Posts 26 to 31 January 2015

(for blogs, see below)

By way of explanation

This is the first completely new medical dictionary to come to the market since the Tabers Medical Dictionary was published in the 1940s.*

*It seems appropriate to discount The International Dictionary of Medicine and Biology, which was published by John Wiley and Sons in the mid-1980s and never made it to a second edition.

After trying to produce this as a text-based work, it became obvious that a lexicon that serves the needs of physicians and health care workers in the 21st century must be designed and developed from the ground up as a database.

This explains the poor implementation (and virtual unusability) of the electronic versions of the standard medical dictionaries (the Dorland’s, Stedman’s and Taber’s medical dictionaries).

For the record, this was the main complaint of my own Concise Dictionary of Modern Medicine, which was an iOS App from 2010 until I had it removed. To access information from a text-based work, a computer has the daunting task of sifting through ALL the information in the text, a problem that doesn’t occur with relational database searches.  

The Concise Dictionary of Medicine and a handful of other text-based eBooks I’ve written over the last few decades are still available on the various eBook stores (iTunes, Kindle, Nook, etc) for those who like the text format and want them on their iPads, tablets, etc. However, database apps are the future and as I go online with the database version of each, I will retire the eBook versions.

I began collecting new medical terms as a hobby in 1984, premised on my belief that the standard medical dictionaries were losing touch with the spoken and working language of medicine.

You’ll find my musings on medical lexicography on the page titled:

New Medical Dictionary

I went live with in May, 2012 and blog about 5 terms/day, which derive from a growing database that now has 183,213 entries*

*The Dorland’s has less than 124,000 entries.

I’ll be making portions of the database available as iOS/Android apps…the first product, Medical Abbreviations, will be out soon…stay tuned.

Most of the terms blogged herein fall into one of three general categories:

• Popular terms–e.g., champagne bottle leg, Michael Jackson syndrome(s), Mickey Mouse sign(s), soap bubble pattern, Sutton’s law, etc. I’ve tried to include something for everyone, in particular as relates to the cultural savvy that doctors are expected to have vis-à-vis music, literature, the arts and the world in general. Even if you’re not in health care, the material is “edutaining”, occasionally droll…

• New biomedical terms–e.g., from genomics and molecular biology, evidence-based medicine, informatics, managed care, sport medicine, etc

• Old terms due for burial with comments on usage

I encourage the reader to look over the 4500+ terms now found on this website. When I started in 2012, I thought it was a good idea to arrange the material chronologically. 

What was I thinking? WHO looks up a term by date?????? So each page has about 25 terms with no unifying theme (yeah, it’s a mess). 

Soooooooo, I consulted a SEO (search engine optimisation) expert to ask why the traffic had stagnated. He said that the website was largely invisible to search engines (Google, Bing, Yahoo), and suggested that I separate each entry into its own page, which I’m now doing, a process that I should finish by July of 2015. What that means for the visitor is that un-reworked terms are arranged by date and pretty difficult to find, whilst the reworked terms pop right up when you type the term in the search bar located at the top right corner of this website. 

I plan to offer this growing pool of blogged terms as an annual subscription, updated monthly.

One change you’ll see soon is the disappearance of the original files, which will result in the dreaded 404 error

Format of entries Whilst I believe the format is self-explanatory, I am biased and may be assuming too much. The following few lines are meant to explain the elements found in most of the terms blogged on this website.

•  Entry name bailout 

•  Area of interest SURGERY 

•  Synonyms Bailout procedure, damage control surgery 

•  Definition The immediate closure… 

•  Reference

A lexicon written in the 21st Century cannot, given of the diverse sources from which its material derives, escape some tongue-in-cheek and even outright comedy.

I tried to confine the jocularity to the choice of illustrations so as to not diminish the value of the work. For most of the terms, the illustration is on point. For others, I took liberties, such as those taken for genes–e.g., HOMER2, which got a mugshot of Homer Simpson and HIP2, which got an illustration from hipster artist Josh Agle.

Small minds, as they say, easily amused…

If you have a new term that you feel has gotten short shrift in a medical dictionary, shoot me an email at and I’ll add it if I agree. And feel free to back-link to this website.

