Describe Turcot Syndrome.

• Multiple colonic polyps
• Predisposition for colon cancern
• Type I patients have a predisposition for glioblastoma multiforme as well
• Type II patients have a predisposition for medullablastoma

See here, here and here

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What tracts of the spinal cord do somatosensory evoked potentials (SSEPs) monitor?

SSEPs monitor the dorsal columns

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What’s the diagnosis?

Pleomorphic xanthoastrocytoma

A supratentorial glial tumor of childhood. Typically graded as WHO II. Imaging demonstrates a superficial, supratentorial mass with large cystic components, often with a mural nodule.

Pathology shows the tumor to be composed of spindle cells and large cells with pleomorphic nuclei with “bubbly” cyloplasm from which the term xanthomatous comes from

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Want to take the fun out of alochol? A paper in the Journal of Neuroscience reports the effects of dihydromyricetin on ethanol’s ability to get you drunk. The New Scientist write up describes the study,

[Dr. Jiang Ling, primary investigator,] injected rats’ abdomens with a dose of alcohol proportionate to the amount a human would get from downing 15 to 20 beers in 2 hours by a human, they took about 70 minutes, on average, to right themselves. However, when an injection of the same amount of booze included a milligram of DHM per kilogram of rat body weight, the animals recovered their composure within just 5 minutes.

DHM also stopped rats in a maze from behaving in ways resembling anxiety and hangovers. Rats given heavy doses of alcohol cowered away in corners of the maze, whereas those given the extract with their alcohol behaved normally and were as inquisitive as rats given no alcohol at all, exploring the more open corridors of the maze.

Finally, DHM appeared to discourage rats from boozing when they had a free choice between drinking a sweetened solution of alcohol or sweetened water. Over a period of three months, rats will normally get addicted to increasing volumes of the hard stuff. Rats given DHM, though, drank no more than about a quarter of the amount that the “boozers” eventually built up to. Moreover, boozy rats that had worked up to the higher levels suddenly dropped down to a moderate intake when given DHM after seven weeks.

I don’t like the idea of an anti-intoxication pill. Drinking is what it is because of the way it makes you feel. And the ill effects of drinking are what they are to prevent your overconsumption. Taking a pill prophylactically to allow yourself to drink as much as you want without feeling the effects of the alcohol defeats the purpose. As does taking a pill, after the fact, to, with certainty, relieve your hangover and the consequences of drinking too much.

There’s some evidence in the study that dihydromyricetin may help prevent true, physiologic withdrawal symptoms such as tremors, anxiety, delirium and may even work to raise the seizure threshold. Such would be a legitimate use. Otherwise I think I may have a philosophical problem with the development of an anti-booze drug.

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Name the branches coming off of the C2/petrous portion of the internal carotid artery.

Veredean
Caroticotympanic

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A survey of more than 300 U.S. neurosurgical residents found that more than 70% felt current ACGME duty hour restrictions were negatively impacting their residency training.

This national duty hour survey of neurosurgical residents reveals considerable concern over the new ACGME proposed standards. The majority of respondents believe that the new standards will have a negative effect on their residency training. Furthermore, this survey indicates an overwhelming negative attitude toward mandated duty hour regulations among neurosurgical residents.

In some surgical specialties, the rigor of training and the hours dedicated to it are a badge of honor. Especially when faced with those, your very mentors and faculty, who have gone before you who have had to endure a training regiment without duty hour protections.

I adamantly oppose the duty hours. I’m all for a reevaluation of common program training guidelines more tailored to surgical specialties, including duty hour guidelines, more focused on surgical specialties; as in breaking off the surgical specialties and forming an Accreditation Council on Graduate Surgical Education. And I’m not surprised a specialty like neurosurgery, a small community, that has, over its history, taken pride in the difficulty and rigor of its training would have residents who feel similiarly and strongly oppose the duty hour restrictions. I imagine aversion to the duty hour restrictions runs as strong in amongst neurosurgery residents as it does amongst residents training in any specialty.

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What is the advantage of PEEP im acute respiratory distress syndrome?

A. Allow for reduction in FiO2
B. Prevents atelectasis
C. Decrease pulmonary edena
D. Both A & B
E. All of the above

A. Allow for reduction in FiO2

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I still love The Onion

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The Snooki tax, a 10% tax on indoor tanning services, that appeared as part of the ACA and its sister bills may or may not be “working,” to reduce the use of indoor tanning services as some of the authors intended.

The impact of the tax on consumer behavior remains unclear. Only 26% of salons surveyed reported experiencing fewer clients after implementation of the tax, and distinguishing the impact of the tax from the current economic climate as the source of decline was difficult. Furthermore, a large number of respondents (78%) reported that clients did not seem to care about the tax.

Study participants frequently reported that the salon’s younger and first-time clients were less likely than its older clients to notice or care about the increased prices resulting from the tax. Taken as a whole, these results may indicate that the demand for indoor tanning services is somewhat inelastic and perhaps insensitive to a 10% tax level.

I’m not a proponent of targeted taxes in general; certainly not those targeted to influence behavior. I don’t support the cigarette tax and I don’t support any hypothetical soda taxes and I don’t support the indoor tanning levy. And I wouldn’t be surprised at all if, at 10%, the influence of the tax was nothing or so small as to be impossible to detect.

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What syndromes involve multiple eosinophilic granulomas?

• Dendritic cell disease
• Hand-Schuller-Christian disease
• Letterer-Siwe disease

See langerhans cell histiocytosis

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