Montgomery tubercles – 蒙氏结节

Areolar glands or Glands of Montgomery are sebaceous glands in the areola surrounding the nipple. The glands make oily secretions (lipoid fluid) to keep the areola and the nipple lubricated and protected. Volatile compounds in these secretions may also serve as an olfactory stimulus for newborn appetite.

Montgomery-glands

The portions of the gland visible on the skin’s surface are called “Montgomery tubercles”. The round bumps are found in the areola, and on the nipple itself. They can become exposed and raised when the nipple is stimulated. The skin over the surface opening is lubricated and tends to be smoother than the rest of the areola. The tubercles become more pronounced during pregnancy.

The number of glands can vary greatly, usually averaging from four to 28 per breast.

蒙氏结节位于乳晕的外周部分,是蒙氏腺导管开口处隆突而成。蒙氏腺是能够分泌乳汁的大皮脂腺。孕妇自妊娠8周起,乳腺腺泡及乳腺小叶增生发育,使乳房逐渐增大。检查见乳房及其周围皮肤(乳晕)着色加深,乳晕周围出现蒙氏结节。

Cardiovascular System – Myocardial perfusion imaging

Cardiovascular System

Myocardial perfusion imaging

Imaging principle: To determine the state of coronary blood flow and the state of cardiomyocyte survival.
Normal cardiomyocytes selectively take up certain monovalent cationic compounds, which can be visualized by radionuclide labeling
Tracer uptake correlates positively with regional myocardial blood flow and correlates with cardiomyocyte function status
Normal myocardium develops, while ischemic or necrotic myocardium does not develop (defect) or image fades (sparse)
Nuclear Stress Myocardial Perfusion Imaging
Nuclear stress myocardial perfusion imaging (MPI) is a nuclear cardiology test that shows how well blood flows to the muscle of the heart (myocardium). This test is used to diagnose the presence or absence of coronary artery disease.

Here is a simple intro about MPI test.

Details

A radioactive tracer (called Myoview) is injected into the patient’s bloodstream and is taken up by the heart tissue. A single photon emission computed tomography (SPECT) camera detects the radiation released by the tracer to produce images of the heart. Two sets of images are taken, one after an injection at rest and another after an injection during a stress test – either exercise stress on a treadmill or drug-induced stress with persantine (dipyridamole) medication, which simulates exercise.

MPI tests can help your doctor:

• Find out if there are narrowings or blockages in your coronary (heart) arteries if you have chest discomfort.
• If you have heart damage from a heart attack if your heart is not working normally.
• Determine if you should undergo a coronary angiogram.
• Decide whether you would benefit from coronary stent or bypass surgery to treat your chest discomfort or help an abnormal pumping function go back to normal.
• If a heart procedure you had to improve blood flow (stent, bypass) is working.
• How well your heart can handle physical activity.

Explain 201TI myocardial perfusion imaging to distinguish myocardial infarction and myocardial ischemia.

201TI enters cardiomyocytes and is related to the activity of sodium pump. The uptake of 201TI by the myocardium is a marker of myocardial cell activity and cell membrane integrity. Therefore, 201TI is a common method for identifying viable myocardium and necrotic myocardium.
201TI MPI is a characteristic manifestation of the diagnosis of reversible myocardial ischemia from early perfusion defects to delayed imaging perfusion defects.
The perfusion defects in the early and delayed necrotic myocardium were fixed without change.

Occupational Environment and Health – Occupational Diseases

Occupational diseases

  1. Cause is clear
  2. Most of the causes can be quantitatively measured dose-response relationship
  3. In the same population, there are a certain number of people who are sick
  4. If the early detection and timely treatment, the prognosis is good
  5. Most occupational diseases currently have no specific treatment, and the later the treatment, the worse the curative effect.

 

Diagnosis and treatment of occupational diseases

Diagnosis of occupational disease diagnosis must collectively by the legal diagnostic facilities

Strong scientific policy, with the vital interests of the State and about patients!

It is undertaken by the medical and health institutions approved by the health administrative department of the people’s government at or above the provincial level;

A collective diagnosis is conducted by more than three licensed physicians who have obtained occupational disease diagnosis qualifications.

 

Occupational disease diagnosis should integrate three factors

(1) Career history: important prerequisites

  • Work type
  • Length of service
  • Types of exposure to harmful factors
  • Time
  • Quantity
  • Contact method
  • Use of protective measures Other diseases of the same type of work
  • Exclude non-occupational contacts similar to occupational diseases

(2) Labor health survey in the production environment

  • Process flow
  • Method of operation
  • Environmental sanitation
  • Protective measures and effects, etc.
  • Level of harmful factors in the workshop

(3) Clinical manifestations and auxiliary examination results, etc.

  • Whether the symptoms and signs meet the characteristics of an occupational disease
  • Pay special attention to early typical symptoms and signs

Acute appendicitis: clinical manifestations, classification, surgical treatment, complications

Explain the clinical manifestations of acute appendicitis

  • Abdominal pain: the first symptom, initially localized to the periumbilical region, persistent aggravation, gradually shifts and fixed in the right lower abdomen
  • Gastrointestinal symptoms: nausea, vomiting, increased frequency of bowel movements
  • Systemic reactions: fever, lack or loss of appetite, oliguria, thirst, toxic symptoms.
  • Signs:
    1. Rebound tenderness, pain on percussion, rigidity, and guarding, McBurney point tenderness: Most specific finding
    2. RLQ tenderness but nonspecific
    3. Left lower quadrant (LLQ) tenderness
    4. Rovsing sign (RLQ pain with palpation of the LLQ): Suggests peritoneal irritation
    5. Dunphy sign (sharp pain in the RLQ elicited by a voluntary cough): Suggests localized peritonitis
    6. Psoas sign (RLQ pain with extension of the right hip or with flexion of the right hip against resistance): Suggests that an inflamed appendix is located along the course of the right psoas muscle
  • Laboratory tests: WBC is elevated and urine is normal.
  • Other checks: X-ray, B-ultrasound

 

Pathological classification of acute appendicitis

  • acute simple appendicitis
  • acute purulent appendicitis
  • gangrene or perforating appendicitis
  • periappendicular abscess

 

What should be differentiated from acute appendicitis disease?

