El Borak, by Robert E. Howard
The White Wolf — a.k.a. El Borak — is my second favorite Howard character (with Solomon Kane being number one). El Borak has swashbuckling adventures in the early part of the twentieth century: think Lawrence of Arabia with a liberal dash of sword and sorcery. His stories have been out of print for decades, but will be available Tuesday in a nice new edition.

Jirel of Joiry and Northwest Smith, by C. L. Moore
Moore was one of the first female adventure pulp writers — she wrote as “C. L.” instead of Catherine to disguise her gender. Most of her stories were published in Weird Tales and have a slight Lovecraftian feel to them.
Jirel is the ruler of a small medieval kingdom and her lands always seem to be under threat from natural, and supernatural, enemies. Her stories tend towards the darker aspect of fantasy.
Northwest Smith is a smuggler and anti-hero in the distant future. His stories have a darker edge to them as well.
The Science Fiction Book Club has inexpensive hardbound collections of Jirel and Northwest Smith. Paizo, under their Planet Stories imprint, also offers a Jirel as well as a Northwest Smith collection. (Paizo also offers several collections of Moore’s husband and fellow writer, Henry Kuttner. Sadly, I haven’t seen any recent reissues of stories by Lewis Padgett, which was the name Moore and Kuttner used when they collaborated together on a story).

Speaking of Paizo, they also are offering what look to be great collections of the Eric John Stark series by Leigh Brackett.

The Plot: At an office building in Manhattan, the workers grouse about a series of small earthquakes the city has been experiencing. Suddenly, there is a larger tremor and one of the workers finds himself caught in the quake. He blacks out for a second and when he comes to, he is pinned by the rubble — and has four arms and four legs.

The Fringe team is called in to examine the office building. So far, no survivors have been found, but many dead bodies. The bodies aren’t normal, however, but each seems to be two separate people fused together. Walter hypothesizes that a “Quantum Tectonic Event” has caused a rip in space that caused the quake and fusion. A survivor is found upstairs: the worker from the opening scene. Walter converses with him while he is slowly dying and learns that the worker is from the alternate universe. Walter has a new theory: an office building from that universe has suddenly merged with the same office building from ours, killing all the inhabitants. Agent Dunham suspects this to be a deliberate act on the part of Newton (the leader of the team from the alternate universe that is trying to destroy ours).

Back at the lab, Walter realizes what has happened — and what will happen. Twenty-five years ago, he and William Bell sent a car to the alternate universe and a short time later, a car of equivalent mass from that universe appeared in ours, merged into a statue. Walter tells the team that a building from our universe will disappear within 35 hours. His only idea how to stop it is to use some of the abilities Dunham gained from Cortexiphan. He drags her and Peter to Jacksonville, where the original Cortexiphan experiments were carried out. He repeats the experiment on Dunham, but it has no effect this time. Belatedly he realizes that her abilities depends on fear, and Dunham no longer experiences fear, but channels it all into anger. Defeated, the three of them return to New York.

While they’ve been in Florida, small earthquakes have started in New York City, signaling that the calamity is impending. The scientists at Massive Dynamic are trying to find a pattern to the quakes, but Walter tells them there is no pattern to find. Instead, he suggests locating the building in New York City of identical mass to the one that appeared from the other universe. They are able to narrow the list down to 147 building, but the thirty-five hours is up. Concern over her failure and the likely loss of life scares Dunham, kick starting her spot-the-things-from-the-other-universe power. She is able to spot a building that weirdly glimmers, a sign that it is the one that is going to disappear. The team is able to identify the building and the authorities evacuate it just in time — with a massive inrush of air the entire building — basement, foundation, and all — disappears.

As the episode ends, Olivia and Peter are heading out for drinks, but when she looks at him, she realizes that he is glimmering too. Walter begs her not to tell Peter the truth.

1. Spellchecker
Manhattan was spelled wrong in the opening scene.

2. Island of Misfit Toys
If the building in Florida has been sealed for 25 years, why did it have toys from the Ice Age movies (’02, ‘06, and ‘09)?

3. Where’s Johnny? He Was Here Just a Minute Ago!
So did a child of identical mass to Peter get transported to the alternate universe when Walter brought Alterna-Peter here?

