Origin of Kehr Sign in<br /> Traumatic Splenic Trauma

Null.

Abu Reyhan Biruni (973-1048 CE): The Pioneer in Clarifying the Role of Pharmacy in Medical Practice

Abu Reyhan Biruni (973-1048 CE) was a Persian polymath in medieval era. He had more than 100 books and treatises on different subjects like astronomy, culture, history, mathematics and pharmacy. In medical sciences, he was one of the first persons who introduced pharmacy as a separated field from medicine. He was pioneer to define pharmacy and pharmacist similar to current definitions. It was one of the earliest definitions of pharmacy. Biruni can be introduced as a pharmacist, nor physician. He also had a book on pharmacy, Al-Saydana fi al-Tibb (Pharmacy in Medicine). This book is one of the most important works on pharmacy in medieval era. He clarifies the role of pharmacists to serve pharmaceutical services to the patients. It shows the importance of pharmacy as an independent field of medical sciences in Persia and Islamic civilization about a thousand years ago.

Signs and syndromes in acute appendicitis: A pathophysiologic approach

Physical examination signs have not been well studied, and their accuracy and reliability in diagnosis remain unknown. The few studies available are limited in that the method of performing the sign was not stated, the technique used was not standardized, and the position of the appendix was not correlated with imaging or surgical findings. Some appendiceal signs were written in a non-English language and may not have been appropriately translated (e.g., Blumberg-Shchetkin and Rovsing). In other cases, the sign described differs from the original report (e.g., Rovsing, Blumberg-Shchetkin, and Cope sign, Murphy syndrome). Because of these studies limitations, gaps remain regarding the signs’ utility in the bedside diagnosis of acute appendicitis. Based on the few studies available with these limitations in mind, the results suggest that a positive test is more likely to be found in acute appendicitis. However, a negative test does not exclude the diagnosis. Hence, these tests increase the likelihood of ruling in acute appendicitis when positive but are less helpful in ruling out disease when negative. Knowledge about the correct method of performing the sign may be a valuable adjunct to the surgeon in further increasing their pretest probability of disease. Furthermore, it may allow surgeons to study these signs further to better understand their role in clinical practice. In the interim, these signs should continue to be used as a tool to supplement the clinical diagnosis.

Medical conditions of Omer Seyfettin (1884-1920), the father of Turkish short stories, enshrined as a mystery

Born in 1884 in Balıkesir, Turkey, Ömer Seyfettin was a leading figure among modern Turkish short story writers whose death in 1920 at the age of 36 led to long-term speculations about his fatal illness. In order to pay homage to his memory in the centennial of his death and to shed light on his later medical condition, this paper seeks to reexamine his last days from a medico-historical perspective. Our findings indicate that there was a notable decline in his health occurring after 1917 when he was confined to social isolation. A carbuncle was diagnosed in his posterior neck when he was 35-years of age and not satisfactorily treated. In late February 1920, he developed progressive symptoms over two weeks consisting initially of a headache, followed by fever, delirium, hallucinations, and diplopia. These clinical signs and symptoms are clinically suggestive of a septic encephalopathy presumably caused by staphylococcus aureus infection secondary to the carbuncle, or perhaps by one of the myriad causes of viral meningoencephalitis.

Physical Examination and Appendiceal Signs During Pregnancy

The clinical diagnosis of acute appendicitis is challenging as patients present with an array of objective and subjective symptoms early or late in the disease course. Ultrasound is routinely performed in all patients with suspected acute appendicitis. Equivocal test results frequently require further assessments using other imaging techniques that are limited in scope during pregnancy because of issues involving safety, availability, and accessibility. Physical examination diagnostic signs in acute appendicitis during pregnancy have not been well studied. Studies failed to describe, standardize, or correlate the technique used to the pathologic disease process. Therefore, gaps remain in current knowledge regarding the usefulness and application of these tests during the physical examination. Improvement in diagnostic acumen is critically important, particularly in cases where there remains diagnostic uncertainty because of equivocal imaging results. This article reviews signs used to diagnose patients with acute appendicitis using a pathophysiologic approach based on visceral and cerebrospinal nerve pathways to explain the mechanism for a positive test result. It also suggests a framework to study them further to better understand their role, if any, in clinical practice.

