Prominent orthopedic surgeon Dr. Alan W. Yasko, 51, has died his family has announced. The cause of death was described as a pulmonary embolism.
Orthopedic Surgeon Dr. Alan W. Yasko Has Died
August 24th, 2010Hypokalemia
August 10th, 2010Pathophysiology
1) decreased potassium levels < 3.5 mmol/L due to increased potassium losses, decreased potassium intake, shift of potassium intracellularly Specific causes – 2) K+ wasting diuretics (furosemide, thiazides) 3) prolonged diarrhea or vomiting 4) metabolic alkalosis 5) excessive sweating 6) hyperaldosteronism
Signs and Symptoms
1) symptoms occur if plasma K+ is < 3.0 2) weak and tired legs 3) fatigue 4) myalgias 5) hypoventilation due to respiratory muscle weakness 6) paralysis 7) nocturia, polyuria, polydipsia
Characteristic Test Findings
EKG – 1) flattening of T waves 2) presence of “u” waves
Associated Conditions
increased incidence with – 1) amphotericin B 2) steroids 3) laxative abuse 4) theophylline 5) tetracycline 6) renal cell carcinoma 7) Cushing’s syndrome 8) treatment of diabetic ketoacidosis hypokalemia causes hypertension
Biochemistry
hypokalemia causes delayed ventricular repolarization
Treatment
1) repletion either by mouth or IV (no more than 20 mmol/h) 2) correction of ongoing losses
Tips for USMLE
1) any condition with high renin will have low potassium 2) hypokalemia in setting of digitalis use can precipitate digitalis toxicity (even if levels are normal) 3) hypokalemia can precipitate hepatic encephalopathy in cirrhotics 4) look for hypokalemia in any question with prolonged diarrhea or vomiting.
Rickets
August 9th, 2010Pathophysiology
1) functional vitamin D deficiency causing inadequate mineralization of bones and the matrix of growth plates 2) two forms – type 1 (vitamin D dependent) and type 2
Signs and Symptoms
1) type 1 – usually presents in first year of life 2) type 2 – usually presents early in life but not uncommon for first signs to appear in childhood up to puberty 3) bowed legs 4) slipped capital femoral epiphysis 5) short stature 6) patients dit in a Buddha-like posture 7) flattened skull 8) prominent forehead (frontal bossing) 9) classic rachitic rosary chest (knobs on costochondral cartilage) 10) pectus carinatum 11) potbelly 12) weak muscles 13) irritability 14) apathetic 15) difficulty in focusing on tasks 16) severe dental caries
Characteristic Test Findings
Laboratory – 1) type 1 – increased serum PTH and alkaline phosphatase, hypocalcemia, hypophosphatemia 2) type 2 – increased 1,25-(OH)2D Radiology – 3) flared and cup-shaped epiphysis
Histology/Gross Pathology
hypertrophy of growth plate (5-15) times thicker than normal) as osteoclasts do not resorb this plate
Associated Conditions
increased incidence secondary to – 1) phenytoin use 2) phenobarbital use 3) hypoparathyroidism 4) tumor-induced osteomalacia 5) chronic renal disease
Biochemistry
1) vitamin D can be ingested in food or synthesized from 7-dehydrocholesterol in the skin by exposure to the UV component of sunlight 2) type 1 – deficiency in renal 1-alpha-hydroxylase, which prevents conversion from precursor form 3) type 2 – defect in vitamin D receptor, making end organs functionally resistant to 1,25-(OH)2D
Inheritance/Epidemiology
1) virtually eliminated in developed nations by addition of vitamin D to foodstuffs and generally improved nutrition 2) vitamin D-dependent rickets is autosomal recessive
Treatment
1) type 1 – 1,25-(OH)2D 2) type 2 – repeat IV calcium
Tips for USMLE
1) if rachitic rosary chest is mentioned, think rickets 2) if bowed legs are mentioned think rickets 3) if anything about deficient vitamin D functioning is mentioned, think rickets
Former Surgeon Dr. Karl Ehrens Wanted For Stalking
July 28th, 2010Former South Carolina surgeon Dr. Karl Ehrens is wanted on charges of harassment for allegedly stalking an 18 year old woman in Charleston, South Carolina.
Cleve Jones, Jim Chud, Phill Wilson Reflect On Being Long-Term HIV/AIDS Survivors
July 24th, 2010With the advent of protease inhibitor drugs, patients with HIV/AIDS are living longer. Three prominent AIDS activists discuss their own battle with the disease.
