Odysseys of George

This is an image taken of an elderly lady with complains of difficulty in swallowing(dysphagia). She has been having these symptoms for a few months now but noted by the family members that it has got worse over the last month associated with vomiting and loss of weight. This was the only finding on doing an upper scope(OGDS), a procedure where a camera is inserted into the feeding tube through mouth to visualize the oesophagus, stomach and duodenum internally.

Care to guess?

Come catch the weeks summary of the medical blogosphere

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From: What an exciting week!

What is it?

Melanosis coli is a condition in which dark pigment characteristic dark brown to black discoloration is deposited in one of the lining layers (lamina propria) of the large intestine (colon). This condition is sometimes called pseudomelanosis coli because the pigment deposits consist of a pigment known as lipofuscin and do not contain melanin as implied by the term “melanosis.” Lipofuscin is a cellular pigment that forms when cells are destroyed, often called “wear and tear” pigment that can be found throughout the body.

The discolouration may be uniform or patterned. The pigment in melanosis coli does not accumulate in polyps or tumors of the large intestine.(refer pic below)

Cause?

Chronic use of laxatives of the anthranoid group like senna and rhubarb derivatives, many of which have been in use for hundreds of years. In 1997, the U.S. Food and Drug Administration (FDA) banned the use of these popular anthranoid laxative due to fears that it might be carcinogenic (cancer-causing).

The anthranoid laxatives pass through the gastrointestinal tract unabsorbed until they reach the large intestine, where they are changed into their active forms, which causes damage to the cells in the lining of the intestine and leads to cell death. The damaged cells appear as darkly pigmented bodies that may be taken up by scavenger cells known as macrophages. When enough cells have been damaged, the characteristic pigmentation of the bowel wall develops.

Symptoms?

None

Diagnosis?

By colonoscopy

Outcome?

1.Reversible and may disappear upon cessation of laxatives

2.Presence of melanosis coli might signal an increased risk for the development of colorectal cancer. This association is however weak as it is not proven in human but only in animal studies.

Anaemia is a condition where the amount of red blood cells in the body is low. Red blood cells contain haemoglobin, a red pigment which gives blood its colour. The job of haemoglobin is to carry oxygen around the body. When red blood cells and therefore haemoglobin are low the blood fails to supply the body’s tissues with sufficient amounts of oxygen. As your lungs and heart will then have to work harder to get oxygen into the blood, symptoms of anaemia, such as difficulty in breathing will begin to develop.

So how does anaemia develop:

* Heavy periods.
* Diet low in iron.
* Internal bleeding, for example if you have an ulcer or a tumour.
* Diet low in vitamin B12 or folic acid.
* Blood diseases such as leukaemia.

This is a 72 year old lady who presented with anaemia. Her CT scan is as below.

Care to guess the diagnosis??

A friend send me this:

In the 21st. century,

Our communication - Wireless

Our dress - Topless

Our telephone - Cordless

Our cooking - Fireless

Our youth - Jobless

Our food - Fatless

Our labour - Effortless

Our conduct - Worthless

Our relation - Loveless

Our attitude - Careless

Our feelings - Heartless

Our politics - Shameless

Our education - Valueless

Our follies - Countless

Our arguments - Baseless

Our boss - Brainless

Our Job - Thankless

Our Salary - Very less.!!!

Two private varsities watched for producing poor quality docs

PUTRAJAYA (Jan 18, 2007): Two private universities are being watched by the Health Ministry over complaints that they produced poor quality doctors.

Health Minister Datuk Seri Dr Chua Soi Lek said the complaints were not only on this aspect but also on the fact that they were training too many medical students and not sticking to the fixed teacher-to-student ratio.

He said the fixed ratio is 1:6 or 1:8 but the universities concerned used a 1:20 ratio.

“There are complaints of doctors produced by these universities were not as good as they should be.

“Universiti Malaya (UM) which set up its medical faculty a long time ago, only produces 200 medical officers a year but these two universities produce 300 although they were set up about 10 years ago,” he told reporters after attending a dialogue with students from UM, Universiti Kebangsaan Malaysia (UKM) and Universiti Putra Malaysia (UPM) here today.

Bernama quoated Chua as saying that seven private universities were offering medical courses and the government was collecting particulars on them.

If the universities were found to have contravened regulations, action could be taken against them, including warning them or their duration of courses would not be extended, he said.

First we had only 3 universities that offered medical education. At that time, the quality of medical education was excellent and impressive. This was going on for years. Then over the last decade, we saw many medical universities coming up. They grew so rapidly and blatantly, that medical education in the 3 main universities were affected. Senior clinicians left to the new institutions in view of promotion. So rampant it was, that professors and associate professors were given to those without caliber. There was no control as many reaped profits from medical education. Everything became worse when political parties decided to have one each by their own — just to widen racial differances. As more medical universities sprout, the countries leading university were going through brain drain so severe that some department that were once a pride of the nation were now a laughing stock. As medical universities sprout, more and more younger fresh graduates became lectures without the much needed experience. Medical students have now lost great teachers thus losing idols that moulded many older doctors to achieve what is expectedly excellent quality. With the loss of idols or role models, the quest for quality dropped as now their role models were fresh graduates from masters or membership examinations joining these institution to attain a better pay, name and better future prospect in private. Nobody cared for the developement of quality medical students - very few did! Many realised the importance of this institutions as a stepping stone to the private sector.
So is this all a surprise? Well I am surprised that it took them this long to realise that there is no quality control in Malaysia in anything. Everything is set for auto-run mode. For such a small country like Malaysia, we have too many medical universities. Quantity is of importance for the government because quantity is money not quality! Why? Because the public is such a tolerant one that we Malaysians will accept anything thrown to us whether it is of quality or otherwise! The general public is happy that many are passing exams and many get the chance to go to university especially many are able to do medicine. Well the truth is, the passing mark and standards have been brought so low that one will still pass his physics or biology by getting 20/100. The general student now who enters university are becoming ill-prepared for university-like structure and are far below par. Many senior lecturers in these universiy will agree with this. To make things worse the education ministry and universities then revise their syllabus to make it easier and lighter to allow many more to pass. Noticed the use of many rather than better.
The government has plenty to do. As many of my previous post, the public must start to rise and work together to voice their need for not just mediocre service but excellent service and the government must better up with a fairer system then the present nonsense system (SSM).