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Q1:there is 2 glistering, white, pedunculated polyp with smooth surface measuring 1x1cm on left vocal cord. the polpys are situated at juction of anterior 2/3 and posterior 1/3 of vocal cord. there is no signs of edematous surrounding area.Q2: provisional diagnosis-laryngeal granulomadifferential: vocal cord polypQ3: a granuloma formation secondary to a healing of secondary intention.hope that my shot is correct;)CC, year 3
Mr Yap.. I was kinda poring over this question.. and wondering what was it .. whether it was just a vocal polyp or nodule or some kinda a single papilloma...Then, I was wondering why you mentioned thyroidectomy where the pt was intubated..then I googled! :)I hope I'm right!:)Q1 : There is a pale white pedunculated mass sitting on the posterior 1/3 or the left vocal cord.It looks like it is a two-lipped structure that ft the vocal process of the opposide side.Q2 : intubational granulomaQ3 : Contact ulcers occur when the thin mucosa overlying the firm cartilage of the vocal process is crushed repetitively against the opposite side, causing a breakdown of the mucosa. An ulcer forms, accompanied by granulation tissue formation. An object such as an endotracheal tube may cause the injury leading to granulomas, or granulomas may result secondary to chronic irritation (eg, persistent gastroesophageal reflux injury). :)
Thank you CC & Jo.Good tries both of you, and would you give you full marks in an undergrad exam. The key to answering such questions is to pay attention to the clues in the opening statement, which both of you have done. Appearances may be deceiving without the information that is intentionally given.Q1: It's hard to commit to 'pedunculated' when you don't see the stalk, nor can you move the mass. Also, it's impossible to measure the size without a reference ruler present. It would have been sufficient to say 'an irregular white mass arising from the posterior 1/3rd of the left vocal cord.' And, if you took a look around and didn't concentrate on the mass alone, you might have (with sufficient knowledge) noticed the interarytenoid bar/edema. Q2: The answer, we can deduce from history and examination - is an Intubation Granuloma, secondary to a traumatic intubation and acid reflux (LPR/GERD).Q3: Theory of pathogenesis is - trauma + acid --> ulcer --> perichondritis + infection --> granulation tissueThe term 'granuloma' here is a bit of a misnomer, since it is not a granulomatous disease but a hypergranulation response. Also the fact that it is pale white indicates that it is a 'mature' granuloma - with a predominance of collagen rather than fibroblasts. An early granuloma would be redder/pinkish - containing more fibroblasts and new vessels.Overall - well done on a challenging case. Excision of this mass revealed exactly that - granulation tissue.
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If you’re like me when you first saw the term “arbitrage sports betting” you just said, “huh?” You may even be reading this article because you were wondering. It is a relatively little method that can actually allow you to make money no matter who wins or loses. Kind of like heads I win, tails I win! Finally, to insure that you do indeed have the best betting odds that you can get, it is crucial as a bettor to shop the money line and the odds. Any reputable sports book online would offer the best line for your wagers without coercion. However, once you have found the best deal, it is important to verify and scrutinize the odds based on the past performance of the particular teams involved you can make appropriate judgments that can be indicative of the weaknesses and strengths of the respective sporting teams. You should also do research on the sports players, injury lists, and the teams if possible. [url=http://www.pulsebet.com]sports bets[/url] Overall, the majority of people feel that the United States is missing the boat on this matter. Instead of simply regulating the industry like the rest of the countries in the world, they are trying to get rid of it altogether. This may have some benefits, but for the most part there is a chance that it could end up back firing. It will be interesting to see what the Senate decides to do in the upcoming months. So, having established that using a good Selection System is an absolute must if you want to make money from sports betting, how does the average Bettor actually go about making his/her betting selections? My research shows me that, in the main (ignoring the extremes), there are generally two approaches taken: - The more conservative group looks at the "Short Odds" calls, and plays safe by selecting only those matches where they themselves feel very confident about the outcome. - The more adventurous group analyses the matches and odds on offer, and then makes selections based on their own gut feeling about how the matches will turn out, making sure that the odds match their concept of a "value" bet.
Everything about horse bettingWe came across an article on ESPN.com written by Bill Finley entitled "2005 was a lousy year for horse racing." In his article Mr. Finley cites 9 reasons why 2005 was such a bad year for horse racing in America. Although we agree with several of his observations, number 8 on his list, "U.S. Pari-Mutuel Handle Falls", should have been dealt with more objectively. [url=http://www.pulsebet.com]horse racing bookmaker[/url]In the United States, races can occur on flat surfaces of either dirt or grass, generally for thoroughbred racing. Other tracks offer quarter horse racing]] and harness racing. The best events in US horse racing have been Kentucky Derby, which, together with the Preakness Stakes and the Belmont Stakes, form the Triple Crown for three-year-olds. However, in recent years the Breeders' Cup races, held at the end of the year, have been challenging the Triple Crown events, held early in. Will Barbaro be the next Triple Crown winner? He has the breeding and the talent, but as of this writing twenty horses have won the first two legs of the Triple Crown only to fail at Belmont. Twenty five more have won two of the three races, but maybe this year... [url=http://www.pulsebet.com]bet horse racing[/url]On paper, Barbaro is the horse to beat, and after his decisive win at the Kentucky Derby, he appears capable of beating all comers. But this is horse racing and no matter how it looks on paper we still have to run the race.
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