25 May 2015
blood colour analyser
A self-explanatory term for an obsolete device used to assess the colour of blood. I’ve been in lab medicine for over three decades and not seen one in practice.
A modern translation of this device might be spectrophotometry of serum…to quantify haemolysis.
Engulfment and cell motility 1, CED12, engulfment and cell motility protein 1
The gene on chromosome 7p14.1 that encodes an engulfment and cell motility protein which interacts with dedicator of cytokinesis–DOCK proteins to promote phagocytosis and cell migration. It is involved in the cytoskeletal rearrangements required for phagocytosis of apoptotic cells, cell motility, and acts as a complex with DOCK1 to activate Rac Rho small GTPases.
Molecular pathology Increased expression of ELMO1 and DOCK1 may increase glioma cell invasion. Single nucleotide polymorphisms of ELMO1 may be associated with diabetic nephropathy.
PSYCHIATRY, SOCIAL MEDICINE
A general term for those social programs which divert individuals with serious mental illness (and often co-occurring substance use disorders) away from jail and provide links to community-based treatment and support services. The individual thus avoids arrest or spends a significantly reduced time period in jail and/or lockups on the current charge or on violations of probation resulting from previous charges.
A self-explanatory term for the reporting of a person by name to public health authorities when that person is infected by certain pathogens. Named reporting is a standard practice for surveillance of certain infectious diseases–tuberculosis, syphilis, gonorrhoea*, which pose a public health threat.
But not of a person’s HIV status, in large part because of the social stigma attached to HIV-1 positivity.
A popular UK term for a GP–general practitioner with a specialty interest and/or skill–e.g., dermatology, gynaecology, geriatrics–who may have earned a diploma in the area of interest, but is not per se a specialist (consultant) or fellow of the Royal College of that particular specialty.
Reference MedspeakUK Mental Health Review Journal 2000; 5:6-13
A popular term for a doctor trained in a specialty for which there are too many specialists for the number of patients with the special problems or diseases for which the specialty was created. As here defined, specialoids often become deskilled, because they spend their professional time treating non-referral (non-specialty) cases.
Reference Medspeak-US NEJM 1993; 328:940, ref 6
Yup, two countries separated by a common language…
24 May 2015
A form of prosopagnosia (face blindness)* attributed to underdevelopment of the face recognition system in the right occipital temporal region. Those with apperceptive prosopagnosia cannot differentiate between same and different faces, but can recognise people based on non-facial clues–e.g., clothing, hairstyle or voice.
*A condition characterised by an impaired ability to recognise faces, with other aspects of visual processing–e.g., object discrimination and cognition–e.g., decision making, remaining intact.
A form of prosopagnosia attributed to underdeveloped face recognition, where perception is spared, but the links between early face perception and one’s semantic information about person X or Y is buggered. Right anterior temporal regions may play a critical role in associative prosopagnosia.
Those with associative prosopagnosia may be able to differentiate between people’s faces (same–different) and guess age and sex from a face–i.e., they can process some facial information, but may not be able to later identify the person in a picture or provide any information about them such as their name, occupation, or when they were last seen.
eye of the tiger sign
A sign seen on T2-weighted MRI, in which there is a very low signal intensity in the globus pallidus due to an excess accumulation of iron, surrounding a central region of high signal intensity attributed to gliosis, increased water content, and neuronal loss with disintegration, vacuolisation, and cavitation of the neuropil (roll your mouse over the image to see the MRI).
First described in Hallervorden-Spatz syndrome (OMIM:234200, now termed by cognoscenti as neurodegeneration with brain iron accumulation, given Hallervorden’s link to the Nazi atrocities), the sign has also been reported in other extrapyramidal parkinsonian disorders: cortical–basal ganglionic degeneration, early-onset levodopa-responsive parkinsonism, and Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy).
References Radiology 2000 217: 895-896
A term of art for a bed in an NHS hospital trust which is placed in a ward in addition to the ward’s legally allowed and staffed bed complement.
