Trans-scaphoid-perilunate dislocation

 

Thanks to radiology signs

See the case
Trans-scaphoid-perilunate-dislocation

Briam & Paola

The Fachisther's in their way to Disney,
It was so very nice to see you guys and the kids, we had a great time... Enjoy Disney!!!

Fetal Circulation

O₂ goes through syncytiotrophoblast of chorionic villus, into the cytotrophoblast, then through the myxomatous stroma of the chorionic villus, then into the blood vessel. The blood vessels of the chorionic villus all coalesce to form the umbilical vein. This has the highest O2 content. It goes to the liver and it can go two ways: 1) into the hepatic sinusoids and recollects into the hepatic vein and gets dumped into the IVC; and 2) ductus venosus and straight into the IVC. Then it goes up the right side of the heart, from where it will  go straight across, through the foramen ovale (which is open in all fetuses) and into the left atrium. So, all this oxygenated blood will go directly from the right atrium through the foramen ovale into the left atrium, then the left ventricle and out the aorta.

What about SVC blood valve? Blood coming from the superior part of the right atrium will go straight down, through the tricuspid valve into the right ventricle. Now, it will go out the pulmonary artery. This is a PROBLEM b/c the pulmonary vessels are too thick and it’s encountering this tremendous amount of pressure. To counter this problem, kept the patent ductus open (which is kept open by the PGE2, a vasodilator, made by the placenta) – so, there is a right to left shunt and blood can get out of the pulmonary artery and dumped back into the aorta.

Then, when the baby is born and takes its first breath, the pulmonary vessels (that were all shut), all open within a millisecond, and blood is going through those pulmonary arteries and gas exchange is occurring through the lungs in literally seconds. Also, the patent ductus closes and forms the ligamentum arteriosum.

This is normal fetal circulation. Vessels with the least O2 are the 2 umbilical arteries, and the one with the most amount of O2 is the umbilical vein.

Bones

Vascullitic disorders

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Takayasu's arteritis ("pulseless disease")	Granulomatous large vessel vasculitis involving aortic arch vessels	Young Asian women and children	Absent upper extremity pulse Visual defects, stroke
Giant cell (temporal) arteritis	Granulomatous large vessel vasculitis involving superficial temporal and ophthalmic arteries; thrombi contain microabscesses	Adults > 50 years of age	Temporal headache, jaw claudication (pain when chewing) Blindness on ipsilateral side Polymyalgia rheumatica (muscle and joint pain; normal serum creatine kinase) Increased ESR
Polyarteritis nodosa	Necrotizing medium-sized vessel vasculitis involving renal, coronary, mesenteric arteries (spares pulmonary arteries)	Middle-aged men Association with HBsAg (30%)	Vessels at all stages of acute and chronic inflammation Focal vasculitis produces aneurysms (detected with angiography) Organ infarction in kidneys (renal failure), heart (acute MI), bowels (bloody diarrhea), skin (ischemic ulcer)
Kawasaki disease	Necrotizing medium-sized vessel vasculitis involving coronary arteries (e.g., thrombosis, aneurysms)	Children < 4 years of age	Desquamating rash, swelling of hands and feet, cervical adenopathy, oral erythema Abnormal ECG (e.g., acute MI) Corticosteroids contraindicated (danger of vessel rupture)
Thromboangiitis obliterans (Buerger's disease)	Medium-sized vessel vasculitis with digital vessel thrombosis	Men 25-50 years of age who smoke cigarettes	Foot claudication, Raynaud's phenomenon, ulceration, gangrene
Raynaud's disease	Medium-sized vessel vasculitis involving digital vessels in fingers and toes	Young women Exaggerated vasomotor response to cold or stress	Paroxysmal digital color changes (white-blue-red sequence) Ulceration and gangrene in chronic cases
Raynaud's phenomenon	Medium-sized vessel vasculitis involving digital vessels in fingers and toes	Adult men and women Secondary to other diseases (e.g., systemic sclerosis, CREST syndrome)	Systemic sclerosis and CREST syndrome: digital vasculitis with vessel fibrosis, dystrophic calcification, ulceration, gangrene
Wegener's granulomatosis	Necrotizing medium-sized and small vessel vasculitis involving upper respiratory tract, lung, renal vessels	Childhood to middle age	Necrotizing vasculitis in upper respiratory tract (nasopharynx, sinuses, trachea), lower respiratory tract (pulmonary vessels; infarction, pneumonia), kidneys (crescentic glomerulonephritis)
			Necrotizing granulomas in upper respiratory tract (saddle nose deformity), lungs c-ANCA antibodies (>90% of cases) Treatment: corticosteroids, cyclophosphamide
Microscopic polyangiitis	Small vessel vasculitis involving skin, lung, brain, GI tract, and postcapillary venules and glomerular capillaries	Children and adults Precipitated by drugs (e.g., penicillin), infections (e.g., streptococci), immune disorders (e.g., SLE)	Vessels at same stage of inflammation Palpable purpura, glomerulonephritis p-ANCA antibodies (>80% of cases)
Churg-Strauss syndrome	Small vessel vasculitis involving skin, lung, heart vessels	Children and adults	Allergic rhinitis, asthma p-ANCA antibodies (70% of cases), eosinophilia
Henoch-Schönlein purpura	Small vessel vasculitis involving skin, GI tract, renal, joint vessels	Children and young adults Most common vasculitis in children IgA immunocomplexes	Palpable purpura of buttocks and lower extremities Polyarthritis, glomerulonephritis, GI bleeding
Cryoglobulinemia	Small vessel vasculitis involving skin, GI tract, renal vessels	Adults Association with HCV, type I MPGN	Cryoglobulins: immunoglobulins that gel at cold temperatures Palpable purpura, acral cyanosis of nose and ears and Raynaud's phenomenon (reverses when in warm room)
Serum sickness	Small vessel vasculitis involving immunocomplex deposition in skin vessels	Children and adults Complication of treatment of rattlesnake envenomation with horse-or sheep-based antivenin	Fever, urticaria with vasculitis, arthralgia, GI pain with melena
Infectious vasculitis	Small vessel vasculitis involving skin vessels	Children and adults Involves all microbial pathogens	Rocky Mountain spotted fever: tick transmission of Rickettsia rickettsiae; organisms invade endothelial cells; petechiae on palms spread to trunk Disseminated meningococcemia due to Neisseria meningitidis Capillary thrombosis produces hemorrhage into skin and confluent ecchymoses

