Another 2 bloggers are added to the Science-Based Medicine blog - After adding Dr. Val Jones (whose other new blog is Getting Better With Dr. Val) to the blog last week, SBM is adding Dr. Peter Lipson aka PalMD of the Denialism blog and David J. Kroll, Ph.D., who's "a natural products cancer researcher who studies plant-derived compounds as potential treatments for cancer." I already regularly read the Denialism blog, so I'm a fan of PalMD already but I also look forward to reading Val Jones' and David J. Kroll's perspectives.

Identifying fake diseases

The case against homeopathy

The natives of Poyue, China claim that just being there adds years to your life - Poyue and villages in the surrounding region comprise a so-called "longevity cluster." They allege to have people who are 113 years old living in the region. Although I haven't researched this issue, the article suggests that the scientific consensus is skeptical. And this would hardly be the first time a people have claimed to possess some form of the timeless elixir of life. (Thanks Brian)

Christopher Hitchens is voting Obama! Yea! - When it comes to the religious criticism you'll find few, if any, better at smacking down religionists than Christopher Hitchens. He has proven time and time again to have earned his placement among that exclusive club many have dubbed The Four Horsemen of Atheism (The other 3 horsemen being Richard Dawkins, Sam Harris, and Daniel Dennett). But when it comes to politics, I frequently disagree with Hitchens, who's a Republican, albeit more of a Goldwater Republican. Now Hitchens has written an article that says McCain lacks the character and temperament to be president and calls Palin a disgrace.

Baseball players relying on magic amulets? - A bunch of baseball players are apparently wearing Phiten necklaces, said to promote pain relief and enhance performance through improved circulation and stress reduction. Of course there is no medical proof the Phiten necklaces actually work, though. The FDA does not approve the therapeutic claims made by the company and many doctors have said there is no indication that titanium affects performance.

This is very similar to the obscenely-priced sham product known as a Q-Link that James Randi has written a great deal about . This latest product seems like just another variation on the same pseudo-scientific theme. (Thanks Brian)

PZ Myers briefly reviews, Why Evolution is True by Jerry Coyne

A review of Godless by Dan Barker - Barker is a former evangelical preacher of the same crazy denomination that Sarah Palin belongs to. And now he's the head of the Freedom From Religion Foundation.

And on a related note, how to de-convert the religious - Greta Christina asked her readers what finally convinced them to stop believing. Some of the answers are surprising.

You've heard of phantom limb syndrome? How about phantom erections? - Just because you've had sexual reassignment surgery and had your penis removed doesn't mean mean you can't have a hard-on.

Premature evacuation? Blame the genes

900-Pound Squid Joins Cast Of The View -

"We feel that the squid brings a fresh new point of view to the program," said View executive producer and host Barbara Walters. "We looked at hundreds of potential candidates, but in the end, this rare and exotic creature from the darkest depths of the sea truly stood out."

"And as far as we can tell, it is a female," Walters added.

The 900-pound cephalopod from the family Architeuthidae joins cohosts Whoopi Goldberg, Joy Behar, Elisabeth Hasselbeck, and Sherri Shepherd.

Sherri Shepherd still remains the only co-host who's uncertain of whether or not the Earth is round.

AND NOW FOR A MOMENT OF SCIENCE:

Unique Fossils Capture ‘Cambrian Migration' - "A unique set of fossils indicates that 525 million years ago marine animals congregated in Earth’s ancient oceans, most likely for migration, according to an international team of scientists."

Baldness Gene Discovered: 1 In 7 Men At Risk - "Researchers at McGill University, King's College London and GlaxoSmithKline Inc. have identified two genetic variants in Caucasians that together produce an astounding sevenfold increase the risk of male pattern baldness."

Through this site we have tried to give you proper information regarding fitness. So that you can easily achieve your target by implementing these information.

