How to connect your liver to your heart with a toothpick

September 19, 2007 - Markus Hoenicka
Here's another one in our ongoing series of how to harm yourself by eating toothpicks.

A 55-year old man reported to the hospital with chest pain and a difficulty to breathe when not at rest. The pain was also noticeable when he was lying on his right side. The patient also suffered from a loss of appetite, accompanied by a loss of weight, and did not feel well in general. He was diagnosed with a massive pericardial effusion (a loss of blood from the heart to the surrounding tissue) and a constrictive pericarditis (an inflammation of the sac surrounding the heart). The patient was taken to a computer tomograph which confirmed the pericardial effusion and additionally detected an abscess of the left side of the liver. The scan also showed a tubular structure connecting the liver and the heart which was obviously of foreign origin. A laparotomy (surgical opening of the belly) revealed a wooden toothpick that somehow made its way out of the bowel, through the liver, and partially into the heart. The toothpick was removed and the patient recovered within a week.

The paper also contains a brief literature search which reveals that only 12% of the patients treated for symptoms of a toothpick gone the wrong way remember swallowing that toothpick. That is, only one in about 10 people eating toothpicks are aware of the fact. On the other hand, 80-90% of the cases where people remember swallowing a toothpick are uneventful. Clearly, there are situations that make you less aware of what you put in your mouth (think alcohol), but it still makes me wonder how absentminded you have to be in order not to notice. But then - shit happens.

How to surgically remove your smoking habit

January 26, 2007 - Markus Hoenicka
While many smokers see smoking as a pleasant habit rather than an addiction, a large part of smokers who want to quit find this very difficult to do. A recent paper in the top-notch journal "Science" suggests a different cure (well, the paper doesn't suggest it, but it is quite obvious). 69 previous smokers with minor brain damage due to stroke were investigated in this study. Minor brain damage implies here that they were able to make sense of questionnaires and interviews. Of these patients, 37 did not quit smoking. The remaining 32 did. Half of the quitters reported that their addiction was gone, whereas the other half reported that they still felt the urge to smoke but had quit anyway. A mapping of the damaged brain regions gave a high correlation between the loss of the urge to smoke and the damage to a particular region of the brain called the insula. According to these findings, the insula is apparently responsible for maintaining learned pleasant feelings, as opposed e.g. to the innate satisfaction caused by eating (none of the patients reported a loss of the urge to eat).

So if you find it hard to quit, why not stop by at your favourite neurosurgeon at the corner and have your insula poked?

When carnivorous plants get hungry

September 30, 2006 - Markus Hoenicka
Nepenthes truncata is one of those carnivorous plants that carry leaves forming pitchers full of a digestive liquid (some nice images are here). The upper edges of the pitchers are coloured attractively, and the scent of the pitchers makes them even more interesting landing places for insects. Being unaware of the plants intentions, some of the insects slip into the pitcher. They are kept from crawling up the side walls by hairs pointing downwards. Eventually the insects drown and are slowly digested by the plant, giving some relief to their nitrogen cravings. Now the botanical garden of the French town Lyon reported that one of their pitcher plants managed to catch a mouse. The half-digested rodent was found one morning as the staff noticed a somewhat strong smell. They also reported that the largest animal found so far in these pitchers were cockroaches of approx. 4 cm (approx. 1.5 inch) in length. The pitchers of this species can reach up to 50 cm (approx. 20 inch) in length, so you might want to keep a close eye on your pets next time you visit your local botanical garden. The story (in German, with a picture) is right here.

Living with a toothpick in your liver

September 06, 2006 - Markus Hoenicka
Looks like this is going to be an obsession for me. But once you've started to follow how happily people eat toothpicks, you end up finding new and interesting cases everywhere. This report, published in the Journal of Clinical Ultrasound (abstract), tells the story of a toothpick that penetrated the duodenum and went right into the liver. The patient reported to the clinic complaining about moderate fever and right flank pain. The heart rate and blood pressure were elevated. An abdominal sonography revealed an object in the liver right next to the duodenum. This diagnosis was confirmed by a CT scan, which nicely showed the foreign body in the liver. The patient refused surgery, so the doctors resorted to treat the infection caused by the toothpick. After a treatment with two different antibiotics the symptoms subsided and all other related diagnostic markers went back to normal. The patient was reinvestigated 2 years after the incident. He was asymptomatic, still carrying the toothpick in his liver.

