Anatomy
Human anatomy can be precisely defined as a complementary basic medical science, which deals with the scientific study of morphology of human body. In simpler words, human anatomy is the study of structure of human body.Learn about human physiology as you study anatomical charts and models of every system in the human body!
Saturday, September 17, 2011
Dermatomyositis
10:21 AM
gagen
Dermatomyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness. Dermatomyositis’ cardinal symptom is a skin rash that precedes, accompanies, or follows progressive muscle weakness. The rash looks patchy, with purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, knees, and toes. Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement. Adults with dermatomyositis may experience weight loss, a low-grade fever, inflamed lungs, and be sensitive to light such that the rash or muscle disease gets worse. Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis). Calcinosis most often occurs 1-3 years after the disease begins. These deposits are seen more often in children with dermatomyositis than in adults. In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses. Dermatomyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus.
The association between dermatomyositis (and possibly polymyositis) and malignancy has been recognized for a long time. Dermatomyositis is a systemic disorder that frequently affects the esophagus and lungs and, less commonly, the heart. Calcinosis is a complication of dermatomyositis that is observed most often in children and adolescents.
Case no.2
6:22 AM
gagen
A 56-year-old woman presented with complaints of an ulcerating lesion at the inner corner of right eye for the past 8 months. There had been an off and on history of yellowish discharge from the lesion; occasionally it is blood tinged. She had a history of trauma with a wooden stick at the affected site, 10 months earlier. Clinically, a firm mass could be palpated. Extraocular movements were full. Slit lamp and fundus examination were within normal limits in both eyes. CT scan showing coronal and axial view is shown above.
1. The most probable diagnosis is:
a. sebaceous gland carcinoma
b. canaliculitis (Actinomyces)
c. chronic dacryocystitis with fistula
d. basal cell carcinoma
2. The treatment would be:
a. curettage of canaliculi and Amphoteracin B
b. dacryo-cystorhinostomy with stent
c. incisional biopsy
d. wide excision of the lesion with margin control
Friday, September 16, 2011
Thursday, September 15, 2011
Staring At An Eclipse Can Blind You
7:53 AM
bolty
True. Never view the sun directly with the naked eye or with any unfiltered optical device, such as binoculars or a telescope!.
As sunlight enters the eye, it can damage the light-sensitive nerve endings in the back of the eye -- known as the retina -- causing vision loss.
Total and partial eclipses can lead to serious damage if precautions are not taken to prevent blindness. This is why there are only a few safe ways to view an eclipse, such as with a referred image. Regular sunglasses, exposed film, and even a welder's helmet are not safe.
As sunlight enters the eye, it can damage the light-sensitive nerve endings in the back of the eye -- known as the retina -- causing vision loss.
Total and partial eclipses can lead to serious damage if precautions are not taken to prevent blindness. This is why there are only a few safe ways to view an eclipse, such as with a referred image. Regular sunglasses, exposed film, and even a welder's helmet are not safe.
Waardenburg syndrome
5:04 AM
bolty
Waardenburg syndrome (WS) is an inherited disorder often characterized by varying degrees of hearing loss and changes in skin and hair pigmentation. The syndrome got its name from a Dutch eye doctor named Petrus Johannes Waardenburg who first noticed that people with differently colored eyes often had a hearing impairment. He went on to study over a thousand individuals in deaf families and found that some of them had certain physical characteristics in common.
One commonly observed characteristic of Waardenburg syndrome is two differently colored eyes. One eye is usually brown and the other blue. Sometimes, one eye has two different colors. Other individuals with Waardenburg syndrome may have unusually brilliant blue eyes.
One commonly observed characteristic of Waardenburg syndrome is two differently colored eyes. One eye is usually brown and the other blue. Sometimes, one eye has two different colors. Other individuals with Waardenburg syndrome may have unusually brilliant blue eyes.
People with WS may also have distinctive hair coloring, such as a patch of white hair or premature gray hair as early as age 12. Other possible physical features include a wide space between the inner corners of eyes called a broad nasal root. In addition persons with WS may have low frontal hairline and their eyebrows may connect. The levels of hearing loss associated with the syndrome can vary from moderate to profound.
Individuals with Waardenburg syndrome may have some or all of the traits of the syndrome. For example, a person with WS may have a white forelock, a patch of white hair near the forehead, and no hearing impairment. Others may have white patches of skin and severe hearing impairment. The severity of the hearing impairment varies among individuals with WS as do changes in the skin and hair.
On rare occasions, WS has been associated with other conditions that are present at birth, such as intestinal disorders, elevation of the shoulder blade, and disorders of the spine. A facial abnormality, known as cleft lip and/or palate, also has been associated with WS.
