Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3074_Библиотеки_им_академика_М_И_Перельмана.pdf
26
Fig. 1.1 Hathcock sign (by Ryan Yale)
Thus, Hathcock sign refers to palpatory tenderness beyond the mandibular angle
found on running the nger along the mandible toward its angle (Table1.1).
1.2.24 Sterling-Okuniewski Sign
Stefan Adam Sterling-Okuniewski (1884–1934) was born in Warsaw, Poland, and
received his medical degree and Doctor of Philosophy degree from the University
of Zurich, Switzerland, and medical degree from the Faculty of Medicine, Wroclaw;
Breslau, Germany (currently Poland) in 1910 [156]. He served as a senior assistant
at the Serological and Bacteriological Institute at Warsaw Scientic Society, fol-
lowed by the chief of the Municipal Bacteriological Library. He founded the rst
cancer clinic in Łódź, Poland, in 1918 and served as senior clerk of the Ministry of
Public Health, Warsaw [156]. During the Polish-Bolshevik War, he conducted
research on typhus and was commander of the Czerniakowski Hospital of Infectious
Disease and Military Hospital no. V in Warsaw, and a Hygiene Ofcer at D.O.K.I. in
1921 [156]. Sterling-Okuniewski obtained his habilitation in pathology and internal
medicine, lecturing on infectious diseases in 1924 [156]. He was appointed physi-
cian for terminally ill cancer patients at St. Lazarus Hospital in Warsaw in 1927 and
1 Oral Cavity Signs
27
associate professor and head of the Ujazdowski Hospital, Warsaw, in 1928 [156].
He cofounded the Polish Anti-Cancer Committee in 1921 and was editor of the
Biuletyn Polskiego Komitetu do Zwalczania Raka (Bulletin of the Polish Anti-
Cancer Committee), renamed the Nowotwory Journal in 1923 [156, 157].
Sterling-Okuniewski described a nding in patients with typhus:
Sometimes the patient cannot protrude the tongue when requested by the physician. (…)
Various authors have long noticed this symptom. Nevertheless, Malcz writes: “On the sec-
ond day, the layers of the throat and tongue swell, and yet, the patient is still able to speak.
On day three, the speech was impeded, and the tongue was slowly being pulled back when
talking” [158, p.225]. In fact, there are cases where the patient cannot stick out the tongue.
If this is present, it can be a serious symptom in the diagnosis of typhus. However, there is
no way of accepting Renilinger’s view that this symptom always occurs (within three years,
“we do not remember […] ever seeing the sign of the faulty tongue”). After reading the
article by the French author, I checked his observations on a hundred or more cases in dif-
ferent periods of the disease, and only in a few cases was it difcult for the patient to pro-
trude the tongue. Once a sick person, at my request, was unable to protrude his tongue but
was able, with a few ngers of his right hand, to pull it out with some effort [158, p.226].
Thus, Sterling-Okuniewski sign refers to the inability of a patient to protrude his
tongue on command (Table 1.1). The pathogenesis is postulated to be caused by
perivascular inltration involving the hypoglossal nucleus and nerve. This sign was
believed to be benecial as a clinical test to differentiate epidemic louse-borne
typhus fever from enteric fever [159].
1.2.25 Jackson Sign
Chevalier Quixote Jackson (1865–1958) was born in Pittsburg, Pennsylvania, and
received his medical degree from Jefferson Medical College, Philadelphia, in 1886
[160–162]. He received further training in laryngology under the auspices of Morell
Mackenzie (1837–1892) in England, returning to Pittsburg in 1887 to practice this
specialty [160, 163]. He designed an esophagoscope prior to 1890 and subsequently
worked on a bronchoscope whose purpose was foreign body extraction [160]. His
later work demonstrated the safety and usefulness of these instruments in diagnos-
ing and treating diseases in infants and adults, including esophageal stricture [160,
164]. He was appointed professor of laryngology at the University of Pittsburgh
Medical School and director of the bronchoscopic clinic at Pittsburgh Children’s
Hospital beginning in 1912 [160, 161, 163]. Jackson published his rst text titled
Tracheo-Bronchoscopy, Esophagoscopy, and Gastroscopy in 1907 and Peroral
Endoscopy and Laryngeal Surgery in 1914 [160, 162, 164].
