UTMJ UTMJ University of Toronto Medical Journal DECEMBER 2000 Volume 78, Number 1/December, 2000 A student-run scientific publication. Established in 1923. 4 Letter to Patrons 26 Clinicopathological Correlation 5 Preface 38 News and Views 8 Patients with Facial Difference: Assessment of 58 Morning Report Information and Psychosocial Support Needs Karen M. Horton, Lorna Renooy and Christopher R. Forrest 63 Quick Diagnosis 14 Dystrophinopathies and Nondystrophinopathies: 68 Technology Review From Molecular Biology to Clinical Diagnosis Lorraine V. Hajdur and Suneil K. Kalia 71 Historical Review VOLUME 78 / No 1 22 Phantom Menace: The Mystery of Phantom Limb Pain: 73 Book Reviews A Case Report and Review of the Literature Sonja Alexandra McVeigh 81 Crossword www.utmj.org An excellent routetoreach Healthcare your patients’lipid targets Pharmaceuticals Life-Saving Plasma Products Choose Equipment and Products first! to Diagnose Human Health In achieving effective lipid control, many delays may prevent you from reaching your targets. LIPITOR lane Possible delays ahead clear ahead NewNew clinicalclinical datadata New data1 showed LIPITOR actually gets patients to tar- get§ with fewer titrations and fewer repeat visits than Zocor ®, Mevacor ®, or Lescol®. Give your new statin patients the benefits of LIPI- Exceptional LDL-C reductions – 39-60% over the full dose range2 Significantly better LDL-C and TC/HDL-C ratio reductions, compared to Zocor or Pravachol® at starting doses3,4,5∞‡ The added benefit of excellent TG reductions – 19-37% over the full dose range2 Priced to be competitive – LIPITOR costs less than Zocor or Pravachol at usual starting doses6 An excellent first choice when you choose statintherapy. § Randomized, 54-week, 30 centre controlled trial treating 662 patients to NCEP targets using atorvastatin, simvastatin, lovastatin, and fluvastatin. Pravastatin was There are many ways to say Bayer not included in the study since its lipid-lowering profile is between that of fluvastatin and simvastatin, and at the time of study initiation, it was not as widely prescribed as lovastatin. ∞ Results at 16 weeks in a study of 177 hypercholesterolemic patients taking LIPITOR 10 mg or Zocor 10 mg in a one-year, randomized, double-blind study. The LIPITOR group had LDL-C and TC reductions of 37% and 29% and an HDL-C increase of 7%, while the Zocor group had LDL-C and TC reductions of 30% and 24% respectively (p<0.05) and an HDL-C increase of 7%. ‡ Results at 16 weeks in a study of 305 hypercholesterolemic patients taking LIPITOR 10 mg or Pravachol 20 mg in a one-year, randomized, double-blind study. The LIPITOR group had LDL-C and TC reductions of 35% and 25% and an HDL-C increase of 6%, while the Pravachol group had LDL-C and TC reductions of 23% and 17% respectively (p<0.05) and an HDL-C increase of 8%. LIPITOR* is an HMG-CoA reductase inhibitor (statin). LIPITOR is indicated as an adjunct to diet for the reduction of elevated total cholesterol, LDL-C, triglycerides, and apolipoprotein B in hyperlipidemic and dyslipidemic conditions (including primary hypercholesterolemia, combined [mixed] hyperlipidemia, dysbetalipoproteinemia, hypertriglyceridemia, and familial hypercholesterolemia) when response to diet and other non-pharmacological measures alone has been inadequate. See prescribing information for complete warnings, precautions, dosing and