Individuals with Waardenburg syndrome may have some or all of the traits of the syndrome. For example, a person with WS may have a white forelock, a patch of white hair near the forehead, and no hearing impairment. Others may have white patches of skin and severe hearing impairment. The severity of the hearing impairment varies among individuals with WS as do changes in the skin and hair.
On rare occasions, WS has been associated with other conditions that are present at birth, such as intestinal disorders, elevation of the shoulder blade, and disorders of the spine. A facial abnormality, known as cleft lip and/or palate, also has been associated with WS.
Pancoast Tumor
4:32 AM
bolty
Pancoast tumors are tumors that form at the extreme apex (very top) of either the right or left lung in the superior sulcus (a shallow furrow on the surface of the lung). Pancoast tumors are a subset of lung cancers that invade the top of the chest wall. Because of their location in the apex of the lung, they invade adjoining tissue.
Pancoast tumors originate at the top margin of the lung. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures:
Pancoast tumors originate at the top margin of the lung. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures:
- Lymphatics (small, thin vessels that carry lymph fluid through the body)
- Lower roots of the brachial plexus (a complex network of nerves that is formed chiefly by the lower 4 cervical [neck] nerves and the first thoracic [chest]nerve)
- Intercostal nerves (nerves that lie between a pair of adjacent ribs)
- Stellate ganglion (a mass of nerve tissue containing nerve cells that form an enlargement on a nerve or on 2 or more nerves at their point of junction or separation)
- Sympathetic chain (either of the pair of ganglionated lengthwise cords of the sympathetic nervous system that are situated on each side of the spinal column)
- Adjacent ribs
- Vertebrae
Carcinomas (cancerous tumors) in the superior pulmonary sulcus produce the Pancoast syndrome, which is characterized by pain in the shoulder and along the inner side of the arm and hand. Pancoast tumors tend to spread to the tissue surrounding them in the early stage of the disease. As long as the cancer has not metastasized (spread) and involved the regional lymph nodes (small, bean-shaped structures found throughout the body), these tumors can be successfully treated.
Wednesday, September 14, 2011
The Man Who Can Eat Everything
5:21 AM
bolty
This basically means the guy can eat and even digest metal, glass and even toxic and poisonous material. Michel Lotito's stomach lining is twice as thick as normal, a rare condition that most doctors agree developed in the womb, though nobody is sure how. Lotito does not often suffer from ill-effects due to his diet, even after the consumption of materials usually considered poisonous.
When performing he consumes around a kilogram of material daily, preceding it with mineral oil and drinking considerable quantities of water during the 'meal'. He apparently possesses a stomach and intestine with walls of twice the expected thickness, and his digestive acids are, allegedly, unusually powerful, allowing him to digest a certain portion of his metallic meals.
Lotito even entered the Guinness book of records when he ate an airplane. The airplane took roughly two years to be 'eaten' from 1978 to 1980
Lotito even entered the Guinness book of records when he ate an airplane. The airplane took roughly two years to be 'eaten' from 1978 to 1980
See the video:
Tuesday, September 13, 2011
Surprising things that give you headaches
11:54 AM
bolty
You've been staring at the computer for hours. You've worked late all week and have in-laws coming this weekend. You have a raging case of PMS. Eyestrain, stress, and hormonal shifts are fairly common causes of headaches, which afflict 45 million Americans (most of them women).
Some people say the roots of their hair hurt when they get a headache.
But sometimes the usual suspects don't explain that pain in your head. That's because some triggers are just plain weird -- like perfume, storms, earrings -- . Here's how to identify the source of your headache so you can send it packing.
Perfume
"Strong scents bother me instantly," says Bethany Hegedus, 35, a writer and receptionist from Brooklyn, New York. She can get a headache from a whiff of Lovely by Sarah Jessica Parker or a stroll past a Yankee Candle. Her sense of smell is so acute that she can sniff out whether a co-worker has changed laundry detergents or hand lotions, a degree of sensitivity common among scent-driven headache sufferers. The headaches can be fleeting if exposure is brief -- or they can last all day.
Why it hurts: Strong odors may activate the nose's nerve cells, which stimulate the nerve system associated with head pain. Ironically, the offending scents are often pleasant, says Vincent Martin, M.D., a headache specialist at the University of Cincinnati College of Medicine.
