There are several extradrenal sites where pheochromocytoma occurs, and this, the 'organ of Zuckerkandl' is one interesting site.
It actually is a cluster of bodies,located either at the bifurcation of the abdominal aorta or at the origin of the inferior mesentric artery and they contain chromaffin cells derived from the neural crest.
These are also known as 'paraortic bodies' but differ from 'corpora aortica'(also a chromaffin body)which lies near to the thoracic aorta.
The organ of Zuckerkandl is said to be responsible for secreting catecholamines and other vasoactive substances. It has a function of supplying catecholamines to the fetus especially in the first trimester of pregnancy and regresses usually in the third trimester.
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Sunday, March 22, 2015
Organ of Zuckerkandl.
Friday, March 20, 2015
Study group discussion: Largest protein and the smallest protein in the human body
10-100 ~ polypeptide
<10 ~ peptide
The largest viruses as Poxviruses measuring 300nm are as large as the smallest bacteria (mycoplasma). The smallest viruses as Parvovirus measuring about 20nm are nearly as small as one of the largest protein molecule, hemocyanin.
Thursday, March 19, 2015
Study group discussion: Hemolytic disease of new born
What is immunogenic hemolytic disease of new born?
Answer: In immunogenic type, the immune system plays a role in the pathogenesis of the disease. Rh incompatibility is an example.
What are the causes of non-immunogenic erythroblastosis fetalis?
Answer: Examples of non immunogenic erythroblastosis fetalis are iron deficiency anemia, CMV infection in mother, etc.
Can congenital hemolytic anemia be a cause of non-immunogenic erythroblastosis fetalis?
Answer: Yes.
Though usually, hemolytic anemias don't present till later in life (Mostly because of HbF).
Exceptions would be severe alpha thalassemia in which all 4 alpha chain synthesis is deleted. 4 gamma chains combine, leading to the formation of HbH (Bart's hemoglobin!) They die in utero due to severe hypoxia and hydrops.
Study group discussion: Drugs used in the treatment of Alzheimers disease
Can anyone help me with pharmacological classification of anti Alzheimer's agents?
For Alzheimers, cholinesterase inhibitors.. And a drug called memantine.
NMDA receptor antagonists.
Drugs: Tacrine (tetrahydroaminoacridine), donepezil, rivastigmine and galantamine.
Mechanism: Inhibition of cholinesterase, with a resulting increase in cerebral levels of acetylcholine.
Antioxidants, selegiline, tocopherol (vitamin E), estrogen replacement in females, Ginkgo Biloba extracts are other drugs which may benefit in Alzheimers disease.
Study group discussion: Eponymous terms in hernia and mnemonics
Here's a list of eponymous hernia terms I was sent. I added a few mnemonics to where I could. Others you'll have to memorize!
Gibbon's hernia- Hernia with hydrocoele
Berger's hernia - Hernia in Pouch of Douglas
Mnemonic: Burgers are made of dough.
Grynfelt's hernia - Upper lumbar triangle hernia.
Petit's hernia - Lower lumbar triangle hernia
Cloquet's hernia- Hernia through pectineal fascia
Mnemonic: The hernia is cloaked, peccantly.
Narath's hernia - Behind femoral artery
Hesselbach's hernia - Lateral to femoral artery
Mnemonic: hesseLBAch - Lateral to big artery.
Serofini's hernia - Behind femoral vessels
Mnemonic: SeroFini - Supported by femoral vessels.
Laugier's hernia - Through lacunar ligament
L for Laugier's, L for Lacunar
Tealse's hernia - In front of femoral vessels
Richter's hernia - Part of circumference of bowel wall is gangrenous
Mnemonic: Richie rich has a large circumference pocket of money.
Alternatively, riChter Circumference.
Littre's hernia - Hernia with Meckels's Diverticulum
Mnemonic: Meckels is a congenital defect, found in Little babies.
Sliding hernia - Posterior wall of sac is formed by colon or bladder
Maydl's hernia - 'w' hernia
Mnemonic: M upside down is W.