Balanced diet, nutritive products and exercise are the best fitness products. We should always use natural products instead of synthetic ones like anabolic steroids. There is not only food products like Organic packaged foods/Wheat and Gluten free products,Vitamins and supplements, Herbal teas and beverages but also so many topical applicants like Aromatherapy oils, Massage oils and Natural Beauty products are also available which will help you to keep healthy. There are also latest exercise equipments which are very much efficient for your physical activity.

Along these products, there are so many synthetic products in the market which are sold as fitness products. These products must be strictly used only after consult with a doctor otherwise their side effects can cause life threatening conditions for you. These products show their effects very rapidly, but their continuous use or withdrawals create a trouble for consumer. Many of them are habit forming drugs and have narrow therapeutic index. Hence, causes addiction and ultimately harm to the body.

While using these products either natural or synthetic, we should also consider our age, gender, physical state and stamina. Since these things and also our requirements vary from individual to individual. So we have to consider them always.

I recently visited a Cabela's that just opened in our town. For the uninitiated, Cabela's is easily the most expansive and comprehensive hunting, fishing, outdoor-gear store on Planet Earth.  They're basically a small city with a roof.  Along with every gear component you can imagine, they have an eye-popping display of stuffed animals in the center of their store.

By "stuffed" I mean taxidermied.  So we're talking, real, wild, once-alive animals now stuffed and posed to look alive.  I have stuffed animals all over my house, but none of them ever had teeth or laid claim to primordial carbon.

Personally, I'm not much attracted to killing animals of the natural world, and stuffing them and putting them on a wall isn't very interesting to me, either.  In general, this city boy thinks of taxidermy as nothing more than bald carnivorism on guiltless parade.  Who ever thought the severed head of a deer, garrishly hung from a wall, would serve as decoration?  Isn't some version of humility or mourning in order for this kind of thing?  If I were a taxidermist, I would recreate the entire scene, complete with twisted, exposed entrails, horrid death-grimace, contorted body and spattered blood in wide, fan-shaped arrays.  And every display would always include the GUN that did the dirty work.

Anyway, these guys have HUGE bears stuffed and in fierce poses with claws bared.  This includes a real polar bear, over 8 feet tall.  Somebody killed a freaking polar bear! I thought we just studied those things.  Staring up at that ginormous carcass, I wondered first where the hapless thing had been shot (heart?  head? gi tract, perhaps?), then ruminated on the ethics of such an action, then wondered how the freaking hell they carried an object that huge out of the woods and into my Cabela's.

Today I saw a patient with back strain who encountered a similar problem.

"Hurt my back."

"Oh?"  I replied, trying very hard to be interested in yet another low-back pain problem.

"Pulling a bear out of Porter Crick."

I looked up, interested without trying now.  "Like, a bear? You mean with claws and fur and omnivorous urgings and the hibernation thing?  That kind of bear?"

"Yep.  Reared up while we were deer-hunting.  Stood about 6 feet.  Took him down with one clean shot."

"Holy crap!"  Oops.  Professional, professional.  Be PROFESSIONAL, stuipd!  "Jeez, how'd you get him out of there?  And, on a non-medical note...were you a little worried about getting your face swiped off?"

"Yeagh.  Poor bastard was coming right for me.  About 50 feet off.  He had a bee up his arse for some reason."

"So, once he was down, what did you do."

"Me and Jake field dressed 'im,"  I nodded approvingly at this...I can only imagine what the heck it really is...maybe try wikipedia later.  "Then we dug some motorcycle straps outta our packs and pulled the critter by his paws."

"You pulled him by straps from his paws," I repeated, acting normal but thinking of No Country For Old Men. "How far?"

"'Bout 8 miles.  Through brush and trees.  Plus our guns and packs and all.  Bear was about 400 lbs."

"Good GOD, man."

"Yep.  Well, whadda ya gonna do for my back, doc?"

"Pretty much nothing, dude!  Anybody carrying a 400 lb. bear out of the backcountry is going to have back pain.  And I doubt you'll listen to me telling you to rest it, right?"