4. Glimmer Glimmer Glumpkin
If Olivia’s powers detect items from the other universe (that’s what Walter was testing in the classroom after all), why did the building from this universe glimmer?

5. Tick Tock
Why 35 hours? I’m guessing that’s how long it took for the car to appear.

6. Mass Effect
How are they going to be able to find the mass of the alternate universe building when it is merged with ours. Are they assuming it was identical to the one in our universe, just like their Nixon coins and double-decker cars are identical to ours?

7. There’s No Babble Like Good Babble
Quantum tectonic event. That is some grad-A prime of technobabble. It sounds impressive, but notice how none of the words really work together (or at least the two most important: tectonic and quantum. They’re pretty much contradictory — “quantum” suggest atomic or sub-atomic, while “tectonic” is very macro in its implications.)

I so wanted to like this episode with the Peter reveal (that we all knew anyway), but I couldn’t — it was dull. It wasn’t horrible, but an episode this big should be more fulfilling. The Fringe Doomsday Clock stays put.

This week’s Fringe cipher was: REVEAL.
A list of all previous Fringe reviews is available here.
Karl has much more to say.

Lana Lang has been found down and bleeding profusely. She is rushed to the emergency room for resuscitation.

First, they’re shocking a flatline. I’m sure I’ve mentioned at least once before that this is not how to treat a flatline.

How should they proceed? Asystole (the fancy, medical word for a flatline) is tough to treat, and the odds are against you from the start, no matter what television tells you. The key to treating asystole is to correct the underlying cause. One concern: Lana’s lost a lot of blood — there’s at least two panels of her laying supine in large puddles of blood and the staff is splattered with blood. As far as the ER staff is aware, this blood loss is a possible cause of her condition, yet they’ve done nothing to treat it. There’s no blood being transfused — in fact, there’s not even a single IV line, which are important in any resuscitation. (As an aside, the defribrillation paddles are also reversed: the upper paddle should be on Lana’s right, and the lower on the left)

Second, as fancy as that face mask is, it’s not going to be any good at getting the air she needs down into her lungs. I appreciate the fact that Cage at least added a breathing tube entering her mouth, but it’s too narrow to be any use (it needs to be about the width of a thumb to work). Plus, if she’s got a breathing tube in place, why does she need a mask?

Third, Lana is bleeding from her mouth, nose, and eyes. If you were the ER staff, what’s one of the first things that would cross your mind? Hemorrhagic fever (Ebola, Marburg, and for the comic-inclined, the Clench). Sure, none of them are endemic to the US, but in this day and age, who’s to say Lana hasn’t been traveling, or exposed to someone who has? The ER staff would be wearing a lot more protective gear.

On the positive side, fzzCHOOMPH is the best sound effect I’ve seen in quite a while.

Or does he? I think this scenario was really a plot by Buzzy and Susie:

This PSA was found in Adventure Comics #154 as well as the other DC comics from July 1950. The ad was written by Jack Schiff, with art by Bob Oksner.

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Tags: comics psa buzzy wolfie jack schiff bob oksner

Daryl is a 22 year-old college football player hoping to be spotted by pro scouts. In the middle of practice, he suddenly becomes uncontrollably violent. He grabs his opponent and drags him around by his helmet until it finally comes loose, and then he bashes himself in the face repeatedly with the helmet until he starts bleeding.

He is admitted to the hospital for evaluation, but has no memory of the incident. A head CT scan and a psychiatric evaluation — both obtained in the Emergency Room — were negative. House suspects Daryl’s symptoms are due to steroids, even though he tested clean in the Emergency Room. He believes he is on the “good stuff,” i.e. steroids that don’t show up on tests. The rest of the team suspects a pituitary adenoma (a tumor in the pituitary gland) caused by repeated head trauma. Tests for GnRH (gonadotropin releasing hormone, which controls the gonadotropins, which control the production of testosterone in men) are high, but a pituitary MRI is negative, which lends credence to House’s theory of steroid abuse. He tells the team to start Daryl on a somatostatin-analog (a medication which inhibits the pituitary gland) to block the effects of the elevated GnRH.