What to do: Avoid perfumes, strong household cleansers, fragranced soaps and shampoos, and air fresheners. That's a challenge when just about everything these days is "Clothesline Clean" or "Citrus Fresh," but Hegedus does her best with unscented laundry detergent and deodorant, and wears no fragrances. At the office, she politely asks colleagues not to wear heavy perfumes. And if all else fails? "I keep a bottle of Excedrin Extra Strength at my desk," she says. Health.com: A power punch against headaches
That remedy has aspirin, acetaminophen and caffeine, a combination endorsed by several medical organizations for migraine and tension headaches. However, you might want to try aspirin or acetaminophen individually rather than mixed together with caffeine, says Andrew Charles, M.D., director of the Headache Research and Treatment Center at the University of California, Los Angeles, School of Medicine. Frequent use of medicines with caffeine can lead to dependency and "rebound" headaches, the kind that come right back as soon as the meds wear off. Aspirin, ibuprofen, and naproxen treat pain and the inflammation often associated with headaches. Acetaminophen fights pain, but not inflammation. (Another caveat: If over-the-counter meds don't help, a trip to the neurologist may be needed, Martin says.)
Weather
Studies show that the headache-prone are especially attuned to changes in barometric pressure, rising temperatures, high humidity, lightning, and cloudy skies. Rebecca Kinney, a 31-year-old librarian from Newton, Massachusetts, calls herself a human barometer. Gray skies and rain on the way trigger excruciating pain. "The headache is usually on one side of my head, and it pulsates, as if someone is drilling into me," she says.
Why it hurts: The meteorological shifts are thought to trigger chemical and electrical changes in the brain that irritate nerves -- sometimes causing fairly dramatic pain. In fact, "50 to 60 percent of migraine patients will identify a weather change as the trigger for their headaches," Martin says.
What to do: On bad-weather days, Kinney puts an ice compress on her eyes in the morning. "Sometimes I can catch the headache before it gets worse," she says. Another trick: Record your symptoms and the weather to piece together patterns. Then check out the "Aches and Pains" forecast on Weather.com; it breaks down how the day is dawning in terms of temperature, barometric pressure, and wind patterns. Pretreat with 400 milligrams of ibuprofen a day or two before expected weather changes, says Mark W. Green, M.D., director of headache medicine at Columbia University. (Naproxen or aspirin may work, as well.) Health.com: Take that! for pain
Earrings, headbands, and ponytails
Some people say the roots of their hair hurt when they get a headache. Kinney describes it as a "hair cramp." Other women swear that their earrings can lead to head pain. And they're all correct!
Why it hurts: The muscle groups around your scalp don't have pain fibers, but their connective tissues do. "Ponytail headaches" result when tightly pulled hair irritates the muscle system. And your swingy updo isn't the only thing contributing to your pain: Tight-fitting hats, headbands, and heavy earrings are also culprits, says Stephen Silberstein, M.D., director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, Pennsylvania. Why earrings? It's possible that earrings can pull on that same connective tissue. But some studies suggest that skin sensitivity around your scalp, face, and ears often accompanies a migraine. The earring supersensitivity could be a sign that a migraine's coming, but not the cause of the headache.
What to do: It probably didn't take a study in the journal Headache to tell you that loosening your ponytail relieves a ponytail ache. Researchers have found that this simple action decreased headache pain within 30 minutes, and, in some cases, instantly. Kinney makes a conscious effort to reposition her ponytail throughout the day. Typically, the thicker your hair or the heavier your headwear, the more likely you'll experience this type of headache. Best bet: Save tight updos and heavy earrings for nights out, when you won't be wearing them for long. Health.com: Best new pain cures for women
Hunger
There's a reason some nutrition gurus recommend that we eat several small meals a day: It keeps our blood sugar on an even keel. Dieting, fasting, skipping lunch -- they all can cause you to bottom out, which may trigger a headache.
Why it hurts: Experts believe low blood sugar may stimulate nerve pathways that bring on these common headaches, but the exact mechanism is murky.
What to do: Uh, eat? Exactly. But remember that what you grab may play a role in whether your headache returns. "Sugar headaches" may occur when we binge on sweets on an empty stomach. The spike in blood sugar ratchets insulin levels, which eventually cause blood sugar to sink even lower. Instead, balance a protein with a complex carbohydrate, such as fish and brown rice, or a snack of whole-wheat toast with almond butter. Martin adds that eating foods rich in magnesium (spinach, beans, nuts, and seeds) and riboflavin (dairy products, lean meats, leafy greens, enriched breads and cereals) may prevent and alleviate head pain. Riboflavin is a B vitamin; large doses are thought to help prevent migraines.
Bear in mind, too, that cheese, chocolate, lunch meats, caffeine, and additives such as monosodium glutamate (MSG) may trigger headaches. In general, if you suffer from moderate, severe, or frequent headaches (more than two a week), consult a headache specialist about your diet. You may need to keep a food diary to hunt for culprits. Health.com: Could painkillers be hurting your heart?
Some people say the roots of their hair hurt when they get a headache.
