Answer of the image challenge
Answer of the image challenge C - Cocaine
Why?
Perforation of the nasal septum and palate are well recognized complications of intranasal cocaine use.
Image Challenge
Source: The New England Journal of Medicine
Which one of the following drugs of abuse is most typically associated with the illustrated complication?
A- Ketamine
B- Heroin
C- Cocaine
D- Phencyclidine
E- Mescaline
Chose your answer?
Answer of the image challenge
Answer of the image challenge A- Palsy of the long thoracic nerve
Why?
Weakness or paralysis of the serratus anterior due to palsy of the long thoracic nerve is a common cause of a winged scapula.
Hypogonadism
Fig.1: Examples of primary and secondary causes of male hypogonadism. Klinefelter’s syndrome results from the 46,XXY karyotypic abnormality present in approximately 1 in 500 male births. The example of Kallmann’s syndrome is rare isolated deficiency of GnRH, resulting in hypogonadotropic hypogonadism associated with olfactory lobe dysgenesis and anosmia. FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone; T, testosterone.
Fig. 2: Regulation of testicular function. Note that the single decapeptide gonadotropin-releasing hormone (GnRH) stimulates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Pulsatile GnRH is required. Chronic exposure downregulates the GnRH receptor and causes impaired FSH and LH release, the mechanism whereby pharmacologic GnRH agonists result in chemical castration. Prolactin excess also results in impaired GnRH pulse generator function and hypogonadotropic hypogonadism. Feedback inhibition of LH secretion is a sex steroid–mediated event, whereas FSH secretion has dual feedback regulation involving inhibition by sex steroids and the Sertoli cell product inhibin. Accordingly, a monotropic elevation of the FSH level (normal LH and testosterone levels) may result from deficient Sertoli cell–spermatogenic function. CNS, central nervous system.
Author: Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children’s Hospital
Introduction
Hypogonadism manifests differently in males and in females before and after the onset of puberty. If onset is in prepubertal males and testosterone replacement is not instituted, the individual has features of eunuchoidism, which include sparse body hair, poor development of skeletal muscles, and delay in epiphyseal closure, resulting in long arms and legs. When hypogonadism occurs in postpubertal males, lack of energy and decreased sexual function are the usual concerns. In females with hypogonadism before puberty, failure to progress through puberty or primary amenorrhea is the most common presenting feature. When hypogonadism occurs in postpubertal females, secondary amenorrhea is the usual concern.
Images Source (1 and 2): Cleveland Clinic
Answer of the image challenge
Answer of the image challenge D - Hypogonadism
Why?
The man on the right has evidence of central adiposity, preservation of scalp hair, loss of body hair, and gynecomastia compared to his identical brother. These findings are most suggestive of hypogonadism. This patient was diagnosed with a pituicytoma.
Image Challenge
Source: New England Journal of Medicine
What endocrine diagnosis is affecting the identical twin on the right side of the image?
A- Acromegaly
B- Addison’s disease
C- Cushing’s syndrome
D- Hypogonadism
E- Hypothyroidism
Chose your answer?
Turner Syndrome
Author: Daniel C Postellon, MD, Clinical Associate Professor, College of Human Medicine, Pediatrics and Human Development, Michigan State University; Consulting Staff, Pediatric Endocrine Clinic, Helen DeVos Children’s Hospital
In 1938, Henry Turner first described Turner syndrome, which is one of the most common chromosomal abnormalities.More than 95% of adult women with Turner syndrome exhibit short stature and infertility.
Image Source: FemaleCare
Isolated abducens nerve palsy: MR imaging findings
MH Depper, CL Truwit, JN Dreisbach and WM Kelly
Department of Radiology, Fitzsimons Army Medical Center, Aurora, CO 80045.
Abstract: The abducens nerve, the sixth cranial nerve, innervates the lateral rectus muscle of the eye and is responsible for lateral horizontal ocular movement. A wide variety of abnormalities, both primary to the nerve itself and secondarily involving the nerve, can paralyze the abducens nerve. MR imaging offers the best opportunity to detect the underlying abnormality causing abducens nerve palsy. In this pictorial essay, we illustrate the MR imaging features of numerous conditions that cause isolated abducens nerve palsy.
Source: American Journal of Roentgenology
FULL TEXT
Image Source: Yale University School of Medicine
Image Challenge (I’m back! \o/)
Source: New England Journal of Medicine
This patient was trying to look right when the image was taken. What is the diagnosis?
A- Internuclear ophthalmoplegia
B- Left fourth cranial nerve palsy
C- Left sixth cranial nerve palsy
D- Right fourth cranial nerve palsy
E- Right sixth cranial nerve palsy
Chose your answer?
Let’s play a game —> Image Challenge
Source: New England Journal of Medicine
In what vessel is this patient’s dialysis catheter?
A- Left axillary vein
B- Left internal mammary vein
C- Left-sided superior vena cava
D- Azygous vein
E- Higher intercostal vein
Chose your answer?
Answer of the image challenge
The correct answer is letter C- Caput Medusae
Why?
These enlarged veins on his abdomen are consistent with caput medusae.