I will correct the inconsistencies in the typography when I transfer the blogged material to the permanent pages. 

The reader will note that the spelling follows that extant on the other side of the pond. Unless they change the name of the language we speak to American, orthographic principles should follow received pronunciation (Queen’s English).  

31 January 2015


GENETICS A gene on chromosome 7q35-q36 that encodes a polycomb group–PcG protein, which is the catalytic subunit of the PRC2/EED-EZH2 complex. The complex methylates Lys-9 and Lys-27 residues of histone H3, leading to transcriptional repression of the affected target gene over successive cell generations. It associates with the embryonic ectoderm development protein–VAV1 oncoprotein, and the X-linked nuclear protein and may play a role in hematopoietic and central nervous systems

Molecular pathology Defects of EZH2 cause Weaver syndrome–an overgrowth syndrome characterised by accelerated bone and growth maturation. 


medical certificate of cause of death 

PUBLIC HEALTH An official UK certificate which enables registration of a death with the Office of National Statistics. The certificate provides a permanent legal record of the fact of death, and enables the family to arrange disposal of the body, and settlement of the deceased’s estate. 

menthol cigarette

methol_cigarettesTOBACCO CONTROL A self-explanatory term for a cigarette with menthol flavouring. First produced in 1925 under the Spud Menthol Cooled Cigarette banner, current brands of menthol cigarettes include Kool, Salem, Newports, Misty, Consulate, Belair, and menthol versions of Pall Mall, Marlboro, and Camel. Menthol cigarettes constitute 20% of all cigarettes sold in the US; they are widely preferred by African American, 80% of whom smoke menthol cigarettes.

Accumulating data suggest that it is more difficult to quit smoking menthol cigarettes than non-menthol cigarettes, an observation attributed to the cooling effect of menthol, which allows the smoker to inhale deeper, deliver more nicotine and (apparently to the tobacco industry’s delight) increase his or her nicotine dependence. The tobacco industry is  aware of the link between menthol cigarettes and addiction and may adjust menthol to create a milder experience for first time smokers. 


K Gandhi, Intl J Clinical Practice, February 2009

rigor mortis

FORENSIC PATHOLOGY Post-mortem corporal rigidity, rigor stiff, stiffness of cadaver A major sign of death in which skeletal muscles acquire a board-like rigidity shortly after death. Rigor mortis–RM first appears in the jaw and other short muscles–e.g., of hand at 2-4 hours after death, later develops in the trunk and extremities, peaks at 24-48 hours, then disappears in the same order as it developed.

Mechanism After death, oxygen and intracellular glycogen are depleted, ATP falls and pH rises precipitously. In the absence of ATP, the SERCA–sarco/endoplasmic reticulum Ca2+-ATPase pump shuts down and calcium ions diffuse from into the sarcomere, binding with troponin and allowing crossbridging between myosin and actin. RM begins at ATP levels of 85% normal and disappears as ATP falls below 15%. The rapidity of onset of RM is related to environmental factors, especially temperature; it occurs more rapidly in hot weather or when accompanied by convulsions, strychnine poisoning, sunstroke and tetanus. It also occurs in cardiac and smooth muscle, affecting vessels and the gastrointestinal and urogenital tracts. It begins earliest in muscles that were most active before death. 

Rule of thumb for rigor

Warm and flaccid   < 3 hours

Warm and stiff       3-8 hours

Cold and stiff         8-36 hours

Cold and flaccid     > 36 hours

Special considerations 

Rigor occurs in the

• Dartos, compressing the testes and epididymis and the muscle fibres of the prostate and seminal vesicles, resulting in expression of semen from the urethral meatus lending weight to the myth of ante-mortem sexual activity

• Arrector pili muscles, resulting in “goose flesh”

• Heart, luring the unwary into overdiagnosing ventricular hypertrophy

• Iris; the pupils may be unequal  


wrecking ball effect 

CARDIOLOGY, PATHOLOGY A tethered ball-like effect of a pedunculated tumour in the cardiac atria or ventricles, often due to a calcified myxoma, which may damage the mitral valve, rupture chordae tendineae or cause severe mitral regurgitation, as it pounds against endocardial structures. 