But sometimes the usual suspects don't explain that pain in your head. That's because some triggers are just plain weird -- like perfume, storms, earrings -- . Here's how to identify the source of your headache so you can send it packing.
Perfume
"Strong scents bother me instantly," says Bethany Hegedus, 35, a writer and receptionist from Brooklyn, New York. She can get a headache from a whiff of Lovely by Sarah Jessica Parker or a stroll past a Yankee Candle. Her sense of smell is so acute that she can sniff out whether a co-worker has changed laundry detergents or hand lotions, a degree of sensitivity common among scent-driven headache sufferers. The headaches can be fleeting if exposure is brief -- or they can last all day.
Why it hurts: Strong odors may activate the nose's nerve cells, which stimulate the nerve system associated with head pain. Ironically, the offending scents are often pleasant, says Vincent Martin, M.D., a headache specialist at the University of Cincinnati College of Medicine.
What to do: Avoid perfumes, strong household cleansers, fragranced soaps and shampoos, and air fresheners. That's a challenge when just about everything these days is "Clothesline Clean" or "Citrus Fresh," but Hegedus does her best with unscented laundry detergent and deodorant, and wears no fragrances. At the office, she politely asks colleagues not to wear heavy perfumes. And if all else fails? "I keep a bottle of Excedrin Extra Strength at my desk," she says. Health.com: A power punch against headaches
That remedy has aspirin, acetaminophen and caffeine, a combination endorsed by several medical organizations for migraine and tension headaches. However, you might want to try aspirin or acetaminophen individually rather than mixed together with caffeine, says Andrew Charles, M.D., director of the Headache Research and Treatment Center at the University of California, Los Angeles, School of Medicine. Frequent use of medicines with caffeine can lead to dependency and "rebound" headaches, the kind that come right back as soon as the meds wear off. Aspirin, ibuprofen, and naproxen treat pain and the inflammation often associated with headaches. Acetaminophen fights pain, but not inflammation. (Another caveat: If over-the-counter meds don't help, a trip to the neurologist may be needed, Martin says.)
Weather
Studies show that the headache-prone are especially attuned to changes in barometric pressure, rising temperatures, high humidity, lightning, and cloudy skies. Rebecca Kinney, a 31-year-old librarian from Newton, Massachusetts, calls herself a human barometer. Gray skies and rain on the way trigger excruciating pain. "The headache is usually on one side of my head, and it pulsates, as if someone is drilling into me," she says.
Why it hurts: The meteorological shifts are thought to trigger chemical and electrical changes in the brain that irritate nerves -- sometimes causing fairly dramatic pain. In fact, "50 to 60 percent of migraine patients will identify a weather change as the trigger for their headaches," Martin says.
What to do: On bad-weather days, Kinney puts an ice compress on her eyes in the morning. "Sometimes I can catch the headache before it gets worse," she says. Another trick: Record your symptoms and the weather to piece together patterns. Then check out the "Aches and Pains" forecast on Weather.com; it breaks down how the day is dawning in terms of temperature, barometric pressure, and wind patterns. Pretreat with 400 milligrams of ibuprofen a day or two before expected weather changes, says Mark W. Green, M.D., director of headache medicine at Columbia University. (Naproxen or aspirin may work, as well.) Health.com: Take that! for pain
Earrings, headbands, and ponytails
Some people say the roots of their hair hurt when they get a headache. Kinney describes it as a "hair cramp." Other women swear that their earrings can lead to head pain. And they're all correct!
Why it hurts: The muscle groups around your scalp don't have pain fibers, but their connective tissues do. "Ponytail headaches" result when tightly pulled hair irritates the muscle system. And your swingy updo isn't the only thing contributing to your pain: Tight-fitting hats, headbands, and heavy earrings are also culprits, says Stephen Silberstein, M.D., director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, Pennsylvania. Why earrings? It's possible that earrings can pull on that same connective tissue. But some studies suggest that skin sensitivity around your scalp, face, and ears often accompanies a migraine. The earring supersensitivity could be a sign that a migraine's coming, but not the cause of the headache.
What to do: It probably didn't take a study in the journal Headache to tell you that loosening your ponytail relieves a ponytail ache. Researchers have found that this simple action decreased headache pain within 30 minutes, and, in some cases, instantly. Kinney makes a conscious effort to reposition her ponytail throughout the day. Typically, the thicker your hair or the heavier your headwear, the more likely you'll experience this type of headache. Best bet: Save tight updos and heavy earrings for nights out, when you won't be wearing them for long. Health.com: Best new pain cures for women
Hunger
There's a reason some nutrition gurus recommend that we eat several small meals a day: It keeps our blood sugar on an even keel. Dieting, fasting, skipping lunch -- they all can cause you to bottom out, which may trigger a headache.
