This lower abdominal X-ray shows narrowing (stenosis) of the end of the small intestine (ileum)with loss of mucosal pattern and bowel wall thickening. Crohn's disease typically affects the small intestine. A solution containing a dye (barium), was swallowed by the patient. When it passed into the small intestines, this X-ray was taken (lower GI series).
Staphylococcal osteomyelitis. (A) Initial film of the first metatarsophalangeal joint shows soft-tissue swelling and periarticular demineralization due to hyperemia. (B) Several weeks later, there is severe bony destruction about the metatarsophalangeal joint.
An 18-year-old woman presented with a 2-month history of visual loss in the right eye. Visual acuity was 20/100 in the affected eye and 20/20 in the left eye.
Adenoma sebaceum of the nose and face in tuberous sclerosis (Bourneville's syndrome)
CT of abdominal aorta shows intimal flap (dark line -red arrow)
Typical appearance of oculocutaneous albinism
This photo shows age-related Maculopathy AMD, Classic Choroidal Neovasculariz.
#In the arterial phase the cartwheel of new choroidal vessels becomes immediately visible (together with the choroidal flush). A slight window defect is in the area of hypopigmentation.
#In mid-angiogram the neovascularization becomes prominent. The ring of surrounding blood blocks fluorescence.
#Late angiogram with diffuse leakage from the new vessels even into some of the blood.
The most commonly affected digits are the ulnar digits (ring and small fingers).
Picture of a central left tympanic membrane perforation.
Picture of left tympanic membrane perforation
Picture of right inferior tympanic membrane perforation.
On physical examination, cachexia was noted, along with a rugated, velvety appearance of the palms (Panel A), acanthosis nigricans, and left hip pain on rotation.
This 62-year-old woman who wore glasses for years developed an erosion on the retroauricular fold of her right ear. The erosion is easily observed when she raises her ear.
A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair located approximately 3 cm from the scalp. The patient first noted the change in hair color 1 week after returning from a 2-week vacation in Costa Rica, during which she took chloroquine phosphate for malaria prophylaxis.
This photo for male patient 54 years old with Eczema discoid (Typical coin shaped lesions of discoid eczema )
Morphology: Excoriation
These are typical lesions of discoid eczema.It is commonly seen in the elderly.
The lesions often weep and become secondarily infected with Staphylococci requiring both antibiotics and topical steroids.
Synonyms: regional ileitis, terminal ileitis, regional enteritis or granulomatous enteritis.
Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.
Crohn's Disease, X-RayThis lower abdominal X-ray shows narrowing (stenosis) of the end of the small intestine (ileum)with loss of mucosal pattern and bowel wall thickening. Crohn's disease typically affects the small intestine. A solution containing a dye (barium), was swallowed by the patient. When it passed into the small intestines, this X-ray was taken (lower GI series).
Alpha 1 Adrenergic Autonomic Receptor of the Sympathetic Nervous System presented in a pictorial mnemonic format. Key Point: Alpha1 Constricts. For Medical learning.
The endolymphatic shunt operation consists of opening the mastoid bone and identifying the endolymphatic sac which is located in the posterior fossa dura.
To find the sac, the sigmoid sinus is denuded of its bony cover except for a small rectangle of thin bone named Bill's Island, after Dr. William House. The sigmoid sinus is then collapsed with gentle pressure and the sac exposed behind the posterior semicircular canal.
The sac is then incised and a shunt tube is inserted. The picture shows a Huang-Gibson tube with a one-way valve that allows fluid to seep out but not back into the sac. This procedure decreases the endolymphatic fluid pressure
It is not difficult to lose your weight when you have the right information, at the right time, and the right tools to put it to use. If you will do these 3 best popular exercises on a consistent basis, week in and week out, then combined with a good diet, you will lose weight fast.
1. Interval running: Running has the potential to burn more calories per amount of time worked than any other exercise there is. No, I don’t mean jogging. Although you can use walking, then jogging as a way to prepare yourself to be able to run in the future. Interval running is just running with short breaks in between. For example: run for 30 seconds, then take a 30 second break then repeat.
