Thursday, December 23, 2010

Osteoporosis of aging (senile or postmenopausal osteoporosis)

Most common form of generalized osteoporosis. As a person ages, the bones lose density and become more brittle, fracturing more easily and healing more slowly. Many elderly persons are also less active and have poor diets that are deficient in protein. Females are affected more often and more severely than males, as postmenopausal women have deficient gonadal hormone levels and decreased osteoblastic activity.

 Osteoporosis of aging. Generalized demineralization of the spine in a postmenopausal woman. The cortex appears as a thin line that is relatively dense and prominent (picture-frame pattern).

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Robotic-Assisted Repair of Diaphragmatic Hernia


Manual of Nephrology: Diagnosis and Therapy

"Manual of Nephrology: Diagnosis and Therapy" by Robert W. Schrier
L W W | 336 pages | English | 2008, 7 edition | ISBN: 0781796199 | CHM | 2,0 MB

Now in its Seventh Edition, this best-selling Spiral Manual is a practical quick-reference guide to the diagnosis and treatment of renal disorders. The book covers all common renal problems in a user-friendly outline format designed for rapid information retrieval. Coverage includes acute and chronic kidney diseases, fluid and electrolyte disorders, acid-base disturbances, urinary tract infections, kidney stones, and hypertension.

Highlights of this Seventh Edition include updated information on kidney disease in diabetes. A chapter on drug dosing in patients with renal impairment provides specific recommendations for over 500 drugs.

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Clinical Examination By Nicholas J. Talley, Simon O'Connor
Publisher: Chu.rchill 2005 | 520 Pages | ISBN: 0729537625 | CHM | 37 MB

The new 5th edition of Clinical Examination continues to serve all medical students with a clear and understandable explanation of clinical examination. Set out logically and systematically, this best-selling textbook has comprehensive coverage of essential skills necessary for history taking and examining the patient. Highly regarded by students world-wide, this text continues to grow in strength. Clinical Examination, 5th edition has been revised and updated to include: more evidence-based medicine; new full-color artwork; and a fresh new look allowing greater accessibility for readers. The new edition covers clinical examination and concepts in a systems approach in a clear, consistent and user-friendly approach.

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CT interpretation : pancreas cancer with liver metastasis

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Toxoplasmosis in Immune-Suppressed Patients

Toxoplasma encephalitis (inflammation of the brain) and Toxoplasma myocarditis (inflammation of the heart) are well recognised opportunistic infections in patients who are immune suppressed, particularly in relation to AIDS and chemotherapy for cancer. The Toxoplasma encephalitis has the usual appearance of an encephalitis from any cause, that is, focal areas of death of cerebral tissue associated with a mononuclear inflammatory cell infiltrate. But in addition, Toxoplasma cysts are found in the affected brain tissue.

This figures are from the heart of a middle aged male who died from AIDS. The Toxoplasma cyst is expanding the myocardial muscle fibre. In this case there is no inflammatory reaction associated with the cyst. The presence of an inflammatory reaction is variable.

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Cellulitis PIC

Cellulitis: Severe bilateral inflammation and swelling of the legs.

Acute inflammation is clearly seen in the image on the left. The picture on the right is of a
normal foot for comparison.

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Anatomy on Thyroid sonography

The anterior neck is depicted rather well with standard gray scale sonography. (FIGURE 1) The thyroid gland is slightly more echo-dense than the adjacent structures because of its iodine content. It has a homogenous ground glass appearance. Each lobe has a smooth globular-shaped contour and is no more than 3 - 4 centimeters in height, 1 - 1.5 cm in width, and 1 centimeter in depth. The isthmus is identified, anterior to the trachea as a uniform structure that is approximately 0.5 cm in height and 2 - 3 mm in depth.
The pyramidal lobe is not seen unless it is significantly enlarged. In the female, the upper pole of each thyroid lobe may be seen at the level of the thyroid cartilage, lower in the male. The surrounding muscles are of lower echogenicity than the thyroid and tissue planes between muscles are usually identifiable. The air-filled trachea does not transmit the ultrasound and only the anterior portion of the cartilaginous ring is represented by dense, bright echoes. The carotid artery and other blood vessels are echo-free unless they are calcified. The jugular vein is usually in a collapsed condition and it distends with a Valsalva maneuver. There are frequently 1-2 mm echo-free zones on the surface and within the thyroid gland that represent blood vessels. The vascular nature of all of these echoless areas can be demonstrated by color Doppler imaging to differentiate them from cystic structures (10-11).
Lymph nodes may be observed and nerves are generally not seen. The parathyroid glands are observed only when they are enlarged and are less dense ultrasonically than thyroid tissue because of the absence of iodine. The esophagus may be demonstrated behind the medial part of the left thyroid lobe, especially if it is distended by a sip of water. (FIGURE 2)
Figure 1. Sonogram of the neck in the transverse plane showing a normal right thyroid lobe and isthmus. L=small thyroid lobe in a patient who is taking suppressive amounts of L-thyroxine, I=isthmus, T=tracheal ring ( dense white arc is calcification, distal to it is artefact), C=carotid artery ( note the enhanced echoes deep to the fluid-filled blood vessel), J=jugular vein, S=Sternocleidomastoid muscle, m=strap muscle.

Figure 2. Sonogram of the left lobe of the thyroid gland in the transverse plane showing a rounded lobe of a goiter. L=enlarged lobe, I= widened isthmus, T=trachea, C=carotid artery ( note the enhanced echoes deep to the fluid-filled blood vessel), J=jugular vein, S=Sternocleidomastoid muscle, m=strap muscles, E=esophagus.

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