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Ewing’s sarcoma is a malignant small cell neoplasm of long bones and pelvis during the first or second decades of life. The involvement of phalangeal bones is extremely rare.

A 25-year old right-hand-dominant man referred to the hand clinic because of pain and swelling in his left hand since 5 months ago. There was no disease or trauma in his past medical history. In physical examination of left hand doctors noticed a fixed firm swelling in proximal of second finger. The swelling was painful in palpation and with prominent dilated superficial veins on it. A decrease in range of motion in metacarpophalangeal and proximal interphalangeal joints was observed but the site was painless. Other physical examinations were normal. Radiography of left hand revealed proximal phalanx of index finger involvement by destructive lytic tumor. Routine lab tests were normal. Chest radiography was also normal. Whole body bone scan showed increased uptake of left index finger without involvement of other areas. The MRI revealed proximal phalanx involvement with tumor invasion to soft tissue. Incisional biopsy was performed and pathological examination revealed homogeneous population of densely packed small round cells with diagnosis of Ewing’s sarcoma. After consultation, a second ray amputation and then chemotherapy were performed. The patient was followed for 25 months and no sign or symptom of tumor recurrence was observed after surgery.

Treatment options for Ewing’s sarcoma in fingers have been controversial during the recent decades. However, the most accepted procedure has been amputation or wide surgical resection followed by chemotherapy. This lesion is very similar to osteomyelitis in clinical and imaging presentation and the rarity of the tumor may mislead the diagnosis.
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Cr:Bagherifard A, Yahyazadeh H, Jafari D, Shoushtarizadeh T. Ewing’s Sarcoma of the Finger: A Rare Case Report and Review of the Literature, Shafa Ortho J. Online ahead of Print ;1(1):e51. 
#medicine #cancer #sarcoma #hospital #surgery #oncology #medschool #medicalschool #nursingschool #nursing #premed #mcat
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Ewing’s sarcoma is a malignant small cell neoplasm of long bones and pelvis during the first or second decades of life. The involvement of phalangeal bones is extremely rare. A 25-year old right-hand-dominant man referred to the hand clinic because

The term ichthyosis is derived from the Greek word ichthys, which means fish. Ichthyosis is not one disease but a group of disorders in which there is excess accumulation of epidermal cells resulting in the appearance of scales. Severity ranges from mild, asymptomatic to life threatening. There are a large number of types of ichthyosis; most are extremely rare. This condition tends to be worse in the dry, cold winter months and generally improve in the warmer, more humid months of summer. The most common type of ichthyosis is ichthyosis vulgaris which accounts for almost 95% of cases. Apart from ichthyosis vulgaris all other forms of ichthyosis are very rare. Ichthyosis vulgaris affects about 1:250 individuals. Ichthyosis occurs worldwide and affects people of all races. Other forms of ichthyosis are lamellar, x-linked, and epidermolytic hyperkeratosis. These conditions are inherited and based on expression of specific keratin genes which result in the formation of abnormal keratins Although the signs and symptoms may vary among the different types of ichthyosis, they all show the characteristic dry, rough, scaly skin. The boy in the picture is affected by a rare form of the disease. His name is Ramesh and he is now receiving treatment at the Kathmandu Medical College TDl.
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The term ichthyosis is derived from the Greek word ichthys, which means fish. Ichthyosis is not one disease but a group of disorders in which there is excess accumulation of epidermal cells resulting in the appearance of scales. Severity ranges from

SCALP NECROSIS! A 74-year-old man presented with a 3-month history of headache, jaw claudication, and worsening scalp ulceration. He reported no visual loss or polymyalgia rheumatica. Examination revealed areas of scalp necrosis (Panel A). Both temporal arteries were difficult to palpate but were nontender. His erythrocyte sedimentation rate was 64 mm per hour, and his C-reactive protein level 45 mg per liter. He received a diagnosis of scalp necrosis as a complication of giant-cell arteritis. Treatment was initiated with glucocorticoids (60 mg of prednisolone per day) and topical dressings that were administered daily. During the next few months, his symptoms decreased and the scalp lesions started to heal (Panels B and C). The dose of prednisolone was tapered by 10 mg every month until it reached 20 mg per day. The dose was then tapered more slowly until the lesions healed completely (Panel D), after which the medication was discontinued. Scalp necrosis is a rare and potentially life-threatening complication of giant-cell arteritis. Early recognition and treatment are important.
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Cr: Qasim Akram, M.R.C.P, Hector Chinoy, M.R.C.P., Ph.D @nejm
#medicine #necrosis #medicalcreations #immunology #arteritis #medical
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SCALP NECROSIS! A 74-year-old man presented with a 3-month history of headache, jaw claudication, and worsening scalp ulceration. He reported no visual loss or polymyalgia rheumatica. Examination revealed areas of scalp necrosis (Panel A). Both tempo

SCHWANNOMA REMOVAL.
A schwannoma is a tumor of the peripheral nervous system that arises in the nerve sheath (tissue that protects the nerves). It develops from a type of cell called a Schwann cell, giving the tumor its name. It is almost always benign (not cancerous), but rare malignant schwannomas have been reported. Although schwannomas can arise from any nerve in the body, the most common locations include the head, arms, legs and trunk.

