery (12 500 ft) Nepal. The sherpas and Tibetan yak drivers encourage their weary beasts with soft whistles and sweet whispers, repeating over and over again the sacred buddhist incantation "om mani padme hum". We are three days out of Katmandu (4500 ft), just four days from sea level at Dhaka and by the evening we will be at Pheriche (14 000 ft). To the north lies the huge face of Nuptse concealing all but the tip of Everest itself. The rate of ascent is highly dangerous-3000 ft a day-but we are a medical expedition studying acute mountain sickness (AMS) and in true scientific tradition we need to acquire the disease ourselves in order to know it. Pheriche-a grim little hamlet of a dozen or so stone and turf dwellings, ten miles from base camp. Two people died here last week of AMS. A bitter, cold wind howls down the valley from the Khumbu glacier bringing flurries of snow. It was here in 1975, that Dr Peter Hackett spent several weeks assessing trekkers for AMS. In a classic paper he showed those who climbed faster than 1000 ft/day had the highest rate of AMS (Lancet 1976; ii: 1149-55). The accompanying editorial was alluringly entitled "See Nuptse and Die". We do our experiments and huddle into sleeping bags, cold, breathless and exhausted. The pace has proved savage for animals
:
:
Timothy Harvey
’Teleology
Tihomil Beritić
:
’Mens
in corpore sano is a foolish the product of the sound mind.’ George Bernard
:
:
Walsall, UK
is
von
Brucke
(1819-1892)
"An echo there whatever is ask’d her, answers ’death’!" Overwhelmed emergency services in Croatia have to be prepared for the hazards of chemical disasters caused by bombing and shelling. Many times in the perplexing conditions of this brutal war I have been asked to give basic recommendations necessary to minimise the number of civilian victims. Once in a single night I was called three times to give advice for emergency medical response to a fire of acetone, possible release of chlorine, and formaldehyde and ammonia. I did my best, but alas! What a bitter and humiliating feeling of helplessness I had on learning that both unprotected victims and rescuers have been met by renewed shelling and snipers, in the war "of a kind the viler, as underhand, not openly bearing the sword." I had to pose to myself upsetting and frustrating questions of how well in such circumstances we are meeting the responsibility. Ammonia gas leakage due to a direct hit from a bomb took 47 casualties in a London air-raid shelter (Lancet 1941; 241 : 95-96). Is a similar chemical disaster now imminent during the long days and nights of shivering in the numerous Croatian shelters overcrowded with citizens and refugees?
Shaw
(1856-1950)
A tale of two carrots
can
Emst Wilhelm
sana
saying. The sound body is
a lady without whom no live. Yet he is ashamed to show himself with her in public.’
biologist
Zagreb, Croatia
:
When I was a clerk in the department of medicine at the Hadassah-Hebrew University Hospital, the chairman was Professor J J Groen from The Netherlands who had an international reputation as a researcher into psychosomatic diseases. It would be something of an understatement to say that the hospital’s intellectual climate was not particularly favourable to the biopsychosocial approach the professor advocated. Attendance at the weekly CPC was compulsory, the occasion often being used to settle scores between rival services. One day, a case of hypoadrenalism in an immunocompromised man was presented. He had disseminated candidiasis and suffered terribly from a painful mouth. When the discussion was opened to the floor, our chairman, eschewing the suprarenal histology, held forth in execrable Hebrew on oral hygiene. There was a swelling undercurrent of laughter when he opined that a raw carrot might have combated the ravages of thrush in the deceased. Eight years later, a woman consulted me about her husband. Radiation therapy had damaged his salivary glands and the ingestion of food or drink was virtually unthinkable. A carrot loomed out of memory’s miasmal reaches. The wife was to be pardoned for her scepticism, but went off to implement the suggestion. The next day, she returned to thank me tearfully for her husband’s marked improvement. Colour is an important aid to memory. A physiology lesson mentioning the carrot as a salivary stimulant would be remembered for eight weeks at best. The distance between trivia and what we reverentially call a "clinical pearl" is very small; they are just one anecdote apart!
Joseph Herman
Jerusalem, Israel
’Irrationally held truths may be more harmful than reasoned errors.’ Thomas Huxley (1825-1895)
363
Rhetorical questions, however dramatic, :10 not for a moment call for burying one’s tiead in the sand-on the contrary, the gap between what we knew and what we could do had to be narrowed as soon as possible. We have devised a strategy along the lines of those given for chlorine by Baxter et al (Br J Ind Med 1989; 46: 277-85). However, we are aware that there still remain many unknowns in wartime chemical disasters particularly when fire effluents are mixing with toxic release. Our empathy for people terrified by such great perils will be long remembered after the "hurly-burly’s done, when the battle’s lost and won."
and
Diverticulum Diverticulum (Latin) A byway, bypath, deviation, wayside shelter or lodging. A smaller sidebranch of any cavity or passage; in anatomy applied usually to a blind tubular process, in pathology to a malformation having this quality. .
