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complete arcus senilis ( gerontoxon )

Image Comments:

The arcus senilis usually starts inferiorly and then appears superiorly. In some cases the two arcs will meet at 9:00 o'clock and 3:00 o'clock as in the photo. There may be a recessive inheritance aspect.
By the way an arcus senilis is not usually related to serum lipids or cholesterol.

A cutaneous side effect of intravenous fluorouracil infusion

This 61-year-old man with recently diagnosed, inoperable esophageal squamous-cell carcinoma was treated with induction chemotherapy combining cisplatin and fluorouracil and concurrent radiotherapy. Because of worsening renal function, the use of cisplatin was suspended, and the chemotherapy was shifted to weekly high-dose fluorouracil and leucovorin. After the seventh infusion of fluorouracil–leucovorin, thrombosis developed in the right jugular and subclavian veins. This venous thrombosis prohibited further use of the permanent tunneled central-infusion catheter. The eighth infusion of fluorouracil–leucovorin was administered continuously over a 24-hour period by means of a peripheral catheter in the left forearm.

A day later, the patient noticed a mildly stinging rash that traced the path of the injected chemotherapeutic agents. Over the next few days, this erythema spread centripetally and became brown (arrows). This condition, known as serpentine supravenous hyperpigmentation, is a cutaneous side effect of intravenous fluorouracil infusion that is thought to result from extravasation of the cytotoxic agent after endothelial damage, causing epidermal basal hyperpigmentation and dermal melanin incontinence. Unlike tender, clot-forming thrombophlebitis, serpentine supravenous hyperpigmentation is characterized by underlying vessels that are patent.
Other chemotherapeutic agents, such as vinorelbine, fotemustine, and docetaxel, have also been found to cause serpentine supravenous hyperpigmentation. This complication is self-limiting and can be prevented by avoiding, if possible, peripheral infusion of these chemotherapeutic drugs, as well as fluorouracil. In this patient, the serpentine supravenous hyperpigmentation faded and had completely resolved 2 months after diagnosis.

Epidemiology & Natural History of Hepatitis C Virus

Dr. Miriam Alter, Director of Infectious Disease Epidemiology at the University of Texas Medical Branch in Galveston TX, discusses the appearance and spread of Hepatitis C.

Kombucha tea may be dangerous to your health

Celebrities are powerful role models and are important to consumers concerned with their health because of the perception that famous people have access to the best health practices and medical care. The public looks to celebrities for hope and inspiration as they struggle with their own health issues and fight disease. However the health practices that celebrities promote are often questionable and misleading.

One currently popular folk remedy, kombucha tea, is part of the dietary regimens of multiple Hollywood actresses and entertainers including Gwyneth Paltrow, Kirsten Dunst, Lindsay Lohan, Madonna, Halle Berry, Meg Ryan, Anna Paquin, Cher, Barbara Streisand, Alec Baldwin and Susan Sarandon. The claims for its medicinal value are as far reaching as they are implausible and include aging, anorexia, arthritis, atherosclerosis, cancer, constipation, diabetes, gallbladder disease, gout, hemorrhoids, hair growth and color restoration, headache, hypertension, HIV, immune boosting, indigestion, increased vitality, treatment of alcohol and coffee addictions, and wrinkle reduction.

Kombucha is a form of black tea and sugar that is fermented using a combination of bacterial and fungal cultures that form a “mushroom” on top of the fermentation vessel. It originated in China thousands of years ago, eventually spreading to Europe, and is today becoming increasingly popular, through celebrity use and endorsement, in the U.S. and U.K. Many home brew recipes for making kombucha may be found on the Internet but it is also manufactured and sold by companies such as Synergy Drinks.

We conducted a literature review of kombucha at and found 40 articles on kombucha tea. Many of these studies originated in China or India and consisted of testing the effects of kombucha tea on rats or mice; a few papers tested effects on human cancer cells in vitro. Some beneficial effects were seen but one study concluded that “Comparable effects and mechanisms in humans remain uncertain, as do health safety issues, because serious health problems and fatalities have been reported and attributed to drinking kombucha.”

Most of the reports of human consumption of kombucha tea are case reports of toxicity, in some cases, life-threatening. The greatest danger from kombucha seems to arise in “home brew” versions that have become contaminated because of improper preparation and/or when kombucha interacts with alcohol or prescription drugs.

Observed adverse effects of kombucha consumption include hepatitis, xerostomia, dizziness, nausea, vomiting, headache, shortness of breath, restless legs, abdominal pain, hypotension, and tachycardia. In most cases, patients fully recovered after discontinuation of kombucha and symptomatic treatment. However there are case reports of serious and sometimes fatal cases of hepatic dysfunction and lactic acidosis.

