Heparin . . . The forgotten hero in myocardial infarction

Description of Hallux Malleus "hammer toe"

-Hallux for the big toe
-Malleus for a hammer

Hallux malleus is a deformity of the great toe. This deformity can be very stiff or flexible. The joint in the great toe becomes contracted in a flexed or downward position.
This deformity usually occurs due to an imbalance of the tendons that insert on the top and the bottom of the great toe. When the tendon on the bottom of the toe (the tendon that causes the toe to flex down) over powers the tendon that causes the toe to bend up, this deformity occurs.

Usually patients will develop a callus and even an ulcer on the tip of the great toe. This deformity is often seen in conjunction with hammer toes. High arched feet are typically the most affected by this deformity.

This deformity is treat initially with padding techniques to prevent sores from developing at the tip of the toe. Custom, soft, accommodative orthoses are sometimes prescribed for the patient to provide cushioning and also to prevent worsening of the deformity.

If conservative treatment fails, surgery is indicated. Surgery usually consists of performing a bone fusion of the 2 bones in the great toe. This can be done with screws, staples, or wire fixation.

About Retinal Detachments

Which of the following statements is TRUE regarding acute traumatic retinal detachments?

• (A) Most detachments can be visualized on standard fundoscopy
• (B) Eighty percent of detachments occur within 24 h of the traumatic event
• (C) Most detachments originate in the inferotemporal quadrant
• (D) Visual outcome depends on the extent of involvement of the optic disc
• (E) Sudden onset of pain is a prominent feature

The answer is C. 

The typical retinal detachment is heralded by painless flashes of light, floaters, and a shade across the visual field. Interestingly, most detachments follow a latent period, up to 8 months posttrauma in 50 percent of cases.

Detachments begin as small tears in the ora serrata (called dialysis), most frequently affecting the inferotemporal quadrant, followed by the superonasal quadrant. Because most detachments are very peripherally situated on the retina, standard fundoscopy is typically inadequate for visualization. Although a number of techniques have been developed to correct the detachment, visual outcome remains largely determined by the degree of macular involvement.

Prostate diseases in relation to Prostate zones

Most cancer lesions occur in the peripheral zone of the gland, fewer occur in the transition zone and almost none arise in the central zone. Most benign prostate hyperplasia (BPH) lesions develop in the transition zone, which might enlarge considerably beyond what is shown.

The inflammation found in the transition zone is associated with BPH nodules and atrophy, and the latter is often present in and around the BPH nodules. Acute inflammation can be prominent in both the peripheral and transition zones, but is quite variable.
The inflammation in the peripheral zone occurs in association with atrophy in most cases.

Although carcinoma might involve the central zone, small carcinoma lesions are virtually never found here in isolation, strongly suggesting that prostatic intraepithelial neoplasia (PIN) lesions do not readily progress to carcinoma in this zone. Both small and large carcinomas in the peripheral zone are often found in association with high-grade PIN, whereas carcinoma in the transition zone tends to be of lower grade and is more often associated with atypical adenomatous hyperplasia or adenosis, and less often associated with high-grade PIN. The various patterns of prostate atrophy, some of which frequently merge directly with PIN and at times with small carcinoma lesions, are also much more prevalent in the peripheral zone, with fewer occurring in the transition zone and very few occurring in the central zone.