Phantom hernia - Localised muscle buldge following muscular paralysis
Mnemonic: Phantom for Phantom, P for Paralysis
Spigelian hernia - Through spegelian fascia
Obturator hernia - Through obturator foramen
Femoral hernia - Hernia medial to femoral vein
Beclard's hernia - Femoral hernia through saphenous opening
Study group discussion: Biliverdin
Why biliverdin is reduced to bilirubin? It isn't toxic, it is water soluble.. Then why convert it to bilirubin?
According to some, biliverdin works just fine. Mammals have evolved the energetically expensive, potentially harmful and apparently unnecessary capacity to reduce biliverdin.
According to others, the conversion is not a wasteful process. Bilirubin is a cytoprotectant and that's why biliverdin is converted into bilirubin. It's also a physiological anti oxidant!
Source: http://m.pnas.org/content/99/25/16093.full
Wednesday, March 18, 2015
About me!
Hello there awesomites! Feels great to write this for Medicowesome :-)
Where to start? Well, I am a total astrophysics geek. Anything -spacetime,dark energy, black holes, wormholes catches my fancy.That type of guy who loves staring at the starry sky. Just finds amazing how the tiny word 'universe' encompasses the massive expanse lying out there. Loves going to the point where physics meets philosophy.
Likes looking into nothing, thinking and imagining.
House MD fan. Sherlocked.
Christopher Nolan worshipper. Interstellar fanatic.
I have a thing for rare, fancy medical syndromes! Dreams include running a diagnostics department like House. :-p
Talking of music,a Linkin Park fan, like the regular Bollywood music too.
Proud of India and its rich heritage.
Hobbies include driving cars, riding bikes and even bicycling. Gaming included.
Finally, an animal lover,dreamer and a bit of foodie..
-Sushrut
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Tuesday, March 17, 2015
Heme synthesis mnemonic
 |
| The biosynthesis of heme mnemonic |
Study group discussion: Temporal arteritis
A 60 year old male presents with headache, scalp tenderness, painful temples, pain on chewing & visual disturbances.. Diagnosis?
Answer: Temporal arteritis
What tests you would do to confirm the diagnosis?
Answer: Raised ESR, temporal artery biopsy
Treatment?
Answer: High dose steroids like prednisolone!
Temporal artery branch of?
Answer: ECA, the external carotid artery!
Monday, March 16, 2015
Study group discussion: Causes of edema
Today, we'll be talking about causes of edema.
Causes of Edema can be inflammatory and noninflammatory!
Noninflammatory causes:
1) Increased hydrostatic pressure
2) Hypoproteinaema
3) Lymphatic obstruction
4) Sodium retention
Inflammatory causes:
1) Acute inflammation
2) Chronic inflammation
3) Angiogenesis
Here is a mnemonic shared by an awesomite: HILARI IS SAVE (Hilary)
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)
I remember this in Conrad Fischer's tone, "Cirrhotic, Nephrotic and CHF. Cirrhotic, Nephrotic and CHF!" though.
That's all!
-IkaN
Study group discussion: Drugs contraindicated in myasthenia gravis
Hey everyone!
Today's topic is about drugs that are contraindicated in myasthenia.
Can you guess them all?
Drug a. Myasthenic woman with eclampsia develops ptosis
Drug b. Patient with hepatitis C develops respiratory depression
Drug c. Filmstar drug
Drug d. Wilson's disease
Answers:
a. MgSO4
b. Interferon
c. Botox
d. Penicillamine
Random fact:
The actor, Amitabh Bachchan has interferon induced myasthenia gravis which was used to cure his hepatitis C infection. And because of that he can't use botox.. Hence, his skin looks so wrinkled compared to other film stars of his age. Hence, two important drugs causing myasthenia and who worsen it are interferon and botox.
More information on study group
Study group discussion: Evening rise of temperature in tuberculosis and malaria
Why is there an evening rise of body temperature in tuberculosis?
Answer: Because endogenous corticosteroid have their levels low in the evening. Cortisol bursts are least frequent in the evening. And steroids are anti-inflammatory!
Why not in all infections? What's special about tuberculosis?