In addition to oral ingestion, skin application of kombucha is also used as a topical analgesic. Such use has resulted in cutaneous anthrax infections from kombucha stored in unhygienic conditions; such conditions make kombucha preparations a potential medium for the growth of pathogenic microorganisms.

Because folk medicines, herbal remedies and dietary supplements, including Kombucha tea, are not considered foods or drugs, they are not routinely evaluated by the U.S. Department of Agriculture or the U.S. Food and Drug Administration (FDA). According to the U.S. Centers for Disease Control and Prevention (CDC), drinking this tea in quantities typically consumed (approximately 4 oz daily) may not cause adverse effects in healthy persons; however, the potential health risks are unknown for those with preexisting health problems or those who drink excessive quantities of the tea.

Recently, Whole Foods removed kombucha drinks from its store shelves because they can contain alcohol as a product of the fermentation process. This fact was used as a possible explanation for why actress Lindsay Lohan’s alcohol-monitoring (SCRAM) bracelet was activated even though she asserted compliance with court orders not to drink alcoholic beverages.

Histopathology Kidney --Systemic lupus erythematosus

Histopathology Kidney--Diabetic glomerulosclerosis

Damaged Long Thoracic Nerve - Winging Scapula

This is 9 months to the day of the accident. She had to clasp her hands together to lift her right arm in the video.

Spinal Cord Model

Dixon discusses Enlargements, cord, pia, dura, mater, denticulate ligaments, 8 spinal nerves, cauda equina, sympathetic chain ganglion , paravetrebral ganglia, plexuses, nerve, etc.

Glaucoma Surgery 3D Animation

Glaucoma surgery is explained using 3D computer animations.

Health Care Payments in U.S.

In 2008, the federal government spent $782 billion on health care through the Medicare and Medicaid program. Below is a breakdown of the expenditures incurred by service product.

Alopecia Totalis PIC

Alopecia Totalis (AT): AT is an auto-immune disorder which results in the total loss of hair, but only on the scalp. It is somewhat of an intermediary condition between Alopecia Areata which is patchy scalp hair loss, and Alopecia Universalis which extends to total body hair loss. AT usually appears in two types: One being a fairly sudden and complete loss of all head hair. The other being a slower form which originates as Alopecia Areata (patchy loss) and advances to complete scalp hair loss. In this sense it is sometimes tied to Alopecia Areata (patchy loss), but not all the time.Patients with alopecia areata lose hair on their scalp in smooth round patches typically causing bald spots about an inch (2cm) across.

Most sufferers are children and young adults under the age of 40, though it can affect people of all ages. It can also affect the the nails, giving them a ridged, pitted or brittle appearance. According to statistics, 2% of men and 1% of women in western society suffer from some form of Alopecia Areata. About 2% of those have Totalis or Universalis. This means that about 1 in every 125,000 men and 1 in every 250,000 women have Alopecia Totalis or Universalis.

The main treatment for Alopecia Totalis are therapies which focus on immunomodulation, such as glucocorticoid injections, anthralin, or glucocorticoids taken orally. We have heard reports from some that years of steroid therapy can put the condition into remission. Years of steroid therapy is not always enjoyable however, as there are side effects. It is important to comment that Rogaine (Minoxidil) is not effective for those with Alopecia Totalis. Some treatments which have been considered include Methotrexate, a treatment for autoimmune disorders, and corticosteroids have been proposed as treatments.

Several genes have been studied and quite a bit of research has focused on the human leukocyte antigen. Two studies demonstrated that human leukocyte antigen DQ3 (DQB1*03) was found in more than 80% of patients with Alopecia Areata, which suggests that it can be a marker for general susceptibility to Alopecia Areata. The studies also found that HLA DQ7 (DQB1*0301) and human leukocyte antigen DR4 (DRB1*0401) were found quite a bit more often in patients with Alopecia Totalis (AT) and Alopecia Universalis (AU).

1-alopecia totalis is not a painful disease and does not make people feel sick.
2-It is not contagious, and people who have the disease are usually otherwise
3-It has no effect on life expectancy, and will not interfere with your ability to
pursue a normal lifestyle.
4-Returning to your faith can play a major role in understanding what is going on.


Abcess draining

Scoliosis pic and how to detect

Scoliosis: Lateral curvature of the spine causes right shoulder area to appear somewhat higher than the left. Curvature is more pronounced on x-ray.

$-Scoliosis is not a disease,it is a descriptive term.It affects 2% of women and 0.5% of men in the general population. these deformities are caused by: abnormal development of bones and/or ligaments of spines or abnormal nervous control over spinal muscles , Infections as T.B. , Swelling and tumours within spinal canal,etc. It occurs either intrauterine or early/adolescent growth spurt.
So,there are -Idiopathic -Congenital -Neuromuscular -Adult or Degenerative Scoliosis.

