Saturday 28 July 2012

WHAT IS STUDENTS ELBOW

Olecranon bursitis also known as student elbow is a condition in which there is pain, redness, swelling around the olecranon due to inflammation of the elbow bursa. The bursa is located on the extensor surface near the extreme proximal end of ulna.


CAUSES: It is usually caused by trauma to to the elbow like a hard blow to the elbow or repeated minor injuries to the elbow for example while studying. Due to the injury the bursa starts producing larger amount of fluid than normal exceeding the normal rate and gets accumulated in the bursa leading to swelling and pain.

Infection of bursa is also one of the cause.

TREATMENT: Usually the 1st treatment is rest and avoiding further injuries to the elbow.
Aspiration of the fluid and injecting steroid into the bursa to reduce inflammation is also one of the practices.
Antibiotics can be prescribed if inection is suspected.
Surgical resection of bursa can also be done if medical management fails.

Here is a video by Dr Vikram Singh Yadav of aspiration and steroid injection into the bursa.


Monday 23 July 2012

PERCUTANEOUS NEPHROSTOMY VIDEO

Here is a video showing how PCN is done. Dr Vikram has explained it in the video very well. 





Indications for PCN are:

  • Pelvi-Ureteric Junction Obstruction
  • Renal abscesses, urinomas
  • PUJ obstruction secondary to stone
  • Urine diversion in obstruction during pregnancy
  • Treatment regarding any fistulas due to iatrogenic or traumatic injuries, malignant or inflammatory fistulas.
Contra-Indications include:

  • Bleeding diathesis
  • Unco-operative patient
  • Severe hyperkalemia (>7) -- Do dialysis first then the procedure

Saturday 21 July 2012

Urethral Stricture


It is abnormal narrowing of urethra due to trauma, STDs or urethritis.

Causes:-

  • Inflammation or scar tissue formation due surgery, disease or injury
  • Pressure from enlarging tumor
  • instrumentation of urethra eg. cystoscopy
  • STDs
  • H/O repeated urethritis
Symptoms:-

  • Decreased stream of urine
  • Incomplete emptying of bladder with terminal dribling of urine
  • Urinary intermittency
  • Frequent micturition
  • Acute or chronic retention of urine
Complications:-

  • Urinary retention
  • Bilateral hydronephrosis
    • Urinary infections
    • Urinary calculi
    Diagnosis:-

    • Urine routine examination with microscopy
    • Urine culture
    • Retrograde Urogram (RGU)
    • Post void residual urine
    • Cystoscopy
    Treatment:-

    • Instrumentation with bougies or catheter depending on severitySurgery eg urethrostomy or urethroplasty can be done

WHAT ARE SEBACEOUS CYSTS

A sebaceous cyst is closed sac under the skin filled with sebum which in a cheesy or oil like material. These cysts are sometimes called epidermal cysts. They are basically caused by blocked sebaceous gland, trauma, swollen sebaceous glands, excessive amounts of testosterone. Usually they present as painless nodule under the skin, can occur anywhere in the body. If they get infected, redness, pain, warm skin and tenderness appear around the area and cheesy like material may drain from the area.


How To Remove A Sebaceous Cyst by VideojugBeautyandStyle
 
Treatment usually include surgical removal of the cyst. If properly removed along with the wall and sac, cyst will not recur. If it gets infected, the cyst is 1st drained and patient is kept on antibiotic treatment. When infection gets settled the cyst is then excised.

This is a sebaceous cyst excised from back of patient

ASPIRATION OF GANGLION CYST AND INJECTING STEROID INJECTION INTO IT

O.k few days earlier I discussed about ganglion cysts, what are they, their treatment modalities. Here is a video showing how to aspirate and then inject kenacort into the cyst.



1st we clean the area and then apply some local anesthetic. When the area becomes numb we insert a wide bore needle into it and then aspirate the fluid. Then keeping the needle in place we replace the syringe with the kenacort (steroid) loaded syringe and then inject it into the cyst.