Top videos
Porcelain gallbladder is a condition characterized by calcium salt deposits in the wall of a chronically inflamed gallbladder. The calcifications can be thin or faintly visible, or may be amorphous, patchy, and thick. The gallbladder is generally large, but its size can vary considerably. Most porcelain gallbladders are associated with gallstones. A plain radiograph generally detects these, but computed tomography (CT) has a higher specificity; therefore, a CT scan is performed to confirm the diagnosis. Due to their high risk of gallbladder carcinoma, all patients with porcelain gallbladder should have an elective cholecystectomy.
This syndrome was previously known as reflex sympathetic dystrophy, algodystrophy, causalgia, Sudeck atrophy, transient osteoporosis, and acute atrophy of bone. Usually occurring after an injury, CRPS presents with pain out of proportion to the injury, temperature change, edema, and abnormal skin color. Type I CRPS (90% of CRPS cases) occurs without a definable nerve lesion, while type II occurs with a definable nerve lesion. The pathogenesis is likely due to an injury causing increased sensitivity to sympathetic nerves, an abnormal response to and sensation of pain, and increased neuropeptide release causing burning pain to light touch (allodynia).
Lithium, a mood stabilizer used in bipolar disorder, has a narrow therapeutic index (small difference between therapeutic and toxic levels}. This patient's gradual onset of neurologic symptoms (slurred speech, confusion, tremors, and ataxia) is consistent with chronic lithium toxicity. Therapeutic lithium levels are 0.8- 1.2 mEq/L. Serum lithium levels >1.5 mEq/L confirm toxicity, and levels ;::2 .5 mEq/L require emergency management.
Benzodiazepines are a class of agents that work on the central nervous system, acting selectively on gamma-aminobutyric acid-A (GABA-A) receptors in the brain. GABA is a neurotransmitter that inhibits or reduces the activity of nerve cells (neurons) within the brain. Benzodiazepines open GABA-activated chloride channels, and allow chloride ions to enter the neuron. This makes the neuron negatively charged and resistant to excitation.
Diagnosis of this condition is based on clinical symptoms alone, as there are no diagnostic laboratory tests. In order to meet the criteria for Tourette syndrome, both motor and vocal tics must be present before the age of 21 , and the tics must occur many times a day for at least 12 months which is the case in this patient. Tourette syndrome is associated with several comorbid conditions, with attention-deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD) the most common. OCD is therefore the condition this child is most at risk of developing in the future.
This is a video which discusses the Vioptix tOX system of near infrared spectroscopy for the monitoring of free tissue transfer. Having information as to the health of the microvascular anastomosis is critical to improved patient outcome and free tissue survival. With better monitoring, supplementing clinical evaluation, surgeons are able to assess the health of the free tissue better and potentially improve patient outcome. The example in this video is of a free breast reconstruction where the tOX system was used to remotely monitor the free flap. The surgeon can follow the flap real time and more importantly follow trend lines to help predict flap complications.