- Horner's syndrome.

Horner's syndrome

*Def:-

It is a clinical syndrome caused by damage to the sympathetic nerve supply to head and neck.

*synonymes:-

• Bernard-Horner syndrome
• oculosympathetic palsy.

*Causes:-

Due to lesion or compression of one side of the cervical or thoracic sympathetic chain which generates symptoms on the ipsilateral (same side as lesion) side of the body:-

-Toxic Causes of respiratory Failure.

Toxic Causes of respiratory Failure

-Guillain Barré syndrome.

Guillain Barré syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

-Lambert-Eaton syndrome.

Lambert-Eaton syndrome
or
Myasthenic-myopayhic syndrome.

*Pathophysiology:-

• a myasthenic syndrome due to autoimmune orocess targeting the mechanism of releasing A.CH from nerve terminals.
• It often associated with bronchogenic carcinoma or other malignancies.

*Clinical picture:-
Proximal weakness,wasting and fatigue but with less common ocular and bulbar affection than Myasthenia.

*Diagnosis:-

• EMG:- shows paradoxical increase  in successive muscle contractions.
• No significant response to prostigmine,but respond to guanidine HCL 20 mg/Kg/day or prednisolone+imuran.
• No acetylecholine receptor antibodies.
• CXR to determine if associated with bronchogenic carcinoma or not.

*Treatment:-

• Treatment of the underlying neoplasm.
• Plasmapheresis.
• Immunosuppression.

Dr Ibrahim

Return to list of medical syndromes here

-Vircow's triad.

Vircow's triad is the aetiology of thrombosis which is composed of :-

1-Damage of vascular endothelium(Vascular trauma):-
this damage expose the endothelial collagen which is rough surface to which platelets can stick firmly and release thromboxane A2 that help more platelet aggregation.

2-Slowing(Reduced)in the blood flow (stasis):-
these changes help thrombosis by allowing the platelets to deviate from the axial stream and cross the peripheral plasmatic zone to stick to the vascular endothelium.

3-Change in blood composition(Increased coagulability ):-
a-Increase number of blood elements.
-Increase platelets so become more sticky and agglutinate in small masses and adhere to vascular endothelium.
-Increase WBCs and RBCs increase viscosity of blood and stasis.
b-Biochemical changes that cause systemic activation of the cloting system.

"VIR chow"

Vascular trauma
Increased coagulability
Reduced blood flow (stasis)

Dr Ibrahim

Return to other triads here.

-Types of laxatives.

Types of laxatives

"Boss"

Bulk laxatives.
Osmotic laxatives.
Stimulant(irritant)laxatives.
Stool Softeners.

Or "Bios"

Bulk laxatives.
irritant(Stimulant)laxatives.
Osmotic laxatives.
Stool Softeners.

Dr Ibrahim

-Drugs causing constipation.

Drugs causing constipation

"Coma"

Calcium channel blockers.
Opioids.
Muscle relaxants.
Antacids,Anticholinergics,Abuse of laxatives.

Dr Ibrahim

-Treatment of urticaria.

Treatment of urticaria

"Scar"

Systemic steroids(sever cases resistant to treatment).
Soothing lotions locally.

Ca gluconate.

Adrenaline.
Antihistamines.

Removal of the cause.

Dr Ibrahim

-Risk factors of cerebral infarction.

Risk factors of cerebral infarction

A)Non-modifiable risk factors:- "Maps"
Male gender.
African-American.
Age(Old age).
Positive family history.
Prior Stroke.

B)Modifiable risk factors by medical treatment:- "Third"
Transient ischemic attacks.
Heart diseases.
Increase Blood pressure(HTN).
Raised Hematocrite.
Diabetes Mellitus.

C)Modifiable risk factors by changing lifestyle:- "chops"
Cigarette smoking.
Hyperlipidemia.
Obesity.
Physical inactivity.
Stressful life.

Dr Ibrahim

-Grades for quantitative assessment of muscle power.

Grades for quantitative assessment of muscle power

Grade(0):-Total paralysis.
Grade(1):-Visible or palpable flicker of contraction but no movement of joint or limb.
Grade(2):-contraction of the muscle  only when the effect of gravity is eliminated.
Grade(3):-Normal movement against gravity but not against additional resistance.
Grade(4):-Normal movement against gravity and additional resistance but not in full range.
Grade(5):-Intact(Normal) muscle power.

Dr Ibrahim

Return to list of medical grades (click here) 

-Mechanical causes of Impotence.

Mechanical causes of Impotence
"Hope"

Huge bilateral hydrocele or inguinal hernia.
Morbid Obesity.
Penile carcinoma.
Peyrone's disease(fibrotic scar of tunica alibuginea surrounding corpora cavernosa resulting in curvature of penis in erection)
Elephantiasis of penis or scrotum.

