Author: Kristopher Maday PA-C

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Bonney Test

Other Known Aliases – none

Definition – bedside test with urinary incontinence to determine if it is due to anatomical or structural issues

Clinical Significance – After a positive stress incontinence test, Bonney test is performed, where either a specialized instrument or examiner’s fingers are placed laterally to the urethral opening and pushed up to elevate the neck of the bladder. The patient then coughs to see if urine still escapes. If no urine leaks, then the incontinence is due the descent of the bladder neck into the vagina. If urine still escapes, it is due to weakness in the sphincter.

History – Named after William Francis Victor Bonney (1872-1953), a British gynecologist who received his medical doctorate from Chelsea Hospital for Women in 1896. He would go on to achieve Master of Surgery distinction in 1899 and was accepted as a fellow in the Royal College of Surgeons and Physicians in 1900. He would spend his entire career developing, pioneering, and mastering operative techniques in gynecologic surgery towards more conservative approaches to reduce mortality, morbidity, and disability associated with the more conventional approaches of the time. This was largely due to his wife, Annie, receiving a total hysterectomy early in their marriage for anemia associated with her heavy cycles. He also developed his own antiseptic solution called “Bonney’s Blue” used during vaginal surgeries which profoundly reduced infectious mortality. He would author more than 200 manuscripts during his career culminating his Textbook of Gynaecologic Surgery that is still in print today. He is regarded as one of, if not the, major influencer in modern gynecologic surgery.

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. Bonney, William Francis Victor (1872–1953). In: Baskett TF. Eponyms and Names in Obstetrics and Gynaecology . Cambridge University Press; 2019. [book]
  7. Powell, John L. MD, FACOG, FACS Powell’s Pearls, Obstetrical & Gynecological Survey: June 2005 – Volume 60 – Issue 6 – p 337-340 doi: 10.1097/01.ogx.0000162245.13467.5d

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Behçet’s Disease

Other Known Aliases – Silk Road Disease

Definition – systemic inflammatory disorder that commonly effects the eyes, mouth, GI/GU tract, nervous system, and blood vessels

Clinical Significance – Pathogenesis is largely unknown, but theorized to have a genetic predisposition. It is rare in the United States and more common in the Middle East and Asia, where it received is other eponym as the “silk road disease” due to the trading routes going through Turkey and the Mediterranean. Onset of the disease in most commonly in 20’s-40’s and is more common in men than women. Treatment is most commonly antiinflammatories and immunosuppressants.

History – Named after Hulusi Behçet (1889-1948), a Turkish dermatologist who received his medical doctorate from the Gülhane Military Medical Academy in Istanbul in 1910. He served as staff physician at the Edirne Military Hospital during World War I and took a special interest in venereal diseases and dermatology. He would go on to become professor in the newly formed republic of Turkey and was the first person in Turkish academia to receive this rank. He took a special interest in the manifestations of syphilis and published extensively on this condition. He described is eponymous condition in 1936 after following several patients with similar symptoms and presenting them at meeting in Paris. It should be noted that several others had described this condition, as early as 1922, but Behçet was the first to recommend it as a previously undiscovered disease process.

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. H. Behçet. Über rezidivierende, aphtöse, durch ein Virus verursachte Geschwüre am Mund, am Auge und an den Genitalien. Dermatologische Wochenschrift, Hamburg, 1937, 105(36): 1152-1163.

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Osgood-Schlatter Disease

Other Known Aliases – tibial tubercle apophysitis

Definition – inflammation of the patellar tendon at the insertion of the tibial tuberosity

Clinical Significance – Seen in adolescent athletes who participates in sports with repeated jumping or overloading of the knee in the bent position. This repetitive trauma on the open growth plates causes the painful separation of the tuberosity from the anterior tibia and manifests as a painful “bump”. Pain will persist until the epiphysis closes, but a persistent bump will remain. Treatment is with rest, NSAIDs, unloading bracing, and potentially casting in knee extension.

History – Named after two physician who contemporaneously studied this condition. Robert Bayley Osgood (1873-1956), an American orthopaedic surgeon who received his medical doctorate from Harvard University in 1899, and Carl Schlatter (1863-1934), a Swiss surgeon who received his medical doctorate from the University of Zurich in 1889. Osgood would spend his career at Harvard University and Massachusetts General Hospital culminating in Professor of Surgery and Chief of Orthopaedic Surgery at both of these institutions. He would help write one of the first textbooks on orthopaedic surgery called “Diseases of the Bones and Joints” and creating one of the first structured orthopaedic residencies in the US at Harvard University. Schlatter surgery training started under Billroth in Vienna and would go on to perform the world’s first gastrectomy with end-to-end esophago-jejunostomy in 1897. Both published case reports and observations of this disease process in 1903

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. Nowinski RJ, Mehlman CT. Hyphenated history: Osgood-Schlatter disease. Am J Orthop (Belle Mead NJ). 1998; 27(8):584-5. [pubmed]
  7. Osgood RB. Lesions of the tibial tubercle occurring during adolescence. Boston Medical and Surgical Journal 1903; 148: 114-117
  8. Schlatter C. Verletzungen des schnabelförmigen Forsatzes der oberen Tibiaepiphyse. Beitrage zur klinischen Chirurgie, 1903; 38: 874-887

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Galeazzi Fracture

Other Known Aliases – none

Definition – fracture of the distal third of the radius with dislocation at the distal radioulnar joint (DRUJ) often seen after a FOOSH with the forearm in pronation

Clinical Significance – Due to the dual injury mechanism, there is a higher than normal risk fo compartment syndrome and nerve injury seen with this injury, specifically the anterior interosseous nerve (AIN). This can lead to to inability to make the “OK” sign with the thumb and index finger. Patients may also present with wrist drop due to injury of the radial nerve. Often described with Monteggia fractures due to the similar, but opposite injury patterns.

