Advertising in 1960s

Some really old advertisements that I found in an old magazine dated back to 1960s:

Summer

"It was summer. And so hot. The sun is possessive of this city in the summer - it wants all its beauty to itself, so it chases everyone away. The rich to their hill stations, the rest of us to darkened rooms, or under trees where the shade marks the edges of the sun's territory."
-Burnt Shadows, Kamila Shamsie

How to read a Chest X-Ray (Basics)

The proposed system for looking at a radiograph of the chest involves remembering part of
the alphabet:

A-airway
B-bone
C-cardiac
D-diaphragm
E&F-equal (lung) fields
G-gastric bubble
H-hilum (and mediastinum)

AIRWAY
ŠLook at the trachea and its branches: check the site, size, shape, and shadow (4 S’s).
ŠIs it patent, or narrowed indicating stenosis or edema? Is it central? (in children it should be
straight but in adults it can deviate to the right due the aortic arch)

BONE
ŠLook at and compare the bony structures paying attention to site, size, shape, shadows and borders:
(clavicles, ribs, scapulae, thoracic vertebrae, and humeri).
ŠAny fractures? Using a pointer follow along the smooth edges of each bone looking for an interruption of the smooth line.
ŠAny lytic lesions? Look for discrete darker areas or a change in bone density.
ŠAny bony deformity? (rachitic rosary at the costochondral joints seen in rickets)
ŠAny extra? (cervical ribs)
ŠAny missing bones? (absent vertebral arches in spina bifida occulta)
ŠLook for lateral deviations of the vertebrae in scoliosis.

CARDIAC
ŠTake note of the cardiac site, size, shape, shadows and borders.
Site: is it located on the right or left?
Size: is it less than half the transthoracic diameter? (i.e. is the largest diameter of the heart
less than half the largest diameter of the thorax)
Shape: is it ovoid with the apex pointing to the left?
Shadows: any change in density?
Borders: is it clear or well defined?
-unclear right border suggest middle lobe consolidation.
-unclear left border suggest lingular lobe consolidation.

DIAPHRAGM
ŠLook at the outline of the diaphragm; it should be clear and smooth.
ŠRight hemidiaphragm should be higher (2-3cm) than the left:
-highest point on the right should be in the middle of the right lung field.
-highest point on left should be slightly lateral to the middle of the left lung field (see Figure 1).
-deviation may indicate pneumothorax. ŠAre the costophrenic angles well defined?
-whiteness immediately above the diaphragm indicates pleural effusion or consolidation.
-the presence of fluid will produce a meniscus (Meniscus Sign) or a concave upper border
ŠIs there air below each hemidiaphragm indicating bowel perforation?
ŠIs the diaphragm below the anterior end of the 6th rib on the right? If so, this indicates hyperinflation.

EQUAL (lung) FIELDS
ŠDivide lung fields into zones: upper, middle, and lower zones
-upper: from the apex to 2nd costal cartilage
-middle: between 2nd and 4th costal cartilage
-lower: between 4th and 6th costal cartilage
ŠLook for equal radiolucency (or blackness due to air filling) between the left and the right lungs
zones.
ŠLook for any discrete or generalized grey/white shadows (described as opacity/patchy shadows)
ŠThe horizontal fissure on the right, divides the upper and middle lobes:
-from the hilum to the 6th rib at the axillary line
ŠLook for vascular markings:
-indicating pulmonary hypertension pruning

Š
More specifically look for:
-Air bronchograms are visible air-filled bronchi, outlined by surrounding consolidation.
-Bat’s wing distribution describes one of two patterns of consolidation (the other pattern being lobar);
refers to the bilateral opacification spreading from
the hilar regions into the lungs (sparing the peripheral lung areas) signifying extensive alveolar disease. The causes of bat’s wing are: pulmonary
edema in heart failure, fluid overload, hypoproteinemia, blood transfusion reaction, and others.
-Reversed bat’s wing distribution are alveolar opacification in the peripheral lung fields with sparing of
the central areas seen in fat embolism 1-2 days following a bone fracture.
-Kerley A, B, and C lines which are fine lines running through the lungs representing thickened connective tissue septae seen in intersitial pulmonary
edema.
ŒKerley A lines are found in the upper lobes.
ŒKerley B lines are short (1-2 cm) horizontal line in the lower lobes.
ŒKerley C lines are diffusively distributed through the entire lung.
These Kerley lines may be associated with cardiac enlargement and pleural effusions.

