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“The students began by reading NC Macnamara’s Textbook on Diseases Of Bones And Joints, 3rd edition (1887), and George Ellis’ Demonstrations In Anatomy: Being A Guide To The Knowledge Of The Human Body Through Dissection, 11th edition (1890), by attending lectures in anatomy, and by dissecting and memorizing the parts of the human body in the laboratory. Maugham later recalled that ‘I was once obliged to study anatomy, a very dreary business. One remark made by my teacher when he was helping me in the dissection of a thigh has always remained in my memory. I was looking in vain for a certain nerve and it needed his greater skill to discover it in a place which I had not sought. I was aggrieved because the text book had misled me. He smiled and said: “You see, the normal is the rarest thing in the world”.’” (

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As the epidemic of obesity continues out of control the search for pharmacological ways to maintain more healthy eating patterns continues. Binge eating disorder is one form of eating disorder that invariably leads to obesity. Evidence is accumulating that the anti-obesity agent sibutramine hydrochloride may be effective in treating binge eating disorder. In a study of 60 obese outpatients, investigators from Rio de Janeiro, Brazil, demonstrated there was a significant reduction in the number of days of binge episodes of eating in the group that took sibutramine compared with the placebo group. This was associated with an important and significant weight loss. Sibutramine would appear to be effective and well tolerated in the treatment of obese patients with this disorder. (

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Does a mild stroke help protect the brain from future strokes? This seems an absurd thesis, but researchers studying mice have found that those animals that experienced a mild stroke induced by 15 minutes of cerebral artery blockade experienced a 70% decrease in brain damage during a second larger attack compared to control mice. The authors have suggested that a preconditioned mouse experiences altered expression of certain genes in anticipation of a future larger stroke. If this is true it may lead to the development of new medications and preventive measures for individuals at risk of stroke. (

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Scientists at the National Institutes of Environmental Health Sciences and the University of North Carolina plan to establish a new gene registry to study the relation between environmental exposures and genetic susceptibility in human disease. The collaborative effort, which will include DNA samples from 20 000 individuals, has begun with a pilot study of 600 patients visiting the University of North Carolina outpatient clinic for other medical purposes. The DNA samples will be screened for polymorphisms or variants of known environmentally sensitive genes. These genes encode a variety of proteins involved in such activity as toxicant and drug metabolism, cell differentiation and death, DNA repair and inflammatory responses. (See www.niehs.nih.gov/)

Migraine headache is a neurological disorder associated with significant disability and in an impaired quality of life. Approximately 11% of the US population experience migraine. The goal of managing migraine is to reduce migraine frequency, severity, and disability. Recent studies suggest that habitual overuse of acute medications including triptans, ergots, and other analgesics can lead to the development of chronic daily headaches. Preventative drugs can serve an important role in the treatment of migraine by reducing migraine frequency and by ameliorating dose escalation and the potential for overuse of acute pharmacological treatments. Topiramate is a broad spectrum anticonvulsant drug that has recently been studied for migraine prevention. In this 26 week study there was a significant reduction in migraine intensity and number of attacks in those patients who were given toprimate for migraine prevention. It proved to be at least as effective as other currently utilised migraine preventative drugs including propranolol, amitriptyline, and valproate. No significant side effects were noted. (

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Studies have suggested that patients with a previous stroke benefit from reducing levels of the amino acid homocysteine in the blood with high dose vitamin therapy. In a study from Wake Forest University School of Medicine a double blind randomised controlled trial demonstrated that high doses of folic acid, vitamin B-6, and vitamin B-12 reduced the risk of an additional stroke over a 2 year period in patients who have suffered a previous stroke. (

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Additional data continue to accumulate that folic acid supplementation reduces the risk of ischaemic stroke. In a study from Northwestern University a group of health professionals (men) were studied by questionnaire about potential risk factors and new cases of ischaemic stroke. In this study a high intake of folate was associated with a significantly lower risk of ischaemic, but not haemorrhagic, stroke. The investigators believe the data are so strong that all men should be encouraged to increase their intake of folate to reduce stroke risk. (

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The treatment of congenital nystagmus has remained one of the major frustrations of ophthalmologists interested in this curious disorder. Current surgical therapies do not improve visual acuity, only rarely do medications seem to have any effect, and most optical devices including prisms have not proved to be effective. Recent reports have suggested that use of contact lenses may dampen the nystagmus and thus improve visual acuity. In a study by investigators from the University of Emory four patients with congenital nystagmus were studied. In this study the clinical improvement that occurred in these patients as the result of contact lens wear appeared to be the result of better optical correction provided by the contact lenses rather than the spectacles without any true dampening effect of the nystagmus induced by the contact lenses. Clearly this is a topic that needs more detailed studies. (

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Randomised controlled prospective trials have become the gold standard for conducting clinical research. Nevertheless, even these studies can be marred by bias and other problems. Researchers from the University of Edinburgh have reviewed how to detect these problems. They suggest that allocation should be concealed during randomisation. Outcomes should be defined carefully. Outcome assessors should be blind to treatment allocation. It should be clear why missing data are missing. Analysis should be on a basis of intention to treat. It is important to read a trial report carefully to make sure that the authors know the precise definition of these terms. One should be particularly careful not to overinterpret the results of subgroup analysis. (

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