Repair of Aortic Arch Dissection

Chronic lymphocytic leukemia, e-pathology

Surface Anatomy of the External Ear

The external ear consists of the auricle and the external auditory canal. The helix rim arises anteriorly and inferiorly from a crus extending horizontally above the external auditory meatus, thus............

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chondrodermatitis Nodularis Helicis

This picture shows the ear of a 74 year old female who has a one year history of a slightly painful lesion on her auricle. The lesion was characteristic of chrondrodermatitis nodularis helicis (CDNH).
CDNH is a slow growing painful lesion which may reach a size of 2 to 4 mm. It begins as a nodule over the cartilage folds of the ear and may progress to form a central crust and ulceration. The cause is unknown but CDNH usually occurs on the side the patient sleeps and may be related to trauma. The most common location is on the mid portion of the antihelix.

Treatment is to excise the lesion and underlying inflamed cartilage. Steroid injections have also been advocated but in my experience they have not been successful.

Heart-Hand syndrome ((Holt-Oram))

Holt-Oram syndrome or heart-hand syndrome, is an inherited disorder characterized by abnormalities of the upper limbs and heart.
People with Holt-Oram syndrome have abnormal development of bones in their upper limbs. At least one abnormality in the bones of the wrist (carpal bones) is present in affected individuals. Often, these wrist bone abnormalities can be detected only by X-ray. Individuals with Holt-Oram syndrome may have additional bone abnormalities including a missing thumb, a long thumb that looks like a finger, partial or complete absence of bones in the forearm, an underdeveloped bone of the upper arm, and abnormalities of the collar bone or shoulder blades.

To see some X-Rays: HERE

The disease is due to mutations in the transcription factor TBX5, which is important in the development of both the heart and upper limbs.
Note that Abnormalities may be unilateral or bilateral and asymmetric ( usually the left side is more affected).

About 75 percent of individuals with Holt-Oram syndrome have some cardiac abnormality. In most patients, the abnormality is either an atrial septal defect (ASD) or a ventricular septal defect (VSD), which varies in number, size, and location.

What is Geographic Tongue !!

This 61-year-old man was referred for treatment of painless white lesions on his tongue that had appeared 1 month earlier. He had been treated with topical and systemic antifungal drugs for presumed oral candidiasis, but the lesions remained unchanged. The patient reported that a similar episode 1 year earlier had resolved spontaneously.
Lingual examination revealed multiple erythematous patches with an annular, well-demarcated white border. A diagnosis of geographic tongue was made.

Geographic tongue (benign migratory glossitis) is a benign inflammatory condition that affects approximately 2% of the world's population. The classic manifestation is a maplike distribution of erythema caused by atrophy of the filiform papillae of the tongue, surrounded by a white hyperkeratotic rim. The lesions typically resolve spontaneously without sequelae but can develop quickly in other areas of the tongue.

Atlas of Urologic Surgery

B. Saunders. Univ. of Calfornia School of Medicine, San Francisco.
Atlas of surgical technique for urologists. Extensive halftone line drawings with commentary.

PART 1    -      PART 2

Some contraindication to Exercise during pregnancy

Which of the following is not a contraindication to exercise during pregnancy?

• A) Pregnancy induced hypertension (PIH)
• B) Incompetent cervix
• C) Preterm labor during a prior pregnancy
• D) Placenta previa
• E) All are contraindications

The answer is :  ( E ).

Although supportive data is limited, there appears to be no reason why women who are in good health should not be permitted to engage in exercise while pregnant. However, women with medical or obstetric complications should be encouraged to avoid vigorous physical activity. Given the current lack of data, a conservative approach is warranted when doubt exists.

Contraindications to exercise during pregnancy include PIH, preterm rupture of membranes, preterm labor during the prior or current pregnancy, incompetent cervix or cerclage placement, persistent second- or third-trimester bleeding, placenta previa, and intrauterine growth retardation.