We don't know the answer to this question. If you do, please tell us!
This answer was submitted to us by an awesomite: Increased Cortisol Cortisone Ratio in Acute Pulmonary Tuberculosis: Recent research works regarding TB has revealed that there is increased cortisol level in TB.
Cortisol & IL-1 interaction: At high level cortisol has negative feedback effect on IL-1.
Conclusion: In TB, cytokines, specifically, IL-1 level is markedly increase that leads to fever, but as cortisol level is also high than normal it counteract the action of IL-1 & as a result fever remains low grade.
Due to exaggerated diurnal variation,cortisol effect is very high in late night while very less in evening onwards that leads to evening rise of temperature & night sweating. Normal diurnal variation of body temperature also play a role to make this change more prominent.
Source: http://www.doctorshangout.com/m/blogpost?id=2002836%3ABlogPost%3A423964
Even malarial paroxysms occur in the evening, don't they?
Answer: Yep. Malarial paroxysms have a different reasons. Steroids ain't responsible.
What's the reason for malarial paroxysms then?
Answer: It depends when the entire cycle of trophozoites burst from RBC's.
Here's from one of the members personal experience:
I have had malaria.. I had paroxysms at late night.
Sunday, March 15, 2015
Study group discussion: Smoking and hernia
I have a doubt .. Today in surgery ward, my professor asked me how does smoking directly cause hernia! :/
I know the indirect cause! Coughing!
By weakening collagen?
Does smoking affect collagen synthesis or metabolism? At which step does smoking affect collagen?
It causes less production!
The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.
Source: http://www.ncbi.nlm.nih.gov/pubmed/9551072
In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.
Source: http://www.ncbi.nlm.nih.gov/pubmed/11910469
Oh....ok. Thanks!
Autonomic system drugs mnemonic
(Terbutaline, ritrodine)
(Neostigmine, physiostigmine)
Saturday, March 14, 2015
Alice in Wonderland syndrome
Wednesday, March 11, 2015
Study group discussion: Structures that pass through the diaphragm mnemonic
When we go to thorax or abdomen... It's hard to remember their relation... Are there any tips?
What sort of relation? The relation of structures that pass through the diaphragm?
Yep.
Ok I know one mnemonic for that.
I ate (8) ten eggs at twelve.
I: Inferior vena cava
aTe: T8!
Eggs: Esophagus (Vagus rhymes with it!)
Ten: T10
AT: Azygous vein, Thoracic duct! Twelve: T12
So to summarize:
IVC - T8
Esophagus, vagus - T10
Azygous, thoracic duct - T12
Hope this helps!
Monday, March 9, 2015
Study group discussion: Purtscher's retinopathy
Does anyone know the name of retinopathy occurring in pancreatitis?
Purtscher's retinopathy!
What are it's characteristics?
Signs visible on fundoscopic examination include
pathognomonic Purtscher flecken and cotton-wool spots around the optic nerve n intraretinal h'age
Yes. The macula is affected too. Granulocyte deposition occurs in the posterior retinal artery.
Study group discussion: Chloroquine and Behcets disease
Antimalarial that causes irreversible retinal toxicity??
Chloroquine?
Yes. It's hydroxychloroquine..!!
Also used in...??
DLE, rheumatoid arthritis!
Lepra reactions too!
Also in extra intestinal amoebiasis!
Skin lesions in dermatomyositis!
Okay, so what pathology in the eye does hydroxychloroquine cause..??
It accumulates there because of high volume of distribution?
It causes Bull's eye maculopathy..!!
And the pathogenesis?
It is said that the drug binds to melanin in the RPE, which could explain the persistent toxicity even if after discontinuation of the medication!!!
I remember the use of hydroxychloroquine (Plaquenil) in Behcet's Disease. Follow up with eye exam every 2-3 months.
What's Behcets disease?
Behcets syndrome is inflammatory, multi system disease of small vessels resulting in frequent aneurysms and rupture..!! Eyes, genitals and mucous membranes are involved.
It takes many months to treat genital ulcers!
What is that test to confirm behcets..??