How do detected?
May be noticed by mother,And in advanced stages the 2 shoulders being at different level"as in photo",waisting being assymetrical ,imbalance with sitting , feeling one lower limb being shorter, OR by simple test (Adam's Forward Bend Test):
ask patient to fold her/his hands and bending her/him self forward without bending the knee and from behind observe any asymetery bump on any side of midline. WATCH VIDEO

Indication for surgery:
The 2 main indications for surgery are curve progression and deterioration in sitting ability.WATCH VIDEO

Large Prolactinoma on MRI imaging

A 32-year-old man presented with a 6-month history of severe headaches, hemiparesis on the left side, and impaired hearing in the left ear. His medical history was otherwise unremarkable.
Magnetic resonance imaging(MRI) with gadolinium revealed a large mass (5.6 cm by 6.9 cm) invading the base of his skull (Panels A and B, arrows). To evaluate the patient for the presence of what was most likely a pituitary macroadenoma, the serum level of prolactin was measured and reported as 7.3 μg per liter (normal range, 4.1 to 18.4).

In cases of large prolactinomas, the initial prolactin level may be erroneously read as normal. After serial dilution of the patient's blood sample to 1:1000, the measured prolactin level was 122,260 μg per liter. Laboratory testing also revealed central hypogonadism. Immunohistochemical staining of a transnasal-biopsy specimen of the mass showed a lactotropic adenoma with tumor cells that were positive for prolactin. Four days after the initiation of treatment with cabergoline, the prolactin level declined to 10,823 μg per liter.
By the time of the 3-week follow-up visit, the prolactin level had further declined, to 772 μg per liter, and the patient's neurologic symptoms had resolved. After 40 months, the prolactin level was maintained at 25 μg per liter and the tumor had regressed substantially (Panels C and D, arrows). The central hypogonadism persisted.

Mole Removal Performed by a Dermatologist

Answer this Case with explanation!!

These are identical twin.

What endocrine diagnosis is affecting the identical twin on the left side of the image ?
And why?

Radiological Features of renal papillary necrosis

A 70 year old diabetic has chronically deteriorating renal function. An intravenous urogram reveals ring shadows and filling defects within dilated calyces. The most likely diagnosis is

  • a) pelvi-ureteric obstruction
  • b) horse-shoe kidney
  • c) medullary sponge kidney
  • d) renal tuberculosis
  • e) renal papillary necrosis

The correct answer is ( E )


Clinically, renal papillary necrosis is a spectrum of disease, most common in patients with diabetes, analgesic nephropathy or sickle cell disease. Patients may have an acute fulminating illness with rapid progression or may have a chronic disease that is incidentally discovered on excretory urography. Some patients may chronically pass necrotic tissue in their urine , and some may never pass papillae.

Although the diagnosis may be made from the passage of necrotic papillae in the urine, most often it is made from the excretory urogram. The radiographs show various degrees of renal involvement with either medullary or papillary changes causing irregular sinuses or medullary cavities or classic ring shadows. Retained necrotic papillae may calcify, especially in association with infection. Furthermore, this necrotic tissue may form the nidus for chronic infection. Opportunistic fungal infections have been reported. Renal sonography may be useful to diagnose papillary necrosis.

Schatzki Ring by Endoscopy

It appears in endoscopy as smooth, concentric narrowing of the lumen at the esophagogastric junction.
...... 82 year-old woman with nausea refractory to therapy; endoscopy also demonstrated gastritis and duodenitis.

In this 53 year-old man with pyrosis (heartburn) and dyspepsia (indigestion),Schatzki ring is often seen in the setting of reflux esophagitis, as seen here with linear, longitudinal esophageal ulcers.

Anatomy In CT abdomen

The video will describe anatomical structures as seen on a CT Scan.

Achilles tendinitis

Achilles tendinitis is inflammation of the achilles tendon or the surrounding paratendon.

The condition occur most commonly in young adults, causing heel pain.

Achilles tendinitis is acutely treated with RICE:

* Rest
* Ice
* Compression
* Elevation

Once the acute stage has passed, stretching and strengthening exercises of the calf muscles are more important.
When stretching the tendo-achilles, the stretch should be gently held for the count of 10-30 seconds, in groups of 5-10, four times per day . This is done with the knee straight and flexed, thus stretching all the muscular components of the tendo achilles.

A heel raise, orthoses and ultrasound may also be used in the treatment of this condition.

A more aggressive treatment is the use of hydrocortisone injections. This treatment option should only be undertaken by a specialist. The injection should be into the space between the tendon and the paratendon - not into the tendon itself. Steroid injections should be used with care as scar formation is a recognised complication. Also there is an increased incidence of tendon rupture associated with steroid injections.

Note that there is also evidence that topical glyceryl trinitrate significantly reduced pain with activity and at night, improved functional measures, and improved outcomes in patients with Achilles tendinopathy .