Daryl denies any use of steroids and begins to suffer a racing heart rate and chest pain. He has an episode of paroxysmal tachycardia (sudden onset of an abnormally fast heart rate) that requires cardioversion to return it to a normal rhythm (by definition “cardioversion” means returning the patient to a normal heart rhythm. This can be done chemically, such as with adenosine, or electrically). Taub reports that the cardiac symptoms do not fit the diagnosis of steroid abuse, so the team gives Daryl’s heart a further work-up including EKG and sestamibi scan (a test that looks at perfusion of the heart itself), but they are completely normal. The differential diagnosis now consists of a PFO (patent foramen ovale, a hole between the two sides of the heart) or hypertrophic cardiomyopathy (muscular thickening of the heart). House favors the latter and has the team put Daryl on a treadmill to stress him until he develops cardiac symptoms. Unfortunately (or fortunately, really), Daryl is in good enough shape that his heart rate never rises high enough to cause a problem. Going for “plan B”, House decides to chemically induce heart stress by injecting Daryl with a vasodilator (such as adenosine or dipyridamole — they mimic the effects of exercise on the heart). Before he injects the medication, however, he notices that the palms of Daryl’s hands are unusually white.

This new symptom causes the team to reassess their diagnosis. Taub thinks Daryl’s pale hands are due to Raynaud’s phenomenom (spasm of the smooth muscles around the small arteries of the fingers), which he thinks is caused by rheumatoid arthritis. Thirteen suspects that Daryl has plaques in his arteries, and these are breaking off and sending tiny clots blocking the arteries in his hands. Chase believes Daryl has Takayasu arteritis (inflammation of the aorta and other large arteries), and Foreman, ever the optimist, blames lymphoma. House likes the last two ideas the best, and tells Foreman to put Daryl on an ethanol drip. If he develops itchiness, it’s a sign of lymphoma, and if he loses his radial pulses, it’s a sign of Takayasu. Daryl develops itchiness while on the drip, so Foreman’s suspicion of lymphoma appears to be correct. Daryl is taken to surgery for a splenectomy, but during surgery Chase notices that his spleen is fine but his liver is inflamed.

Biopsies reveal no lymphoma and a non-specific liver inflammation. The new differential diagnosis includes polymyositis (a chronic inflammation of the muscles), Felty syndrome (rheumatoid arthritis + splenomegaly, which doesn’t fit at all), and viral hepatitis. Blood is drawn for further testing, but Foreman reports that the blood clotted almost immediately after being drawn. This suggests that Daryl has cryoglobulinemia (abnormal proteins in the blood that thicken with cold temperatures), brought on by football practice on cold days, and needs to be started on anticoagulants (blood thinners). This isn’t good enough for Daryl; he doesn’t want to miss his shot at the pros, so he leaves the hospital, promising to come back the next day. At the exhortation of Daryl’s mother, Foreman tags along to look after him — it was a good thing he did, too, as Daryl starts to experience shortness of breath and blurry vision. He is admitted back to the hospital. As the team begins to evaluate the new symptoms, Foreman admits that their really aren’t any new symptoms. He had dosed Daryl with nitrates (a class of blood pressure medication) to drop his blood pressure so he’d feel bad enough to want to come back to the hospital.

Looking over the chart, House notices that Daryl has only lost one pound during his stay in the hospital and he should have lost more. This lack-of-weight-loss could be due to steroid abuse, or paraneoplastic syndrome — only there’s been no evidence of cancer. The team performs blood test after blood test, and scan after scan, but can find no cancer. House then realizes that the cancer they are looking for is not inside the body, but outside. It turns out that Daryl has melanoma, a skin cancer hard to spot on African-Americans, and this cancer (or course) is causing paraneoplastic syndrome, which explains his symptoms.

(Here’s my take on what’s going on: you may have noticed during the episode that the team gave two different definitions of paraneoplastic syndrome. First, they described a situation where a cancer produces a hormone which can cause systemic effects: in this case, the melanoma is apparently producing GnRH which increased Daryl’s testosterone and gave the appearance and symptoms of steroid abuse including “roid rage,” weight gain, and probably the heart symptoms. Second, House describes paraneoplastic syndrome as a situation where the body is making antibodies against the cancer, and this produces the systemic effects. This would explain the kidney failure and liver inflammation. The apparent cryoglobulinemia may be an effect of the extra paraneoplastic antibodies, or cryoglobulinemia can occur with certain cancers. Both definitions of paraneoplastic syndrome are correct, but I’m not certain if a patient would ever experience both situations.)