2. Rowing: ..wow I love it, Rowing is a complete body workout and can be done outside on a lake, in the comfort of your own home, or at a gym. It burns a lot of calories and builds lean muscle.
3. Squat Presses: This exercise is well known to trainers and athletes alike, but not to the mainstream. It is simply taking a dumbbell or a barbell, then doing a squat. As you come to the top of your squat, you press the dumbbells (or barbell) above your head and then bring it back down and repeat. This exercise works every large muscle in the body and if done with short rest periods can be a good cardio workout (gets the heart rate up).
If you really want to lose weight, and want to do it fast, then you will have to use exercise. If you do these exercises 3-5 times per week (and be sure to mix it up), then you will reach your weight loss goals.
Localized osteoporosis often is the first (though nonspecific) radiographic manifestation of inflammatory diseases such as osteomyelitis, tuberculosis, and rheumatoid arthritis.
In pyogenic infections, bone destruction typically precedes osteoporosis, whereas in tuberculosis the reverse is true.
Periarticular demineralization is a classic early sign of rheumatoid arthritis.
Staphylococcal osteomyelitis. (A) Initial film of the first metatarsophalangeal joint shows soft-tissue swelling and periarticular demineralization due to hyperemia. (B) Several weeks later, there is severe bony destruction about the metatarsophalangeal joint.
An 18-year-old woman presented with a 2-month history of visual loss in the right eye. Visual acuity was 20/100 in the affected eye and 20/20 in the left eye.
Ophthalmoscopy revealed an orange–yellow tumor (Panel A, arrow) with tortuous feeding vessels and optic-disk edema (Panel A, arrowhead), indicating retinal hemangioblastoma. The patient underwent ruthenium plaque radiotherapy, cryotherapy, and photodynamic therapy, which induced complete tumor regression and sclerosis of the dilated vessels (Panel B).
After treatment, the visual acuity improved, to 20/70. A systemic evaluation, including magnetic resonance imaging of the brain, computed tomography of the abdomen, and measurement of urinary vanillylmandelic acid levels, was unremarkable. However, genetic studies revealed a mutation in the von Hippel–Lindau tumor-suppressor gene VHL, confirming von Hippel–Lindau disease.
Visual disturbance caused by exudation or retinal detachment due to retinal hemangioblastoma may be the initial symptom of von Hippel–Lindau disease. Thorough, systemic evaluation is important to detect potential tumors of the central nervous system, adrenal glands, kidneys, and pancreas early enough to permit treatment.
While examining the male genitalia, you are unable to retract the foreskin of an uncircumcised patient. There is no evidence of erythema. Which of the following is
the most likely diagnosis?
What is adenoma sebaceum?
Adenoma sebaceum is a hamartoma on the face, composed of fibrovascular tissue and appearing as an aggregation of red or yellow papules that may be associated with tuberous sclerosis, also called Bourneville 's syndrome or Bourneville-Pringle's disease.
Bourneville's syndrome consists of epilepsy, severe mental retardation associated with adenoma sebaceum (overgrowth of the sebaceous glands) of the face, cerebral cortical tubers (hence the name "tuberous sclerosis") and hamartomatous tumours of the heart and kidney. It is heredofamilial and usually manifests itself early in life. Females are more often affected. Incomplete forms of the syndrome occur. Transmitted as an autosomal dominant trait with variable expressivity.
Adenoma sebaceum of the nose and face in tuberous sclerosis (Bourneville's syndrome)
What is Red man syndrome??
It is an infusion-related reaction peculiar to vancomycin.Typically it consists of pruritus, an erythematous rash that involves the face, neck, and upper torso.
Less frequently, hypotension and angioedema can occur. Patients commonly complain of diffuse burning and itching and of generalized discomfort. They can rapidly become dizzy and agitated, and can develop headache, chills, fever, and paresthesia around the mouth.
