Varicocele grading.

 

Clinical and ultrasonography grading of varicocele

Varicocele grading is done to provide a standardization in the diagnosis, treatment and follow-up of the disease.

Varicocele staging (grade) is done in two main ways:

1.     Grading system made clinically, namely by examination.

2.     Grading with scrotal color Doppler ultrasonography.

Clinical Grading of varicocele

Grade	Description
Grade 0	Seen on ultrasound, but not physically detectable (also called “subclinical varicocele”)
Grade I	Palpable (felt on exam) when the patient is performing the valsalva maneuver (“bearing down”)
Grade II	Palpable even without valsalva
Grade III	Varicocele causing visible deformity of the scrotum.

- Criteria of hypersplenism.

Criteria of hypersplenism.

1. Splenomegally.
2. Cytopenias (mono or pan).
3. Hypercellular bone marrow.
4. Scanning with Cr51 labelled with RBCs>> reversed liver to spleen ratio.
5. Splenectomy will improve the condition.

(A huge spleen after splenectomy for female patient with hypersplenism)

Dr Ibrahim samaha

- Heel foreign body X-ray.

Heel foreign body X-ray.

A child presented to Mansoura Emergency Hospital by a needle in heel which not appear on the skin,An X-ray was made and shown this..

Dr Ibrahim samaha

- Arterial Doppler Examination.

Arterial Doppler Examination.

An Arterial Doppler evaluates the arterial blood flow of the body. It is used many times to evaluate the arteries of the legs.

It may be ordered when there is suspicion on exam or with symptoms suggestive of blockage of the arteries.

There is no radiation for this test as it uses sound waves and pressure cuffs.

This video shows how to interpret vascular arterial doppler signal wave-forms in a simple and informative fashion.

This is educational especially in teaching how to better utilise a simple hand-held Doppler.

- Eye signs of thyrotoxicosis.

Eye signs of thyrotoxicosis.

"DR Joffroy may validate symptoms"

• Dalrymple sign:- rim of sclera is seen all around the cornea, on looking straight forward.
• Rosenbach's sign:- fine tremor of the upper eyelids on slight closure of the eye.
• Joffroy's sign:-lack of wrinkling of the forehead when a patient looks upward.
• Moebius sign:- lack of convergence on looking to near object.
• Von Graefe's sign (lid lag sign):-lagging of the upper eyelid on looking downward without movinh the head.
• Stellwag's sign:-staring look with infrequent blinking.

Dr Ibrahim,,

- Gallbladder stone and surgery.

Gallbladder stone and surgery.

video shows normal function of gallbladder and then problems from gallstones and how laparoscopic surgery is done to remove gallbladder.

- Savary miller endoscopic grading of GORD.

 Savary miller endoscopic grading of GORD.

I-single erosive lesion.
II-multiple erosion lesion.
III-Circumferential erosion lesion.
IV-chronic lesions(ulcer,stricture,Short esophagus)
V-columnar epithelium (Barrett´s Epithelium).

Dr Ibrahim
Return to list of medical grades (click here) 

- Complications of reflux oesophagitis.

Complications of reflux oesophagitis.

"USA-IBM"

Peptic Ulcer.

Short esophagus due to spasm of longitudinal muscles.
Stricture of esophagusdue due to spasm of longitudinal muscles.

Aneamia.


Inhalation pneumonia from recurrent reflux.

Bleeding.
Barretts oesophagus.

Monilial invasion with further mucosal damage.
Malignancy.

Dr Ibrahim

- Causes of acute oesophagitis.

Causes of acute oesophagitis.

"birds"

• Burn (corrosive)
• Infective(candidiasis,herpes virus)
• Radiation
• Drug induced (NSAIDs)
• Specific diseases e.g. behcets syndrome.

Dr Ibrahim

- Laparoscopic Nissen Fundoplication (video).

Laparoscopic Nissen Fundoplication (video)

In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped , around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter.

In a Nissen fundoplication,"complete fundoplication", the fundus is wrapped all the way 360 degrees around the esophagus.

This is a video of a Laparoscopic Nissen Fundoplication 

- Saint's triad.

Saint's triad.

