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Medical Mysteries, Bizarre Cases

This woman's severe rheumatoid arthritis escalated to include a rare condition in which the bones in the hands and wrists shrink, resulting in the fingers "telescoping" (as in collapsing a segmented telescope).
Woman's Bones Shrank in Rare Case of 'Telescoping Fingers'

A rare condition caused a woman's fingers to scrunch back into her hands as the bones of her hand and wrist steadily disappeared, according to a report of the case.

The bone loss caused the 69-year-old woman's fingers to buckle back into her hand like segments of a collapsing telescope, a distinct symptom that explains the unusual condition's nickname: "telescoping fingers."

An estimated 3.7% to 6.7% of people with a condition called psoriatic arthritis develop "telescoping fingers," according to a 2013 report in the journal Reumatología Clínica; the condition also occurs in people with rheumatoid arthritis, but even more rarely. When clinicians originally described the condition, in 1913, they called it "la main en lorgnette," or "the opera-glass hand." That term referenced the telescoping action of magnifying glasses used by theatergoers to enhance their view of the stage, according to a 1938 report in the Journal of Bone and Joint Surgery.

In the recent case, described in a report published today (Dec. 11) in The New England Journal of Medicine, the woman's hands appeared severely deformed and swollen when she went to a rheumatology clinic in Turkey for treatment. The patient had been diagnosed with rheumatoid arthritis 18 years earlier, and over time, her knuckles had grown so swollen that her fingers skewed to one side, toward her pinky fingers, her doctors noted. Upon examining the patient's hands, the doctors discovered that the bones of her displaced digits seemed unusually short — far too short for the woman to properly flex her fingers or make a fist.

Radiographs of the patient's wrists and hands revealed the extent of the damage: The bones of the woman's fingers, hand, wrist and lower forearm appeared worn down, as if substantial amounts of tissue had disappeared. The doctors diagnosed the woman with telescoping fingers, medically known as arthritis mutilans, and attributed the tissue loss to a process called osteolysis, which causes bones to be "reabsorbed" by cells called osteoclasts. ...
FULL STORY: https://www.livescience.com/woman-with-rare-case-of-telescoping-fingers.html
A physician passenger on an airline flight diagnosed and resolved what appeared to be another passenger's stroke. It turns out that the paralysis on one side of the victim's face was caused by pressure effects rather than a true stroke event.
Doc on plane diagnoses man's unusual condition midair

A few minutes after his flight reached cruising altitude, Dr. Alan Hunter responded to a flight attendant's call for a doctor on board. A passenger was having a stroke, or so it seemed, the attendant said. This was certainly urgent — a passenger having a stroke could be one reason for an emergency landing.

But the passenger, whose face was drooping on one side, wasn't having a stroke after all, Hunter determined. Rather, the passenger had an unusual yet typically temporary condition, resulting in part from pressure changes in the airplane. No emergency landing was needed, and with Hunter's help, the patient was soon feeling fine. ...

Hunter, who is an internal medicine doctor at Oregon Health & Science University, said he had never seen a case like this before. To alert other doctors about this condition, Hunter described the case in a report published Monday (Jan. 27) in the journal Annals of Internal Medicine. ...

When Hunter responded to the call, the patient told Hunter that he'd had a sudden headache and pain and a sense of fullness in his ears, as well as slurred speech and drooling. But the case didn't look like a stroke, Hunter said. When people's faces droop on one side during a stroke, usually either the top or the bottom of the face is affected. In this case, the entire right side of the patient's face was drooping. And the patient was young and healthy looking, making stroke less likely, Hunter said. The patient also mentioned that he'd just recovered from a cold.

"Ultimately, it just made sense that it was a pressure-related phenomenon" rather than a stroke, Hunter said. ...

Because Hunter suspected that the patient's symptoms might be due to a clogged eustachian tube, he had the patient swallow a few times. He also gave the patient some extra oxygen. Within minutes, the patient was back to normal.