In severe cases, patients complain of chest pain and dyspnea. In many patients, the syndrome is a mild, evanescent pruritus at the end of the infusion that goes unreported.
It would appear about 4–10 min after an infusion started or may begin soon after its completion.
Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. Even after improvement in vancomycin's purity, however, reports of the syndrome persist.
Other antibiotics (e.g. ciprofloxacin, amphotericinB, rifampicin and teicoplanin) or other drugs that stimulate histamine release can result in red man syndrome.
Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most of the reactions. Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.
A 73-year-old man presented to the emergency department after having intermittent fevers for 2 weeks. He had a history of recurrent urinary tract infections, parkinsonism, and a compression fracture at the L2 vertebra that was the result of a fall 2 years before presentation.
In addition, he had paraparesis and a neurogenic bladder, also subsequent to the fall. The results of physical and laboratory evaluation were notable for the identification of Pseudomonas aeruginosa in a blood culture and for a urinalysis showing more than 100 white cells per high-power field. He was treated with empirical antibiotics.
Intravenous urography showed no obstructive uropathy, but symmetric diverticula could be seen near both ureteral orifices (arrows). These lesions, known as Hutch diverticula, are usually congenital rather than occurring as a result of a neurogenic bladder or an infection or obstruction. They represented a new finding in this patient. Hutch diverticula are more commonly seen in men and boys and are usually unilateral and asymptomatic. After treatment with antibiotics, the patient's fever and pyuria subsided.
He declined any further evaluation or intervention. During the year after diagnosis, two more urinary tract infections developed.
Following intracapsular cataract surgery with vitreous loss, this eye struggled with bullous keratopathy. The photo shows a huge ruptured bulla involving the cornea superiorly.The light reflex lies in the inferior bed of the ruptured bulla.
The edge of the bulla can be seen superiorly from 11:00 o'clock to 1:00 o'clock. This was a major complication of cataract surgery in 1965 when this photo was taken. The loss of vitreous was a dreaded subject since the approach to its loss was extremely primitive compared to the wonderful techniques now employed by vitreous surgeons.
The repair of a large epigastric (ventral) hernia using a laproscopic or keyhole surgery technique.
Primary insomnia is usually associated with
It appeares as :Hemispherical or horizontal, shelflike protrusion on the posterior aspect of the esophagus at approximately the C5-C6 level.
Short Comment.......It is Failure of the upper esophageal sphincter to relax. Can result in dysphagia by obstructing the passage of a swallowed bolus. In severe disease, can cause aspiration and pneumonia.
Demonstrates on the skull and on a patient, various injection techniques. It also describes the basic dental chair position for injections.
A concise lecture on basics of hemostasis; the triggers of the development of the hemostatic plugs (primary) and (secondary). The differences between Hemostasis and Thrombosis.
Clinical presentation and importance are also discussed.
* 3:1 male to female predominance
* Over the age of 40
* Hemorrhage in the media (at vasa vasorum) leading to either
CT of abdominal aorta shows intimal flap (dark line -red arrow)
You are called to see an infant in the newborn nursery. The child was delivered 60 hours prior to your visit. The child appears jaundiced but otherwise healthy. A total serum bilirubin level is measured at 18 mg/dL. Appropriate treatment includes
Diagnosis: acute angular meibomitis ( meibomianitis ) with marked chemosis, lid edema, and pain OS
Acute meibomitis causes increasing subjective and objective symptoms as the outer canthus is approached by the involved meibomian gland. The reason for this is that there is a confluence of nerves and bloodvessls at the outer angle. In addition, the tissues are more taut and less giving. A pressure is built up in the area with resultant pressure on the nerves and pressure on the bloodvessels. The former pressure gives pain, the latter gives edema of the more easily distended bulbar conjunctiva and skin of the lids. At times there may be collateral edema of the lids of the other eye.
There is exquisite tenderness to finger pressure over the area just above the outer canthus. There is lid edema. There is marked chemosis .