"Wahl I was only comin' in today because we leave for some elk hunting in Idaho in 2 days and I wondered if you could give me something to help with the pain before I go."

"If you want to stand across the room, I'll shoot you with one of those tranquilizers they shoot into elephants on the nature channel.  That might make you woozy, though.  It might affect your ability to shoot safely."

"Nevermind, then.  I'll be fine.  Just checkin' in, doc."

Well if anyone noticed you were one class member less all of last week.  I was reluctantly forced to be subdued to a week in a vicodin-induced semi-comatose state.  No I was not spending the week in some prescription drug relapse but merely recuperating from an emergency appendectomy early Saturday morning.  Here's some early background to the situation at hand.  First off, my week had been just fantastic as I had struggled against a head cold all week that led to me losing my voice on Thursday (which was quite enjoyable to those you were in my discussion group).  So the weekend finally arrived and I was feeling somewhat normal, which was a good thing as my parents had just come to town for Family weekend.  And as if by some humbling act, my stomach had also begun to bother me throughout the week as I noticed that I was getting full much faster, which turns out to be a precursor to the swelling of my appendix.  So to make a long, long story short: After pain and multiple failed attempts at sleep, I called my parents to come pick me up at my dorm at 2 in the morning to go to the emergency room.  At 4 in the morning I had a C/T scan on my whole body to determine the cause.  And finally at 6 the surgery was performed and I was back in recovery at 8 on Saturday.  Sadly, I had to stay over night for observational purposes and finally came home at 5:30 on Sunday evening.  And that began my week as quasi-vegetable where I attempted multiple times to accomplish school work but was unable as the work I was completing was incoherent.

Sunday, I decided to use the BBQ.  I had been marinading the steak for a couple days and was ready to fire up the grill.  I open the grill and saw a field mouse lounging on the coals.  I closed the lid and ran into the house.  After a few minutes I went back outside and opened the grill.  It looked like the mouse was gone.  I fired up the grill and the next thing I noticed, a mouse was still in the grill.  He was trying to jump out of the top of the grill but he could not fit.  Well, it seemed like I waited an eternity but I finally ventured outside with my wife to see if the mouse was dead.  As we approach the grill we saw the  mouse drop out of the bottom of the BBQ and run out of the yard.

After the excitement, my wife and I decided not to BBQ the steak.  We ended up picking up pizza from a hole in the wall pizza place down the street.  My kids barely ate any of the pizza.

The intentions of this blog is to provide high res scans of electrocardiograms. I am an ER nurse who finds electrocardiology and ECG interpretation interesting. I am no expert, nor is my purpose to educate the masses. Feel free to discuss the ECGs using the commentary fields. Click the images to see the high res scans.

Technical information, lead placement and artifacts

All ECGs are recorded at 50mm/s unless stated otherwise. All machines were correctly calibrated at the time of recording. Most ECGs here are recorded with the patient in the supine position.

As I have not recorded all of these ECGs myself, please be advised that some of these ECGs can suffer from misplaced leads. Vertical displacement of the precordial leads is known to alter the electrocardiographic morphology. This most often results in R-wave changes.

All of these ECGs are recorded using a 50Hz noise filter, but some of them still contain noise artifacts. In most cases this is due to patient tremor/movement or reduced contact between patient skin and electrodes due to different circumstances.

Interpretation, clinical data and anamnesis

Most ECGs will be provided without much clinical data or anamnesis from the patient. When available, gender, age and vital parameters together with a short anamnesis will be provided along with the ECG recording.

I will add my own analysises and interpretations of the ECGs. I am still an ECG learner (and will hopefully always be), so please feel free to add comments and/or corrections.

So why is the hospitalization of thousands of children and deaths of hundreds of them from the side effects of drugs not worthy of the same attention and response? Why is the permanent disability of even one child from medications not worthy of ongoing media attention. Again, if a child entered into a coma from eating Cheerios, the media would follow his day to day progress for quite a while until some final resolution was reached.

