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

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Differential Diagnosis Dr. H.R. Glowbox: The striking lesion seen on the film is located near the anterior communicating artery in the Circle of Willis. I know of only one disease entity which could cause the response that we have witnessed today. Fortunately, today we have in our midst a renowned neurologist, Dr. C. Rebrum. Dr. C. Rebrum: Ya, Ich bin Hier. But I am too excited to speak!!! My associate must speak for me. Dr. Tref Ihnation: The amazing entity which was first described by Dr. Rebrum is the infamous Wamper's Syndrome . The pathophysiology is that through a small venous fistula a fecal embolus from the rectum enters the paravertebral venous system, from which, after ascending, it enters the vertebral artery via an arteriovenous malformation. From there, the embolus enters the Circle of Willis. Here, the embolus goes around and around (going wamp, wamp, wamp ) and sometimes it can occlude the ophthalmic artery, such that the patient can't see for shit , and is often is described as having a shitty outlook on life . It is a terrible but transient disease, which usually disappears shortly after leaving the hospital. Of course, massive doses of corticosteroids and ampicillin are necessary. Unfortunately, those struck by this malady often have recurrent episodes of carbbiness which characterize what some call Mecca Madness . 27

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Case Records Of The Wizard General Hospital Daily Clinicopathological Exercises George Burns, Editor Case 1-1978 A 25 year old male medical student was admitted to the hospital complaining of flickering vision . This fine, but cranky young fellow was in relatively good health until the day of admission. After being on call the preceding night, he began complaining about the cold, snotty eggs being served . Those about him perceived that he was suffering from quite a bit of flatulence that morning. Suddenly, he complained of a chill going up his spine and of a severe headache. Shortly thereafter, he began to express copralalia, uttering: we're getting the shaft , and this hospital sucks ! He continued to express this air late into the morning during staffing (grilling or straffing). Suddenly he moaned, Why are the lights flickering? He then grabbed his head and sunk to the floor. He was dire ly admitted to the hospital (via the E.R. of course). He did not pass go, but he did have to pay $400. Upon examination, the chap appeared glassy- eyed and dazed. Vital signs were normal. Gooseflesh covered his pale body. Pupils were equal, anisocoric, but responsive ( a beer can in view caused mydriasis - Cole's sign). Fundascopic exam showed the arteries to be slightly pale and the disks showing signs of papillitis. The visual fields were diffusely obscured, and the patient stated that he couldn't see for shit . With the exception of rather massive flatus, the remainder of the physical examination was normal. Throwing caution (and money) to the wind, laboratory studies were ordered. No test was left undone. Important data included: WBC 15,000 with left shift and 1,000 eosinophils; SGOT 50 mg%; BUN 25 mg%; Molybdenum 2 mcg%; Blood cultures (X6 for reproducibility, of course) did grow several strains of coliform bacteria; CSF studies including an opening pressure of 10 mm, glucose and chloride were normal except WBC count of 1,000: Microscopic exam of the CSF showed no remarkable findings; EKG showed normal sinus rhythm: Chest roentgenogram was unremarkable; However, the skull films were quite interesting. Please see figure 1 below: Figure 1 Right lateral view of the patient's skull demonstrates a large lesion in the area of the anterior communicating artery in the Circle of Willis. 26

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They say man has succeeded where the animals fail because of the clever use of his hands, yet when compared to the hands, the sphincter ani is far superior. If you place into your cupped hands a mixture of fluid, solid, and gas, and then through an opening at the bottom, try to let only the gas escape, you will fail. Yet the sphincter ani can do it. It apparently can tell whether its owner is along or with someone, whether standing up or sitting down, whether its owner has his pants on or off. No other muscle in the body is such a protector of the dignity of man, yet so ready to come to his relief. Banish the use of the four-letter words whose meanings are never obscure, The Angles and Saxons, those bawdy old birds were vulgar, obscene and impure. But cherish the use of the weak-kneed phrase that never quite says what you mean, Far better you stick to your hypocrite ways than be vulgar, coarse, or obscene. You may speak of a movement or sit on a seat, have a passage, or stool, or simply excrete; Or to say to the others I'm going out back , then groan in pure joy in that smelly old shack. You can go lay a cable, or do number two or sit on the toidey and make a do-do. But ladies and men who are socially fit under no provocation will go take a shit. When your dinners are hearty with onions and beans, with garlic and claret and bacon and greens; Your bowels get so busy distilling a gas, that Nature insists you permit it to pass. You are very polite, and you try to exhale without noise or odor, you frequently fail, Expecting a zephyr, you carefully start, but even a deaf one would call it a fart. ULCER THERAPY To the editor: What's all this new talk I hear about cement-a-dean being good for ulcers? Now, I know that antacids and milk are good for ulcers, and I know that venting a lot of )ent up anger and hostility is good for ulcers; )ut I honestly can't believe that some new angled idea would so easily capture the minds of young doctors. How could anyone want to cement-a-dean for their stomach craters? I suppose that some people could be very mad at their deans, especially if the deans went and raised national board score cutoffs or hiked the tuition in the summer when most of the students were gone, but even so, I think people and certainly young doctors should be able to handle that ulcer causing anger in better ways than by soaking their deans in wet cement and throwing them into the White River; and anyway, there might be fish in that water! Dr. Emily S. Litella Speedway, Ind. Bush Clinic The above letter was referred to the appropriate parties for reply: To the editor: Dear Dr. Emily, That's cimetidine, cimetidine, not cement-a-dean. Rex Hall V.P. Schmidt, Cline, Phrench Rx Reply: To the editor: Never Mind! Dr. Emily S. Litella 28