Showing posts with label Wonderment. Show all posts
Showing posts with label Wonderment. Show all posts

Wednesday, January 20, 2010

Jaw dropper

Cowboys don't really do it for me. But these guys?

OMG.

*topples*



If these guys ever make it to our shores, Ima empty the piggy bank to go and watch.

*licks lips*

And no Brokeback quips, ok? Let me have some fantasy of straight men who can move.

Monday, January 18, 2010

Take a chance on me ...

This short film was screened at Cannes and won last year. I love how much was told in such a short period and how creatively it was done.

Sweet and lovely.

Monday, October 12, 2009

Food ambassador

You gotta love Jamie Oliver. This is a guy who doesn't accept limitations and goes out to do what he feels is right. He overcame dyslexia and hyperactivity to become one of the world's most famous proponent of good food for everybody. Watching him cook is like watching a controlled whirlwind; but instead of destruction, he left lovely and delicious gustatory creation in his wake.

On his crusade to teach the world that you can cook and eat well, healthy and cheap, Jamie has embarked on a new journey: to teach super-size-this America to eat right.

Good luck, Jamie!

Tuesday, September 22, 2009

Soul barer ... Jamal Abdillah

I confess. When it comes to Malay songs, my taste seems to freeze somewhere before 1990. I'd like to blame the domination of the sound waves by Eddie Hamid's wailing rock ballads (laments of limp-wristed losers whose girl left them for better prospects) that sounded the death knell to easy listening Malay music, but that would be too sweeping (and I don't know enough to elucidate on this matter).

Jamal Abdillah has been rightly named the King of Pop in Malaysia, generating tonnes of hits and starred in movies that made girls sighs and the explosion of baby girls to be named Azura. Gifted with a voice not just mellifluous and resonant; his passion and emotions imbued lifted the song to more than just melodies. His hits are mostly melancholic songs of heartbreak and loss, such as “Seniman Menangis” and “Sepi Seorang Perindu”. When performing a duet, he is excellent at not drowning out his co-performer with his powerful voice, a talent that is missing in many singers.

Jamal first came into my musical consciousness with Tidurlah Wahai Permaisuri, a most unlikely lullaby that I've always thought was sung by a languishing courtier to the object of his affection. There, you know it now. I have a taste for melodramatic romance. Shut up.

Last night TV1 had shown Jamal's latest consert dubbed "Kembara Seniman" that he performed at the Istana Budaya. It started with a musical of his journey as a singer and ends with an energetic performance of a wonderful of medley of his hits. I was impressed with the musical bit as he really bared his soul (so to speak), alluding to his struggle with addiction and inner demons. But he really blew us away with the concert segment, especially how he belted out all the numbers with a near effortlessness that has been missing for a long bit. His rendition of "Gadis Melayu" made you boogie along and "Seroja", as usual, brought tears to my eyes. (And people wonder why I want to kill Mawi for massacring these beautiful songs. Tsk.)

Bravo, Jamal!

PS: Is late and am lazy so no clicky links. Google away.

Wednesday, September 9, 2009

How to live with a hole in your soul (or torso)

Ganked in its entirety from Medscape. But it is sooooo fun and gruesome and the not-so-little geek in me just wanted to have a show and tell.

From Medscape General Surgery > Historical Perspectives in Surgery

The Case of the Wounded Woodsman and His Dedicated Physician

Albert B. Lowenfels, MD

Published: 09/02/2009

The Case

The patient was a 28-year-old, healthy itinerant laborer who was accidentally shot at close range by a companion. The shell entered the left anterolateral side of his body a few inches below the left nipple. The patient fell to the ground but remained conscious. A physician who examined the patient shortly after the accident noted a large wound of entry about the size of a man's hand, but no wound of exit. The left lung protruded through the opening along with a portion of the stomach, with an opening caused by the bullet. Several adjacent ribs had been fractured. Food from a recent meal was present in the wound.

In describing the patient's injury, his physician wrote: "I considered any attempt to save his life entirely useless." Nevertheless, his physician debrided the wound, replaced the protruding stomach and lung, and applied a protective dressing. On the following day, the patient developed fever, a cough, and had evidence of pneumonia. For the next week, the patient continued to be febrile; the wound became infected; and the patient was fed rectally.