Reimagining the Terms Mongolian Spot and Sign

The term “Mongolian Spot” rather than the preferred descriptive name congenital dermal melanocytosis (CDM) continues to be used despite compelling objections to the contrary. Terms that stigmatize a culture, region, people, country, communities, and ethnic group should be replaced by their more descriptive counterparts. Herein, we clarify terminology, discuss the historical significance, and provide a recommendation about naming this disease.

How to Classify, Teach, and Learn Ophthalmic Eponyms

Introduction

There are limited educational studies on effective ways to teach and learn medical eponyms. While there is no consensus on how to best address this issue, developing novel strategies to teach medical eponyms has become critical in many branches of medicine, including ophthalmology. 

Materials & Methods

An ophthalmologic eponymic database was created using eight source texts (e.g., books, encyclopedias, and dictionaries) and included the year the eponym was introduced, related name, nationality, specialty, and the eponym’s description. PubMed database with a Medical Subject Headings (MeSH) keyword for “eponym” and “eye” and “ophthalmology” and a Google search for a combination of related keywords was also performed. A careful biographical search was conducted for each name in the second phase to obtain further biographical details. Inclusion criteria for eponyms in the dataset were: i) named after at least one person, ii) identified as a specific medical term in the literature, iii) related to any field of medicine. Names derived from art, history, mythology, patient, family, chemistry, botany (or other fields outside of medicine) were excluded. The three authors independently screened to eliminate duplicated names and ensure eligible names met inclusion and exclusion criteria.

Results

A total of 1,257 unique ophthalmologic eponyms representing 8.8% of 14,332 medical eponyms were identified. Three-hundred fifty-one of 743 (47.2%) eponyms were named after ophthalmologists representing 36 countries. The United States of America and Germany comprised the largest fraction of nationalities (40.2%), not necessarily representing their birthplace. Signs, syndromes, and diseases composed the largest category (45.8%) of eponymous ophthalmologic names.

Discussion

The current volume of eponymous names impedes the ability of a learner to retain this information. Classifying eponyms based on form, intention, or function, provides a more refined method for placing eponyms in their respective categories. Teaching eponyms by enumerating their historical content, demonstrating the correct performance of the eponym, assessing the technique, and providing feedback, affords the learner a more fruitful and meaningful learning experience. Understanding the context of the signs, syndrome, or techniques further allows the learner to gain insights into the clinical application of eponyms in diagnostic decision-making.

Conclusion

The teaching model proposed incorporates key aspects that may facilitate retention and recall of the eponymous name. The model includes imparting historical knowledge about the person who described the sign, technique, or process; demonstrating the correct procedure as originally reported; and coaching to ensure that the appropriate skill is mastered. Before abandoning eponyms, it is first necessary to understand their efficacy, effectiveness, usefulness, and role in clinical medicine.

Demetrius Zambaco Pasha (1832-1913): The first leprologist of the Orient

Démétrius Zambaco Pasha (1832-1913) was an internationally renowned Ottoman-born French dermatologist of Greek origin who is considered the first leprologist of the Orient. A graduate from the Faculty of Medicine in Paris, he practised there until he returned to Istanbul in 1872 and later served as a private physician to the Ottoman sultan Abdul Hamid II (1842-1918), then Abbas Hilmi Pasha (1874-1944), the last Khedive of Egypt. Dr Zambaco produced numerous publications in a variety of medical subjects including leprosy, syphilis, morphinomania, eunuchs, and medical history. Leprosy, however, was his main field of scientific interest, with nearly 40 studies published and many other communications presented at international medical congresses. Due to his outstanding scientific contributions, Dr Zambaco garnered many accolades including the Cholera Medal of Honour, the Montyon Prize, and Légion d'Honneur from France as well as the honorary title of Pasha, a higher rank in the political and military system, from the Ottoman Empire.

Eponymous signs in toxicology and poisoning in the nineteenth and early twentieth centuries

•

Eponyms named for people are terms used to honor one’s accomplishment(s) and contributions to science and medicine.

•

Nearly 30 eponymous signs associated with toxicology and poisoning have been identified in the literature, almost half of which were named for persons between 1831 and 1910.

•

Signs are clinical, radiologic, surgical, laboratory, and pathological findings which assist in recognizing features or patterns of a disease or a phenomenon.