History – Named after Ricardo Galeazzi (1866-1952), an Italian orthopaedic surgeon who received his medical doctorate from the Turin Medical School in 1886. His career would primarily focus on pediatrics making advancements in the understanding in congenital hip dysplasia, scoliosis, and achondroplasia after being appointed Director of the Pius Institute for Crippled Children in 1903, and going on to direct the orthopaedic clinic of the University of Milan for 35 years. He would publish his experience of 18 cases bearing his name in 1935, but it should be noted that it was first published in 1842 by Sir Astley Cooper.

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. Galeazzi R. Archivio di ortopedia pubblicazione ufficiale del Pio istituto dei rachitici. Istituto ortopedico Gaetano Pini. 1935. [link]
  7. SCAGLIETTI O. Riccardo Galeazzi, 1866-1952. J Bone Joint Surg Br. 1953; 35-B(4):679-80. [pubmed]

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Epstein-Barr Virus

Other Known Aliases – Human gammaherpesvirus 4

Definition – double-stranded DNA herpes virus that infects B lymphocytes and epithelial cells and has both active replication and latency periods that can cause disease

Clinical Significance – known to the be the causative pathogen for infectious mononucleosis, it is also associated Burkitt’s lymphoma, Hodgkin’s lymphoma, and other various other diseases and cancers. It is transmitted through oral transfer of saliva and genital secretions

History – Named after Sir Michael Anthony Epstein (1921-), a British pathologist who received his medical doctorate from Cambridge University, and Yvonne Barr (1932-2016), an Irish pathologist who received her PhD from the University of London in 1966. Upon hearing a lecture by Denis Burkitt in 1961 on a new endemic cancer in Africa, the former decided to change his career path to search for the cause of this cancer. After working for two years on tumor cells from this cancer, he, with the help of the later as a PhD student, finally isolated the virus cell lines and published their preliminary findings, with colleague Bert Achong, in the Lancet in 1964.

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. EPSTEIN MA, ACHONG BG, BARR YM. VIRUS PARTICLES IN CULTURED LYMPHOBLASTS FROM BURKITT’S LYMPHOMA. Lancet. 1964; 1(7335):702-3. [pubmed]

PAINE #PANCE Pearl – Pulmonology

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Question

A 68yo man, with a history of COPD and 57-pack-year history of smoking, presents to the office with worsening shortness of breath on exertion, dizziness, and leg swelling over the past 6-months. He states that his inhalers don’t seem to be helping as much and he is finding it more and more difficult to walk without getting breathless. He denies orthopnea, paroxysmal nocturnal dyspnea, or increased cough. Vital signs show BP-157/98 mmHg, HR-88 bpm, RR-23 bpm, O2-90% on room air, and temp-98.9o. Physical examination reveals (+) JVD, widened split S2, 1+ pitting edema of the legs to the knee, and hepatomegaly. EKG is below.

  1. What does the EKG show?
  2. What is the diagnosis?
  3. What is the next step in evaluation?
  4. What is the definitive diagnostic study for this condition?

Answer

  1. The EKG shows numerous findings of chronic pulmonary disease including:
    • Right axis deviation
    • Peaked P-waves (>2.5mm) in inferior leads (II, III, aVF)
    • Clockwise rotation of the heart with delayed R/S transition point
    • Absent R-waves in right precordial leads (V1-V3)
    • Low voltage left sided leads
  2. Given the absence of left sided heart failure and the patients extensive pulmonary history, the presentation is highly suggestive of pulmonary hypertension with cor pulmonale.
    • Cor pulmonale is a complication of pulmonary hypertension and is defined as structural alterations or impaired function of the right ventricle
  3. The next step in evaluation of this patient is getting an echocardiogram to evaluate global heart function and degree of pulmonary hypertension present
  4. The definitive diagnostic study of pulmonary hypertension and cor pulmonale is a right heart catheterization.

References

  1. https://litfl.com/ecg-in-chronic-obstructive-pulmonary-disease/

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Schamroth Test

Other Known Aliases – none

Definition – test used for diagnosing nail clubbing by examining the window seen between the nails of opposite fingers

Clinical Significance – there should be a diamond size window in “normal” nails when performing this test. In patients with nail clubbing, this window is obliterated

History – Named after Leo Schamroth (1924-1988), a Belgium-born, South African cardiologist who received his medical doctorate from the University of Witwatersrand in 1948. He completed his residency at Johannesburg General Hospital and joined the staff at Baragwanath Hospital in 1956, where he would stay his entire career culminating in chief physician in 1972. He would publish over 300 papers and eight textbooks in the realm of cardiology, and his Introduction to Electrocardiography is still one of the most stolen medical textbooks in the world. He published his eponymous finding in an article entitled “Personal Experience” in 1972 in the South African Medical Journal.

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. Schamroth L. Personal experience. S Afr Med J. 1976; 50(9):297-300. [pubmed]