Wednesday, November 24, 2010

Apthous Ulcers

Apthous Ulcers: Large oral ulcers in patient infected with HIV.SEE VIDEO


Spirotome Bone biopsy for osteolytic lesions under CT guidance

Soft tissue biopsy from osteolytic lesions is a challenge for the interventionist. The Spirotome Bone is conceived for this intervention. The procedure is straigthforward and produces tissue specimens of high quality in sufficient amounts to allow quantitative molecular biology.

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Yearbook of Intensive Care and Emergency Medicine - Febuary 2010 Edition

The Yearbook compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

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Abscess in Abdominal Wall

An 83-year-old man with hypertension presented with a 3-month history of a painful, progressively enlarging mass in the right subcostal region. He reported no associated constitutional symptoms and no history of abdominal surgery. Local examination revealed a tender, erythematous, fluctuant mass, 3 cm by 2 cm, with clinically significant surrounding induration and an underlying fixed mass (Panel A).

Computed tomography revealed that the mass was communicating with a large gall bladder mass (Panel B, arrow). Ultrasonography-guided needle biopsy, along with histologic and immunocytochemical examinations, confirmed that the mass was an adenocarcinoma of the gall bladder. The patient did not agree to any further evaluation or treatment. He was discharged with plans for palliative care and died 5 weeks later.

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Severe pulmonary hypertension increases right ventricular afterload and eventually leads to the clinical syndrome of right heart failure with systemic congestion and inability to adapt right ventricular output to peripheral demand at exercise. Many patients with advanced COPD present with ankle edema but normal right atrial pressures (at rest). This apparent paradox has stimulated speculation that edema in COPD might be a renal rather than a right ventricular problem .

However, it is now better realized that edema in COPD is likely to be initially caused by repeated stretching of the right atrium from increased right ventricular diastolic pressures at exercise or conceivably with oxygen desaturation during sleep, causing increased sympathetic nervous system tone and activation of the renin-angiotensin-aldosterone system, with resultant renal salt and water retention.
 Renal salt and water retention may be aggravated by hypercapnia, which directly increases proximal tubular reabsorption of sodium, but also activates the sympathetic nervous system and the renin-angiotensin-aldosterone system, which causes additional distal tubular sodium reabsorption through amiloride-sensitive sodium channels.

In summary, and as summarized in , systemic congestion in COPD is caused by right heart failure, involving mechanisms that are very similar to those accounting for systemic and pulmonary congestion in left heart failure, but with an important additional contribution of hypercapnia .

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