MedRophine Science

2022-06-09 13:21:36 When I was first introduced by AlphaTec to PTP XLIF, I was incredibly skeptical. In all honesty, I had little to no plan of adopting this technique. To date, every single XLIF case I have performed in practice has been PTP XLIF by AlphaTec. Ironically, now there is little to no plan of doing anything else. This series highlights the indications and breadth of PTP XLIF applicability - 1) Degenerative 2) Adjacent Segment Disease / PJF 3) Revision 4) Deformity
——————————————-
Thanks to Dr joshua Barber ( spine surgeon at physicians clinic of lowa) for share this case whit us. باز کردن / نظر دهید

2022-06-07 07:05:19 18-yo male with left hip pain for 3 months.
Coronal, axial, and sagittal fat sat PD-WI (first image) demonstrate moderate/extensive area of bone marrow edema in the anteromedial acetabulum with questionable sclerosis internally; there is no clearly defined focal bone lesion. Coronal, axial, and sagittal reformatted CT images (second image) show a radiolucent lesion with central calcification in the subchondral bone of the superomedial acetabulum (arrows), as well as subtle perilesional reactive sclerosis. These findings are consistent with an intra-articular osteoid osteoma (OO) of the hip.

Juxtaarticular/intra-articular OO may be difficult to diagnose because they are often subperiosteal or centrally located and not infrequently found in anatomically complex regions. The hip is the most common site of intra-articular OO, often with inflammatory signs that may simulate primary monoarthritis. باز کردن / نظر دهید

2022-06-07 06:58:30 This ECG was recorded in a coronary care unit from a patient admitted 2 h previously with an acute anterior myocardial infarction. The patient was cold, clammy and confused, and his blood pressure was unrecordable. What does the ECG show, and what would you do?
*Detailed Answer
The ECG shows:
• Broad complex tachycardia,rate about 215 bpm.Regular QRS complexes•QRS complex duration uncertain: probably about 280 ms
• Indeterminate axis and QRS complex configuration.

*Clinical interpretation
In the context of acute myocardial infarction, broad complex tachycardias should be considered to be ventricular in origin ,unless the patient is known to have bundle branch block when in sinus rhythm. Here, the regularity of the rhythm and the very broad complexes of bizarre configuration leave no room for doubt that this is ventricular tachycardia.

*What to do?
In cases of severe circulatory failure, immediate direct current (DC) cardioversion is needed. باز کردن / نظر دهید

2022-06-07 06:50:28 Another serie of an Before/After RCT of rectal cancer. باز کردن / نظر دهید

2022-06-04 17:31:13 Complex Mitral Clips:
A 73-years old man with history of CABG. Now come with severe MR. It was complicated MR. As you. As you can see. We tried with first clip at first in lateral commissure but afetr good delpoymen, it ruptured posterior leaflet in few minuts Then we try to put second one near becore and when there was residual MR we tried to third one. Result was amazing. No stenisis and trivial MR. باز کردن / نظر دهید

2022-06-04 17:29:13 85 y/o male patient with left lower extremity radiating pain.
Asymmetric hypertrophy of left piriformis muscle, in favor of entrapment sciatic neuropathy and piriformis syndrom. باز کردن / نظر دهید

2022-06-03 10:06:50 4 yrs old, midline cystic lesion (Thyroglossal duct cyst).

DD midline cystic lesions:
Upper Ranula
Mid Thyroglossal duct cyst
Lower Dermoid cyst باز کردن / نظر دهید

2022-06-03 09:36:03 Preop standing, intraop (lateral decubitus), postop standing XRs. Complete reduction of grade 1 spondylolisthesis and restoration of lordosis at L4-L5 with single position lateral lumbar interbody fusion. باز کردن / نظر دهید

2022-06-01 10:57:33 A female with ruptured saccular aneurysm on left PICA origin was treated with simple coiling. During the beginning of the procedure the left vertebral artery was suddenly occluded. We thought that it could be a dissection or maybe just a spasm. We gave a Nimotop and it took about 15 min for the artery to reappear again. Meanwhile we were thinking to enter form another side because we thought that it was a dissection( because of sever tourtosity and arterial injury). So always at first think about vasospasm, never lose the access wire and let the Nimotop does its magic action Muris Becircic باز کردن / نظر دهید

2022-05-31 16:29:16 Had a very interesting case this week
64/F, h/o trauma to right upper abdomen
CECT s/o Grade III/IV liver injury to right posterior sector (Segment 6, 7 and 8)

patient had persistent fall in Hb inspite of transfusion and was becoming hemodynamically unstable
taken up for surgery

Intra-op she had
Grade IV injury to right posterior sector (Seg 6 & 7)
Transected Right hepatic vein at sector 6 / sector 7 junction
lacerated right portal vein
lacerated right posterior sectoral bile duct

underwent
Right posterior sectorectomy of segment 6 and 7 with control of Hepatic vein / portal vein / bile duct of segment 6 & 7

Extubated and started normal feed by POD1

ambulated and to be discharge on POD4 باز کردن / نظر دهید