Why it hurts: Experts believe low blood sugar may stimulate nerve pathways that bring on these common headaches, but the exact mechanism is murky.
What to do: Uh, eat? Exactly. But remember that what you grab may play a role in whether your headache returns. "Sugar headaches" may occur when we binge on sweets on an empty stomach. The spike in blood sugar ratchets insulin levels, which eventually cause blood sugar to sink even lower. Instead, balance a protein with a complex carbohydrate, such as fish and brown rice, or a snack of whole-wheat toast with almond butter. Martin adds that eating foods rich in magnesium (spinach, beans, nuts, and seeds) and riboflavin (dairy products, lean meats, leafy greens, enriched breads and cereals) may prevent and alleviate head pain. Riboflavin is a B vitamin; large doses are thought to help prevent migraines.
Bear in mind, too, that cheese, chocolate, lunch meats, caffeine, and additives such as monosodium glutamate (MSG) may trigger headaches. In general, if you suffer from moderate, severe, or frequent headaches (more than two a week), consult a headache specialist about your diet. You may need to keep a food diary to hunt for culprits. Health.com: Could painkillers be hurting your heart?
Monday, September 12, 2011
Saturday, September 10, 2011
Chimera
6:38 AM
bolty
Chimera: In medicine, a person composed of two genetically distinct types of cells. Human chimeras were first discovered with the advent of blood typing when it was found that some people had more than one blood type. Most of them proved to be "blood chimeras" -- non-identical twins who shared a blood supply in the uterus. Those who were not twins are thought to have blood cells from a twin that died early in gestation. Twin embryos often share a blood supply in the placenta, allowing blood stem cells to pass from one and settle in the bone marrow of the other. About 8% of non-identical twin pairs are chimeras.
Many more people are microchimeras and carry smaller numbers of foreign blood cells that may have passed from mother across the placenta, or persist from a blood transfusion. In vitro fertilization (IVF) is also contributing to the number of human chimeras. To improve success rates, two or more embryos are placed in the uterus so women who have IVF have more twin pregnancies than usual. More twins mean more chimeras.
In Greek mythology, the Chimera was an awesome fire-breathing monster with the head of a lion, the body of a goat, and the tail of a serpent. The Chimera was killed by the hero Bellerophon mounted, in most versions of the tale, on Pegasus, the winged horse.
Many more people are microchimeras and carry smaller numbers of foreign blood cells that may have passed from mother across the placenta, or persist from a blood transfusion. In vitro fertilization (IVF) is also contributing to the number of human chimeras. To improve success rates, two or more embryos are placed in the uterus so women who have IVF have more twin pregnancies than usual. More twins mean more chimeras.
In Greek mythology, the Chimera was an awesome fire-breathing monster with the head of a lion, the body of a goat, and the tail of a serpent. The Chimera was killed by the hero Bellerophon mounted, in most versions of the tale, on Pegasus, the winged horse.
Mysterie people
6:22 AM
bolty
Chimera |
Instead she received a hammer blow. The letter told her outright that two of her three sons could not be hers. What was going on?
It took Kruskall and her team two years to crack the riddle. In the end they discovered that Jane is a chimera, a mixture of two individuals - non-identical twin sisters - who fused in the womb and grew into a single body. Some parts of her are derived from one twin, others from the other. It seems bizarre that this can happen at all, but Jane's is not an isolated case. Around 30 similar instances of chimerism have been reported, and there are probably many more out there who will never discover their unusual origins.
Spot Diagnosis 005
1:29 AM
bolty
A 9-month-old boy presented with progressive hypotonia and developmental delays, with a weight below the fifth percentile for his age despite a normal food intake. He was born at 38 weeks' gestation after an uncomplicated vaginal birth, and there were no concerns about his growth or development until he was 7 months, when the family physician realized that the boy had been regressing developmentally over the last month. He was not yet sitting, had almost stopped rolling over and had decreased head control. There was no history of seizures or serious illnesses.
Neurological examination revealed a marked central and peripheral hypotonia and normal deep tendon reflexes in his arms and legs. His skin was dry and lax, and his hair was quite coarse and wiry.There were no abnormal birthmarks.
The complete blood count and levels of electrolytes, calcium, magnesium, phosphate, albumin, pre-albumin,total protein, liver enzymes, blood urea nitrogen and creatinine were all within normal limits. The serum copper level was 7.1 μmol/L, and the ceruloplasmin level was 120 mg/L.
Neurological examination revealed a marked central and peripheral hypotonia and normal deep tendon reflexes in his arms and legs. His skin was dry and lax, and his hair was quite coarse and wiry.There were no abnormal birthmarks.