How to amputate a leg with a toothpick

August 08, 2006 - Markus Hoenicka
I've mentioned ingested toothpicks as a cause of serious problems previously, but things can turn out far worse. In another case reported by the New England Journal of Medicine the toothpick ultimatively led to the loss of a leg, due to a series of complications and coincidences.

A 60-year old patient presented to the hospital complaining about rectal bleeding, pain in one of his legs, and an episode of fainting. A thorough medical examination confirmed bleeding in the colon as well as a lack of vascular flow in the affected leg. Upon performing a laparotomy (simply put, they opened the belly for visual inspection) the surgeons found a toothpick which got stuck at a sharp turn of the colon. Incidentally, this turn was right next to the external iliac artery (one of the arteries which delivers blood to the leg) which was perforated after the toothpick pierced a hole into the colon wall. Due to the increased risk of an infection (it is not a good idea to place a graft on the artery if the contents of your colon has spread right there...) the surgeons were not able to perform a revascularization at the affected site. This eventually led to the amputation of the lower leg due to gangrene, followed by an amputation above-the-knee a few days later due to wound healing problems.

Now if you must use toothpicks and ingest one every now and then, please choose models made from metal which can be located radiographically. It'll make it so much easier for your doctor to find out what's wrong, and it might even save you a leg.

Believe it or not, revisited

March 31, 2006 - Markus Hoenicka
I already told you so, but now there is another study about praying out there, funded by your tax money and healthcare insurances. While the first study didn't report any effect of praying, positive or negative, the new study has some real bad news for the religious among you. The study agrees that praying itself does not affect the outcome of coronary artery bypass grafting (the kind of surgery to cure heart attacks). However, patients who knew that someone was praying for them ran a higher risk of suffering from complications than patients that didn't know. It seems possible that the certainty of receiving prayer raises expectations which cannot be fulfilled. To the best of my knowledge this is the first study that shows that praying for others may cause harm.
One weakness of this study may leave some hope for the religious though. The praying support was delivered only by Christian groups (both Catholic and protestant) as the authors were not able to locate prayer groups of other religions. The debate may well go on claiming that praying to Jewish, Muslim or ancient Greek gods may provide better results.
New York Times digest (requires registration)

Happy coronary patients

February 06, 2006 - Markus Hoenicka
A recent report in the section "Opinions and Hypotheses" of the Journal Chest suggests the use of Type-5 phosphodiesterase inhibitors in coronary artery bypass grafting. According to the reviewed data, a 100mg-dose per day is well suited to inhibit platelet aggregation and vasospasms, the two most common and most dangerous complications of coronary artery bypass grafting. The best known of these Type-5 phosphodiesterase inhibitors is sildenafil citrate, better known as - Viagra. It just so happens that this 100mg dose is what most patients with erectile dysfunction need to have some fun again. The article does not discuss what the patients are supposed to do with their (in this case unwanted) arousal if the dose kicks in.

BTW sildenafil citrate has originally been tested for use against pulmonary hypertension. That "other" effect of the substance was only detected after the volunteers of a clinical trial kept on asking for more.

Watch out for toothpicks

December 04, 2005 - Markus Hoenicka
There is a case report in the New England Journal of Medicine showing which odd ways an accidentally ingested toothpick may take (if you think the obvious now - this may be the least eventful outcome [no pun intended]). A 67-year-old woman showed up in the hospital with chest pain and signs of a cardiac tamponade (the accumulation of fluids in the pericardial space), which may be caused by a postinfarction rupture of the ventricle. After draining 150ml of blood from the pericardial space, the woman was taken to an emergency surgery. The doctors removed another 600ml of clotted blood from the pericardial space and finally found a wooden toothpick which had gone through the diaphragma and then perforated a coronary artery. The woman recovered. A statistic reports 3.6 toothpick incidents per 100000 person-years. Next time you find meat rolls secured with toothpicks on your plate, do yourself a favour and remove them in time.

Help is coming for us cowards

December 01, 2005 - Markus Hoenicka
A recent article in Nature links anxiety to oxidative stress metabolism. Looks like overexpression of glyoxalase 1 and of glutathione reductase 1, two enzymes involved in detoxifying substances generated by oxidative stress, increase the anxiety in mice. This may of course lead to new approaches to cure anxiety-related disorders, but the interesting question is why there is a link. Are we supposed to avoid oxidative stress?

Digital data and science

December 01, 2005 - Markus Hoenicka
Nature carries a couple of interesting articles this week (Vol438, issue 7068, 2005-12-01), about the use of digital data in science. Here is a discussion how the linking of public data and the use of web services may help to make the fate of data independent of the fate of a particular lab. Although the technical means to share data are out there (think Google base), it will also require a new thinking about data, which are now held captive until published in order to get the next grant.

