Niven Abu Ramadan
Niven Abu Ramadan
in Case Study
Piebaldism!!
Piebaldism!!
The baby Maiah of just 26 days has barely arrived in the world, but already draws attention to an unusual feature. The daughter of the publicist Talyta Youssef, 40, and Maycon Oliveira, a 30-year-old kayak teacher, was born with a genetic and hereditary condition called piebaldism. Piebaldism is a rare autosomal dominant disorder of melanocyte development characterized by a congenital white forelock and multiple symmetrical hypopigmented or depigmented macules. This striking phenotype of depigmented patches of skin and hair has been observed throughout history, with the first descriptions dating to early Egyptian, Greek, and Roman writings. Generation after generation demonstrated a distinctive predictable familial mark—a white forelock. Families have sometimes been known for this mark of distinction, carrying such surnames as Whitlock, Horlick, and Blaylock. Note the image below. Piebaldism is due to an absence of melanocytes in affected skin and hair follicles as a result of mutations of the KIT proto-oncogene.As of a 2001 review by Richards et al, 14 point mutations, 9 deletions, 2 nucleotide splice mutations, and 3 insertions of the KIT gene were believed to be mutations causing piebaldism. The severity of phenotypic expression in piebaldism correlates with the site of the mutation within the KIT gene. The most severe mutations seem to be dominant negative missense mutations of the intracellular tyrosine kinase domain, whereas mild piebaldism appears related to mutations occurring in the amino terminal extracellular ligand-binding domain with resultant haplo insufficiency
Medicaltalks
Medicaltalks
in General
Multiple uterine myomas of different sizes! Who knows what’s the device at the center?
Multiple uterine myomas of different sizes! Who knows what’s the device at the center?
Uterine leiomyomas (fibroids) are benign, hormone-sensitive uterine neoplasms. These tumors are classified as either submucosal (beneath the endometrium), intramural (within the muscular uterine wall of the uterus), or subserosal (beneath the peritoneum). They seldom develop in the cervix, the lower part of the uterus. When they do, they are usually accompanied by myomas in the larger upper part of the uterus, which are also called fibroids. The larger ones can cause blockage of the urinary tract or even protrude (prolapse) into the vagina. Symptoms depend on the location, size, and number of myomas, and include menstrual abnormalities (menorrhagia), features of mass effects (e.g., back/abdominal/pelvic pain or bladder and bowel dysfunction), and infertility. If left untreated, infections may develop, causing further blessing, pain and vaginal discharge. Pelvic physical examination can detect lump in the abdomen (of the myomas are large enough) and the patient experiences feelings of pressure. Ultrasound are used to confirm the diagnosis and to visualize and determine sizes. If myomas are small and do not cause any symptoms, no treatment is needed. If they cause symptoms, they are surgically removed if possible (a procedure called myomectomy). Myomectomy (excision of the subserosal or intramural fibroids only) is preferred for women planning future pregnancies. However, if myomas are large, removal of the entire uterus (hysterectomy) may be necessary. The procedure can be done by making a large incision in the abdomen (laparotomy) or by instruments inserted through one or more small incisions near the navel (laparoscopy), which is less invasive and is associated with less intra and post-operative complications.
Medicaltalks
Medicaltalks
in General
Extreme acid burn all over the neck region!!
Extreme acid burn all over the neck region!!
Who knows if acid or base cause more tissue injury? A chemical burn occurs when living tissue is exposed to a corrosive substance (such as a strong acid, base or oxidizer) or a cytotoxic agent (such as mustard gas, lewisite or arsine). All may cause extensive tissue damage. Acids are defined as proton donors (H+), and bases are defined as proton acceptors (OH-). Bases also are known as alkalis. Both acids and bases can be defined as caustics, which cause significant tissue damage on contact. The strength of an acid is defined by how easily it gives up the proton; the strength of a base is determined by how avidly it binds the proton. Most acids produce a coagulation necrosis by denaturing proteins, forming a coagulum (eg, eschar) that limits the penetration of the acid. Bases typically produce a more severe injury known as liquefaction necrosis. This involves denaturing of proteins as well as saponification of fats, which does not limit tissue penetration. Hydrofluoric acid is somewhat different from other acids in that it produces a liquefaction necrosis. The severity of the burn is related to a number of factors, including the pH of the agent, the concentration of the agent, the length of the contact time, the volume of the offending agent, and the physical form of the agent. The ingestion of solid pellets of alkaline substances results in prolonged contact time in the stomach, thus, more severe burns. In addition, concentrated forms of some acids and bases generate significant heat when diluted or neutralized, resulting in thermal and caustic injury. The long-term effect of caustic dermal burns is scarring, and, depending on the site of the burn, scarring can be significant.
Medicaltalks
Medicaltalks
in General
Removal of a fascinating cholesterol gallbladder stone!
Removal of a fascinating cholesterol gallbladder stone!
What does it resemble? 🥚 The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. It holds a digestive fluid called bile that's released into the small intestine. Gallstones come in many different shapes, sizes, and quantities. They can be made up of a variety of different combinations and percentages of cholesterol, bile salts, lecithin, bilirubin, etc. Cholesterol stones account for > 85% of gallstones, and for them to actually form, bile must be supersaturated with cholesterol, with nucleation and stone growth. Normally, water-insoluble cholesterol is made water soluble by combining with bile salts and lecithin to form mixed micelles. Supersaturation of bile with cholesterol most commonly results from excessive cholesterol secretion but may result from a decrease in bile salt secretion or in lecithin secretion. Thus, the excess cholesterol must precipitate from solution as solid microcrystals, which aggregates and grows. Yellow snd soft gallstones have more cholesterol in them, black ones have more bilirubin, and hard ones likely have more bile salt component to them. Migration of a gallstone into the opening of the cystic duct may block the outflow of bile during gallbladder contraction. The resulting increase in gallbladder wall tension produces the characteristic type of pain we know as biliary colic. Cystic duct obstruction, if it persists for more than a few hours, may lead to acute gallbladder inflammation (acute cholecystitis). Choledocholithiasis on the other hand, refers to the presence of gallstones in the common bile duct. Usually, this occurs when a gallstone successfully passes further all the way from gallbladder to the cystic duct and into the common bile duct.