At the time, Hunter didn't know exactly what condition he had just treated. But after he got off the plane, he did some research and found something called facial barotrauma, a condition that seemed to fit the current case. Most often described in scuba divers coming up from the deep, facial barotrauma occurs when a patient experiences a drop in pressure, and a blocked eustachian tube reduces blood and oxygen flow to one of the facial nerves. In the case of a diver, that pressure drop occurs as the patient swims toward the surface and water pressure lessens; in the case of an airplane passenger, it happens as the plane rises and atmospheric pressure drops.

According to Hunter's research, this phenomenon happens only if the eustachian tube is somehow dysfunctional. ...
FULL STORY: https://www.livescience.com/in-flight-diagnosis-facial-barotrauma.html


Published letter (report) on the incident:

Annals of Internal Medicine
28 January 2020

Unilateral Facial Paralysis During an Airline Flight
Alan J. Hunter, MD

Background: A medical emergency during a commercial airline flight may require an unplanned landing, which disrupts travel plans and is expensive.

Objective: To alert clinicians to a condition that can mimic acute stroke but does not require an unplanned aircraft landing. ...

Published letter (report) on the incident:

Annals of Internal Medicine
28 January 2020

So to be clear on this, please: is it the case that in the USA, a medical doctor who is an "internist" is not an 'intern'? Ie they are NOT in the process of receiving training in a specialism, but have arrived at a professional destination, or level of vocational capability? And: an ''internist'' is not an 'internalisist'(sic) despite being a specialist in internal medicine? (US terms)

Because I'm not really helped by this definition:
Wikipedia said:
Internal medicine or general internal medicine (in Commonwealth nations) is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians (without a modifier) in Commonwealth nations

I've never head the term "general internal medicine" used in the UK, but have (of course) always heard the term 'general practise', or "general practitioner" (which is the term used in the UK for a family/community doctor (cf someone "seeing their GP") I've also always known that this term was unrecognised in the US, but had assumed it was in general use across the Commonwealth (it certainly is, in India, but I'm now unsure re Canada).

I'm now puzzling over whether I would've forgivably-presumed that 'Internal Medicine' refers to biological ailments internal to the sufferer: but surely that starts to get into a strange tautology....also might that mean that 'external medicine' (as it were, if it definably-existed?) might be looking at disease and pathological situations, rather than the victims?

I'm now really puzzling over this: and (because I've started to think too much about it)....is there a parallel between someone in medicine being an "intern" (ie 'practicing' in the British-not-US strict sense of the word, ie almost an apprentice-under-training, the status of what we'd now call in the UK a "foundation doctor); and someone 'practising' medicine (this in the British/Commonweath/semi-deprecated sense of the word, and probably not recognised as a differentiated word in the US at all) a state of being where they have already-mastered their discipline....
'intern' to 'internist'

'practice' into 'practise'
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So to be clear on this, please: is it the case that in the USA, a medical doctor who is an "internist" is not an 'intern'? Ie they are NOT in the process of receiving training in a specialism, but have arrived at a professional destination, or level of vocational capability? And: an ''internist'' is not an 'internalisist'(sic) despite being a specialist in internal medicine? (US terms) ...

One refers to the stage of professional development, whereas the other refers to the focus of professional interest and expertise.

As I understand it ...

Intern (as used in medicine): Someone in a professional field who is near or beyond the completion of their professional (book-learning) education and who is serving a period of supervised practical experience before being finally certified as a journeyman professional.
(Not to be confused with "a student or non-professional serving as a junior grade helper" - e.g., "office intern".)

Internist: A medical sub-field or area of specialization focusing on diagnosis / treatment of problems (including diseases) "internal" to the body, but not encompassing direct participation in treatment involving surgical intervention. Internists analyze and treat, but they don't "cut."

Crudely stated: All licensed internists will have been interns at some point, but not all interns will become internists.
Ahhhhh....we've actually got a couple of beers here in Australia that would parallel what this Lady is creating...
Some more background to the Yosemite cases.

Oh dear! Hantavirus is back!

