Friday, 10 June 2011

Significance of Carnett's sign

The idea of Carnett's sign is that (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed.So, if Pain source is Intra-Abdominal (Negative Carnett's Sign),Abdominal Pain decreases with tensing abdomen.
And in Abdominal Muscle Wall Pain (Positive Carnett's Sign), Pain increases or remains unchanged

Technique

A- Patient lies supine
B- Patient tenses abdominal wall by
-asking the patient  to lift the head and shoulders from the examination table to tense the abdominal muscles
-An alternative is to ask the patient to raise both legs with straight knees.


Carnett's sign for patients with pelvic pain. The examiner places his or her finger on the tender area of the patient's abdomen and asks the patient to raise both legs off the table. An increase in the patient's pain during this maneuver is considered a positive test.

Tuesday, 7 June 2011

Picture and Imaging of Nasopharyngeal Cyst


This nasopharyngeal mass on the left side was discovered during a routine nasopharyngoscopy in a 38 year-old smoker who presented with hemoptysis and epistaxis.

The CT scan below showed a mass arising from the left lateral nasopharyngeal wall. The mass was surgically removed. It turned out to be a benign mucocele.

Monday, 6 June 2011

How to distinguish Athetosis from Chorea ?

Sometimes is difficult to distinguish athetosis from chorea (hence the term choreoathetosis). Typically, however, athetoid movements are slower than choreiform movements.

Athetosis is an extrapyramidal sign characterized by slow, continuous, twisting, involuntary movements. Typically, these movements involve the face, neck, and distal extremities, such as the forearm, wrist and hand.
Facial grimaces, jaw and tongue movements, and occasional phonation are associated with neck movements. Athetosis worsens during stress and voluntary activity, may subside during relaxation, and disappears during sleep. It is commonly a lifelong affliction.
A: With athetosis, movements are typically slow, twisting, and writhing. They're associated with spasticity and most commonly involve the face, neck, and distal extremities. 
B: With chorea, movements are brief, rapid, jerky, and unpredictable. They can occur at rest or during normal movement. Typically, they involve the hands, lower arm, face, and head.

Positions of fingers in movements of athetosis.
Athetosis usually begins during childhood, resulting from hypoxia at birth, kernicterus, or a genetic disorder. In adults, athetosis usually results from a vascular or neoplastic lesion, a degenerative disease, drug toxicity, or hypoxia.

Saturday, 4 June 2011

Schatzki Ring as appeared by Endoscope and barium swallow


A Schatzki ring also called Schatzki-Gary ring is a narrowing of the lower part of the esophagus that can cause intermittent dysphagia. The narrowing is caused by a ring of mucosal tissue (which lines the esophagus) or muscular tissue.And This ring is congenital in origin.

Two rings have been identified in the distal esophagus.
1- Muscular ring, or A ring, is a thickened symmetric band of muscle that forms the upper border of the esophageal vestibule and is located approximately 2 cm above the gastroesophageal junction. The A ring is rare; furthermore, it is even more rarely associated with dysphagia.
2- Mucosal ring, or B ring, is quite common and is the subject of discussion in this topic. The B ring is a diaphragmlike thin mucosal ring usually located at the squamocolumnar junction; it may be symptomatic or asymptomatic, depending on the luminal diameter.
Endoscopic image of Schatzki ring.

Patients typically present with intermittent nonprogressive dysphagia for solids. Fortunately, most patients respond well to initial and repeat dilatation therapy. A small number of patients may have stubborn rings that require more aggressive endoscopic or surgical intervention.

This Prone, single-contrast barium esophagogram demonstrating Schatzki ring a thin, ringlike narrowing (arrows) in the lower esophagus just above a hiatal hernia. This view is most sensitive for detecting lower esophageal rings, provided adequate esophageal distention is achieved.