s*****o
发帖数: 48 | 1 【 以下文字转载自 ComputerGraphics 讨论区 】
发信人: slishuo (slishuo), 信区: ComputerGraphics
标 题: Special Issue on Computational Methods and Clinical Applica (转载)
发信站: BBS 未名空间站 (Mon Dec 3 23:33:47 2012, 美东)
发信人: slishuo (slishuo), 信区: CS
标 题: Special Issue on Computational Methods and Clinical Applications for Spine Imaging
关键字: Special Issue
发信站: BBS 未名空间站 (Mon Dec 3 23:15:01 2012, 美东)
Computerized Medical Imaging and Graphics (CMIG)
Special Issue on Computational Methods and Clinical Applications for Sp... 阅读全帖 |
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I****a
发帖数: 407 | 2 Nice catch but the case seems a little odd to me. If patient has lower
extremity weakness and the stenosis is at the cervical spine, wouldn't that
automatically imply that patient has cervical cord myelopathy therefore he
should have UMN signs. |
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I****a
发帖数: 407 | 3 Nice catch but the case seems a little odd to me. If patient has lower
extremity weakness and the stenosis is at the cervical spine, wouldn't that
automatically imply that patient has cervical cord myelopathy therefore he
should have UMN signs. |
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A*******s
发帖数: 9638 | 4 Good question。
I posted this in a physician forum initially and a neurosurgeon also asked
same question. My explaination is that the patient may also have severe
neuropathy which masked the UMN signs。
The surgeon who did the laminectomy asked me to write an article regarding
these odd findings. He was also surprised about the LMNs on this patient
and even admited he would miss the diagnosis.
Another interesting fact a NSG mentioned is that the down's syndrome, CP and
neurodegenerative disease p... 阅读全帖 |
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A*******s
发帖数: 9638 | 5 有人提到了spinal cord compression。 我想跟大家再提醒一下，特别是PCP， 不要忘
了cervical stenosis。 这是最容易miss的， 产生的后果也最容易打官司。
这个病人我上周看到他， 手术后已经可以独立行走， 没有任何后遗症。 |
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V*****G
发帖数: 337 | 6 this guy finally went to the hospital. It turns out this guy had a heart
attack, 3 vessel stenosis, had a CABG
before released from hospital. |
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V*****G
发帖数: 337 | 7 this guy finally went to the hospital. It turns out this guy had a heart
attack, 3 vessel stenosis, had a CABG
before released from hospital. |
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L****n
发帖数: 12932 | 8 great informative post， guess that's what this board is for - just in case
if Rose is around to read the post, rather than just bitch and moan.
i like the response down under:
DrWes said...
"I've never had that happen. Nor do I know why it happened. Stenosis
perhaps? "
Most likely the tip of the catheter caught the azygous vein osteum (a
normal variant) and prolapsed on itself.
That'll be $250, please... |
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L****n
发帖数: 12932 | 9 great informative post， guess that's what this board is for - just in case
if Rose is around to read the post, rather than just bitch and moan.
i like the response down under:
DrWes said...
"I've never had that happen. Nor do I know why it happened. Stenosis
perhaps? "
Most likely the tip of the catheter caught the azygous vein osteum (a
normal variant) and prolapsed on itself.
That'll be $250, please... |
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A*******s
发帖数: 9638 | 10 She likely has failed back surgery syndrome.
DDx: 1. Cervical stenosis.
2. DM amyotrophy
Rec:
1. MRI of C-spine.
2. EMG/NCV.
3. HgA1c. I guess elevated Glu is not fasting.
4. Hold PT. |
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s******t
发帖数: 579 | 11 Thanks. I'd like to know that what make you think about cervical stenosis.
She does not have neurological deficit in her upper extremities. |
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A*******s
发帖数: 9638 | 12 I noticed there are some changes. Thanks for the updates.
For a case like that, you have to make sure if the patient has true weakness
. In some cases, the patient could not walk or feel weak just because of
PAIN. I haven't noticed you mentioned the pain which I believe she has.
I would check ERS/CRP and CK, a lot of cases like that, especially an aged
woman, could have PMR.
DM amyotrophy is another DDx if PMR can be R/O.
With both sensory/motor involvement on a single leg, radiculopathy is mo... 阅读全帖 |
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R*******t
发帖数: 367 | 13 Do no harm. If he is relatively young and doesn't have symptoms from carotid
and renal stenosis, why putting him through those invasive procedures?
