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 )

Explanation
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...................

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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.

Results: 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