Dr Ibrahim

-Deep tendon reflex grading.

Deep tendon reflex grading

Grade(-):- Absent.
Grade(+):- Hypoactive(Weak).
Grade(++):- Normal(Average).
Grade(+++):- Hyperactive without clonus or moderate exaggeration without clonus.
Grade(++++):- Hyperactive with clonus or marked exaggeration with clonus.

Dr Ibrahim

 

Return to list of medical grades (click here) 

- Mesothelioma Treatment Options.

Mesothelioma Treatment Options.

Dr. Michael Milano, consulting oncologist, discusses the various treatment options available to an asbestos cancer patient..

- What are the symptoms of peritoneal mesothelioma?

What are the symptoms of peritoneal mesothelioma?

Mary Hesdorffer, MS, APRN, nurse practitioner with the Mesothelioma Applied Research Foundation discusses the symptoms of peritoneal mesothelioma.

-Sites of esophageal constrictions.

Sites of esophageal constrictions are
collected in the word "Dial" at

Diaphragm (15 inches from incisor).
Inlet of the esophagus(6 inches from incisor).
Aortic arch crosses it(9 inches from incisor).
Left main bronchus crosses it (12 inches from incisor).

Importance :-

• During passage of insturments (gastroscope) along the esophagus.
• Lodging of swollen foreign bodies.

Dr Ibrahim

- Metabolic cuases of Impotence.

Metabolic cuases of Impotence (erectile dysfunction).

"Rash"

Renal Failure.
Alcoholism.
Sickle cell disease
Hoemochromatosis.
Hepatic failure.
Hyperglycemia (D.M).

Dr Ibrahim

- Lymphadenopathy - presentation.

Lymphadenopathy presentation

- By

Dr.Manal Abdel Hamid

Assistant professor
Mansoura University, Oncology center.

- Download (Click here)

- Kallmann syndrome.

 Kallmann syndrome

- Def :- It is a rare X-linked recessive genetic disease which characterized by delayed or absent puberty and an impaired sense of smell, also referred as olfactogenital dysplasia.

- Kallmann syndrome is a form of secondary hypogonadism, reflecting that the primary cause of the defect in sex-hormone production lies within the pituitary and hypothalamus rather than a physical defect of the testes or ovaries.

- Kallmann syndrome was described in 1944 by Franz Josef Kallmann, a German-American geneticist.(1)(2)

- Incidence:-

It affects primarily males at an incidence of 1 out of 10,000 in a study of French conscripts.(3)
The male-to-female ratio ranges from 4:1 to 5:1.

- Cause:-

Mutations in the KAL1, FGFR1, PROKR2, and PROK2 genes cause Kallmann syndrome.
These genes play a role in the development of certain areas of the brain before birth. Although some of their specific functions are unclear, these genes appear to be involved in the formation and movement (migration) of a group of nerve cells that are specialized to process smells (olfactory neurons).(4)

- Synonyms:-

• de Morsier’s syndrome II.
• Morsier-Gauthier syndrome.
• Kallmann-de Morsier syndrome.
• Maestre-Kallmann-de Morsier syndrome.
• Maestre de San Juan-Kallmann syndrome.
• Maestre de San Juan-Kallmann-de Morsier syndrome.
• anosmic hypogonadism.
• anosmic idiopathic hypogonadotropic hypogonadism.
• hypogonadotropic hypogonadism and anosmia.
• hypogonadotropic hypogonadism-anosmia syndrome.
  
  

- Sertoli-cell-only syndrome (germinal cell aplasia).

Sertoli-cell-only syndrome (SCO)

-Def:- It is a condition in which only Sertoli cells line the seminiferous tubules of the testes and characterized by male sterility (due to azoospermia) without sexual abnormality.

- Synonyms:-

• Del Castillo syndrome.
• Germ cell aplasia.

-The etiology (1):-

• Most causes of SCO syndrome are idiopathic. A congenital absence of germ cells due to failure of migration of gonocytes is theoretically possible.
• Massive deletions in the azoospermia factor (AZF) region of the Y chromosome. found.
• Exposure to chemicals and toxins may cause SCO; however, direct cause-and-effect relationships in humans have been difficult to document.
• Klinefelter syndrome, 47 XXY, results in a characteristic biopsy appearance of SCO and Leydig cell hyperplasia.
  
  

- Parasites affecting Spleen.

Parasites affecting Spleen

"Spleen"

Schistosoma species.

PLasmodia species.

LEishmania donovani.

EchiNococcus granulosus .

Dr Ibrahim