Mystery case: a 63-year-old man with progressive proximal pain and weakness.

A 63-year-old man with a history of type 2 diabetes presented with hip and shoulder pain in June 2010. He was on atorvastatin 80 mg daily and his creatine kinase (CK) was mildly elevated, so he was switched to simvastatin 20 mg daily. Three months later, he was referred to a rheumatologist.

Clinical examination for prognostication in comatose cardiac arrest patients.

Objective: To build new algorithms for prognostication of comatose cardiac arrest patients using clinical examination, and investigate whether therapeutic hypothermia influences the value of the clinical examination.

Methods: From 2000 to 2007, 500 consecutive patients in non-traumatic coma were prospectively enrolled, 200 of whom were post-cardiac arrest. Outcome was determined by modified Rankin Scale (mRS) score at 6 months, with mRS≤3 indicating good outcome.

Hippocampal magnetic resonance imaging abnormalities in cardiac arrest are associated with poor outcome.

Background: The role of neuroimaging in assessing prognosis in comatose cardiac survivors appears promising, but little is known regarding the import of particular spatial patterns. We report a specific spatial imaging abnormality on magnetic resonance imaging (MRI) that portends a poor prognosis: bilateral hippocampal hyperintensities on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.

Methods: Eighty sequential comatose cardiac arrest patients underwent MRI scans.

Clinical examination for outcome prediction in nontraumatic coma.

Objectives: Determine the utility of the neurologic examination in comatose patients from nontraumatic causes in the modern era.

Design: Prospective observational study.

Setting: Single academic medical center.

An update on brain death criteria: a simple algorithm with complex questions.

Brain death criteria have been based on 3 cardinal features throughout history: coma, brainstem areflexia, and apnea, and thus have undergone little change. In 1995, the American Academy of Neurology (AAN) detailed these criteria in a step-by-step fashion that included meeting prerequisites, performing the clinical examination, performing ancillary testing, and documentation. Fifteen years later, many questions still remain regarding the diagnosis of brain death.

Enhancement's place in medicine.

Many enhancement technologies are distributed by healthcare professionals-by physicians-who are held to the Hippocratic Oath and the goals of medicine. While the ethics of enhancement has been widely discussed with regard to the social justice, humanism, morals and normative values of these interventions, their place in medicine has not attracted a great deal of attention. This paper investigates the potential for enhancement technologies to fulfil the goals of medicine, arguing that they play a role in promoting the health of individuals, and thus, an unavoidable place in medicine.

Neurologic examination and extubation outcome in the neurocritical care unit.

Background: Extubation failure in the neurocritical care unit (NCCU) is difficult to predict, and is an important source of prolonged intensive care, exposure to morbidity, and increased cost.

Methods: In this observational cohort study in the NCCU of a tertiary care hospital, we examined patients undergoing extubation or tracheostomy with >6 h of intubation. Observational data were collected at the time of the decision to extubate or pursue tracheostomy.