  • Gastric duodenal ulcer perforation
  • Right ureteral stones
  • Gynecological diseases: ectopic pregnancy, ovarian follicular or Corpus luteum cyst rupture, acute salpingitis and acute pelvic inflammatory disease
  • Acute mesenteric lymphadenitis

 * Acute salpingitis is infection of the fallopian tubes.

** Ruptured corpus luteal cysts are one of the commonest causes of spontaneous haemoperitoneum in a woman of reproductive age.

 

Briefly describe the complications after surgical resection of acute appendicitis

  • Incision infection
  • Peritonitis, abdominal abscess
  • Bleeding
  • Fecal fistula = one between the colon and the external surface of the body, discharging feces.
  • Appendiceal stump inflammation = Stump appendicitis refers to inflammation of the residual appendiceal tissue post appendectomy.
  • Adhesive intestinal obstruction

Hyperthyroidism – Classification, Indications & Surgical Treatment

Classification of hyperthyroidism, indications, Surgical operation indications and contraindications.

Hyperthyroidism symptoms

Hyperthyroidism symptoms

Classification

  • Primary hyperthyroidism
  • Secondary hyperthyroidism
  • Hyperfunctioning thyroid adenoma

Indications:

  1. Nodular hyperthyroidism, although drugs or iodine can eliminate or alleviate the symptoms of hyperthyroidism, but the nodules still exist, and may be secondary to hyperthyroidism or cancer.
  2. Diffuse hyperthyroidism, after systemic drug treatment, no significant improvement, or relapse after stopping the drug.
  3. Retrosternal goiter with hyperthyroidism, or compression symptoms caused by thyroid enlargement.
  4. Within 6 months of pregnancy, there is hyperthyroidism, which is adversely affects both situation mutually.
  5. Suspected of malignant. (primary condition has a localized nodule or a scanning find outs a cold nodule)
  6. Hyperfunctioning thyroid adenoma

Surgical operation indications:

  1. Secondary hyperthyroidism, hyperfunctioning thyroid adenoma
  2. Moderate or above primary hyperthyroidism
  3. Hyperthyroidism with thyroid compression symptoms or retrosternal goiter, or suspected cancer
  4. Medical treatment of side effects such as allergies or myelosuppression
  5. Long-term drug treatment relapse after drug withdrawal or relapse after 131I treatment
  6. Those with the above indications in the early and middle stages of pregnancy should also consider surgery

Contraindications:

  1. Teen hyperthyroidism
  2. Mild primary hyperthyroidism
  3. Exophthalmos is severe and hyperthyroidism is mild.
  4. The patient has severe organ dysfunction such as heart and lung, and the drug is not improved, and surgery is not allowed.

 

The role and usage of iodine as a preoperative preparation for hyperthyroidism.

  1. Inhibits proteolytic enzymes, thereby reducing the decomposition of thyroglobulin, which gradually inhibits the release of thyroxine, and does not cause sudden changes in the circulatory system after surgery.
  2. Iodine can reduce the blood flow of the thyroid and reduce the congestion of the gland, with the time glands get shrunken and harden.

Use of iodine: compound potassium iodide solution, 3 times a day, 3 drops per day on the first day, then add 1 drop each time to 16 drops each time, then maintain this dose.

What are the routes of Urinary tract infections?

(1) Ascending infection: Pathogens travel up the bladder via the urethra, and even ureters or renal pelvis, infections are called ascending infections, accounting for about 95% of urinary tract infections. Under normal circumstances, a small amount of bacteria such as streptococci, lactic acid bacteria, staphylococcus, and diphtheria-like bacilli are located around the anterior urethra and urethral orifice, and do not cause diseases. Some factors such as sexual life, urinary tract obstruction, iatrogenic operation, genital infection, etc. can lead to the occurrence of ascending infection.

(2) Hematogenous route infection refers to the infection caused by pathogenic bacteria reaching the kidneys and other parts of the urinary tract by blood transport. This type of infection is rare and less than 2%. Occurred in patients with chronic diseases or immunosuppressive therapy. Common pathogens include Staphylococcus aureus, Salmonella, Pseudomonas, and Candida albicans.

(3) Direct infection: When the infection occurs in the organs and tissues around the urinary system, pathogenic bacteria can directly invade the urinary system and cause infection.

(4) Lymphatic tract infections: Pathogenic bacteria can infect the urinary system from lymphatic vessels when pelvic and lower abdominal organs are infected, but it is rare.

Diagnosis and Classification of Proteinuria

Diagnosis and Classification of Proteinuria

Daily urinary protein exceeds 150 mg or urinary protein/creatinine ratio (PCR) > 200 mg/g is called proteinuria. 24-hour urinary albumin excretion is called microalbuminuria in 30-300 mg.

 

 

 

 

 

 

 

 

 

 

 

 

 

Pathological proteinuria is more persistent and more:

1) Overflow proteinuria: The concentration of a certain protein in the plasma is too high and is filtered out by normal or abnormal glomeruli;

2) Renal globulinuria: glomerular filtration barrier damage;

3) Tubular proteinuria: Abnormal absorption of normal filtered proteins by renal tubules;

4) Tissue proteinuria: protein secreted by kidney tissue