GASTRIC FUNDUS
ŠLook for an air bubble under the left hemidiaphragm.
ŠLook for diaphragmatic hernia on the right or left.

HILUM AND MEDIASTINUM
ŠLook at the hilum (which consists of main bronchus and pulmonary arteries)
-the left should be higher than the right.
ŠCompare the convex shapes and densities on both sides.
ŠThe paratracheal lines are thin lines of the right and left tracheal margins which are thickened in lymphadenopathy.

Source:
TSMJ Volume 2 2001: Clinical Medicine
www.tcd.ie/tsmj

Karachi vs Mumbai

From The Tales of Two Cities by Asif Noorani and Kuldip Nayar

Umar ki Naqdi

Ibn-eInsha wrote this in his last days, when he was in his last stages of laryngeal carcinoma...

UMAR KI NAQDI

Ibn-e-Insha

Ab Umer Ki Naqdi Khatam Hui
Ab Hum Ko Udhar Ki Hajat Hai
Hai Koi Jo Sahookar Bane?
Hai Koi Jo De-wan Haar Bane?
Kuch Saal, Maheene Din Logo!

Par Sood Biyaj Ke Bin Logo!

Haan. Apni Jaan Ke Khazanay Se
Haan, Umer Ke Tosha-khanay Se
Kia Koi Bhi Sahookar Nahi?
Kia Koi Bhi Dewanhaar Nahi?
Jab Naam Udhar Ka Aya Hai
Kion Sab Ne Sar Ko Jhukaya Hai

Kuch Kaam Humein Nimtanay Hain
Jinhain Jaan-ne Walay Janay Hain
Kuch Pyar Dular Ke Dhandhe Hain
Kuch Jag Ke Dosre Phande Hain
Hum Maangte Nahi Hazar Baras
Dus Paanch Baras Do Chaar Baras
Haan, Sood Biyaj Bhi De Lain Ge
Haan Aur Khiraj Bhi De Lain Ge

Asaan Bane, Dushwar Bane
Par Koi To Dewanhaar Bane
Tum Kaun, Tumhara Naam Hai Kia?
Kuch Hum Se Tum Ko Kaam Hai Kia?
Kion Iss Majmay Main Ai Ho?
Kuch Mangti Ho? Kuch Lai Ho?
Ye Karobaar Ke Bateein Hain
Yeh Naqd Udhar Ke Baatein Hain
Hum Beythe Hain Kashkol Liey
Sab Umrr Ke Nakdi Khatam Liey

Ger Sher Ke Naatay Ai Ho
Tab Samjho Jald Judai Ho
Ab Geet Gaya Sangeet Gaya
Haan Sher Ka Mausam Beet Gaya
Ab Putjhur Aye Paat Girain
Kuch Subh Girain, Kuch Raat Girain
Ye Apne Yaar Puranay Hain
Ek Umer Se Hum Ko Jane Hain
In Sab Ke Paas Hai Maal Buhat
Haan Umer Ke Mah-o-saal Buhat
In Sab Ko Hum Ne Bulaya Hai
Aur Jholi Ko Pheylaya Hai
Tum Jao Tou Unn Se Baat Karain
Hum Tum Se Na Mulakat Karain

Kia Paanch Baras?
Kia Umer Apne Ke Paanch Baras?
Tum Jaan Ki Theli Laai Ho?
Kia Pagal Ho ? Soadai Ho?
Jab Umer Ka Akhair Ata Hai
Her Din Sadd-yaan Ban Jata Hai
Jeene Ki Hawas He Nirali Hai
Hai Kaun Jo Iss Se Khale Hai