Okay, so Cheerios is generally considered to be a safe choice, and drugs have inherent risks. Are these risks worth any child's life. How about your life? Don't we use medications believing that they are basically safe and benefit us? You probably wouldn't feel to good knowing that no doctor knows how drugs do what they do, or that no one does. That also means that no one can predict what they will do to you, good or bad, or what the long-term results of using them will be. The Physician's Desk Reference lists most drugs that are available, and is a resource for doctors to use. There is however, no information on how the drugs work inside the body, because no one knows and it states this for almost all drugs listed in there.

Drugs are prescribed based on risk-reward. I have never understood how the risk of death or permanent disability was worth any reward, yet most drugs carry this risk. Drug companies should be required to provide more assurances and research that proves the safety of the drugs they sell. As it is, the drug companies have now switched to spending more money on advertising and marketing than they do on research.

So where does this leave us and our children? I believe that it places us exactly where we need to be, in a position of assuming personal responsibility for how we take care of our health and the health of our children. The drug companies are going to continue to do what they need to do to make profits, so we need to do what is in our best interests. We need to make the hard choices between commitment and popularity. We need to choose what is best for our bodies, and those of our children, if any of us is going to have a chance of living in a drug-free world, even if it is just our own little corner of the world.

To lead a healthy life, is to lead a life out of the ordinary. It is an extra-ordinary life!

Dr. Jeffrey S. McCombs, DC, is a 3^rd generation Doctor of Chiropractic, author of the book: LifeForce, and developer of the Life Force Plan. His 25 years of ongoing research and practice emphasizes addressing the nutritional, environmental, emotional, structural, and biochemical aspects of acute and chronic health conditions in his patients. An innovative forerunner in the continuously evolving fields of advanced healing arts, Dr. McCombs has worked with Olympic and Professional athletes, dancers, CEO's, and people from all walks of life. He currently consults with people from around the world.

He can be contacted at www.mccombsplan.com, 888.236.7780.

"Doctor" the word has weight in it but now the word is on dieting. Doctors were believed to be next to the God. But now-a-days doctor are losing their respect. Since past few years doctors are found involved in many sorts of illegal works. They have gained titles like organ smugglers, man-slaughters and sex-doctors etc. People are losing faith in them. A number of such cases have aroused which are disgusting. Another reason is that its easy to get a fake degree these days. People are in doubt. Nobody prefers a newcomer in this profession. And the survey shows old and experienced doctors are involved in crimes.

Doctors are also found guilty in organ smuggling. Earlier this year the Indian Kidney Racket had smashed the doctor's reputation more. Kidney transplant needs are now met easily as these doctors have made their own organ banks. Un-lawfull selling of organs like kidney, liver etc is becoming a business these days.

Doctors are also gaining publicity as sex doctors. Making sex tapes of patients and putting them on Internet is a easy and fast way to make money. Sexual harassment by doctors is also making to news.

As a result of such incidences by few doctors, whole of the community is suffering. Doctor is a noble profession and a hand full of people are making it sin-full.

And much more doctors are in news just stay updated and avoid such doctors. Report to nearest police station if you observe any un-lawfull activity being carried out by a professional.

The American Academy of Pediatrics has doubled its recommendation for a daily dose of vitamin D in children in the hopes of preventing rickets and reaping other health benefits, the group said on Monday.

"We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits," said Dr. Frank Greer, of the American Academy of Pediatrics, which released the new guideline recommendations at a meeting in Boston.

"Supplementation is important because most children will not get enough vitamin D through diet alone," Greer said in a statement.

The new guidelines from the nation's leading group of pediatricians now call for children to receive 400 international units of vitamin D per day, beginning in the first few days of life.

Children who do not get enough vitamin D are at risk for rickets, a bone-softening disease that result in stunted growth and skeletal deformities if not corrected while the child is young. Babies who are exclusively breast-fed are at particular risk.

