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From the Four Humours to Antisepsis: A Radiologist’s Walk Through Medical Edinburgh

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

D’Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Adjunct Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

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Abstract:
This article explores Edinburgh’s pivotal role in the evolution of medicine through the perspective of a radiologist attending a medical conference. Walking from the Real Mary King’s Close to Surgeons’ Hall and the old Royal Infirmary, the author reflects on the transition from humoral theory to antiseptic surgery, highlighting Joseph Bell, Joseph Lister, and a remarkable Brodie’s abscess specimen. The journey underscores the enduring importance of observation, evidence, and compassionate patient care.

Key Words: medical history, Edinburgh, antisepsis, radiology.
Medical history is local and walkable in Edinburgh. The Real Mary King’s Close, the Surgeons’ Hall Museums (Royal College of Surgeons of Edinburgh), and the old Royal Infirmary buildings near Infirmary Street sit within a short walk of one another and trace medicine from the humoral era to antisepsis.
Joseph Bell’s clinical observation, taught at the Edinburgh medical school, inspired Conan Doyle’s Sherlock Holmes—and remains a useful emblem of diagnostic reasoning, including the inference-from-evidence at the heart of radiology.
Joseph Lister’s antisepsis is commemorated on Infirmary Street by a plaque installed in 1957 by physicians from Toronto.
William Ernest Henley wrote “Invictus” (1875) while under Lister’s care, fighting to save his remaining foot from tuberculosis of the bone; he later inspired Stevenson’s Long John Silver.
Brodie’s abscess is a subacute/chronic osteomyelitis presenting as a walled-off intraosseous abscess, classically in the metaphysis of a long bone (often the tibia), typically due to Staphylococcus aureus. It is characteristically indolent and can mimic a bone tumour. On radiographs it appears as a lucent lesion with a sclerotic reactive rim; on MRI the “penumbra sign”—a rim of granulation tissue around the cavity—is a helpful discriminator. The museum’s specimen, in which the patient fashioned a wooden plug to drain the cavity intermittently, is a striking pre-antibiotic illustration of the same lesion clinicians still encounter today.
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Related Terms: Radiology, medical history, Edinburgh, antisepsis, radiology
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Error in Radiology: Negligence or Human Nature

D'Arcy Little, MD CCFP FRCPC, Chief of Diagnostic Imaging, Orillia Soldiers' Memorial Hospital,
Adjunct Clinical Lecturer, Department of Medical Imaging, University of Toronto, Toronto, ON,
Forensic Radiologist, Forensic Sciences and Coroners' Complex, Toronto, ON,
2015 Resident in Scientific Communications, Banff Centre, Banff, AB.

Related Terms: Radiology, radiology, errors

Diagnostic Radiology in Low Back Pain

Diagnostic Radiology in Low Back Pain

Teaser: 

Dr. Ted Findlay, D.O., CCFP,1 Amar Suchak, MD, FRCP(C),2

1Clinical Assistant Professor, Department of Medicine, University of Calgary, Private Family Medicine practice, Medical Staff, Alberta Health Services, Calgary Zone, Calgary, Alberta.
2Clinical Assistant Professor Department of Radiology, Department of Nuclear Medicine, University of Calgary, Calgary, Alberta.

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Abstract: Many clinicians believe that imaging is necessary to accurately diagnose and manage low back pain. However, there is good evidence that in the absence of "Red Flags", there is an overuse of both routine X-rays and advanced diagnostic imaging such as MRI. When imaging is used without appropriate clinical indications, it is rare for the results to lead to a change in a treatment plan. Management is based on adequate history and confirmatory physical examination. This article uses three actual cases as the basis for exploring the place of diagnostic imaging in treating low back pain.
Key Words: low back pain, diagnosis, radiology, indications, appropriate.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
1. While imaging may be required in the management of specific cases of low back pain particularly when "Red Flags" are present, it is rare that unexpected findings will result in a change of the treatment plan.
2. Be very cautious about the terminology used to describe the results of imaging studies and whenever possible normalize the results for the patient. Many abnormal findings may be "normal" for patients in older age groups. Many may be present in patients who are pain free.
3. Ensure that the patient understands that the results of the images are not necessarily a barrier to recovery.
4. Except to establish the boney contours of the spine, when advanced imaging is required an MRI examination is often the preferred option.
5. Be very cautious about attributing the cause of a patient's pain to the results found on imaging. Careful correlation with the clinical presentation is required before deciding on any change in treatment.
In the absence of clinical "Red Flags", there is no indication to image the spine before initiating treatment.
It is never appropriate to delay treatment for mechanical low back pain to wait for an imaging procedure.
Prepare the patient, before advanced imaging is performed, that there is a very high likelihood that the investigation will find "abnormalities" but that these changes are usually the result of natural aging and no cause for concern.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, diagnosis, radiology, indications, appropriate