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Medicaltalks  Medicine sometimes snatches away health, sometimes gives it. Sharing the medical story through photos.😷

Loving @plasticsurgery right now! Has the best surgical content on instagram! You got to check out this page for more.

This man has miraculously survived after apparently hammering three 10cm (4-inch) nails into his own head. Swipe to see the photo!
The 69-year-old psychiatric patients’ x-rays revealed that the nails had been hammered through his skull and into his brain – but he made a full recovery following a surgery over a 3-month stay at the hospital.
He claimed that he hammered the nails in himself and was very insistent to the doctors that the police were not called in relation to his injuries.

This heart is all ready to be transplanted!

This isn’t a human fetal heart beating, but rather it is a great example of how all hearts function!
Look at that heart beating peacefully on its own!
That's a classic presentation of cardiac automaticity, which is the property of a specialized cardiac cells called pacemakers to generate spontaneous electrical impulse.
Cells normally capable of generating an impulse and maintaining a heart rate commensurate with the body’s need are the pacemaker cells in the sinus node and AV node among others, which fire at regular intervals and leads to the beat.
The sinus node is located at the intersection of the superior vena cava and the right atrium laterally. While the sinus node cells have an intrinsic automaticity of their own, they are influenced by the sympathetic and parasympathetic nervous system. The former increases the heart rate during exertion or when the sympathetic tone is high while the latter slows the heart rate.
So as you might guess, the cardiac action potential and regulatory mechanisms lies within the heart itself and depends on these intrinsic nodes rather than the CNS.
Cardiac cells with automaticity displaying the fastest rate take over pacemaker cells with slower rates. The sinus node has the fastest intrinsic rate, other cells capable of generating a rhythm (automaticity) are termed latent pacemakers. They can take over pacing the heart if the sinus node becomes dysfunctional (sick sinus syndrome).
Furthermore, in a developing fetus, the myocardium begins to contract rhythmically by 3 weeks after conception, initiated from these spontaneously depolarizing myocardial pacemaker cells.

Skull with a super massive mandibular tumor!!
Notice the drawing at the upper right corner!
This was a unique case of a giant osteosarcoma of the mandible.
Osteosarcoma is the second most frequent primary malignant bone tumor and is usually found in long bones with a small fraction of cases occurring in the skull and jaw.
The patient presented with swelling in the left lower jaw which wasn’t addressed on time.
Mandibular osteosarcomas present with pain, swelling over bone and adjacent soft tissues, bulging and dislocation of tooth, lack of healing and swelling at the site of tooth extraction.
The classical osteosarcoma is the most frequent variant, which develops in the medullary region of the bone and can be subdivided in osteoblastic, chondroblastic and fibroblastic histological types, depending upon the extracellular matrix produced by tumor cells.
Early detection of the tumor and early resection of the tumor are the keys to survival. The treatment of osteosarcoma consists of radical or conservative surgery which is followed by radiotherapy or chemotherapy.
Photo credit @marvinjarodd , University Museum Utrecht, Netherlands.

Removing tooth brushes from the GI tract, one after another!!
This 32 year old male psychiatric patient underwent surgery to remove 19 toothbrush, 4 wooden sticks, 2 pieces of metal, 2 pieces of plastic, 1 spoon and 1 piece of cloth. Fortunately, the patient is now stable and recovering.
Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients, and there has been no previously reported case of a toothbrush in the colon. There has been a documented case of a swallowed toothbrush found in the ascending colon that caused a fistula between the right colon and the liver, with a complicating small hepatic abscess. That patient was also successfully managed using exploratory laparotomy.
Although this behavior can be seen in other mental illnesses, it may be the first clue to the diagnosis of an eating disorder and is one of the easiest for the radiologist to recognize. Recognition of this finding and its immediate communication to the referring physician is important, because the management of ingested foreign bodies includes removal via endoscopy or laparotomy to avoid pressure necrosis or bowel perforation.

