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'Marjolin's ulcer' is a term that has come to be used for epidermal squamous cell carcinomas that have developed in areas of chronic inflammation. To our knowledge this is the first ever report of a Marjolin's ulcer developing following long-term irritation of the skin of the neck. The history of the eponym is traced and reveals that Marjolin probably never actually described this pathological process.
Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel's syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel's syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods. A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS. We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel's syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.
Fournier gangrene is a necrotizing infection involving the soft tissues of the male genitalia. It was first described in 1764 by Baurienne and given its eponymous name after Jean-Alfred Fournier in 1883 presented a case of perineal gangrene in an otherwise healthy young man. While only 600 cases of Fournier gangrene have been reported in the world literature since 1996, it is a common and serious disease in Africa. In Maputo Central Hospital alone, between 12 and 16 cases are admitted every year and treated with a 20% mortality. The typical patient is an elderly male in his sixth or seventh decade with co-morbid diseases. While considered to affect males only, a similar condition may occasionally affect the female genitalia.
We evaluated a comprehensive deidentification engine at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, that uses a complex set of rules, dictionaries, pattern-matching algorithms, and the Unified Medical Language System to identify and replace identifying text in clinical reports while preserving medical information for sharing in research. In our initial data set of 967 surgical pathology reports, the software did not suppress outside (103), UPMC (47), and non-UPMC (56) accession numbers; dates (7); names (9) or initials (25) of case pathologists; or hospital or laboratory names (46). In 150 reports, some clinical information was suppressed inadvertently (overmarking). The engine retained eponymic patient names, eg, Barrett and Gleason. In the second evaluation (1,000 reports), the software did not suppress outside (90) or UPMC (6) accession numbers or names (4) or initials (2) of case pathologists. In the third evaluation, the software removed names of patients, hospitals (297/300), pathologists (297/300), transcriptionists, residents and physicians, dates of procedures, and accession numbers (298/300). By the end of the evaluation, the system was reliably and specifically removing safe-harbor identifiers and producing highly readable deidentified text without removing important clinical information. Collaboration between pathology domain experts and system developers and continuous quality assurance are needed to optimize ongoing deidentification processes.
This discussion reviews the Greco-Roman mythic origins of the eponymic Hermaphroditus. It reviews the two major tales, one Greek, the other from Ovid, regarding the origins of the sexual and gender predicament of Hermaphroditus. It explains the genealogy of Hermaphroditus in Greek mythology, and includes a discussion of Ovid's text on Hermaphroditus. A comparison of the two renditions offers the opportunity to reflect on who Hermaphroditus may have been, and to reflect on the implications of his nature. The discussion also attends to some of the ethical and emotional conflicts for the intersexed today. Finally, the discussion explores whether lessons from, and hypotheses regarding a mythic figure, such as Hermaphroditus, may provide guidance for intersexed individuals and their parents.
With emphasis on the pulmonary circulation, three general types of vascular disease are discussed: fibroproliferative (atherosclerosis), cellular proliferative (endothelial neoplasms) and inflammatory (granulomatous vasculitis). The causes of these phenotypic responses are invariably multifactorial, but infectious agents including viruses, Chlamydia, Helicobacter, Rickettsia, mycobacteria and other infectious agents have been increasingly implicated in the pathophysiology. The classifications of vascular diseases are complicated and confusing and many eponymous diseases are specific variations of more general disease processes. The pivotal role of the monocyte/macrophage and T-cells is discussed, particularly with regard to intracellular infections. In addition to antimicrobial therapy, modifications of macrophage function by IFN-gamma and blockade of TNF are attractive areas for therapeutic research. Diseases with many synergistic causes will probably also require multifaceted therapeutic interventions.
The author reports a case of neurocysticercosis and hypoparathyroidism in a 28 year-old female with bilateral symmetric basal ganglia calcification demonstrable by C.A.T.-Scan. A brief review of the literature is made in order to show why the eponym "Fahr's disease" should not be applied to this case.
The Lennox-Gastaut syndrome (LGS), although described earlier, was first accepted in 1966 as a form of severe childhood epileptic encephalopathy, characterized by refractory epileptic seizures of diverse types, typical EEG abnormalities and slow mental development. This condition, however, is surrounded by controversy as the clinical criteria used by various authors to define it are quite different. It is very likely that this eponym has been used to harbour distinct epileptic conditions, all of which have in common a slow spike and wave complex in their EEG recording. Despite the fact that one of the hallmarks of LGS is an onset in early childhood, to add to the confusion, some cases of a LGS-like condition with onset in adulthood have been described. We report here one such case: a 28 year old man whose LGS-like condition started after severe head trauma at the age of 20. In addition we briefly review the difficulties in making this diagnosis, using this case to illustrate these aspects.