30 January 2015

Dr Strangelove syndrome 

NEUROLOGY Alien hand syndrome, anarchic hand syndrome A popular term for alien hand syndrome* in which a person’s hand or limb acts as if it has a mind of its own and has independent voluntary activity. As an example, the “good” hand, which is under the person’s normal voluntary control might put a cigarette in the mouth, and the “bad” (alien) hand might knock it out. Neuroimaging of patients with Dr Strangelove/alien hand syndrome typically reveals lesions in the medial frontal lobe and corpus callosum.

The reason for the syndrome is unknown; it is thought that the primary motor cortex controlling hand movement is isolated from influences of the premotor cortex, but is still able to execute hand movements. There is no cure or treatment.

*As of 29/01/2013, Dr Strangelove syndrome continues to be in wide use and thus this is one of the few definitions that appears twice in this work.



PLASTIC SURGERY Meloplasty Plastic surgery of the cheek.

While melonoplasty fills a lexical void, it got 24,700 hits on 29/01/2013; meloplasty, an alternative spelling of the same term, got 7,920 hits, both most commonly in secondary and non-English language literature. The unwieldy plain English plastic surgery of the cheek, got 944,000 hits and thus would be preferred in the working medical parlance.  


MOLECULAR MEDICINE A gene on chromosome 8q21-q24 that encodes nibrin, a component of the MRE11-RAD50-NBN–MRN complex, which plays a critical role in the cellular response to DNA damage and maintenance of chromosome integrity. The MRN complex is involved in double-strand DNA break repair, DNA recombination, maintenance of telomere integrity, cell cycle checkpoint control and meiosis.

Molecular pathology Defects of NBN cause Nijmegen breakage syndrome, and are associated with increased susceptibility to aplastic anaemia and breast cancer. 



INTERNAL MEDICINE Neonatal onset multisystem inflammatory disease, chronic infantile neurological cutaneous and articular syndrome, infantile onset multisystem inflammatory disease An über rare–100 cases in the world literature–condition characterised by an early onset of persistent multisystem–CNS, skin, joints–inflammation, and recurrent fever.

Clinical findings

• Meningeal irritation–headaches, seizures, vomiting

• Hearing and vision loss due to nerve damage and inflammation

• Persistent rash–typically of neonatal onset,

• Joint inflammation, swelling, cartilaginous overgrowth–resulting in characteristically prominent knees, joint contractures

• Other findings include short stature with short lower legs and forearms, characteristic facies (prominent forehead, protruding eyes), amyloidosis leading to kidney damage.

Molecular pathology Missense mutations in the nucleotide-binding site of NLRP3, which encodes cryopyrin, a protein involved in regulating inflammation and apoptosis, cause NOMID


Am J Hum Genet. 2002 Jul;71(1):198-20 

watered silk appearance watered silk

PATHOLOGY Moire appearance A descriptive term for the wavy, loosely parallel fascicles of tumour cells seen by low-power light microscopy in granulosa cell tumours of the ovary and uterine leiomyomas, which has been fancifully likened to a fabric known as moire or watered silk (roll your mouse over the cloth to see a granulosa cell tumour). 

Reference CAP, 2011—May Case of the Month

29 January 2015

Kabuki syndrome kabuki

GENETICS, PAEDIATRICS Kabuki make up syndrome, Kabuki mask syndrome, Niikawa-Kuroki syndrome A congenital condition that primarily affects the Japanese, which is characterised by a typical facial dysmorphia–long palpebral fissures, eversion of the lateral lower eyelids, arched eyebrows, a broad depressed nose, fancifully likened to the makeup worn in Kabuki theatre (roll your mouse over the image to see an example)

Further changes include prominent ears, recurrent otitis, hearing loss–50%, a high arched or cleft palate, growth retardation–83%, skeletal defects–e.g., bradydactyly, spinal deformity including scoliosis, ± sagittally cleft vertebrae, unusual dermatoglyphic patterns, heart defects–30%, urinary tract disorders, hypotonia, joint laxity, short stature. In terms of neuropsychological development, most have–92%–mild to moderate intellectual disability. These children are distinctive behaviourally: 87% are happy; 75% prefer routines; 50% are unusually sociable; 30% engage in only minimal interaction with others. They often have defects in fine motor skills, speech, and memory 

Molecular pathology A loss-of-function mutation in MLL2, which encodes histone methyltransferase, an enzyme that plays a key role in epigenetic programming during development, has been found in more than half of cases of Kabuki syndrome. 