He accepted an appointment as a professor of laryngology at Jefferson Medical
College, Philadelphia, Pennsylvania, in 1916 [162, 164]. He served as chair of
Bronchoscopy and Esophagoscopy at the University of Pennsylvania, Graduate
School of Medicine, in 1919. He held a similar position at Jefferson Medical
College, Temple University, where he developed the Chevalier Jackson
1.2 Eponymously Named Signs oftheOral Cavity
28
Bronchoscopy Clinic of Temple University and Medical School and at Woman’s
Medical College of Pennsylvania [160, 163, 164]. He was appointed president of
the latter institution from 1935 until 1941 [160]. Another signicant and perhaps
less well- recognized achievement was that he was instrumental in promoting the
passage of the Federal Caustic Act in Congress, signed by President Coolidge in
1927, requiring all manufactures to label and print the antidote for poisonous caus-
tic or corrosive substances [160, 162, 164].
He served as president of the American Laryngological, Rhinological, and
Otological Society in 1911, founding member of the American College of Surgeons
in 1913, and as president of the American Laryngological Society in 1926. He
received the chevalier rank of the Legion of Honor from France and the chevalier
rank of the Order of Leopold from Belgium in 1927 [160]. He received many other
awards and accolades throughout his career, including the Distinguished Service
Medal of the American Medical Association and meritorious services from the
American College of Chest Physicians in 1952 [160, 161].
As to his character as described by Holinger:
The great modesty, sincerity and singleness of purpose of this man who lived through
almost a century of medicine can hardly be realized. He developed a specialty through keen
observation, consummate skill and great perseverance. (…) His kindness, gentleness, and
courtesy pervaded all his actions and these basic attitudes commanded the greatest respect
from his patients and the colleagues who worked with him. (…) Those few who had the
privilege of a visit to “The Mill” where he lived in the beautiful countryside outside of
Philadelphia saw a man keenly interested in nature and humble in his appreciation of the
beauty of his surroundings. (…) Chevalier Jackson’s inuence in medicine will continue to
be felt far beyond the borders of his country and the span of his life. Modern medicine as
well as his individual patients pay great homage to this man who did so much more than his
part “as his turn came round” [160, p.569].
In the words of Maxwell Ellis:
There could have been no more single-minded man in the history of medicine. He sighted
his goal early in life; he moved towards it unerringly and steadily for over half a century; and
in the end he saw his work become an integral part of the practice of medicine [161, p.568].
Jackson described the following ndings found in patients with a foreign body:
Tracheal Foreign Body. (1) “Audible slap”, (2) “palpatory thud”, (3) “asthmatoid wheeze”
are pathognomonic. The “tracheal utter” has been observed by McCrae. Cough, hoarse-
ness, dyspnea and cyanosis are often present. Diagnosis is established by roentgen ray,
auscultation, palpation, bronchoscopy. Listen long for “audible slap,” best heard at open
mouth during cough. The “asthmatoid wheeze” is heard with the ear or stethoscope bell
(McCrae) at the patient’s open mouth. History of initial chocking, gagging, and wheezing
is important if elicited by is valueless negatively [165, p.316].
Thus, (Chevalier) Jackson sign refers to the ability to hear a wheezing sound over
the open mouth in a patient with a foreign body within the trachea or bronchus
(Table1.1).
1 Oral Cavity Signs
29
1.2.26 Biederman Sign
Joseph B.Biederman (1907–1984) was born in Mazowieckie, Poland, and received
his medical degree from the University of Cincinnati College of Medicine in 1932
[166, 167]. He practiced medicine at the Cincinnati General Hospital Allergy Clinic
at the University of Cincinnati Medical College. He patented several products,
including a mask to prevent and relieve respiratory allergy symptoms and a respira-
tory ltering device [168].
He was a recipient in 1983 of the American College of Allergy, Asthma, and
Immunology Award of Merit, which stated:
To qualify for the award, candidates must have demonstrated outstanding performance in
the eld of clinical allergy and immunology, be Fellows of recognized national organiza-
tions of allergy and immunology, reached the age of 70 and have practiced in the eld for
at least 25years [169, p.3].
Biederman described in patients with latent syphilis that:
The anterior tonsillar pillars frequently present a dark dusky red color in a well-dened
congested area. This area begins at the base of the pillars and extends upward ½ to 2½cm
and is approximately 6 to 10mm in breadth. The appearance is that of a denite vascular
congestion. In the examination of 469 syphilitic patients this sign was present in 324 or 69.1
per cent. Not every case of syphilis presented this sign, nor could every patient having this
sign be proved to have syphilis [170, p.305].
Thus, Biederman sign refers to the dark red color involving the anterior tonsillar
pillars of the tonsillar fauces in late syphilis (Table1.1).