The complete blood count and levels of electrolytes, calcium, magnesium, phosphate, albumin, pre-albumin,total protein, liver enzymes, blood urea nitrogen and creatinine were all within normal limits. The serum copper level was 7.1 μmol/L, and the ceruloplasmin level was 120 mg/L.
Friday, September 9, 2011
The Girl Who Was "Born" Twice
1:26 PM
bolty
When Keri and Chad McCartney went to the ob-gyn to find out the sex of their baby-to-be six months into the pregnancy, they got some unexpected and frightening news: A grapefruit-size tumor was slowly killing the fetus. Doctors had to remove the tumor—although it wasn’t cancerous, it was sucking up the blood that the fetus needed to grow—and to do so, they performed a surgery that has been completed fewer than 20 times.
They brought the baby about 80% out of her mother’s womb, excised the tumor, and then tucked her back in. Ten weeks later, in May 2008, Macie Hope McCartney was born—again. And this time for good.
Source : http://www.cbsnews.com/stories/2008/06/06/eveningnews/main4161410.shtml
They brought the baby about 80% out of her mother’s womb, excised the tumor, and then tucked her back in. Ten weeks later, in May 2008, Macie Hope McCartney was born—again. And this time for good.
Source : http://www.cbsnews.com/stories/2008/06/06/eveningnews/main4161410.shtml
Spot Diagnosis 003
12:55 PM
bolty
A 73-year-old woman presented with new-onset periorbital purpuric, nonblanching, nonpruritic lesions. The lesions appeared spontaneously and were not associated with any recent trauma. She did not take aspirin, non-steroidal anti inflammatory drugs, or any other anticoagulant agents. On physical examination, no similar skin lesions were found elsewhere. In addition, laboratory studies revealed mild impairment of renal function and nephritic-range proteinuria. The blood count showed mild thrombocytopenia (platelet count, 80,000 per cubic millimeter), whereas the prothrombin time and partial-thromboplastin time were normal.
The patient was diagnosed with multiple myeloma 3 years earlier.
What is the diagnosis of the eye lesions ?
The patient was diagnosed with multiple myeloma 3 years earlier.
What is the diagnosis of the eye lesions ?
Thursday, September 8, 2011
Spot Diagnosis 002
4:32 AM
bolty
What is your diagnosis?
Tuesday, September 6, 2011
Treatment And Prognosis for Stevens-Johnson Syndrome
12:55 PM
bolty
Early diagnosis and recognition with prompt withdrawal of all suspected potential causative drugs are essential for a favorable outcome. Morbidity and mortality decrease if the culprit drug is withdrawn no later than the day when blisters or erosions first occurred. No difference was seen for drugs with long half-lives. The patient must be transferred to an intensive care unit or a burn center. Rapid referral reduces risk of infection, mortality rate and period of hospitalization. Supportive care is the mainstay of treatment. Intervention should include intravenous fluid and electrolyte replacement, environmental temperature control, careful and aseptic handling, early initiation of enteral nutrition by nasogastric tube and pain and anxiety control. Many remedies have been proposed for topical care. Silver-sulfadiazine (silverol) should be avoided because it contains sulfa which is one of the culprit drugs capable of inducing SJS-TEN.
Systemic Corticosteroids. Systemic steroid therapy has been the accepted treatment for SJS-TEN for years. It is believed to suppress the intensity and the extension of the necrolytic process in the skin as well as in internal organs.
Conversely, the use of steroids has also almost become a contraindicated mode of therapy. They were regarded as being hazardous, owing to reports of iatrogenic decrease of host resistance, increase of morbidity and complications, prolonged recovery and reduced survival, following their use.
Parallel to the change in regard to steroid treatment in SJS-TEN, the management of this severe disease was shifted to specialized burn centers and was taken over by nondermatologists, mostly surgeons, who sometimes erroneously regarded SJS-TEN and burns as similar entities. However, in terms of etiology and pathogenesis, a burn is a one-time acute event that affects the skin from the outside, whereas SJS-TEN is a more complex, probably immune (T lymphocyte)-mediated process that reaches the skin from within. The disease process continues to progress over a period of several days after first appearance.
Today, in the absence of clinical control trials, most authors believe that systemic steroids are of unproven benefit in early forms of and are clearly harmful in advanced SJS-TEN.
Intravenous Immunoglobulin. As mentioned previously, the results of IVIg treatment are not uniform in all reports. It should be avoided in patients with renal failure, as increased mortality has been observed. Thus, currently intravenous immune globulin is not considered part of the standard of care for TEN.
