Wednesday, March 5, 2008

eponyms in medicine - part 50

491 - Sappey - veins of is retroperitoneal veins located around liver and diaphragm connecting epigastric and internal mammary veins with azygos and which become dilated in portal hypertension.

492 - Tinel's sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.

For example, in carpal tunnel syndrome where median nerve is compressed at the wrist, Tinel's sign is often "positive" causing tingling in the thumb, index, and middle finger. Tinel's sign is sometimes referred to as "distal tingling on percussion" or DTP.

493 - Wolff-Parkinson-White syndrome is paroxysmal supraventricular tachycardia caused by conduction through abnormal accessory bypass tract (bundle of Kent) between atria and ventricles characterized by triad of 1. wide QRS complex - 2. relatively short PR interval - 3. slurring of initial part of QRS delta wave; in familial WPW - associated with mutation in gamma2 regulatory subunit of AMP-activated protein kinase (PRKAG2).

494 - Lowenberg’s sign is in deep vein thrombosis - two calves are wrapped with cuffs to if there is assymetry in tolerance to pressure of 180 mm Hg.

495 - Hoffmann's sign, named after the German neurologist, Johann Hoffmann (born 1857, Rheinhesse; died 1919, Heidelberg), is a finding elicited by a reflex test which verifies the presence or absence of problems in the corticospinal tract. It is also known as the finger flexor reflex.

The test involves tapping the nail or flicking the terminal phalanx of the third or fourth finger. A positive response is seen with flexion of the terminal phalanx of the thumb.

496 - Sipple’s syndrome is MEN type IIa; pheochromacytoma - medullary carcinoma of the thyroid - and hyperparathyroidism due to hyperplasia or tumor.

497 - Heister - spiral valves of is found in the neck of the gallbladder - where tiny folds of mucosal epithelium coalesce to form these valves - may assist in retaining bile between meals.

498 - McConnell’s sign is in acute pulmonary embolism - distinct regional pattern of RV dysfunction - with akinesia of the mid-free wall but normal motion at the apex - 77% sensitive - 94% specific for PE.

499 - Occam’s razor is described in 14th century - “plurality must not be posited without necessity -” in other words - parsimony in diagnosis.

500 - Wallenberg syndrome is infarction in posterior inferior cerebellar artery (PICA) - lateral medulla 1. lesion in nucleus ambiguus - difficulty in swallowing and hoarseness - loss of gag reflex 2. vestibular nucleus - dizziness and nystagmus 3. trigeminal - loss of pain and temperature on ipsilateral 4. inferior cerebellar peduncle - ipsilateral limb ataxia 5. anterolateral system - reduced pain and temperature on contralateral limb 6. ipsilateral Horner’s syndrome hiccup - for reasons not known solitary nucleus may also be destroyed - leading to loss of taste on ipsilateral half of tongue.

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