... Vitamin D can prevent and treat rickets, but dietary sources of vitamin D are fairly limited. Vitamin D-fortified milk is the most common source, but fortified cereals and oily fish such as tuna, mackerel and sardines also contain vitamin D.

via Reuters: Pediatricians double vitamin D

    1. It came out this year that Parkland Hospital in Dallas has a special list. If you are rich, famous, or a politican, you are on this list. The staff of the hospital was told to treat these people as royalty and give them substantial care, far outceeding what the average person could expect.  Now forward to the month of September 2008. A man who is part owner of Herrero's restaurant went to Parkland for a severe stomach ache he had. He waited for over 18 hours before he was to be seen, but it was too late. He collapsed and died going from the waiting room to the emergency room. This man who paid taxes for this hospital to stay open, definitely didn't receive his money's worth. But if he had been a non-tax paying star from another state who happened to need their services, he would have got in pronto. The jerk who manages the hospital defended the tragedy saying that considering the circumstances there is no other way that this could have been prevented. He said nothing of the special list. He also said that the hospital was adequately staffed, but that because too many people used it for primary care, thus causing the long wait to get help. But may I remind you, he said nothing of the special list for special people. The best advice I can give you, if you have to go to their facilities and you are not special to them, is to stand up in the waiting room and start screaming at the top of your lungs, I think I'm going to die. Do this with the alternate scream of "Oh my God, it hurts so bad". You may say this is extreme, but if you really feel like you are going to die, then what does it matter. Another quite possible advantage can probably be ascertained by giving the attendate/gate keeper your purse or wallet, and telling them everything inside of it is yours, if you can get me in right away. Once you get back to the emergency room start playing up your insurance. Say things like, I'm so glad nurse that my deductible is already paid, and I have really great insurance. If you don't have insurance, tell everyone the medical staff that you are so glad you won the lottery this week, because now you can afford what ever services they may provide. The above advice is good for every hospital that you may have to go to in Texas. To sum this up, if you have a dire circumstance that is causing you great pain, learn to play the game. Your life is at risk. The hospital might have to cut out expensive retreats for some of their staff if everyone starts doing this, but I have no bad conscious about it and you shouldn't either - dear taxpayer. The hospital is there because of taxes you have paid all your life, make the slime balls earn their money.

   Stay tuned for more episodes of healthcare gone wild in Texas.

Viruses in general need a host cell.  They infect the host cell, and use the cell to nourish itself and replicate.  The influenza virus is responsible for the most devastating plague in human history and killed millions of people worldwide.  It wasn't until 1933 that an actual disease agent was isolated.  There are three types of influenza viruses, types A, B, and C.  Type A is responsible for the 1918 outbreak, and also regularly affects domestic animals.  Influenza invades the respiratory system, where certain molecules bind to parts of the host cell, which are then swarmed by receptor mediated endocytosis.  What follows are a series of chemical reactions that result in replication of the virus, infection of new cells, and the potential for viral pneumonia to ensue. 

The weakened state of the host, leaves it susceptible to secondary infection.  In extreme cases of mortality, comorbidities are often present while interestingly the flu virus is rarely isolated.  This leads to a bit of obfuscation with flu statistics... intentional, or not?  Well, I'd have to say intentional.  So will you after you get to page 24 of this document (that used to be 51 pages long but the remainder is not available online anymore).  In the slides that followed 26, there were carefully outlined measures that could be taken to instill fear into the public to generate demand for the vaccine.  Since they removed the "recipe", I'll be forced to post the steps from the missing slides from a different source.

Step 1: Start discussing the flu at the beginning of the “immunization season.”

[Posters, fliers and media campaign materials are generally mailed to the public health departments and healthcare provider offices in mid-August, “planting the seeds” to request the flu vaccine when it arrives. ] Tenpenny's comment

.

Step 2: The media will begin to make pronouncements that the “new” influenza strains anticipated this year “will be associated with severe illness and serious outcomes.”