Ref Kabuki-mask-syndrome 


MEDSPEAK adjective Black, very dark brown

Melanotic refers to melanin; melenic refers to melena. When referring to darkened stool, melenic is the correct adjective; in practice, however, the terms are used interchangeably, with melanotic being increasingly preferred. 



MEDSPEAK Melanhidrosis A virtually extinct term for the sweating of dark-coloured fluid.

This term got 44 hits on 27/01/2013, all in secondary and non-English language literature and thus best regarded as retired.  


PHYSIOLOGY A gene on chromosome 3q28-q29 that encodes melanotransferrin, a cell-surface glycoprotein found on melanoma cells, which shares sequence similarity and iron-binding properties with the transferrin superfamily. It is involved in cellular uptake of iron and possibly also zinc.


placental clock 

OBSTETRICS Placental timer A popular term for the hypothetical timer which some workers believe is intrinsic to the placenta, and control sthe length of gestation.

Evidence supporting a placental clock is the inverse relationship between corticotrophin-releasing factor–CRF, which rises and CRF-binding protein–which falls at the end of pregnancy. An abrupt rise in available CRF may be the trigger for parturition in humans. Other hormones to be considered during the placenta’s expiring shelf life include urocortins 1, 2 and 3 and the ratios of oestradiol and oestriol. The concept of a placental clock may be oversimplistic, given that parturition is a complex interplay of hormones and neurochemicals between the placenta, the fetus and the mother.


Useless big names for useless big numbers 

quattuordecillion 1045

quindecillion 1048

quadryllion 1064  

quattuorvigintillion 1075

quadragintillion 10123

quintyllion 10128  

quinquagintillion 10153

quattuordecyllion 1065,536  

quindecyllion 10131,072  


28 January 2015

Adam Walsh Child Protection and Safety Act 

PUBLIC SAFETY PubL 109-248 An Act intended to protect children from sexual exploitation and violent crime, prevent child abuse and pornography, promote Internet safety, and honour Adam Walsh and other child crime victims.

The Act was signed into law by GW Bush in 2006. It slots sex offenders into three tiers, mandating that Tier 3 offenders (the worst) update their address every 3 months for life, Tier 2s must do so every 6 months for 25 years; Tier 1s must do so every year for 15 years. Failure to register and update information is a felony under the Act.

The Act is named for Adam John Walsh (1974 -1981), an American boy who was abducted from a Sears department store in Hollywood, Florida and later found murdered and decapitated. His father, John Walsh, became an advocate for victims of violent crimes and the host of the television program America’s Most Wanted, a program which has saved countless lives by helping track down violent criminals. 


Brueghel syndrome

bruegel_gaperNEUROLOGY Blepharospasm-oromandibular dystonia syndrome, jaw-opening dystonia, median facial spasm, Meige’s disease (in part), Meige syndrome 2, oromandibular dystonia with jaw-opening A movement disorder characterised by blepharospasm, oromandibular dystonia, involuntary spasms of the facial, tongue, and neck muscles. It has been linked to organic disease of the brain–cavum septi pellucidi and Verga’s ventricle and is a rare complication of neuroleptic–e.g., phenothiazine and butyrophenone–therapy. It is more common in middle-aged to elderly females and may be accompanied by yawning, forced opening of the jaw, oromandibular dystonia, lip retraction, blepharospasm, hemifacial spasm, spasm of the platysma, and protrusion of the tongue, or the jaw may be clamped shut and the lips pursed. 

