MedClips

Diagnosis Adrenocortical carcinoma is a rare cancer that occurs in one to two patients per million per year. Adrenocortical carcinoma is thought to be a very malignant tumor, but it exhibits very different biological and clinical characteristics for each individual. Patients with large, suspected adrenal tumors should be treated with a multidisciplinary team of medical professionals including endocrine, cancer, surgeon, radiologist, and pathologist. A suspected adrenocortical carcinoma is not an indication for FNA. First, malignancy and benignity of the adrenal mass can not be distinguished either cytologically or pathologically. Second, FNAs invade cancer capsules and can lead to cancer metastasis. It is difficult to distinguish benign from malignant pathologically even when the whole cancer mass is present. The most commonly used pathological category is Weiss Score. Weiss Score considers high nuclear grade, rate of dissection (> 5 / HPF), atypical cleavage, clear cell of 25% or ...

Epidemiology Adrenal incidentaloma is an adrenal mass lesion with a diameter of more than 1 cm incidentally detected by imaging. Adrenal incidentaloma is found in at least 2% of the population, and the prevalence increases with age. Adrenal incidentaolma is found in 1% of 40s and 7% of 70s. Most adrenal incidentalomas are endocrine-inactive adrenocortical adenomas that do not release hormones. The prevalence of endocrine-inactive adrenocortical adenoma is 60 to 85% of endocrine-active adrenocortical adenoma, endocrine-active adrenocortical adenoma is 5 to 10% of cortisol producing adenoma, aldosterone-producing adenoma is 2 to 5%, and pheochromocytoma is 5 to 10 %. 2 to 5% of the unilateral adrenal mass is a malignant adrenocortical carcinoma and 15% is metastatic cancer at other sites. Diagnosis Diagnostic evaluation should be performed in patients with adrenal masses greater than 1 cm. Two important factors must be considered. First, does the tumor secrete hormones that can harm...

DKA and HHS are among the most urgent complications of diabetes. DKA is known as Diabetic and Ketoacidosis is found. It is mainly caused by lack of insulin administration or infection in patients with type 1 diabetes. HHS is the hyperglycemic hyperosmolar state most commonly caused by infection in patients with type 2 diabetes. In DKA, metabolic acidosis is frequently found and serum glucose is found to be less than 800 mg / dl. However, occasional severe DKA patients may exceed 900 mg / dl. HHS shows differences in the presence or absence of DKA and ketone acidosis and the elevation of blood glucose. However, DKA and HHS coexist in approximately one-third of all acute complications. Treatment The treatment of DKA and HHS is similar in that the fluid and electrolytes are matched and insulin is administered. The first step of treatment is the supplementation of the extracellular volume by administering isotonic saline. First, treatment is meaningful because it can stabilize cardio...

Causes Cushing's syndrome is a syndrome characterized by hypertension, fatigability, weakness, sexual dysfunction, striae, edema, osteoporosis, and truncal obesity of chronic glucocorticoid (cortisol). Cushing's syndrome is the cause of exogenous origin of cushing's syndrome caused by drugs such as glucocorticoid. The next is cushing's syndrome of endogenous origin. ACUT-dependent pituitary adenoma, cushing's disease, is a microadenoma of less than 10 mm mostly over 90%. It may also be caused by ectopic ACTH secretion. This may be caused by SCLC, thymoma, pancreatic islet cell tumor, MTC, and pheochromocytoma, which induces hypersecretion of ACTH at the origin, not the pituitary gland. ACTH independent causes are adrenal neoplasm and adrenal nodular hyperplasia. Adrenal neoplasm is usually unilateral, 8-10% of adenoma, and 8-10% of carcinoma. Therefore, it must be distinguished, and if it is uncertain as to the imaging test, postoperative biopsy is essential. It i...

Diagnosis The diagnosis of Cushing's syndrome begins with identifying and abolishing the history of the disease, such as when taking herbal medicines, taking steroids, or injecting intra-articular steroids. There were three screening tests: the first one was overnight 1 mg dexamethasone suppression test, and the first one was dexamethasone 1 mg at 11 o'clock the night before, and the next day at 8 o'clock, plasma cortisol was measured at 1.8 ug / dL Or more. This test is called pseudo-cushing's syndrome, which is very likely to be false, because it is very diverse, including obesity, depression, alcoholism, acute infection / trauma, and pregnancy. Re-measurement after removal and supplementation to other tests are necessary. The second is a 24hr urinary for cortisol excretion test, which is positive if the urine collected from the urine collected for 24 hours is higher than normal or the concentration is increased more than 3 times. The third screening test is positiv...