[Right on cue, the government announced on August 25, that it is “preparing for world's next big flu outbreak. ” A report released to the Associated Press suggests that a bad flu season could kill up to 207,000 Americans. To fuel the hysteria, the CDC and the Department of Human Services announced that they are jointly issuing a “The Pandemic Influenza Response and Preparedness Plan” which will stress “ways to speed up vaccine production, limit the spread of a super-flu, and care for the ill.”[2] ] Tennpenny's comment

.

Step 3: The build up will continue throughout the early fall, as local and national “medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination.”[3]

[Here’s one example:
"We know we're going to have a pandemic because, historically, we're overdue for one," said Neil Pascoe, epidemiologist in the infectious disease division of the Texas Department of Health. "When it happens, it's going to be huge. It will be global, and everyone is going to be affected…it could be terribly fatal. Imagine 4 million Texans are infected, and 20 percent of them die."[4] Be prepared for many similar statements in major newspapers and on national TV stations as the weeks progress. ] Tennpenny's comment

.

Step 4: Reports from medical expert will be used to “frame the flu season in terms intending to motivate behavior.” Language to be used includes, “very severe,” “more severe than last or past years,” “deadly”).”[5]

[Last year, there were 1026 messages sent through the media between September 21-28. Phrases used included, “this could be the worst flu season ever,” “the flu kills 36,000 people per year” and “the flu shot is the best way to prevent the flu.”[6] Anticipate even a greater number of messages pushed through a wider network of media outlets this year. ] Tennpenny's comment

.

Step 5: Continue to release reports from health officials through the media that influenza is causing severe illness and/or affecting lots of people–“helping to foster the perception that many people are susceptible to a bad case of influenza.” (emphasis added.)

Step 6: Give visible and tangible examples of the seriousness of influenza by showing pictures of ill children and affected families who are willing to come forward with their stories. Show pictures of people being vaccinated, “the first to motivate, the latter to reinforce.” (emphasis added.)

Step 7: List references to, and have discussions regarding, the influenza pandemic. “Make continued reference to the importance of vaccination.”

The language reported here for Steps 5, 6, and 7 is taken directly from Nowak’s presentation.[7] This should leave little doubt that the government intends to use the media to create hysteria that will increase the demand for a pharmaceutical product.

.

via inyourpocket.com

i visited this lovely, eccentric museum whilst in krakow and fell in love with it.

find the museum website here

and more of my (blurred/unfocused - no flash allowed!) pictures here

The conservatives pat each other on the backs every time something as biased and cruel as this gets on the books. They feel clever and accomplished for having found a way to make women who are already in a  difficult and emotionally trying situation suffer even more. Kudos, guys, we may not be able to make it illegal for them to have abortions, but let's make those whores and sluts really feel it!

That's exactly the kind of thinking behind laws such as the one in Oklahoma that not only requires women to have an ultrasound before an abortion can be performed, but also requires the ultrasound screen to be turned toward the woman, so that she is basically forced to watch it.

Oklahoma's law also contains no exceptions for the victims of rape or incest, making it just one more of the revolting "victimize the victims" pieces of legislation that we can be sure to see more of if John McCain and Sarah Palin take up residence in the White House.

The good news is that the Center for Reproductive Rights is fighting this law in Oklahoma, and has filed a lawsuit.

The other good news is that in less than a month, you get to vote on whether you want the kind of leadership that really, really doesn't give a shit about women's rights, victim's rights, or really, any civil rights, or whether you might like to try to find out what the Democrats are capable of this time around.

So, vote against this kind of bullshit, because I assure you, it's spreading. If you see laws like this proposed in your state, vote against it, en masse. If you  give half a damn about human rights or civil rights, vote for Barack Obama, and then hound his administration and MAKE SURE that they keep their promises. At least with them we've got half a chance.

2.  Salary increase (as most of us are in debt once we start working as an attending).

3.  More equal respect and responsibility at all levels of training (med student, resident, etc.)

4.  Flexible job opportunities (right to choose inpatient, outpatient, or both)

5.  More guidance in colleges as to what medcine is really like.

The remarkable brightly glowing green fluorescent protein, GFP, was first observed in the beautiful jellyfish, Aequorea victoria in 1962. Since then, this protein has become one of the most important tools used in contemporary bioscience. With the aid of GFP, researchers have developed ways to watch processes that were previously invisible, such as the development of nerve cells in the brain or how cancer cells spread.

