Transcranial Doppler findings in reversible cerebral vasoconstriction syndrome.

BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome characterized by reversible segmental vasoconstriction of cerebral arteries. Digital subtraction and noninvasive angiograms are typically used to detect vasospasm; however, due to the dynamic nature of RCVS these tests are often negative initially and may need to be repeated multiple times. Transcranial Doppler (TCD) offers many advantages as it is a noninvasive and nonradiating modality. Studies investigating its diagnostic utility for capturing vasospasm and studying temporal evolution of RCVS are limited. METHODS: We conducted a retrospective analysis on all patients admitted with suspected RCVS from 2009 to 2014 to a single center at Jackson Memorial Hospital. RESULTS: We identified 9 patients (88.9% women, age 46.6 ± 13.5 years) who met diagnostic criteria for RCVS. All patients presented with headache, 5 developed nonaneurysmal subarachnoid hemorrhage, 5 developed ischemic stroke, and 1 developed posterior reversible encephalopathy syndrome. At initial TCD, 8 patients had increased flow velocities in at least one large intracranial artery and ultimately all patients had abnormal middle cerebral artery flow velocity over the course of RCVS. We found that the number of vessels with abnormal velocities increases gradually and peaks between 13 and 14 days after first symptom onset. Finally, mean flow velocity of affected vessels also increases around the same time frame and normalizes at 60 days. CONCLUSIONS: In this case series, we found TCD to be useful in detecting vasospasm and monitoring the temporal evolution of RCVS. TCD could be a helpful clinical tool to diagnose and monitor RCVS.

Evidence and explanation in Cicero's On Divination.

In this paper, I examine Cicero's oft-neglected De Divinatione, a dialogue investigating the legitimacy of the practice of divination. First, I offer a novel analysis of the main arguments for divination given by Quintus, highlighting the fact that he employs two logically distinct argument forms. Next, I turn to the first of the main arguments against divination given by Marcus. Here I show, with the help of modern probabilistic tools, that Marcus' skeptical response is far from the decisive, proto-naturalistic assault on superstition that it is sometimes portrayed to be. Then, I offer an extended analysis of the second of the main arguments against divination given by Marcus. Inspired by Marcus' second main argument, I formulate, explicate, and defend a substantive principle of scientific methodology that I call the "Ciceronian Causal-Nomological Requirement" (CCR). Roughly, this principle states that causal knowledge is essential for relying on correlations in predictive inference. Although I go on to argue that Marcus' application of the CCR in his debate with Quintus is dialectically inadequate, I conclude that De Divinatione deserves its place in Cicero's philosophical corpus, and that ultimately, its significance for the history and philosophy of science ought to be recognized.

La enseñanza y el diagnóstico de la muerte / Teaching and the death diagnosis

La misión principal del médico es la asistencia a los enfermos; no obstante, diagnosticar la muerte correctamente puede permitir la continuación de la asistencia a aquellos que están en las denominadas muerte aparente y muerte clínica. Existen evidencias de que la enseñanza del diagnóstico de la muerte, no goza de igual atención en el currículo de la carrera de Medicina, en cuanto a forma, contenido y desarrollo de habilidades. Por ello se decidió profundizar en estos aspectos, para precisar si está concebido su estudio en los programas de enseñanza de la carrera de Medicina y si los alumnos adquieren correctamente los métodos y habilidades para el diagnóstico de la muerte. Se revisaron los programas de estudio de la carrera de Medicina desde el 1ro. hasta el 6to. año y se realizó una encuesta anónima a 225 alumnos de 5to. año de las facultades "Finlay-Albarrán" y "Enrique Cabrera" en los cursos 2001, 2002 y 2003, antes de la clase de Tanatología que se imparte en la asignatura Medicina Legal en ese año. Se halló que en ningún año ni asignatura está concebida la enseñanza del diagnóstico de la muerte y se identificaron en los alumnos deficiencias para establecer este diagnóstico y los signos de la muerte.

The main mission of a physician is to give medical assistance to the patients; however, to diagnose death correctly may allow to continue assisting those who are in the so-called apparent death and clinical death. There is evidence that no much emphasis is made on the teaching of death diagnosis in the medical career curriculum as regards form, content and development of skills. That's why it was decided to go deep into these aspects to determine wether or not its study is included in the medical career syllabus and to know wether or not the students acquire the methods and skills for the diagnosis of death correctly. The medical career syllabuses were reviewed from the 1st to the 6th year and an anonymous survey was done among 225 5th-year medical students from "Finlay-Albarrán" and "Enrique Cabrera" Medical Faculties in the courses 2001, 2002 and 2003, before the class of Tanatology, which is taught as part of the Legal Medicine subject. It was found that the teaching of death diagnosis is not included in any year or subject. Some deficiencies to establish this diagnosis and the signs of death were observed among the students.

La enseñanza y el diagnóstico de la muerte / Teaching and the death diagnosis

La misión principal del médico es la asistencia a los enfermos; no obstante, diagnosticar la muerte correctamente puede permitir la continuación de la asistencia a aquellos que están en las denominadas muerte aparente y muerte clínica. Existen evidencias de que la enseñanza del diagnóstico de la muerte, no goza de igual atención en el currículo de la carrera de Medicina, en cuanto a forma, contenido y desarrollo de habilidades. Por ello se decidió profundizar en estos aspectos, para precisar si está concebido su estudio en los programas de enseñanza de la carrera de Medicina y si los alumnos adquieren correctamente los métodos y habilidades para el diagnóstico de la muerte. Se revisaron los programas de estudio de la carrera de Medicina desde el 1ro. hasta el 6to. año y se realizó una encuesta anónima a 225 alumnos de 5to. año de las facultades "Finlay-Albarrán" y "Enrique Cabrera" en los cursos 2001, 2002 y 2003, antes de la clase de Tanatología que se imparte en la asignatura Medicina Legal en ese año. Se halló que en ningún año ni asignatura está concebida la enseñanza del diagnóstico de la muerte y se identificaron en los alumnos deficiencias para establecer este diagnóstico y los signos de la muerte(AU)