To the physician's surprise, over the next several weeks the patient's condition gradually improved, although the gastric wound never completely closed. Nevertheless, he could tolerate oral feedings if the gastric opening was occluded with a compressive dressing. Over the next year, the patient's strength gradually returned to normal, but the gastric wound refused to close. The physician made an arrangement with the patient to follow him more closely and to study his gastric physiology; these studies continued intermittently over the course of many years.

Who was the patient?

Daniel Boone
Kit Carson
Alexis St. Martin
Paul Bunyon

Who was the physician?
William Osler
William Beaumont
Harvey Cushing
William Wells


Brief History of the Physician and His Patient

William Beaumont (1785-1853) was born into a farming family and grew up in Connecticut, where he remained until his early 20s when he joined his brother in Upstate New York.[1] There, he taught school for several years, before deciding at the age of 25 to study medicine. Although it was possible in the early 19th century to practice medicine without any formal training, Beaumont became an apprentice to Dr. Benjamin Chandler, a prominent Vermont physician. This apprenticeship lasted for 1 year, covered both medicine and surgery, and led to certification by the Vermont Medical Society. His training never included any formal background in physiology, and it is unlikely that Beaumont was aware of the available rudimentary knowledge of gastrointestinal physiology.

Figure 1. Portrait of William Beaumont, frontier doctor and scientist.
From Gillett MC. Early campaigns in the North, 1812 to 1813. In: Matloff M, ed. The Army Medical Department 1775-1818. Army Historical Series. Available at: http://history.amedd.army.mil/booksdocs/rev/gillett1 Accessed August 26, 2009

In 1812, a few months after receiving his certification, Beaumont enlisted in the US Army, and then actively engaged in war with the British Empire. Eventually, after the conclusion of the War of 1812, Beaumont was posted to Fort Mackinac, an important trading post located on a small, remote island between Lake Huron and Lake Michigan.

By good fortune, Beaumont was at the Fort on June 6, 1822, when Alexis St. Martin, a French-Canadian employee of the American Fur Company, was accidentally shot in the left chest. Beaumont had received some surgical training during his apprenticeship and additional experience while caring for injured soldiers during the War of 1812. Without Beaumont's presence, it is unlikely that St. Martin would have survived such a serious injury.

St. Martin came from a background that was very different from Beaumont's. According to his birth certificate, St. Martin was born in 1794, in the small Canadian village of Berthier. His family, who originated from Bayonne, France, was poor, and St. Martin grew up to be an illiterate trapper. He earned his living as a fur trader and voyageur (a porter and large cargo canoe man) in the region between what is now Michigan and Canada. When he was wounded, St. Martin was 28 years old and unmarried.

When St. Martin was sufficiently recovered, he signed a contract with Beaumont, who offered him employment as a handyman in return for a stipend, food, and permission to carry out experiments on St. Martin's stomach. To facilitate the research, and to ease the financial burden on the physician, the US Army made St. Martin a sergeant, paying him a small salary.

About a year after St. Martin's injury, when Beaumont realized that the gastric wound was unlikely to close, he began detailed studies of the process of digestion within St. Martin's stomach. These experiments, conducted with the often reluctant St. Martin, continued intermittently over the course of about a decade. St. Martin agreed to travel to Europe to be examined and studied by leading physicians, including Claude Bernard, but he changed his mind before embarking on the voyage. He never did go to Europe, but he did exhibit his fistula at several American medical schools.

Despite Beaumont's efforts, the wound never completely healed; nevertheless, St. Martin was able to resume a nearly normal life if he plugged up the gastric opening with a piece of cloth. Eventually St. Martin married and had several children. He was always poor, however, and frequently drunk. His health, despite the fistula, was sufficiently robust so that he could support his family by hard labor, such as chopping wood.

Regardless of his persistent gastric fistula and his heavy consumption of alcohol, St. Martin lived to be 86 years old; even now this is well above the normal life span for white men in North America. As for Beaumont, after completing his army service, he settled in St. Louis, Missouri, where he practiced medicine until he died in 1853 from a head injury after falling on an icy path. St. Martin outlived his physician by several decades.