Watch the cool video starring the Bruce Banner mouse!

I am a physician in my 30s and decided to start this blog so any physician can share his/her thoughts.  This includes anyone in any phase of training to become a physician.  There are many great aspects of medicine and some not so great.  Feel free to discuss anything and everything that is on your mind.  I hope to continually build this blog with many useful resources.  Hope this blog helps even one person.

I'm barely able to type today needing my left hand to support my right arm whenever I need to move it more than a few inches.  This past weekend at a recreational event for my company, people were jumping on my scooter to ride around the courtyard.  I jump on and go a little faster than most and find out that the gravel/dirt on the playground is too loose to go too quickly and "Wham!", I land on my right shoulder not knowing what had just happened.

Due to the shock, I was able to get back on and ride it back to the starting point, but since then, I've been reeling in pain and wondering what happened.  I barely could get out of bed this morning and have to go back to the doctors tomorrow to potentially see how bad the injury really is.

This post isn't about the actual injury, but you really do start to appreciate what you "had" when you are healthy.  As a reminder to all of you who are injury free and healthy -- you don't know how good you got it.  I was sitting "feeling bored" before this little mishap, but now realize I should of taken advantage of simply being healthy.  Now, I'm going to have a harder time staying healthy and it hasn't been easy cooking or eating.  I've been eating out for the most part instead of using the stuff in my fridge.

Anyway, hopefully, I'll remember how good it really is when I'm injury free.  I hope you all do too...

Department of Otolaryngology Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.

KEYPOINTS: Endoscopic ligation of the sphenopalatine artery (ESPAL) has recently become the treatment of choice for refractory epistaxis. This paper reviews the background, indications and potential complications of ESPAL. The main focus of this article is an online video tutorial on the anatomy and surgical technique of ESPAL. Web links lead to video clips of operative steps and therefore this paper should be read in front of a computer with access to the Internet. To study the techniques the links detailed below should be followed. (For computers running RealPlayer software the .wmv extension in each of these links should be replaced with the .rm extension.) * Incision, http://nhsgg.org.uk/content/streams/Figure3.wmv * Flap elevation, http://nhsgg.org.uk/content/streams/Figure4.wmv * Pedicle location, http://www.nhsgg.org.uk/content/streams/Figure5.wmv * Clip application, http://www.nhsgg.org.uk/content/streams/Figure6.wmv.

Harald zur Hausen took half the nobel price in Medicine for discovering the link between the human papilloma virus and cervical cancer.  The remainder of the prize was shared between Francoise Barre-Sinousse and Luc Montagnier for their role in the discovery of the human immunodeficiency virus.

The Nobel Prize in Chemistry was shared equally between three Americans, Osamu Shimomura, Martin Chalfie and Roger Tslen.  They were cited for their discovery and development of a green fluorescent protein GFP.

The Nobel prize in Physics was shared between three.  Japanese physicists Makoto Kobasyashi and Toshihide Maskawa were awarded one quarter of the prize each for “their discovery of the origin of a broken symmetry that predicted the existence of at least three families of quarks”.  The American physicist Yoichiro Nambu received the remainder of the prize for “the discovery of the mechanism of spontaneous broken symmetry in subatomic physics”.

Jean-Marie Gustave Le Clezio, the French “author of new departures, poetic adventure and sensual ecstasy, explorer of a humanity beyond and below the reigning civilization” took home the Nobel prize in Literature.

Martti Ahtisaari of Finland was awarded the Peace prize as a sort of lifetime achievement award.  The citation reads “for his important efforts, on several continents and over more than three decades, to resolve international conflicts”.

The Economics prize was awarded to Paul Krugman of Princeton University for his analysis of trade patterns and location of economic activity.