Funtabulously Frivolous Friday Five 311

Ernest Hemingway

One out our readers Hon Liang pointed us to a Reuters fact checking page. Which tracked down the famous speech on March the 18th 2020

Trump’s only mention of death was when he was talking about a possible airline bailout:

The best year they’ve ever had by far, to boom. One day, empty, because of what we have to do to win this war. Or we would have a level of death like people haven’t seen before.

The Reuters fact checking team found two biographies of Ernest Hemingway, and subsequent use of this phrase. However, it is not clear whether Hemingway himself coined the phrase.

Reference:

• Reuters: UK Fact Check Donald Trump
• Ernest Hemingway, selected letters, 1917-1961. 1981: 335-336

Tutankhamun 1342 – 1325 BC – died aged 18 or 19

Genetic tests in 2010 found multiple malarial infections in Tutankhamun making him the oldest know record of malaria in a human. Causes of his death and also his co-morbidities are vastly debated. The paper published in 2010 hypothesises he had avascular bone necrosis in conjunction with the malarial infection as the most likely cause of death.

Tutankhamun did have a walking impairment supported by the discovery of canes in his tomb but also a CT scan showed his right foot was flat with hypophalangism, while his left foot was clubbed with the aforementioned bone necrosis of the second and third metatarsals (Köhler disease II), however, many people do not agree with this conclusion.

A lot of his aliments are likely due to inbreeding. Tutankhamun married his half-sister, Ankhesenpaaten. They had two daughter, neither of whom survived infancy. CT studies published in 2011 revealed that one daughter was born prematurely at 5–6 months of pregnancy and the other at full-term, 9 months. The daughter born at 9 months gestation had spina bifida, scoliosis and Sprengel’s deformity (see question 4).

References:

• Hawass Z et al. Ancestery and pathology in King Tutankhamun’s family. JAMA 2010;303(7):638-47

Sprengel’s Deformity

Named after Otto Gerhard Karl Sprengel (1852 – 1915) a German surgeon.

He was especially interested in abdominal surgery and many may know of the ‘Sprengel’s incision’ ( transverse sub-umbilical incision). In 1891 he described a condition in a paper titled Die angeborene Verschiebung des Schulterblattes nach oben (“The congenital upward displacement of the scapula”) now known as Sprengel’s deformity.

A congenital condition with a small and undescended scapula. An omovertebral bar (fibrous, cartilaginous and/or osseous connection between the scapula and cervical spine) is often present along with hypoplasia and atrophy of regional muscles. These associated features can cause further misshaping of the shoulder and limitation of shoulder movement.

It is the most common congenital shoulder anomaly in children with a 3:1 predominance in females.

Reference:

• Sprengel OK. Die angeborene Verschiebung des Schulterblattes nach oben. Archiv für klinische Chirurgie, 1891; 42: 545-549.
• Radiopaedia – Sprengel’s deformity
• Orthobullets – Sprengel’s deformity (+ image credit)

Erythema Induratum or Bazin disease.

It is a panniculitis on the calves. Panniculitis being an inflammation of the fatty layer under the skin (panniculus adiposis). It occurs mainly in women, but it is very rare now. Historically, when it has occurred, it has often been associated with cutaneous TB.

Pierre-Antoine-Ernest Bazin (1807 – 1878) was a French physician and dermatologist. He described EI in 1861 with the association of TB. But many have challenged his theory stating there are other causes of EI. Currently the term Bazin’s disease is reserved for those patients with EI secondary to TB. What complicates the hypothesis is the inability to consistently sample skin tissue for TB. Most tests at the present time rely on PCR but these are still not 100%. Interestingly many authors have show EI does respond to standard anti-TB regimens. So while Bazin’s disease maybe a dated term, there is definitely a strong likelihood the patient has some form of TB.

When I looked at the picture it also reminded me of erythema nodosum except this was on the flexor aspects of the legs. Not necessarily the worst connection as erythema nodosum is also a form of panniculitis but on the extensor surface of the legs and also has an association with TB (as well as lepsory, sarcoidosis, drugs and connective tissues disorders).

Reference:

• Bazin E. Leçons théoriques et cliniques sur la scrofule considérée en elle-même et dans ses rapports avec la syphilis, la dartre et l’arthritis. 1861 [Erythème induré 145-154, 501]
• Alothman A et al. Erythema induratum: What is the role of Mycobacerium tuberculosis? Ann Saudi Med. 2007;27(4):298-300

Renal Calculi

Some urologists still employ ureteroscopy to manipulate the stone retrogradely into the renal pelvis and then proceed with Extracorporeal shock wave lithotripsy – ESWL (referred to as “push-bang”).