I admit that I’m somewhat confused by House’s take on steroids. If Daryl was taking steroids, his GnRH should be suppressed — lower — not higher. Or is House suggesting that Daryl was receiving GnRH itself, or a synthetic substitute — and if that’s the case, the body generally downregulates GnRH receptors when GnRH levels are unusually high, actually leading to hypogonadism and less testosterone.

As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

The clotting in cryoglobulinemia resolves at normal temperatures, so why would Daryl be clotting in the presumably warm hospital room. Did Princeton-Plainsboro not pay the electric bill?
Why didn’t he show abnormal clotting during surgery as most operating rooms are kept PDC (pretty damn cold).
Surely they drew blood before surgery, at least a blood type/transfusion panel, and should have notoiced the clotting then.
Blood thinners are not the recommended treatment for cryoglobulinemia.

Giving a patient enough of a nitrate to intentionally cause hypotension (low blood pressure) is dangerous. How did Foreman know he didn’t give too much? I’d also expect Daryl to develop a severe headache — the most common nitrate side effect – before any other symptoms.
I guess he learned it from House, who was trying to induce a cardiac event in a patient without even having him hooked up to any cardiac monitors.

Stress tests aren’t used to test for hypertophic cardiomyopathy, at least not as a first-, second-, or even third-line test. An EKG has already been obtained. A structural test, such as an echocardiogram or MRI is the next logical step. If needed, cardiac catheterization may also be performed.

Sorry Taub, steroid abuse can cause heart problems, including tachycardia.

Is there really a link between repeated trauma and pituitary adenoma, a type of cancer? I haven’t been able to find one, but then again, I’m not a neurologist or sports medicine specialist.
GnRH is released into the pituitary, not from it, so why would a pituitary cancer lead to “leaking” GnRH?

There is a condition known as the “lymphoma itch” that is a severe itching, primarily of the lower extremities. It is most commonly seen in Hodgkin’s lymphoma, but even then it only occurs in 10-25% of patients.
It is not associated with alcohol. A separate condition (severe aches and pains) can be worsened by alcohol intake in certain patients with lymphoma.

I don’t know it alcohol will really shut off blood flow in the radial arteries in patients with Takayasu’s arteritis, but who in the hell would thank that is a good idea. Personally, I like my hands to have full blood flow, thank you.

Return to full contact football a day after abdominal surgery, even a laparoscopic one? Nonsense.

Blood in the urine is really not a sign of kidney failure. It suggests that there is a problem with something farther along in the urinary system. This is especially true in patients on blood thinners, were urinary bleeding is more common – maybe from inserting the catheter in the first place.

Why would a melanoma secrete GnRH?

It is certainly possible to have rheumatoid disease with a negative rheumatoid factor.
Wasn’t Chase the one who shot down Taub’s suggestion of rheumatoid arthritis? So why would he later suggest Felty’s, which requires rheumatoid arthritis?

Paraneoplastic syndrome has become the lupus of this season.

I found the medical mystery interesting this week. Not great, but better than recent episodes. I give it a B+. The final solution clever (hidden melanoma in a black male), but too much of “Been there, got the T-Shirt” feeling (paraneoplastic, again, and a nearly impossible one at that). I give the solution a C-. Overall, the medicine was more driven this week, and followed a logical progression, but too much of it was questionable or downright wrong. Another C-. The soap opera was decent. I liked the Foreman and Foreman scenes, and the Wilson/House scenes were good, but I figures Lucas was the culprit fairly early on as Mark Michael Weston was listed as a guest star, but nowhere to be seen. I give the soap opera a B.

The review of the previous episode of House
A list of all prior House reviews

Bunches of high scores this episode, thanks to this year’s ubiquitous diagnoses: paraneoplastic syndrome and “lymphoma.” TRad led this week with 18 points.

Overall, TRad and Noether increase their dominance, with 77 and 75 points, respectively. Theta Sigma stays in third with 57 points, and Corien retains fourth with 54 points. The Erskine holds on to fifth with 52 points.

