Lymphadenopathy: a misnomer

Medical nomenclature contains numerous examples of outdated, but widely used terminology.

The term "lymphadenopathy", meaning lymph node disease, is a case in point. In former times, lymph nodes (as they are known now) were known as lymph glands. It was believed that the lymph fluid circulating in the lymph vessels, was produced by the lymph nodes. Organs that produce chemicals that are circulated to other tissues are referred to as glands (e.g., endocrine glands, exocrine glands). Hence the term "lymph gland". A disease of the lymph gland was termed "lymphadenopathy" from lymph + adenos (Greek for gland) + pathei (Greek for disease).

Derivation of lymph fluid.
Source: National Cancer Institute, public domain
The term for a neoplasm of a lymph node was "lymphadenoma"

The term for inflammation of a lymph node was "lymphadenitis"

Nearly everything about lymph node pathology was saddled to the ill-conceived notion that a lymph node is a type of gland.

We now know that lymph is not produced by the glandular activity of lymph nodes. Lymph is interstitial fluid (i.e., fluid between tissue cells) that is absorbed into lymph vessels. Lymph fluid is somewhat milky because it contains white cells, sloughed from lymph nodes, but the fluid comes from tissue interstitium and its composition is akin to blood plasma.

Modern pathologists have dropped the "adeno" in "lymphadenoma" and replaced it with the less confusing term, "lymphoma".

Regrettably, the terms "lymphadenopathy" and "lymphadenitis" persist into modern usage.

- Jules J. Berman, Ph.D., M.D. tags: lymph node, lymphoid, lymphedema, lymphatics, lymphatic vessels, common disease, orphan disease, orphan drugs, rare disease, subsets of disease, disease genetics, logophile, medical terminology, medical nomenclature, medical dictionary

---

In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

Patient identifiers

I have posted an article on patient identifiers. Here is a short excerpt from the article:

Imagine this scenario. You show up for treatment in the hospital where you were born, and in which you have been seen for various ailments over the past three decades. One of the following events transpires:

1. The hospital has a medical record of someone with your name, but it's not you. After much effort, they find another medical record with your name. Once again, it's the wrong person. After much time and effort, you are told that the hospital has no record for you.

2. The hospital has your medical record. After a few minutes with your doctor, it becomes obvious to both of you that the record is missing a great deal of information, relating to tests and procedures done recently and in the distant past. Nobody can find these missing records. You ask your doctor whether your records may have been inserted into the electronic chart of another patient or of multiple patients. The doctor does not answer your question.

3. The hospital has your medical record, but after a few moments, it becomes obvious that the record includes a variety of tests done on patients other than yourself. Some of the other patients have your name. Others have a different name. Nobody seems to understand how these records got into your chart.

4. You are informed that the hospital has changed its hospital information system, and your old electronic records are no longer available. You are asked to answer a long list of questions concerning your medical history. Your answers will be added to your new medical chart. You can't answer any of the questions with much certainty.

5. You are told that your electronic record was transferred to the hospital information system of a large multi-hospital system. This occurred as a consequence of a complex acquisition and merger. The hospital in which you are seeking care has not yet been deployed within the information structure of the multi-hospital system and has no access to your record. You are assured that the record has not been lost and will be accessible within the decade.

6. You arrive at your hospital to find that it has been demolished and replaced by a shopping center. Your electronic records are gone forever.

These are the kinds of problems that arise when hospitals lack a proper patient identifier system (a common shortcoming). The purpose of the article is to list the features of a patient identifier system, emphasizing the essential role of identifiers in healthcare services and biomedical research.

The full-length article is available at:

http://www.julesberman.info/book/id_deid.htm

---

In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, rare disease, subsets of disease, disease genetics, identifiers, identification, ehr, emr, electronic health records, electronic medical record, health informatics, HITECH, medical informatics, pathology informatics

Three neglected principles of Big Data: identifiers, immutability, and introspection

My book, Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information was published last year by Morgan Kaufmann.

There are three crucial topics related to data preparation that are omitted from virtually every other Big Data book: identifiers, immutability, and introspection.

A thoughtful identifier system ensures that all of the data related to a particular data object will be attached to the correct object, through its identifier, and to no other object. It seems simple, and it is, but many Big Data resources assign identifiers promiscuously, with the end result that information related to a unique object is scattered throughout the resource, attached to other objects, and cannot be sensibly retrieved when needed. The concept of object identification is of such overriding importance that a Big Data resource can be usefully envisioned as a collection of unique identifiers to which complex data is attached. Data identifiers are discussed in Chapter 2.

Immutability is the principle that data collected in a Big Data resource is permanent, and can never be modified. At first thought, it would seem that immutability is a ridiculous and impossible constraint. In the real world, mistakes are made, information changes, and the methods for describing information changes. This is all true, but the astute Big Data manager knows how to accrue information into data objects without changing the pre-existing data. Methods for achieving this seemingly impossible trick is described in detail in Chapter 6.

