The snake has served as a medical emblem for more than 2400 years, since its association with the ancient Greek god of medicine and healing, Asclepius, in the 4th century BC. Its symbolic background can be traced further back to the worship of gods of earth's blossom in ancient Egypt and earth-related deities of the archaic period of Greek antiquity. It is featured entwined around a staff of knowledge and wisdom in most anaglyphs depicting Asclepius. The snake was impressed in the Old and the New Testament as well as in the Christian tradition as a symbol of sin, rejuvenation, death, resurrection, asthenia, and therapy. It is postulated that the double-snake motif was reintroduced by Renaissance philosophers as a medical emblem due to the symbolic connections of Hermes with deliverance and redemption. However, its use during the last two centuries seems to lack substantial historical background. The historical, mythological, and traditional retrospection of the snake's symbolism validates its appropriateness in the health-care field.
Intra-parenchymally sited electrodes can be used to consistently identify depolarization events in humans. This technique greatly extends the capability of monitoring for spreading depolarization events in injured patients, as electrodes can be sited without the need for craniotomy. The method provides a new investigative tool for the evaluation of the contribution of these events to secondary brain injury in human patients.
We report the case of a 65-year-old Caucasian woman who experienced two separate episodes of acute renal failure within an 18-month period, both requiring emergency admission and complicated treatment. Each episode was precipitated by hypovolaemia from intestinal fluid losses, but from two rare and independent pathologies. Her first admission was attributed to community-acquired Clostridium difficile-associated diarrhoea (CDAD) and was treated in the intensive therapy unit. She returned 18 months later with volume depletion and electrolyte disturbances, but on this occasion a giant hypersecretory villous adenoma of the rectum (McKittrick-Wheelock syndrome) was diagnosed following initial abnormal findings on digital rectal examination by a junior physician. Unlike hospital-acquired C. difficile, community-acquired infection is not common, although increasing numbers are being reported. Whilst community-acquired CDAD can be severe, it rarely causes acute renal failure. This case report highlights the pathological mechanisms whereby C. difficile toxin and hypersecretory villous adenoma of the rectum can predispose to acute renal failure, as well as the values of thorough clinical examination in the emergency room, and early communication with intensivist colleagues in dire situations.
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