Video of Muscle-Splitting Breast Augmentation

Breast augmentation usually is performed in subglandular, subfascial, or partial submuscular pockets, including the dual plane. A new pocket has been described and used by the author. Methods: From October 2005 to April 2008, 600 patients underwent bilateral breast augmentation using the new technique.
Soft cohesive gel micro-textured round implants (range 200- 500cc) were used. The initial pocket is made in the subglandular plane up to the lower level of the nipple areolar complex. The submuscular plane is reached by splitting the pectoralis major muscle at the level of middle and lower third of sternum.

The muscle is split along the direction of its fibers up and laterally to the anterior axillary fold. No pectoralis major is released from costal margin. The implant lies in this plane simultaneously behind and in front of the pectoralis major. Procedure is performed as a day case under general anesthetic with no drains.

: Postoperative analgesia requirements is reduced because of dissection in natural planes resulting in quick recovery. No muscle contraction associated deformities is seen. All patients had aesthetically natural cleavage, with the nipple at the most projected part of the breast with three-dimensional enhancement.
Conclusion: An adequate muscle cover of the prosthesis is achieved by muscle splitting breast augmentation technique and the procedure is used in all breast augmentations procedures

Appearance of Vocal cord Granuloma

is a non-cancerous growth on the vocal fold made up of inflammation tissue in response to irritation or injury (An inflammatory growth).usually presented by hoarseness, throat pain, and ear pain

The granulomas are usually found near the back portion of the vocal folds over the vocal process of the arytenoid cartilages at the site of contact during vocal fold closure. They often appear pale or sometimes red.

NOTE THAT :Surgery should only be used to treat granulomas that do not respond to first-line treatments of the cause"which may be endotracheal intubation trauma/excessive voice use/Backflow of acidic stomach fluids", or if underlying laryngeal cancer is also suspected.

The photo below shows Vocal Fold With Granuloma and Reflux Laryngitis:

A granuloma (gr) is detected as a yellowish growth covering the right arytenoid process. Irritation from reflux of stomach fluids into the voice box is also detected with redness and swelling in vocal folds (vf) and false vocal folds (f vf) and pachyderma or thickening of tissue in the back of vocal folds

Accessory Nipples

Accessory nipples usually develop along the course of the embryological milk lines, which run from the anterior axillary folds to the inner thighs, but may also occur in other sites. In the majority of cases they appear as small brown papules, usually on the chest wall. A familial incidence is sometimes noted.

Ulcer Examination

ITB Surgery

Triple Negative Breast Cancer

Triple negative breast cancer is an aggressive type of breast cancer in which the tumor cells lack receptors for estrogen, progesterone and the HER2 protein on their surfaces. Because the tumor cells lack these receptors, treatments such as hormone therapy, like tamoxifen and aromatase inhibitors, or drugs that target HER2, like Herceptin, are not effective.

In this video, Dr. Sara Chumsri, a member of the UMGCC Breast Evaluation and Treatment Program, discusses triple negative breast cancer and some of the promising new research underway to develop new therapies to successfully treat this type of breast cancer.


Stapedotomy and stapedectomy are operations done to improve hearing. You may have learned the 3 bones behind the ear drum as the hammer, anvil, and stirrup. Their real names are malleus, incus, and stapes. The stapes is supposed to move like a piston in a motor, but if bone grows between it and the surrounding bone it can't move well. This causes hearing loss. These operations either bypass the stuck part of the stapes(stapedotomy) or remove it (stapedectomy) to improve hearing.


It is the endoscopic examination of the colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected lesions.IT differs from sigmoidoscopy in allowing an examination of the entire colon while sigmoidoscopy allows to vizualize only the final two feet of the colon.


1. Gastrointestinal hemorrhage

2. Suspicion of malignancy

3. Inflammatory bowel disease (chron's disease & ulcerative colitis)

4. Unexplained drop in hematocrit (In anemia)

5. Positive feacal occult blood test

6. Unexplained changes in bowel habit

7. If any abnormality found on colon x- ray or a CT scan


Bowel preparation

* The colon must be free of solid matter for the test to be performed properly

* For one to three days, the patient is required to follow a low fiber or clear-liquid only diet

* Patient should be well hydrated

* The patient should be given appropriate Colonic Cleansing

* Most medications should be continued as usual, but some may interfere with the examination.