•

Signs of poisoning are important to recognize as these findings may assist in diagnosis.

•

Learning these signs eponymously named for a person and their historical background provides a more in-depth appreciation of their accomplishments that occurred at a time when there were more limited laboratory and diagnostic tests.

Toxicology emerged as an independent discipline in the early nineteenth century and has been aided by the development of numerous sophisticated tests that allow physicians and scientists to identify, quantify, and quantitate elements, chemicals, compounds, and toxins and to sort them into their component parts. These developments also contributed to enrich toxicological terminology with many new terms and eponyms in particular. Eponyms are ascribed to a variety of phenomena including attributing, in many cases, to the person who first identified or described a particular phenomenon and are named for the variety of findings found during the medical, surgical, pathological, or laboratory evaluation. Focusing on eponymous signs caused by poisons and toxins, the purpose of this paper is to honor the eponymous persons who first discovered, described, or more fully elaborated the finding. Nearly 30 associated eponyms have been identified in the literature, half of which were named for persons (e.g., Anstie sign, Billard sign, Blyth sign, Burton sign/line, Corrigan sign, Hertoghe sign, Peary sign). We believe that they are important to learn as they impart an in-depth appreciation of their role and application during the clinical examination. Knowledge of the person’s biographical accomplishment(s) and character imparts a personalized and humane qualities to these signs from a medico-historical perspective. Understanding these signs and how to recognize them provides a method applying the bedside clinical examination to further support clinical suspicion or diagnose disease.

COVID-19 Era Requires Urgent Integration of Virtual Reality Simulations in Medical Education

Description The COVID-19 pandemic continues to cause an unprecedented level of disruption across every part of the globe. This disruption detrimentally affects the field of medical education; in particular, anatomical, surgical and clinical training, all which require hands-on experience. On the other hand, the pandemic not only brings new challenges in medical education but also opportunities for testing the validity of our old education paradigms and for developing the ability to embrace a rapid pace of change in better integrating new technologies in the medical curriculum. We contend that the future of medical education lies in the successful use of VR and similar technologies in medical education. Even though this does not mean it can fully replace hands-on training, at present it seems to be the best way possible to support modern medical education in times of limited physical interaction, such as pandemics. However, future studies with robust, comprehensive and culture specific designs are clearly necessary in order to determine the value and feasibility of this approach.

Abdominal Physical Signs and Medical Eponyms: Part II. Percussion and Auscultation, 1924-1980

BACKGROUND

Percussion and auscultation are derived from the Latin words to touch and hear, respectively. Covered are abdominal percussion signs and ausculatory signs discovered from 1924 to 1980. Signs ascribed as medical eponyms pay homage to these physicians who provided new and unique insights into disease.

DATA SOURCES

PubMed, Medline, online Internet word searches, textbooks, and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.

CONCLUSION

Many of these signs have been discarded because of modern imaging and diagnostic techniques. When combined with a high clinical suspicion, positive results using percussion combined with palpation is a useful bedside technique in detecting splenic enlargement. Thus, some of these maneuvers remain important bedside techniques that skilled practitioners should master, and along with a meaningful history, provide relevant information to diagnosis. It is through learning about these signs that we gain a sense of humility on the difficulty physicians faced prior to the advent of techniques that now allow us an easier way to visualize and diagnose the underlying disease processes.

Fothergill and Carnett signs and rectus sheath hematoma

Fothergill and Carnett signs are used to distinguish intrabdominal from abdominal wall diseases. These bedside techniques may be useful in distinguishing intrabdominal from an abdominal wall cause of disease. Timely and accurate diagnosis of rectus sheath hematoma in at risk patients in the appropriate clinical setting is important because of the associated morbidity and mortality associated with this condition. Diagnosis requires an accurate and thorough history and bedside physical examination and performance of these maneuvers as originally described.

William Cheselden (1688-1752): 18th-Century Pioneer of Lateral Lithotomy and Iridectomy

William Cheselden (1688-1752) was a British surgeon and anatomist who was famous for his rapid and skilful techniques. He emphasized learning through dissection and introduced lateral lithotomy as an effective approach for the removal of bladder stones. Medical practitioners throughout Europe adopted his techniques. Cheselden also has been credited with the first known case of full recovery from blindness using iridectomy. Moreover, a milestone in his career was his indirect instigation for the separation of surgeons from barbers. He is considered the founder of modern British surgery.

