Nick Mark MD Profile picture
Nov 9, 2021 23 tweets 11 min read Read on X
Medicine has thousands of eponyms. Most are named for doctors but a few eponyms honor patients.

For example, Bacitracin, named for the bacteria Bacillus subtilis var Tracy, was first identified in a little girl “Tracy I.”

New post & medical history🧵
1/
onepagericu.com/blog/magnanimo…
Hieronymus Karl Friedrich Freiherr von Münchhausen, a German Baron, was legendary for telling stories of his adventures in the Russian Cavalry during the Russo-Turkish War.
(even the dogs look entertained!)
Notably he was *NOT* regarded as a liar but as a great story-teller!
2/
A German writer & con-artist, Rudolf Erich Raspe, created a fictional character Baron Munchausen loosely based on Baron Münchhausen (note the spelling: u not ü)

Munchausen had incredible adventures such as riding a cannonball, fighting a 40 foot crocodile, & going to the Moon
3/
The real baron Münchhausen was not happy about his fictional namesake
He unsuccessfuly sued Raspe, but the fictional Munchausen was a success, with >10 editions in 4 languages by 1790
Münchhausen died a recluse, refusing to host parties or tell stories, bitter about his legacy
4/
He would have been pissed when Asher described 'Munchausen Syndrome'
"Like the famous Baron...the persons affected have always travelled widely; & their stories, like those attributed to him, are both dramatic & untruthful...The syndrome is respectfully dedicated to the Baron"
5/
In short, Muchausen’s syndrome & its derivates - Munchausen’s by proxy & Munchausen’s by internet - don’t paint a very flattering picture of the real Münchhausen, who was by all accounts a generous host & great story-teller.
Maybe it’s best to retire this (misspelled) eponym.
6/
The story of Henrietta Lacks and the eponymous HeLa cells taken from her is already well known.
One interesting fact that I uncovered researching this was that in August 1960, Korabl-Sputnik 2 carried HeLa cells into orbit. Thus HeLa were likely THE FIRST HUMAN CELLS in space!
7/
French internist Armand Trousseau described an association between GI cancer & migratory thrombophlebitis noting “the frequency with which cancerous patients are affected with painful oedema of the…extremities.”
This paraneoplastic phenomenon was called "Trousseau's Sign."
8/
Soon after describing this finding, however, Trousseau himself developed thrombophlebitis & told a confidant, “I am lost; a phlegmasia which showed itself…leaves me no doubt about the nature of my affliction."
His story is described beautifully @NEJM: pubmed.ncbi.nlm.nih.gov/12374880/
9/
Trousseau was not the only physician to describe a disease in themself. Julius Thomsen described a myotonia in himself & family members:
“after a fright, or in an unexpected joyous movement, this convulsive constriction occurs in all limbs…the victim can not stand upright…"
10/
The disease - Myotonia congenita - also called Thomsen's disease, is due to a chanellopathy in CLCN1.

An analogous mutation causes the "fainting goat" syndrome. (This is a misnonmer: the goats are awake but their muscles spasm when startled/afraid)

11/
Another physician to diagnose himself was South African cardiologist Leo Schamroth.
While critically ill with endocarditis he had the presence of mind to observe a subtle change in his nail beds.
The change in "Schamroth Window” remains a useful diagnostic maneuver.
12/
I highly recommend reading Schamroth’s article “Personal Experience” (if only for his description of hospital food).

Aside: He also has one of the oddest wikipedia entries (and I read/edit a lot of wiki)…
13/
ID doctors apparently have a long history of intrepid self-diagnosis.

Dr. Howard Ricketts became famous after research that involved injecting himself with blastomycoses “until he became sick enough to realize that this was an experimental procedure not to be repeated.”
14/
Ricketts went to study Rocky Mountain Spotted Fever, identifying the pathogen once again by injecting himself.
The organism was later named: Rickettsia rickettsii. Unfortunately, he tempted fate one too many times, & died of typhus (Rickettsia prowazakii) Mexico City in 1909.
15/
His colleague, Stanislav von Prowazek, also died while trying to understand typhus.
The bacteria that killed both intrepid ID docs - Rickettsia prowazekii - is named for the heroic contributions of both Ricketts & Prowazek.
16/
Another, ID hero was a Peruvian medical student Daniel Alcides Carrión García who, in 1885, injected himself with Bartonella bacilliformis.

In 1870 Carrión had watched ~1/4 of his hometown die from “Oroya Fever” and was fixated on understanding this enigmatic disease.
17/
Carrión theorized that 2 different diseases, an acute illness known as "Oroya fever" & a chronic skin rash known as the Peruvian Wart (“veruga peruana”), were actually manifestations of one infection.

To test his hypothesis injected himself with bacteria from the "wart"
18/
Over the next 5 wks, he carefully documented his symptoms - fevers, hemolytic anemia that characterized “Oroya Fever" - proving that the 2 diseases were in fact caused by a single bacteria, later known as Bartonella.

The infection now known as Carrión's disease after him.
19/
40 days after injecting himself to prove his theory, Carrión died from his eponymous disease.

More than a century after his death, Carrión is still celebrated a hero in Peru. To this day, October 5th, is remembered as the Day of Peruvian Medicine in his honor.
20/
Finally, the Great Satchmo, “King of Jazz” Louis Armstrong, in 1935 sustained a rupture of the orbicularis ori muscle from his forceful trumpet playing. This injury, eponymously called the “Satchmo Syndrome,” obligated Louis to put down his trumpet for much of the next year.
21/
I hope you've enjoyed this rambling thread on stories of patient eponyms: from Bacitracin to Jazz.