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar status (HHS) are typical complications of diabetes mellitus. These are commonly characterized by insulin deficiency, volume depletion, and acid-base abnormalities. Generally, DKA has ketoacidosis associated with hyperglycemia and is known to occur mainly in diabetes mellitus (DM) type 1, but it also occurs in DM type 2 patients who do not show immunological characteristics of DM type 1. On the other hand, HHS is mainly found in DM type 2. DKA occurs well in younger patients under 65 years, whereas HHS tends to occur mainly in patients over 65 years of age Symptoms DKA generally has an acute tendency to develop for 24 hours. In some cases, DM type 1 is found through the diagnosis of DKA, but it is common in DM type 1 patients who are undergoing blood glucose control after diagnosis. Patients with DKA show nausea / vomiting and also thirst / polyuria due to hyperglycemia. In addition, increased osmolarity, dehydration, hypoten...

 Distal ulnar fx Axial  load of the hand  80% through distal radius 20% through the ulna Uncommon in isolation  Isolated ulna Fx. : Nightstick fracture Usually with distal radius Fx. -  5.6% Mainly Styloid Fx. (60~70%) Metaphysis : 5~6%  (old age) Anatomy  Anatomy  Distal ulnar Fx with distal radius Fx  combined with  5.6% of DRFx.  Old age poor quality and comm. of metaphyseal bone  small distal fragment Risk factor of reduction loss of DRFx. Complication of DUFx. Ulnar malunion (shortening, angulation) LOM of DRUJ and radiocarpal joint. arthritis, TFCC  problem Classification Biyani classification  -> Intraarticular ? Extra articular? AO classification Q1 : Styloid Q2 : Ulnar neck simple Q3 : Ulnar neck comminuted Q4 : Ulnar head Q5 : Ulnar head and neck Q6 : Shaft  Ulnar styloid Fx. Traditional : Base Fx. with 2mm displacement -> May be DRUJ injury -> Fixation  Current : 1) No DRUJ instability...

 Subscapularis Largest and most powerful of the rotator cuff Important role in shoulder motion internal rotation anterior stabilizer of the shoulder ‘force couple’ Subscapularis anatomy Two part of SSC insertion: by the most sup. border of LT Four part 1. attaching area of tendinous slip * 2. insertion of superior-most part of intramuscular tendon 3. another tendinous insertion 4. muscular insertion Subscapularis anatomy The most cranial insertion of SSC Normally tear initiates Supports LHB: related with biceps dislocation Connects SSC & SSP  Strongest: clinically important! Subscapularis anatomy SSC is composed of 2 layers deep layer  → LT superficial layer splits into 2 bands forming sling around the LHBT  Superficial band → LT Deep band → GT Biceps long head Stabilizers  CHL   (Coracohumeral lig.) SGHL   (Superiorglenohumeral lig.) interwoven fibers of SSc & SSt Biceps long head Stabilizers  Medial sling robust deep layer (medial head o...

 SSc tear classification 30% length of entire footprint Almost 80% of tear occurs in the F1 Insertion angle F1 : closest to SSt angle → abd. than rotation F2 : almost parallel with humeral shaft SSc tear  anterior shoulder pain  loss of arm function in activities of daily living such as washing under the contralateral arm belly press lift-off test (> 75%) increased passive ER (complete) SSc tear US is limited Sensitivity was lower for small tears → SSc tear without retration SSc tear on MRI MRI to assess the subscapularis frequently missed (62.5% SSc tear missed, Pre-op MRI sensitivity : 36%)  tears are best appreciated on axial images  presence of biceps subluxation indicates a subscapularis tear Atrophy of the upper SSC SSc tear on MRI

 Failure of ACL reconstruction Factors Surgical technique Graft selection Condition of articular & meniscal cartilage Post op Rehabilitation Early failure (<6 months) Technical errors Incorrect rehab Premature return to sports Later failure (>1 year) Recurrent injury The most avoidable & common cause : Surgical technique Revision ACL reconstruction Continued symptomatic and functional instability Radiographs, 3D-CT, MRI Pre op planning with 3D-CT Tunnel position Tunnel widening Hardware position Revision ACL reconstruction Continued symptomatic and functional instability Radiographs, 3D-CT, MRI Pre op planning with 3D-CT Tunnel position Non-anatomic : completely outside of the anatomic footprints Anatomic : completely within the anatomic footprints Semi-anatomic : partially overlapping the anatomic footprints Revision ACL reconstruction Continued symptomatic and functional instability Radiographs, 3D-CT, MRI Pre op planning with 3D-CT Tunnel position Non-anatomic : co...