Radiological features of Rheumatoid Arthritis:
(LESS):
L: Loss of joint space
E: Erosions
S: Soft tissue swelling
S: Soft bones (osteopenia).
#Rheumatology
#Medicine
(LESS):
L: Loss of joint space
E: Erosions
S: Soft tissue swelling
S: Soft bones (osteopenia).
#Rheumatology
#Medicine
-Osteomalacia occurs because of inadequate mineralisation of bone matrix
-Osteoporosis, the bone is normally mineralised, but deficient in quality, quantity and structural integrity.
#Medicine
#Metabolic
-Osteoporosis, the bone is normally mineralised, but deficient in quality, quantity and structural integrity.
#Medicine
#Metabolic
•What's the difference between osteoporosis and osteomalasia ?
-In osteoporosis, bone mass decreases, but the ratio of bone mineral to bone matrix is normal.
-In osteomalacia, the ratio of bone mineral to bone matrix is low.
#Surgery
-In osteoporosis, bone mass decreases, but the ratio of bone mineral to bone matrix is normal.
-In osteomalacia, the ratio of bone mineral to bone matrix is low.
#Surgery
-Breast cancer is the Most common cancer in female .
So always keep it in mind and try to exclude it in any patient presenting with a breast mass and you must perform Triple assessment .
1. Clinical assessment of the mass
2. Imaging ( mammography / ultrasonography )
3. Biopsy ( FNAC / corecut ) .
#Breast
So always keep it in mind and try to exclude it in any patient presenting with a breast mass and you must perform Triple assessment .
1. Clinical assessment of the mass
2. Imaging ( mammography / ultrasonography )
3. Biopsy ( FNAC / corecut ) .
#Breast
-Mammography is superior to MRI in DCIS ( Ductal carcinoma in situ )
Supiculated micro calcifications seen only by mammograhy .
#Breast
Supiculated micro calcifications seen only by mammograhy .
#Breast
-Tests done, in suspecting DVT cases:
•MOSE'S sign/ Bancroft's sign - Calf tenderness on direct pressure on calf
•Pratt's sign - Calf tenderness on squeezing from side to side.
•HOMAN'S sign - By forcible dorsiflexion with extended knee / without folding the knee, tenderness felt over calf
•NEUHOF'S sign - Thickening and deep tenderness while palpating deep in calf muscle
•LINTON'S sign - After applying tourniquet at SFJ patient made to walk +/- removal of tourniquet -> prominent superficial veins observed.
#Vascular
•MOSE'S sign/ Bancroft's sign - Calf tenderness on direct pressure on calf
•Pratt's sign - Calf tenderness on squeezing from side to side.
•HOMAN'S sign - By forcible dorsiflexion with extended knee / without folding the knee, tenderness felt over calf
•NEUHOF'S sign - Thickening and deep tenderness while palpating deep in calf muscle
•LINTON'S sign - After applying tourniquet at SFJ patient made to walk +/- removal of tourniquet -> prominent superficial veins observed.
#Vascular
Needle biopsy/Cytology
◼️Histology can be obtained under local anaesthesia using a trucut or corecut biopsy device.
◼️Biopsy can give definitive preoperative diagnosis and can differentiate between duct carcinoma in situ (DCIS) and invasive disease, and can provide staining of the tumor for receptor status which is important for planning on neoadjuvant therapy.
◼️Fine needle aspiration cytology (FNAC) is the least invasive cell based diagnostic tool, it is very accurate if both the operator and cytologist are experienced, however false negative can still occur mainly due to sampling error, also FNAC cannot differentiate between in situ disease and invasive disease.
◼️Above figure is fine needle aspiration cytology showing grade III ductal carcinoma cells.
#Breast
◼️Histology can be obtained under local anaesthesia using a trucut or corecut biopsy device.
◼️Biopsy can give definitive preoperative diagnosis and can differentiate between duct carcinoma in situ (DCIS) and invasive disease, and can provide staining of the tumor for receptor status which is important for planning on neoadjuvant therapy.
◼️Fine needle aspiration cytology (FNAC) is the least invasive cell based diagnostic tool, it is very accurate if both the operator and cytologist are experienced, however false negative can still occur mainly due to sampling error, also FNAC cannot differentiate between in situ disease and invasive disease.
◼️Above figure is fine needle aspiration cytology showing grade III ductal carcinoma cells.
#Breast
Remember:
-MC cancer in males (PLC): Prostate >Lung >Colorectal.
-MC cancer in females (BLC): Breast >Lung >Colorectal.
-Cancer deaths in males (LPC): Lung >Prostate >ColorectalQ.
-Cancer deaths in females (LBC): Lung >Breast >Colorectal.