If you want to read more of these stories, check out my blog on the subject: onepagericu.com/blog/magnanimo…

And if you know any examples I missed, please do share in the comments!
22/22
For those interested in all the patient eponyms that I uncovered - here's a summary table.
23/22

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More from @nickmmark

Oct 13
#HurricaneHelene damaged the factory responsible for manufacturing over 60% of all IV fluids used in the US, leading to a major national shortage.

As clinicians what can we do to about the #IVFluidShortage and how can we prevent this crisis from happening again?

A thread 🧵
1/ Image
There are many things we can do as clinicians to improve ICU care & reduce IVF use.

1️⃣Don't order Maintenance IV Fluid!
Almost no patient actually needs continuous IV fluids.
Most either need resuscitation (e.g. boluses) or can take fluid other ways (PO, feeding tube, TPN).
2/
Frequently if someone is NPO overnight for a procedure, MIVF are ordered.
This is wrong for two reasons.
We are all NPO while asleep & don't need salt water infusions!
We should be letting people drink clears up to TWO HOURS before surgery, per ASA.

3/ pubs.asahq.org/anesthesiology…Image
Read 16 tweets
Oct 1
New favorite physiology paper: Central Venous Pressure in Space.

So much space & cardio physiology to unpack here including:
- effects of posture, 3g shuttle launch, & microgravity on CVP
- change in the relationship between filling pressure (CVP) & LV size
- Guyton curves!
1/

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To measure CVP in space they needed two things:
📼 an instrument/recorder that could accurately measure pressure despite g-force, vibration, & changes in pressure. They built & tested one!
🧑‍🚀👩‍🚀👨‍🚀 an astronaut willing to fly into space with a central line! 3 volunteered!
2/
Image
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The night before launch they placed a 4Fr central line in the median cubital vein & advanced under fluoro.

🚀The astronauts wore the data recorder under their flight suit during launch.

🌍The collected data from launch up to 48 hrs in orbit.
3/
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Read 16 tweets
Jul 16
The media silence on this is deafening.

Did he have a head CT? What did it show?
Did he have stitches? Tetanus shot?

The NYT ran nonstop stories about Biden’s health after the debate but can’t be bothered to report on the health of someone who was literally shot in the head?
To the people in the replies who say it’s impossible because of “HIPPA”
1. I assume you mean HIPAA
2. A normal presidential candidate would allow his doctors to release the info. This is exactly what happened when Reagan survived an assassination attempt.
washingtonpost.com/obituaries/202…
My advice to journalists is to lookup tangential gunshot wounds (TGSW).

Ask questions like:
- what imaging has he had?
- what cognitive assessments?
- has he seen a neurosurgeon or neurologist?
- he’s previously had symptoms like slurred speech, abnormal gait - are these worse?
Read 4 tweets
Jun 30
You've probably heard "don't give lactated ringers because it raises lactate"

This statement is ~98% false, but there's one crucial practice-changing fact that you need to know.

A 🧵 all about lactic acid and lactated ringers!
1/
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First off, we should ackowledge the obvious: Lactated ringers does in fact contain lactate... 28 mEq/L in fact

BUT there's one little detail to remember:
Lactate ≠ Lactic acid

When we measure "lactate" we care about the ACID (H+) which lowers pH & causes organ dysfunction
2/ Image
But the correlation between pH & lactate is really bad!

Look at this analysis of lactate vs pH in 171 ICU patients.

There is a *weak* correlation in people with arterial lactate > 5, but even w/ lactate =10, pH ranged from 7.5 to 7.05. Quite a spread!

3/ ncbi.nlm.nih.gov/pmc/articles/P…
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Read 10 tweets
Jun 13
If you intubate you need to read the #PREOXI trial!
-n=1301 people requiring intubation in ED/ ICU were randomized to preoxygenation with oxygen mask vs non-invasive ventilation (NIV)
-NIV HALVED the risk of hypoxemia: 9 vs 18%
-NIV reduced mortality: 0.2% vs 1.1%

#CCR24
🧵
1/

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Hypoxemia (SpO2 <85%) occurs in 10-20% of ED & ICU intubations.

1-2% of intubations performed in ED/ICU result in cardiac arrest!

This is an exceptionally dangerous procedure and preoxygenation is essential to keep patients safe.

But what’s the *BEST* way to preoxygenate?
2/
Most people use a non-rebreather oxygen mask, but because of its loose fit it often delivers much less than 100% FiO2.

NIV (“BiPAP”) delivers a higher FiO2 because of its tight fit. It also delivers PEEP & achieves a higher mean airway pressure which is theoretically helpful!
3/
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Read 15 tweets
Jun 12
Results from #PROTECTION presented #CCR24 & published @NEJM.
- DB RCT of amino acid infusion vs placebo in n=3511 people undergoing cardiac surgery w/ bypass.
- Reduced incidence of AKI (26.9% vs 31.7% NNT=20) & need for RRT (1.4% vs 1.9% NNT=200)

Potential game changer!

🧵
1/
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I work in a busy CVICU & I often see AKI following cardiac surgery.

Despite risk stratification & hemodynamic optimization, AKI remains one of the most common complications after cardiac surgery with bypass.

Even a modest reduction in AKI/CRRT would be great for my patients.
2/ From Nature reviews nephrology  https://www.nature.com/articles/nrneph.2017.119
During cardiac surgery w/ bypass, renal blood flow (RBF) is reduced dramatically. This causes injury, especially in susceptible individuals.

But what if we could use physiology to protect the kidneys?

Renal blood vessels dilate after a high protein meal increasing RBF & GFR!
3/ https://www.jtcvs.org/article/S0022-5223(18)33243-4/fulltext
Read 11 tweets

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