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DAVID was rather shocked. In association with the NHS North of Tyne DR SCOTT'S SURGERY.

Byline: DR SCOTT

DAVID was rather shocked. He had with him a summary of his grandfather's post mortem result.

He had died of pneumonia, which was not a surprise as he had suffered from lung problems for most of his adult life. The report was detailed but it was the line "there was no evidence of clubbing" that had alarmed the family.

David wanted to make it clear that there was no suspicion of any history of violence towards the old man while he had been at home, and that they were all happy about his considerate care while in hospital.

The consensus in the family was that the examination probably referred to club foot, a condition in which the ankle, at birth, is twisted inward. It seemed odd to mention it and indeed, grandad had no sign of this condition, as the report confirmed.

David had wondered if this was a possible medical euphemism for evidence of heavy drinking.

His grandad didn't go to cool nightspots, although he had been a member of the local CIU where he enjoyed a pint or two and a game of darts.

Clubbing is the common name for pachydermoperiostosis. It describes the appearance of finger nails which form a pronounced convex curve.

Hippocrates, if not the first person to notice it, was the first to record its existence in about 400BC.

This apparently trivial finding can be of great significance as clubbing can be an early warning of many serious diseases.

The list of unpleasant illnesses connected to clubbing is long and involves many organs. The last person I saw with it has a liver tumour. Finger clubbing often occurs with lung cancer, and especially with mesothelioma, which is usually caused by asbestos. It's also seen in lung infections, especially when abscesses form.

Clubbing in a young person makes doctors think of cystic fibrosis or a hole in the heart defect. However, just to confuse doctors, it is sometimes a harmless condition which just happens to run in the family.

In grandfather's post mortem report, the pathologist was aware that the patient had suffered from lung disease and smoked cigarettes.

Until recently, modern doctors had no more clue than Hippocrates as to why clubbing occurs. Recent studies have increased our understanding.

Their findings implicate a fatty compound called PGE2, which is produced naturally by the body to help internal inflammation. Once it has done its work, PGE2 is broken down by an enzyme, 15- HPGD, produced in the lungs.

An excess of PGE2 can cause clubbing. We may soon be able to measure this compound to determine if a case of clubbing is due to a serious illness or just an incidental finding.

Generally speaking, any medical test is better than the post mortem exam.
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Publication:Evening Chronicle (Newcastle, England)
Date:Dec 15, 2008
Words:462
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