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Showing posts from April, 2012

Hypertrophic pyloric stenosis of infancy

Epidemiology:   Incidence of 3/1000 births.  4 times more in males.  Aetiology is unknown. In some cases there seems to be a familial association. In such families the mother has suffered from the condition in 50 per cent of cases. Characteristically it is a first-born male child that is most commonly affected. The condition is most commonly seen at 4 weeks after birth ranging from the third week to, on rare occasions, the seventh. Inexplicably, it is the time following birth that seems important and not the child’s gestational age. A premature infant will also develop the condition at about 4 weeks after birth. Pathology: Grossly hypertrophied musculature of the pylorus and adjacent antrum, the hypertrophy being maximum in the pylorus itself. The mucosa is compressed such that only a probe can be inserted. Clinical features : Vomiting is the presenting symptom that after 2—3 days becomes forcible and projectile. The child vomits milk and no bile is present. Immedi

Interpretation - Heart borders on Chest X ray

It is at times difficult to interpret a PA chest X-ray as the amount of information present is huge. A systematic approach should always be done.  One should have the understanding of what is normal. This must include an evaluation of the  1) soft tissues,  2) bones and joints,  3) pleura, lungs, major airways and pulmonary vascularity,  4) mediastinum and its contents,  5) heart and its chambers, as well as  6) the areas seen below the diaphragm and above the thorax. The heart borders are explained in this post.  On the right side of the heart the following structures can be identified: 1) Az - Azygous vein 2) A - Ascending aorta 3) S - Superior vena cava 4) RA - Right atrium On the left side of the heart, we can identify the following: 1) SC - Subclavian artery 2) AA - Aortic arch 3) PA - Pulmonary artery 4) LB - Lower border of pulmonary artery 5) LA - Left atrial appendage 6) LV - Left ventricle The x-ray on the right side i.e. B shows the actual positio

Antidotes of toxic agents

The search for and use of an antidote should never replace good supportive care. Specific systemic antidotes are available for many common poisonings as shown in the table above. Inadequate availability of antidotes at acute care hospitals can complicate the care of a poisoned patient.  An evidenced-based consensus of experts has recommended minimum stocking requirements for 16 antidotes for acute care hospitals. These recommendations may provide guidance to pharmacy and therapeutics committees in establishing a hospital’s antidote needs. Drugs used conventionally for non-poisoning situations may act as antidotes to reverse acute toxicity, such as glucagon for β-adrenergic blocker or calcium channel antagonist overdose and octreotide for sulfonylurea-induced hypoglycemia. As our understanding of drug toxicity increases, antidotes may have applications beyond contemporary indications, such as for acetylcysteine, which has shown promise for treating approximately 25 different