A tale of medical curiosities

Medical Matters: Reference is frequently made in medicine to the textbook or classic case of a disease.

While useful for teaching purposes, the longer I am in practice the more I realise that such cases are more the exception than the rule.

And then there are the extreme examples of illness that occasionally border on the unbelievable. So with a nod to the post-bank holiday lethargy that many of us will feel today, this column will take a look at some medical curiosities.

Cancer can be an aggressive disease, depending on the type of cells that multiply uncontrollably and their location in the body. It can progress rapidly in young people; equally, however, in the extreme, elderly cancer can be strikingly slow growing. This phenomena led to the description of a bizarre physical finding, "a colonic crunch", in the British Journal of Hospital Medicine in 1993.

A 91-year-old man was admitted to the accident and emergency department of a London hospital in a state of confusion. Doctors found that his abdomen was massively distended. When they carefully palpated (felt) his tummy, they were taken aback to feel a distinct crunching sensation in the upper abdomen. The sensation was similar to feeling a bag of granulated sugar.

X-rays of the patient's abdomen showed a widened section of bowel containing chalky material. Other tests confirmed the presence of a colon cancer which was obstructing his bowel.

When the man was operated on, the segment of colon above the obstruction had ballooned out and was full of small, stone-like calcified particles of faeces. These were responsible for the crunching sensation felt by his doctors.

The elderly man was operated on successfully. The cancer had not extended outside the bowel even though the calcification suggested the cancer was present for a long time. (The process of calcification in the body can take months or years.)

Although I have never seen a case as striking as this one, I have certainly looked after people diagnosed with cancer in their 80s and 90s, which has been so slow growing they ultimately passed away following a stroke or heart attack rather than from the cancer.

The following tale, described by Robert Youngson in his book Medical Curiosities, illustrates the challenge of unusual presentations.

A middle-aged woman turned up at a hospital complaining of feeling faint, with dizziness on standing and a severe headache. The symptoms had started while she was still in bed that morning.

A detailed history failed to establish an obvious cause, nor was she taking any medication that might have explained her symptoms.

Because of the severity of the dizziness, doctors decided to admit her to hospital for full investigation. All her blood tests were normal as were a full cardiac and neurological work-up. Her doctors were stumped.

However, a sharp-eyed nurse solved the conundrum.

While changing the patient's sheets, she noticed a medication patch firmly attached to the woman's buttocks. It contained nitroglycerine, and seemed to contradict the patient's assurances that she was not taking any form of medication.

Following further gentle inquiries, the now- embarrassed patient said her husband suffered from angina, for which he applied a nitroglycerine patch to his skin every morning. The significance of a bout of lovemaking, just before her symptoms developed, now became clear. The patient's symptoms settled quickly once the patch was removed.

This is a case I can relate to, having once been consulted by a couple who were alarmed at the inadvertent migration of the wife's hormone replacement therapy (HRT) patch. They had woken up that morning to find the patch was now firmly attached to her husband's penis. He suffered no side effects, but did require extensive reassurance that the female hormones would not damage his equipment in any way.

Youngson's book is full of unusual medical curiosities. Inevitably there is a section on unfortunate phrases found in letters dictated by doctors, including the following: "I am pleased to say there is no evidence of endocrinological abnormality. The child will probably be shorter than he wants to be, but if he wanted to be tall he should have picked different parents."

Finally, thanks to all of you who responded to my recent column on how God might go about redesigning the human body. One reader would like to get rid of our excretory function entirely. Another would like to see the head attached to the neck in a way that would help future generations avoid suffering from whiplash.

And a teacher of the Alexander technique for better posture wondered if God could beam us down the user's manual on how to use the present model.

"How come people in Africa can walk for miles with their goods on their heads and yet we have difficulty shuffling across the car park?" he not unreasonably asks.

Dr Muiris Houston is pleased to hear from readers but regrets he cannot answer individual medical queries.