Kia Maut Se Pehle Marna Hai?
Tum Ko To Buhat Kuch Kerna Hai
Phir Tum Ho Humhare Kaun Bhala
Haan Tum Se Humhara Kia Rishta?
Kia Sood Biyaaj Ka Lalach Hai??
Kissi Aur Khiraj Ka Lalach Hai?
Tum Sohni Ho Mann-mohni Ho
Tum Ja Ker Poori Umer Jiyo

Ye Panch Baras, Ye Chaar Baras
Chhin Jayein To Lagain Hazar Baras
Sab Dost Gaye Sab Yaar Gaye
Thay Jitne Sahookar Gaye
Bas Ek Ye Naari Baithi Hai!
Ye Kaun Hai? Kia Hai? Kaise Hai?
Haan Umer Humain Darkar Bhi Hai!
Haan Jeene Se Humain Piyar Bhi Hai

Jub Maangain Jivan Ki Gharian
Gustaakh Akhian Kite Ja Larian
Hum Qerz Tumhain Lauta Den Ge
Kuch Aur Bhi Ghar-ian Laadain Ge
Jo Saa-at-e-Maah-o-Saal Nahi
Wo Gharian Jin Ko Zawaal Nahi
Lo Apnay Ji Main Utaar Lia
Lo Hum Ne Tum Se Udhaar Lia

Gyn/Obs Surgery Instruments- I

Instruments used in the dilatation and evacuation and dilatation and curettage are:

1. SIM'S SPECULUM

                        

                                            

FEATURES:
It is a non-retaining type of speculum and an assisstant is required to hold it in position.
It is introduced along its edges with the blades lying vertically in anteroposterior diameter of the vagina. The instrument is rotated into its position after introduction.
It is available in various sizes.

USES:
It is used for retracting the posterior vaginal wall during:
1. Dilatation and evacuation.
2. Dilatation and curettage.
3. For taking biopsy from genital tract.
4. Out door cauterisation of erosions.
5. For routine per speculum examination in OPD.


2. CUSCO'S BIVALVED SPECULUM

FEATURES:
It is a self-reataining type of speculum, and has two hinged blades which can be opened up and adjusted at various angles by means of a screw arrangement.
It is introduced into the vagina with its blades closed. The blades are opened and locked in position after introduction. The cervix and some part of the lateral walls of the vagina are seen.

USES:
It is used:
1. When a biopsy is to be taken from the cervix.
2. For cauterisation of cervical erosions.
3. For insertion of I.U.C.D.


3. HEGAR'S CERVICAL DILATORS

FEATURES:
These are metallic instruments used for the dilatation of the cervix in pathological conditions where approach to the uterine cavity is required through the cervical canal.
They are available in gradually increasing sizes.

USED IN:
1. Dilatation and curettage.
2. Dilatation and evacuation.
3. To diagnose incompetent Os of cervix by passing size no. 8 in non-gravid uterus.

Dangers associated with the use of dilators are:

• Sepsis
• Hemorrhage
• Perfortion of the uterus
• Cervical tears which cause cervical incompetence or cervical dystoxia at a later date

4. SIMPSON'S UTERINE SOUND

FEATURES:

It is a graduated metallic rod about 12 inches long. The distal end is curved at and is 2 inches long (normal cervical canal length). The tip of the instrument is blunt.

USES:

1. It is used to asertain the size and direction of the uterus before passing the cervical dilator.

2. To ascertain the position of abnormal uterine contents, eg tumor, polyps, placenta, products of conception or an IUD.

3. It is used cautiously for correction of a mobile retroverted uterus.

4. Uterus is sounded routinely before operations on uterus and cervix.

It is contraindicated when:

1. Pregnancy is suspected.

2. Cervical infection is present.

Complications:

1. Sepsis.

2. Perforation.

5. UTERINE VOLSELLUM FORCEPS

They are of two types:

1. Single toothed volsellum

2. Multiple teeth volsellum

SINGLE TOOTHED VOLSELLUM

As the name indicates, it has a single tooth at the tip.

