Fabricius ab Aquapendente

Abstract

In his "original" description of the "Trendelenburg position," Friedrich Trendelenburg made it quite clear that he did not claim originality. He pointed out that Fabricius ab Aquapendente had ordered patients hung up by the knees and feet with the head down and the pelvis higher than the thorax. Both he and the ancients found the position conducive to the spontaneous reduction of such things as incarcerated femoral hernias.To be proper, therefore, we should refer to the "Fabricius ab Aquapendente position" rather than the "Trendelenburg position" when we lower the top end of the patient in order to get a better look in the pelvis. You will find these truths in the article by Trendelenburg, To the Editor:\p=m-\The liver scan is attaining an increasing clinical usefulness as investigators gain more experience with the indications and interpretation of this test. In most instances, results of other liver function tests are abnormal when the liver scan demonstrates discrete or diffuse hepatic lesions.1 In this case, the liver scan demonstrated a nonhepatic tumor and was the only criterion which led to a decision to perform laparotomy. The lesion, in fact, was a large asymptomatic pheochromocytoma, which revealed its presence by way of its unusual alteration of liver anatomy. Report of a Case:\p=m-\A 68-year-old retired records clerk came to the Portland Veterans Administration Hospital because of a 25-lb weight loss in the preceding six months. His illness began three months before admission when a dull left-upper-quadrant abdominal pain which was constant and radiated to his left flank suddenly de-veloped. Ten days later he noticed blood in his urine; however, the hematuria and also the pain cleared the next day. He then was asymptomatic until admission, except for the weight loss. He specifically denied having headaches, palpitations, dizziness, or flushing of the face. At physical examination, blood pres¬ sure was 124/60 mm Hg; pulse rate, 90 beats per minute; temperature, 98.6 F. The heart was normal size. A soft, grade 1 systolic murmur was heard at the left sternal border; it did not radiate upwards. The liver was palpated 8 cm below the costal margin with a total percussion height of 15 cm at the midclavicular line. No other abdominal masses were noted, and re¬ sults of the rest of the physical exam¬ ination were completely normal, ex¬ cept for the finding of a slightly enlarged, soft prostate by palpation.Glucose tolerance test results were abnormal, showing at fasting, one half hour, one hour, two hours, and three hours blood sugars of 112, 174, 175, 143 and 70 mg per 100 cc, respective¬ ly, with no glucosuria. Other liver function test results were 5% reten¬ tion of sulfobromophthalein (BSP) at 45 minutes; cephalin flocculation, neg¬ ative; bilirubin, 0.6 mg/100 cc; prothrombin time, 100%; serum glutamic oxaloacetic transaminase, 12 units, alkaline phosphatase, 24.5 King-Arm¬ strong units; total protein, 7 gm/100 cc; albumin, 4.8 gm/100 cc. Complete blood count, serum protein electrophoresis, urinalysis, an...