Prior to St. Martin's death, prominent physicians, including William Osler, had tried without success to persuade the family and the patient to agree to an autopsy.[2] Osler was particularly anxious to examine St. Martin's famous stomach and to have it preserved in the US Army Museum. However, the family was vehemently opposed to any further contacts with the medical profession. To ensure that his body would not be disturbed, the family buried St. Martin in an unmarked deep grave. Only in 1962, more than 80 years after his death, did the Canadian Physiological Society place a marker at the approximate grave site.

What Beaumont Added to the Knowledge of Gastric Physiology

Before Beaumont's long-term observation of St. Martin's progress, other patients had sustained gastric wounds and lived with a gastric fistula, but none had been studied in a scientific fashion.[3] Toward the end of the 18th century, the Italian Lazaro Spallanzini conducted a series of experiments and concluded that the stomach contained an active principle and that digestion was more than a simple mechanical process. In 1803, Jacob Helm, a Viennese physician, studied a middle-aged woman with a gastric fistula, noting the ability of the gastric juice to act upon stomach content. Just prior to Beaumont's first publication, an English chemist, William Prout, noted that the stomach secreted hydrochloric acid.[4] It is unlikely that Beaumont knew about any of this work on the stomach: His observations are unique.

Without any formal training in physiology, gastroenterology, or any branch of science, Beaumont recognized a unique opportunity, and over the course of several years he performed numerous experiments that led to a solid foundation for gastric physiology. The astonishing aspect of Beaumont's research is that under difficult circumstances he took advantage of a rare chance to study digestion by visualizing the interior of the stomach and obtaining samples of gastric juice from a living subject under various circumstances. Moreover, he took careful, detailed notes.

Beaumont performed a series of 3 experiments on St. Martin at geographic locations separated by thousands of miles.

Figure 2. Map listing locations and dates for major events in the lives of St. Martin and Beaumont.

The experiments were carried out under less than ideal circumstances on a patient who was not always cooperative. Today, it would be difficult to obtain approval to perform a similar series of experiments. Beaumont describes his first experiment as follows[5]:

EXPERIMENT 1. August 1. 1825 -- At 12 o'clock, A.M., I introduced through the perforation, into the stomach, the following articles of diet, suspended by a silk string, and fastened at proper distances, so as to pass in without pain -- viz.: -- a piece of high seasoned la mode beef, a piece of raw salted fat pork, a piece of raw salted lean beef, a piece of boiled salted beef, a piece of [unclear] bread, and a bunch of raw sliced cabbage; each piece weighing about two drachms, the lad continuing his usual employment about the house. At 1 o'clock, PM, withdrew and examined them -- found the cabbage and bread about half digested; the pieces of meat unchanged. Returned them into the stomach. At 2 o'clock, PM withdrew them again -- found the cabbage, bread, pork, and boiled beef, all cleanly digested,* and gone from the string...The lad complaining of considerable distress and uneasiness at the stomach, general debility and lassitude, with some pain in his head, I withdrew the string, and found the remaining portions of aliment nearly in the same condition as when last examined; the fluid more rancid and sharp...I did not return them any more.

*These experiments are inserted here, as they were originally taken down in my note-book....

Beaumont published his early results in January 1825, after his first series of experiments and about 3.5 years after St. Martin's injury.

His major contributions to our knowledge of the digestive process included:

  • Studies of gastric motility;
  • Studies of gastric acidity (recognition of the importance of hydrochloric acid);
  • An important role for neurogenic influences on digestion, which eventually led to vagotomy as a treatment for peptic ulcer disease; and
  • A suspicion that something other than acid accounted for the stomach's ability to digest food.

Of note, this last substance turned out to be pepsin, which was eventually identified by Theodore Schwan in 1836, shortly after Beaumont concluded his third series of experiments.

How Would the Patient's Wound Be Treated Today?

St. Martin sustained the full force of a shotgun blast fired accidentally at close range, resulting in a complex wound involving the left lung, the stomach, and the diaphragm. Beaumont describes a "fist-sized" hole (approximately 9 x 9 cm) in the left lateral chest wall. St. Martin apparently remained hemodynamically stable after his injury, although the sphygmomanometer wasn't invented for several more decades -- so there were no blood pressure measurements.

