Wednesday, October 6, 2010

Thoracic Aortic Aneurysm

The most frequent cause of Aortic Aneurysms is atherosclerosis. Major risk factors include a high level of LDL cholesterol, smoking, and diabetes. The arterial wall thins as result of destruction of the media and a localized dilatation occurs (aneurysm).

You can see the aneurysm here as a bulge in the thoracic aorta. Atherosclerosis is usually more severe distally in the aorta, perhaps because the blood flow might be more turbulent here. So most atherosclerotic aneurysms occur in the abdomen, although the pulse pressure is actually higher in the chest.

Advanced syphilis, the classic cause of thoracic aortic aneurysms, is thankfully uncommon today.

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A Case of Purple Urine.

A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. Torsades de pointes was noted on telemetry monitoring.
When a urinary catheter was placed, purple urine was drained. The patient had no fever, lower urinary tract symptoms, or leukocytosis.

The urinalysis showed a pH of 9.0 and bacteriuria but no hematuria or pyuria. The urine culture showed 10 power 5 colony-forming units or more per milliliter for both Pseudomonas aeruginosa and enterococcus species. Over the next 3 days, the urine gradually became yellow and clear, in the absence of antibiotic treatment.

Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species. The clinical course is benign, and the urine typically clears with resolution of the bacteriuria and acidification of the urine. This patient had no further episodes of torsades de pointes and returned to the nursing home in stable condition.


Excellent videos explain Crohn's Disease



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USMLE Catecholamine synthesis

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Tennis elbow (lateral epicondylar tendonitis)

A 20y old woman presents complaining of proximal forearm pain exacerbated by extension of the wrist against resistance with the elbow extended. She denies trauma but is an avid racquetball player. Which of the following is the most likely diagnosis?
  • a.Lateral epicondylar tendonitis
  • b.Medial epicondylar tendonitis
  • c.Olecranon bursitis
  • d.Biceps tendinitis
  • e.Long thoracic nerve early paralysis

The answer is (a).
Tennis elbow or lateral epicondylar tendonitis is most commonly characterized by ................

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Acute Care Surgery: Principles and Practice

The practice of general and trauma surgery frequently involves a broad range of emergency situations. Surgeons must be familiar with diagnosis and operative management principles in the fast-paced environment of the emergency setting. Acute Care Surgery: Principles and Practice comprehensively presents the full spectrum of surgical emergencies, including trauma and non-traumatic acute surgical diseases of the abdominal, pelvic, and cardiothoracic organs as well as the extremities, skin and soft tissue, and head and neck. Management of surgical infections is also discussed. Edited by an internationally renowned trio of experts, Acute Care Surgery is the ideal reference text for surgical trainees as well as practicing surgeons. Authoritative, comprehensive, and user- friendly, the text features over 40 chapters complete with case studies as well as question and answer commentaries. Every chapter begins with a box highlighting the key points and current areas of controversy. In addition to clinically focused discussions on surgical emergencies in all the major organ systems, the editors include chapters on basic principles of initial assessment and early resuscitation, anesthesia and emergency surgery, the intensive care unit, pharmacology and pharmacokinetics in the emergency setting, and management of the hemodynamically labile patient. In addition, a timely section on ethics and legal issues discusses the challenges of providing care in the emergency setting with chapters on advanced directives, informed consents, and organ procurement. The text is augmented by more than 500 tables and illustrations. emergency surgery is destined to be the gold-standard reference for surgeons faced with split-second decision making in the acute setting.

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