Click here to see the full scoreboard.

Volume Four of Apothecarius Argentum moves the action from Beazol to the neighboring kingdom of Navara, a poor and starving country with a widespread wasting disease brought on by overuse of a toxic pesticide. Princess Primula and her companions, including friend/love-interest/Royal apothecary Argent and his rival, Lorca, third Prince of Navara.

The storyline revolves primarily around royal intrigue, including a sequestered king, a kidnapped heir, and stirrings of rebellion.

There is not as much medicine in this volume as previous ones, which makes sense as Argent does not play as large a role in this storyline. Several medical errors crop up in this volume, which is unusual, because author Tomomi Yamashita, a pharmacist by training, is usually very careful about his medical references.

There’s probably a spoiler or two in the annotations, so consider yourself warned.

Belladonna
The young prince has been suffering from seizures and was given belladonna to treat them.

Belladonna is a plant that has a long history of use in traditional medicine and continues to be used, to some extent, in modern medicine as well. The plant is very potent and must be used sparingly because of the high potential of adverse events, especially death. This is especially true for children (especially sickly malnourished ones like the prince). Let me put it this way: the more common name for belladonna is Deadly Nightshade.

Historically, while belladonna has been used to treat a variety of different ailments, it has not been used to treat seizures. The only mention I’ve even seen of the use of belladonna for seizures comes from homeopathy, which is not traditional medicine — or really any sort of medicine at all (despite what its practitioners would like you to think); homeopathy can best be described as a delusion combining sympathetic magic, wishful thinking, and an early-19th century understanding of science.

Belladonna contains several potent chemicals, most notably atropine, scopolamine, and hyoscyamine — all drugs that are used today. Belladonna extract itself is still used in a few modern medicines, Donnatal (a stomach medication) is probably the best known.

Dandelion
The prince has been given an overdose of belladonna, and Argent gives him dandelion extract to correct it.

Argent is correct that belladonna is excreted almost entirely through the kidney, so increasing kidney function should get rid of the medicine faster. Diuretics (drugs that increase urine output) are one way of doing this. Dandelion has long been used as a diuretic. While I have seen no recent studies or reports that confirm its benefits in this regard, I’m willing to give the plant the benefit of the doubt because the effects of a diuretic are hard to miss (if you pee a lot, it’s a diuretic).

Activated Charcoal
Activated charcoal is used again to treat the chronic wasting disease that is common in Navara. I covered this in depth in the Volume 3 annotations.

Cochineal
The cochineal is a tiny insect (Dactylopius coccus) that grows on cacti in Central and South America. When the females of the species are collected, dried, and crushed they produce the brilliant red dye carmine which is used for coloring fabrics, cosmetics, and food.

It takes 70,000 insects, all collected by hand, to make a pound of dye, which is worth about $36 in today’s market.

Prince Lorca mentions several times that the insects grow on citrus, but they don’t — they can only live on certain species of cactus. I wonder if this might be a translation error, either in the translation of the manga, or from the author’s original sources. (There is a similar insect known as “Polish Cochineal,” and while it doesn’t grow on cacti, it doesn’t grow on citrus either.)

Marijuana
The story mentions a link between marijuana use and psychiatric disease. There haves been several studies that have looked at this very subject, but the results have been unclear. Can marijuana use lead to psychiatric illness, or do people with pre-existing psychiatric disease tend to use marijuana more? Studies have suggested both results, so just leave this one as “undecided.”

Is it possible to die from a marijuana overdose? Again, sources vary, but almost all seem to agree that it would take an incredibly high level of exposure to be fatal, and many experts suggest that it would be physically impossible to achieve this high a dose. (On the other hand, with incense burning in a sealed room with heavy curtains, I suspect the king suffocated to death when the incense used up all the oxygen).

The Plot: At a wedding, the groom’s grandmother notices someone standing in the back who alarms her. As she moves to confront him, she starts gasping for breath, turns an ashen gray, and then collapses, dead. Soon, other members of her family start dying as well – fourteen total – and the Fringe team is called in. After examining the corpses, Walter and Peter declare that everyone has died of asphyxia (suffocation). Agent Dunham notices a tattoo on the grandmother’s arm that indicates she was a concentration camp survivor. Poking around the church, they find the groom, still alive, but gasping for air. He dies at their feet, bringing the death toll to fifteen.