Even when the world is trying to find a cure for the dreaded coronavirus pandemic, a report in Global Times said that a man from China's Yunnan province died from Hantavirus while on a bus to the Shandong province.

All the fellow passengers on the bus have been tested for the virus.

What is Hantavirus?

The Centre for Disease Control says that the virus is spread mainly from rodents. It goes on to say that infection with any of the hantavirus can cause hantavirus disease in people. "Hantaviruses in the Americas are known as “New World” hantaviruses and may cause hantavirus pulmonary syndrome (HPS). Other hantaviruses, known as “Old World” hantaviruses, are found mostly in Europe and Asia and may cause hemorrhagic fever with renal syndrome (HFRS)," the CDC website said.

Have we had this?

I dimly recall seeing the documentary - or part of it - years ago.

"unable to walk properly," seems to beg for a misprint!

More feasible than Viz imagined! RIP. :oops:

No, wait a minute, I may be confusing him with the bloke who had an elephantine dick. He was Mexican, I think and earned a crust in pornography. :thought:

The condition is variously labeled as scrotal lymphoedema / lymphedema or scrotal elephantiasis. Extreme cases are often labeled as "giant" or "massive."

The extensive swelling and hardening of tissues can result from a variety of causes. Most generally speaking:

Elephantiasis is the enlargement and hardening of limbs or body parts due to tissue swelling. It is characterised by edema, hypertrophy, and fibrosis of skin and subcutaneous tissues, due to obstruction of lymphatic vessels. It may affect the genitalia. The term elephantiasis is often used in reference to (symptoms caused by) parasitic worm infections, but may refer to variety of diseases where parts of a person's body swell to massive proportions.


Here are links to two case reports on cases similar to Mr. Warren's.
NOTE: Explicit clinical images; NSFW.

... Was a wheelbarrow involved?

No, but covering the scrotal mass was creatively achieved by taking a large hoodie, flipping it upside down, and re-purposing it as a sort of baggy diaper.
Very sadly, Warren died less than a year after his operation from complications of diabetes. The treatment had gone well and he was delighted with his new freedom of movement.

Techy was watching and he wondered why Warren hadn't sought help a long time before, when the swelling was more manageable. I'm guessing it was to do with medical costs.

In my previous work in hospitals I met patients with similar conditions. This being Britain and the NHS being free at the point of delivery, they were admitted and cured in double-quick time.

(There is of course a funny story which is not at all derogatory towards the patients.)
Hard to believe that a man can end up with gonads weighing as much as my entire body.
Hard to believe that a man can end up with gonads weighing as much as my entire body.

It wasn't his gonads though, it was his scrotum. When he has the operation his penis and testicles are found inside the enormous scrotum and the surgeon delightedly juggles them.
This woman's combination of prescription drugs induced ergotism ...
Woman's migraine medication caused a bizarre 'medieval' disease

A woman's migraine medication caused a rare reaction: a burning sensation in her legs and the loss of one of her toes, according to a new report of the case.

Doctors diagnosed the woman with ergotism — also known as St. Anthony's fire — a now uncommon condition that once caused mysterious outbreaks in medieval Europe. Her medication was derived from the same natural chemical behind these historical outbreaks.

The 24-year-old woman went to the doctor after she suddenly began to experience a severe burning pain in her legs, from her midthigh down to her toes, according to the report, published Wednesday (July 22) in The New England Journal of Medicine. She also had discoloration in her feet and trouble walking, and both legs were cold to the touch, according to the authors ... Four days earlier, she had started taking a medication called ergotamine for migraine headaches. The woman was also born with HIV and was taking several antiviral medications to treat the disease.

A CT scan revealed that the arteries in both her legs had narrowed and thus reduced blood flow to the area.

Based on her symptoms, her doctors suspected she had ergotism, a disease traditionally caused by ingesting poisonous compounds made by a fungus called Claviceps purpurea, which infects cereal grains such as rye. In the Middle Ages, the disease caused large outbreaks among people who ate tainted rye, according to the American Society for Microbiology (ASM). Afflicted individuals developed mystifying symptoms including burning pain and gangrene in their limbs, while others experienced convulsions and hallucinations. ...