This 7 year-old boy was referred because of reduced poor vision. Examination revealed the vision to be 6/60 in both eyes with the typical facial appearance of oculocutaenous albinism: fair skin, blonde hair, bilateral pink iris and pendular nystagmus. Fundoscopy did not show any optic disc or macular hypoplasia. Cycloplegic refraction showed significant astigmatism of 3.00D in both eyes and glasses were prescribed.
Typical appearance of oculocutaneous albinism
This photo shows age-related Maculopathy AMD, Classic Choroidal Neovasculariz.
Note that in an area of slight depigmentation (presumably a previous RPE detachment) is a darkly pigmented spot surrounded by a slim ring of subretinal blood.
With Angiogram:#In the arterial phase the cartwheel of new choroidal vessels becomes immediately visible (together with the choroidal flush). A slight window defect is in the area of hypopigmentation.#In mid-angiogram the neovascularization becomes prominent. The ring of surrounding blood blocks fluorescence.#Late angiogram with diffuse leakage from the new vessels even into some of the blood.
The most commonly affected digits are the ulnar digits (ring and small fingers).
Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).
It is more common in men than in women.
The cause of Dupuytren's contracture is not known. It is not caused by an injury or heavy hand use.
Symptoms:
Dupuytren's contracture symptoms usually occur very gradually.
1-Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.
2-Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the skin.
3-Curled fingers. One or more fingers bend (flex) toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your hand in a pocket becomes difficult.
Treatment:
**Nonsurgical Treatment:
-Steroid injection. If a lump is painful, an injection of corticosteroid - a powerful anti-inflammatory medication - may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.
-Splints. Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.
The intralesional enzyme, collagenase clostridium histolyticum, was approved by the FDA in February 2010.
**Surgical Treatment:
Surgery is recommended when joint contracture exceeds 30°, or when nodules are painful and interfere with hand function.
Surgical procedure. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.
Achondroplasia is a type of genetic disorder that is a common cause of dwarfism. People with this condition have short stature, usually reaching a full adult height of around 4'0" (1.2 meters).
Incidence and Prevalence
This condition occurs at a frequency of about 1 in 25,000 to 1 in 40,000 births. Achondroplasia also occurs in all races with equal frequency in males and females.
Clinical Features
Clinical features of the disease:
* nonproportional dwarfism (short stature)
* shortening of the proximal limbs (termed rhizomelic shortening)
* short fingers and toes
* a large head with prominent forehead
* small mid-face with a flattened nasal bridge
* spinal kyphosis (convex curvature) or lordosis (concave curvature)
* varus (bowleg) or valgus (knock knee) deformities
* frequently have ear infections (due to Eustachian tube blockages), sleep apnea (which can be central or obstructive), and hydrocephalus
Causes
The disorder is a result of an autosomal dominant mutation in the fibroblast growth factor receptor gene 3 (FGFR3), which causes an abnormality of cartilage formation. FGFR3 normally has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones.
People with achondroplasia have one normal copy of the fibroblast growth factor receptor 3 gene and one mutant copy. Two copies of the mutant gene are invariably fatal before, or shortly after birth. Only one copy of the gene needs to be present for the disorder to occur. Therefore, a person with achondroplasia has a 50% chance of passing on the gene to their offspring, meaning that there will be a 50% chance that each child will have achondroplasia. Since two copies are fatal, if two people with achondroplasia have a child, there's a 25% chance of it dying shortly after birth, a 50% chance the child will have achondroplasia, and a 25% chance the child will have a normal phenotype. However, in 3 out of 4 cases, people with achondroplasia are born to parents who don't have the condition. This is the result of a new mutation.
New gene mutations are associated with increasing paternal age (over 35 years). Studies have demonstrated that new gene mutations are exclusively inherited from the father and occur during spermatogenesis (as opposed to resulting from a gonadal mosaicism). More than 99% of achondroplasia is caused by two different mutations in the fibroblast growth factor receptor 3 (FGFR3). In about 98% of cases, a G to A point mutation at nucleotide 1138 of the FGFR3 gene causes a glycine to arginine substitution (Bellus et al 1995, Shiang et al 1994, Rousseau et al 1996). About 1% of cases are caused by a G to C point mutation at nucleotide 1138.