Well it’s time for some organs to be examined in depth!
Autopsy sometimes remains the only definitive way to confirm and sometimes diagnose disease.
Autopsy is a post-mortem examination, performed on a body after death. It is a highly specialized surgical procedure that consists of a thorough examination of a corpse by dissection to determine the medical cause and manner of death or to evaluate any disease or injury that may be present, cases of unknown or uncertain death, or for research or educational purposes.
These are important in clinical medicine as they often shed light on medical error and can be used to help guide continuous improvement.
Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and an internal examination is conducted, with special attention to each and every vital organ.

I have never quite realized the true depth of this before, but after extensively studying the human body and its complex inner machinations, I can't help but feel so completely overwhelmed by how perfectly constructed we are.
This is a 12-week interstitial gestation, which eventually resulted in a hysterectomy.

His tattoo "HARD TO KILL" is really on point!
It looks like the knife went by the lateral side of the nose and got stuck somewhere in the maxillary region. A person with such a head injury may be evaluated using X-ray, CT scan, or MRI (MRI can only be used when the penetrating object would not be magnetic, because MRI uses magnetism and could move the object, causing further injury). If someone has been stabbed, call 911 immediately. Lay the stabbed person down and check their pulse and breathing. If the stabbing object is still embedded, do not remove it!

Let’s talk vocal cords. Or perhaps should we sing it out?! Here a look at a young females’ vocal cords during a stroboscopy examination.
The vocal folds or cords are located within the larynx (the voice box) at the top of the trachea. They are open during inhalation and come together to close during swallowing and phonation. When closed, the vocal folds may vibrate and modulate the expelled airflow from the lungs to produce speech and singing.
Stroboscopy is a method used to visualize vocal fold vibration. It uses a synchronized, flashing light passed through a flexible or rigid telescope. The flashes of light from the stroboscope are synchronized to the vocal fold vibration at a slightly slower speed, allowing the examiner to observe vocal fold vibration during sound production in what appears to be slow motion.
This special viewing allows the voice care team to evaluate each vocal fold's vibration properties during the different phases of the vocal fold's vibration cycle. Because vocal fold vibration is so fast, the slow motion view is actually derived from many successive vibration cycles. The information acquired from the stroboscopic examination of the vocal folds is essential for planning effective phonomicrosurgery (endoscopic surgery to enhance vocal function). Optimal human voice production is dependent on optimal vocal fold vibration. This requires aerodynamically competent closure of vocal folds along with pliable phonatory mucosa.

A megacolon from sigmoid volvulus!! The image above shows a greatly dilated sigmoid colon that almost fills the entire abdomen!
The patient presented with large bowel obstruction symptoms - constipation, abdominal bloating, nausea and vomiting, with marked abdominal distention on examination.
Intraoperatively, sigmoid volvulus was found to be the cause of his intestinal obstruction.
This condition occurs when the sigmoid colon twists around itself and its narrow and elongated mesentery and, not surprising, the intestinal obstruction risk rises when twisting of the intestines is more than 180 degrees with the sigmoid involved in up to 90% of cases.
Plain abdominal radiography showing the dilated loops often with a few air-fluid levels is used to diagnose the volvulus in most cases with CT scan or MRI as the confirmatory tests when necessary.
Surgically, after the colon has been untwisted, the definitive and standard therapy is sigmoid resection and primary anastomosis.
A nonresective alternatives is also widely used with mixed success.
Rapid surgical involvement is mandatory to prevent complications such as hemorrhagic infarction, perforation, septic shock, and death.
Photo by @drbuckparker

Giving birth is like the beginning of all things: wonder, hope, a thousand dreams and possibilities within that first scream.
We can never get our fill of looking.
There should be a song for women to sing at this moment, or a prayer to recite. But perhaps there is none because there are no words strong enough to name that moment.
Photo by @dr.bengi

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