Indiana University School of Medicine - Caduceus Yearbook (Indianapolis, IN)

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CLINICOPATHOLOGIC CONFERENCE EU.M.C. MARCH 10, 1969 Case No. 691969 The case for discussion today is that of Perry Anal, a 43-yr-old Caucasian male go-go dancer who was seen in the RW of Marion County General Hospital for the first time on 8 10 68 complain- ing of rather acute borborygmus, tenesmus, tris- mus, strabismus, meningismus, and merry x-mas. Physical examination recorded by the crack senior extern) revealed a mass in the neck, unilateral right gynecomastia, and 3+ pitting edema sur- rounding a Peyronie's plaque. A diagnosis of acute gonococcal quinsy and confirmed, and the patient was treated with IM Metubine and given a 10-day course of Premarin cream. He was re- leased that night, MHB with PHC. The patient was next seen in the ER at Robert Long Hospital on 10 8 68 bleeding profusely from a punctate stab wound in the left posterior flank. Mr. Anal stated that he was just leaving Coleman Hospital, where his wife (a 190-lb. achondro- plastic gargoyle and chronic Thalidomide addict) had just delivered a 7-lb. 3-oz. left ankle. He was walking toward his car when he was attacked by some hamburger running around the parking lot waving a renal biopsy needle and yelling, 'I'm a staffman, I'm a staffman. ' Unfortunately, the assailant's needle found its mark. In the ER, an incision was made and from the wound was withdrawn a 10-cm solid-gold biopsy needle Author Hillis Discussants: Drs. French 8 Nasser Discussants: Drs. Soper G Helmen . . . and we see from the x-ray exactly where the fracture occurred.

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 It just HAS to be one of those seventeen California hospitals! I got it! The bad part's over--let's get back to the beer. Stat o. B. !

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obturator on which was inscribed, All my love, Stuart. A Band-Aid was applied and, after ap- propriate diagnostic procedures (including Schist tonometry and a rectal biopsy) the patient was dis- charged MHB with PHC. and dysuria. Also, during the ten days prior to ad- mission, he had experienced about 73 acute pria- pistic crises. FAMILY HISTORY The next and final episode occurred on 12 31 68 when, after being brought to the MCGH emergency room, the patient was admitted for diagnostic evaluation, possibly even treatment. When first seen, the patient was tachypneic, diaphoretic, and had a blood pressure of 60 80. The medicine resi- dent noted marked onychogryposis and elevated nasal eosinophils. IV fluids were started and the extern was told to pass an N-G tube, anchor a Foley, and admit the patient. PRESENT ILLNESS: The patient's present illness was manifest by pro- gressive feelings of weakness, dyspnea, and a bloating of the humors of the abdomen. Just prior to admission, the patient had been watching a 1938 Mickey Rooney movie when he palpitated, felt dizzy, and had a sensation that all my bodily fluids were flowing down into my bladder and gentle (sic) parts. He fainted and was brought to the ER. PAST MEDICAL HISTORY Positive, in that the patient had had the normal childhood diseases, including tetanus, scurvy, the plague, anthrax, and two psychotic episodes in which he was found in his backyard, sali- vating and practicing bestiality on his his hyperhidrotic squirrel Sidney, who lived in the oaks. He had chronically suffered from purulent, pustular pig- mented, pearly penile papules. REVIEW OF SYSTEMS Neuropsychiatric: Patient stated that he had sought psychiatric help recently, for what was found to be acute, inappropriate affect. However, he discon- tinued his own therapy, as he'd never been treated by anyone so grosz. HEENT: Patient complained of occasional uni- lateral scotomata, intermittent rhinophyma, and infrequent sore throats. Chest: Symptoms related to the chest were negative except for occasional hemoptysis, a chronic cough, and a history of a right middle lobectomy. Heart: Occasional micturational palpitations were noted by the patient. GU: Patient had recently noted increased frequency The patient's father, a transvestite Presbyterian minister, expired one night when, during an unci- nate fit, he fractured his buffalo hump, everted a Zenker's diverticulum, aspirated, and died. The patient had 10 siblings, 4 male, 5 female, 1 border- line--all living and well except one sister (the for- mer Miss Infra Anal, who married Bob Fissure to become Mrs. Infra Anal Fissure). She succumbed age 32 after taking an overdose of testosterone. She evidently had an episode of acute vulvar atrophy and died of fulminating penis envy. The patient's mother is living and well, although there is history of a canal of Nuck cyst. She has no history of ASHD, RHD, CHF, SOB, DOE, HNP, PID, COPD, URI, HA, or TBNA. The patient's daughter was well until age 19 when she suffered concomi- tant lower abdominal distress and human chorionic gonadotro- pinuria. This was one of the first documented cases of the so-called Senior Medical Stu- dent-Freshman Nurse syndrome, in which an abdominal mass is the direct causative factor in the development of a nuptial mass. SOCIAL HISTORY The patient worked 20 years as a male go-go dancer in Roscoe's Romper Room, an infamous dive referred to as Charcot's Joint and frequented by hoodlums, street-walkers, radiologists and the like. There, while listening to the sock-it-to-me music of that wild combo, Chuckie Bumps and the Throckmortons Three, the patient and his fellow dancers would wriggle in their go-go cages and squirt each other with IVP dye. PHYSICAL EXAMINATION Physical examination on the morning after admis- sion revealed a WD, WN, WM of 43, with a 22 Bardcx-Foley catheter taped to his right cheek and passing into the right nostril. Remembering the orders he had given to the junior female extern the night before, the resident quickly checked to see where the N-G tube might be. After this situation was corrected, the physical examination was con- tinued and is recorded as follows: HEENT: Examination of the head revealed marked dolichocephaly, bilateral Parrot's nodes, and obvi- ous Treacher-Collins facies. There was dullness to percussion over Broca's area. Ophthalmoscopic exam of the right eye revealed 8 spirochetes swim- Continued on page 36