"Some examples of a SLAP. The first picture shows a SLAP or possibly an ALPSA taken from the internet. The second picture taken in the axial plane shows a partial undersurface tear. The seond case is taken from a 50's year old man who could not raise his left arm above his head after doing a single pushup which triggered the whole problem. He failed to respond to steroid injection."
"Good case of hypertensive encephalopathy involving a young woman with uncontrolled hypertension. Her renal MRA was normal so the exact cause is unclear. The woman was unresponsive on a hypertensive medicine drip in the ICU. The MRI whows patchy areas on increased signal on the FLAIR sequences involving bilateral cerebellar hemispheres, basal ganglia, frontal lobes and with diffuse involvement of the pons. Thre was corresponding aignal abnormality seen on the T2 sequences and no corresponding abnormality seen on the diffusion weighted sequences. There was mild associated mass effect. The basilar cisterns appeared tight and the cerebellar tonsils were low about 1 cm below the foramen magum.
The characteristic lesions of hypertensive encephalopathy may be seen in preeclampsia/eclampsia, chronic renal failure, TTP, hemolytic uremic syndrome, SLE, and cyclosporin toxicity. The characteristic distribution is posterior, thought to be due to deficient autoregulation, but frontal lobe involvement may also be seen as in this case. The changes are reversible and may enhance. Diffusion imaging may show hypointensity in the affected areas, to distinguiish this process from infarction. This distribution could also be seen with dural sinus thrombosis, and the dural sinuses should be closely inspected for normal flow voids."
"Complete or calssic mole = fertilization of ovum by two 23x sperm after loss of maternal haploid chromosome. or occasional fertilization of an empty egg by 2 different sperm 46xy and resulting in generalized of all chorionic villi with prominent acellular space centrally.
pt gets serere eclampsia prior to 24 wks and uterus too large for dates. Get 1st trim bleeding and marked elevation of hcg with hyperemesis.There is passing of grape like vesicles per vagina and hyperthyroidism due to the thyroid stimulating properties of hcg. There is anemia due to hyper expansion of plasma volume and due to blood loss from vaginal bleeding. There is da diploid karyotype almost always paternal xx. There is a moderately hyperechoic central uterine mass with punctate interspersed hypoechoic areas and numerous discrete cystic apaces. No fetal parts are seen.There are often bilateral theca lutein cysts which may takes months to regress after evacuation of the molar pregnancy.80 percent is benign 20 percent is an invasive mole.
the ddx is hydropic degeneration of the placenta, degenerating uterine fibroid, incomplete abortion, and choriocarcinoma. The above case in a hypertensive woman with 3 failed pregnancies is a path confirmed mole."
"Rolando Fracture: This 40 year old construction worker presented with a crushing hand injury. This type of fracture is a fracture of the thumb metacarpal base. The fracture is comminuted in nature and is intra-articular.
The fracture may appear as a T or Y shaped fracture. Soft tissue swelling is present over the base of the 1st metacarpal. This fracture occurs secondarily to a significant axial load that splits and crushes the articular surface. The fracture is at risk of further displacement due to the resting tone present in the multiple tendons acting on the thumb. The extensor pollicis brevis and longus act to shorten the thumb ray, as does the pull of the flexor pollicis longus. The adductor pollicis muscle tends to pull the distal metacarpal toward the palm, which, in conjunction with the abductor pollicis longus acting on the metacarpal base, commonly produces varus at the metaphyseal-diaphyseal junction. With respect to treatment, an assessment of the amount of comminution and the size of the fragments is made with traction radiographs. If the fracture is nondisplaced with less than 1 mm of articular step off, the treatment is percutaneous pinning. If there is displacement of the fracture with large (>3 mm) fragments, then the treatment of choice is open reduction with internal fixation. If there is displacement of the fracture with small (<3 mm) fragments, then distraction techniques are used as treatment of the injury. The 2nd fracture shown is a Bennett with is less a fracture dislocation of the base of the first metacarpal and is considered less severe then the Rolando; there is lateral retraction of the first metataarsal shaft by the abductor hallucis longus tendon."
"Elderly unresponsive woman. Note the rim calcified right MCA berry aneurysm that has ruptured."