Average arterial stents have 3-year patency of ~75%. PTA has 40-50%.
What he needs at this moment is solving his claudications. Later on he
should adjust his life style, diet, with necessary medications, to lower his
blood lipid and slow down his atherosclerosis. |
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A*******s
发帖数: 9638 | 14 I had a patient who has asymptomatic carotid stenosis. He had a CEA and
ended up with a complete carotid occlusion and a large infarct.
carotid
his |
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w***0
发帖数: 222 | 15 these are the partial list but the major ones:
1. pulmonary vein return anomaly
2. interrupted IVC
3. AV canal, likely single ventrical (function)
4. Pulmonary artieries b/l stenosis
5. PDA
6. Left SVC
7. right arch
8. No sure if the echo showing the truncus arteriosus?
9.others......see Chinese echo report.
10. Junctional rhythm
to improve her life quality, she will need staged palliative cardiac
surgeries; in addition to periodic cardiac catheterizations. |
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m********4
发帖数: 607 | 16 What will happen if stenosis, but not occlusion, exists on the deep branch
of MCA?
angina vs MI is different.
Trop doesn't have 100% sensitivity or 100% specificity.
Medicine is science. Medical diagnosis needs evidence to r/o or r/i, right? |
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A*******s
发帖数: 9638 | 17 MCA stenosis: ASA
MCA occlusion: ASA
MCA wide open but multiple risk factors for stroke: ASA
CTA with perfusion is not going to change anything.
Do you know how much CTA with perfusion costs? Save the money for the most
needed. |
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L****n
发帖数: 12932 | 18 sorry, i disagree strongly. Not only i think she need surgery, she need it
quite urgently.
觉得这个病人首先的differential dx应该是symptomatic carotid sternosis which
is extactly what carotid endarteractomy is for， 其次，再怎么铁血， 沸腾，
药物治疗都没有手术那么definitive的, a symptomatic may not have time to wait
for medical treatment to take effect。 再三， i think it's ok to talk
inbetween ourselves with liberal choice of words, but be prudent when
talking to people coming here asking question about a patient.
for reference, from A... 阅读全帖 |
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L****n
发帖数: 12932 | 19 not mean to doubt your expertise, physicians don't put themselves directly
against literature without evidences. I think in this patient "symptomatic
carotid sternosis" is a more logical explanation than a "innocent" carotid
sternosis with "syncopy" of unknown source. Basic rule is first try to
explain everything with one disease.
you can go hunt for other cause of "syncopy", but if nothing being done
about the carotid stenosis at the meanwhile, and the patient develop stroke
and die, u coul... 阅读全帖 |
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r********n
发帖数: 48 | 20 Dear Dr. Lexian, I completely agree with Dr. Aplusplus on this case.
Unilateral carotid stenosis just does not do the job -- You just have to
have both sides of the brain out to make that person unconscious. If you
have to pick on stroke in this case, think about vertebral-basilar problems.
difference
well
it
our |
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A*******s
发帖数: 9638 | 21 你误解了。
我是说我的病人没有TIA/Stroke， 我不会order carotid u/s。
对这个病人， 因为有人order了， 就得由这个人来address这个stenosis， 我已经帮
这个人address了。 |
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A*******s
发帖数: 9638 | 22 1. Impossible.
2. Never said superior。 There were 3 clinical trials on asymptomatic
carotid stenosis, VACS, ACAS, ACST. The VACS included TIA so is not really
asymptomatic.
The data was pooled and the conclusion is: if surgical risk can be lower
than 3%, the benefit is about 1%/a year. You have to live long enough to see
real benefits.
From Neurology, feb 2012, in press:
It is important to emphasize that selection of asymptomatic patients for
carotid revascularization should include careful co... 阅读全帖 |
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A*******s
发帖数: 9638 | 23 给你做个carotid u/s吧， 不过不管address你的stenosis。 lol
得撤了， 晚安 |
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A*******s
发帖数: 9638 | 24 new onset 是刚刚发现的， 没人知道什么时候的开始的。
这个病人做了MRA of subclavian artery。 99% stenosis on the left
的Emboli， 常见。
，如果不采取强力措施，大多数最后的结局也是Emboli脱落，脑梗塞。 |
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A*******s
发帖数: 9638 | 25 Hospital tech says no, but my clinic tech who works for a vascular surgeon
said he is doing it all the time.