USES:
The instrument is used to hold:
1. Cervix of nulliparous woman.
2. Small cervix.
3. Amputated cervical stump.

MULTIPLE TEETH VOLSELLUM

It has 2 teeth at the tip.

USES:

1. For holding the anterior and posterior lip of the cervix in various operations, eg: dilatation and curettage, cauterisation of cervix.

2. To test mobility of the cervix and laxity of ligamnets in proplapse.

3. In vaginal hysterectomy, to bring down the fundus or uterus.

4. For grasping small fibroids in myomectomy.

6. ANTERIOR VAGINAL WALL RETRACTOR

FEATURES:

It has two loop-shaped ends with transverse serrations. The loops are set at an angle to the shaft.

USES:
It is used with Sim's speculum to retract the anterior vaginal wall for visualizing the cervix and the anterior fornix.

7. SPONGE (SWAB) HOLDING FORCEPS

FEATURES:
It has ring shaped tips, which may be serrated or smooth.

USES:
1. It is used for holding the sponges to swab out cavities eg, the vagina.
2. Sometimes when the anterior lip of the cervix is friable and cannot be held by volsellum, sponge holding forcep can be used.
3. It can be used in place of ovum forceps.
4. It may be applied on the infundibulopelvic ligaments to control bleeding in myomectomy.
5. For applying antiseptics over the vulva, vagina or abdominal skin, before operations.


8. TENACULUM

FEATURES:
It is a single-toothed volsellum forcep and is used as a volsellum.
The advantage is that it only pierces the tissue at one point so there is very slight bleeding, if any.
In Rubin's test, it is used to grasp the anterior lip of cervix tranversely. It allows cannula to fit air tight in cervis and prevents leakage of gas.

USES:
1. It is used for holding the anterior or posterior lip of cervix in various operations, eg: D&C and cauterisation of cervix.
2. To test mobility of cervix and laxity of ligaments in prolapse.
3. To bring down fundus of uterus, in vaginal hysterectomy.
4. For grasping small fibroids in myomectomy.


9. UTERINE CURETTES

Types of Uterine curettes:

Sim's Uterine Curette

  Sharp and Blunt Curette











Blunt Flushing Curette







Sharp and Blunt curettes are used:
1. To curette out the production of conception in case of missed or incomplete abortion.
2. To curette out endometrium in cases of endometrial diseases for diagnostic and therapeutic purposes, eg:

• In cases of infertility to know the pattern of endometrium and for hormonal assay.
• In patients with post menopausal bleeding.
• For diagnosis and after treatment for endometrial carcinoma.
• For "check curettage" done 1 week after evacuation of a hyaditiform mole.

COMPLICATIONS OF UTERINE CURETTAGE:

1. Hemorrhage

2. Sepsis

3. Vigorous curettage leads to amennorhea due to total removal of endometrium (Asherman's syndrome).

Source: Instruments by Farooq and Samad

Difference between UMN lesions and LMN lesions

Upper Motor Neuron lesions:

> Paralysis affects the movement of a group of muscles.
> Tone of the muscles is increased.
> No wasting of muscles.
> Fasciculations absent.
> Babiniski sign +ve.
> Clonus absent.

Lower Motor Neuron lesions:

> Individual group of muscle is paralysed.
> Tone of the muscles is decreased.
> Wasting of the affected muscles.
> Fasciculations present.
> Babiniski sign -ve.
> Clonus absent.

Rain at dmc, a rare sight.

Photo credits: Shahzad Anwar.

Ita erat quando hic adveni.

Finally got time to start a new blog. Had this planned for ages in my mind.. Its the lazy Pakistaniat in me; we plan to do a lot of things but "not now".

Wont write much. Just wanna share some cool latin words that I came across :

Ita erat quando hic adveni. (It was that way when I got here.)

Yeah, world was like this when we came here.