Nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein). There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis.This condition is not to be confused with superior mesenteric artery syndrome, which is the compression of the third portion of the duodenum by the SMA and the AA.
This early stethoscope belonged to Laennec (Science Museum, London)
The stethoscope was invented in France in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural. His device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a “microphone”.
The first flexible stethoscope of any sort may have been a binaural instrument with articulated joints not very clearly described in 1829.In 1840, Golding Bird described a stethoscope he had been using with a flexible tube. Bird was the first to publish a description of such a stethoscope but he noted in his paper the prior existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird’s stethoscope had a single earpiece. In 1851, Irish physician Arthur Leared invented a binaural stethoscope, and in 1852 George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practice. Rappaport and Sprague designed a new stethoscope in the 1940s, which became the standard by which other stethoscopes are measured, consisting of two sides, one of which is used for the respiratory system, the other for the cardiovascular system. The Rappaport-Sprague was later made by Hewlett-Packard. HP’s medical products division was spun off as part of Agilent Technologies, Inc., where it became Agilent Healthcare. Agilent Healthcare was purchased by Philips which became Philips Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague stethoscope was finally abandoned ca. 2004, along with Philips’ brand (manufactured by Andromed, of Montreal, Canada) electronic stethoscope model. The Rappaport-Sprague model stethoscope was heavy and short (18–24 in (46–61 cm)) with an antiquated appearance recognizable by their two large independent latex rubber tubes connecting an exposed-leaf-spring-joined-pair of opposing “f”-shaped chrome-plated brass binaural ear tubes with a dual-head chest piece. Several other minor refinements were made to stethoscopes, until in the early 1960s Dr. David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics. The Littmann stethoscope is the model used by most medical students today.
Veins are blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart. Veins differ from arteries in structure and function; for example, arteries are more muscular than veins, veins are often closer to the skin and contain valves to help keep blood flowing toward the heart, while arteries carry blood away from the heart
Image: Video of venous valve in action
If you went to see the Kings of Leon concert on March 28 in Seattle, let’s hope you came home with nothing but great memories.
A young woman at that concert in Seattle has come down with measles, which can be spread for days by a person who’s infected but not yet sick. That’s bad news for the thousands of people who shared the concert hall with her, or were at the many other places she went that week.
And that’s why the Washington State Department of Health has published the unidentified woman’s schedule online.
"The reason we’re doing this is that it’s so highly contagious," says Dr. Jeffrey Duchin, who is chief of communicable disease control for Seattle and King County Public Health, which investigated the measles case. “It can stay in the air for hours after the contagious person has left. If we don’t treat these people, the chain of transmission can continue.”
The young woman became contagious on March 26, after visiting a family with measles cases that were linked to an outbreak in British Columbia. Unaware she was infected, she went to work at a bakery, filled her car up at a gas station, went to the concert, went to Pike Place Market and went out for sushi. All the while she was spreading viruses in the air.
So if you were at the Starbucks at 102 Pike Street between 11:15 a.m. and 2 p.m. on March 29 and you’re not sure if you’re immune to measles, the Washington State Department of Health wants you to see a health care professional immediately. You may be in the market for a quick shot of vaccine or immune globulin.
Photo: This one’s virus-free: Matthew Followill, Nathan Followill and Caleb Followill of Kings of Leon performed in Los Angeles in December. (Kevin Winter/Getty Images for Radio.com)
In the fetus, the ductus venosus shunts most of the left umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver. In conjunction with the other fetal shunts, the foramen ovale and ductus arteriosus, it plays a critical role in preferentially shunting oxygenated blood to the fetal brain. It is a part of fetal circulation.
The ductus venosus is open at the time of the birth and is the reason why umbilical vein catheterization works. Ductus venosus naturally closes during the first week of life in most full-term neonates; however, it may take much longer to close in pre-term neonates. Functional closure occurs within minutes of birth. Structural closure in term babies occurs within 3 to 7 days. After it closes, the remnant is known as ligamentum venosum.
The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.
In 2012, more than 61,000 babies in the U.S. were conceived with the help of IVF, the Society for Assisted Reproductive Technology reported Monday.
That means IVF babies made up 1.5 percent of the 3.9 million births in the U.S, the agency wrote on its website. And it makes 2012 the biggest year for IVF on record: Doctors performed the most procedures and delivered the most IVF babies.
