Sunday, September 26, 2010

Rectal bezoars in children

A bezoar is a solid mass formed in the gastrointestinal tract as a result of the consumption of indigestible or poorly digestible substances. Bezoars most commonly form in the stomach, but can occur in the small intestine and, rarely, in the colon or rectum. They are usually classified according to the material of which they are derived, for example, trichobezoars (hair), lactobezoars (milk curd), phytobezoars (plant fibre) and medication bezoars. The term originates from the Arabic term badzehar, meaning "antidote," a reference to historical medicinal use of these concretions found in animal gastrointestinal tracts in the treatment of human poisonings.

See this case of a previously well 8 year-old boy was brought to the emergency department with a three-day history of constipation. He had consumed three handfuls of flavoured unshelled sunflower seeds four days previously. His mother had unsuccessfully tried several sodium biphosphate and sodium phosphate enemas at home, as well as the use of bran to aid defecation. On examination, the patient’s abdomen was soft and nontender with normal bowel sounds. A bolus of stool mixed with unshelled sunflower seeds was visible at the anus.

A radiograph of the abdomen showed stool extending from the descending colon down to the rectum, which contained a large mass . Oral phosphate soda and a mineral oil enema were ineffective. The patient was taken to the operating room for digital and instrumental extraction under general anesthesia. He was monitored in hospital for 24 hours and discharged when he was taking liquids and passing soft stool.

Although small rectal bezoars may pass spontaneously, options for the care of patients presenting to clincians with symptomatic rectal bezoars include the use of enemas and extractions with conscious sedation or general anesthesia. Formation of bezoars from sunflower seeds may be more likely in children or preteens who are unable or unwilling to spit out the shells, particularly with flavoured shells.

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Oxyhemoglobin dissociation curve


Current Indications for Tonsillectomies

Tonsillectomy-strong indications

1. Carcinoma of the tonsil. The best technique for optimal results from biopsy and staging requires complete removal of the tonsil.
2. Peritonsillar abscess (PTA) . A bacterial abscess, PTA is most often caused by anaerobic organisms. Incision and drainage is mandatory. Recurrent abscess rate is 10% and recurrent abscess may be fatal. Therefore, the tonsil should be removed. This may be done at the time of the initial PTA presentation or may be done electively 6 weeks later.
3. Congestive heart failure. Failure of the right-side of the heart can be caused in young children by a constant upper airway obstruction (SDB/OSA). This is reversed by tonsillectomy.
4. Tonsillitis causing respiratory difficulties, dysphagia, and requiring hospitalization. Any episode of tonsillitis causing respiratory embarrassment, or so severe that hospitalization is required, is best treated by elective tonsillectomy 6 weeks after the episode.

Tonsillectomy-philosophic indications

1. Recurrent tonsillitis. It is currently believed by most otolaryngologists that a patient having four or more episodes of tonsillitis a year for at least 2 years that necessitates their missing 10 or more days a year of school or work will benefit from a tonsillectomy.
2. Sleep disturbances. Sleep disordered breathing/obstructive sleep apnea, and snoring can be caused by upper respiratory tract lymphoid tissues that prolapse into and obstruct the airway during sleep. In these cases, tonsillectomy, adenoidectomy, and even partial palatectomy with uvulectomy (UP3) may improve the airway.


differential diagnosis of inflammatory neck mass

Algorithm for differential diagnosis of inflammatory neck mass. Dx = diagnosis; CT = computed tomography; CBC = complete blood cell count; PT = patient; Bx = biopsy; WBC = white neck mass. Dx = diagnosis; CT = computed tomography; CBC = complete blood cell count; PT = patient, Bx = biopsy; WBC = white blood cell count.

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American Diabetes Association Complete Guide to Diabetes

American Diabetes Association | English | 2005-08-15 | ISBN: 1580402372 | 554 pages | PDF | 3,3 MB

The ADA's bestselling resource on living with and managing diabetes
The organization's flagship book on diabetes care, and American Diabetes Association Complete Guide to Diabetes is the quintessential sourcebook for people who want to take charge of their disease for a lifetime. Containing detailed explanations and step-by-step instructions on self-managing diabetes, this definitive guide arms readers with hundreds of effective self-care techniques to solve scores of common diabetes-related problems─safely and easily.

This completely revised fourth edition is filled with the latest information about:
• Insulin and oral diabetes medications
• Tools and techniques for managing diabetes
• Meal Planning, including sample meal plans
This mega-volume also includes chapters on gestational diabetes, glucose control, health care professionals, the ins and outs of insulin, healthy eating, diabetes tools, health insurance and hospital stays, and much more.

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Epley maneuver for Vertigo

The manuever starts sitting upright . This maneuver should be done by a doctor or physical therapist both for safety (you may be dizzy) and to observe the eye movements.

This maneuver is done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed. When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo will move freely and no longer cause symptoms.

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure. It was invented by Dr. John Epley.
It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV( Benign Paroxysmal Positional Vertigo ) after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

When performing the Epley maneuver, caution is advised should neurological symptoms (for example, weakness, numbness, visual changes other than vertigo) occur. Occasionally such symptoms are caused by compression of the vertebral arteries ), and if one persists for a long time, a stroke could occur.

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Carpal Tunnel Choices

This 3D medical animation depicts carpal tunnel syndrome and carpal tunnel release. Carpal tunnel syndrome is a nerve disorder of the hand caused by compression of the median nerve.2 different types of carpal tunnel release are animated, an open carpal tunnel procedure and the endoscopic approach.

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