A great video shows and simply illustrates minimally invasive trigger finger release surgery performed by Dr. Stephen L Helgemo. In-office procedure done with local anesthesia and an extremely high success rate.

How to differentiate clinically between LTB (croup) and epiglottitis

Which of the following best differentiates, by history, LTB (croup) from epiglottitis?

• (A) Temperature
• (B) Presence of inspiratory stridor
• (C) Length of time from onset to defining symptom
• (D) Lung field auscultation
• (E) Presence or absence of dyspnea

The answer is C.
Croup, laryngeotrachiobronchitis, a viral illness with subglottic involvement, typically exhibits the symptoms of inspiratory stridor only after 12 to 24 hours of coryza, typical of a viral “cold.” Epiglottitis, which is a much more serious condition, begins suddenly. Epiglottitis is caused by bacterial infection with supraglottic involvement, classically by H.influenzae but also by S.aureus and Corynebacterium diphtheriae.

Although epiglottitis is characterized more by high fever than is croup, this appears to be a weak factor on which to base a preliminary diagnosis. Whereas croup virtually always includes a cough, epiglottitis rarely
does so. Epiglottitis typically includes dysphagia while croup does not. The child with croup is comfortable in all positions, whereas the patient with epiglottitis will be sitting forward with the mouth open. Both conditions are characterized by inspiratory dyspnea. Croup is benign and epiglottitis is potentially critical.

Sesamoid bones, Functions and mechanism of action.

The sesamoid bone is a small rounded bone embedded within a tendon that usually passes over a joint (Sesamoid bones are the bones not connected to any other bone).The largest sesamoid bobe is the patella.

Latin........."ossa sesamoidea"

Sesamoid bones functions probably are to modify pressure, to diminish friction, and occasionally to alter the direction of a muscle pull.Sesamoid bones also prevent the tendon from flattening into the joint as tension increases and therefore also maintain a more consistent moment arm through a variety of possible tendon loads.
Sesamoid bones can be found in the knee, hand and foot...

Sesamoid bones at the distal end of the first metatarsal bone of the foot.

Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, so they increase the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the big toe.

Associated conditions result in intestinal intussusception in children

An 8 year old boy is seen in the emergency room secondary to abdominal pain. Further evaluation confirms the presence of intussusception. The most likely precipitating cause for this intussusception is :

• A) colon polyp
• B) Meckel's diverticulum
• C) lymphoma
• D) parasite infection
• E) foreign body

The answer is C.

Intussusception is the most common cause of intestinal obstruction in the first 2 years of life. It is more common in males than in females. In most cases (85%) the cause is not apparent. Associated conditions that can result in intussusception include :
-polyps, Meckel's diverticulum, Henoch–Schonlein purpura, lymphoma, lipoma, parasites, foreign bodies, and viral enteritis with hypertrophy of Peyer patches.

Intussusception of the small intestine occurs in patients with celiac disease and cystic fibrosis—related to the bulk of stool in the terminal ileum. Henoch–Schonlein purpura may also cause isolated small-bowel intussusception. In children older than 6 years, lymphoma is the most common cause. Intermittent small-bowel intussusception is a rare cause of recurrent abdominal pain.

Hay WW Jr, Levin MJ, Sondheimer JM, et al., eds. Current pediatric diagnosis & treatment, 18th ed. New York: McGraw-Hill; 2007:616–617

Burns Injury and Burns Degrees

example of 2nd dgree burn

A burn is a part of traumatology that is caused by heat, radiation, chemicals or electricity. Burns affect usually the skin (epidermis and dermis).Affection of deeper tissues, such as muscle, bone, and blood vessels may be fatal

1-Outer skin layer
2-Middle skin layer
3-Deep skin layer
4-First degree burn
5-Second degree burn
6-Third degree burn

Burns can be classified by depth of injury into :

1st degrre burn

1- 1st Degree Burns ;the least severe of commonly seen burn injuries, just affects the epidermal layer and appears as dry area of redness "erythema" with pain and tingling sensation.
1st degree burn usullay has no complication and healed in about 1 week.

2- 2nd Degree Burns ; this type of burn affects tha dermis layer and may be subdivided into superficial partial thickness and deep partial thickness.
These second-degree burns are characterized by extreme pain and appears as wet, red, swollen and blistered areas. healing time 2-3 weeks and complications like Local infection/cellulitis, Scarring, Contractures may be seen.

3- 3rd Degree Burns ;affect the whole thickness of the skin and should be treated in a hospital setting, Symptoms may include:

*dry and leathery skin
*black, white, brown, or yellow skin
*swelling
*lack of pain because nerve endings have been destroyed

4- 4th Degree Burns ;are life threatening injury where the burn Extends through skin, subcutaneous tissue and into underlying muscle and bone, the affect limb usually amputated.

Nasogastric Intubation Demonstration NGT