The lady between two majors

Bicipital groove: attachments of muscles near it

"The lady between two majors" :

Teres major attaches to medial lip of groove.
Pectoralis major to lateral lip of groove.
Latissimus (Lady) is on floor of groove, between the 2 majors.

Myocardial ischemia in older patients

Which of the following symptoms is more likely to represent myocardial ischemia in older patients?

• A) Chest pain
• B) Dyspnea
• C) Diaphoresis
• D) Back pain
• E) Jaw pain

Answer and Discussion

The answer is B.
Exertional angina (chest pain) is the most common manifestation of myocardial ischemia in young and middle-age persons. Because of their more sedentary lifestyle or possibly a difference in pathophysiology, this may not be true in elderly patients. Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients. Other elderly patients with CAD may be completely asymptomatic, although silent ischemia may be demonstrated by stress testing or Holter monitoring.

Note:

Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients.

Synthesis of eicosanoid autacoids

The eicosanoids are an important group of endogenous fatty acid derivatives that are produced from arachidonic acid, a 20-carbon fatty acid lipid in cell membranes................

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Applied Basic Science for Basic Surgical Training (MRCS Study Guides)

This title is directed primarily towards health care professionals outside of the United States. It has been written to encompass the basic anatomy, physiology and pathology required by the syllabus of the UK Royal Colleges and the Intercollegiate Surgical Curriculum Project. For this Second Edition many of the chapters have been updated, especially the chapters on immunology, basic microbiology, the endocrine and locomotor systems and the breast. An attempt has been made throughout to indicate the clinical relevance of the facts and the reason for learning them. There are several new contributors to the author team, all of whom are experts in their field and many of them are, or have been, experienced examiners at the various UK Royal Colleges.

Thoroughly revised to take account of latest changes in basic surgical training, especially the chapters on immunology, basic microbiology, the endocrine and locomotor systems and the breast.

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Diagram of meniscal tear patterns

Meniscal injuries can be classified according to their tear patterns. A vertical or longitudinal tear occurs in line with the circumferential fibers of the meniscus . If long enough, this tear is known as a bucket-handle tear. At arthroscopy, the bucket-handle tear may be seen as being attached anteriorly and posteriorly. Alternatively, it may be detached at either end or transected in the middle with unstable anterior and posterior flaps. A bucket-handle tear may displace into the intercondylar notch, where it may cause true locking of the knee joint.

(A) Vertical or longitudinal (Bucket-handle), (B) Flap or Oblique, (C) Radial or Transverse, (D) Horizontal, (E) Complex degenerative.

-Oblique tears are also known as flap or parrot beak tears and are perhaps the most common . These occur generally at the junction of the posterior and middle thirds.

-Radial tears occur in a similar location. They extend from the inner free margin toward the periphery . If such a tear reaches the periphery, it transects the meniscus and renders the hoop stress-distributing capacities of the meniscus useless. Such a tear is the functional equivalent of a total meniscectomy.

-Horizontal cleavage tears usually occur in older individuals. They extend from the inner free margin peripherally to the intrameniscal substance where myxoid degeneration may be present. These tears divide the meniscus into superior and inferior flaps, either of which may be unstable

-Complex degenerative tears occur in older patients. Osteoarthritic changes may be visible on plain radiographs, and chondromalacia of the articular surfaces is commonly encountered. The tears occur in multiple planes .

Nutcracker phenomenon

It results most commonly from the compression of the left renal vein between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal view, the SMA and AA (with some imagination) appear to be a nutcracker crushing a nut (the renal vein).
There is a wide spectrum of clinical presentations and diagnostic criteria are not well defined resulting in frequently delayed or incorrect diagnosis. This condition is not to be confused with superior mesenteric artery syndrome, which is the compression of the third portion of the duodenum by the SMA and the AA.

This Computed tomography for a 52-year-old woman with mild episodic gross hematuria revealed compression of the left renal vein between the superior mesenteric artery (SMA) and the aorta (Ao) before the vein merges into the inferior vena cava (IVC). This compression caused marked dilatation of the distal part of the renal vein (RV). The renal venous congestion caused hematuria, presumably through the rupture of submucosal veins into the renal pelvis. No treatment was given. Entrapment of the renal vein is a known cause of hematuria.

ABO Blood Types

New - Laparoscopic Repair of Incarcerated Ventral Hernia