[Scurvy. A rare differential diagnosis of rheumatic diseases]. / Skorbut. Eine seltene Differenzialdiagnose rheumatischer Erkrankungen.

BACKGROUND: In December 2014 a patient presented to our clinic with the clinical symptoms of vasculitis. However, treatment with glucocorticoids did not lead to any improvement; therefore, the differential diagnostics were extended to other indications and ultimately led to the diagnosis of scurvy. OBJECTIVE: This article describes the clinical picture of scurvy and its relationship to rheumatic diseases based on a clinical case and additional information from the literature. Differences and similarities with important rheumatological disease symptoms are presented. RESULTS: Scurvy is a rare hypovitaminosis disease which can be manifested in different forms. In addition to vasculitis the symptoms can also resemble arthritis and hemarthrosis is a typical finding. These symptoms can be accompanied by unspecific manifestations, such as muscle pain and due to impaired collagen synthesis characteristic features, such as corkscrew hair can be observed. The causal therapy of scurvy is substitution of ascorbic acid. CONCLUSION: Scurvy is a rare differential diagnosis in the context of rheumatic diseases. The indications for scurvy can be a lack of response to immunosuppressive and immunomodulatory drugs as well as individual symptoms, such as corkscrew hair.

The discovery of vitamin C.

The term 'scurvy' for the disease resulting from prolonged vitamin C deficiency had origins in 'scorbutus' (Latin), 'scorbut' (French), and 'Skorbut' (German). Scurvy was a common problem in the world's navies and is estimated to have affected 2 million sailors. In 1747, James Lind conducted a trial of six different treatments for 12 sailors with scurvy: only oranges and lemons were effective in treating scurvy. Scurvy also occurred on land, as many cases occurred with the 'great potato famine' in Ireland in 1845. Many animals, unlike humans, can synthesize their own vitamin C. Axel Holst and Theodor Frölich fortuitously produced scurvy in the guinea pig, which like humans requires vitamin C in the diet. In 1928, Albert Szent-Györgyi isolated a substance from adrenal glands that he called 'hexuronic acid'. Four years later, Charles Glen King isolated vitamin C in his laboratory and concluded that it was the same as 'hexuronic acid'. Norman Haworth deduced the chemical structure of vitamin C in 1933.

[Dental aspects of general symptoms in the 18th century]. / Altalános kórképek fogászati vonatkozásai a XVIII. században.

In the 18th century, numerous diseases with symptoms of oral cavity were cured by chirurgien-dentist, barber-surgeons, or tooth drawer. The so called "dentitio difficilis" was blamed for the high children mortality, therefore gum cut or use of leeches was advised as a treatment. Both acute and chronic type of gum inflammation was called scurvy. It seems that the mechanical removal of plaque was enough to cure the scurvy as it was written in advertisements from that time. Syphilis was present in the everyday life throughout centuries, and assumed to cause different stigmas in the oral cavity. Today we consider theses stigmas as the toxic signs of mercury treatment.

Tocopherols, tocotrienols and tocomonoenols: Many similar molecules but only one vitamin E.

The aim of this article is to correct a very general error in scientific articles, in textbooks and in the Internet that has become an accepted fact. In this literature, the term "vitamin E″ is used for several similar molecules (both tocopherols and tocotrienols) that have never been shown to have vitamin property, i.e. a protective effect against the human deficiency disease. In fact, the name "vitamin E″ should only be used to define molecules that prevent the human deficiency disease "Ataxia with Vitamin E Deficiency" (AVED). Only one such molecule is known, α-tocopherol. This error may confuse consumers as well as medical doctors, who prescribe vitamin E without realizing that the current use of the name includes molecules of unknown, if not unwanted functions.

History of evidence-based medicine. Oranges, chloride of lime and leeches: barriers to teaching old dogs new tricks.

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes. I will also review the reasons why evidence is not used and consider what factors facilitate the uptake of evidence. Understanding these concepts will make it easier for individual clinicians and institutions to change clinical behaviour and provide a starting point for those looking at implementing 'new' practices, new therapies and clinical guidelines. Finally, I will offer a list of criteria that clinicians might choose to consider when deciding on whether or not to adopt a new practice, treatment or concept.

Severe scurvy: an underestimated disease.

Scurvy is one of the oldest diseases in human history. Nowadays, although scurvy tends to become a forgotten disease in developed country, rare cases still occur, especially in people undergoing extreme diet, old people or children with poor diet and patients with malabsorption. We describe three cases of scurvy. The first case is a patient diagnosed with Crohn's disease, the second one is in a context of anorexia nervosa and drug addiction, and the third case is in a context of social isolation. Early recognition of scurvy can be difficult because symptoms may appear nonspecific and can mimic more common conditions. In any patient with spontaneous hematoma and purpura, in the context of nutritional disorder, scurvy should be systematically considered. As this disease can lead to severe complications, such as bone pain, heart failure or gastrointestinal symptoms, nothing should delay vitamin C supplementation, which is a simple and rapidly effective treatment.

Food intake, dietary supplements and survival time of scorbutic guinea pigs.

Manual presentation of a liquid scorbutogenic diet permitted a more complete characterisation of the terminal stages of scurvy in guinea pigs. A bioflavonoid preparation from orange peel, previously shown both to increase the tissue concentrations of ascorbic acid and to stimulate the growth of hypovitaminotic C guinea pigs, had no influence on the survival time of scorbutic guinea pigs. Tetrahydrofolic acid, reported to possess 40% of the activity of ascorbic acid in the protocollagen proline-hydroxylase system, also failed significantly to prolong the survival period. This latter finding could indicate that ascorbic acid has essential biochemical functions in addition to its involvement in the hydroxylation of proline and lysine.

Jean-Baptiste Charcot, the French Antarctic expedition and scurvy.

During the second expedition to the South Pole, Commander Jean-Baptiste Charcot and some members of the crew of "Pourquoi Pas?" developed symptoms suggestive of scurvy. The clinical picture was totally reversed after dietary changes.

Dieta restrictiva en frutas como causa de escorbuto en niño de 7 años / Restricted diet in fruits causes scurvy in a child of 7 years old

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Scurvy: past, present and future.

This study outlines the major landmarks in the research on scurvy and its relationship to vitamin C. A thorough search including original manuscripts, books and contemporary reviews published in PubMed was conducted using as keywords "scurvy", "vitamin C", and "history of medicine". Observations on scurvy first appear in Egyptian medical scrolls 3500 years ago, and continue through to the discovery of vitamin C and the modern research on the physiological role of ascorbic acid. The observations of great navigators during the 15th and 16th centuries, when scurvy plagued ships' crews, played an important role in clarifying scurvy's etiology. Among the personalities in the history of the disease, James Lind and Albert Szent-Györgyi are most noteworthy, the first for conducting the first clinical trial on the treatment of scurvy with lemon and orange juices, and the second for discovering and identifying vitamin C.