But people can sometimes develop ergotism even when taking normal doses of ergot-based drugs. This happens when people are taking other medications that lead to a drug interaction. One such drug is the HIV medication ritonavir, which blocks the enzyme involved in breaking down ergot compounds ...

The woman in this case was taking ritonavir as part of her HIV treatment. Doctors treated her ergotism with the blood-thinning drug heparin, and her symptoms soon improved — her pain subsided and her legs became warmer. However, the treatment didn't come soon enough to prevent gangrene in one of the toes on her left foot, which had to be amputated. ...

SOURCE: https://www.livescience.com/migraine-medication-caused-ergotism.html
It appears this 2016 incident hadn't been previously reported here ...
Needle Stuck in Woman's Heart Gives Her a Stroke

A 48-year-old woman in China suffered a stroke that was later found to be caused by a finger-length needle stuck in her heart, according to a new case report.

The needle had pierced the woman's chest a few months before the stroke (although the case report doesn't say how it happened). It had penetrated layers of tissue and had gotten stuck in her heart muscle.

Once the needle was there, a calcified mass formed around it, and this mass eventually created a blood clot that traveled to her brain, where it caused multiple strokes. ...

"According to her cousin, she had been pierced by a foreign body through her chest wall approximately three months or longer before presentation," the doctors wrote.

Upon closer inspection, the doctors determined that the object was the needle, and that it was as long as a finger. The needle had gone right through heart muscle, puncturing the lung on the other side. But the hole in the lung seemed to have closed on its own, leaving the woman with only some coughing and a fever.

"Our patient was extremely lucky that she survived her penetrating heart injury," the doctors wrote. ...


I once had a so called dentist push a needle through my jaw and out through
my lower cheek he did not get it when he asked if my face was going numb
and I said no but my arm is, until I showed the daft sod the wet patch on my
shirt sleeve.
I used to assist a vet from time to time with big animals and one of the things
you had to be aware of was that a broken needle could quickly disappear and
would be very difficult to extract, never saw it happen but could be some sort
of explanation.
In 2018 this Russian woman noticed a lump beneath the skin on her face. Then the lump moved ... She was infected with a mosquito-borne parasitic worm with a known range of Europe, Africa and Asia. Luckily, the worm is relatively benign and its removal is all that's required.


A Weird Lump on a Woman's Face Turned Out to Be a Worm Crawling Under Her Skin

When a woman in Russia noticed a small lump under her left eye, she snapped a selfie to document the unusual bulge. Then, something even stranger happened: The lump moved.

In a series of selfies, the woman tracked the mysterious lump as it moved across her face. Five days after she first noticed the lump, it migrated to above her left eye. Then, 10 days later, it moved to her upper lip.

Soon after the lump's latest migration, the 32-year-old woman went to an eye doctor, who also observed a "superficial moving oblong nodule at the left upper eyelid" — in other words, a lump ...

It turned out that the woman had an infection with a type of parasitic worm called Dirofilaria repens. These thread-like worms naturally infect dogs, cats, foxes and other wild mammals, and typically live in the tissue under the skin, according to a 2011 report of a similar case. Humans are "accidental" hosts — in other words, not where the worms want to end up — and once a worm gets into a human, it typically can't reproduce. ...

The worms are spread by mosquito bites, and human cases have been reported in parts of Europe, Asia and Africa, the 2011 report said. ...

In humans, the parasitic infection usually shows up as lumps beneath the skin, and sometimes, the lumps — or rather, the worms — move around. ...

As horrifying as this sounds, the treatment is relatively simple: Surgically removing the worm can cure the infection ...

FULL STORY: https://www.livescience.com/62864-worm-crawling-under-skin.html
Isn't everyone going to want an animated worm-face, now?

I could see how it might become an extreme body modification fad - especially since it's relatively benign and reversible without leaving much if any visible evidence.

I perversely wonder whether someone somewhere is testing it as a transient means of making a face unrecognizable to facial recognition scanners.
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