There are two other syndromes with a genetic basis similar to achondroplasia: hypochondroplasia and thanatophoric dysplasia. Both of these disorders are also caused by a genetic mutation in the FGFR3 gene.
Diagnosis
Achondroplasia can be detected before birth by the use of prenatal ultrasound. A DNA test can be performed before birth to detect homozygosity, where two copies of the mutant gene are inherited, a condition which is lethal and leads to stillbirths.
Radiologic Findings CLICK HERE
A skeletal survey is useful to confirm the diagnosis of achondroplasia. Skull films demonstrate a large skull with a narrow foramen magnum, and relatively small skull base. The vertebral bodies are short and cuboidal, and there is congenitally narrowed spinal canal. The iliac wings are small and squared, with a narrow sciatic notch. The tubular bones are short and thick with metaphyseal cupping and flaring and irregular growth plates. Fibular overgrowth is present. The hand is broad with short metacarpals and phalanges, and a trident configuration. The ribs are short with cupped anterior ends. If the radiographic features are not classic, a search for a different diagnosis should be entertained.
The diagnosis can be made on by fetal ultrasound by progressive discordance between the femur length and biparietal diameter by age. The trident hand configuration can be seen if the fingers are fully extended.
Treatment
Growth hormone (GH) therapy has been proposed as a possible treatment for the short stature of achondroplasia. However, the people who participated in the studies on the subject have not yet reached adult size, so this type of therapy has unknown results.
Early experience with surgical limb lengthening procedures resulted in a high incidence of complications, but recent experiences have improved results considerably.
New animal studies have demonstrated efficacy of parathyroid hormone-related peptide (PTHrP) replacement.
Picture of a central left tympanic membrane perforation.Picture of left tympanic membrane perforationPicture of right inferior tympanic membrane perforation.
Ptosis and inverted epicanthal folds in blepharophimosis.
The patient has bilateral ptosis with reduced lid size.There are inverted epicanthal folds, telecanthus. The nasal bridge is flat and there is hypoplastic orbital rim. Other examination:
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A 54-year-old woman who had a 34-pack-year smoking history presented with a 5-month history of changes in palmar skin texture associated with a 15-kg weight loss and left hip pain waking her at night.On physical examination, cachexia was noted, along with a rugated, velvety appearance of the palms (Panel A), acanthosis nigricans, and left hip pain on rotation.
Laboratory evaluation revealed neutrophil leukocytosis (white-cell count, 42,300 per cubic millimeter), thrombocytosis (platelet count, 1.17 million per cubic millimeter), and hypercalcemia (calcium corrected for albumin, 4.5 mmol per liter [18 mg per deciliter]).
Chest computed tomography (CT) revealed nodules (Panel B, arrow), and bone scintigraphy showed increased uptake in the left hip. Both these radiographic findings suggest metastasis. CT-guided fine-needle aspiration of a lung nodule revealed cells consistent with non–small-cell carcinoma of the lung.
The palmar changes represent a cutaneous paraneoplastic sign known as tripe or velvet palm. It is highly associated with cancer (94% in some reports), most frequently with gastric adenocarcinoma or bronchogenic carcinoma. The patient was referred to oncology for chemotherapy but died a few weeks later of metastatic lung cancer.
Pathology: Conjunctiva -> Bullous Disease of Skin and Mucous Membranes -> Erythema Multiforme
Late phase with extensive scarring of the conjunctiva (symblepharon) which has led to obstruction of the accessory tear glands and tear retention cysts.
Diagnosis:late Phase of Bullous Erythema Exsudativum Multiforme, Stevens-Johnson Syndrome.