It is a common association of:-

1. Gall stones.
2. Hiatal Hernia
3. Diverticulosis coli.

Dr Ibrahim

Return to other triads here.

unhappy triad - O'Donoghue's triad

unhappy triad

or O'Donoghue's triad

or terrible triad

Twisting force in a weight bearing knee joint causes injury to;-

1. Medial collateral ligament.
2. Anterior cruciate ligament.
3. Medial meniscus.

Dr Ibrahim

Return to other triads here.

- TNM Staging of Renal cell carcinoma (illustrated).

TNM Staging of Renal cell carcinoma.

Primary tumor (T):-

T0: No evidence of primary tumor
T1: Tumor 7 cm or less in the largest dimension, Tumor is confined to the kidney (i.e no penetration through the capsule).

- Compound fracture grading - Gustilo-Anderson grading.

Compound fracture grading 

Gustilo-Anderson grading.

- Grade I :- clean , less than 1cm wound , minimal soft tissue injury, simple or minimally comminuted fracture. 

- Renal trauma grading scale.

Basically we can divide renal trauma into five grades.

The grades I , II and III are classified as minor traumas, and the grades IV,V as major :-

• Grade I: contusion or subcapsular hematoma, without parenchymal laceration.
• Grade II: superficial cortical laceration less than 1 cm deep.
• Grade III: deep cortical laceration extending more than 1 cm.
• Grade IV:
1. corticomedullary laceration with collecting system injury and urinary extravasation. 
2.  vascular injury:- laceration or thrombosis of a segmental artery.

• Grade V:
1. Multiple deep lacerations.
2. Thrombosis of the main renal artery.
3. Avulsion of renal hilum which devascularizes kidney.

- Bladder Injury.

Bladder Injury

Aetiology:-

1. Blunt trauma : 10% of pelvic fractures.
2. Penetrating trauma :gunshots or stap wounds.
3. Iatrogenic:-
• Obestetric :- 0.3% with caeserean section.
• Gynaecological e.g.during a vaginal or abdominal hysterectomy.
• Urological e.g during cystescopy.
• Orthopaedic e.g. pins and screws can commonly perforate the urinary bladder, particularly during internal fixation of pelvic fractures.
4. Idiopathic:- due to presence of a previous scar.

Classification(Pathophysiology):-

1. Extraperitoneal rupture bladder:
Usually due to fracture pelvis,and Extravasation occur at the perivesical space and may extend up to the anterior abdominal wall,If the urogenital membrane is injuried.
2. Intraperitoneal rupture bladder:(The most dangerous)
Usually due to direct trauma when the bladder is full,associated with electrolyte disturbance and may passed unnoticed for along time.

- Arterial line placement.

Arterial line placement.

An intra-arterial catheter (A-line) is a very small plastic tube (called catheter) placed in one of your blood vessels (an artery) by highly trained personnel. This is usually done during or before certain types of surgery or in the Intensive Care Unit.

To see how to undergo Arterial line see the following video from New Engeland Journal of Medicine.

you can see the video online on NEJM here or

Download it directly from here 

  or watch it now :D

- ASA Grading system.

ASA Grading system

American Society of Anesthesiologists (ASA) grade is the most commonly used grading system to measure of a persons overall health, rather than a fitness for anaesthesia and surgery.   

• Grade  I   Healthy individual with no systemic disease 
• Grade II  Mild systemic disease not limiting activity
• Grade III Severe systemic disease that limits activity but is not incapacitating .
• Grade IV  Incapacitating systemic disease which is constantly life-threatening.
• Grade V   Moribund, not expected to survive 24 hours with or without surgery.
  Dr Ibrahim
  Return to list of medical grades (click here)

- Carpal tunnel syndrome.

Carpal tunnel syndrome 

*Def:- is a medical condition in which the median nerve is compressed inside the flexor retinaculum leading to paresthesias, numbness and muscle weakness in the hand.

*Causes:-

Due to fibrosis,fluid accumulation,soft tissue or bone hypertrophy which my be due to:-

"MEDIAN TRAP"(1)

Myxoedema
Edema
Diabetes mellitus,Drugs(e.g Oral contraceptive pills)
Idiopathic
Acromegaly
Neoplasm 

Trauma,Typists(Occuptional).
Rheumatoid arthritis
Amyloidosis
Pregnancy

-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