Grand Rounds Here on July 27, 2010
July 22nd, 2010
Rembrandt's The Anatomy Lesson
InsideSurgery is hosting this weeks Grand Rounds, to be published July 27. There is no theme this week but please send us your bests posts and please send them early!! Cut-off for submissions is Sunday, July 25 at 11PM EDT.
Grand Rounds Sneak Preview!!
Rich Elmore at Healthcare Technology News provides a compendium of resources and analyses related to the meaningful use of electronic health records.
Include your blog title in the email and blog and post title in the body of the email. Please contact: insidesurgery then the at sign then of course gmail followed by the symbol for dot followed by the word com.
Management of Chylothorax
July 21st, 2010
Left pleural effusion (white area in the lung field on the readers' right)
Chylothorax results when there is injury to the thoracic duct and lymph tissue escapes in the chest cavity causing a pleural effusion, most commonly the left chest.
Initial management steps include chest tube drainage of the affected pleural space and nothing per mouth with supplementation of total parenteral nutrition (TPN)
If leak persists after two weeks, surgery is performed to ligate the thoracic duct.
“It turns out you can be a doctor and be almost anything else.”
July 20th, 2010Atul Gawanda, MD, American surgeon, author, and political advisor
Herbal Weight Loss Supplement Slim-30 Recalled For Safety Risks
July 18th, 2010J & H Besta Corp. has recalled some batches of the herbal weight loss supplement Slim-30 due to concerns that is contaminated with the non-approved substance sibutramine.
RPI Wins Grant To Develop Haptic Technology For Laparoscopic Surgery
July 15th, 2010Researcher Suvranu De and colleagues at Renssellaer Polytechnical Institute have won a $2.3 million grant to meld haptic technology (touch sensitive virtual reality) to standard laparoscopic surgery equipment and procedures to improve the operative performance of surgeons.
Amnesty International Report Claims North Korea Amputations Performed Without Anesthesia
July 15th, 2010An Amnesty International report released today and authored by Norma Kang Muico states that the state-run healthcare system in North Korea is on the verge of collapse and can no longer provide even basic care to North Koreans. The report claims that amputations are performed without anesthesia.
Multiple Sclerosis
July 3rd, 2010
Pathophysiology
1) marked by selective demyelination of CNS 2) cause is unknown; likely the four forms (relapsing-remitting, secondary progressive, primary progressive, and progressive relapsing) have different causes 3) several conditions mimic MS (e.g., Lyme disease), which may lead to a misdiagnosis 4) diagnostic confusion arises because MS is a clinical diagnosis (as is Lyme disease) and there are no specific test that reliably diagnose either one 5) some cases of MS are likely autoimmune in a genetically susceptible patient with an environmental exposure (infectious or sexually transmitted)
Signs and Symptoms
1) limb weakness 2) spasticity 3) hyperreflexia 4) sensory loss and paresthesias 5) optic neuritis and diplopia 6) ataxia 7) vertigo 8) internuclear ophthalmoplegia (INO) 9) nystagmus 10) sensation of body parts being tightly wrapped, swollen, raw, or wet 11) bladder dysfunction 12) cognitive dysfunction – memory loss, emotional lability, depression 13) fatigue
Characteristic Test Findings
Laboratory – 1) CSF show increased intrathecally synthesized IgG, oligoclonal banding, and increased mononuclear cells
Deceased NFL Player Chris Henry’s Brain Showed Signs of Brain Damage
July 2nd, 2010
NFL player Chris Henry’s brain showed the signs of traumatic brain disease known as chronic traumatic encephalopathy or CTE after studies were conducted at the Brain Injury Research Institute at West Virginia University. The presence of tau protein is an indicator of CTE, as explained by Dr. Julian Bailes, Chair of Neurosurgery at WVU.
Austrian Surgeons Amputate Wrong Leg On Woman
July 2nd, 2010
Surgeons at St. Johann Hospital in Tyrol, Austria amputated the wrong leg on a patient recently - and then tried to cover it up by amputating the correct leg.
Drs. James Giordano and Cyrus Rangan Discuss Looming Health Problems From BP Oil Spill
June 17th, 2010Dr. James Giordano of the Center for Neurotechnology Studies at the Potomac Institute and Dr. Cyrus Rangan of the California Poison Control Center share their concerns about future health problems from the Gulf oil spill.
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