Thursday, November 18, 2010

Hyperlipidemia: Cholesterol Guidelines

Dr. Melissa Stiles interviews Dr. Patrick McBride about the NCEP Adult Treatment Panel III Cholesterol Guidelines.
Part 1

Part 2

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Just the Facts in Pediatrics

Everything a resident or clinician needs-to-know about pediatric medicine in a concise bulleted format. Written by a preeminent team of clinicians from the top children’s hospitals in the country, this quick-reference and board review is organized according to the clinical issues tested on the Board of Pediatrics Examination.

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Berry aneurysm

A berry aneurysm refers to an intracranial aneurysm with a characteristic shape which accounts for the vast majority of intracranial aneurysms as well as non-traumatic subarachnoid haemorrhages. They occur at branch points, usually of sizable vessels, but sometimes at the origin of small perforators which may not be seen on imaging.

This photo on the right is Photo of a Norwegian blueberry.


The aneurysmal pouch is composed of thickened hyalinised        intima with the muscular wall & internal elastic lamina being absent.

Comments required on a radiology report:

* size : ideally 3 axis maximum size meansurements
* neck : maximal width of the neck of the aneurysm
* shape and lobulations
* orientation : the direction in which the aneurysm points is often important in both endovascular and surgical planning
This small berry aneurysm projecting inferiorly from the ACOM had pushed into the optic chiasm causing a bitemporal hemianopia, similar to that seen in pituitary lesions.

SAH angiogram

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Extraglottis Devices

Vertebroplasty with Procedure Demonstration

What is Vertebroplasty :
The vertebral column or backbone tends to get weak as a person gets old. This is more common in women since female hormones are necessary for normal mineralization. The weak bones in the spine collapse, producing painful fractures. Till a few years ago the only treatment that was available for condition was a major surgery. However thanks to interventional radiology today a fractured bone of the spine can be strengthened by injecting a specialized medical cement ( bone cement) into the diseased vertebral body .

Procedure Demonstration :
Stryker Vertebroplasty uses a specially formulated acrylic bone cement to stabilize and strengthen the fracture and vertebral body. Its done on an outpatient basis and requires only a local anesthetic and mild sedation, eliminating the complications that may result from open surgery and general anesthesia. Stryker Vertebroplasty is considered a minimally invasive procedure because it is done through a small puncture in the patients skin (as opposed to an open incision). Technically simple, it usually takes about 30 minutes to complete.

Using sterile technique and fluoroscopic visualization, a 10-, 11- or 13- gauge needle is advanced into the fractured vertebra using a transpedicular approach. Bi-pedicular needle placement is recommended. Once the needles are in the correct position, bone cement is slowly injected into the vertebral body, diffusing throughout the intertrabecular marrow space and creating an internal cast that stabilizes the bone.

Following the procedure, patients lie flat on their back for a short period of time as the cement continues to harden. They may then go home. Almost all patients undergoing Stryker Vertebroplasty experience 90% or better reduction in pain within 24-48 hours and increased ability to perform daily activities shortly thereafter.

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In lungs: good side down

If a patient has significant right-sided lung disease, his or her preferred recumbent position would be which of the following? Why?
  • a.Right lateral decubitus position
  • b.Left lateral decubitus position
  • c.Prone position...........
Read more..............>>

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