الـ xanthomata تظهر عند المريض بسبب الـ hypercholesterolemia وبالعادة تكون حول المفاصل أو الأوتار، مثلًا بحالة الكيس الفوك جانت حول الـ Achilles tendon

يكلك نسبة المرض عند المسيحيين اللبنانيين توصل 1:170 which is fairly high

There's another disease called polygenic hypercholesterolemia (PGH) in which patients have a similar lipid profile to familial hypercholesterolemia but they do not develop xanthomata.

Also, PGH is caused by multiple genetic mutations, while FH is caused by a single gene.

Yet another disease is called familial combined hyperlipidemia (FCH) in which both triglycerides and cholesterol are raised.

In contrast to FCH, patients with FH or PGH have either normal or slightly elevated triglycerides.

يكلك أكو مضاد حيوي إسمه Demeclocycline من عائلة الـ tetracycline يسبب عارض جانبي زبالة كلش هو nephrogenic diabetes insipidus (يقلل تأثير الـ vasopressin على الكِلية بشكل كبير). هالأيام محد يستخدمه بصفته مضاد حيوي لأن صارت تجاهه مقاومة من البكتيريا وفقد فعاليته بشكل كبير، بس بحالات الـ SIADH¹ يستغلون عارضه الجانبي هذا ويستخدموه لعلاج المتلازمة، خاصة إذا ما متوفرة الـ vasopressin antagonists.

مصائب قومٍ عند قوم فوائد

الفكرة هي أنّ الـ SIADH والـ Diabetes insipidus (DI) هنّ حالات متعاكسة:
الأول يمثل إفراز الـ vasopressin بشكل جبير كلش، والثاني يمثل إفرازه بشكل قليل كلش.

فالأدوية اللي تسبب الثاني (DI)، ممكن نستخدمها لعلاج الأول (SIADH): سابقًا جنة نستخدم الليثيوم لأن همين يسبب DI، بس أعراضه الجانبية مزعجة فاستبدلناه بالـ demeclocycline. وبعدين حتى هذا استبدلناه بالـ vasopressin-receptor antagonists مثل الـ Tolvaptan

ليهسة أتذكر طالبة المرحلة الخامسة مدري السادسة بالفاينل، عود داساعدها، حليت الها السؤال: SIADH واني جنت اقصد DI... يمكن ليهسة بعدها تغلط علية...

Let's hope she had the skeptic spirit to doubt my answer and think for herself

Lesson is: don't trust my answers
I don't trust my answers

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Esophageal cancer (squamous cell vs adenocarcinoma)

UTI in children

All children should be investigated after a single episode of UTI, this is because VUR occurs in 1–2% of the asymptomatic pediatric population but in 30–40% of children with a UTI and is apparent in 90% of children with renal scarring on an IVU.

VUR: Vesico-Ureteral Reflux

There are 5 recognised normal narrowings in the ureter which may present obstacles to a stone’s passage through to the bladder and these are the PUJ (Pelvic-Ureteral Junction), the point at which the ureter crosses the bifurcation of the common iliac artery, and 3 areas involving the distal ureter.

A straddle injury will cause damage to the bulbar urethra:
The bulbar urethra is crushed upwards onto the pubic bone, typically with significant bruising. In the days of sailing ships, the common cause was falling astride a spar (a wooden pole in the ship) and the modern equivalent is seen among workers losing their footing on scaffolding. Cycling accidents, loose manhole covers and gymnasium accidents astride the beam account for a number of cases.

Almost certainly King William I of England died in 1087 following a ruptured bulbar urethra. It was written that ‘his horse reared in fright at a blazing timber and threw its ponderous rider against the iron of his saddle’, suggesting that he ruptured the urethra on the saddle’s pommel.
He subsequently developed urinary retention and sepsis secondary to infection of the haematoma and he died some days after the accident.

Sailing ships, William the conqueror, and bulbar urethral injuries🍻

Bulbar urethral injury

• Suspect urethral injury after blunt perineal trauma when the man cannot void, when there is perineal bruising and when there is blood at the urethral meatus.

• Diagnosis is made by retrograde urethrography using water-soluble contrast.

• The safest initial management is to insert a suprapubic catheter.

• Beware of urinary extravasation and sepsis in the perineal haematoma.

• Delayed urethroplasty is the preferred definitive management of complete disruptions

Pelvic fracture urethral disruption injury

• Suspect the diagnosis in cases of pelvic fracture, when the patient has not voided and when there is blood at the urethral meatus.

• If the diagnosis is suspected, a water-soluble urethrogram is needed to confirm the diagnosis.

• Initial management is insertion of a suprapubic catheter.

• Immediate surgical exploration is needed if there is coexisting rupture of the bladder.

• Delayed anastomotic urethroplasty is the preferred definitive management Results.