Ep-PAINE-nym



Duct of Wirsung

Other known aliasesmain pancreatic duct

DefinitionThis is the main pancreatic duct that joins the pancreas to the common bile prior to the ampulla of Vater before emptying into the second portion of the duodenum

Clinical SignificanceHaving a single, major pancreatic duct is the most common anatomic variant for pancreatic anatomy, but some individuals may have an accessory duct that could be functional.  The issue with this, of course, is management of pancreatic pathology so imaging may be required prior to instrumentation or surgical management.

HistoryNamed after Johann Georg Wirsung (1589-1643), who was a German anatomist from Padua.  He made this discovery while dissecting a criminal (Zuane Viaro) who was recently hanged for murder in 1642.  Instead of formally publishing his findings, he engraved the sketch on a copper plate so numerous casting could be made and sent to the leading anatomists of the time.  This finding is not without controversy.  One year after this discovery, Wirsung was murdered in his house late at night by a Belgian student named Giacomo Cambier over a quarrel of first discovered this duct.  In a cruel twist of fate, 5 years after his death, one of Wirsung’s students who was assisting in the dissection, Moritz Hoffman, claimed it was he who discovered this duct in a turkey rooster a year before Wirsung.

Original copper plate etching
Painting of the murder of Wirsung

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Howard JM, Hess W, Traverso W. Johann Georg Wirsüng (1589-1643) and the pancreatic duct: the prosector of Padua, Italy. Journal of the American College of Surgeons. 1998; 187(2):201-11. [pubmed]

PAINE #PANCE Pearl – Gastrointestinal/Nutritional



Question

What vitamins have a higher potential for causing toxicity and why?



Answer

Fat soluble vitamins can be stored in the adipose tissue instead of excreted if in excess.  As a result, vitamins A, D, E, and K can cause toxicity if patients take too much (in this order of incidence as well).

  • Hypervitamintosis A can result in ataxia, hepatotoxicity, visual impairments, and orange skin.
  • Hypervitamintosis D can result in hyperphosphatemia and hypercalcemia.
  • Hypervitamintosis E can block vitamin K absorption and leads to easy bleeding and bruising
  • Hypervitamintosis K is very rare and really only seen in infants receiving newborn injections after birth.

References

Ep-PAINE-nym



Morison’s Pouch

Other known aliaseshepatorenal recess/fossa, right posterior subhepatic space

Definitiona potential space between the liver and the right kidney

Clinical SignificanceThis a space where fluid can accumulate in the setting of ascites or abdominal trauma and be seen on CT or ultrasound.  It is one of the view of a Focused Assessment of Sonography in Trauma (FAST) exam. Typically, 30-40mL of fluid needs to be present to be visualized.

Ultrasound
Computed Tomography

HistoryNamed after James Rutherford Morison (1853-1939), a British surgeon who received his medical degree from the University of Edinburgh in 1874.  He was also an assistant and “surgical dresser” for Joseph Lister early in his career and later founded a school of surgery at the University of Durham where he made his name as a prolific instructor of surgery.  He is well known as a pioneer of modern surgery with several of his contemporaries noting he was twenty years ahead of his time and was a driving force of he surgical arts in Great Britain at the turn of the 20th century. 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. http://livesonline.rcseng.ac.uk/biogs/E004690b.htm

Ep-PAINE-nym



Zenker’s Diverticulum

Other Known Aliasespharyngeal diverticulum

Definitionsac-like outpouching of the mucosa and submucosa through Killian’s triangle, which is the area of structural weakness between the cricopharyngeus and lower inferior constrictor muscles.

Clinical SignificanceThere are actually three different types of diverticulae that can form in this region and are based on anatomic location:

  • Zenker’s – immediately above the upper esophageal sphincter
  • Traction – near midpoint of the esophagus
  • Epiphrenic – immediately above the lower esophageal sphincter

Signs and symptoms of a Zenker’s diverticulum are pretty awful and include dysphagia, pulmonary aspiration, and halitosis from partially rotting food in the outpoaching.  It is diagnosed via barium swallow under flouroscopy. The majority of the patients are male and present after the age of 60.  Management is surgical resection.