Figure 3. Beaumont's sketch of St. Martin's wound about 4-6 weeks after the injury.
From Beaumont W.5

Even today, this injury would present a significant challenge to a surgeon.[6,7] However, long-term results following current surgical repair of severe chest wall injuries are excellent, with patient status being similar to the general population.[8] Current management would include the following:

  • Careful physical examination supplemented by imaging studies to determine the extent of injury.
  • If there were a pneumothorax or respiratory compromise following this chest wound, ventilatory support would be provided via an endotracheal tube until the patient was ready for surgery. (Note: there was no mention of shortness of breath from a pneumothorax in St. Martin's case.)
  • Exploration via a left thoracoabdominal incision.
  • Careful exploration to ensure that no other organs, such as the pancreas or the spleen, had been injured.
  • Debridement and cleansing of the original wound to remove shattered rib fragments, necrotic lung tissue, imbedded clothing, fragments of the shell, and food particles.
  • Blood transfusion, rather than bloodletting, as was done for St. Martin.
  • Closure of the gastric wound and the diaphragmatic tear.
  • Repair of the chest wall defect. This would probably require application of a synthetic mesh covered by a muscle flap. If necessary, the repair in the chest wall could be closed with a split-thickness skin graft.

Summary

By a fortunate coincidence, William Beaumont -- a young, resourceful, relatively inexperienced US Army surgeon -- happened to be stationed in a remote fort on the western frontier of the United States when Alexis St. Martin, a French-Canadian voyager, received a near-fatal gunshot wound of the chest. St. Martin survived, but was left with a permanent gastric fistula, permitting Beaumont to perform a series of unique experiments that greatly expanded our knowledge of gastric physiology.

Traditionally, St. Martin's physician has received full recognition for the brilliant series of experiments carried out under primitive conditions. However, St. Martin also should be credited for participating in tedious, repetitive experiments that must have been disagreeable and sometimes painful.[9] Although not always cooperative, he should be remembered as being perhaps the first of that special group of human "guinea pigs" who have done so much to advance the progress of medicine. Two centuries later, physicians and patients remain indebted to Beaumont and Alexis St. Martin -- Beaumont's often reluctant patient.

Additional Reading

  • Green AH. The Market Cultures of William Beaumont: Ethics, Science and Medicine in Antebellum America, 1820-1865 [doctoral thesis]. Baltimore: The Johns Hopkins University; 2007. AAT 3262421.

Internet Sources

Museums


References

  1. Horsman KR. Frontier Doctor. William Beaumont, America's First Great Medical Scientist. Columbia, Mo: University of Missouri Press; 1996.
  2. Sarr MG, Bass P, Woodward E. The famous gastrocutaneous fistula of Alexis St. Martin. Dig Dis Sci. 1991;36:1345-1347. Abstract
  3. Modlin IM. From Prout to the proton pump -- a history of the science of gastric acid secretion and the surgery of peptic ulcer. Surg Gynecol Obstet. 1990;170:81-96. Abstract
  4. Rosenfeld L. William Prout: early 19th century physician-chemist. Clin Chem. 2003;49:699-705. Abstract
  5. Beaumont W. Experiments and Observations on the Gastric Juice and the Physiology of Digestion. Mineola, New York: Dover Publications, Inc.; 1959. Available at: http://books.google.com/books?id=H6F4_9joRkgC&pg=PA8&dq Accessed August 20, 2009.
  6. Koch H, Tomaselli F, Pierer G, et al. Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy. Eur J Cardiothoracic Surg. 2002;21:874-878.
  7. Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg. 2006;81:279-285. Abstract
  8. Mayberry JC, Kroeker AD, Ham B, Mullins RJ, Trunkey DD. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg. 2009;75:389-394. Abstract
  9. Myers NA, Durham-Smith E. A debt to Alexis: the Beaumont-St Martin story. Aust N Z J Surg. 1997;67:534-539. Abstract

Authors and Disclosures

Author(s)

Albert B. Lowenfels, MD

Professor of Surgery, Professor of Community Preventive Medicine, New York Medical Center, Valhalla, New York; Emeritus Surgeon, Department of Surgery, Westchester Medical Center, Valhalla, New York

Disclosure: Albert B. Lowenfels, MD, has disclosed that he has served on an advisor to Solvay Pharmaceuticals Inc.