Such beds are used at times of overcrowding and are usually located near the specialty ward to which the patient would have been admitted had a “legal bed” been available.
vitreoretinopathy—exudative type 1
Criswick-Shepens syndrome, exudative vitreoretinopathy—familial—autosomal dominant, familial exudative vitreoretinopathy, familial exudative vitreoretinopathy—autosomal dominant
An autosomal dominant disorder OMIM:133780 of retinal vasculature characterised by an abrupt cessation of growth of peripheral capillaries, leading to an avascular peripheral retina. The loss of peripheral vessels causes ischaemia, triggering compensatory retinal neovascularization. The new vessels are prone to leakage and rupture, causing exudates and bleeding, followed by scarring, retinal detachment and blindness.
Clinical findings Highly variable, even within the same family. Patients with mild disease are asymptomatic, and only identified by an arc of avascular retina in the extreme temporal periphery. It resembles retinopathy of prematurity but there is no evidence of prematurity or small birth weight in the patient history.
Molecular pathology Defects of FZD4, which encodes a member of the frizzled family of Wnt protein receptors, cause exudative vitreoretinopathy type 1.
23 May 2015
Homo neanderthalensis, Homo sapiens neanderthalensis, Neandertal, Neanderthal Man
An extinct pre-human Homo who lived between 230,000 and 22,000 years ago (the last known Neanderthals lived in the Gravettian region of France). They primarily lived in cold climates; their body proportions are similar to those of modern cold-adapted peoples: short and solid, with short limbs. Men averaged ±168 cm; their bones were thick and heavy, and showed signs of powerful muscle attachments.
Neanderthals would have been strong by modern standards; their skeletons show that they endured brutally hard lives. Once thought stupid, they made symbolic objects, adorned their bodies, and may have played musical instruments. Neanderthal tools and weapons are regarded as more advanced than the tools of Homo erectus. They were hunters, and the first Homo spp known to have buried their dead–the oldest known burial site is ±100,000 years old. Neanderthal skeletons are found throughout Europe and the Middle East. Recent data suggest that the Homo sapiens and neandertals coexisted but did not interbreed. Neanderthal lifestyles differed from that of humans; they used weapons differently, and fought at closer range; while the human was a migrating species, Mr Neanderthal was a homebody, staying for prolonged periods in the same site, depleting the food supply, possibly leading to his demise. The “classic” western European Neanderthals were more robust than those found elsewhere. The average brain size is larger than that of modern humans, about 1450 cc, but this correlated with their greater bulk; the cranial cavity is longer and lower than that of modern humans, with a marked bulge at the back. Like Homo erectus, Neanderthals had a protruding jaw and receding forehead. The chin was weak; the midfacial area also protrudes, a feature not found in Homo erectus or Homo sapiens and may have been an adaptation to cold. Other minor anatomic differences from modern humans include peculiarities of the shoulder blade, and pubic bone.
Neanderthals were named for the site in the Neander Valley, near Düsseldorf, where their bones were first discovered; their skeleton and teeth were less robust than Homo erectus, but more robust than modern humans–Homo sapiens sapiens; many had large brow ridges and receding foreheads and chins; there is no clear dividing line between late Homo erectus and archaic Homo sapiens; many fossils between 500,000 and 200,000 years ago are difficult to classify as one or the other.
An NHS (UK) term of art for the inability to provide a needed inpatient service due to the lack of a hospital bed. Queuing for beds results in cancelled operations, placing of medical patients in surgical beds, missed waiting time targets, and the sceptre of organisational chaos, with increased hospital errors, cross-infection and patient death.
R Jones, author of a paper to the effect in the 2011 British J of Healthcare Management compellingly argued that the Stafford Hospital scandal was linked to the unrecognised role of excessive whole hospital occupancy. Whereas major hospitals in the USA and European have a 77-78% national average bed occupancy rate, the UK average is 87%, a rate which results in patient turnaway.
Reference Jones R (2011) Hospital bed occupancy demystified. Brit J Healthcare Man 17(6): 242-248
Peroxiredoxin 6, non-selenium glutathione peroxidase, AOP2, NSGPx, PRX, EC 22.214.171.124, P29, acidic calcium-independent phospholipase A2, EC 126.96.36.199, antioxidant protein 2, EC 3.1.1.-3
The gene on chromosome 1q24.1 that encodes 6, a member of the thiol-specific antioxidant protein family, which is involved in intracellular redox regulation. It reduces H2O2 an short chain organic, fatty acid, and phospholipid hydroperoxides, and may play a role in regulating phospholipid turnover as well as in protecting the cell against oxidative injury.
spinocerebellar ataxia type 1
Cerebelloparenchymal disorder type I, CPD1, CPDI, Menzel syndrome, Menzel type OPCA, olivopontocerebellar atrophy—Menzel type, olivopontocerebellar atrophy—Schut-Haymaker type, olivopontocerebellar atrophy type 1, olivopontocerebellar atrophy type IV, OPCA 1, OPCA 4, OPCA I, OPCA IV, Schut Haymaker syndrome, spinocerebellar atrophy type I
An autosomal dominant condition OMIM:164400, which is characterised by cerebellar ataxia, as well as optic atrophy, ophthalmoplegia, bulbar and extrapyramidal signs, peripheral neuropathy and dementia.