The patient shown below most likely has:
a. A large left pleural effusion
b. A large right pneumothorax
c. Atelectasis of the left lung
d. Pneumonia in the left lung
e. Unilateral pulmonary edema
The correct answer
Pneumonia in the left lung
Explanation
-----------
There is opacification of the left hemithorax. There is no shift of the heart and mediastinal structures (i.e. the trachea). This eliminates pleural effusion and atelectasis as possibilities. A tension pneumothorax would displace the heart and mediastinal structures away from the side of the pneumothorax and would not cause complete opacification of the opposite lung. In addition, there should be no lung markings visible in the hemithorax which contains the pneumothorax. Either pneumonia or pulmonary edema could cause the findings shown, but pneumonia is a much more common cause.
This chest x-ray shows stage II coal worker's pneumoconiosis (CWP). There are diffuse, small light areas on both sides of the lungs. Other diseases that may explain these x-ray findings include simple silicosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse, infiltrative pulmonary diseases.
Description: red linear erosion with surrounding scaleThis 62-year-old woman who wore glasses for years developed an erosion on the retroauricular fold of her right ear. The erosion is easily observed when she raises her ear.
Acanthoma fissuratum cutis is a common cutaneous lesion induced by chronic mechanical trauma. Most cases are caused by poorly fitting spectacle frames. The main differential diagnosis is basal cell carcinoma.
Which of the following is considered first-line therapy for primary dysmenorrhea?
An 83-year-old man with hypertension presented with a 3-month history of a painful, progressively enlarging mass in the right subcostal region. He reported no associated constitutional symptoms and no history of abdominal surgery. Local examination revealed a tender, erythematous, fluctuant mass, 3 cm by 2 cm, with clinically significant surrounding induration and an underlying fixed mass (Panel A). Computed tomography revealed that the mass was communicating with a large gall bladder mass (Panel B, arrow). Ultrasonography-guided needle biopsy, along with histologic and immunocytochemical examinations, confirmed that the mass was an adenocarcinoma of the gall bladder. The patient did not agree to any further evaluation or treatment. He was discharged with plans for palliative care and died 5 weeks later.
A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair located approximately 3 cm from the scalp. The patient first noted the change in hair color 1 week after returning from a 2-week vacation in Costa Rica, during which she took chloroquine phosphate for malaria prophylaxis.
Instead of taking 500 mg weekly, the recommended dose for prophylaxis, the patient took 500 mg of chloroquine phosphate daily, starting 1 week before the trip, during the 2 weeks in Costa Rica, and for 1 week after returning home. She had taken the first dose 3.5 months before presentation. Hair hypopigmentation is a rare but reversible side effect of chloroquine.
Although most cases occur after 3 consecutive months of treatment with daily doses of more than 500 mg of the drug, rapid onset is also possible.
Miichael Palin experiments with a traditional Russian health therapy in Estonian capital Tallinn by allowing a doctor to cover him in sucking leeches. Fascinating video that is definitely not for the faint hearted! Taken from BBC travel documentary, Palin's New Europe.
In modern medicine, however, leeches are used in reconstructive surgery to provide a vacuum effect that helps stimulate blood circulation. This process is crucial to help kick start blood flow into, for example, a reattached finger.
Krish 5 Year old boy brought to the hospital by his mother because she has noticed that her child did not have appropriate height for his age and having Mild limb deformity.This child has a previous Hx of Right tibial fracture when the child was 3years old.
The history of this eye: A corneal ulcer formed. The ulcer produced a minute perforation of the cornea. The aqueous humor rushed towards the site of perforation and carried the iris with it.
The iris plugged the perforation and became incorporated with the scar issue healing process. Notice the iris pigment that is incorporated in the corneal scar -evidence of iris involvement and thus, an adherent leukoma.
Fortunately, this eye recovered from this potentially catastrophic situation. Other eyes might have gone on to staphyloma, glaucoma,endophthalmitis, panophthalmitis and / or phthisis bulbi from the same initial corneal ulcer.
A woman on antimalarial medications takes an overdose .
Which of the following is the most consistent feature of antimalarial overdose?