Pathergy test
Pricking the skin with a needle = pathergy test. After one or two days, people with Behçet's can develop a lump or nodule where the needle broke the skin.
Correct!
I had a patient with several mouth ulcer's looking like Aphthous ulcer. No other symptoms, just episodic mouth ulcers!
Okay.. Could be due to stress and vitamin deficiency..
And it turned out to be Behçet's disease.
They have a lot Behçet's disease clinic's in Turkey! Must be genetic which is why it is so common.
The exact cause of the disease remains unclear. But Behçet's disease is thought to involve an autoimmune response. This means the body's defense mechanism begins to attack its own tissues. Something in the environment may trigger this abnormal immune response in susceptible individuals. Genetic factors may also play a role.
It is common in young men in Mediterranean area..
Our patient was a woman.
Oh nice to know, thanks!
Saturday, March 7, 2015
Study group experience #14
Cutaneous signs of insulin resistance and lipoproteinemia
Electrolyte abnormalities that cause constipation
Aspirin
Cycloserine
Morphine and atropine
Drug for neurological manifestations of Wilson's disease
ACE in lung diseases
Central trachea in pleural effusion
Walking pneumonia
Aortic regurgitation
Pressure and volume reservoir in the human body
HOCM
Cardiac embryology and fetal heart sounds
Atrial septal defects - Why do they present late?
Gallstone ileus
Hepatic encephalopathy
Kartageners syndrome
Haemosiderosis and haemochromatosis
Thyroid surgery practicals viva questions
Venous ulcer
Pre-eclampsia and HELLP syndrome
Differentials of discharge in a pregnant woman
Glycogen storage diseases mnemonic
Cytochrome c
Agranular cytoplasmic reticulum
Colorful amino acids and pH
Difference between antibody and anti-toxin
Lymph nodes in various diseases
It's been a crazy busy week, especially with group 3 and all, I stay on my toes!
-IkaN
Study group discussion: Haemosiderosis and haemochromatosis
Differences between haemosiderosis and haemochromatosis?
Haemochromatosis is iron overload primary and secondary, iron overload is within cells and interstitium, causes tissue damage. Hemochromatosis is primarily genetic!
Where as haemosiderosis is a form of secondary hemochromatosis due to repeated blood transfusions, deposition of haemosiderin in the cells, with reversible accumulation of iron in RES. I hope its clear!
So heamochromatosis is irreversible?
The tissue damage, I agree, will have consequences. But you can chelate the excess iron?
Yes! But reversible if in the form of secondary- haemosiderosis
Blood letting! Pts encouraged to donate blood it seems, and iron chelating agents would help.
Those untreated develop HCC
Even cardiomegaly
And endocrine issues.. Especially, pituitary and the adrenals
Yeah I think they continuously need to get their iron chelated
So it can be counted as reversible then?
Not reversible..But manageable.
Yes that's a good term actually
Controllable I would say!
Heart failure cells are macrophages laden with haemosiderin in LVF OR pulmonary odema.
Was an episode in house MD. The girl was suspected to have it cause her skin tone had changed several tones darker.
There was this one more episode where they diagnosed Wilson's disease based on the colour change of nailbed on rubbing it with nail remover! I so want to try that.
Really ?
The blood copper level wasn't raised.. No kf rings in cornea.
The lady was a mean woman.. She couldn't feel emotions.. Was manipulative. And the change in personality happened when she was a teenager.
Interesting!
They applied nail remover and behold.. The nail turned blue.
I had a suspected case of Wilson's disease in my college.. She took discharge before I could experiment this.
There is even one more episode on Wilson's in season 1. They diagnose it by observing KF ring over the cornea.
Also, an another episode on Hemochromatosis with a mean chess playing lad.
Yup.. I remember both the episodes! The alcoholic mom with schizophrenia had Wilson's. And the jerk xD
Yeah! Actually, she did not have schizophrenia. They were the manifestations of Wilson's itself.
It was pretty cool how House figures that self sacrifice isn't a symptom of Schizophrenia
Yeah! I love the way House has epiphanies leading to diagnoses.