Wine Signs in Medicine

Numerous direct connections exist between wine and medicine. Many physicians enjoy drinking wine, for example, and grateful patients sometimes express their appreciation by giving their physicians a bottle of wine.¹ Other physicians make wine or are involved in organizations that stimulate scientific research on wine and its beneficial health effects.^2,3 Consumption of red wine, for example, has been cited as one possible explanation for the so-called “French paradox” of a low incidence of cardiovascular disease in the French population despite a diet rich in saturated fat.⁴ Other connections between wine and medicine are less direct, but references to grapes, wine, and wine paraphernalia can be found in many fields of medicine. The purpose of this brief article is to heighten awareness of some of the interesting connections between wine and medicine.

GRAPES

Many medical terms are derived from references to grapes. For example, the Latin “uva,” or grape, provides the basis for both “uvula” and “uvea.”⁵ The Greek “staphule,” or cluster of grapes, is the verbal root for Staphylococcus, named for its microscopic appearance similar to a bunch of grapes.⁶ The Greek “botrus,” or group of grapes, provides the basis for Botrytis cinerea, the fungus responsible for the hypersensitivity pneumonitis known as winegrower’s lung.⁷ Ephedrine is derived from the plant genus, Ephedra, also known as the “sea grape” for its pattern of growth in clusters. Bagassosis, the pneumoconiosis caused by inhalation of fungus-laden debris left over after sugarcane extraction, draws its name from the Spanish “bagazo,” the husks of grapes after pressing.⁵

Several human growths have been described as having a grape-like appearance. The abnormal molar pregnancy known as a complete hydatidiform mole has a unique “bunch-of-grapes” look on ultrasound.⁸ The childhood uterine tumor, sarcoma botryoides, is named for its polypoid appearance resembling grapes.⁹ Cotyledonoid leiomyoma is a benign uterine tumor whose gross appearance has been described as grape-like.¹⁰ One nodular variant of medulloblastoma has a characteristic grape-like pattern on neuroimaging that marks a favorable prognosis.¹¹ Multiseptate or honeycomb gallbladder has a characteristic grape-like appearance on magnetic resonance cholangiopancreatography.¹² The dermatologic tumor, elastoderma, has a distinctive globular pathological structure resembling grapes.¹³

WINE PARAPHERNALIA

Corkscrew. Medicine is replete with references to corkscrews. The helical shape of Helicobacter pylori, for example, is often described as resembling a corkscrew. Patients in the late stages of scurvy may develop dystrophic or “corkscrew hairs.”¹⁴ A common finding in thromboangiitis obliterans (Buerger disease) is the visualization of “corkscrew collaterals” using color Doppler ultrasonography.¹⁵ There have been several reported cases of Dupuytren’s disease with “corkscrew” or double-spiral neurovascular bundles.”¹⁶ The condition of diffuse esophageal spasm is also known as “corkscrew esophagus” for the pattern seen on an esophagram.¹⁷ A recently described form of congenital tracheal stenosis is known as “corkscrew trachea.”¹⁸ The finding of “corkscrew vessels” in an endometrial biopsy reflects the progesterone-laden endometrium of the second half of the menstrual cycle, and suggests that ovulation has occurred.¹⁹ Some patients with neurofibromatosis type 1 have been noted to have “corkscrewing” of the retinal vessels.²⁰ In urology, a “corkscrew ureter” may be caused by extrinsic obstruction of its distal segment.²¹ Women with genital tuberculosis have been described as having “corkscrew Fallopian tubes” visualized on hysterosalpingography.²² In radiology, contrast-enhanced upper gastrointestinal examination of infants and young children with midgut volvulus may demonstrate the “corkscrew sign” of a spiraling of the fourth portion of the duodenum and proximal jejunum.²³ Manual laborers (such as metal workers) who use the hypothenar aspect of their hand as a hammer may develop thrombosis of the superficial palmar arch of the ulnar artery. Arteriography in patients with this condition, known as the hypothenar hammer syndrome, may show a characteristic “corkscrew sign.”²⁴

Wine glass. Even the wine glass has many meanings in medicine. Patients with primary lateral sclerosis may have “wine-glass hyperintensities” seen on T2-weighted spinal magnetic resonance imaging.²⁵ An unusual radiographic finding of an esophageal foreign body has been called the “inverted wine glass sign.”²⁶ Otorhinolaryngologists may use a “wine glass incision” for certain neck dissections.²⁷ The renal “calyx” is derived from the Greek “kalyx,” or chalice, for its resemblance to the large wine cup.²⁸ Mucin-secreting “goblet cells” of the intestines and airways are named after their microscopic appearance, also similar to a large wine vessel.²⁹ Many anatomical “ampullae” are named for their likeness to the ancient Roman two-handled, globular wine flasks.³⁰

VARIETIES OF WINE

Several medical terms and phrases make reference to champagne. Patients with achondroplasia sometimes have flattening of the iliac blades, which causes a “champagne-glass” radiographic appearance of their pelvic inlet.³¹ In the literature on hip arthroplasties, the trumpet-like shape of the proximal end of the femur is often likened to a champagne flute.³² The sonographic appearance of emphysematous cholecystitis has been described as “effervescent, like a glass of champagne.”³³ A “champagne tap” is a common reference to an atraumatic lumbar puncture with no red blood cells in the first and last tubes.³⁴ A junior house officer performing such a tap may be rewarded by an appreciative supervisor with a bottle of bubbly. Sclerosing panniculitis has a pattern of induration due to venous insufficiency that causes an “inverted champagne bottle” appearance of the skin of the leg.³⁵ The papilledema seen in patients with pseudotumor cerebri has been described as causing a “champagne cork” elevation of the optic disk.³⁶

Other specific varieties of wine have also been commemorated in medical jargon. For example, the “port-wine stain,” or nevus flammeus, is a capillary vascular malformation causing reddish to purplish skin discoloration similar to port wine. The amniotic fluid of a placental abruption is blood-rich and may also resemble port wine.³⁷ The “vin-rosé appearance” of urine in a patient with iron poisoning undergoing chelation with deferoxamine refers to its light pink color, similar to the clear pink hue of rosé wine.³⁸

ADVERSE EFFECTS OF WINE

Wine may have detrimental effects. For example, patients who take monoamine oxidase inhibitors should avoid wine to prevent the so-called “wine-and-cheese effect,” a hypertensive crisis caused by the sympathomimetic properties of tyramine.³⁹ Professional wine tasters who swish and spit a significant amount of wine have been reported to develop a severe form of dental caries called “wine assessor erosion.”⁴⁰ Used in excess, wine can contribute to the hazardous health effects of alcohol poisoning, alcohol dependence, and alcohol withdrawal.

IN SUMMARY

References to wine are found in almost every field of modern medicine, and many terms involving grapes, wine, and wine paraphernalia have entered into the medical lexicon. It is hoped that this brief review of medical terms related to wine will heighten awareness of the many interesting connections between wine and medicine.