1.2.27 Gorlin Sign
Robert James Gorlin (1923–2006) was born in Hudson, NewYork, and received his
Doctor of Dental Surgeons (DDS) degree from the Washington University School
of Dentistry, St. Louis, in 1947, followed by a medical and surgical pathology fel-
lowship at the National Institute of Health and Columbia Presbyterian Medical
Center from 1947 to 1951 [171–175]. During this time, he also had appointments as
an instructor in medical pathology at Columbia Presbyterian Hospital and oral
pathology at Bronx Veterans Administration Hospital [175]. At the State University
of Iowa (currently the University of Iowa), he taught a medical pathology course to
dental students while advancing his education, receiving a master’s degree in chem-
istry in 1956 [175]. He was appointed associate professor and chairman of the
Division of Oral Pathology and held faculty appointments in the departments of
pediatrics, laboratory medicine and pathology, and dermatology in 1971; and in the
departments of obstetrics and gynecology and otolaryngology at the University of
Minnesota in 1973 [173, 175, 176]. From the University of Minnesota, he was
appointed Regents Professor of Oral Pathology and Genetics in 1978, professor
1.2 Eponymously Named Signs oftheOral Cavity
30
emeritus in 1993, Reagent Professor Emeritus in 2000, and Honorary Doctor of
Science in 2002 [171, 173, 177, 178].
His career and research interests spanned the elds of dentistry, oral and maxil-
lofacial pathology, otolaryngology, obstetrics, craniofacial and orofacial genetic
malformations, hereditary hearing loss, pediatrics, and dermatology [171, 172,
177]. His primary area of interest was in delineating the cause of congenital mal-
formation affecting the head and neck, culminating in the description of more than
100 syndromes, 11 eponymously named craniofacial syndromes (Gorlin syndrome
or basal cell nevus syndrome), one sign (Gorlin sign), and benign odontogenic
cysts (Gorlin cyst) ascribed to honor and acknowledge his keen insights and obser-
vations. As further testimony to his accomplishments, he was instrumental in iden-
tifying the gene responsible for some of these syndromes and diseases [171].
Robert James Gorlin and Jens Jørgen Pindborg (1921–1995) published their
highly acclaimed medical reference book Syndromes of the Head and Neck in 1964;
the second edition published in 1976 included Michael M.Cohen, Jr. (1937–2008)
as co-editor. The third edition, published in 1990, was authored by Gorlin, Michael
M.Cohen (1937–2018), and L.Stefan Levin, and the fourth by Gorlin, Cohen, and
Raoul C.M.Hennekam, published in 2002 [179].
Gorlin had an impressive list of honors and accomplishments. He cofounded and
was elected diplomate of the American Board of Medical Genetics, president of the
International Association for Dental Research and American Academy of Oral
Pathology, and was a senior fellow of the Institute of Medicine of the National
Academy of Science, Premio Phoenix Anni Verdi Award from the Italian Genetics
Society to name a few [171, 175]. He also received an Honorary Doctorate in
Science from the Universities of Athens and Thessalonica, Greece [180]. He was
the editor of oral pathology in the Journal of Oral Surgery, Oral Medicine and Oral
Pathology [180].
As to his character, he was described as:
A larger-than-life presence in oral pathology for over 50years, he was a man of enormous
intellect and curiosity, thoughtful deliberation, and innite compassion and kindness [176].
Gorlin made the following statement regarding his perception about eponyms
assigned to the syndromes and diseases which bear his name:
I am personally opposed to eponyms since they say nothing about the disorder, frequently
give rise to argument regarding priority of discovery, and may be chauvinistic and unfair to
those whose contributions to knowledge of the syndrome far exceed those of the individual
for whom the disorder is named. Perhaps, at some distant time a nifty system for an
International Nomenclature of Syndromes will be devised and universally accepted, but I
doubt it [175, p.323].
1 Oral Cavity Signs
31
Fig. 1.2 Gorlin sign (by Ryan Yale)
As described by Michael M.Cohen:
He was a very warm human being who had an engaging way with everyone. He loved
people from all walks of life and had a wide array of friends. He was a loving husband, a
wonderful father, a consummate and caring clinician, and an astounding humorist. (…)
With patients, Bob was an empathetic listener. The more troubled a patient was, the more
sensitive and caring he became and the more time he would spend. He had a warm way of
making a patient feel less isolated and better about himself or herself. He often hugged men,
women, and children. He had a special way of communicating with the distraught parents
of an affected child [181].
