Chronic arterial thrombosis of the lower extremity!!
This is a 60-year-old patient who arrived at the emergency room with limb pain, lameness, cold and pale extremities. He was diagnosed with arterial thrombosis with limb ischemia and subsequent necrosis, and evolved with waiting for the public medical service. Unfortunately, due to the severity of his gangrene, the only way out was limb amputation. Arterial thrombosis usually occurs after the erosion or rupture of an atherosclerotic plaque and, through platelet-mediated thrombi, can cause ischemic injuries especially in tissues with a terminal vascular bed. Acute ischemia is defined as a sudden loss of limb perfusion for up to 2 weeks after the initiating event. The occlusion can occur in any peripheral artery of the upper and lower extremities. Once arterial blood flow is impeded, malperfused tissues switch from aerobic to anaerobic metabolism, causing lactate production, acidosis, and an increased concentration of free radicals. Prolonged and untreated ischemia will cause the hypoxic muscle to deplete its ATP stores; this is followed by dysfunction in the sodium/potassium-ATPase and calcium/sodium pump leading to intracellular calcium leakage into the myocytes. Increasing free calcium negatively interacts with the muscle's myosin, actin, and proteases and eventually causes muscle fiber necrosis. The classic presentation of limb ischemia is known as the "six Ps": pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia. The surgical approach is directed at reperfusion of the affected extremity. This can be accomplished by the surgical bypass, endarterectomy, or embolectomy. Photo by @arthurreimann
X-ray of a baby
Look at the gaps between those bones, this is why they are so flexible.
50 medications Good to know to study these!
Gingival recession (receding gums) refers to the progressive loss of gum tissue
Burning and itching pain
DR.MOHAMMED IRFAN SHEIKH
Hand, Foot, and Mouth Disease in an Adult
A 36-year-old man presented to the dermatology clinic with a 5-day history of blisters on his palms (Panel A) and soles (Panel B) and ulcerations on his tongue (Panel C). He also reported fevers, malaise, and a sore throat. One week before his illness began, his 2- and 4-year-old children had had similar symptoms, and they received a diagnosis of hand, foot, and mouth disease. Fluid from a blister on the patient’s right sole was tested by reverse-transcriptase–polymerase-chain-reaction assay, and an enterovirus species was identified; serologic testing for antibodies to coxsackievirus confirmed infection with coxsackievirus A16. Hand, foot, and mouth disease was diagnosed. This disease is caused by enteroviruses and is most common in children younger than 5 years of age. Typically, symptoms are mild and self-limiting, and the diagnosis is made clinically. In rare instances, hand, foot, and mouth disease is associated with severe complications, including meningitis, encephalitis, and myocarditis. The patient’s symptoms abated with supportive care, which included treatment with nonsteroidal antiinflammatory medication. The lesions on the palms resolved within 2 weeks after presentation. The lesions on the feet (Panel D) and the small ulcerative lesions on the oral mucosa did not resolve completely until 8 weeks after presentation.
Anterior Thoracic (Chest Wall) Lung Herniation and Repair
We report a case of acquired anterior thoracic lung herniation in a 63-year-old female. This painful herniation developed four years after uncomplicated video-assisted thoracic surgery for lung cancer resection and adjuvant radiation for concomitant breast cancer. The herniation site was remote from all prior incisions, and demonstrated intercostal muscle denervation and radiation fibrosis. The 8 cm x 10 cm chest wall defect was reconstructed with inlay PROCEED mesh and reinforced with a pedicled latissimus dorsi flap. Six months postoperatively the patient had complete resolution of symptoms, no evidence of herniation, and a stable wound. Lung hernias are subdivided into congenital and acquired cases. Congenital lung hernias account for 18% of cases and involve developmental chest wall defects. Acquired lung hernias can be further classified as traumatic, spontaneous, or pathologic. Traumatic events include surgical procedures and blunt force. Spontaneous lung hernias can be triggered by chronic coughing, COPD, forceful Valsalva, chronic steroid use, or heavy lifting3. Pathological events leading to lung herniation may be inflammatory or neoplastic in nature7. Lung hernias are also classified by location. Seventy percent are thoracic, while the remainder are cervical and diaphragmatic8. The anterior chest wall is inherently prone to lung herniation because only a single layer of intercostal muscle exists parasternally3,9. Lateral and posterior lung herniations are rarely problematic due to the greater support provided by side and back muscles6,10. We believe the lung herniation presented here was likely caused by a combination of events including denervation of muscle in the third intercostal space, resulting from distant VATS, and soft tissue damage from radiation. Fibrosis of muscles after radiation compromises blood supply and innervation, which possibly contributed to the defect. Muscles themselves can also become weakened and easily fatigued following radiation11. There are multiple points during VATS procedures at which injury may occur. The incision may be made with less care, leading to muscle or fascial injury, costal cartilage damage, or muscle denervation. There may also be damage from excessive cauterization or poor dissection2,3. However, this case of lung herniation after uncomplicated VATS demonstrates a chest wall defect that was both temporally and spatially remote from the incision site. The large and worsening defect in this patient required surgical repair. Although smaller defects in the chest wall can be approached with mesh and rib suturing alone, lung hernias due to missing ribs or extensive trauma may require the support and blood supply associated with muscle flaps2. A latissimus dorsi muscle flap was used to reinforce the large inlay mesh repair and provide a reliable source of vascularized tissue to the radiated field. Pedicled muscle flaps are well-tolerated by patients in other procedures. In this case, it resulted in both long-term reduction of the hernia and regaining of strength and range of motion.
