董遇、字季直、性質納而好学。.......人有従学者、遇不肯教，而云：“必当先読百遍。”言読書百遍而义自見。従学者云：“苦渴無日”遇言：“当以三余。”或問三余之意、遇言：“冬者歳之余、陰雨者時之余也。”由是諸生稍従遇学。 出典：「三国志」魏書の王朗伝そう、100回とは言わなくても、同じ素材を30回くらいは咀嚼することが必要なのだ。そのための素材の準備方法を３つほど提案。
A CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by Ryan Sullivan and colleagues.
A 68-year-old man was seen in the cancer center at this hospital because of metastatic melanoma. Eleven years earlier, a superficial spreading melanoma had been excised from the right lower leg. The patient had been well until approximately 5 weeks before presentation. Examination revealed a mass in the right groin, with surrounding erythema. An ultrasound-guided biopsy of a lymph node in the right groin was performed at the other hospital. Pathological examination showed metastatic melanoma.
Masses were present in the right groin and right medial thigh. CT of the chest, abdomen, and pelvis revealed enlarged retroperitoneal, pelvic sidewall, and inguinal lymph nodes on the right side, with the largest lymph node in the right groin.
The diagnostic test in this case was a repeat biopsy of the groin lesion to obtain tissue for genetic testing which was suggest new treatment options for this patient with advanced metastatic disease.
A CLINICAL PROBLEM-SOLVING article by Jonathan Casey from Brigham and Women's Hospital, Boston.リウマチ熱診断基準の覚え方 J♡ NES PEACE
A 28-year-old woman with no clinically significant medical history presented to the emergency department for evaluation of fatigue and joint pain. She initially noted pain and swelling in her right foot and ankle, which limited her ability to walk. These symptoms resolved, but pain in her knees and hips then developed, along with swelling and pain in her right elbow.
The physical examination was notable for a temperature of 38.3°C (101.0°F) and for diffuse tenderness of the joints on palpation.
The patient was born in Brazil and moved to the northeastern United States 10 years before presentation. The patient recalled that when growing up in Brazil, she became short of breath easily and was unable to play with other children.
Transthoracic echocardiography revealed severe mitral regurgitation and mild aortic insufficiency. There was thickening of the mitral valves and evidence of chronic mitral stenosis. Titers for antistreptolysin and antiDNase B antibodies were high.
The range of possible causes of joint pain and fatigue is broad, but the polyarticular, migratory nature of the joint pain in this patient helps to narrow the possibilities. The patient has no documented risk factors for infective endocarditis, but the fact that she was born in Brazil puts her at increased risk for rheumatic heart disease.
A CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by Alberto Puig and colleagues.
A 29-year-old man was admitted to this hospital because of anemia and jaundice.
The patient had been in his usual health until 4 days before admission, when increasing fatigue, malaise, headache, intermittent testicular discomfort, yellowed eyes, dark urine, nausea, and diffuse body aches developed and chronic leg pain worsened.
The patient had been generally well, with intermittent asthma, acne, and chronic leg pain until 4 months earlier, when he traveled from an urban area of New England to his family's home in North Africa and stayed for 3 months. While he was there, a prolonged cough productive of green sputum developed, associated with fatigue, subjective fevers, chills, drenching night sweats, and intermittent dyspnea at rest, and he reportedly had a weight loss of 9.1 kg.
There are several features of this case that are potentially important but are not easily correlated with the patient's presentation and, hence, leave us wondering about their clinical significance. Specifically, fever, cough, and weight loss developed while the patient was visiting North Africa, where he encountered a dying brother, was exposed to sheep, and drank unpasteurized milk. In addition, his medical history is notable for a previous episode of acute anemia that occurred after surgery. We must pursue a unifying diagnosis for these findings.聴き取りをしていて、いまさらながら、Massachusettsの綴りに自信が持てない。これはネイティヴの人も同じらしく、まぁ、日本人だって北海道のアイヌ語の地名が読めなかったりするのと同じようなもんなんだろう。他にも、Cincinnatiとか、Mississippiとか、そんな類の地名で、下のように覚えたりするらしい。
Cincinnati
Cincinnati is a word
Hard to spell but easy heard.
