Progress in clinical neurosciences: The 'antiplatelet' agents and the role of the endothelium

The antiplatelet drugs, commonly used in the prevention and treatment of cerebrovascular disease, possess a number of effects that are independent of direct antiplatelet actions. Beneficial and detrimental effects both occur. The endothelium is an important mediator of these non-antiplatelet effects. We performed a literature search to locate articles related to acetylsalicylic acid (aspirin), clopidogrel, ticlopidine, and dipyridamole and the interactions of these medications with the endothelium. The role of each of the above medications is explored in relation to vasodilation, inflammation, oxidation, platelet-leukocyte interactions, and thrombogenic tendency via platelet-vessel wall interactions.

[Imagination: its definition, purposes and neurobiology]

Imagination, distinct from imagery, memory, and cognition, is a poorly understood but fascinating cognitive ability of human beings. Herein, imagination is defined as 'the cognitive process which enables the individual to manipulate intrinsically generated phenomenal information in order to create a representation perceived by the mind's senses.' This definition is expanded within the context of the neurobiology of the brain and the possible purposes the imagination fulfills in daily living, human development, and normal behavior.

Extensive myocardial infiltration by hemopoietic precursors in a patient with myelodysplastic syndrome

Background

Although myocardial infiltration with leukemic blasts is a known finding in patients with acute leukemia, this phenomenon in myelodysplasia is not reported in the literature. Cardiac symptoms in patients with myelodysplasia are often due to anemia and may be due to iron overload and side effects of therapy.

Case presentation

Herein we report the first case of neoplastic infiltration of the heart with associated myocardial necrosis in a patient with myelodysplasia. It was associated with unicellular and multifocal geographic areas of necrosis in the left ventricle and the interventricular septum. It is likely that cardiac compromise in our patient was due to a combination of restrictive cardiomyopathy due to leukemic infiltration, concomitant anemia, cardiac dilatation, conduction blocks and myocardial necrosis. Myocardial necrosis was most likely due to a combination of ischemic damage secondary to anemia and prolonged hypotension and extensive leukemic infiltration. Markedly rapid decrease in ejection fraction from 66% to 33% also suggests the role of ischemia, since leukemic infiltration is not expected to cause this degree of systolic dysfunction over a 24-hour period. The diagnosis was not suspected during life due to concomitant signs and symptoms of anemia, pulmonary infections, and pericardial and pleural effusions. The patient succumbed to cardiac failure.

Conclusion

Hemopoietic cell infiltration was not considered in the differential diagnosis and contributed to this patient's morbidity and mortality. This case highlights the clinical importance of considering myocardial infiltration in patients with myelodysplasia and cardiac symptoms.

Future practice location and satisfaction with rural medical education: survey of medical students

OBJECTIVE

To explore the desired future practice location of a cohort of medical students with strong rural representation and to inquire whether they were satisfied with their medical experiences in rural primary care settings.

DESIGN

Survey questionnaire.

SETTING

The College of Medicine at the University of Saskatchewan in Saskatoon.

PARTICIPANTS

One hundred twenty-two medical students.

MAIN OUTCOME MEASURES

Demographic information, plans for future practice, and opinions on rural medical experiences in primary care settings.

RESULTS

Although students from both rural and non-rural backgrounds were highly satisfied with mandatory and voluntary rural experiences and considered them valuable for their medical education, fewer than 10% of the 122 students desired to work in centres with less than 10 000 population. Only 2 students hoped to practise in such locations. Most students interested in family practice were interested in urban practice, and most students from rural areas were not interested in rural practice.

CONCLUSION

Both rural and non-rural students were highly satisfied with their medical education in rural primary care settings, but this did not mean either group wanted to practise in rural settings. Demographic profiling of students (to ascertain whether they have rural origins) and assessing satisfaction with rural medical education give only partial information on who might choose to practise family medicine in rural areas.