#Surgery
-MC cancer in males (PLC): Prostate >Lung >Colorectal.
-MC cancer in females (BLC): Breast >Lung >Colorectal.
-Cancer deaths in males (LPC): Lung >Prostate >ColorectalQ.
-Cancer deaths in females (LBC): Lung >Breast >Colorectal.
#Surgery
Remember:
In liver neoplasms:
-MC malignancy of liver: Metastasis.
-MC primary malignancy of liver: HCC.
-MC primary malignancy of liver in children: Hepatoblastoma.
-MC benign tumor of liver: Hemangioma.
#Surgery
In liver neoplasms:
-MC malignancy of liver: Metastasis.
-MC primary malignancy of liver: HCC.
-MC primary malignancy of liver in children: Hepatoblastoma.
-MC benign tumor of liver: Hemangioma.
#Surgery
DEXA SCANS (Dual Energy Xray Absorptiometry)
-Simultaneous measurement of the passage of Xrays through the body é 2 diff.energies.
-Low Radiation, accurate, Can be performed on hip, spine, whole body, or any where
• If T score is > -1 ....................................... reassure patient
• If Tscore between (-1)&(-2)................. request DEXA of
hip/spine
• If Tscore < -2 (more -ve) ....................... treat, If monitoring required, refer for DEXA.
#Surgery
-Simultaneous measurement of the passage of Xrays through the body é 2 diff.energies.
-Low Radiation, accurate, Can be performed on hip, spine, whole body, or any where
• If T score is > -1 ....................................... reassure patient
• If Tscore between (-1)&(-2)................. request DEXA of
hip/spine
• If Tscore < -2 (more -ve) ....................... treat, If monitoring required, refer for DEXA.
#Surgery
Brown tumor:
-The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.
-They are a form of osteitis fibrosa cystica.
-It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.
-Brown tumours are radiolucent on x-ray.
#Surgery
-The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.
-They are a form of osteitis fibrosa cystica.
-It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.
-Brown tumours are radiolucent on x-ray.
#Surgery
-Characteristic brown coloration results from hemosiderin deposition into the osteolytic cysts.
-Hemosiderin deposition is not a distinctive feature of brown tumors; it may also be seen in giant cell tumors of the bone.
#Surgery
-Hemosiderin deposition is not a distinctive feature of brown tumors; it may also be seen in giant cell tumors of the bone.
#Surgery
Remember:
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
Causes of Postoperative FeverDay
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
Indications for Open Reduction
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
Gleason Grade of Carcinoma Prostate
(1–5)is asfollows:
1.Small uniform glands
2.More stroma between glands
3.Distinctly infiltrative margins
4.Irregular masses of neoplastic glands
5.Only occasional gland formation (undifferentiated).
#Surgery
(1–5)is asfollows:
1.Small uniform glands
2.More stroma between glands
3.Distinctly infiltrative margins
4.Irregular masses of neoplastic glands
5.Only occasional gland formation (undifferentiated).
#Surgery
Lugol’s Iodide Solution or Saturated Potassium Iodide.
-Administered 7-10 days preoperatively (three drops twice daily)
-Reduce vascularity of the gland and decrease the risk of precipitating thyroid storm.
-The major action of iodine in this situation is to inhibit release of thyroid hormone.
#Thyroid
-Administered 7-10 days preoperatively (three drops twice daily)
-Reduce vascularity of the gland and decrease the risk of precipitating thyroid storm.
-The major action of iodine in this situation is to inhibit release of thyroid hormone.
#Thyroid
Treatment of Hypospadius:
Staged Procedure
I. At the age of one and half years, surgical correction of the chordee is done.
II. At the age of 5–7 years, reconstruction of urethra is done using prepucial skin (ideal) or scrotal skin if the patient has been circumcised. Best is prepucial skin.
-Perineal urethrostomy is done for diversion.
-Perineal urethrostomy should be there until reconstruction of urethra takes up well (Denis-Browne procedure).
-MAGPI repair: Meatal advancement glandular repair—for glan-dular hypospadias.
#Surgery
Staged Procedure
I. At the age of one and half years, surgical correction of the chordee is done.
II. At the age of 5–7 years, reconstruction of urethra is done using prepucial skin (ideal) or scrotal skin if the patient has been circumcised. Best is prepucial skin.
-Perineal urethrostomy is done for diversion.
-Perineal urethrostomy should be there until reconstruction of urethra takes up well (Denis-Browne procedure).
-MAGPI repair: Meatal advancement glandular repair—for glan-dular hypospadias.
#Surgery
Remember:
-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.
#Surgery
-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.
#Surgery