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More than 200 bladder stones found in an 81-year-old man! 🗿 The patient in this case is an elderly man who has had urinary stasis obstruction for a long time due to benign prostate hyperplasia (BPH). Due to urinary stasis, numerous stones have formed inside the bladder. Given the large number of bladder stones and the patient’s symptoms, the management plan involved a multidisciplinary approach, including Transurethral resection of the prostate (TURP): To alleviate bladder outlet obstruction caused by BPH and reduce the risk of recurrent stone formation, an open bladder stone removal, which led to the removal of a mind-blowing number of over 200 stones! Bladder stones are solid calculi that are primarily found in the urinary bladder. While often calcified, they may also be composed of non-calcific material. Urinary stasis, such as BPH or neurogenic bladder disorder, is the primary cause. Most such stones are newly formed in the bladder. Some come from the kidneys either as a stone or a sloughed papilla. Any foreign body left in the bladder that is not spontaneously expelled will eventually form layers of stone material and develop into calculus. In 50% of cases the stone composition is uric acid. In regards to surgical therapy, endoscopic surgery is used. Cystolitholapaxy (to break up bladder stones into smaller pieces and remove them), can be achieved by disruptive or ablative therapy, including lasers, pneumatic-powered mechanical contact jackhammer, ultrasound, and direct mechanical crushing with a lithotrite. Extracorporeal shockwave lithotripsy is also used. In some cases of extremely large bladder stones or prostates, open suprapubic surgery is done. This allows for the removal of the intact stone, followed by an open prostatectomy (for prostates more than 75 g in size). The advantage of an open suprapubic cystostomy for bladder stone removal is the reduced surgery time (half the time compared to endoscopic means), easy removal of large or multiple stones, ability to remove stones that might be difficult or hard to fragment with endoscopic treatments and the ability to handle stones that are stuck to the bladder lining. Photos by @zahed_hosseinii
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Are these aliens... or human babies? Mind-boggling MRI scans of fetuses are terrifying people!! 👽 Possessing menacing eyes and devilish grins, you would be forgiven for assuming these were just aliens from a Hollywood sci-fi blockbuster. These images were circulating on social media apps and while some suggest they have been traumatised by viewing such discomforting images, others seem to find them comical. Some users even believed the fetus was an extra-terrestrial being. Yet, believe it or not, they are not fake. Instead, they are genuine MRI scans of human babies in the womb. MRI scans are different to ultrasounds. Parent's are not regularly offered MRI throughout their pregnancy and will typically only have the scan if there is a concern for the child's growth and development. For example, they can help define and detect neck, thoracic, abdominal and spinal malformations in fetuses. When used during pregnancy, however, MRIs can produce a very life-like image of their baby. The detailed black and white images burst the bubble of many parents who blindly believe their tiny tot is going to be adorable through and through. One user said MRIs are discouraged during pregnancy because 'people would realise they're incubating nightmare demons and would be rightfully terrified'. We can confirm these images are authentic and real. MRI uses magnetic fields and radio waves to produce detailed images of the inside of the body. The eyes and brain have high levels of 'signal' — a radio wave — which causes them to appear brighter and stand out on the scan. Other parts of the body give off lower levels, and therefore appear darker.
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A dodgeball injury that resulted in radius and ulnar shaft fracture, aka broken forearm! This sustained dodgeball injury has led to a bilateral diaphyseal fracture involving both the radius and ulnar shaft, thereby presenting as a fracture of the forearm. This particular injury entails the disruptive discontinuity of the long bones situated within the antebrachial region, namely the radius and ulnar diaphyses. Etiologically, such fractures arise consequent to an abrupt forceful impact or trauma, commonly encountered within dynamic sports such as dodgeball. Timely medical intervention is imperative to accurately ascertain the nature and extent of this injury, often accomplished through radiographic imaging modalities like X-ray examinations. Treatment modalities encompass immobilization employing a cast or, in severe instances, surgical intervention to achieve anatomical alignment and biomechanical stability of the fractured bony elements. Due to significant displacement, the initial treatment is closed reduction that is attempted when fracture angulation exceeds 10 degrees or displacement exceeds 50%. Reduction involves placing the patient's affected arm in finger traps while the brachium is secured with a strap or weights. This setup allows for ready manipulation of the forearm and rapid splinting once reduction is achieved. After satisfactory alignment is achieved, the fractured arm is placed in a long-arm posterior splint with the elbow at 90 degrees and the wrist in neutral (ie, without supination or pronation) and slight extension.
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A rare case of ovarian ectopic pregnancy!! This rare and potentially life-threatening condition, is characterized by the aberrant implantation and subsequent development of a fertilized ovum within the ovarian parenchyma. In other words, the fertilized egg implants and develops within the ovary instead of the uterus. It occurs when the fertilized egg fails to travel down the fallopian tube and instead implants in the ovarian tissue. Clinically, it manifests with a constellation of symptoms including abdominal pain, frequently localized to one side, and vaginal bleeding. The symptomatology may demonstrate variable intensity, while concurrently mimicking other gynecological conditions, thereby precipitating diagnostic challenges and potential delays in appropriate management. Diagnostic modalities encompass the utilization of transvaginal ultrasonography, which reveals the presence of a gestational sac within the ovarian milieu. Additional sonographic findings may encompass adnexal masses, augmented vascularity within the ovarian bed, or the absence of a gestational sac within the uterine cavity. Serial monitoring of serum human chorionic gonadotropin (hCG) levels contributes to the diagnostic algorithm, facilitating the assessment of pregnancy progression and viability. Surgical intervention is frequently preferred and is typically accomplished through laparoscopic means, which confer enhanced visualization and precision in the removal of the ectopic pregnancy while minimizing collateral ovarian damage. However, instances necessitating extensive ovarian involvement or situations wherein laparoscopic proficiency is limited may necessitate recourse to laparotomy. The overarching goal of surgical intervention is the complete eradication of the ectopic pregnancy while preserving the functional integrity of the ovarian tissue. Alternatively, selected cases may be amenable to medical management, wherein the administration of methotrexate, a folic acid antagonist, retards the growth of trophoblastic tissue, facilitating gradual resorption of the ectopic pregnancy by the body. Photo by @Figure1
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Transforming Curves: From Struggle to Strength - Witness the Journey of Scoliosis! Scoliosis is characterized by a lateral deviation and rotational deformity of the spine, resulting in an abnormal sideways curvature. It can manifest in different regions of the vertebral column and exhibit varying degrees of severity. This 13-year-old’s scoliosis was progressing so rapidly that major spinal surgery was her only treatment option. In just over six months, her curve progressed from what was initially 49-degree to a 99-degree curve. The girl now has a combination of titanium rods and screws around her spine. Luckily she fully recovered and got back to her normal activities. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. About 3% of adolescents have scoliosis. Treatment depends on the degree of curve, location, and cause. Minor curves may simply be watched periodically. Management options may involve close observation, utilization of orthotic devices (e.g., braces) for stabilization, or, in severe cases, surgical intervention aimed at rectifying the curvature and achieving spinal stability. The brace must be fitted to the person and used daily until growing stops. Surgery is usually recommended by orthopedists for curves with a high likelihood of progression (i.e., greater than 45 to 50° of magnitude), curves that would be cosmetically unacceptable as an adult, curves in people with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing. To completely straighten a scoliotic spine is usually impossible, but for the most part, significant corrections are achieved. Credit: Isabel Dayman, Mobile.abc.net.au
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