administration. LIPITOR is contraindicated during pregnancy and lactation. Lipid levels should be monitored periodically and, if necessary, the dose of LIPITOR adjusted based on target lipid levels recommended by guidelines. Caution should be exercised in severely hypercholesterolemic patients who are also renally impaired, elderly, or are concomitantly being administered digoxin or CYP 3A4 inhibitors. Liver function tests should be performed before the initiation of treatment, and periodically thereafter. Special attention should be paid to patients who develop Changing the world elevated serum transaminase levels, and in these patients measurements should be repeated promptly and then performed more frequently. The effects of atorvastatin induced changes in lipoprotein levels, including reduction in serum cholesterol, on cardiovascular morbidity, mortality, or total mortality have not been established. Registered trademarks: Zocor®/Mevacor® – Merck Frosst; Pravachol® – Bristol-Myers Squibb; Lescol® – Novartis. with great care. University of TorontoUTMJ Medical Journal Volume 78, Number 1/December, 2000 A student-run scientific publication. Established in 1923. Table of Contents 4 Letter to Patrons Morning Report 58 The Young Golfer’s Swollen Leg 5 Preface Martin C. Chang and Catherine Chung Plastic Surgery Quick Diagnosis 8 Patients with Facial Difference: Assessment of 63 Piero Tartaro and Steven Hwang Information and Psychosocial Support Needs Karen M. Horton, Lorna Renooy and Christopher R. Forrest Technology Review 68 UltraLIGHT: New Frontiers in Medical Imaging Molecular Biology Victor Yang, Alex Vitkin, Maggie Gordon, Alvin Mok, 14 Dystrophinopathies and Nondystrophinopathies: Louis Wongkeesong, Paul Muller, Norman Marcon, From Molecular Biology to Clinical Diagnosis Sheldon Mintz and Brian Wilson Lorraine V. Hajdur and Suneil K. Kalia Historical Review Neurology 71 The University of Toronto as a World Leader in 22 Phantom Menace: The Mystery of Phantom Limb Medical Genetics: Past, Present and Future Pain: A Case Report and Review of the Literature Charis Kepron, Chris Lane, David Maslove, Sonja Alexandra McVeigh Vladislav Miropolsky, and Peter Zakrzewski Clinicopathological Correlation Book Reviews 26 The Parasite that Wasn’t: A Case of Detached Ciliary 73 Medical Education below the 49th Parallel Tufts in Cerebrospinal Fluid Chris McIntosh Andrea K. Boggild, Yael Friedman and Christine A. Sundermann 74 Modernizing a Class Curriculum Elana Lavine 30 A Perplexing Peripheral Neuropathy Andrew S.-P. Lim and Warren Shih 75 The Monster Psychiatrist on the Loose in Toronto Christopher Tam News and Views 38 In the Literature 76 An Updated Respiratory Classic Philippe L. Bedard Amy S.M. Tam 40 Prolific Scientist Profiles: The 2000 Gairdner Awards 76 The Vanishing Art of Prognosis Rohit Bose Lilia Malkin 42 Prolific Scientist Profiles: 78 Is There More to Life than Medicine? An Interview with Dr. Jack Hirsh, 2000 Gairdner Jacqueline H. Perry Award Winner Rohit Bose 79 Healthy Diet for Dummies Wilson W. Marhin 44 Back to Basics IV: Fracture Management Murray Beuerlein, Chris Hall and Emil H. Schemitsch 80 Being Open to Second Opinions Sanjeev Luthra 51 Law and Ethics in Medicine: The Ethics of Organ Donation: Examining Consent Policies and Donor Criteria 81 Crossword Denise Mackey and Maria Kjerulf 55 Forum: Evaluating Financial Supports for Medical Students