Shown here is an infant born with cleft lip.Cleft lip is an embryological defect, it occurs in 1:1000, more common in males. Of the known 200 syndromes associated with cleft lip and palate, van der Woude syndrome is the most common. Risk factors are alcohol, tobacco, phenytoin, and retinoic acid. The pathophysiology behind this is maxillary and medial nasal prominences fail to fuse together resulting in the characteristic persistent labial groove (cleft lip). By the 18th week of the embryo we can do prenatal ultrasound which can diagnose the condition. Primary treatment is surgical correction.
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DR.MOHAMMED IRFAN SHEIKH
Scleral Discoloration from Minocycline Treatment
A 70-year-old man presented to the ophthalmology clinic with a 1-year history of progressive bluish discoloration of the sclerae of both eyes. He reported no ocular discomfort or blurry vision. He had previously received a diagnosis of an inflammatory arthritis for which he had been taking minocycline at a dose of 100 mg daily for more than 15 years. Ophthalmologic examination was notable for a bluish discoloration of the sclerae. Extraocular movements were intact, and the pupils were equal and reactive to light. Best corrected visual acuity, visual fields, and intraocular pressure were normal. Ocular coherence tomography showed no scleral thinning. Bluish discoloration of the pinnae of both ears was also noted. Minocycline-induced pigmentation was diagnosed. Prolonged treatment with minocycline can cause blue-gray pigmentation of the skin, sclerae, pinnae, fingernails, teeth, gums, and scar tissue. A proposed mechanism for this pigmentation is that metabolites of minocycline form insoluble complexes with melanin or iron that can deposit in body tissues, particularly in tissues that are exposed to light. The staining may resolve slowly, or it can be permanent. The patient returned to the referring rheumatologist, who, following the recommendation of the ophthalmologist, advised him to stop taking minocycline. At a follow-up visit 1 year after treatment with minocycline was stopped, minimal reduction in the scleral pigmentation was noted.
In this picture, we get to see the portal vein and also the inferior vena cava bringing deoxygenated blood back to the heart. The portal vein leads to the liver. Why? Because the liver needs to detoxify the things that we eat and nowadays most of our food are non-organic and full of toxic materials. If the portal vein is blocked, a lot of complications could happen such as portal hypertension and right heart failure with a lot of different clinical manifestations that we can observe such as oedema, phlebestasia (dilatation of the superficial vein of the abdomen), ascites (accumulation of fluid in the abdomen) and even haemorrhages. Sometimes the body will create pathways called collaterals which could possibly cause the vein to go into the inferior vena cava without passing the liver. In this case, could cause the toxic to accumulate in the body which is very dangerous. To be on the safe side, be picky with what you put in your system because sometimes our natural detox machine might not work at its best 😌
| 16 hours ago
Discuss the treatment options for Diphyllobothrium latum
This is a traumatic cataract with an iridodialysis (separation of the iris from it's attachment to the ciliary body) from a blunt injury during childhood. There is an anterior cortical cataract with evidence of capsular compromise and adhesion of the displaced iris to this area. There is also a lens pseudo-coloboma (lessened convexity along the equator) inferotemporally secondary to zonular dehiscence (not shown).
Some facts about human brain:• Your brain keeps developing until your late 40s• New brain connections are created every time you form memory.• Your brain uses 20% of the total oxygen in your body.• 60% of your brain is fat.• The human brain has the same consistency as tofu.• The smell of chocolate increases theta brain waves, which triggers relaxation.
Percussion of the Spleen
This Stanford Medicine 25 video was created in conjunction with Stanford's AIM lab teaching the percussion of the spleen. The Stanford Medicine 25 is a Stanford School of Medicine initiative to teach and promote the bedside physical exam. Here you will find videos teaching bedside physical exam techniques.
Brain operation: Surgical removal of brain tumor, glioblastoma multiforme (GBM)
Video clip of surgical removal of a malignant brain tumor known as glioblastoma multiforme (GBM). Case presentation by Dr. Farhad Limonadi MD, director of neurosurgery at Eisenhower Medical Center.
DR.MOHAMMED IRFAN SHEIKH
Embolization of Struts from an Inferior Vena Cava Filter
A 28-year-old woman presented to the emergency department with pain in the right flank. Her medical history was notable for nephrolithiasis as well as for deep venous thrombosis and pulmonary embolus that had occurred 10 years earlier and for which she had received an inferior vena cava filter that had not been retrieved. Computed tomography (CT) of the abdomen revealed a fragmented inferior vena cava filter with multiple perforated struts. One strut was approximately 1 mm from the right ureter (Panel A, arrow). Whether this finding was related to the flank pain or was incidental was unclear. Two additional struts had fractured and embolized — one to the left prevertebral space (Panel A, arrowhead) and one to the right ventricle. Cardiac CT angiography revealed that the strut was within the right ventricular trabeculae with no evidence of perforation (Panel B, arrow). The inferior vena cava filter was retrieved with endovascular intervention. The patient’s flank pain resolved with only supportive care before the retrieval of the filter. After consideration of the risks of an intervention to retrieve the struts, a decision was made to leave the embolized struts in place. Fracture of inferior vena cava filters is a potential complication of these devices. At follow-up after the filter retrieval and at 1 year after presentation, the patient was feeling well, and she is being monitored clinically.
Anatomy of stathoscope
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