In conclusion, optimal treatment for the SJS-TEN spectrum remains to be clarified. To date, no specific treatment has been proven to be beneficial for SJS-TEN. The best management is early recognition, prompt withdrawal of causative drugs and supportive care.
Prognosis
In order to rank severity and predict prognosis in TEN patients, the severity-of-illness score (SCORTEN), was developed. The score is a mathematical tool consisting of the sum of seven clinical variables (age, history of malignancy, heart rate, initial epidermal detachment, admission blood urea nitrogen, glucose levels and serum bicarbonate) as prognostic factors.
The SJS-TEN spectrum is an acute illness with potentially life-threatening complications. Reported mortality rates are 5% with SJS, 10-15% with overlap forms and 30-35% with TEN. Most deaths in patients with TEN are a result of sepsis-induced organ failure.
TEN might also result in late complications, such as transitory hyper- and/or hypopigmentation, scarring primarily due to pressure or secondary infections, alopecia, anonychia and sicca-like syndrome. Phimosis and vaginal synechiae may also be present. Ocular sequelae affecting up to 40% of the survivors may cause corneal lesions, which may result in severe impairment of vision. Therefore, intensive ophthalmologic follow-up and treatment is mandatory in patients with the SJS-TEN spectrum.
< Diagnosis
Systemic Corticosteroids. Systemic steroid therapy has been the accepted treatment for SJS-TEN for years. It is believed to suppress the intensity and the extension of the necrolytic process in the skin as well as in internal organs.
Conversely, the use of steroids has also almost become a contraindicated mode of therapy. They were regarded as being hazardous, owing to reports of iatrogenic decrease of host resistance, increase of morbidity and complications, prolonged recovery and reduced survival, following their use.
Parallel to the change in regard to steroid treatment in SJS-TEN, the management of this severe disease was shifted to specialized burn centers and was taken over by nondermatologists, mostly surgeons, who sometimes erroneously regarded SJS-TEN and burns as similar entities. However, in terms of etiology and pathogenesis, a burn is a one-time acute event that affects the skin from the outside, whereas SJS-TEN is a more complex, probably immune (T lymphocyte)-mediated process that reaches the skin from within. The disease process continues to progress over a period of several days after first appearance.
Today, in the absence of clinical control trials, most authors believe that systemic steroids are of unproven benefit in early forms of and are clearly harmful in advanced SJS-TEN.
Intravenous Immunoglobulin. As mentioned previously, the results of IVIg treatment are not uniform in all reports. It should be avoided in patients with renal failure, as increased mortality has been observed. Thus, currently intravenous immune globulin is not considered part of the standard of care for TEN.
In conclusion, optimal treatment for the SJS-TEN spectrum remains to be clarified. To date, no specific treatment has been proven to be beneficial for SJS-TEN. The best management is early recognition, prompt withdrawal of causative drugs and supportive care.
Prognosis
In order to rank severity and predict prognosis in TEN patients, the severity-of-illness score (SCORTEN), was developed. The score is a mathematical tool consisting of the sum of seven clinical variables (age, history of malignancy, heart rate, initial epidermal detachment, admission blood urea nitrogen, glucose levels and serum bicarbonate) as prognostic factors.
The SJS-TEN spectrum is an acute illness with potentially life-threatening complications. Reported mortality rates are 5% with SJS, 10-15% with overlap forms and 30-35% with TEN. Most deaths in patients with TEN are a result of sepsis-induced organ failure.
TEN might also result in late complications, such as transitory hyper- and/or hypopigmentation, scarring primarily due to pressure or secondary infections, alopecia, anonychia and sicca-like syndrome. Phimosis and vaginal synechiae may also be present. Ocular sequelae affecting up to 40% of the survivors may cause corneal lesions, which may result in severe impairment of vision. Therefore, intensive ophthalmologic follow-up and treatment is mandatory in patients with the SJS-TEN spectrum.
< Diagnosis
Diagnosis Of Stevens-Johnson Syndrome
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Doctors often can identify Stevens-Johnson syndrome based on your medical history, a physical exam and the disorder's distinctive signs and symptoms. To confirm the diagnosis, your doctor may take a tissue sample of your skin (biopsy) for examination under a microscope.
No specific laboratory studies (other than biopsy) exist that can definitively establish the diagnosis of Stevens-Johnson syndrome.
- A complete blood count (CBC) may reveal a normal white blood cell (WBC) count or a nonspecific leukocytosis. A severely elevated WBC count indicates the possibility of a superimposed bacterial infection.
- Skin and blood cultures have been advocated because the incidence of serious bacterial bloodstream infections and sepsis contribute to morbidity and mortality.
- Determine renal function and evaluate urine for blood.
- Electrolytes and other chemistries may be needed to help manage related problems.