Medscape General Surgery © 2009 Medscape, LLC


Monday, June 22, 2009

The many forms of beauty

You are only limited by the limitations you place upon yourself. I learn this from my friend who has spina bifida and went on to obtain a PhD in neuroscience and is now teaching and raising hell. With the advent of technology, the barriers that kept disabled people from moving on and up are disappearing. You have computers that can talk to aid the blind, better hearing aids and intervention to help the deaf and a slew of other innovations that can improve their quality of life and enjoyment.

In view of the can-do spirit, the China Disabled People’s Performing Art Troupe presented a magnificent performance of the Thousand Hand Guan Yin at the last Spring Festival. What amazing coordination and team work!

Enjoy.

Sunday, June 21, 2009

Wallowing in auditory bliss ...

Mary Kay and I went to Hujan's Rainger's Gathering at the Itudio Studio at Kelana Mall today. Lyn joined us there. Gotta say it was a lovely surprise to have a jam session begin with prayers of thanksgiving. Apparently it was the band's tribute to their loyal fans for their support for the past three years; allowing them to grow and go places.

I first heard of them while watching the television series Kami on 8TV; stumbled across the show by accident while I was ironing. It was intriguing with a gritty realism that is largely absent in most Malay dramas; the story was reflective of the realities facing urban and suburban teenagers (i.e. drugs, truancy, isolation, angst, family trouble, friends, love, music etc).

Gotta say that their energy and verve is really something. They sound better live than on radio, unlike a number of the Akademi Fantasia product. Their songs are catchy, lyrical and poetic, capturing the their thoughts on issues ranging from heartbreak, loss, social musings and political headlines. I was bopping my feet and head along; the crowd was very restrained, doing anything more would be inappropriate.

I was humbled by the fantastic opportunity for me to experience Malaysian indie music at its finest. It is also delightful to know that their fame hadn't blinded them to other struggling bands and fellow artistes who are working to make their name and work known. Stormbay (?), one of the guest acts, acknowledged that Noh helped them gain exposure by telling the producer of Remaja, a show on TV3 to give them a chance. Near all of the guest acts have a story to tell regarding how the Hujan members have helped them out one way or another.

Have a listen. Enjoy.

Friday, June 19, 2009

Miserly emotions not required

We would all love to be the first and only love of someone's life. And hopefully, we feel the same way about our partner.

This woman, however, had the courage to be the second love of her husband's life. Her generosity of spirit and love is humbling. She's no saint and I'm sure many a wife would identify with her exasperation at her husband's inability to score his clothes in the laundry hamper. Her wry acknowledgment that she may fare poorly in comparison to his first wife resonates with honesty and an expansiveness of spirit.

Ah, vive l'amour ...

Friday, May 29, 2009

Learning from the animal kingdom ... NOT!!!!

We humans like to think that we are special. But there is a group of people who believe that humans are no better than animals and as such, all creatures should be treated equal. If you want to give paid maternity leave to your cat or your seat on the LRT (light rail transit) to the visiting hippopotamus, be my guest.

But as human beings, we are held accountable by a different set of rules, yes? You may say that homosexuality is natural, but if a human being had done what this male duck did, he would be imprisoned. With a straitjacket over his prison uniform.

Apparently, it took Dr Moeliker over five years to gather up courage to report the necrophiliac homosexual rape of a male mallard (fancy name for duck) outside his office. Love how deadpan and wry his writing is (it is something I don't see in the journals I usually read, darn those dry, snooze generating stuff) and it is reflected in his presentation (see below a video presentation of Dr Moeliker on the occasion of receiving his IgNobel Prize).



Guys, I won't blame you if you feel a little inadequate; the rapist duck clocked in at 75 minutes thrust time and only stopped after the estimable Dr Moeliker interrupted his business. In between, he had rested only twice, each time lasting less than five minutes.

Sexual harrassment also exist in the animal kingdom. South African biologist Nico de Bruyn reported of an Antarctic fur seal who had (mistakenly?) mounted an adult king penguin (of unknown sex) for 45 minutes. Golly, there is just no escaping jerks like that, huh?

Saturday, April 25, 2009

Tripping down under (part 2) ... journeying over water for our zoo adventure.