HistoryNamed after Friedrich Albert von Zenker (1825-1898), who was German physician and pathologist and received his medical doctorate at Leipzig in 1851.    He held numerous teaching posts including chief prosector and professor of general pathology and anatomy at Dresden city hospital.  Dr. Zenker, along with Hugo Wilhelm von Ziemssen, published a case series and literature review on his eponymous diverticulum in 1867 entitled “Krankheiten des Oesophagus”. He also was the first to document and describe trichinosis in a girl who died in 1860, proving that the once thought harmless parasite could cause severe disease.

Friedrich Albert von Zenker

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. F. A. Zenker and Hugo Wilhelm von Ziemssen:
    Krankheiten des Oesophagus. Leipzig, 1867
  7. Ueber die Trichinenkrankheit des Menschen. Virchows Archiv für pathologische Anatomie und Physiologie und für klinische Medizin, Berlin, 1860, 18: 561-572.

PAINE #PANCE Pearl – Endocrine



Question

58yo male, with DMI controlled with insulin, has blood glucose measurements in the morning of 205-272 mg/dL for the past week.  He reports that his evening blood glucose measurements before bed range from 103-127 mg/dL.  What are two potential causes of these findings?



Answer

There are two potential causes of early morning hyperglycemia in a diabetic patient on insulin.

  1. Dawn Phenomenon
    1. Due to the early morning rise of cortisol, patients can experience an early morning hyperglycemia as a result
  2. Somogyi Phenomenon
    1. (as covered by last week’s Ep-PAINE-nym) This was theorized to occur as undetectable hypoglycemia while the patient was asleep and the resultant hyperglycemia from instrinsic protective mechanisms.

Ep-PAINE-nym



Somogyi Phenomenon

 

Other Known Aliasesposthypoglycemic hyperglycemia

 

Definitionrebounding hyperglycemia in the setting of a undetected hypoglycemic event

 

Image

 

Clinical Significance It had been hypothesized that patients who had a hypoglycemic event during sleep would have rebound hyperglycemia due to the protective mechanism of the body to counteract this.  This would result in an undetectable change that would cause hyperglycemia in the morning.  This hypothesis has been proven wrong by numerous studies, but it is still a favorite among endocrinologists to pimp their students on.

 

History – Named after Michael Somogyi (1883-1971), who was a Hungarian American biochemist and received his doctorate degree from the University of Budapest in 1914.  He took a position as professor of biochemistry in 1922 at the Washington University’s Medical School in St. Louis, where later that year the first child with diabetes was treated with an insulin prepared by Somogyi himself.  His career work revolved around diabetes and theorized that insulin itself could causes unstable diabetes.  He published this paper describing the phenomenon that bears his name in 1938 in the Weekly Bulletin of the St. Louis Medical Society entitled “Insulin as a cause of extreme hyperglycemia and instability”.  He also went on to develop the test for serum amylase to help diagnose acute pancreatitis.  Dr. Somogyi died from a stroke on July 21st, 1971.

 

Michael Somogyi early portrait cropped 01.03.002.tif


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. M. Somogyi, “Insulin as a cause of extreme hyperglycemia and instability,” Weekly Bulletin of the St Louis Medical Society, 1938, 
  7. Tordjman KM, Havlin CE, Levandoski LA, White NH, Santiago JV, Cryer PE. Failure of nocturnal hypoglycemia to cause fasting hyperglycemia in patients with insulin-dependent diabetes mellitus. The New England journal of medicine. 1987; 317(25):1552-9. [pubmed]
  8. Hirsch IB, Smith LJ, Havlin CE, Shah SD, Clutter WE, Cryer PE. Failure of nocturnal hypoglycemia to cause daytime hyperglycemia in patients with IDDM. Diabetes care. 1990; 13(2):133-42. [pubmed]