In this case, the tech told me he should be able to tell me if there is
stenosis in subclavian on u/s only. |
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b******a
发帖数: 704 | 26 Am I eligible for a Baozi? Thank you so much!
Although SSP was my first differential, I still don't know why there is no
difference in left and right arm BP given there is only left subcalavian
stenosis. Maybe it's too early to detect the subtle difference in such a
stress.
stem
flow
basilar |
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s******t
发帖数: 579 | 27 I have questions about how to order MRA:
Should we order to look at some specific locations most of the time or can
we order to see all the blood vessels from aorta to circle of Willis or even
higher level to look for any stenosis and embolization etc.?
If we need to see more blood vessels, it just takes longer and more
expensive or some else?
Thanks a lot! |
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A*******s
发帖数: 9638 | 28 1. Syncope is from brain stem ischemia due to SSS, brain stem infarct is
just a part of it.
2. Not sure about vertebral A direction, I would assume it would be
antegrade on the right and retrograde on the left.
3. No syncope before.
4. It is not uncommon to see a single artery stenosis (atherosclerosis)on
MRA or CTA.
infarct)
than
a
of |
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A*******s
发帖数: 9638 | 29 new onset 是刚刚发现的， 没人知道什么时候的开始的。
这个病人做了MRA of subclavian artery。 99% stenosis on the left
的Emboli， 常见。
，如果不采取强力措施，大多数最后的结局也是Emboli脱落，脑梗塞。 |
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A*******s
发帖数: 9638 | 30 Hospital tech says no, but my clinic tech who works for a vascular surgeon
said he is doing it all the time.
In this case, the tech told me he should be able to tell me if there is
stenosis in subclavian on u/s only. |
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b******a
发帖数: 704 | 31 Am I eligible for a Baozi? Thank you so much!
Although SSP was my first differential, I still don't know why there is no
difference in left and right arm BP given there is only left subcalavian
stenosis. Maybe it's too early to detect the subtle difference in such a
stress.
stem
flow
basilar |
|
s******t
发帖数: 579 | 32 I have questions about how to order MRA:
Should we order to look at some specific locations most of the time or can
we order to see all the blood vessels from aorta to circle of Willis or even
higher level to look for any stenosis and embolization etc.?
If we need to see more blood vessels, it just takes longer and more
expensive or some else?
Thanks a lot! |
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A*******s
发帖数: 9638 | 33 1. Syncope is from brain stem ischemia due to SSS, brain stem infarct is
just a part of it.
2. Not sure about vertebral A direction, I would assume it would be
antegrade on the right and retrograde on the left.
3. No syncope before.
4. It is not uncommon to see a single artery stenosis (atherosclerosis)on
MRA or CTA.
infarct)
than
a
of |
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A*******s
发帖数: 9638 | 34 I would choose C.
MRA of subclavian is not a routine test.
Carotid u/s is able to identify vertebral retrograde flow and subclavian
artery stenosis although it is tech dependent. |
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d****y
发帖数: 2180 | 35 Is it right that use carotid/us as the initial screen test since it's
relately unexpensive, if identy vertebral retrograde flow and subclavian
artery stenosis, then do a MRA or angiogram of the subclavian ? |
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A*******s
发帖数: 9638 | 36 ultrasound can detect the flow direction. MRA or CTA can't. We use CTA to
comfirm and evaluate the degree of stenosis. |
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h*******r
发帖数: 182 | 37 贴在Medicareer只有围观没人回应, 只好来这里求助.原来贴在Medicareer, 也是希望
教授,老师们能评点以下这一治疗方案,让成长的麦穗们学习一下.多谢多谢!
Last Easter Sunday, We had dinner with friends. 男主人头发半年之内全白了, 看
了让人难
过.
Earlier his wife called us, asking us praying for his health, especially for
his deteriorating renal function. When I asked the detail, he could not
give the exact number, but he said if it still goes down, he has to consider
dialysis. He took too many medications, a lot of them I don't quite agree.
Please take a look, and give some kind s... 阅读全帖 |
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R*******t
发帖数: 367 | 38 来自主题: Medicalpractice版 - 两个病例 Conclusion of this case:
There is no doubt post-op fluid has component of fat necrosis. The fluid I
drained looks like those from liposuction. In training, we always take cases
with a final diagnosis of A or B. But in real life, A and B can happen
simultaneously, since patients come in without reading a textbook first.
This case is seroma/fat necrosis with superimposed infection. Patient was
put on vanco and has been doing well.