At the lab, Walter starts his autopsy of one of the victims and notices that the blood is a deep blue (Prussian blue, perhaps?), indicating some form of toxin exposure. The team also realizes that everyone who died was a blood relative and a direct descendant of the grandmother. Re-examining the church, Peter finds a candle that is different from the others and brings it to Walter. A quick run through the lab equipment shows that the candle contains some sort of cyanide compound. Walter suspects the deaths at the wedding were an experiment by the murderer to see if his toxin would work, and predicts that he will strike again soon. Sure enough, in a similar episode, nine people die in a coffee shop. The connection this time is that they all have brown eyes.

Back at the lab, Walter has isolated the toxin and shows how it can be set up to target different proteins, depending on who the murderer wants to kill. He points out a carbon chain on the toxin that he claims in the creator’s “signature.” When Peter remarks that it looks like a seahorse, Walter realizes that the poison was created by his own father who had been a scientist in Berlin until fleeing in 1943 (his nickname was “seahorse”). He has kept his father’s formulas in some old German books, Peter sold them ten years ago when Walter was in the asylum. It all turns out to be a red herring though, as they are not connected to the mysterious murderer.

Meanwhile, Walter has managed to get a partial DNA profile of the killer from skin cells left on a fingerprint. He claims that it’s a bad sample though, because the telomeres are severely damaged, suggesting that the person must be at least one hundred years old. The FBI is able to track down the chemicals used in the making of the toxin, and get the killer’s address. They search the house (poorly), but find nothing, as their target is at that very moment escaping from his lab in the basement. Eventually, Agent Dunham finds the basement lab, but the killer has set a trap for them, with some of the toxin specifically targeted to Walter. Luckily, Dunham and Peter get Walter to medical care in time, and he survives. A clue (found by Dunham even) tells the team that the killer has his sights set on a World Tolerance conference going on in Boston. Peter, Dunham, and the FBI head over to the conference to look for the killer. Walter stays behind, mixing up something in the lab, and then he heads over to the conference himself. Peters spots the poison and he and Dunham are able to confiscate it before it can be activated – but they are interrupted by a horrible coughing sound and rush over to find the killer, disguised as a waiter, gasping for breath and dying. Walter has turned the tables on him and made a version of the poison specifically tuned to his DNA. As the episode ends, Peter and Walter are still puzzled how the murderer got his hands on Walter’s father’s research, not realizing that the killer was a Nazi scientist himself, somehow still alive sixty years later.

1. Stay on Target
According to Walter, the toxin binds to a particular protein, and this protein can be altered depending on who the target. Unfortunately, the Nazi scientist’s poor understanding of molecular biology has doomed more people than he realizes. For instance, there is no protein specific to brown eyes. Brown eyes simply have more melanin than other eye colors — but the other eye colors still contain melanin. Everyone in that coffee shop, including the Nazi, should have died. Similarly, there is no special protein in dark skin that sets them apart — people with darker skin simply have more melanin than lighter skinned people. Trying to kill off the darker skinned people would have killed everyone — well, except the albinos. Good job, Nazi scientist. Now the albinos rule the world.
Suddenly, in a virtual deus ex machina, the toxin can be programmed with a specific DNA — even though Walter made it point, repeatedly, to mention that it was created before DNA was understood.
Even if the poison could target DNA, how are you going to get that big of a molecule into the nucleus of the cell, let alone through the cell membrane?

2. Those Who Do Not Know History…
Walter is off on his history: the discovery of DNA predated the Nazis, not the other way around. DNA was discovered in the middle of the 19th century, well before the Third Reich. By the 1920s, there was strong evidence that DNA was involved in inheritance, with the first definitive experiment performed in 1943. Walter is probably thinking of Watson and Crick’s famous work on the structure of DNA, which was published in 1953.

3. Sure Hope He Never Testifies in Court
The signs Walter mentions — petechiae, bulging eyes — are seen in asphyxia caused by strangulation (they are related to increased venous pressure in the head from the compression of the blood vessels in the neck), not by asphyxia due to toxin inhalation.
Can the vitreous humor, a gel-like liquid, really swell?