* If the patient is on Aspirin products, blood thinners (Coumadin, etc.), arthritis medications, insulin, and iron preparations that may require special instructions

## Regimens For Colonic Cleansing Before Colonoscopy:-

a.Diet - Dietary modifications alone, such as a clear liquid diet, are inadequate for colonoscopy

b.Enemas - Used in patients who present to endoscopy with a poor distal colon preparation and in patients with a defunctionalized distal colon

c.High-Volume - Gut Lavage such as mannitol

d.Rectal Pulsed Irrigation - Rectal pulsed irrigation administered immediately before the procedure combined with magnesium citrate given the evening before the procedure is a reasonable alternative to full-volume (4-liters) polyethylene glycol (PEG) in those individuals who cannot tolerate per oral administration of PEG

e.PEG (Electrolyte Lavage Solution) -

faster, more effective, and better-tolerated method

PEG is safer than osmotic laxatives/sodium phosphate (NaP) for patients with electrolyte or fluid imbalances, such as renal or liver insufficiency, congestive heart failure, or liver failure

PEG regimens (2–3 liters given the night before the colonoscopy and 1–2 liters on the morning of procedure)

f.Aqueous Sodium Phosphate - An equal alternative to PEG solutions except for pediatric and elderly patients, patients with bowel obstruction, and other structural intestinal disorders, gut dysmotility, renal failure, congestive heart failure, or liver failure

-Contraindications of NaP

* In patients younger than five years of age

* Those with serum electrolyte imbalances

* Advanced hepatic dysfunction

* Acute and chronic renal failure

* Recent myocardial infarction, unstable angina, congestive heart failure

* Ileus, malabsorption, and ascites


* It usually takes 15 to 60 minutes

* The patient is often given sedation intravenously such as fentanyl or


* Monitoring the Vital parameters

* Patients will be lying on their left side or back

* First step is usually a digital rectal examination, to examine the tone of the

sphincter and to determine if preparation has been adequate

* Then endoscope is passed to visualize the entire colon

* Suspicious lesions may be cauterized, treated with laser light or cut with an

electric wire for purposes of biopsy or complete removal polypectomy

* Medication can be injected, e.g. to control bleeding lesions


1. Gastrointestinal perforation, which is life-threatening

2. Bleeding

3. Splenic rupture

4. On very rare occasions, intracolonic explosion

Dance of the ECG

Radiologic Findings of Achondroplasia

Image shows inverted femoral physes (inverted V configuration), which contributes to a waddling gait.

Enlarged calvaria. Note the enlarged mandible.

Achondroplasia: Sagittal section of the cervical spine T2-weighted MRI showing narrowing of the foramen magnum at C1 canal, effacement of the subarachnoid spaces at the cervicomedullary junction, abnormal intrinsic cord signal intensity in this 6-year-old patient who presented with a neurologic deficit.



3D Medical Animation of a Knee Replacement

OMG....Extraoccular Muscle Entrapment

Extraoccular Muscle Entrapment: This patient fell, sustaining orbital floor fracture of left eye.
The inferior rectus muscle has become stuck in the fracture, preventing the patient from being able to look directly downward.
This is evident in the picture below. The diffuse scleral redness is due to traumatic subconjunctival hemorrhage.

more targeted therapy for psoriatic and rheumatoid arthritis by contrast-enhanced MRI

In the past the treatment for patients with psoriatic arthritis was based on the treatment for those with rheumatoid arthritis
According to a new study ,contrast-enhanced magnetic resonance imaging (MRI) could help to differentiate between psoriatic and rheumatoid arthritis in hands and wrists. the results of the study might lead to a more targeted therapy unique to each condition.

This study
that was done at the University Hospital of Tubingen imaged using contrast-enhanced magnetic resonance imaging 31 patients with rheumatoid arthritis and 14 with psoriatic arthritis. The contrast media in rheumatoid and psoriatic arthritis is presumed to be different and the difference can only be seen 15 minutes after the contrast material is given.
“Our study revealed a significant difference in perfusion between those patients with rheumatoid arthritis and psoriatic arthritis after 15 minutes. However, since it was a small group of patients and there was an overlap in perfusion values between both types of arthritis, a diagnosis could not be led by contrast-enhanced MRI alone. Our results are nonetheless promising though,” said Nina Schwenzer, lead author of the study.

Cosmetic Lasers Remove Some Skin Lesions

Contents of foley catheter kits

Commercial kits are available which contain all of the equipment needed to place a urethral catheter. These kits usually contain a standard-tip 14-16 Fr catheter, a urine collection bag, and the rest of the required supplies. Viscous lidocaine, which should be used when placing a catheter in a male patient (see Procedure section) is not included in the standard kit and must be obtained separately.

Stomach regions & muscle layers

DNA Structure

Simplified Aqueductal Stenting for Isolated Fourth Ventricle

In this video, the authors demonstrate a new method for treating isolated fourth ventricle syndrome using a fiber optic endoscope. They illustrate the technique in a 39-year-old woman with coccidiomycosis. This case demonstrates that the technique is feasible and may offer several advantages over currently applied methodologies.