Flemish artist Pieter Bruegel (Brueghel) the Elder (c 1525-1569). The name is from Brueghel’s painting, de Gaper–yawning Man, 1564–Brussels, Musées Royaux des Beaux-Arts; the sitter appears to have been a neuroleptic, which is more commonly linked to orofacial dyskinesia–choreoathetotic chewing, lip smacking, and licking movements 

References Eur J Neurol. 2003 Nov;10(6):727-9’s_syndrome

integrative personal omics profile 

MOLECULAR DIAGNOSTICS Analysis of a person’s molecular data and activity in the context of personalised medicine, that combines genomic, transcriptomic, proteomic, metabolomic, and autoantibody profiles, which some believe may be the future of diagnostic medicine. 

Reference Cell. 2012 Mar 16;148(6):1293-307.

doi: 10.1016/j.cell.2012.02.009


MOLECULAR MEDICINE A gene on chromosome 11q21 that encodes meiotic recombination 11 homolog A (S cerevisiae), a nuclear protein involved in homologous recombination, telomere length maintenance, and DNA double-stranded break repair. On its own, MRE11A has endonuclease and 3′ to 5′ exonuclease activities. With the RAD50 homolog, it forms a complex, which is required for the nonhomologous joining of DNA ends. The complex has increased single-stranded DNA endonuclease and 3′ to 5′ exonuclease activities. With DNA ligase, MRE11A promotes the joining of noncomplementary ends.

Molecular pathology Defects of MRE11A cause ataxia telangiectasia-like disorder–ATLD, which is clinically similar to ataxia telangiectasia, but milder, as well as nephronophthisis-related ciliopathies. 



EVIDENCE-BASED MEDICINE, ONCOLOGY SELenium and vitamin E Cancer prevention Trial A cancer prevention study evaluating the efficacy of antioxidants–e.g., selenium, vitamin E–in preventing prostate cancer.

Conclusion The initial data, reported in late 2008, indicated that neither selenium nor vitamin E prevented prostate cancer in healthy men. Two trends were noted: a small increase in prostate cancers in men taking only vitamin E, and a small increase in diabetes in men taking only selenium. Follow-on studies in 2011 confirmed the uptick (17%) in prostate cancer in men taking only vitamin E, at which time vitamin E supplements were stopped.

Logistics Randomised, placebo-controlled trial  of 35,533 men from 427 medical centres in North America and Puerto Rico randomised to 4 groups (selenium; vitamin E; selenium + vitamin E; placebo)  


JAMA 2009;301(1):39-51doi:10.1001/jama.2008.864 


PSYCHOLOGY Morbid fear of stars*

*Celestial, not terrestrial 

27 January 2015


MEDSPEAK Cheiromegaly, macrocheiria, macrochiria, megalocheiria, megalochiria Enlargement of one or more hands. 

Acromegaly is more commonly used in the working medical parlance, despite the fact that it is a more general term which includes enlargement of the nose, head, feet and hands. Chiromegaly got 16,400 hits with the keyword 2012; most of those hits were in secondary and non-English language literature. Acromegaly got 678,000 hits. 


IMMUNOLOGY, MOLECULAR MEDICINE A gene on chromosome 7q11.23 that encodes a linker protein involved in high-affinity immunoglobulin epsilon receptor–FCER1-mediated signaling in mast cells, and possibly also in B-cell antigen receptor–BCR-mediated signaling in B-cells and high-affinity immunoglobulin gamma Fc receptor I–FCGR1-mediated signaling in myeloid cells. LAT2 couples activation of FCER1, BCR and FCGR1 and their associated kinases with distal intracellular events by recruiting GRB2.

Molecular pathology Haploinsufficiency of LAT2 may cause some of the cardiovascular and musculoskeletal defects seen in Williams (aka Williams-Beuren) syndrome. 



SEXOLOGY, UROLOGY Macrophallus, megalopenis, megalophallus, megaphallus A really big penis. 

In 1940, a Dr. Dickinson documented a dick which, under full sail, measured 34.3 cm (13.5 inches) bow to stern and 15.9 cm (6.25 inches) around at midships. 95% of adult male members measure 10.7 to 19.1 cm (4.23 to 7.53 inches). 