Gorlin and Pindborg described a nding in patients with Ehlers-Danlos syndrome;
50% of persons with Ehlers-Danlos syndrome “have the ability to touch the nose
with the tongue, an ability manifested by about 8–10 per cent of ostensibly normal
person” [182, p.197]. Thus, Gorlin sign refers to the ability to touch the tip of the
nose by the protruded tongue in patients with Ehlers-Danlos syndrome (Table1.1
and Fig.1.2).
1.2 Eponymously Named Signs oftheOral Cavity
32
Table 1.1 Oral cavity signs
Name Year Description of sign Method Etiology
Burton [5] 1840 The margins of the gums at the neck of two or more teeth in the maxilla or mandible are
distinctly bordered by a narrow lead-blue line
Inspection Lead
Carabelli [8] 1844 On the rst median wall of the molars, there is an enameled hump (tuberculus anomalous), the
base of which arises from the neck of the tooth, and the tip stands free in the oral cavity,
somewhat remote from the crown
Inspection Hereditary
Corrigan [24] 1854 There is a purple color on the margin of the gums, incisor, canine, and bicuspid teeth of the
maxilla and mandible
Inspection Copper
Trélat [30] 1870 Tuberculosis ulcers of the mouth develop in the following way: one nds on the mucous
membrane a spot, a barely protruding plate, which is round and wide from 1 to 3 or 4mm and
revealing on its surface still covered with epithelium, one or more several follicular orices.
This spot is light yellow, similar to that of phlegmonous pus. The epithelium is destroyed after
a few days leaving an ulcerated surface. Instead of one spot, several are observed at different
stages of development
Inspection Tuberculosis
Clarke [40] 1873 A ssure transverses deeply into the tongue, while rugae are conned to the mucosa. This
ssure is best demonstrated by taking the tongue between the ngers and gently stretching it.
The rugae can be obliterated in these cases, while no change occurs on the ssures—their
sides may be separated, but they cannot be obliterated
Inspection Syphilis
Drummond [45] 1882 While in the supine position, the patient is told to breathe as quietly as possible through the
wide open mouth. The oval piece of the binaural stethoscope is introduced into the mouth. If
the sign is present, expiration will appear interrupted at each beat of the heart by a “whiff,”
which, in some cases, is very loud, while, in others, it is detected only at the end of expiration.
In some instances, especially if the aneurysm is large, a diastolic whiff can be heard as well as a
systolic. In cases where the sign is well marked, it is heard in the trachea during quiet
expirations or when the patient is holding his breath with the mouth open and the tongue
depressed to allow the gaping glottis to communicate freely with the buccal cavity. In very
well-marked cases, the whiff is audible in the trachea with the mouth closed and disappears
when the ngers compress the nostrils. It is crucial to avoid cardiac excitement; hence it should
only be sought after the patient has lain in the recumbent position for a short while and after the
reasons for inserting the binaural stethoscope into the mouth have been fully explained. Indeed,
it is well to explain to the patient accurately before commencing the examination, for nervous,
interrupted respiration, and forcible or nasal breathing defeat the reason for the examination
Auscultatory Thoracic
aneurysm
1 Oral Cavity Signs
33
Name Year Description of sign Method Etiology
Mueller [52] 1889 The inamed, reddened tonsils and the anterior and posterior palatine arches moved somewhat
medially synchronously with each carotid pulse; pulsation was also noted on the soft palate,
and the free edge moved downwards with the uvula. In this way, the palatine arches and
tonsils’ contraction and the soft palate and uvula deepen with each pulse resulting in a
narrowing of the palate. A rhythmic intensication of the reddening of the palate is also
observed
Inspection Thoracic
aneurysm
Shelly [55] 1893 The soft palate is completely studded with minute translucent lenticular elevations varying in
size, in most cases about 0.5mm, and hardly ever exceeding 1mm in diameter. They gave the
impression of small localized distensions of a thin layer of transparent epithelium. Their
lens-like appearance is increased so that a minute blood vessel lying beneath one of them
occasionally becomes magnied. However, it might be impossible to observe any other part of
its course as it entered or left the vesicle on either side. These vesicles were most abundant
about the soft palpate above the root of the uvula. However, in some cases—and, these were
generally of the more severe type—they occupied a much larger area being visible over the
greater part of the roof of the mouth, but being always most marked and most abundant at the
soft palate
Inspection Inuenza
Fournier [60] 1894 One of the most common manifestations of newborn or congenital syphilis occurs on the lip