Biomedical Engineers Combat Congestive Heart Failure With Aquapheresis
Biomedical engineers designed a machine that removes the excess sodium and water from blood. If not removed, those items can compromise breathing and heart function. An intravenous catheter withdraws blood and removes fluid before returning it to the body. The process is intended to reduce swelling and ease the load on the heart.
Five million Americans suffer from congestive heart failure, a debilitating illness that can seriously compromise a patient’s quality of life. And as the population ages, the number of people diagnosed with the disease is growing by eight percent each year. Now, as Ivanhoe reports, a new procedure is helping patients feel better and get their condition under control.
Recently, Ken Richard thought he was running out of time. Fluid overload was literally suffocating him. “I’d sit in an easy-chair and I’d press on my back and I couldn’t breathe,” Richard recalls. “I’d lay on the bed and I couldn’t breathe. I’d walk 15 feet — couldn’t breathe.”
The diagnosis — congestive heart failure. Fluid builds up in the body, causing swelling and interfering with the heart’s ability to function. “It was quite serious,” Yvens Laborde, M.D., an internal medicine specialist at Ochsner Medical Center in New Orleans, told Ivanhoe. “The main thing was he actually has a significant compromised cardiac function.”
The diagnosis — congestive heart failure. Fluid builds up in the body, causing swelling and interfering with the heart’s ability to function. “It was quite serious,” Yvens Laborde, M.D., an internal medicine specialist at Ochsner Medical Center in New Orleans, told Ivanhoe. “The main thing was he actually has a significant compromised cardiac function.”
“Oh, it makes an incredible amount of difference for a number of reasons,” Dr. Laborde explains. “Number one, it’s safe, it’s very effective and it’s predictable, and the amount of fluid that you remove, you can remove it very controllably.”
Though this process used to be used only for patients with kidney disease, new studies have found it has a dramatic effect on patients with congestive heart failure and can be more effective than traditional treatment with diuretics.
In 38 hours, Aquadex removed 20 pounds of fluid from ken’s body. “It reduces the amount of congestion and fluid retention and so what happens is it actually enables his heart function — his cardiac function — to improve,” Dr. Laborde says. Now, ken is feeling like himself again ý grateful to have his life back.
Congestive heart failure leads to more than three million hospitalizations every year in the United States, at a cost of more than 23 billion dollars. Doctors say this new procedure actually reduces the amount of time patients spend in the hospital and the chances they’ll have to come back for further treatment.
HAVE A HEART: The heart pumps 5.6 liters of blood through the entire body in roughly 20 seconds; each day your blood travels some 12,000 miles, and your heart beats about 100,000 times. This delivers oxygen and other essential nutrients to the body’s cells and organs.
A heart attack occurs when the blood supply to the heart muscle is cut off, either because part of the heart is damaged (such as the valves to the chambers), or because plaque has built up inside the arteries, narrowing them and severely restricting blood flow. Symptoms of a heart attack include a squeezing discomfort in the center of the chest, pain or tingling in the left arm, shortness of breath, and sometimes a cold sweat, nausea, or dizziness.
ABOUT HEART DISEASE: Most heart diseases arise from hardening of the arteries, especially the buildup of fatty material along the inner lining of the arteries. Coronary arteries supply blood to the heart. When a blockage occurs, this flow is decreased. Heart medications target these blockages in several different ways. Nitrates dilate the veins, decreasing the oxygen requirements of the heart. They also dilate the coronary arteries to increase blood flow to the heart. Beta-blockers decrease the heart rate and the force of the heart’s contractions. Aspirin prevents platelets in the blood from clotting and clumping on blood vessel walls.
Source: ScienceDaily
Image Challenge
What is the diagnosis?
A- Subcutaneous Metastases
B- Filariasis
C- Caput Medusae
D- Neurofibromatosis
E- Hepatocellular Carcinoma
Chose your answer?
Source: New England Journal of Medicine
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Image Challenge
This patient presented with unilateral rhinorrhea. What is the diagnosis?
A- Nasal foreign body
B- Osteoma
C- Pituitary tumor
D- Skull fracture
E- Sinusitis
Chose your answer?
Source: New England Journal of Medicine
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Pseudomonas aeruginosa Infections
Pseudomonas is a gram-negative rod that belongs to the family Pseudomonadaceae. More than half of all clinical isolates produce the blue-green pigment pyocyanin. Pseudomonas often has a characteristic sweet odor.
These pathogens are widespread in nature, inhabiting soil, water, plants, and animals (including humans). Pseudomonas aeruginosa has become an important cause of infection, especially in patients with compromised host defense mechanisms. It is the most common pathogen isolated from patients who have been hospitalized longer than 1 week. It is a frequent cause of nosocomial infections such as pneumonia, urinary tract infections (UTIs), and bacteremia. Pseudomonal infections are complicated and can be life threatening.
Author: Samer Qarah, MD, Pulmonary Critical Care Consultant, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center and Cornell University
Coauthor(s): Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital; Pratibha Dua, MD, MBBS, Staff Physician, Department of Internal Medicine, The Brooklyn Hospital Center; Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Read the entire article here: Medscape (really worth it)
Image credit: Image © James A. Sullivan (CELLs alive)
