Homan’s Sign

Other Known Aliases – dorsiflexion sign

Definition – pain in the posterior leg (classically behind the knee) with forced dorsiflexion of the foot

Clinical Significance – this examination finding was used in patients with a suspected DVT and before D-Dimers and clinical ultrasound were readily available. It is clinically useless as it has been studied extensively and found to have a sensitivity of 10-54% and specificity of 29-89%, thus not ruling in or out the condition consistently.

History – Named after John Homans (1877-1954), who was an American surgeon and received his medical doctorate from Harvard Medical School. He worked with Harvey Cushing and Samuel Crowe early in career exploring the connection between the piuitary gland and the reproductive system. He first described his eponymous finding in 1944 in a NEJM article entitled “Diseases of the veins” and later published the first case report of a DVT occuring after prolonged sitting on a flight between Boston and Caracas in 1954. He was a founding member of the the Society for Vascular Surgery and the namesake of the John Homans Chair of Surgery position at Harvard Medical School and John Homans Fellowship in Vascular Surgery at the Brigham and Women’s Hospital.

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. McGee, Steven (2012). Evidence-Based Physical Diagnosis. Philadelphia, USA: Saunders. pp. 472–473. ISBN978-1-4377-2207-9
7. Homans J. Diseases of the veins. N Engl J Med 1944: 231; 51-60
8. Homans J. Thrombosis of the deep leg veins due to prolonged sitting. The New England journal of medicine. 1954; 250(4):148-9. [pubmed]
9. Barker WF. John Homans, MD, 1877-1954. Arch Surg. 1999;134(9):1019–1020. doi:10.1001/archsurg.134.9.1019

Schilling Test

Other Known Aliases – none

Definition – laboratory test for pernicious anemia (specifically intrinisic factor deficiency) that led to vitamin B12 (cobalamin) deficiency. It involved ingesting a oral dose of radiolabeled vitamin B12 (to test oral absorption), an IM injection of vitamin B12 (to saturate liver stores), and a 24hr urine collection to see how much was absorbed and excreted. If intestinal absorption was intact (intrinsic factor present), then > 10% of the radiolabeled vitamin B12 would be in the urine.

Clinical Significance – This was the first and only test at the time to be able to diagnose pernicious anemia, but is now largely a test of historical interest only as better diagnostic studies have been developed.

History – Named after Robert F. Schilling (1919-2014) an American physician and researcher who received his medical doctorate from the University of Wisconisn-Madison in 1943. Immediately after graduation, he joined the Pacific Front as a physician in the 3d Marine Division. After the war, he completed postgraduate training at Harvard before returning to Wisconsin to practice hematology. He studied extensively on the metabolism of vitamin B12 and the urinary excretion of radiolabeled vitamin B12 in pernicious anemia and in 1953, published a paper entitled “The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B12”, which would go on to be called the “Schilling Test”.

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. Schilling RF. Intrinsic factor studies. 2. The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B12. J Clin Lab Med. 1953;42;860-866
7. Schilling Test. Stat Pearls. 2018. https://www.ncbi.nlm.nih.gov/books/NBK507784/

Hodgkin’s Lymphoma

Other Known Aliases – none

Definition – Type of lymphoma predominantly from lymphocytes that arise from germinal center or post-germinal center of B cells

Clinical Significance – Accounts for 10% of all lymphomas and 0.6% of all cancers.  It is also associated with a bimodal age distribution of young adults (20s) and older adults (60s), with a slight male predominance.  Epstein-Barr virus is the most common causative agent and it carries a favorable prognosis.

History – Named after Thomas Hodgkin (1798-1866), who was British physician and considered one of the most prominent pathologists of his time.  He was also a perpetual student constantly learning new techniques including being an early adopter of the stethoscope anda fervent advocate for preventative medicine.  He first described his findings on his eponymous disease in 1832, but it wasn’t until 33 years later when another British physician, Samuel Wilks, “re-discovered” the disease and Hodgkin’s work did it gain any traction and recognition.

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. Hodgkin Lymphome.  British Medical Journal – Best Practice. http://bestpractice.bmj.com/topics/en-us/311
6. Hodgkin T.  On Some Morbid Appearances of The Absorbent Glands and Spleen.  Med Chir Trans.  1832;17:68-114.

Auer Rods

Other Known Aliases – none

Definition – Auer rods are azurophilic granules found in the cytoplasm of leukemic blast cells and are composed of fused lyosomes.

Clinical Significance – These are found in high grade myelodysplastic and myeloproliferative syndromes and are pathognomonic for acute myelogenous leukemia (AML).

History – Named after John Auer (1875-1948), an American physiologist and pharmacologist, who held appointments at Johns Hopkins Hospital, Rockefeller Institute for Medical Research, and the St. Louis School of Medicine. He first described these structures in a 21yo male who was suffering from a sore throat and nosebleed and admitted to Sir William Osler’s service for work-up.  He published this finding in 1906, but were first described by a colleague of his at Johns Hopkins Hospital, Thomas McCrae.  Interestingly, they both erroneously thought that the cells containing these structures were lymphoblasts, not myeloblasts.

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. Gordon SW, Krystal GW. Auer Rods. NEJM. 2017; 376(21):2065. [pubmed]
6. Auer J. Some hitherto Undescribed Structures Found in the Large Lymphocytes of a Case of Acute Leukemia. AJMS. 1906;131(6):1002-1014 [article]
7. McCrae T. Acute Lymphatic Leukemia, with Report of Five Cases. BMJ. 1905; 1(2304):404-8. [pubmed]
8. John Auer. http://www.iqb.es/historiamedicina/personas/auer.htm