Over the past decade, the number of IVF treatments has been rising. Doctors performed about 113,000 cycles back in 2003. That number jumped by nearly 50 percent to about 165,000 in 2012.
Video: A new instrument, called an Embryoscope, allows fertility doctors to watch the embryo develop after in vitro fertilization. In the video, you can see the embryo go from the first cell division to the blastocyst stage when the cells move to the outside. The time-lapse video takes about five to six days in real time.
More than a decade of research on children raised in institutions shows that “neglect is awful for the brain,” says Charles Nelson, a professor of pediatrics at Harvard Medical School and Boston Children’s Hospital. Without someone who is a reliable source of attention, affection and stimulation, he says, “the wiring of the brain goes awry.” The result can be long-term mental and emotional problems.
A lot of what scientists know about parental bonding and the brain comes from studies of children who spent time in Romanian orphanages during the 1980s and 1990s. Children likeIzidor Ruckel, who wrote a book about his experiences.
When Ruckel was 6 months old, he got polio. His parents left him at a hospital and never returned. And Ruckel ended up in an institution for “irrecoverable” children.
But Ruckel was luckier than many Romanian orphans. A worker at the orphanage “cared for me as if she was my mother,” he says. “She was probably the most loving, the most kindest person I had ever met.”
Then, when Ruckel was 5 or 6, his surrogate mother was electrocuted trying to heat bath water for the children in her care. Ruckel ended up in an institution for “irrecoverable” children, a place where beatings, neglect, and boredom were the norm.
Researchers began studying the children in Romanian orphanages after the nation’s brutal and repressive government was overthrown in 1989. At the time, there were more than 100,000 children in government institutions. And it soon became clear that many of them had stunted growth and a range of mental and emotional problems.
When Nelson first visited the orphanages in 1999, he saw children in cribs rocking back and forth as if they had autism. He also saw toddlers desperate for attention.
"They’d reach their arms out as though they’re saying to you, ‘Please pick me up,’ " Nelson says. "So you’d pick them up and they’d hug you. But then they’d push you away and they’d want to get down. And then the minute they got down they’d want to be picked up again. It’s a very disorganized way of interacting with somebody."
The odd behaviors, delayed language and a range of other symptoms suggested problems with brain development, Nelson says. So he and other researchers began studying the children using a technology known as electroencephalography (EEG), which measures electrical activity in the brain.
Many of the orphans had disturbingly low levels of brain activity. “Instead of a 100-watt light bulb, it was a 40-watt light bulb,” Nelson says.
As the children grew older, the researchers were able to use MRI to study the anatomy of their brains. And once again, the results were troubling. “We found a dramatic reduction in what’s referred to as gray matter and in white matter,” Nelson says. “In other words, their brains were actually physically smaller.”
The scientists realized the cause wasn’t anything as simple as malnutrition. It was a different kind of deprivation — the lack of a parent, or someone who acted like a parent.
Top photo: Izidor Ruckel, shown here at age 11 with his adoptive father Danny Ruckel in San Diego, Calif., says he found it hard to respond to his adoptive parents’ love. (Barry Gutierrez for NPR)
Middle photo: In the Institute for the Unsalvageable in Sighetu Marmatiei, Romania, shown here in 1992, children were left in cribs for days on end. (Tom Szalay)
Bottom: Izidor Ruckel dons a hat of a style common in his birthplace, Romania. He now lives in Denver. (Barry Gutierrez for NPR)
The Morphology of Human Blood Cells (1956)
Dorothy Sturm’s beautiful watercolors are difficult to distinguish from an actual microphotograph (except perhapsthey are clearer and more detailed than a micrograph, and certainly superior to images from the 1950’s). Sturm’s watercolor on paper illustrations, drawn directly from Wright-stained smears prepared by [microbiologists], depicted normal, pathological and infectious hematology with a clarity, detail and beauty that photomicrography of the 1950’s simply couldn’t approach. JAMA, in a review of the first edition, even called her work “of exceptional quality.”
 This table showing hematopoiesis (as it was understood in 1956) was the frontispiece of the first edition of Diggs’ The Morphology of Human Blood Cells. Here’s the key to this illustration.
 Cell types found in smears of peripheral blood from normal individuals
 Blood parasites
 Fat cells
 Megakarocytes and thrombocytes