4. How Dare You Kill People With My Dad’s Poison!
Walter was upset that the murderer was “perverting” his father’s work, but let’s not forget that his father’s work was a nasty chemical warfare agent.

5. It Is Impolite To Inquire As To A Telomere’s Age
Telomeres are special DNA sequences on the ends of chromosomes that keep it from breaking down or fraying. There has been some good research suggesting a link between aging and the break down of telomeres. Still, it’s a dubious stretch to tell someone’s age from looking at their telomeres.

6. Nasty Poison
Hydrogen cyanide can kill remarkably fast, depending on its concentration.

6. Comes With A Certificate of Authenticity
That seahorse “signature” is so incredibly bulky and large that it would interfere with the biological activity of the toxin. Plus, it’s bad planning because it provides an easy target to identify and develop an antibody against.

7. Two Puffs Four Times A Day
A nit-pick here, but the groom sure has poor inhaler technique (but then, so do many of my patients — and a quick Google search reveals that much of the internet has a similarly poor understanding.) The inhaler should be held an inch or two in front of the mouth, not actually in the mouth.

The science was quite questionable this week, but I thought the story did a good job keeping the suspense going — and the Nazi scientist was truly creepy — so it’s a wash and the Doomsday Clock stays at 11:58.

This week’s Fringe cipher was: FATHER.
A list of all previous Fringe reviews is available here.
Karl has much more to say. And he’s still talking about it a week later.

As usual when dealing with these science PSAs, I have some questions and concerns:
Did the Brazilian doctor use radiolabeling to find the tumor (such as a bone scan or PET scan), or did he use radiation to treat it?
By 1959, there was already a Yellow Fever vaccine available, which would probably do more to eradicate the disease than making radioactive mosquitoes (wasn’t that a SciFi SyFy movie?)
The fourth panel is what really worries me. I think they’re using radioactive fertilizer in Canada to grow mutant tobacco plants.

This PSA was found in Batman #128 as well as the other DC comics from December 1959. This ad was written by Jack Schiff. There is some debate about the identity of the artist, but most sources list Lou Cameron.

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Tags: comics psa atom isotope mosquito jack schiff lou cameron

Valerie is a 27 year-old ruthless business woman who experiences the sudden onset of severe bilateral ear pain. She is admitted to House’s team, even though he finds her case uninteresting, because she is “hot” and yet has an ugly husband. Chase suggests that due to a recent dietary change, Valerie may have a vitamin deficiency which is causing her symptoms. House thinks that her change in diet may have boosted her already elevated cholesterol, leading to blocked arteries, heart damage, and an arrhythmia (abnormal heart rhythm) which she experiences as ear pain. Testing shows no evidence of blocked arteries, but it does confirm an arrhythmia. The team plans to start her on unspecified “cardiac medications.”

An ex-coworker of Valerie’s appears in her room, drunk, and accuses her of having an affair with him and later poisoning him to cause him to lose his job. She denies these accusations and security escorts the man out. The male members of the team jump to her defense, but Thirteen thinks that Valerie is up to something. When the team discussed the situation with House, he suggests that she may have been poisoned with thyroid medication, which would rev-up her heart and cause the arrhythmia. House and Foreman want her started on beta-blockers (to block the effects of the thyroid medication), but Thirteen sneaks her off to the MRI suite. Her testing reveals that Valerie has no emotions and is by definition a psychopath. Confronted later, Valerie admits to everything Thirteen suspects. All that her co-worker said is true — she slept with him and then poisoned him. She also admits she only married her husband for his trust fund.

Taking both the heart and brain symptoms into account, the new differential diagnosis consists tertiary syphilis (late stage syphilis where mental symptoms are common), Wilson’s disease (a disease of copper metabolism), and Hashimoto’s thyroiditis (autoimmune inflammation of the thyroid gland). The first seems the most likely, so they start Valerie on penicillin. There is a heated discussion between Valerie and Thirteen, and when Thirteen reaches to turn over Valerie’s arm, she breaks it. Further testing reveals elevated BUN (blood urea nitrogen) and creatinine levels which suggest kidney failure, which would explain the brittle and easily-broken bones.

