X-Ray of a 33 year old man’s hand mangled following a firecracker accident! This is an injury from an explosive device with a sole purpose of producing a striking display by the combustion of explosive or flammable compositions. Since fireworks are often used around holidays, fireworks injuries tend to cluster about holidays and can spoil them. A common outcome of fireworks-related hand injuries is multiple finger amputations due to a strong firecracker exploding in the patient's hand.
That’s a lot of excess fat and skin!! This is 22 pounds of skin removed from a weightloss patient. He now weighs in the 200s for the first time in 25 years! Abdominoplasty or tummy tuck is an aesthetic procedure performed for an abdominal deformity of excess skin and subcutaneous tissue and laxity of the abdominal wall musculature. The most common cause of abdominal deformity is pregnancy (often multiple pregnancies), which stretches the skin beyond its biomechanical capability to spring back and stretches the musculoaponeurotic structures of the abdominal wall. The result is stretching and thinning of these structures and diastasis of the rectus muscle. Major weight loss, whether from dieting or a gastric bypass surgery, also plays a role in excess skin and laxity of the abdominal wall. No surprise, The most significant area of the defect is around and below the umbilicus, where excess skin over a diastasis of the rectus muscles is most apparent. Abdominoplasty removes not just the excess fat and skin, but in most cases, it restores weakened or separated muscles and tightens then to create a smooth and firm abdominal profile. Photo credit to @drjosephmichaels
Pulling the skin off to expose the skull!! This is a coronal flap to the upper facial skeleton!! This is a frontal bone (forehead) exposure for facial reconstruction after a car accident. A coronal flap approach is indicated to expose the anterior cranial vault, the forehead, and the upper and middle regions of the facial skeleton, known as the craniomaxillofacial region. It is used in the repair of extensive upper facial/craniofacial fractures after extreme accidents. The advantage is that with strict adherence to surgical principles, is poses minimal complications during surgery as well as an aesthetic advantage of a hidden scar in the hairline.
Rapunzel syndrome alert! A hairball being extracted through a gastronomy!! Due to the bulky size of the trichobezoar, the patient underwent exploratory laparotomy, with an incision from the center of the upper abdomen extended vertically along the anterior wall of the stomach, which revealed a stomach completely filled by the large trichobezoar, and a long tail extended through the pylorus and the duodenum into the upper parts of the jejunum. The total length was approximately 25cm, with a weight of over 3000g. Broadly speaking, a bezoar is a tightly packed collection of indigestible material that is unable to exit the stomach, most being hair-trichobezoars. Trichobezoar is basically a human hairball that obstructs the gastrointestinal system. It is rare but serious condition and can be fatal and is usually associated with the condition called Trichtotillomania compulsive hair pulling. Bezoars that extend through the pylorus in the form of a tail into the small bowel are known as the Rapunzel syndrome, which is clearly seen in this case. They cause potentially life-threatening complications such as intestinal obstruction, gastric bleeding, and perforation and must be removed once the diagnosis is made, especially when they become embedded in the gastric mucosa. Gastric trichobezoars may attain large sizes before becoming symptomatic, causing symptoms and signs of partial or complete gastric outlet obstruction, unless being removed surgically through a midline incision gastrotomy to prevent complications.
Happy Father’s Day! Skin to skin contact with a father can change everything. This preterm baby required a ventilator support and was placed on his father’s chest for a skin-to-skin contact immediately after birth while the mother was still recovering from the cesarean delivery. This is called a Kangaroo care, a manner in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences. There is good evidence that preterm newborns who are placed skin to skin with their mothers or even fathers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress. Positive psychological responses were also found in parents of intubated preterm infants, they exhibited more caring behaviours and developed a more sensitive approach to their infants.
The bigger it is, the more dilated it is from the inside! Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile dysfunction. The right ventricle may also be dilated and dysfunctional. In half of the cases, the cause is idiopathic. next most common cause is viral myocarditis, and other causes may include substance abuse, connective tissue disease, certain medications, nutritional deficiencies, infiltrative diseases and toxins. Viral myocarditis can cause dilated cardiomyopathy via direct viral damage due to an initial inadequate immune response that allows the virus to invade cardiac myocytes, leading to cytotoxicity and impaired contractile function. Decreased systolic function and ventricular dilation (due to eccentric hypertrophy) ensue. Patients experience fatigue, dyspnea on exertion, shortness of breath, cough, noctural dyspnea (at night) and orthopnea (dyspnea when lying flat). Diagnosis is made by echocardiogram, which typically shows dilated ventricles with diffuse hypokinesia resulting in a low ejection fraction (I.e. systolic dysfunction). Treatment is largely supportive, and mainly involves the management of symptoms caused by congestive heart failure with ACE inhibitors, beta blockers, angiotensin II receptor blockers and nitrates. Cardiac transplantation is an option for patients with severe heart failure, and a left ventricular assist device, or LVAD, may help to bridge a patient while awaiting transplantation.