I remember A++ once showed a case with MS and spinal stenosis. The ... 阅读全帖 |
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A*******s
发帖数: 9638 | 39 To my knowledge, ACEI is contraindicated in renal artery stenosis. But for
DM nephropathy, ACEI is recommended. ARBs appear to be safer than ACEIs. |
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c***y
发帖数: 811 | 40 Integral iliac artery stenosis |
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A*******s
发帖数: 9638 | 41 这三个药没一个会缓解你妈的症状。
有一种脑血管供血不足可以引起眩晕，叫做椎基底动脉供血不足，比方说subclavian
steal，basilar artery stenosis， 等等。 这个MRI结果不可能反映上述病症，所以
需要进一步检查。
通常情况下，头晕可以因为血压引起，如果一切正常，应该考虑内耳的问题，比方说
BPPV， 所以最最有效的治疗恐怕就是antivert了。 |
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A*******s
发帖数: 9638 | 42 Neuro deficits are about her symptoms which you can not tell on MRI, eg,
incontinence, leg weakness and unable to walk.
She has severe lumbar stenosis, surgery intervention could significantly
improve her life quality. Once again, you need to consult her Doctor to make
the decision. |
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A*******s
发帖数: 9638 | 43 Neuro deficits are about her symptoms which you can not tell on MRI, eg,
incontinence, leg weakness and unable to walk.
She has severe lumbar stenosis, surgery intervention could significantly
improve her life quality. Once again, you need to consult her Doctor to make
the decision. |
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A*******s
发帖数: 9638 | 44 今天早上一睁眼，天已经亮了，翻身看了一下闹钟，8点，还觉得困不想起，这两天过
节过的，根本睡不够。 突然想起今天加了几个病人，8：30就来了，只能挣扎着爬起来
，迅速冲了个热水澡，觉得神志清醒了不少，胡乱吃了点东西，一路绿灯到了诊所，病
人早在那里等待了。
一口气看了几个早到的病人，心情愉快了很多。 每次休假后总觉得很压抑，休息了几
天又要上班真痛苦，可每当真正开始上班了以后，早上起床时的悲怆心情就烟消云散了
：与病人的互相问候， 疾病的正确诊断，以及病人痛苦的解除，实实在在地带给我好
的情绪， 相信大家都有类似的感觉。
有一个病人没有来，于是掏出手机， 看到medicalprac讥笑我把single写成singer，不
由笑起来了，改正了一个，好对得起他老人家的一片苦心。 看到Linsanity一如既往的
拥抱single payer，突然恻隐之心大动，与其跟他争论，不如让他好好发挥，希望
obama/pelosi能够看到听到，不辜负他的一片痴情和坚贞。
病人John是一个50岁的白人，因为剧烈的牙疼被家庭医生诊断为三叉神经痛，给了
Tegretol治疗，有一点效果，但疼痛还在，所以... 阅读全帖 |
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M****a
发帖数: 577 | 45 1. Reproduce symptoms from physical exam
2. Arterial Duplex to eval flow
3. CTA to eval stenosis |
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P**k
发帖数: 264 | 46 Without knowing the whole history, PE, and reviewing neuroimages, difficult
to make any comments. But a few things to consider:
1. SSS more common on L side. Reversal of vertebral artery flow may not
indicate SSS. Need to r/o vertebral artery origin stenosis.
2. SSS need to be confirmed by blood pressure cuff test. Most of SSS is
asymptomatic.
3. Even if SSS, not sure there is enough evidence there is "clot" in
subclavian artery. not sure role of anticoagulation in this situation. Most
of time, ... 阅读全帖 |
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A*******s
发帖数: 9638 | 47 1. The MRA done most recently in the stroke center shows no evidence of
stenosis in the basilar artery system.
difficult |
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A*******s
发帖数: 9638 | 48 5. I did not mention she has bilateral weakness during some of spells. In
the stroke center they even did MRI of L- spine and C-spine.
7. This patient never had a stroke.
Although you can argue about the role of anticoagulation, current studies
are
only on intracranial stenosis. ASA apparently failed when she had her
first TIA.
difficult |
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s*********8
发帖数: 1630 | 49 Carotid endarterectomy is a common procedure and standard treatment for
severe carotid stenosis and stroke for more than 50 years. In a experienced
surgeon hands, the complications including stroke is less than 2%. Recently
ballon angioplasty and stent also used, but long term outcome is uncertain. |
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