Lumbosacral Plexus

Plexus Lumbalis and Plexus Sacralis

L1: iliohypogastric
ilioinguinal

L2: genitofemoral

L3: lateral femoral cutaneous
femoral

L4: femoral
obturator

L5: lumbosacral trunk
superior gluteal

S1: inferior gluteal
sciatic (common peroneal)

S2: sciatic (tibial)

S3: sciatic (tibial)
posterior femoral sutaneous

S4: pudendal

S5: pudendal

Cochlear Implant and Hybrid Implant

Presentation from Med El and Dr Nirmal Petal

CI implant system is not good for tonal language such as Cantonese and Mandarin as its poor frequency resolution.

Hybrid implants showed best speech discrimination score in patients with Ski-Plate hearing loss at high frequencies.

15% patients lost their low frequency hearing after hybrid implants but still have good speech discrimination abilities.

The Level of Consciousness

Glasgow Coma Scale:

Best motor response

Best verbal response

Eye opening



In most systems, the scale is scales out of 15

3 compatible with brain death

7 usually accepted as a state of coma

Contracture

Dupuytren's Contracture

A progressive painless thickening and tighening of subcutaneous tissue of the palm, causing the fourth and fifth fingers to bend into the palm and resist extension

Tendons and nerves are not involved
Surgical removal of the excess fibrous tissue



Valkmann's Contracture

Ischaemic muscle necrosis due to acute vascular occulsion affecting the musckes of the volar forearm compartment, the flexors of the fingers, and thumb and wrist.

Most common associated is with supercondylar humeral fracture in Children



Ulnar Claw Hand

Ulnar nerve palsy

Hyperextension at the metacarpo-phalangeal joints of the little and ring fingers is accompanied by flexion at interphalangeal joints

The deformith is due to lumbrical paralysis to thesr fingers

Wasting of hypothenar muscles and interossei

Hormone

Calcitonin: reduce the blood level of calcium and to inhibit bone resorption
Parathyroid hormone: raise the blood calcium level, and enhance bone resorption

Neck lump

Parotid lump

Benign parotid tumour
Benign pleomorphic adenoma
Displace the ear lobe outward
Slow growing
Do not cause facial nerve paralysis
The most common parotid tumour

The adenolymphoma
A less common benign parotid tumour

Carcinoma of the parotid
Infiltrate the facial nerve causing facial palsy
Spread by local invasion and by lymphatics

Parotid calculus
Acute and painful swelling



Tumour of the submandibular gland
More common malignant
Do not displace the ear lobe



Brachial cyst
Cystic lump in the anterior triangle of sternomastoid
First appearance in the second or third decades
Squamous epithalium
Treat by surgical excision


Carcinoma of the thyroid
Papillary carcinoma
Solitary
Spread to the lymph node
Slow growing
Surgical excision

Follicular cell tumour
Multifocal
Spread through the blood stream to bone

Medullary tumour
Rear
Produce calcitonin, hypocalcaemia


Submandibular duct onstruction by stone
Sudden onset of pain
Bimanual palpation of the floor of the mouth
Confirmed by an intra-oral X-ray


Ranula
Cystic transilluminable swelling
Unroofing of fenedtration into the oral cavity



Congenital branchial fistual

First independent day at Bondi Junction

This is the first independent day at Bondi Junction. Before that several persons mentioned that the clients in Bondi Junction were hardest to deal with. Today I were careful, clients were ok, they were not too hard and they came from higher income community.

We have no receptionist now. Amy went to Wollongong. Allison come today. Van back from his holiday.

I need business card for the Bondi Junction. Contact with Ginny with my key in Hurstville. So far so good.

Overall still happy for this new job.

Skin disease

Malignant melanoma:

The depth of invasion: 0.76 mm

Breslow classification

wider excision
Not a radiosensitive tumour



Skin burn:

Marjolin ucler: malignant ulcer



Cystic lesion:

Benign mucoid cyst

Squamous cell carcinoma, basal cell carcinoma

Sebaceous cyst

Syphilitic lip lesion


Lipomas/sebaceous cyst

never in scrotum/scrotum
freely mobile/attach skin
lobulated contour/smooth contour


Naevus:

Intradermal naevi: benign
Junctional naevi: Malignant change
Compound naevi: Malignant change


Premalignant squamous cell carcinoma
Leucoplakia
Bowen disease
Chronic radiation
Solar keratosis