Case of Secondary antibody deficiency

A patient has secondary antibody deficiency due to B-cell suppression His primary pathology is likely to be

a) Waldenstrom macroglobulinemia
b) X-linked agammaglobulinemia
c) immunoglobulin A deficiency
d) immunoglobulin M deficiency
e) common variable immunodeficiency

The correct answer is A

Antibody immunodeficiency can be primary or secondary. Secondary antibody deficiency due to B-cell suppression can occur with multiple myeloma, Waldenstrom macroglobulinemia, or chronic lymphocytic leukemia. Secondary deficiencies leave patients susceptible to the same pathogens that can cause recurrent pneumonia in patients with primary antibody deficiencies Primary antibody deficiencies include X-linked agammaglobulinemia, common variable immunodeficiency, selective immunoglobulin A or immunoglobulin M deficiency, and hyperimmunoglobulin M immunodeficiency. These disorders are characterized by chronic or recurrent pyogenic infection, especially pneumonia, caused by encapsulated bacteria (eg, S pneumoniae, H influenzae, and S aureus) and P aeruginosa . Untreated or recurrent pneumonia may lead to bronchiectasis.

External Jugular Vein Distention

External Jugular Vein Distention:The picture above demonstrates a markedly distended right external jugular vein (EJV). This is the result of elevated central venous pressure (CVP). The picture below demonstrates the effect of hepatic pressure on the appearance of the EJV (i.e. vein becomes more engorged).
In practice the EJV is not as reliable in determining CVP as the internal jugular vein(not visualized here) due to the fact that it sometimes has valves and is not in a direct line with the right atrium. Pressure on the liver, however, will have similar impact on the appearance of the IJV as demonstrated above for the EJV. This is referred to as hepatojugular reflux.

Some Bronchopneumonia Pathology photos

Bronchopneumonia area with only vascular congestion, alveolar capillaries

Bronchopneumonia with alveolar capillary congestion and alveolar edema.

Bronchopneumonia with exudate in bronchiole.

Bronchopneumonia with fibrin deposition in alveoli.

Bronchopneumonia, Streptococcus pneumoniae and Haemophilus influenzae.

Bronchopneumonia, consolidation of alveoli by cellular exudate (AI)

Pagets Disease Pic

The photos show Pagets of the tibia - lower leg - bowing - clinical and Xray

Pagets Disease
is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. The patient is frequently entirely assymptomatic and the condition can be discovered after routine Xrays, requested for other reasons. However of those people who become symptomatic, the commonest features are:

Deformity of bone
Manifestations of complications.
Detail of the thickened and irregular bone structure

In pagets disease
, the remodelling process(by osteoclast and osteoblast) is disordered, with large abnormal osteoclasts working at a much greater turnover than normal, followed by the irregular laying down of bone

Gone are the days where pain killers and antiinflammatories were the only approach. The mainstay of therapy at the current state of the art is that of bisphosphonates, either oral or intravenous pulse. Such preperations include - alendronate(oral), risedronate (oral) and pamidronate (intravenous) . Such therapy results in a reduction in the alkaline phosphatase, and reduction in pain.

Axillofemoral bypass graft

This elderly female patient underwent an axillofemoral graft (also called axillofemoral bypass graft) for loss of blood flow in the right femoral artery. The procedure involved connecting the right femoral artery and right axillary artery using an artificial graft tube, which was placed along the subcutaneous plane of the chest and abdomen. This patient underwent Color Doppler imaging to assess the condition and flow in the graft tube. The color Doppler image above shows the artificial axillofemoral graft tube with normal flow through it.
Note the large diameter of the graft tube and location in the subcutaneous plane of the chest wall.

NEJM Procedure: Thrombus Aspiration

n an occluded infarct-related artery, reperfusion can be achieved by the standard means of primary percutaneous coronary intervention or by the new method of thrombus aspiration, followed by stenting, as depicted in this video.

Schwann Cell and Action Potential (Why teenagers have quick responses!!)

This video demonstrates the development of myelin in the peripheral nervous system and the propagation of action potential along a myelinated axon. The video was completed by Marziah Karch as her 2008 sabbatical project from the script and voiceover of Professor Marilyn Shopper.

This is close captioned, but in some cases a few of the words were left out to make it possible to read it at all.

How Klebsiella infection appears on chest X-ray

Imaging Findings :

Homogeneous parenchymal consolidation containing air bronchograms (simulates pneumococcal pneumonia). Primarily involves the right upper lobe. Typically induces a large inflammatory exudate, causing increased volume of the affected lobe and characteristic bulging of an adjacent interlobar fissure.See this figure below:

Small Comment:

Most commonly develops in alcoholics and in elderly patients with chronic pulmonary disease. Unlike acute pneumococcal pneumonia, Klebsiella pneumonia causes frequent and rapid cavitation, and there is a much greater incidence of pleural effusion and empyema.

For Comparison with pneumococcal pneumonia :


Traditional Chinese Medicine:Suggestions for Long Term Breast Health

# Eat as many fresh, lightly cooked vegetables as you wish. Go easy on spicy, sweet, or greasy foods

# Avoid overeating. This stagnates the stomach qi - the stomach channel irrigates the breast tissue. Stagnant qi in any form is bad for the breasts.

