Developing an effective management plan requires physicians and patients to reach agreement in three key areas: the nature of the problems, the goals and priorities of treatment, and the roles of the doctor and patient. Often doctors and patients have widely divergent views in each of these areas. The process of finding a satisfactory resolution is not so much one of bargaining or negotiating b...

Its great virtue is that it describes sexual development in a social setting?in terms of growing-up and of friendships and loveaffairs between boys and girls?not just as a list of facts; and there is much that is very helpful and informative to English girls, whether they are in jobs or still at school. The author is very just about the special difficulties and disadvantages of being a girl, an...

Lemuel Whitley Diggs’s work reminds us how much of what we do is anchored in the work of our predecessors. Diggs had many heroes in his early education, among them Sir William Osler, physician-in-chief (1888–1905) at the newly formed Johns Hopkins Hospital and one of the founders of the Medical Library Association (MLA). Although the two never met, Diggs trained at the Johns Hopkins University ...

ion should not surprise us: to the contrary, as Castagno points out, portraiture as well as religious and allegorical painting during the period reflected the “hegemony of typification over individuation” (Early Commedia dell’Arte, 165); and Katritzky reminds us that “a sixteenth-century artist is rarely or never concerned with presenting an accurate ‘snapshot’ of a particular performance” (“Re...

Congenital arteriovenous communications involving the external carotid artery and jugular veins are rare. We report a 4-year-old girl with a history of an abnormal audible sound in the right ear during sleep. Physical examination revealed a carotid bruit, thrill and a pulsatile mass in the right neck. A simple congenital right external carotid-jugular arteriovenous fistula was confirmed and suc...

Acute myocardial ischemia is a rare and possibly life-threatening manifestation of hyperthyroidism. We describe a 48-year-old woman with severe coronary vasospasm associated with hyperthyroidism. The patient presented with chest pain and increasing shortness of breath for several days. Acute non-ST elevation myocardial infarction was diagnosed. Coronary angiography revealed diffuse vasoconstric...

Richter’s hernias are not uncommon, however there have been very few articles which describe this type of hernia the transverse colon. This case report is regarding a 76-year-old gentleman who presented with periumbilical pain and obstipation was found to anti-mesenteric He underwent an open extended right hemicolectomy resect strangulated contents made good recovery subsequently. Upon review l...

The papers by Turrell and Harding remind us that we need to see any action to tackle health inequalities in the wider social context of income distribution, employment, community infrastructure and global forces. As big as the health system is, it still plays only a small part in the overall solutions. Turrell emphasises the need for action on upstream, midstream and downstream influences on he...

The following narrative was written by Nancy MacRae, an occupational therapy professor at the University of New England. Her experience from the other side of the health care relationship reminds us all how very different the client/patient view is and what an invaluable learning opportunity this perspective can afford. We can all be humbled by the real life client role, yet the learning and di...

Although small cell cancer of the lung may have protean manifestations, tumor embolization and inability to identify the primary sites are unusual features. We present a patient with anti-Hu antibody-associated paraneoplastic sensory polyneuropathy and tumor embolism diagnosed by endovascular biopsy to be due to small cell cancer, the primary site of which was not evident. To our knowledge, thi...