It need not cause you irritation,
Just drop the ON from CIN CIN NATION.
Massachusetts
The simple answer to this little riddle:
Two esses, two tees, with one ess in the middle.
Mississippi
Four simple words will get you by:果たしてこれで、次回はまごつかずにMassachusettsを打てますかどうか…
What you'll never MISS IS SIP PI.
」を読了。訳本の方は、馬鹿高い値が付いているので、原著のリンクを張っておきました。シービオクの論文だけで良ければ、「シャーロック・ホームズの記号論―C.S.パースとホームズの比較研究 (同時代ライブラリー (209))
」として、中古本がまだ安く入手できます。しかし、ウンベルト・エーコ編の右本のほうが多彩な筆者を揃え、ジョヴァンニ・モレッリ、ジークムント・フロイト、カミロ・バルディ、ヴォルテールなどの逸話が引き合いに出され、読み応えがあります。最後は、メタ・アブダクションの説明に、ブランドのZadig & Voltaireの由来になったと思われるVoltaireの小説"Zadig ou la Destinée"が引用されていますが、これまたSerendipityの語源ともなった「セレンディップの3人の王子」にインスパイアされた作品とのこと。人間の思想の連綿とした連続性に感じ入った次第。1.出典
Mark: See, there's two kinds of doctors. The kind that gets rid of their feelings. And the kind that keeps them. If you're going to keep your feelings, you're going to get sick from time to time. That's just how it works. - 24 Hours
2. Doug: At my age Mozart was dead. - Into that Good Night
3. Jerry: Dr. Carter, I presume. "Dr. Livingstone, I presume"の引用ですね。
4. [Randi is reading everyone's horoscope]
Randi Fronczak: Hey, Abby. What's your sign?
Abby Lockhart: "Out of order".
5. Benton's Mother: Your talent is God's gift to you. What you do with it is your gift back to God.
6.
Dr. Kerry Weaver: Did you even take the Hippocratic Oath?
Dr. Robert Romano: I had my fingers crossed.
7.
Nurse Lily Jarvik: Anyone seen Dr. Weaver?
Dr. Doug Ross: Follow the trail of partially-digested residents.
8. [In the OR]
Dr. Robert Romano: Will somebody turn down the damn heat. Feels like a hundred in here.
Nurse: The thermostat is set at 68 degrees.
Dr. Peter Benton: Maybe you're coming down with the flu.
Dr. Robert Romano: It's NOT the flu.
Nurse: Maybe you're going through "The Change."
9. Dr. Robert Romano: I'm beginning to think that "ER" stands for "everyone's retarded".
10. Dr. John Carter: [Instructing his med student] Grab that penis and show it who's boss.
11.
Dr. Susan Lewis: I think you should talk to him, he seems depressed.
Abby Lockhart: He's european, it's his baseline.
12. Abby Lockhart: These are the desk clerks, Jerry and Frank, please don't feed them.
A CLINICAL PROBLEM-SOLVING article by Eileen Scully from Brigham and Women's Hospital, Boston.慢性炎症性脱髄性多発神経炎(CIDP)です。日本神経学会のHPでは、まだガイドラインの公開はないようです。
A 65-year-old man presented with fevers and progressive weakness. He had been well until 4 months previously, when daily fevers, sweats, fatigue, impaired concentration, and weakness developed. He also reported that pain in his feet and calves.
On physical examination, strength was normal in the proximal arms but was decreased in both wrists, the fingers, the right hip, the right foot, and the great toes bilaterally. Ambulation without supportive bracing revealed a profound foot drop on the right side (a finding that is shown in the video at NEJM.org).
The patient had undergone coronary-artery bypass grafting 15 months earlier, which had been complicated by a hernia in the upper abdominal wall that was repaired with surgical mesh. The patient's medical history also included hepatitis B virus (HBV) infection, gout, hyperlipidemia, hypertension, gastroesophageal reflux, and hypothyroidism.
Ongoing fevers in a previously well patient may be caused by infection, a malignant condition, autoimmune or inflammatory disease, or medications.
Two components of the medical history that warrant attention are the hypothyroidism which may be associated with neuropathy and the HBV infection which is associated with a painful vasculitic neuropathy. (206 words/ 99sec = 125 wpm)