# Try to avoid becoming overweight. There is a known relationship between body fat, fat consumption, and breast cancer.

# Stay relaxed. Remember the "Serenity Prayer" or simply learn to know the difference between what you can and cannot change and control in your life and in the lives of those around you. Try to let go of what you cannot change and work at changing what you can.

# If you cannot relax, use relaxation tapes or meditation techniques to help you learn to do so. Stress, when not released or diffused by some method, is an enemy of breast health.

# Avoid caffeine in as many forms as you can. Stop eating chocolate except as a rare treat. Switch from coffee to black tea, or better yet, to green tea.

# If you can, get some form of exercise every day, or at least every other day. It burns fat
cells, reduces stress, increases energy, and improves self image.

# Eat meat sparingly. Use it in broths, soups, stews, and not necessarily every day. Don’t just eat chicken and fish; a variety of meats is better over the long term.

# Grains, well cooked and/or in the form of noodles, should be the foundation of any diet. Try eating something else instead of bread. Try cutting back to bread products only once per day.

# When you use oil, use olive oil. Studies show it to be a better option for breast health than other oils or fats.

#Breast massage and any form of self-massage is helpful in keeping qi and blood circulating. Learn a simple self-massage regime from a book or make one up for yourself.

Mnemonic for Shock: signs and symptoms

  • Thirst
  • Vomiting
  • Sweating
  • Pulse weak
  • Anxious
  • Respirations shallow/rapid
  • Cool
  • Cyanotic
  • Unconscious
  • BP low
  • Eyes blank

Yoga as an effective treatment for back pain

New researchs from the U.S. suggests that the millennia-old therapy of yoga could benefit millions of people who suffer from back pain problems. In an article published in the Annals of Internal Medicine on December 20, researchers concluded that yoga act as a more effective treatment for back pain than conventional therapy.
A study conducted at the Group Health Cooperative in Washington State required 101 adults to follow a choice of remedial treatments – a 12-week course in yoga, 12 weeks of standard therapeutic exercise or the same period following instructions in a self-help book. The results showed yoga both expedited relief from pain and had longer lasting benefits. Lead researcher Dr. Karen Sherman said this was because “mind and body effects” were in collusion.

The article states that: “Most treatments for chronic low back pain have modest efficacy at best. Exercise is one of the few proven treatments…however, its effects are often small, and no form has been shown to be clearly better than another. Yoga, which often couples physical exercise with breathing, is a popular alternative form of ‘mind–body’ therapy…[It] may benefit patients with back pain simply because it involves exercise or because of its effects on mental focus. We found no published studies in western biomedical literature that evaluated yoga for chronic low back pain; therefore, we designed a clinical trial to evaluate its effectiveness.” Millions of people worldwide swear by yoga to improve their mental and physical health.



Asbestos is a tough, heat-resistant mineral that was added to the building materials of many older homes. It can pose health hazards to workers and homeowners who renovate or demolish those homes. This animation shows how asbestos fibres could damage lung tissue and lead to lung disease.

A case of male with abdominal pain (with CT & Pathology)

A 45-year-old male presented to his physician with the complaint of abdominal pain for 6 months. In addition to this pain, the patient related a loss of appetite with difficulty eating and frequent emesis over this period of time. In total, he had lost 20 pounds in the last 2 months, which was attributed to eating less. On physical examination, the patient’s abdomen was distended, with decreased bowel sounds. An abdominal X-ray (not shown) showed dilated loops of small intestine; however, no free air was present. An abdominal CT scan (Figure 1) was performed and revealed thickening of the terminal ileal wall and a mass in the ileocecal mesentery.

The patient was taken to surgery and right hemicolectomy was performed. On gross examination (Figure 2), there was a 7.5 cm tumor that circumferentially involved the intestinal wall and extended into the surrounding mesentery. The small intestinal mucosa overlying the mass was ulcerated.

Tear of Medial Cruciate Ligament

These are ultrasound images of the right knee joint following a motorcycle accident. There is a curvilinear echogenic structure within the medial part of the right knee joint cavity. Diagnosis: traumatic rupture of the distal insertion of the medial cruciate ligament, which now floats within the fluid distended (possible hemorrhagic) joint space.

The Largest Kidney Stone

Endoscopic endonasal transsphenoidal adenomectomy

This video demonstrates the endoscopic endonasal transsphenoidal approach and removal of a pituitary adenoma (EETA). This is a benign hormonally inactive tumor of the pituitary gland.
The surgery is performed by E.J. van Lindert, MD PhD, in the neurosurgical department of Radboud University Nijmegen Medical Centre, The Netherlands.