Molecular pathology Expansion of a CAG repeat in the coding region of ATXN1, a gene which encodes ataxin 1, a chromatin-binding factor, cause spinocerebellar ataxia type 1.
Stafford Hospital scandal
Mid Staffordshire Inquiry, Mid Staffordshire scandal
A scandal which began when the UK’s Healthcare Commission began an investigation into the apparently–later confirmed–high mortality rates of patients admitted to Stafford General Hospital’s A&E (casualty) department. As it turned out, the mortality rate was just the tip of the iceberg of the mess at Stafford Hospital.
The Mid Staffordshire Foundation trust (Foundation trusts hospitals are meant to be the best hospitals in the UK), which runs Stafford General, conducted an internal investigation and, quelle surprise, found “Ain’t no problems here, Boss”. Unconvinced, the Commission launched a full scale investigation, and uncovered a litany of serious problems at Stafford, where patients weren’t properly nursed due to deliberate understaffing (to save the almighty dollar), were left lying in soiled sheets, crying in pain, frightened, and so thirsty that they drank water from flower vases. The Commission concluded patient welfare was sacrificed to meet a financial target of saving £10 million, which the Board decided could only be achieved by reducing staffing levels, which were already insufficient. The Health Service was so angry with the incompetent executives at Stafford…that they promoted them, most notably, Cynthia Bower, who later helmed the (!!!) Care Quality Commission–CQC. Fittingly, La Bower took office on 1 April, 2009. But before you go thinking she slept her way to the top, see www.bbc.co.uk/news/world-us-canada-14954478…
God bless her…sooooo, I’m going with the Peter principle, because Boss Bower’s CQC was making the news less than two years later, having ignored warnings by a whistle blower about the shocking systematic abuse of vulnerable adults at a residential hospital in Bristol…the Secretary of State for Health job might be opening up soon…
22 May 2015
Case report, vignette
A report of one or more clinical cases that illustrates a new disease entity, or a prominent or unusual clinical feature of an established disease. Clinical vignettes generally include a summary of pertinent patient history, physical findings, imaging studies, laboratory data, and details about management.
Erlenmeyer flask appearance
Erlenmeyer flask change
A descriptive term for a lesion seen in patients with fulminant Entamoeba histolytica-induced amebiasis. Gross examination reveals mucosal ulcers, cross sectioning through which demonstrate, by low-power light microscopy, typical lesions with a narrow neck and a broad ulcerated base that have been fancifully likened to an Erlenmeyer flask. The extensive submucosal lesions may be covered by relatively intact mucosa.
Protocadherin beta 2, PCDH beta-2
The gene on chromosome 5q31 that encodes a calcium-dependent cell-adhesion protein of the protocadherin beta gene cluster—one of 3 related gene clusters tandemly linked on chromosome 5. It is an integral plasma membrane protein, has a genomic organisation similar to that of B-cell and T-cell receptor gene clusters, and may play a role in establishing and maintaining specific neuronal connections in the brain.
