Spalding sign

Spalding sign is an obstettric Ultrasonography sign which show overlaping of cranial bone in the uterine cavity .
what does it mean?? Its a passport to IUFD( intrauterine fetal death)

normal cephalic without overlapping 

overlapping of fetal cranial bone.

Dukes Criteria for IE

 a bit about Dukes Criteria .
Major :
Little scarry bug
•  viridans streptococci, Streptococcus bovis, or HACEK group , or
•  community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus

 

on the Heart  what is seen ?

• perivascular abcess
• prosthethic valve
• valvular regurgitation.. newly formed...

Minor criteria ..

Clinical SiGN 

Osler Nodules

 Flat, painless, erythematous lesions 

-roth spot
-splinter H/r






IE, risk factor for old age patient, drug abuse-narcotic IV,  went to OT( tooth extraction, tonsilectomy, obs n gyne procedures and etc), Prosthetic Valve Replacement, Cardiac Transplant....

IE onset with Fever followed with Chille.
Aneamic Syndrome : pallor, asthernic, fatigue and weakness. Why? huporegeneration anemia ( blood analysis may show leococytopenia).. due to Bone marrow suppression .. which later lead to Spleenomegaly.. compensatory .

IE morphology in echocardiogram commonly is vegetation and perforation of valve.. most common is aourtic valve( diff diagnose with RF=>Mitral Valve)

                                                              vegetation of aoutic valve lealet 

main target organ of damage for  IE is heart .. infective endocardial surface...

enuf for today... sambung esok ... heheheheh

Chilaiditi syndrome

Chilaiditi Syndrome is transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver.
also known as 

•  interpositio hepatodiaphragmatica,
•  subphrenic displacement of the colon,
•  subphrenic interposition syndrome and
•  pseudopneumoperitoneum.

triad for CS is, abdominal pain, volvulus and shortness of breath..

on X-ray, classically u will find , gas in the right hemidiagphragma always misdiagnose with pneumoperitoneum...

 A small crescent of air can be seen under the right part of the diaphragm

gas between liver and diaphragmrugal 

rugal folds within the gas suggesting that it is within bowel and not free

COD:a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. 

Cardiac Cachexic Syndrome.... wow

Cardiac Cachexia (CC) syndrome, is a complication of CHF(Congestive Heart Failure)
I didnt know this, until i start reading my Harrison's
it is a sign of bad prognosis. and related to age, sex , LV ejection fraction and exercise capacity.

it happen when generalized lose of body lean mass, tissues, fat and skeletal. Therefore, patient is weak and very weak, asthenic syndrome.
pathogenesis: neorohumoral and immunologic disbalance.

• increase amount of norepineprine,epinephrine, cortisol, renin-angiontensin aldosteron system activation 
• and increase plasma inflamatory cytokines that is TNF-a.

increase of above mentioned lead to catabolic imbalance n metabolic imbalance and later lead to wasting...

so that about it lah... the cascade that bring to dead end= CC...

Angel and Devil.....

so it was Halloween.2010.. 

ninie and I decided to come in pair.
it was a long journey to prepare for our splendid attire...
going up n down the town to find the convincing enough outfit. But, it worth for what we did, at least we get a free entrance to MATRIX.. means our costume is convincing enuf.. to scare the soul awaY... hahaha

Credit goes to dearly Mollen... for all the effort given to do this angelic costume.. n bear up with my unsatisfied remarks on the baju initially..

However, it turn out well....

my DEVIL is super Hot wei.....


present to u... ANGEL N DEVIL....

wake me up.. when september end....

Its been so long before i managed to finish my summer holiday stories..
well.. semester had started two months ago.. time speed .... without u even realizing it.

so many thing in my mind. my new semester resolution....which i planned as if like i'm going to build the entire Rome...so far not much have been accomplish beside slacking it gradually...
Lord, Please HELP ur helpless child here...

waking up... just another day... time speed...
now its November.... i took this pictures after few days returning from malaysia....

my russian tour.....2010

so as i had said.. so many plan ... dearly plan of vacation....
so i m going to tell a bit.. i hope not so much .. the places that i visited in russia
After about 5 years staying here.. in this ex Soviet country...
only now, i have the chance to visit those places....they call it SPLENDID... RUSSIA...


we left Kursk, by train after dust, but its ... so there u go.. a mix feeling in me...
my greatest worry is... oh my, i m travelling with my 20kg luggage, with extra laptop, bag.. documents...........
how great!!! so finally reach moscow, thanks to few generous friend that stay in Moscow, who allowed us to leave our stuff in their hostel.... the long travel up n down to and fro metro station...the worries of getting lose in the big crowd.... our stop was in Part  Kultury station.. FYI, this is one of the station involve in MOSCOW METRO BOMBING 2010... scarry!!!

But it all went well, except on our stop to the Sheremetyevo airport, we were confused which terminal should we go down.. since it was like a to z terminal... but a kind russian lady directed us, ... spaciba ...
 thax to Scarlett, we managed to get a cheap so called air-asia airline, to travel to st. peterburg... heheheheh
compare to travel long way 12 hours by bus from moscow to SPB, or a day from Kursk to SPB...


sO we finally reach SPB(st. peterburg) AKA.. PITER!!!too much for an intro.. just look true the photos.. that i uploaded k....

 Scarlet Sailing Festival...