Vitamin D: Interactions of Vitamin D and Calcium

s vitamin D the wonder vitamin? Can it prevent certain cancers and chronic diseases? Find these answers and more in this series brought to you by UCSD School of Medicine and GrassrootsHealth where experts discuss the latest research on vitamin D. In this program, Robert Heaney, MD, talks about vitamin D and calcium metabolism safety. Series: Vitamin D Deficiency - Treatment and Diagnosis

Cancer Treatment Costs Nearly Double (Exceed $48 Billion, Patients' Out-of-Pocket Payments Decrease)

May 10, 2010 -- The cost of treating cancer in the U.S. has nearly doubled in the past 20 years, according to a new analysis.

The analysis also found that outpatient care has become a trend and out-of-pocket costs to patients have declined.

Researchers from the CDC and other institutions looked at data from the 1987 National Medical Care Expenditure Survey and compared the information with data from the 2001 through 2005 Medical Expenditures Panel Survey. The report is published online in the journal Cancer, a journal of the American Cancer Society.

Among the findings:

* The total medical cost of cancer in 1987 was $24.7 billion, expressed in 2007 dollars.
* The total medical cost of cancer increased to $48.1 billion during 2001-2005.
* The increase is the result of new cases in the aging population as well as an increase in the prevalence of cancer.
* As a share of overall medical expenses, cancer costs remained fairly constant, accounting for about 5% each time period.
* Outpatient care became more common, with the expenses for inpatient care for cancer falling from 64.4% to 27.5% of total cancer treatment costs.
* The share of cancer costs paid for by private insurance increased from 42% to 50%, and the share of out-of-pocket costs fell from 17% to 8%. In 1987, Medicare paid for 33% of costs; by 2001-2005, it paid for 34%.

The researchers note limitations of the study, such as the tendency for cancer patients with advanced disease not to participate in surveys, which may translate to an underestimate of costs. The data don't include some information on the "true burden" of cancer, such as the nonmedical costs for child care, travel, caretakers, and lost productivity.

Even so, the data ''enhances our understanding of the burden of cancer on specific payers and how this burden may change as a result of healthcare reform measures or other changes to healthcare financing and delivery,'' the authors write.

2-D & 3-D Ultrasound images of normal fetal spine

Ultrasound images of normal anatomy and appearances of fetal spine:
*This 2-D, ultrasound image shows the sagittal section of the normal fetal spine in longitudinal section. (Image courtesy of Dr. Ravi Kadasne, UAE).

3-D Ultrasound images of normal fetal spine:

*Sonography of fetal spine using 3-D/ 4-D ultrasound reveals greater detail of the fetal spine in 3-Dimensions. Ultrasound visualizes the ossified part of the fetal spine. The 3 main ossification centers in the fetal vertebrae are:
a) the centrum b) the right neural process and c) the left neural process.

The centrum forms the central part of the vertebral body. The postero-lateral parts of the vertebrae are formed by the right and left neural processes. (These 3-D ultrasound images are courtesy of Dr. PK Srivastava, India, and Dr. Ravi Kadasne, UAE).

Ehler's Danlos Syndrome picture

Ehlers-Danos syndrome is a group of inherited disorders characterized by excessive looseness (laxity) of the joints, hyperelastic skin that is fragile and bruises easily, and/or easily damaged blood vessels. The syndrome sometimes involves rupture of internal organs.

Facts on Primary mediastinal large B-cell lymphoma(C.T.)

Primary mediastinal large B-cell lymphoma accounts approximately 5% of large B-cell lymphoma, which are usually disseminated or present in the abdomen. There appears to be a younger age of diagnosis (30s) and female predilection (F:M 3:2), when compared to other large-cell lymphoma, which usually present in the 50s and have a male predilection (M:F 2:1).

Unfortunately from an imaging point of view, these demographics are similar to those of nodular sclerosing Hodgkin lymphoma, which is a common cause of a primarily mediastinal lymphoma.

There Clinical presentation is usually due to the mass effect of the typically large anterior mediastinal mass. SVC compression resulting in SVC syndrome is relatively common, present in up to 35% of cases.

Radiographic features

The vast majority of patients have an anterior mediastinal mass. Middle and posterior mediastinal involvement, either in isolation or contiguously with the anterior mediastinal component is uncommon.

Plain film

Chest radiography demonstrates a soft tissue anterior mediastinal mass.


CT of the chest usually shows:

* soft tissue attenuating mass

* usually large at diagnosis ~10cm diameter

* mass effect common

  • bowing and compression of trachea
  • SVC obstruction : up to 35% cases
* cystic areas are common : up to 44%

* calcification pre-treatment is uncommon, but recognised

* chest wall invasion may occur

* pleural effusion(s) / pericardial effusion

  • seen in up to a third of cases
  • pleural effusion may be associated with poor outcome
“CT of the chest of 22 year old demonstrates a large mediastinal mass with significant external compression of the SVC. A moderately sized pericardi...”

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