The presence of a schwannoma may first become apparent with a cosmetic deformity, a noticeable mass, symptoms similar to a compressive neuropathy (pinched nerve), or some combination of these. Neurologic symptoms tend to occur later. Symptoms can be vague, and it may be several years before the tumor is diagnosed.

The cause of schwannomas is not known. In some cases they are associated with neurofibromatosis. In these cases, multiple tumors may be present. Treatment of benign schwannomas involves surgery to remove the tumor, which usually results in complete and fast relief of symptoms. Treatment of malignant schwannomas may involve surgery and radiation therapy. Chemotherapy is usually not used in these tumors, but in some cases it may be used to shrink the tumor before the surgery, or to keep it stable.
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SCHWANNOMA REMOVAL. A schwannoma is a tumor of the peripheral nervous system that arises in the nerve sheath (tissue that protects the nerves). It develops from a type of cell called a Schwann cell, giving the tumor its name. It is almost always beni

A 44 year old diabetic patient presented with extensive infection in the right foot, with gangrene of the second toe. She was managed by ray amputation of the second toe, surgical debridement and later free gracilis muscle transfer.

A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any chronic complication of diabetes. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropaty is called diabetic foot syndrome.

Due to the peripheral nerve dysfunction associated with diabetes, patients have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while. People with diabetes are also at risk of developing a diabetic foot ulcer. In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities. Around half of patients with diabetic foot ulcer have co-existing PAD. 
Where wounds take a long time to heal, infection may set in and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.
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Cr: Dr. N. Jithendran
#medicine #trauma #diabetes #hospital #medschool #medicalschool #nursingschool #rn #bsn #medicalstudent
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A 44 year old diabetic patient presented with extensive infection in the right foot, with gangrene of the second toe. She was managed by ray amputation of the second toe, surgical debridement and later free gracilis muscle transfer. A diabetic foot

End stage liver disease. Caput medusae is usually related to liver disease, which eventually causes liver scarring, or cirrhosis. This scarring makes it harder for blood to flow through the veins of the liver, leading to a backup of blood in your portal vein. The increased blood in the portal vein leads to portal hypertension.
This refers to high pressure in the portal vein. The portal vein carries blood to the liver from the intestines, gall bladder, pancreas, and spleen. The liver processes the nutrients in the blood and then sends the blood along to the heart.

With nowhere else to go, some of the blood tries to flow through nearby veins around the bellybutton, called the periumbilical veins. This produces the pattern of enlarged blood vessels known as caput medusae.
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End stage liver disease. Caput medusae is usually related to liver disease, which eventually causes liver scarring, or cirrhosis. This scarring makes it harder for blood to flow through the veins of the liver, leading to a backup of blood in your por

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Incredible! This is a case of an engorged vein rupturing. Located very near the surface of the skin, varicose veins may rupture and bleed spontaneously or due to a very minor injury to the skin. Often, the veins which bleed spontaneously are small veins near the ankle and they do not necessarily cause pain or tenderness. Venous pressures inside some varicose veins near the ankle or foot can be nearly as high as arterial blood pressure due to the effect of gravity and failure of valves in veins at multiple levels in the legs. The very high pressures within the veins may stretch the walls of the veins causing weakness over time. The vein may rupture very suddenly causing bleeding into the tissues or through the surface of the skin if the skin has become thin overlying the vein.
Bleeding varicose veins may be small amounts on sporadic occasions or it may be life-threatening with blood squirting many feet across the room.
Emergency treatment for bleeding from a varicose vein is simple:
▪️Elevate the leg higher than the heart, and
▪️Apply pressure over the bleeding site. This may be done initially with a finger to control the bleeding followed by a pressure dressing.
A folded gauze sponge or a cloth applied over the site with pressure from compression hose or an elastic wrap usually work well to prevent repeat bleeding for the short term.
▪️Suturing (if needed)
Ultrasound guided sclerotherapy has proven to be one of the best treatments to prevent repeat bleeding episodes. Complete evaluation of the veins of the lower extremity is important to find the underlying causes of the problem for definitive treatment.
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What would you have done in this situation? Comment below 
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#bleeding #varicoseveins #premed #medschool #nursingschool #emt #hospital
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Incredible! This is a case of an engorged vein rupturing. Located very near the surface of the skin, varicose veins may rupture and bleed spontaneously or due to a very minor injury to the skin. Often, the veins which bleed spontaneously are small ve