Megan’s Law 

PSYCHIATRY, PUBLIC HEALTH A popular term for the body of laws aimed at registering, tracking, and notifying communities regarding the movements of convicted sex offenders and paedophiles.

The law was named after a 7-year-old New Jersey girl, Megan Kanka, who was sexually assaulted and strangled to death by Jesse Timmendequas. The community was not notified that Timmendequas, who lived across the street from the Kanka family with four other sex offenders, was a previously convicted sex crimes offender. 


twinkling_star_correcttwinkling star artefact 

IMAGING A descriptive term for short linear or stellate radiations that extend from pulmonary blood vessels, which have been fancifully likened to intermittently pulsating celestial bodies. They appear in non-ECG-gated thin-slice CT scans of the lungs and are an artefact caused by distortion of pulmonary vessels due to cardiac motion (see arrowheads). “Twinkling stars” help distinguish normal blood vessels from tumour masses, which may have the same CT density

References 212/3/649/F3.expansion.html

Radiology September 1999 vol. 212 no. 3 649-654.

26 January 2015

box jellyfish jellyfish

GLOBAL VILLAGE, TROPICAL MEDICINE Any of a group of marine invertebrates of the Class Cubozoa, which include Chironex fleckeri, Carukia barnesi–irukandji jellyfish and Chiropsolmus quadrigatus, native to the warm waters of northern Australia and Indo-Pacific Ocean. Many–but not all–can cause lethal injuries. The highest risk period is from October to May. Once a tentacle adheres to skin, it pumps nematocysts with venom into the skin (roll your mouse over the jellyfish to see a person who died of box jellyfish injuries), causing the sting, intense pain and cardiovascular collapse in extreme cases

Management Topical vinegar is the only effective way to disable the box jellyfish’s nematocyts and stop further discharge into the bloodstream

Box jellyfish have caused at least 5,568 recorded deaths since 1954, due to a high-molecular-weight dermatonecrotic venom, the nature of which is as yet unknown. Unlike true jellyfish which drift, box jellyfish actively seek their prey. 



ORTHOPAEDICS A gene on chromosome 11p12-p11 that encodes exostosin 2, a glycosyltransferase involved in the chain elongation step of heparan sulfate synthesis.

Molecular pathology Defects of EXT2 cause hereditary multiple exostoses type 2, formally known as exostoses—multiple—type 2 



MOLECULAR MEDICINE A neologism for the constellation of an organism’s “-omic” information, which includes the genome itself–genomic, transcription products–transcriptomic, protein products–proteomic, and metabolic products–metabolomic data. 

Reference Cell. 2012 Mar 16;148(6):1293-307.

doi: 10.1016/j.cell.2012.02.009

will_rogers_phenomenonWill Rogers phenomenon 

ONCOLOGY Stage migration A shift in the mean values of two sets of data when a subset is moved from group A to group B. The term was coined in honour of American cowboy-philosopher, Will Rogers (1879-1935), who observed that truth was relative to one’s vantage point and famously said, “When the Okies left Oklahoma for California, they raised the IQ of both states.”

As applied to oncology, the Will Rogers phenomenon refers to the “improved” survival of patients with cancer by either reclassifying them into different prognostic groups, as a result of recognising more subtle disease manifestations, or by using diagnostic modalities which allow the disease to be diagnosed at an earlier stage. The Will Rogers phenomenon results in a zero-time shift and an improved prognosis without affecting actual survival. When classified by symptom stages without using new diagnostic procedures, survival for the same cancer has not substantially changed. Some authors believe that advances in diagnostic technology blinds the medical community to the actual lack of progress in treating cancer.

References Ann Int Med 1983; 99:843

NEJM 1985; 312:1604, 313:1291c.

Zimmermann-Laband syndrome 

DERMATOLOGY, GENETICS Hereditary gingival fibromatosis, Laband Zimmermann syndrome An über rare autosomal dominant OMIM:135500 condition characterised by gingival fibromatosis, hypoplasia o distal phalanges, nail dysplasia, joint hypermobility, hepatosplenomegaly and mental retardation. 

Molecular pathology The defective gene has been tentatively localised to chromosome 3p14.3 or 3p21.2.