Oxford English Directory
Om Mani Padme Hum Thyanboche Monastery (12 500 ft) Nepal. The sherpas and Tibetan yak drivers encourage their weary beasts with soft whistles and sweet whispers, repeating over and over again the sacred buddhist incantation "om mani padme hum". We are three days out of Katmandu (4500 ft), just four days from sea level at Dhaka and by the evening we will be at Pheriche (14 000 ft). To the north lies the huge face of Nuptse concealing all but the tip of Everest itself. The rate of ascent is highly dangerous-3000 ft a day-but we are a medical expedition studying acute mountain sickness (AMS) and in true scientific tradition we need to acquire the disease ourselves in order to know it. Pheriche-a grim little hamlet of a dozen or so stone and turf dwellings, ten miles from base camp. Two people died here last week of AMS. A bitter, cold wind howls down the valley from the Khumbu glacier bringing flurries of snow. It was here in 1975, that Dr Peter Hackett spent several weeks assessing trekkers for AMS. In a classic paper he showed those who climbed faster than 1000 ft/day had the highest rate of AMS (Lancet 1976; ii: 1149-55). The accompanying editorial was alluringly entitled "See Nuptse and Die". We do our experiments and huddle into sleeping bags, cold, breathless and exhausted. The pace has proved savage for animals
:
:
Timothy Harvey
’Teleology
Tihomil Beritić
:
’Mens
in corpore sano is a foolish the product of the sound mind.’ George Bernard
:
:
Walsall, UK
is
von
Brucke
(1819-1892)
"An echo there whatever is ask’d her, answers ’death’!" Overwhelmed emergency services in Croatia have to be prepared for the hazards of chemical disasters caused by bombing and shelling. Many times in the perplexing conditions of this brutal war I have been asked to give basic recommendations necessary to minimise the number of civilian victims. Once in a single night I was called three times to give advice for emergency medical response to a fire of acetone, possible release of chlorine, and formaldehyde and ammonia. I did my best, but alas! What a bitter and humiliating feeling of helplessness I had on learning that both unprotected victims and rescuers have been met by renewed shelling and snipers, in the war "of a kind the viler, as underhand, not openly bearing the sword." I had to pose to myself upsetting and frustrating questions of how well in such circumstances we are meeting the responsibility. Ammonia gas leakage due to a direct hit from a bomb took 47 casualties in a London air-raid shelter (Lancet 1941; 241 : 95-96). Is a similar chemical disaster now imminent during the long days and nights of shivering in the numerous Croatian shelters overcrowded with citizens and refugees?
Shaw
(1856-1950)
A tale of two carrots
can
Emst Wilhelm
sana
saying. The sound body is
a lady without whom no live. Yet he is ashamed to show himself with her in public.’
biologist
Zagreb, Croatia
:
When I was a clerk in the department of medicine at the Hadassah-Hebrew University Hospital, the chairman was Professor J J Groen from The Netherlands who had an international reputation as a researcher into psychosomatic diseases. It would be something of an understatement to say that the hospital’s intellectual climate was not particularly favourable to the biopsychosocial approach the professor advocated. Attendance at the weekly CPC was compulsory, the occasion often being used to settle scores between rival services. One day, a case of hypoadrenalism in an immunocompromised man was presented. He had disseminated candidiasis and suffered terribly from a painful mouth. When the discussion was opened to the floor, our chairman, eschewing the suprarenal histology, held forth in execrable Hebrew on oral hygiene. There was a swelling undercurrent of laughter when he opined that a raw carrot might have combated the ravages of thrush in the deceased. Eight years later, a woman consulted me about her husband. Radiation therapy had damaged his salivary glands and the ingestion of food or drink was virtually unthinkable. A carrot loomed out of memory’s miasmal reaches. The wife was to be pardoned for her scepticism, but went off to implement the suggestion. The next day, she returned to thank me tearfully for her husband’s marked improvement. Colour is an important aid to memory. A physiology lesson mentioning the carrot as a salivary stimulant would be remembered for eight weeks at best. The distance between trivia and what we reverentially call a "clinical pearl" is very small; they are just one anecdote apart!
Joseph Herman
Jerusalem, Israel
’Irrationally held truths may be more harmful than reasoned errors.’ Thomas Huxley (1825-1895)
363