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

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Indiana University School of Medicine Class of 1972 E. JOSEPH ALBERDINC, M.D. Remington, Endiana JAMES E. ALBRIGHT, M.D. Clarks Hill, Indiana THOMAS J. ALLEN, M.D. Noblesville, Indiana JAMES N. ALLEYN, M.D. Miama, Florida TONY G. ANDREWS, M.D. Kokomo, Indiana PAULD. BAKER, M.D. Winimac, Indiana MARGARET J. BALLACE, M.D. Clarksville, Indiana DOUGLAS A. BENNER, M.D. Indianapolis, Indiana

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DR. KILLERFILLER: As an opening comment here I feel compelled to mention that although we in radiology arc con- sidered technicians and are often maligned, you will notice upon whom the clinician called first. Now in reviewing these Barium contrast studies, we must, first of all, make the judgment that they are totally inadequate, as they were not performed by my loving hands. However, we will, with this despicable preparation, attempt to make some semblance of a diagnosis. I will say, that although the patient was poorly prepared, they are consistent with, but not diagnostic of, normal. Now with reference to the chest X-ray, which I'm sure you gentleman were convinced I would not be able to read. I must make note of the fact that there is an old, calcified granuloma present in the apical, posterior segment of the . . . left upper . . . right upper . . right side of the chest. In closing I feel as if I must once again review the proper order of X-ray procedures . . . DR. DII.DO: Although no direct tracing was made at the time of the patient's acute attack, an ESC was being taken while the nurses were rapidly preparing to prepare a bed for this dire emergency. At the time that the hoofbeats were heard, a rhythmic, two-second oscillation appeared on the tracing superimposed on the non-specific ST-T wave changes. These findings are compatible with hoofbeats, but I would have recommended serial tracings. DR. CHALLENGER: Dr. Dildo, 1 would like to point out that the two-per-second oscillations, superimposed as they were on the non-specific ST-T wave changes, could lead to some confusion in the diagnosis. Albeit, you may be right concerning them being compatible with hoofbeats, I must report that in some unpublished reports containing uninterpretable data, the concommitent presence of either B 52's, sunspots, or tornadoes must be excluded. DR. DILDO: In a series of 14 former patients here at IU, all of whom presented with a history of prostration occur- ring seconds to minutes to hours to days after hoofbeats were heard, it was found the 6 had been trampled by cows, 4 by sows, 1, a zoo-keeper by trade, by a zebra, 2 were found to lie malingerers, and one had made an indecent proposal to a student nurse. Unfortunately, in only two of these cases were fecal specimens obtained, and in both cases analysis and crapochromatography showed values very much like those noted in today's case. In neither case, however, is the potassium below 2.3. Well now, how about the fecal specimen, uh, Dr. Joshua You-know. DR. JOSHUA YOU KNOW: I'm very glad you asked me that. We've just finished a study on this subject, since I've been formally interested in crap metabolism for years and we find that 83.8' of the time, day or night, fecal matter can be found in the halls of the Veteran's Hospital. This proved to be unidentifiable as to source most of the time. DR. DILDO: Dr. Battered, would you care to make a few timely, pungent, pithy comments concerning this case? Will someone nudge Dr. Battered, being careful to avoid his sterile shawl. DR. STANLEY BATTERED: There has been noticed in the literature over the few years, and I've had fifty cases my- self, of FLATUS IMPERFECTUS in which it is know that there is an increased susceptability to trampling. DR. DILDO: In light of these findings, I am inclined to totally ignore the surgeon and disregard the afore-mentioned crap-analysis. As for the hoofbeats, this is anotoriously unreliable sign. However two facts are pertinent. First, the sow-show anually held at Ball Residence was active at this time, and secondly, there were two zebras housed as color- ful reminder for the residents of the sixth floor. I have to conclude, therefore, that this patient had been trampled to death either by a sow or zebra. In summary my diagnosis is paroxysmal protoplasmic insufficiency secondary to trauma, porcine, zebrine, or bovine. DR. JOSHUA YOU-KNOW I have a few slides here. The pathological diagnosis was golloping consumption. Today's case has, of course, come as a surprise to most of you. In retrospect, I think more attention should have been paid to that sputum stain. That AFB turned out on culture to be MYCOBACTERIUM BOVINUM. I think that there can be no doubt that the hoofbeats were indeed bovine and on autopsy, the diag- nosis of acute massive miliary TB was, of course confirmed. All CLINIC IANS have been fooled many times by the protean manifestations of this dread killer disease. Once again, this great deceiver has outwitted and eluded our finest diagnosticians. V Mil jut X nv MM ■«-

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ROBERT H. BISHOP, M.D. Champaigne, Illinois KATHLEEN L. BLOOM, M.D. Indianapolis, Indiana JERRY E. BLYTHE, M.D. Indianapolis, Indiana JEFFREY A. BOESTER, M.D. Fairfield, Connecticut KENNETH R. BOREN, M.D. Owensville, Indiana THOMAS W. BROOKS, JR., M.D. Evansville, Indiana Vice President DOUGLAS K. BROWN, M.D. LaPorte, Indiana GEORGE E. BROWN, JR., M.D. Greenwood, Indiana LINDA J. BURDEN, M.D. Argos, Indiana ROBERTA. BURSTINE, M.D. Elkhart, Indiana 23