Petr Skrabanek: the abominable no-man.

Petr Skrabanek (1940-94) was a Czech-born doctor, polemicist and literary scholar. He qualified in medicine in Ireland, and spent most of his career at the Medical School of Trinity College Dublin. He was an outspoken critic of modern medicine, particularly of what he called 'coercive healthism'.

When is feeding via a percutaneous endoscopic gastrostomy indicated?

Purpose Of Review: This review addresses current controversies regarding appropriate indications for percutaneous endoscopic gastrostomy (PEG) insertion. We address specific indications, namely, dementia, stroke, aspiration, motor neurone disease/amyotrophic lateral sclerosis, and head and neck cancer. We recommend practical strategies for improving patient selection.

W Somerset Maugham (1874-1965) and St Thomas's Hospital: Medical School and the making of a writer.

William Somerset Maugham was one of the most successful and prolific authors of the twentieth century. He excelled in several genres, writing novels, plays, short stories, travel-books, memoir and criticism. His prose style was simple, witty; his world view weary and cynical.

Ethereal and material gain: unanticipated opportunity with illness or disability.

When caregivers address the positive aspects of illness or disability, there is a risk of patronising the sufferer. It is equally problematic when secondary gain is judged in a negative light and impedes an effective doctor-patient relationship. Changing attitudes, and particularly the negative perception of a patient's gain from illness, are reflected in biographies of artists, philosophers and other creative individuals.

Malignancy-associated gastroparesis: an important and overlooked cause of chronic nausea and vomiting.

A 69-year-old woman was referred to a gastroenterology clinic with a 1-year history of protracted nausea and postprandial vomiting. She had a background of gastro-oesophageal reflux disease, irritable bowel syndrome and chronic obstructive pulmonary disease with a significant smoking history. Her laboratory work-up including autoimmune screen, coeliac serology and synacthen test were unremarkable.

In Praise of Richard Asher (1912-1969).

This essay aims to stimulate a reawakening of interest in the writings of the physician Richard Asher (1912-1969), who is now best known for coining the term "Munchausen's syndrome." Asher's essays are as relevant now as when first published. His articles were a model of clarity, wit and elegance: he argued consistently for precision in thought and expression, for logic in clinical thinking, and for evidence in treatment.

Against narrative medicine.

This essay aims to provoke debate on how and what the medical humanities should teach. It argues that the field has been dominated (to its detriment) by two misguided movements, postmodernism and narrative medicine, and that it should be redirected from utilitarian aims towards the goal of exposing medical students to a climate of thought and reflection.

Motility disorders in the patient with neurologic disease.

Gastrointestinal symptoms are common in the patient with chronic neurologic disease and may loom large in terms of impact on quality of life and on nutrition and mobility. A knowledge of the range of gastrointestinal disorders associated with a given neurologic disease, together with an understanding of the risks and benefits of various therapeutic options and approaches, should aid gastroenterologists in their efforts to contribute to the care of these patients. In most instances a multidisciplinary team (neurologist/neurosurgeon, gastroenterologist, nutritionist, therapist, specialist nurse) aware of the wishes and needs of the family and their carers and mindful of the nature and the natural history of the underlying disease process are best placed to assess and manage these problems.

Symptomatic stent cast.

Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis.

Endoscopy in pregnancy.

Endoscopy is rarely required during pregnancy. The potential risks of endoscopy during pregnancy include foetal hypoxia due to sedative drugs and exposure to radiation. There is no evidence that endoscopy precipitates premature labour, and studies in this area have concluded that endoscopy during pregnancy is generally safe.

Intestinal tuberculosis mimicking Crohn's disease: lessons relearned in a new era.

Over 400 000 cases of tuberculosis existed in Europe in 2002, 1% of which were intestinal tuberculosis. With population migrations on the increase, physicians may have to face an increase in intestinal tuberculosis. One of the attributes of intestinal tuberculosis is its ability to present in nonspecific ways and to mimic other disorders, in particular inflammatory bowel disease.