December 2005

Meckel's diverticulum is among the most common congenital defects of the gastrointestinal tract. Although often considered a disorder of childhood, it can also be diagnosed in adults. Meckel's diverticulum is often asymptomatic. When patients present with symptoms, diagnosis is complicated because the features are similar to those of many other gastrointestinal conditions, and traditional imaging studies often do not demonstrate an obvious abnormality. Management is evolving, and there is no consensus on the appropriate approach to treatment. This article discusses the pathophysiology, associated complications, and management options for this often-overlooked condition.

Drug-induced aseptic meningitis is an uncommon and mysterious adverse reaction to some commonly used medications. This condition can mimic the signs and symptoms of a true infectious meningitis. This article provides a concise summary of drug-induced aseptic meningitis, outlining the challenges a primary care physician may face in making the clinical diagnosis. An illustrative case highlights the role of trimethoprim/sulfamethoxazole in the pathogenesis of aseptic meningitis. Although trimethoprim/sulfamethoxazole is the most common antibiotic associated with drug-induced aseptic meningitis, to date only 27 cases have been described in the literature.

The standard methods of teaching clinical medicine are stated. Lectures are simply sources of information that may not always be understood or used by the listeners. Lecturers are not true teachers, because they have no feedback from the listeners. Certain aspects of self-learning are described. This method of learning, guided by a true teacher, should be mastered during internship and residency. Self-learning places patients at the center of the activity where doctors care for them and simultaneously learn medicine by asking themselves questions about their patients and searching for the answers. A clinician who learns medicine using this approach may know more about a problem than can be found in standard textbooks. Textbooks discuss the general rules about an illness, whereas the expert clinician may know the exceptions to such rules. The self-learner always correlates the data found by one technique with the data found using other techniques. This approach improves all skills, including thinking. The self-learner must teach. This discipline demands that trainees organize the data they collect and improve their skill of communication. Finally, trainees should learn early in their training that good doctors make many types of decisions about their patients, and such decisions must always be made in favor of the comfort and convenience of their patients.