House now feels that the Valerie’s psychopathy is something she was born with, and not a symptom of her condition. Focusing on the heart and kidney symptoms, Foreman suggests that she has paraneoplastic syndrome, likely from a lymphoma. House orders full body radiation therapy. Thirteen wants to run some tests first, but Foreman shoots her down.

There are more confrontations between Valerie and Thirteen, with Thirteen’s “innocent” questions lead Valerie’s husband to realize she’s was having an affair, and Valerie reporting her to the medical board. Eventually, Thirteen is removed from direct patient contact with Valerie, but Cuddy explains is it because Thirteen does not deserve to have Valerie inflicted upon her.

Valerie starts bleeding heavily from her mouth due to esophageal varices (enlarged, bleeding esophageal veins related to liver disease). She is taken to the operating room for a TIPS procedure (transjugular intrahepatic portosystemic shunt) — placement of a stent which bypasses the liver, relieving the elevated blood pressure in the liver which lead to the varices. This new symptom causes the team to reevaluate their diagnosis, and this time they consider and discard amyloidosis and alpha-1 antitrypsin deficiency before settling on primary hepatic fibrosis (fibrosis of the liver not due to another disease). She is started on steroids and a search begins for a liver donor for transplant. Thirteen talks to Valerie’s sister and learns that she wasn’t always a psychopath — that started during her teen years. This suggests that the psychopathy is a symptom of her condition, and not something that can be overlooked. Thirteen and House realize that she must have Wilson’s disease, which is confirmed by looking at her fingernails which are blue. She is started on chelation therapy to remove the excess copper. By the end of the episode it seems to be working

Those of you who read comic books will know what I mean when I say that the medicine of this episode was the television equivalent of a Mark Millar comic: a bunch of dramatic set pieces connected by sketchy plotting and poor logic. Sudden ear pain (hand waving) It’s her heart! (hand waving) Oh no, kidney failure! (hand waving) It’s cancer! (hand waving) Now it’s liver failure (hand waving) Wilson’s disease and presto! Iit’s cured, and now the world is safe for democracy.

As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

You do not treat a patient for cancer — be it radiation therapy or chemotherapy — without knowing what sort of cancer it is first. Different cancers have different treatments. Even if it is a B-Cell Lymphoma, there are over a dozen different cancers of that type, and only some are treated with radiation therapy. This seems to be a recurrent mistake this year.

Her kidney failure is so bad that her bones break that easily and she’s stopped producing urine and nobody noticed?
There’s no way it took that long before they checked her BUN/Creatinine. They would have been checked before running any cardiac artery testing to make sure her kidney could handle the dye.
Similar arguments for no one noticing her chronic liver disease bad enough to cause bleeding varices.

Wilson’s disease should have shown up on the MRI. You know, the one they used to dismiss the diagnosis of amyloidosis.

She sure improved from her fifteen years of Wilson’s disease improbably fast, especially her psychiatric symptoms.

A paraphrase:
Thirteen: If she has Wilson’s, why doesn’t she have Kayser-Fleischer rings?
House: Notice how I avoid answering — or even acknowledging — your question by distracting you with another symptom. Aren’t I (and by extension, the writers) clever?
(House could have just said that KF rings only occur in 2/3 of the patients with Wilson’s. Blue nails [azure lunula] are certainly seen in Wilson’s, but less commonly than KF rings).

Technically, Broca’s area is only on one side of the brain, it is not bilateral.

I suspect the fingernail polish under the pulse-ox (oxygen monitor) had already been wiped off – the monitors work a lot better that way.

The team never “ruled out” Wilson’s, they just focused on the tertiary syphilis instead.

The medical mystery was modestly interesting, but quickly forgotten and ear-pain was never again mentioned after the seven minute mark. It deserves a B. The final solution was a bit of a stretch, but actually fit fairly well (especially if you ignore the whole “chronic” aspect of the disease). It also earns a B. Overall, the medicine was spotty, with the team missing things an intern would have noticed. I give it a B-. The soap opera was light, but generally well done. I thought Olivia Wilde held up her end better than expected, but I’m surprised House never ran any sort of background check on his classmate. I give the soap opera a B.

The review of the previous episode of House
A list of all prior House reviews