A regional term for a woman who trades sex for crack or money to buy crack
MEDICAL ETHICS A medical decision in which the difference between the outcomes from following one strategy–e.g., screening, or treating or another–not screening, or not treating is negligible and the caring physician is faced with a heads you win, tails you lose-type decision, popularly termed a “tossup”
Reference NEJM 1997; 337:639
VOX POPULI American slang used as a
noun Vomitus, puke, or as a
verb To vomit, to puke
NEPHROLOGY, TRANSPLANT MEDICINE
A proprietary formulation of UW (University of Wisconsin) solution, the gold standard solution for preserving transplantation-bound organs. It is used to optimise the viability of tissues–e.g., kidneys, liver, pancreas, small bowel from the time of procurement to transplantation
Composition Adenosine, allopurinol, glutathione, HES-hydroxyethyl starch, magnesium sulphate, potassium lactobionate, potassium phosphate, raffinose
Physiologic considerations of Viaspan
• Maintain osmotic balance
• Prevent oedema–using HES–hydroxyethyl starch
• Prevent accumulation of free radicals–with free radical scavengers
21 May 2015
CELL BIOLOGY HACBP, SSA, Grp60, CRT, RO, Calregulin, sicca syndrome antigen A (autoantigen Ro; calreticulin), endoplasmic reticulum resident protein 60, CRTC3CRP55, ERp60 A gene on chromosome 19p13.3-p13.2 that encodes calreticulin, a key multifunctional protein which acts as a major Ca2+-binding (storage) protein in the endoplasmic reticulum–ER. It also acts as a calcium-binding chaperone, promoting folding, oligomeric assembly and quality control in the ER via the calreticulin/calnexin cycle. In the nucleus, it regulates gene transcription by nuclear hormone receptors: the amino terminus of calreticulin interacts with the DNA-binding domain of the glucocorticoid receptor, preventing the latter from binding to its cognate glucocorticoid response element. Calretinin can inhibit androgen receptor binding to its hormone-responsive DNA element, inhibiting androgen receptor and retinoic acid receptor transcription, as well as retinoic acid-induced neuronal differentiation. It is also involved in regulating maternal gene expression, and may participate in oocyte maturation by regulating calcium homeostasis.
complex post-traumatic stress disorder
A mental state induced by prolonged psychosocial trauma coupled with disempowerment and an inability to escape one’s situation. While C-PTSD is similar to PTSD, the latter doesn’t account for all of the symptoms of C-PTSD and lacks C-PTSD’s inescapability and helplessness. Examples Sexual abuse (especially of children), physical abuse, emotional abuse, domestic violence or torture.
C-PTSD had been proposed as an entity a sui generis to be included in American Psychiatric Association’s DSM 5–Diagnostic and Statistical Manual of Mental Disorders, 5th edition, but was not added.
In Scotland, cremation also requires a Certificate of Registration of Death–BD8, which is issued by the Registrar of Births and Deaths. In addition to Form A (Application for Cremation, and Medical Forms B and C), another crematorium certificate is required, which is signed by the medical referee at the crematorium Once the death occurs, a Form 11 is issued. The registrar keeps this document and issues a Form 14, a Form BD8 and any number of extracts the family require. The family arrange the funeral and complete a Form A. The deceased’s doctors sign Forms B and C. The crematorium requires Forms 14, A, B and C. In the working medical parlance, “crem forms” refer to those forms (Medical Form B–filled out by the doctor who attended the deceased before death and Medical Form C–filled out by the doctor who confirmed the cause of death) which are filled out by doctors, for which each doctor is paid £79. Form A–Application for Cremation must be completed by the next of kin or executor, and must be countersigned by a householder who knows the person completing the form. A fourth document, Notice of Cremation, gives notice of the cremation, details of the deceased and information about the service, and is a binding contract concerning the payment of fees to the cremation authority. For cremation in Scotland, the certificate of registration of death, issued by the registrar must be provided. In addition to the Application for Cremation and two cremation certificates signed by two doctors as above, a third crematorium certificate is required, signed by the medical referee at the crematorium.
EVIDENCE-BASED MEDICINE, PUBLIC HEALTH
A popular term for any measurable change in the characteristics of a population over time–e.g., increased or decreased concentration of a particular racial or ethnic group, age bracket, sex ratio, etc.
quadriceps fat pad impingement
Fat pad impingement, fat pad syndrome, Hoffa’s disease, Hoffa’s syndrome, solitary lipoma of the knee, suprapatellar fat pad syndrome
An inflammatory process of the anterior suprapatellar fat, seen on MRI as high T2 signal, low T1 signal and a mass effect on the quadriceps tendon. It is characterised by a proliferation of fat, and may follow mild trauma to the anterior knee, especially if the fat pad is large, and is compressed between the tibia and femur when the bent knee is extended suddenly. It is commonly accompanied by quadriceps laxity. Hoffa’s test elicits a positive Hoffa sign.
Average age 38 years
Clinical findings Pain at the anterior knee, effusion and signs suggestive of ligament instability