2007年3月26日 星期一
2007年3月19日 星期一
82y/o female with repeated falling down and headach
Dr. 劉金亮: adjacent brain swelling with low density around the separation of 3rd ventricle. meaning acute obstructive hydrocephalus with symptoms. indicated for VP shunt.
KUB according to radiologist Dr. 王德珍: a soft tissue mass density at pelvic cavity with bony destruction at both pubic bones; bone mets should be ruled out.
2007年3月12日 星期一
30 y/o male, ext ear laceration for 2 sites
Two laceration wound at his left external ear. xylocain for anesthesia is difficult in such case because soft bone could not absorb anesthesia easily. I put a cotton ball inside his left ear and told him to keep it in place for compression. Right eyebrow laceration wound
He refused to shae his right eyebrow. The wound looked like a mouth of a woman.
54 y/o female right shoulder pain, falling from her bicycle down the hill
Right shoulder pain
X ray: fracture of greater tuberosity with mild displacement about 5mm(Neer type 1). No emergent operation is indicated because of the displacement is less than 1cm. Shoulder splint(sugar tong shape) is supported for her shoulder pain, Dr:蔣岳峰: keep splint for 3 weeks and check x ray if poor healing of displacement is present, then operation is considered.(probability:10-20%) history number:50824499
2007年3月5日 星期一
80 y/o male motorcycle accident
Left humeral neck fracture.Dr.董: the humeral bone rotated 180 degree and the total separation with the humeral head.
Complications: vascular compromise to the humeral head, leading to necrosis of the articular segment. Displaced surgical neck fractures and shat ractures may have associated brachial plexus and vascular injuries.
2007年2月26日 星期一
A 58 y/o male with acute left buttock pain
Sx: acute pain at left thigh and flank, low back, radiated to the medial thigh
Dr. 董: abduction of left thigh and tenderness at left buttock
CT: low density at the left greater gluteal muscle, 60=filiformis
Imp: left greater gluteal inflammation, abscess pending
Treatment: 1 mL xylocain + 1 mL kenacord-A with spinal needle injection along with the greater trochanter, arrange CT after pain control failed
Admission for IV 3rd Generation ABx, if abscess formation, keep IV ABx and oral for 3 weeks
If low density formed, echo guided aspiration for anaerobic culture should be done.
Lab: Cr: 1.6, K: 3.4, CPK:400, WBC:13500, Seg:92%
梨狀肌起自於骨盆的後壁，肌纖維發自第2、3、4骶椎椎體前面，向外集中穿坐骨大孔進入臀部，而是止於股骨大轉子上緣的後部。
當梨狀肌因解剖上的變異或因外傷，不良工作姿勢與動作而導致梨狀肌發炎水腫、痙攣、肥厚而影響刺激到坐骨神經，造成臀部疼痛甚至放射傳導到下肢，稱為梨狀肌症候群或梨狀肌綜合症。
梨狀肌症候群(Piriformis syndrome)：這是指坐骨神經通過骨盆的坐骨大孔時，被橫斜而過的梨狀肌壓迫引起的疼痛。這類的疼痛包括下肢麻痛、感覺異常、有時合併無力，或有放電的感覺，簡直就是一般人所謂的「坐骨神經痛」，唯一的不同處在於本病不是因為「骨刺」，而是因為「肌肉」引起疼痛。大部分的病因是外傷(跌倒使臀部突然墜地)，也可能因過度使用臀部或下肢肌肉引起。由於是肌肉的病變，所以病人常照了許多腰椎的X光都沒有異常；如果不巧可以看到一些退化或骨刺，就可能被當成腰椎神經根病變治療而不得要領；事實上，有一些簡單的理學檢查，可以在門診就對此病作出診斷，並馬上以類固醇注射，往往有很好的治療效果。
避免引起梨狀肌痙攣的因子，如：
1.盡量不穿高跟鞋。
2.不翹腿。
3.臀後口袋不放錢包。
4.坐伸展梨狀肌運動：仰臥，彎曲患側下肢，將其外踝放至伸直的健側腿膝蓋上，將患側盡量往內收，停留約十秒，重複數次。
1.盡量不穿高跟鞋。
2.不翹腿。
3.臀後口袋不放錢包。
4.坐伸展梨狀肌運動：仰臥，彎曲患側下肢，將其外踝放至伸直的健側腿膝蓋上，將患側盡量往內收，停留約十秒，重複數次。
This patient admitted for parenteral antibiotics however, septic shock took place the next day and emergent I&D was arranged in the morning. He was transferred to ICU for hypotension. Because of limited medical device and facilities(SWAN guns), he was referred to TSGH the next day. Necrotizing fascitis and 4 times debridement was done. Hemorrhoid related infection was suspected for his spreading infection in a short time.
A 22 y/o female with pain at standing
The closed fracture of right 4th & 5th metatarsal bone. Short leg splint was utilitized for the enhancement and stability of her right foot.
A 51 y/o male, drunk and precordial discomfort
I learned the right rib oblique to check the rib pathology more clearly. (from Dr.董福義) The patient came again to my duty with not subsided right precordial discomfort. I checked the CXR again and gave him intravenous fluid with KETO and Felinamin.
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