Takayasu's arteritis

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Takayasu's arteritis ("pulseless disease")	Granulomatous large vessel vasculitis involving aortic arch vessels	Young Asian women and children	Absent upper extremity pulse Visual defects, stroke

Source Goljan, Wikipedia

Temporal Arteritis

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Giant cell (temporal) arteritis	Granulomatous large vessel vasculitis involving superficial temporal and ophthalmic arteries; thrombi contain microabscesses	Adults > 50 years of age	Temporal headache, jaw claudication (pain when chewing) Blindness on ipsilateral side Polymyalgia rheumatica (muscle and joint pain; normal serum creatine kinase) Increased ESR

Polyarteritis nodosa

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Polyarteritis nodosa	Necrotizing medium-sized vessel vasculitis involving renal, coronary, mesenteric arteries (spares pulmonary arteries)	Middle-aged men Association with HBsAg (30%)	Vessels at all stages of acute and chronic inflammation Focal vasculitis produces aneurysms (detected with angiography) Organ infarction in kidneys (renal failure), heart (acute MI), bowels (bloody diarrhea), skin (ischemic ulcer)

Kawasaki Disease

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Kawasaki disease	Necrotizing medium-sized vessel vasculitis involving coronary arteries (e.g., thrombosis, aneurysms)	Children < 4 years of age	Desquamating rash, swelling of hands and feet, cervical adenopathy, oral erythema Abnormal ECG (e.g., acute MI) Corticosteroids contraindicated (danger of vessel rupture)

Buerguer's Disease

Disorder	Vasculitis	Epidemiology/Etiology	Clinical/Laboratory Findings
Thromboangiitis obliterans (Buerger's disease)	Medium-sized vessel vasculitis with digital vessel thrombosis	Men 25-50 years of age who smoke cigarettes	Foot claudication, Raynaud's phenomenon, ulceration, gangrene

Complete occlusion of the right and stenosis of the left femoral artery are seen in a case of thromboangiitis obliterans

Source Goljan, Wikipedia