Suzi and I caught a bus round the corner from our lodge (more about the Sydney public transport later). It is good to go on a trip with someone who had the foresight to research transportation dues before going on a trip. Suzi had purchased transport passes for AUD 38 at the airport: good for seven days and gave us access to most bus, rail and ferry lines in Sydney. This is truly value for money: a regular bus ticket for a 7 km trip cost about AUD 4.90 a single way. I guess they are trying to make it easy for the tourists to move around a lot; then they would spend more, no?

The bus wound around the suburbs. It looked to me as though Sydney doesn't believe in zoning. You could see mid-size shopping malls in the middle of the suburbs and just a few blocks away, rows of shops offering everything from dry cleaning, Lebanese bread, lotto and liquor to real estate. The houses seem to be on a small side, but Suzi pointed out that it gets really cold in winter and that smaller houses are more efficient to heat. However, although the gardens of the homes are the size of a postage stamp, they are immaculately kept and boasts a variety of colours. Some even shaped their shrubs into topiaries! None of the apartment buildings are over 5 stories high, which is amazing. I don't know whether this means Sydney doesn't have very many people (which I doubt) or because the development sprawls away into the countryside.

We got off near a train station to try out the double decker train to get to Circular Quay.


On board the train we were giggling away like demented girls as we craned our necks about, commenting at the age of the well-preserved vinyl seats and generally just oohing and ahing. Circular Quay housed the ferries harbour that we took to get to Taronga Zoo, where I got this cute little fellow for my niece.

However, it seems that he spends most of the time on my bed. Huh.

We bought breakfast at a cafe at the port?dock? of the ferry heading towards Taronga. Suzi told me that the school holiday had just begun with Easter last weekend. There was a large number of families also waiting for the ride. Many comprised of three generations; so for those who generalise about the moral and family institution decay of Western society, better shut your trap. There was quite a few where it was the grandparents who took the kids out; no parents. It was noisy and cheery and this atmosphere continued on board the ferry.

The ferries weren't very large and are quite old, I think. Autumn in Sydney was blissfully cool and the delicious cold breeze over the water was a fantastic contrast to the heat back home. The journey took us past a few major landmarks of Sydney such as:

The famed Sydney bridge. Apparently there are guided tour to the bridge inclusive of a climbing expedition. Those crazy mat sallehs.


The Sydney Opera House reminded me of some building in Shah Alam. Don't ask me why. I was just shocked to see how close it was: something that I had not thought to see except on postcards and television. The harbour water looked quite clear and did not carry the unpleasant reek that one often associates with a busy harbour. No debris, no floating pseudo jellyfishes (i.e. plastic bags) either. Fantastic.


I was admiring that white structure on the foreground of this picture; no idea what it was. You can see sailboats moored in the cove in the background; there are all kinds of water vessels to be found here, from paddleboats, schooner-types, water taxis etc.


The ride on this baby wasn't covered by our transport pass, so we only took pictures.


Boats big and small idylly made their way around the harbour, unhurried and casual.

Some of the hydrofoils carry passengers for special tour trips around the Darling Harbour and stuff. They serve food and provide some kind of entertainment on board.


This classic ship also carries passengers for tour trips to reminisce about the historical beginnings of Sydney. Unfortunately none were moored when we were at the quay; it would have been nice to be able to get on board to see what it's like.

Next: Wildlife encounter!

Wednesday, April 8, 2009

Love is a Splendiferous Thing

To love and be loved unconditionally is the penultimate gift, no?



Please don't wait until that person is no more for you to show your love, even if you never say it.

Monday, March 30, 2009

Robbing Peter to Pay Paul ... The Good Version

The economic crunch is hurting pretty much everyone. You can't help but feel your blood boil when you read about how the AIG execs are still getting their bonuses (after screwing up other people's life savings, thank you very much) and the President of the Royal Bank of Scotland keeping his USD 1 million pension (also after screwing up other people's life savings).

And then you read how the doctors at the Beth Israel Deaconess Medical Centre in Boston is giving up part of their pay to help support their departments and stave off lay-offs. It appears that each of the heads of department are willing to contribute $27,000 of their annual salary to the cause. I have no idea whether this would suffice to bolster the financial woes of the hospital, but I think a contribution of $350,000 would make a dent to reduce potential redundancy.

Your faith in human nature is restored.