Short Takes and Quick Consults- April 9, 2010

Impresario Malcolm McLaren, 64, has died of mesothelioma. McLaren is known as a fashion designer as well as an influential entrepreneur who influenced punk rock with his creation of the Sex Pistols in the 1970’s. Neil McCormick in the Daily Telegraph wrote that McLaren was motivated less by money than “by mischief, philosophy and style, by the egotistic belief that he could imprint his personal (and highly idiosyncratic) vision on the world through the agency of other people’s talent.”  Mesothelioma (sometimes called meso) is a rare cancer of the mesothelium, the lining of the chest cavity. Recently, it was responsible for the deaths of sports legend/ actor Merlin Olsen, and columnist Archie Archerd. (See these articles for the basics about mesothelioma.)

Mesothelium consists of two layers of cells, one which covers the organs, and the other which covers the inner body wall. The mesothelial cells produce a small amount of fluid  which provide lubrication between these two layers, and allow the organs of a body cavity to move smoothly. The mesothelium of the chest cavity is called the pleura, the space of the abdominal cavity- the peritoneum, and the space around the heart, the pericardium.

There are three  types of mesothelioma, which correspond to these three body cavities. Pleural mesothelioma, which is the most common form of the disease, accounts for approxiately 70% of the cases.  It occurs in the lining of the lung known as the pleura. Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma originates in the pericardium, which lines the heart.

The symptoms of abdominal mesothelioma include collecting abdominal fluid,called ascites- which corresponds to the lung fluid accumulation in pleura mesothelioma. It ca cause swelling of the abdomen, abdominal pain, indigestion, weight gain and swelling of the feet and ankles. Weight loss, fever, anemia, or bowel obstruction are other possible symptoms.

Symptoms of pericardial mesothelioma, which is the rarest kind of mesothelioma, include chest pain, cough, shortness of breath, chest palpitations and irregular heart beat.

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Camilla Parker-Bowles, wife of Prince Charles, broke her leg while hiking in Scotland this week. The Duchess, age 62, may have stepped into a pothole while hiking at the Queen’s private Balmoral Estate in Aberdeenshire on Wednesday. Although she needed some assistance down the hill, an x-ray was not done until Thursday, which revealed a “twisted fracture of the fibula” near the ankle. According to her spokeswoman, “Consequently, her Royal Highness is wearing a plaster cast and will be for six weeks. She has been advised not to put weight on her leg. Her Royal Highness has every intention of carrying out all planned engagements.”

The lower leg is comprised of two long bones.The tibia is the larger of the two, and is located toward the middle of the lower leg. The fibula is the smaller bone and it is located on the outside of the lower leg. There are three main muscles in the lower leg. The soleus and gastrocnemius  muscles make up the calf, and the anterior tibial muscle runs along the outside of the leg in the front. There are also smaller muscles that help move the big toe and the foot in directions other than up and down.
Symptoms of a leg fracture include pain, swelling, decreased mobility, and sometimes an obvious deformity of the legs.  If the bones remain in good alignment, the injury can be treated with casting to protect the leg while it heals. If the alignment is not good, surgery will be required to fix the fractured parts in place to allow for optimal healing. Failure to do so can lead to leg length discrepancies.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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