Redefining terminology for medical eponyms

There are those who support and others who refute the use of medical eponyms. Clarified are the use of the terms eponyms and medical eponyms. We proposed the redesign of a more specific definition for a medical eponym. Therefore, a medical eponym in clinical medicine is defined as a honorific term bestowed to an individual who identified or discovered, a disease, sign, symptom, syndrome, test, finding, anatomical part, or designed a device, procedure, view, treatment, classification, prediction rule, principle, or algorithm. Thus medical eponyms include those aspects which involve patient care or applications of care. Further discussed and clarified are misconceptions regarding the use of medical eponyms, distinguishing features of other types of “onyms”, and supporting and opposing views regarding their retention and disbarment. Recognized is the importance that medical eponyms be carefully studied using an evidence-based approach before they are abandoned.

Abdominal Physical Signs and Medical Eponyms: Part I. Percussion, 1871-1900

BACKGROUND

Percussion is derived from the Latin word to hear and to touch. Percussion of the abdomen is used to detect areas of tenderness, dullness within an area of tenderness suggestive of a mass, shifting dullness representing fluid or blood, splenic, hepatic and bladder enlargement, and free air in the peritoneum. Covered are abdominal signs of percussion attributed as medical eponyms from the time-period beginning in the mid-late nineteenth century. Described is historical information behind the sign, descriptions of the sign, and implication in modern clinical practice.

DATA SOURCES

PubMed, Medline, online Internet word searches, textbooks, and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.

CONCLUSION

Percussion signs defined as medical eponyms were important discoveries adopted by physicians prior to the advent of radiographs and other imaging and diagnostic techniques. The signs perfected during this time-period provided important clinical cues as to the presence of air within the peritoneum or rupture of the spleen.

Abdominal Physical Signs of Inspection and Medical Eponyms

BACKGROUND

An eponym in clinical medicine is an honorific term ascribed to a person(s) who may have initially discovered or described a device, procedure, anatomical part, treatment, disease, symptom, syndrome, or sign found on physical examination. Signs, although often lacking sufficient sensitivity and specificity, assist in some cases to differentiate and diagnose disease. With the advent of advanced technological tools in radiological imaging and diagnostic testing, the importance of inspection, the initial steps taught during the physical examination, is often overlooked or given only cursory attention. Nevertheless, in the era of evidence-based and cost-effective medicine, it becomes compelling, and we contend that a meticulously performed history and physical examination, applying the basic tenets of inspection, remains paramount prior to obtaining appropriate diagnostic tests.

DATA SOURCES

PubMed, Medline, online Internet word searches and bibliographies from source text and textbooks. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.

CONCLUSIONS

We describe the historical aspect, clinical application, and performance of medical eponymous signs of inspection found on physical examination during the 18th to 20th centuries.

The Unna Boot: A Historical Dressing for Varicose Ulcers

The German dermatologist Paul Gerson Unna (1850-1929) is a prominent figure in the history of medicine for pioneering modern dermatopathology and dermotherapy (Figure 1) (1). Aside from writing extensively on anatomy, histopathology, and treatment of skin diseases, he contributed to medicine in many other ways: he originated the idea of using coated pills to enhance local absorption in the intestine, introduced ammonium bituminosulfonate (ichthyol) and resorcinol into medicine, and described several skin conditions including seborrheic dermatitis. Moreover, in 1881 he established a private clinic in Hamburg, Germany, which became a leading expert center in the diagnosis and treatment of skin disorders, hosting postgraduate physicians from all over the world for training (2). Unna also was one of the first to work with pharmacology of dermatotherapeutic agents (1). With the help of pharmacists Paul Carl Beiersdorf (1836-1896) and Oscar Troplowitz (1863-1918), Unna greatly enriched dermatologic formulas with new ingredients (2). As an alternative option to the poorly tolerated compression bandages of his time, in 1885 he invented a special gauze bandage impregnated with a mixture of 15% zinc oxide in a glycogelatin-based paste for treatment of varicose ulcers. This mixture had drying and cooling effects as well as antipruritic effects due to its continuous slight pressure on the skin (1). After numerous tests on different forms of bandages in the following years, Unna presented a new form of skin-tone compression bandage at the Third International Congress of Dermatology in London in August 1896 and published a paper on the topic in the Wiener medizinische Wochenschrift (Vienna Medical Weekly) on 17 October 1896 (3). His bandage technique later became a widely recognized therapy because of its effectiveness and simplicity. Several companies subsequently introduced similar ready-to-use zinc bandages to the market after the turn of the century. Furthermore, in 1910 Unna's pupil Heinrich Fischer (1857-1928), MD also recommended a modified version of the Unna boot for deep vein thrombosis (1,4). Having partially lost its earlier prominence in the first phase of compression therapy, the historical paste dressing and its modified versions are still used effectively to contribute to quicker healing in patients with chronic venous ulcers, and are sometimes used for diseases such as nummular dermatitis, lichen simplex chronicus, and atopic dermatitis on the extremities (4,5). Although the current trend in the use of medical eponyms is likely to decrease in literature, the Unna boot is one of those that have been fortunate to survive, honoring its inventor's name.

