Funtabulously Frivolous Friday Five 317

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 317


Question 1

When might you experience ‘veisalgia’?

  1. After consuming 6 pints of 7.5% IPA.
  2. Running your first marathon unprepared and develop bleeding nipples from your running vest.
  3. Pain in the eye resulting from mud or other soil contaminants.

Reveal the funtabulous answer

  1. After a big night on the tiles…

Veisalgia is suffering the unpleasant after-effects of the consumption of alcohol.

From the Norwegian kveis (uneasiness after debauchery) + algia (Greek for suffering).

Veisalgia was coined as a medical term by Jeffrey G. Wiese, Michael G. Shlipak, and Warren S. Browner in a 2000 article published in the Annals of Internal Medicine – see below. It has not been widely accepted as a term perhaps due to its hybrid origins of Greek and Norwegian.

Christian KrohgDagen Derpå, Selvportræt (The Day After, Self-portrait, 1883)

There is no consensus definition of veisalgia… Most descriptive and experimental studies have identified a set of common symptoms: headache, diarrhea, anorexia, tremulousness, fatigue, and nausea. Objective criteria have focused on decreased occupational, cognitive, or visual–spatial skill performance or on alterations in hemodynamic and hormonal measurements. Although tachycardia, tremor, orthostasis, cognitive impairment, and visual–spatial impairment are frequently observed, they do not capture the overall experience for the patient.

Wiese JG June 2000

Question 2

By simply laying a hand on the abdomen, Ottomar Rosenbach could discover which cardiac valvular issue?

Reveal the funtabulous answer

Pulsatile liver with aortic regurgitation aka Rosenbach sign

Recently I have again observed a case of incompetence of the aortic valves of the highest degree, in which exquisite systolic liver pulsation existed, without signs of tricuspid insufficiency.

Rosenbach 1878

Ottomar Ernst Felix Rosenbach (1851 – 1907) was a German physician. He published numerous works across a wide scope of medicine, including clinical signs, disease processes, novel laboratory methods in diagnosis, psychotherapy, heart disease pathophysiology, philosophy, and sociomedicine.  Controversially, Rosenbach opposed the bacteriology ideas, arguing that there was lacking evidence that microorganisms were part of the aetiology of certain diseases.

Dr Ottomar Rosenbach’s name is eponymous with Rosenbach sign of aortic regurgitation (1878); Rosenbach sign of autoimmune hyperthyroidism; Rosenbach-Semon Law (1880); and the Rosenbach test (1880).


Question 3

You see a 63 year old lady who’s been complaining of ‘feeling full’ for the past 3-4 months. On examination you note a roundish abdomen and a nodule in her umbilicus. What is top of the differential?

Reveal the funtabulous answer

Cancer

Sign observed in the umbilicus is the ‘Sister Joseph nodule‘ (1928)

Metastatic carcinoma of the umbilicus characteristically associated with adenocarcinoma from the stomach, large bowel, ovary, or pancreas. For many patients the nodule is the first sign of malignancy.

Sister Joseph observed the presence of a palpable cutaneous nodule in the umbilical area in patients diagnosed with abdominal malignancy while prepping the abdomen prior to surgery. She reported her clinical observations to Dr. William James Mayo. 

William Mayo first reported the condition as “pants-button umbilicus” (without credit to Sister Mary Joseph) in a lecture to the Cincinnati Academy of Medicine in 1928 and recorded in the Proceedings of the Staff Meeting of the Mayo Clinic that same year.

The ‘pants-button’ umbilicus does not seem to be so well known. In many doubtful cases, examination and palpation of the umbilicus will reveal that it is hard and infiltrated, perhaps not prominently.

Mayo 1928

Henry Hamilton Bailey (1894-1961) was a British surgeon and influential publisher, who named this sign in recognition of Sister Joseph in his textbook Demonstration of Physical Sign in Clinical Surgery in 1949.

In advanced intra-abdominal carcinoma, a neoplastic nodule can sometime be seen or felt at the umbilicus. This is known as Sister Joseph’s nodule*.

* Sister Joseph of the Mayo Clinic imparted this clinical observation to Dr William Mayo

Hamilton-Bailey 1949: 227

however the sign had been previously published…many times

1846 – Walter Hayle Walshe (1812-1892) reported the presence of umbilical metastases

Professor Hermann of Strasburg perished, thus according to Lobstein: an enormous tumor had originated in the pelvis, and in the course of six months extended to the umbilicus, without causing pain or any notable symptom; the patient attended to scientific pursuits to the day of his death

Walshe 1846

Question 4

Dr Deanne Chiu published a piece on LITFL – surviving night shifts. While reading this again researching further a field I cam across ‘anchor sleeping’ What is anchor sleeping and how can that help?

Reveal the funtabulous answer

Anchor sleep is a period of at least four hours during which one sleeps every day while on a particular shift rotation. For example, if you sleep from 0800 to 1600 after working nights and from 0400 to 1200 on days off, the overlapping interval from 0800 to 1200 constitutes anchor sleep.

The effect of sleep at regular times on the stability of rhythms was studied in young male and female students. In the first design, subjects slept for 8 hours at irregular times. In the second design, they slept in two 4 hour long periods per day. In another design, one 4 hour sleep period was taken at a constant time on each day. This period designated anchor sleep (AS)….. Analyses suggested that when AS was either 0000 to 0400 or 0400 to 0800, stable 24 hour rhythms were rapidly obtained and maintained thereafter.

Minors DS and Waterhouse JM 1981

Question 5

Since working in North America, I’ve been exposed to different drug names but also dosing. I was curious why low dose aspirin is 81mg when most other drugs are a nice round number? What is the history behind 81mg of aspirin?

Reveal the funtabulous answer

The answer comes from medieval times with the the apothecary system of weights and measures was in use in England and France. This system came to be used for medication dosages before the development of the now-standard metric system in the late 1700s. In the metric system, mass is based on the kilogram but in the apothecary system, the base weight was derived from the weight of a grain of barleycorn. The grain is equivalent to 64.8 mg.

In the United States, the American Pharmacopeia began to slowly include the metric system alongside the apothecary system in 1883, with the metric system fully integrated alongside the apothecary system by 1894. The dual system persisted into the 1940s due to the prescribing practices of American doctors, who only slowly took up prescribing in metric. In 1943, the American Medical Association ruled that the publications of its Council on Pharmacy and Chemistry would solely use the metric system. In 1993, the United States Pharmacopeia officially terminated the use of the apothecary system, 30 years after the British Pharmacopeia.

The standard adult aspirin dose was 5 gr, or 325 mg in metric, the dose still used today for analgesia. Low-dose aspirin was one quarter of the standard dose, 1.25 grains, which converted to 81 mg. This dosing regimen has persisted to modern times.

The above answer is an abbreviation of the work done by Joshua Novack – The history behind aspirin 81 – Clinical Correlations


…and finally


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Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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