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LAST CHANCE to receive your Suture Kit before Christmas at an incredible price! In this video our Favorite MD @emilyjacobsmd ‍️ shows us how fun it is to practice on our Suture Pad! What are you waiting for? Grab your coupon code now so that you can

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Inflammatory pseudotumor (IP) is an uncommon benign neoplasm. It was first described in the lung but it has been recognized in several somatic and visceral locations. Mesenteric presentation is rare and its clinical presentation is variable but patients can be completely asymptomatic. Complete surgical resection is the only curable treatment.

A 57 years-old patient, with no relevant medical or surgical history and completely asymptomatic, was sent to General Surgery Department after performing an abdominal contrasted computed tomography (CT) for the evaluation of a mass on the right hypochondrium. On physical examination, one could see and palpate a voluminous and indurated, yet mobile, mass.

The CT showed a single, round, 14 × 12,5 cm mass, with heterogeneous density (some small calcifications and hypodense areas), thick-walled, which compressed several intestinal loops, the uncinate process of the pancreas and also the third portion of the duodenum. Laboratory results were unremarkable. A huge and well vascularized mass was found, which was adjacent to the second and third portions of the duodenum, transverse colon, body of the pancreas, and to the superior mesenteric artery and vein. A segmental colectomy of the transverse colon and a primary anastomosis needed to be performed as result of ischemia. Definitive histology revealed a 1245 g and 14 × 14 × 10 cm mesenteric inflammatory pseudotumor, with associated ischemia, cavitary disintegration and almost complete necrosis. Preoperative diagnosis of IP can be troublesome to establish, mainly due to the lack of a typical clinical presentation. The patient was discharged on the fifteenth postoperative day with no relevant morbidity. After a four-years follow-up, there is no clinical or imagiological evidence of recurrence.
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Cr: VĂ­tor Neves Lopes, CĂ©sar Alvarez, M. Jesus Dantasab CarlaFreitas, JoĂŁoPinto-de-Sousa
International Journal of Surgery Case Reports Volume 32, 2017
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Inflammatory pseudotumor (IP) is an uncommon benign neoplasm. It was first described in the lung but it has been recognized in several somatic and visceral locations. Mesenteric presentation is rare and its clinical presentation is variable but patie

Regression of Clubbing after Treatment of Lung Cancer! 
A 59-year-old woman with a smoking history of 60 pack-years presented with progressive shortness of breath and clubbing of her fingers that had developed over a 1-year period (Panel A). A computed tomographic scan showed a large mass with cavitation in the left lower lobe of the lung (Panel B shows the axial view). Transbronchial biopsy revealed an undifferentiated non–small-cell cancer with positive immunohistochemical staining for tumor protein 63 and cytokeratin 5/6, findings that were consistent with a diagnosis of poorly differentiated squamous-cell lung cancer. The patient was treated with carboplatin and paclitaxel chemotherapy and radiation therapy, and she was enrolled in an immunotherapy trial with a programmed death ligand 1 (PD-L1) inhibitor as maintenance therapy. Six months after diagnosis and the initiation of treatment, the patient noticed that the clubbing of her fingers had diminished (Panel C) and that she was no longer short of breath. A follow-up computed tomographic scan showed a decrease in the size of the mass (Panel D). Physical examination of the nails for clubbing may aid in the diagnosis of lung disease, including lung cancer. In this patient, the clubbing diminished after an impressive response to treatment of the cancer.
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Cr: Ari J. Ciment, M.D. Larry Ciment, M.D. @nejm 
#medicine #cancer #hospital #medschool #oncology #nursingschool
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Regression of Clubbing after Treatment of Lung Cancer! A 59-year-old woman with a smoking history of 60 pack-years presented with progressive shortness of breath and clubbing of her fingers that had developed over a 1-year period (Panel A). A comput

This is just absolutely beautiful. The best and the worst thing about love is that it just can’t be expressed in words ️
Credit: @katiewhiddon
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This is just absolutely beautiful. The best and the worst thing about love is that it just can’t be expressed in words ️ Credit: @katiewhiddon

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Spend $20 on books on Amazon.com and get $5 off. If you want more information about the discount code and how you can claim it just DM us! . . Photos: @themedgrind