Steve Singh Front cover illustration by Andrée Jenks and Victoria Rowsell, Department of Biomedical Communications, University of Toronto. volume 78, number 1, December 2000 1 University of TorontoUTMJ Medical Journal Room 2141, Medical Sciences Building, 1 King’s College Circle, Toronto, Ontario M5S 1A8 A student-run scientific publication. Established in 1923. UTMJ Staff EDITORS-IN-CHIEF CPC EDITORS UTMJ CROSSWORD EDITORS Prateek K. Lala, M.Sc. (0T3) Andrea K. Boggild, M.Sc. (0T3) Angela Marrocco, B.Sc., B.P.H.E. (0T3) Valerie Panet-Raymond, M.Sc. (0T3) Yael Friedman, M.Sc. (0T3) Sarah A. Shaikh, B.Sc. (0T3) Andrew S.-P. Lim, B.Sc. (0T3) SENIOR ASSOCIATE EDITORS Warren Shih, B.Sc. (0T3) EDITORIAL BOARD Michael A. Levesque, Ph.D. (0T3) Kathy Barnard, B.Sc. (0T2) Kenji S. Miyata, Ph.D. (0T3) QUICK DIAGNOSIS EDITORS Steven W.H. Hwang, B.Sc. (0T3) Sam Bederman, M.Sc. (0T1) JUNIOR ASSOCIATE EDITORS Shoba Subramanian, B.Sc. (0T3) Jonathan Dostrovsky, Ph.D. Stanley Liu, Ph.D. (0T4) Piero Tartaro, B.Sc. (0T3) Patrick Gullane, M.D., F.R.C.S.(C), F.A.C.S. Andrea Molckovsky, M.Sc. (0T4) Mohammed T. Hussain, B.Sc. (0T2) Jamie I. Spiegelman, B.Sc. (0T4) MORNING REPORT EDITORS Nancy McKee, M.D. Karol Wroblewski, M.Sc. (0T4) Martin C. Chang, Ph.D. (0T3) Maria Muraca, M.Sc. (0T3) Catherine Chung, B.Sc. (0T3) David Naylor, M.D., D.Phil. LAYOUT EDITOR Peter Ray, M.D., Ph.D. Andrea E. Waddell, B.Sc. (0T3) SENIOR TECHNOLOGY REVIEW EDITOR Andrew Schumacher, Ph.D. (0T1) Victor X.D. Yang, M.A.Sc. (MD/PhD3) Nicholas Tan, B.Sc. (0T3) MANAGING EDITORS David B.Yan, M.D. Mohammed Ali Warsi, M.Sc. (0T3) BOOK REVIEW EDITOR Sharon Cushing, B.Sc. (0T3) Irfan A. Dhalla, B.A.Sc. (0T3) Anand Govindarajan, B.Sc. (0T3) FACULTY ADVISORY BOARD Natalie Kontakos, B.Sc. (0T3) SENIOR COPY EDITORS Chair, Allan S. Detsky, M.D., Ph.D. Paul J. Belletrutti, B.Sc. (0T3) Jane Aubin JUNIOR MANAGING EDITOR Philip M. Buckler B.Sc. (0T3) Michael Baker Larry Pan, B.Sc. (0T4) Dawn Owen, B.Sc. (MD/PhD 2) John Chalis Jay S. Keystone TREASURER JUNIOR COPY EDITORS Murray Krahn Christopher A.K.Y. Chong, B.Sc. (0T3) Timothy Hanna B.Sc. (0T4) Tony Lang Amy E. Lin, B.Sc. (0T4) David Naylor ART DIRECTORS Anil J. Misir B.Sc. (0T4) Andree Jenks, B.Sc. (M.Sc. BMC, 0T1) Christina R. Tunzi, M.Sc. (0T4) Don Redelmeier Victoria Rowsell, B.Sc. (M.Sc. BMC, 0T1) June Ma, B.Sc. (0T4) Duncan Stewart Sharon E. Straus SENIOR NEWS AND VIEWS EDITORS WEBMASTER Donald Stuss Philippe L. Bedard, B.ArtsSc. (0T3) Errol Colak, B.Sc. (0T3) Ian Tannock Steve K. Singh, B.Sc. (0T3) Bryce Taylor JUNIOR WEBMASTERS John Trachtenberg NEWS AND VIEWS SERIES EDITORS Ralph Baddour, B.Sc., B.E.Sc. (0T4) Donald Wasylenki Back-to-Basics Olivia Y.Y Cheng, B.Sc. (0T4) Murray J. Beuerlein, M.Sc. (0T3) Christopher J. Hall, (0T3) HISTORICAL REVIEW EDITORS TYPESETTING Law and Ethics in Medicine Jewel Samadder, B.Sc. (0T3) Type and Graphics Manish Shah, B.Sc. (0T3) Vladislav Miropolsky, B.Sc. (0T3) Prolific Scientist Profile Rohit Bose, B.Sc. (MD/PhD2) JUNIOR HISTORICAL REVIEW EDITORS Julia Grebenyuk, B.Sc. (0T4) JUNIOR NEWS AND VIEWS EDITORS Karoon C. Danayan, B.Sc. (0T4) Ann M. Stewart, M.Sc. (0T4) E-mail: [email protected] • http://www.utmj.org • Phone: (416) 946-3047 • Fax: (416) 971-2163 2 University of Toronto Medical Journal UTMJ Subscribers The University of Toronto Medical Journal is funded in part by its subscribers and the Medical Society.