Abdominal Physical Signs and Medical Eponyms: Part III. Physical Examination of Palpation, 1926-1976

BACKGROUND

This paper describes medical eponyms associated with abdominal palpation from the period 1926-1976. Despite opposition by some, eponyms are a long standing tradition and widely used in medicine. The techniques may still be useful in some cases, assisting in the selection of an appropriate and cost-effective approach to patient care. In this piece, we cover signs named in honor of physicians who contributed to medicine by developing new palpatory techniques in an attempt to better diagnose disease of the abdominal wall, umbilicus, gallbladder, pancreas, and appendix.

DATA SOURCES

PubMed, Medline, online Internet word searches, textbooks, and references from other source texts. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.

CONCLUSION

We describe brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication into today's medical practice.

Venothromboembolic signs and medical eponyms: Part I

Eponyms are honorific terms ascribed to individuals who discovered a sign, test, syndrome, technique, or instrument. Despite some contentions, eponyms continue to be widely ingrained and incorporated into the medical literature and contemporary language. Physical signs are considered unreliable methods alone for detecting deep venous thrombosis (DVT). The accuracy of the majority of these signs is unknown. For those signs that have been studied, there are a number of methodological limitations hindering the ability to draw meaningful conclusions about their accuracy and validity in clinical practice. Nevertheless, some findings when present and used in conjunction with other key signs, symptoms, and aspects of the patients history may be useful in further supporting the clinical suspicion and likelihood of DVT and/or pulmonary embolism (PE) or venothromboembolism (VTE). These signs also provide the means to better recognize the relationship between clinical findings and VTE. The acquisition of historical knowledge about these signs is important as it further enhances our understanding and appreciation of the diagnostic acumen that physicians were required to employ and to diagnose VTE prior to the advent of advanced imaging methods. Described in this paper is a brief overview of thrombosis as enumerated by Rudolf Virchow, and eponymous signs described in the late eighteenth and nineteenth centuries.

Abdominal Physical Signs and Medical Eponyms: Part II. Physical Examination of Palpation, 1907-1926

BACKGROUND

Abdominal palpation is an important clinical skill used by physicians to detect the cause of the underlying disease. Abdominal physical signs reported as medical eponyms are sometimes helpful in supporting or confirming clinical suspicion of a diagnosis. With the advent of advanced and rapid imaging techniques physicians often know the diagnosis prior to setting their hands on patients. Nevertheless, knowledge of these signs may still remain important in settings where imaging may not be readily available and importantly provide deeper insights into the mechanism of disease. In this paper, described are medical eponyms associated with abdominal palpation from the period 1907-1926.

DATA SOURCES

PubMed, Medline, on-line Internet word searches, textbooks, and references from other source text were used as the data source. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.

CONCLUSION

We describe brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication into today's medical practice.

Ahmed Hilmi Pasha (1839-1905): A remarkable Ottoman physician and medical translator

Besides being a founding member of the Ottoman Medical Society (est. 1867) and general director of the Imperial Military and Civil medical schools in Istanbul, Dr Ahmed Hilmi Pasha offered a pathology course for the first time in the Ottoman Empire. He also translated various medical textbooks from French, and he paved the way for using Turkish in Ottoman medical education.