Monday, July 26, 2010



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

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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.

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