Origin of Kehr Sign in Traumatic Splenic Trauma.

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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.

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.

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

Born in 1884 in Balikesir, 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.

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.