Babies, bilirubin and bullshit?!

Time for a bit of a yarn.

During my Trainee Intern year a few years back I worked at the Sophia Kinderziekenhuis at Erasmus MC in Rotterdam. Whilst there I was told the tale of the invention of ultraviolet therapy for neonatal jaundice. There are a number of different versions but like many stories I like the one I was told first best.

Most midwives will tell you that for many generations people have placed young infants in the sunshine to help them lose their yellow tinge. But it wasn’t until the 1950 and more so the 1970’s that medicine started using phototherapy widely.

Phototherapy baby

The story I was told goes “One day a young paediatrician was walking his dog in the park. Being a beautiful sunny day (when presumably he wasn’t on call) He was enjoying letting his mind wander and the fresh air. Then splat! he stood right in a dog shit and slipped to the ground. Whilst lying on the ground likely in a less stellar mood than he had previously been he noticed something. The dog turd which he had fallen on had been there for sometime and the outer-layer had turned white. He wondered if this was due to the sunshine breaking down the bile and other compounds. This set in motion a further thought about the potential for other compounds to react with sunlight and be broken down perhaps even in the skin?”

white-dog-shit

Since being told this tale I have chased up the origins of UV phototherapy and sadly no excrement was involved in its discovery. A number of observations including the breakdown of bilirubin in test-tubes exposed to sunlight and improvements in infants treated with natural sunlight lead to Dr. Cremer making the first study and then after the Yanks followed up it was more widely used.

Its interesting the stories which you are told during your medical training and the ones that stick. Anyone got a good yarn they remember from their med school days?

 

 

Kicking it.

 Young bloke presents after footy practice last week. Kicking when had sudden pain in his right groin. Did what most do and ignored but still painful and has not improved with rest.

He had been reviewed by the team physio and given a diagnosis of a sprain and persisted playing through his pain.

O/E
Fit young man.
Tender on even passive motion at the hip. Power of hip flexion and knee extension both reduced due to pain.

Clinical suspicion leads you to order a pelvic X-ray.

HIP

 

HIP 2
The above films show an avulsion fracture of the Anterior inferior iliac spine. with minor separation.

 

Avulsion fractures of the pelvis.

Points to remember:

Pelvic avulsion fractures are seen in patients aged 14 to 25.

This fracture is due to forced hip flexion often eccentric breaking the physis.

Most common are Ischial tuberostiy approx 50% (sprinters/tennis players)

Anterior inferior iliac spine (15-20%) (kicking as above)

Anterior superior iliac spine (15-20%) (also sprinting)

Treatment is conservative unless significant (1.5cm+) seperation has occured. very important to slowly return to activity as re-injury is common.

I have a low threshold for imaging young atheletes with injuries sustained at times of maximum effort as these fractures are common and do follow a different course to a standard sprain. (slower and more painful generally)

A beautiful summary image of these fractures from learning radiology

IMG_0273-0.JPG

Refs: http://www.learningradiology.com/archives06/COW%20205-Ischial%20Avulsion%20Fx/avulseischiumcorrect.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465275/

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