commissures (one could also say scars on the corners of the mouth because they occupy the
angle formed by the lip commissure). The diseases in this place are erosions, decomposed
papules, or ulcers. They only occur at the commissure, encroaching on the surrounding skin
on rare occasions. In and of themselves, they remain supercial, with tears almost always
appearing at the level of the corners of the mouth. Here they form rhagades, ulcerous streaks
that repeatedly tear one after the other, hollow out more and more, become deeper, heal slowly
and with difculty, and leave behind persistent, always visible scars. This scar usually forms a
small whitish line drawn out, elongated, and running transversely or slightly obliquely from
top to bottom. It may be that they are barely visible on the mucosa. (It is known that diseases
of the mucous membrane heal less conspicuously than those of the skin.) However, there
always remains a distinct and noticeable skin scar. Rarely are scars of this type found around
the lips
Inspection Congenital
syphilis
(continued)
1.2 Eponymously Named Signs oftheOral Cavity
34
Table 1.1 (continued)
Name Year Description of sign Method Etiology
Krisowski [63] 1895 Linear-shaped and radial-positioned scars occur at the corner of the mouth, separated by
normal-appearing skin
Inspection Congenital
syphilis
Koplik [70] 1896 There is invariably a distinct eruption on the buccal mucous membrane and the inside of the
lips. It consists of small, irregular spots of bright red color. In the center of each spot, there is
a minute bluish-white speck. These red spots, with accompanying specks of a bluish-white
color, are pathognomonic of early measles and, when seen, can be relied upon as the
forerunner of the skin eruption. The buccal eruption is of greatest diagnostic value at the
outset of the disease before the appearance of the skin eruption and at the outset and height of
the skin eruption
Inspection Measles
Silex [80] 1896 Multiple scars (pseudoscars) and furrows located on the corners of the mouth and radiating to
the chin
Inspection Congenital
Syphilis
Forchheimer [85] 1898 Erythematous maculopapular lesion located on the velum of the palate and the uvula,
extending to, but not upon, the hard palate. The spots are arranged irregularly and are the size
of large pinheads
Inspection German
measles
(Rubella)
Comby [93] 1900 Oral enanthema and erythema with swelling of the gums and an exudative coating involve the
mucous membrane
Inspection Measles
Tresilian [97] 1901 A bright red papilla is observed at the opening of Stensen duct (buccal mucosa at the second
upper molar), along with excess salivation
Inspection Mumps
Castellani- Low
[120]
1903 Persistent ne and coarse tremors in the tongue Inspection Sleeping
sickness
Schultze [123] 1903 Indentation occurs on the tongue when percussing one-half of a protruded tongue Percussion Tetany
Miécamp [127] 1903 In early mumps parotitis, a sapid substance (dilute acetic acid or vinegar) is placed on the
tongue, and the patient is told to swallow. Painful salivation more commonly occurs on the
side of parotid swelling
Inspection Mumps
Filatov [130] 1904 Circumoral pallor Inspection Scarlet fever
Marfan [136] 1907 A triangle-shaped peeling tongue extends from tip to base. The tongue has a characteristic red
and thin appearance at the edges and tip, covered in the middle with a more or less thick
saburral coating. In severe forms, the tongue dries and covers itself and the lips with
fuliginosity
Inspection Typhoid
1 Oral Cavity Signs
35
Name Year Description of sign Method Etiology
Escherich [146] 1909 A sharpening and protrusion of the mouth occur as if grasping the nipples, which disappears
quickly, sometimes followed by sucking movements. The fact that the amplitude of the muscle
contractions is more clearly perceptible on the non-percussed side is based on the obvious
mechanical conditions. The phenomenon cannot be triggered in the waking state
Inspection Tetany
Gaucher [152] 1913 Separation of the upper middle incisors Inspection Congenital
syphilis
Hathcock [155] 1918 Palpatory tenderness is located near the angle of the mandible Palpation Mumps
Sterling-
Okuniewski [158]
1922 Inability to voluntarily protrude the tongue Inspection Typhus
Jackson [165] 1923 An audible slap, palpatory thud, and asthmatoid wheeze are pathognomonic of a tracheal
foreign body. Cough, hoarseness, dyspnea, and cyanosis are often present. The audible slap is
best heard by asking the patient to keep the mouth open during cough. The “asthmatoid
wheeze” is heard with the ear or stethoscope bell at the patient’s open mouth
Auscultatory Foreign body
Biederman [170] 1934 Anterior tonsillar pillars are dark dusky red in a well-dened area that begins at the pillars’
base, extends ½–2½cm upward, and is approximately 6–10mm in width
Inspection Syphilis
Gorlin [182] 1964 Touch the nose with the tongue Inspection Ehlers-
Danlos
syndrome
1.2 Eponymously Named Signs oftheOral Cavity