Moniccca
Moniccca
in General
Humerus Fractures - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes humeral shaft fractures, signs and symptoms, imaging and diagnostic tests, and treatment options. There are several important points involving humeral shaft fractures: 1-Humeral shaft fractures are treated without surgery in the majority of cases. Nonoperative treatment gives a satisfactory outcome. A perfect alignment of the humerus is not important for an acceptable functional result. 2-Radial nerve palsy in not uncommon: check for neurovascular deficit before and after reduction (Especially wrist and finger extension). Holstein-Lewis fracture is commonly associated with neuropraxia of the radial nerve (Approximately 22% of cases). 3-Platting of the humerus is better with an IM rod. Treatment •Nonoperative is used in the majority of cases. •Acceptable alignment •Hanging arm cast occasionally used •Humeral fracture brace: 7-10 days when the swelling and the pain is less. •Functional bracing Indications for surgery •Open fractures •Vascular injury •Floating elbow •Loss of reduction •Polytrauma patient •Brachial plexus injury Surgery •Plate fixation, more stable, less reoperation or complications. plate fixation is better than a rod •Rod fixation: less stable, more reoperation •External fixation: not commonly used. Complex fracture: types of fixation : •plate •rod •external fixator (near fracture, away from fracture). Anterolateral approach: in the proximal 2/3 the nerve lies posterior to the intermuscular septum, so its difficult to see the nerve. In order to see the nerve, you need to search for it between the brachialis and brachioradialis distally. Posterior approach: is used for the distal 1/3 of the humerus. Plating technique •Pre-bend the plate: allows compression on the near and far cortex. Usually use 4.5 mm plate and screws. The humerus is subject to larger rotational forces. Staggered hole screw placement is ideal. •Lag screw and neutralization plate for oblique fracture. •Use bridge plate for comminuted fracture. •Posterior approach for plating of fractures in the distal third of the humerus. The posterior surface is flat. Anatomically easier approach. Biomechanically better. In general, plating of the humerus allows for immediate weight bearing with crutches or walker use. •Locking plate •Used for osteoporotic patients •Sometimes 3.5 mm locking plate is used instead of 4.5 mm plate. IM rod indications: •Segmental fracture •Osteoporotic fracture •Pathological fracture •Comminuted fracture There is higher complication rate and shoulder pain with IM rod fixation. IM rodding will give you callus endochondral ossification. More callus than with plating. Distal screws may have complications with plating. If you go from anterior to posterior, you risk injury to the musculocutaneous nerve. External fixation is used in •infected or contaminated cases with bad soft tissue injury •Sometimes used temporarily •Watch the position of the radial nerve when you insert the screws. Usually three complications with humeral shaft fractures 1-Varus: common, especially after conservative treatment (does not affect function). 2-Nonunion: check 25-hydroxy vitamin D. usually plate and bone graft. If a rod has been used, remove the rod and then do plate and bone graft. If the nonunion is hypertrophic, use a compression plate alone. 3-Radial nerve palsy Splint the wrist and obtain EMG studies in about 6 weeks. Fibrillation is bad, polyphasic is good. Monitor the brachioradialis muscle since it is the first muscle to recover. Extensor indices muscle is the last muscle to recover. Wrist extension radial deviation recovers first. Explore the nerve f the nerve fails to recover within 4-6 months.
Niven Abu Ramadan
Niven Abu Ramadan
in Case Study
Patient with stomach full of gold Jewelry This mentally ill patient had eaten almost  total were valued at about RM270,000 and weighed 1.6kg of gold jewelries and few other coins!!
Patient with stomach full of gold Jewelry This mentally ill patient had eaten almost total were valued at about RM270,000 and weighed 1.6kg of gold jewelries and few other coins!!
26-year-old patient Runi Khatun was admitted to a government hospital in the West Bengal state of India after she complained of abdominal pains and vomiting each time she would eat. When the woman was admitted to the hospital her condition was very critical According to the Head of the Surgery Department Dr Siddhartha Biswas, she required at least five bottles of blood. "She could not even intake food physically so we had to administer Total Parenteral Nutrition (TPN) to artificially inject food through her mouth," said the doctor, adding that she would die if they operated on her, as reported by The Sun. TPN is a method to supply nutrition by dripping them directly into the digestive system. Once her condition stabilised, scans revealed that there was metal in her stomach When the doctors opened her up, they were stunned to find large chunks of coins and jewellery in the stomach. The operation lasted for nearly one hour and 15 minutes during which the surgeons removed 90 coins, 80 earrings, 69 chains, 11 nose rings, eight lockets, five anklets, four keys, a watch dial, and two silver coins from the woman's stomach. Most of the items were made of copper and brass while some of them were gold which in total were valued at about RM270,000 and weighed 1.6kg. “Despite keeping an eye on her, she somehow managed to swallow all these objects. She was not well for the past two months," said the mother, adding that Runi had consulted various private doctors and was on medication with no result. Dr Biswas shared that the patient is now stable and will soon be discharged, adding that she is also currently undergoing psychiatric treatment.
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