Hirayama's disease (HD) is frequently found in Asia, and is rarely referred among westerners. It affects young people with higher incidence in males. It is a focal distal amyotrophy with unilateral or asymmetric bilateral involvement of C7, C8 and T1 innervated muscles. HD appears sporadically and has a benign evolution with clinical stabilization in around one year. We report four young male patients with clinical and electrophysiological alterations described in HD, which were followed-up during 5 years. Electromyographic findings were indicative of lower motor neuron involvement. We analyzed cervical MRI aiming at understanding if a questionable spinal cord compression could be implicated in the pathogenesis, but no abnormality was verified. In view of its clinical, and EMG characteristics, HD is no more than a benign monomelic amyotrophy (BMA) clinical variant, and not a specific disease. This eponym could be considered only for the distal upper limb variant (Hirayama's variant) of the BMA.
"Pierre Robin" is one of the most readily recognized diagnostic eponyms in medicine, yet it is a poorly understood nonspecific grouping of malformations that has no prognostic significance. Although the science of dysmorphology and in particular those who study children with clefts would be reluctant to forego the use of this diagnosis, the reality is that fewer than 20 percent of children with micrognathia and cleft palate should have this term applied. The syndromic diagnoses of 100 children with Robin sequence are presented and discussed in relation to morphologic characteristics. Upper airway obstruction and its relationship to feeding problems is also discussed.
Historically, pelvic fractures have been classified according to whether there is pelvic stability or instability, although confusion has been caused by the inclusion of many eponyms that mainly reflect the observation of a single author on a particular fracture pattern. Pennal and Tile were the first authors to attempt to classify pelvic fractures according to the force vector causing them. This concept was refined by Young and Burgess, who provided a more detailed classification system, again relating to force vectors. This article focuses on this classification and its significance with regard to pelvic stability, type of pelvic disruption, and hence the type of corrective forces that should be applied in the surgical management. Use of a classification system of pelvic fractures based on force vectors allows the orthopedic surgeon to apply external fixation in the most appropriate manner to correct pelvic deformity and to maximize patients' survival.
Sister Mary Joseph's nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph's nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.
Although Purkinje observed the eponymous phenomenon at dawn, it is identical to what happens in the dark-adapting eye. It is shown that most modern definitions of the phenomenon couch it in terms of dark adaptation and that the author's definition of it in similar terms is justified in spite of Brozek's objection.
Two eponyms, the Purkinje phenomenon and the Bezold-Brücke phenomenon, are sometimes confused in discussions of the effect of light intensity upon perceived color. The former refers to a change in apparent brightness; the latter refers to a change in perceived hue.
A variety of identity disturbances has been described in psychiatric patients. Although such disturbances possess some common features linked to shared or core psychological structures, qualitative differences that allow them to be distinguished from one another also exist. The cases reported are intended to draw attention to a severe and striking type of identity disturbance observed in psychotic patients, for which we have proposed the eponym, 'the Zelig phenomenon'. The discussion focuses upon the issue of the coexistence in psychopathology of continuity and discontinuity. This apparent paradox can be regarded as an example of parallax, in which two quite different, yet equally valid, perspectives are possible and may be brought alternately into play. It is, however, argued that in the delineation of psychopathological entities it is necessary to adopt the perspective that considers discontinuities and matters of form, even though they may be at times overshadowed by continuities that derive from the alternate perspective.
Two psychotic individuals, who performed acts of genital self-amputation, are presented. One of the patients had self-mutilated with the intention of suicide and had also in the past amputated his hand. Psychotic patients with delusions (often religious), sexual conflict associated with guilt, past suicide attempts or other self-destructive behaviour and depression, severe childhood deprivation, and major premorbid personality disorder, are the group at risk for genital self-amputation. It has been proposed that the eponym, the "Klingsor" syndrome, be applied only to acts of genital self-mutation, involving religious delusions. The author suggests that this syndrome should be expanded to include all cases of genital self-mutation resulting from a psychotic illness.
This paper examines neurosurgery in the 18th century and suggests that the origins of the specialty can be recognized at the time when surgeons began to use the neurological status of the patient as a guide for surgical intervention. Percivall Pott (1714-1788) was one of the leading surgeons in London in the 18th century. He is remembered through eponyms of Pott's puffy tumor, Pott's fracture, and Pott's disease. A review of his writings and those of his contemporaries indicates that these surgeons were aware of the importance of changes in level of consciousness after head injury. The recognition and significance of the lucid interval was described and understood as a neurosurgical sign in the 18th century. Because of Pott's pre-eminence in the surgery of his time through his writings and lectures, he should be considered one of the founders of neurosurgery as a separate surgical discipline.
As we commemorate the first centennial since Alzheimer's disease (AD) was first diagnosed, this article casts back into the past while also looking to the future. It reflects on the life of Alois Alzheimer (1864-1915) and the scientific work he undertook in describing the disorder suffered by Auguste D. from age 51 to 56 and the neuropathological findings revealed by her brain, reminding us of the origin of the eponym. It highlights how, throughout the 1960's, the true importance of AD as the major cause of late life dementia ultimately came to light and narrates the evolution of the concepts related to AD throughout the years and its recognition as a major public health problem. Finally, the article pays homage to the work done by the Alzheimer's Association and the research undertaken at the Alzheimer's Disease Centres within the framework of the National Institute on Aging (NIA) Program, briefly discussing the long road travelled in the fight against AD in the past 25 years and the scientific odyssey that we trust will result in finding a cure.