The base of the brain is a masterpiece on its own! This unique photo shows the inferior surface of the brain, primarily the brainstem, upper portion of the spinal cord, circle of Willis, and both right and left hemispheres. Of you recall from anatomy classes, The brain is composed of 3 main structural divisions: the cerebrum, the brainstem, and the cerebellum. At the base of the brain is the brainstem, which extends from the upper cervical spinal cord to the diencephalon of the cerebrum. The brainstem is divided into the medulla, pons, and midbrain and posterior to the brainstem lies the cerebellum. The midbrain has fibers that connect the brain stem to the cerebrum and cerebellum; this area is very important in the control of skeletal movements. The pons, which lies between the midbrain and medulla oblongata, relays sensory information between the cerebrum and cerebellum. The medulla oblongata contains centers for the control of breathing and cardiovascular function. The cerebellum on the other hand regulates muscle tone, coordinates movement and helps maintain posture and balance. It does not initiate movements, but is responsible for their smooth and balanced execution, for maintaining muscle tension and making movements work together in complex action such as walking. It comprises approximately 10 percent of the brain’s volume, contains at least half its neurons and is connected to the brain stem via three major bundles of input and output fibers called peduncles. Art and creation at their finest.
Giant brain tumor, in a 5-year-old pediatric patient!! The tumor was classified as Grade III ependymoma in the last pathology report, which arises for ependymal cells of the central nervous system and is dominated by intracranial mass. It was a left parieto-occipital localization, dominant hemispheres. Swipe to see photographs of the imaging and the surgery! Fortunately, the doctor Juan Manuel Riesta performed the resection of the tumor successfully! 🧠 Credit to @neurocenter10
Contact dermatitis from sandals!! This young lady wore a new pair of sandals and about a week later got this rash which was painful, itchy and had blisters that wept. At first she thought it was poison ivy but the urgent care doctor diagnosed this as contact dermatitis from something they treated the sandals leather with. As you can see, the rash appeared in a symmetrical pattern that follows the shape of the sandal and larger blisters appeared where the toe strap had been. The parent doesn’t have a history of sensitive skin so it was a surprise that she would react to a pair of shoes. She’s being treated with hydrocortisone 2.5%. Contact dermatitis is a skin reaction resulting from exposure to allergens or irritants. Only the superficial regions of the skin, and epidermis and dermis, are affected in contact dermatitis. It represents a type IV hypersensitivity reaction, with initial sensitization occurring within days of contact with the causative substance. On re-exposure, the antigen is presented to sensitized lymphocytes, leading to inflammation within hours. It takes days to fade away. Even then, contact dermatitis fades only if the skin no longer comes in contact with the allergen or irritant. Acute symptoms include erythema, vesicles, weeping, and crusting. Most patients respond to low- or mid-potency topical corticosteroids and elimination of exposure to the allergen. Credit to @abbie__davis
This is the femur of a 10-year-old boy with Ewing’s Sarcoma who underwent limb salvage therapy. It was removed, treated with liquid nitrogen to kill remaining tumor cells, and then reimplanted. Following adjuvant chemotherapy, the patient is recovering well and able to ride his bike again. Credit to @Figure1 app
Ovarian torsion - see that twist!!! This condition involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal edema, internal hemorrhage, and infarction with the subsequent sequelae. It classically occurs unilaterally in a pathologically enlarged ovary but torsion of a normal ovary is also common among young children. Patients present with the sudden onset (commonly during exercise or other agitating movement) of severe, unilateral lower abdominal pain that worsens intermittently over many hours accompanied by nausea and vomiting. Some patient also describe bilateral lower quadrant pain described as sharp and stabbing or, less frequently, crampy. Ovarian tumors, both benign and malignant, are implicated in 50-60% of cases of torsion. Involved masses are nearly all larger than 4-6 cm, although torsion is still possible with smaller masses. Photo by @medical_gossips