This article discusses the good and evil of digitizing books in science. Good would be of course the availability and searchability. Bad would be that even researchers might limit themselves to the snippets they find on the web (due to copyright issues, newer publications are likely to be available only as partial data), just like Joe Sixpack erroneously thinks himself well informed after watching those 20 second headline news instead of reading a newspaper. Apparently some publishers want to collect the digital data of current books and sell them online as well.

Another article evaluates the blessings of Google Scholar, a search engine meant for, well, scholars. This service has an edge over other databases like Pubmed as it tracks citations which you can explore at a mouseclick. However, due to the automatic scanning of only those papers which are currently available online somewhere, there is a huge bias towards publications since the mid '90 (this is where the full-text archives of many journals start), a fact that commercial databases avoid.

Finally, here is an article which explains how blogs and wikis may change the ways scientists cooperate, although it is agreed that these techniques will not replace the classic "paper".

Abuse of Science

November 29, 2005 - Markus Hoenicka
There is an interesting writeup in the New England Journal of Medicine covering one of the topics that all researchers in the biomedical field should be interested in. Meng-Kin Lim starts his essay saying "All technological advancements - from knives and forks to airplanes and rockets - have been exploited for destructive ends". Needless to say that it is not a solution to end research in order to end its abuse, but it is sad to see that there is no real solution to this problem, regardless of the attempts mentioned in the article.
I assume that only a fraction of all research worldwide is conducted to develop outright weapons. However, as just about anything that can be abused will be abused, we're always running the risk to contribute to a kind of research we never wanted to. And while the information was hardly accessible to non-experts until a couple of years ago, most of it is accessible on the internet these days, both for good and for bad. Dr. Lim points out that not even ethical guidelines or even self-imposed ethical conduct will help as there is always the possibility of higher considerations overriding these guidelines. So while we teach terrorists all over the world how to abuse our research, we also have to fear that even legal bodies will abuse the research in order to fight just this threat by the terrorists. The treatment of the captives in Guantanamo can give a hint that not even "unalienable rights" are unalienable if they would hinder the secret services. Now add to this the economic dependency of researchers on public funding, and you get an impression how strictly the members of the scientific community will be able to resist. This is not encouraging.

Glowing in the dark

October 18, 2005 - Markus Hoenicka
You've seen this before - moon and stars on your kids bedroom ceiling that glow in the dark, or t-shirts with fancy images that glow greenish at night. But you haven't seen this before, and I'm sure this will be on the christmas wishlist of many adult men than never really grew up - glowing sperm. Imagine her stunned look when she realizes that glow after you did it the first time...priceless.
Now seriously, this does work, but so far only in Anopheles, a mosquito species infamous for transmitting diseases. Needless to say this was not invented by perverts, but by researchers in pest control. The goal is to release sterile males, as they do not transmit diseases and keep fertile males from mating, thus reducing the offspring. Genetically modified mosquito larvae can be easily sorted by sex in early stages of breeding by the greenish glow of the male gonads, caused by the expression of Green Fluorescent Protein in the spermatozoa and in the spermatogenic tissue.

Towards the killer perfume

October 14, 2005 - Markus Hoenicka
The neuropeptide oxytocin has been shown to increase trust in humans if applied as a nasal spray. After administration, the test persons were more willing to bear risks that were under control of other persons (as in giving someone your money and let him trade stocks to make a profit) compared to a control group. I wouldn't be too surprised to see this substance as a new ingredient in perfumes. Smell me, trust me, be mine...

Believe it or not - praying does not help cardiac patients

October 13, 2005 - Markus Hoenicka
Interestingly our healthcare systems still have sufficient resources to prove the obvious. It has now been shown in a randomized, double-blinded multicenter study that prayer (and other "esoteric" interventions) does not improve the outcome of percutaneous cardiac treatments. Needless to say that this result was independent of the religion applied to the procedure. Christian, Buddhist, Muslimic, and Jewish prayer groups did their best to no avail. It was not reported whether this procedure helped the praying persons in any respect

Is male homosexuality an immunological disorder?

October 13, 2005 - Markus Hoenicka
Male homosexuality is more likely to occur if you have several older brothers. The reason is most likely the progressive immunization of some mothers against male-specific antigens in the maternal circulation. A similar mechanism which would explain female homosexuality is apparently not known.