FAT CONTAINING LESIONS IN MAMMOGRAPHY...

Hi, guys & gals... this topic has been asked several times...

Fat containing lesions on mammography

• Hamartoma
• Posttraumatic cyst/ Fat necrosis/ Oil cyst
• Galactocele
• Lipoma
• Intramammary node

Descent of testis

Descent of testis:

At deep inguinal ring— 7th month of intra uterine life.

In inguinal canal — 8th month of intrauterine life.

At superficial inguinal ring — 9th month of intrauterine life.

Ectopic testis-testis abnormally placed outside its path

Retractile testis- in infancy 80% of inapparent testis are rectractile testis & require t/t

Undescended testis-  testis arrested in some part of its path to the scrotum

§  m.c. in preterm,small for gestational age, LBW, twin neonates

§  m.c. on right side

§  Secondary sexual characters – normal

§  Approx. 70—75% of cryptorchid testis spontaneous descent usually by 3 months of age

§  Most undescended testicles descend spontaneously, so that by one year of age, the prevalence decreases to <1% which is similar to that in adults

§  Spontaneous descent rare  after  age of 6 months -----  the optimal time for surgical correction is as soon as possible after  6  months

§  If a child comes at 7 months------- answer should be manipulation/examination followed by sugery.

§  Orchidopexy for cryptorchidism is done at age  -----------  6months-12 months (before 1 yr)

§  Complications of incomplete descent

o   torsion of testis

o   epididymo-orchitis

o   indirect inguinal hernia

o   atrophy

o   pain

o   sterility

o   malignancy

Food poisoning...

               

Food poisoning

incubation period	organisms	symptoms	food
1-6 hrs	o    staph. Aureus o    bacillus cereus—emetic type	diarrhea,vomiting,NO fever vomiting>diarrhea,NO fever	meat,dairy products,poultry products fried rice
8-16 hrs	bacillus cereus—diarrheal type Cl. Perferingens	diarrhea,NO vomiting,NO fever Diarrhea,NO vomiting,No fever	wide range--meat,vegetables,cereal beef,poultry,legumes
>16 hrs	V.cholerae V.parahemolyticus salmonella shigella campylobacter	diarrhea,vomiting,NO fever diarrhea,vomiting,fever diarrhea,fever,rarely vomiting diarrhea,fever,rarely vomiting diarrhea,fever,NO vomiting	wide range of food sea food beef,poultry,eggs,dairy products potato salad,egg salad,raw vegetables raw poultry milk

branchial anomalies- from anatomy to surgery

Branchial arches

§  Branchial apparatus appears around 4^th wk of gestation

§  The structures of head are derived from 5 pairs of branchial arches, their intervening clefts externally, & pouches internally

§  At first there are 6 arches

§  5^th arch disappears & only 5 are left ---------- no structure develops from 5^th arch

§  Ventral ends of arches of both sides meet in midline

§  Endoderm lining inside forms---------- pouches

§  Surface ectoderm forms --------- clefts

§  Each branchial/pharyngeal arch contains------ skeletal muscle(cartilage that forms bone),striated muscle,nerve of arch,arterial arch

Derivatives of skeletal elements of arches

Cartilage of 1st arch ( Meckel’s cartilage )	§  maxilla ,  §  incus, §  malleus, §  anterior ligament of malleus (from sheath/perichondrium)
Cartilage of 2nd arch (Reichert’s cartilage)	§  stapes, §  styloid process, §  stylohyoid ligament (from sheath/perichondrium), §  smaller/lesser cornu of hyoid bone, §  superior part of body of hyoid bone
Cartilage of 3rd arch	§  greater cornu of hyoid bone, §  lower part of body of hyoid bone
Cartilage of 4th arch	§  thyroid cartilage, §  epiglottic cartilage
Cartilage of 6th arch	§  Cricoids, §  arytenoids, §  Corniculate

Nerves & muscles of  pharyngeal arches

Arch	nerve	Muscles
1	mandibular	Muscles of mastication §  Medial pterygoid §  Lateral pterygoid §  Masseter §  Temporalis Mylohyoid Ant. Belly of Digastric Tensor tympani Tensor palate
2	Facial	Muscles of facial expression Occipito-frontalis Platysma Stylohyoid Post. Belly of digastrics Stapedius Auricular muscles
3	glossopharyngeal	Stylopharyngeus
4	Vagus nerve (X) Superior laryngeal nerve	Cricothyroid all intrinsic muscles of soft palate including levator veli palatini
6	Vagus nerve (X) Recurrent laryngeal nerve	All intrinsic muscles of larynx except the cricothyroid muscle

Fate of clefts

§  1^st ectodermal cleft------------ external acoustic meatus

Fate of pouches

§  1^st endodermal pouch(& a part of 2^nd ) ----------- tubotympanic recess---------- middle ear , auditory tube

§  2^nd pouch---------- palatine tonsil

§  3^rd pouch------- inferior parathyroid gland(so called parathyroid III), thymus

§  4^th pouch ----------- superior parathyroid gland(so called parathyroid IV), some contribution to thyroid

Arteries of arches

Pharyngeal arch	Artery
1st ( "mandibular arch")	Maxillary artery,  external carotid artery
2nd ("hyoid arch")	Stapedial Artery
3rd	Common carotid/Internal carotid
4th	Right 4th aortic arch:subclavian artery Left 4th aortic arch: aortic arch
6th	Right 6th aortic arch:pulmonary artery Left 6th aortic arch:Pulmonary artery andductus arteriosus

Foramen caecum at floor of pharynx  gives rise to --------- Median diverticulum-------- Thyroglossal duct---------- thyroid gland

Branchial anomolies

1st arch branchial remnants	§  located in front or back of ear or in upper neck in the region of mandible §  Fistulas typically commence through the parotid gland & end in external auditory canal
2nd branchial remnants are m.c.	§  fistulas/sinuses with external opening along anterior border of sternocleidomastoid & internal opening at tonsillar fossa §  Fistulous track passes b/w internal & external carotid arteries
3rd branchial cleft remnants—	§  No associated sinuses/fistula §  Located in in suprasternal notch/ clavicular region §  Most often contain cartilage & present as firm mass or subcutaneous abscess §  Rarely sinus may occur which open internally into pyriform sinus

§  Branciogenic anomalies occur with equal frequency on each side of neck & 15% are bilateral

§  Fistulas & sinuses appear at birth

§  Cysts appear in late childhood & adults

§  Cysts are characteristically found  anterior & deep to the upper 3^rd of sternocleidomastoid (inferior to the angle of mandible)

§  Sinuses & cysts are prone to become repeatedly infected producing cellulitis & abscess formation

§  Children ---------- fistulas>sinuses>cysts

§  Cysts are more common in adults BUT they may occur at any age

§  Adults ------ cysts > sinuses

§  t/t

o    All branchial abnormalities should be excised early in life

o    Complete surgical removal necessary

o    A series 2-3 small transverse incisions in stepladder fashion