Introspection is a term borrowed from object oriented programming, not often found in the Big Data literature. It refers to the ability of data objects to describe themselves when interrogated. With introspection, users of a Big Data resource can quickly determine the content of data objects and the hierarchical organization of data objects within the Big Data resource. Introspection allows users to see the types of data relationships that can be analyzed within the resource and clarifies how disparate resources can interact with one another. Introspection will be described in detail in Chapter 4.

I urge you to read more about my book. Google books has prepared a generous preview of the book contents. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

Jules J. Berman, Ph.D., M.D.tags: big data, metadata, data preparation, data analytics, data repurposing, datamining, data mining

Pitfalls in Medical Terminology

Back in 2008, I posted a list of medical terms that are easily confused, such as ileum (part of small intestine), and ilium (a pelvic bone). Medical transcriptionists and healthcare workers who input chart data (i.e., just about everybody), should be aware of medical term-pairs that have nearly the same orthography, are often pronounced identically, and have completely different meanings. These words are not picked up by spell checkers (because they are not misspelled). You can avoid such errors if you know what to look for.

Since 2008, there have been many updates to the list:

acinic, actinic
anisakiasis, anisokaryosis
aptotic, apoptotic
arboreal, aboriginal
arteritis, arthritis
auxilliary, axillary
brachial, brachium, branchial
callous, callus
causality, casualty
chlorpropamide, chlorpromazine
chondroid, chordoid
chondroma, chordoma
chorionic, chronic
cingula, singular
coitus, colitis
colic, colonic
colitis, coitus
costal, coastal
cryptogam, cryptogram
cygnet, signet
decease, disease
deceased, desist
digitate, digitize
dioecious, deciduous
diploic, diploid
disc, disk
disease, decease
diseased, deceased
dyskaryosis, dyskeratosis
dysphasia, dysphagia
ectatic, ecstatic
endochondral, enchondral (these are synonyms)
engram, n-gram, ngram
epistasis, epistaxis, epitaxis (the last is a misspelling of the second)
exxon, exon
facial, fascial
facies, faeces
fetal, fatal
firearm, forearm
foreword, forward
hallux, helicis
helicis, hallux
herpetic, herpangina
hydatid, hydatidiform
ileitis, iliitis
ileum, ilium
insular, insulin
intercostal, intercoastal
intubation, incubation
isotope, isotrope
kerasin, kerosene, keratin
keratotic, keratinic, actinic
keratinocytic, keratinolytic
keratosis, ketosis
lipoma, lymphoma
lumbar, lumber
malleolus, malleus
metachronous, metacrinus
milia, milium
miotic, mitotic, meiotic
mitosis, meiosis, myosis, myiasis
monogenic, monogenetic, and Monogenetic (last, related to class Monogenea)
mucous, mucus
myelofibrosis, myofibrosis
myofibroma, myelofibroma
neuroplastic, neoplastic
nucleus, nucleolus
oncocyte, onychocyte
oncology, ontology, ontogeny
organic, organoid
palatal, palatial
paleodontology, paleontology
palette, palate
palpation, palpitation
parasite, pericyte
parental, parenteral
pathogen, parthenogen
pathogenesis, parthenogenesis
pathogenic, pathogenetic (these two are synonyms)
penal, penile, pineal, panel
penicillamine, penicillin
perineal, peroneal, perianal
pleiotropic, pleiotrophic, pleiotypic (the first two are synonyms)
plural, pleural
porphyria, porphyruria
proptosis, ptosis
prostrate, prostate
protuberant, protruberant (the second term is simply a common misspelling)
quinine, quinidine
rachischisis, rachitis, rachischitic, rachitic
radial, radical
relics, relicts
reticle, reticule, radical
rett, ret
rosacea, rosea
semantic, somatic
serous, serious
silicon, silicone
singleton, singultus
sinusitis, synositis
somatic, semantic
sonography, stenography
taenia, tinea
takoma, trachoma
thecoma, thekeoma
torsion, distortion
trachoma, trachea
trichina, trachoma, trichura
trichinosis, trichosis, trichuriasis
trichrome, trichome
trochlear, tracheal
troglobite, troglodyte, trilobite
tuberous sclerosis, tuberculosis
tunicate, tourniquet
urethral, ureteral
vagitis, vaginitis
venous, venus

If you know the meaning of half of the terms in this list, you have a good grasp of medical terminology; but please don't settle for half measures. Physicians, nurses, chart reviewers, and medical transcriptionists should be aware of the correct meaning of each alternate word in these listed pairs.

---

In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, rare disease, medical terminology, medical errors, malaprop, malapropism, definition, confusing terms, confused medical terms, medical definitions, medical transcription, nomenclature, terminology, transcription errors, transcription mistakes, EMR, EHR, electronic medical record, electronic chart, electronic health record, avoidable errors, avoidable mistakes, sources of confusion, sources of error, common mistakes, common sources of confusion