- Cultures of blood, urine, and wounds are indicated when an infection is clinically suspected.
- Bronchoscopy, esophagogastroduodenoscopy (EGD), and colonoscopy may be indicated.
Skin biopsy is the definitive diagnostic study but is not an emergency department (ED) procedure.
- Skin biopsy specimens demonstrate that the bullae are subepidermal.
- Epidermal cell necrosis may be noted.
- Perivascular areas are infiltrated with lymphocytes.
< Causes Treatment >
Causes Of Stevens-Johnson Syndrome
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Stevens-Johnson Syndrome (SJS) is usually caused by a response to a medicine that has been taken. The response may happen within one week to two months of taking the medicine. SJS may also be caused by infection, vaccinations, or diseases involving your organs or whole body. The cause of SJS may be unknown, and SJS risk may be genetic.
The most common medicines that may cause SJS are:
Bacterial infections include diphtheria, Brucellosis, mycobacteriae, mycoplasma pneumonia and typhoid. Fungal infections previously associated with SJS include coccidioidomycosis, dermatophytosis and histoplasmosis. Certain types of protozoal infections, including malaria and trichomoniasis, have also been reported. Although Stevens Johnson Syndrome is relatively rare in children, it has been associated with Epstein-Barr virus.
< Symptoms Diagnosis >
The most common medicines that may cause SJS are:
- Antibiotics (used to treat infection)
- Anti-seizure medicines (used to treat convulsions).
- Non-steroidal anti-inflammatory medicine (used to treat swelling or fever)
- Penicillins, which are used to treat infections
- Infections
- Drug Reactions
- Malignancies
- Unknown Causes.
Bacterial infections include diphtheria, Brucellosis, mycobacteriae, mycoplasma pneumonia and typhoid. Fungal infections previously associated with SJS include coccidioidomycosis, dermatophytosis and histoplasmosis. Certain types of protozoal infections, including malaria and trichomoniasis, have also been reported. Although Stevens Johnson Syndrome is relatively rare in children, it has been associated with Epstein-Barr virus.
< Symptoms Diagnosis >
Symptoms of Stevens-Johnson Syndrome
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Typically, Stevens-Johnson syndrome affects the mucous membranes of the oral cavity, nostril, eyes, and both the anal and genital regions. It may or may not be associated with skin lesions elsewhere on the body. Oropharyngeal (mouth) lesions may be so intolerable as to prevent eating, and there may be recurring oral ulcers. Often, the skin lesions may look like a target-lesion (3 concentric zones of color change) or as bullae (bubble-like).
A painful conjunctivitis may occur in the eye, frequently with a pus discharge, and can lead to corneal scarring and loss of vision. In addition to the mucous membrane lesions, fever and exhaustion are usual.
Approximately one-third of patients have pulmonary involvement with cough and patchy infiltrates (material that has permeated into the tissues) on chest x-ray. In fatal cases, renal failure and pneumonia may occur.
Signs and symptoms of Stevens-Johnson syndrome include:- Facial swelling
- Tongue swelling
- Hives
- Skin pain
- A red or purple skin rash that spreads within hours to days
- Blisters on your skin and mucous membranes, especially in your mouth, nose and eyes
- Shedding (sloughing) of your skin
Up to two weeks before SJS sores appear on your mouth and skin,
you may have the following symptoms:
- Cough
- Fatigue (sleepiness)
- Fever and chills
- Headache.
- Muscle and joint pain
- Sore throat
- Nausea, vomiting, constipation, or diarrhea
- Mild dizziness or drowsiness
- Tender or swollen glands
- Swollen or painful gums
- Headache
- Muscle twitches
- Increased facial hair
- Swelling of breasts
- Insomnia
When to see a doctor
Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience any of the following signs or symptoms:
- Unexplained widespread skin pain
- Facial swelling
- Blisters on your skin and mucous membranes
- Hives
- Tongue swelling
- A red or purple skin rash that spreads
- Shedding of your skin
Stevens-Johnson syndrome
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Stevens-Johnson syndrome is a rare, serious disorder in which your skin and mucous membranes react severely to a medication or infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, eventually causing the top layer of your skin to die and shed.
Stevens-Johnson syndrome presents a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.
Recovery after Stevens-Johnson syndrome can take weeks to months, depending on the severity of your condition. If your doctor determines that your case of Stevens-Johnson syndrome was caused by medication, you'll need to permanently avoid the medication and all others related to it.
Stevens-Johnson syndrome presents a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.
Recovery after Stevens-Johnson syndrome can take weeks to months, depending on the severity of your condition. If your doctor determines that your case of Stevens-Johnson syndrome was caused by medication, you'll need to permanently avoid the medication and all others related to it.