Is that a big pessary in your pelvis or are you just happy to see me?

These pessaries come in wide variety of shapes and sizes.  I don’t recall seeing this type exactly before.  My guess is the patient has to fold it up and stuff it in.   This one is really doing it’s job, pinning the uterus between the bladder and the cystic mass in the pelvis (that requires further eval based on size).  The uterus is standing up like a flagpole on the sag images.

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Cecal Volvulus

This is a case of initally missed or underdiagnosed cecal volvulus.  A broad diff was given for the initial Dx which was evident on the initial study.  A glance at the scout view would have led to suspicion for the diagnosis.

Image1

initial scout view

 

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initial CT

 

A delayed scan was ordered for “abscess” which was in fact the cecum in the left upper quadrant.  This subsequent exam came to me with a nebulous history and practically no clinical info, along with no images of the prior.

 

Image2

delayed CT with excreted contrast in the urinary bladder and persistent “bean” in the left upper quadrant

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delayed diagnosis CT with my diagnosis of cecal volvulus. Note the mesenteric vessel twisting which is also evident on the initial study and the lack of normal position of the cecum.

Liftmaster MQTT Hack Job

I’ve wanted for a long time to extend the range of my garage door opener but using the existing radio signal just wasn’t feasible. The wall unit is the 888LM which uses rolling codes and I’m not sophisticated enough to get into that protocol. I looked at the MyQ gateway a lot and ended up deciding against it because my existing setup was a little bit unreliable and adding more seemed like a great way to make it more unreliable.

I found this [link] that described a slightly different model wall unit and tore mine down to see if it was feasible.

Sure enough, a tactile button actuates the hand press on the controller and by connecting to Wemos D1 mini with a relay shield I was able to get one of them up and running. It was stable for a month with no unexpected openings.

I then moved to the 2nd garage door controller, and wanted to use the same the Wemos D1 mini (NB: it’s easy to confuse pin D1 with the Wemos D1 when reading this). The problem was that the relay shields use pin D1 for the relay so you can only piggyback one shield per Wemos D1 and I wanted (for no good reason) to stay with the relay shields. I was able to solder headers and use a long extension that comes with the D1 to put a relay above and below the Wemos D1. I yanked the D1 header pin out when I was soldering and soldered a bridge across pin D2 and D1 on the relay (which is not connected to pin D1 on the board and goes to relay 1). So now I have a single Wemos D1 Mini with two piggybacked relay shields simulating a keypress on the wall unit.

It’s truly an analog approach to a digital problem.

Hardware:

  • Wemos D1 Mini (or Clone) x 1
  • Wemos D1 Mini Relay Shield x 2
  • Power (Link to mysensors thread):
    • Hi Link HLK-PM01
      • Beware of Fakes.
      • The above-referenced thread is a great example crowdsourced knowledge.
    • Fast Blow Fuse
      • I had fast blow on hand, I’m not sure whether a fast or slow blow fuse is better
    • Varistor
    • Thermal Fuse attached to HLK-PM01

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Complicated Arthroplasty – Shoulder Reverse

Since reverse shoulder arthroplasties are relatively new to the arthroplasty scene, we are just now starting to see the spectrum of complications that can be associated with arthroplasties. These resemble variants of the complication seen at the hip and in the traditional shoulder arthroplasty. This particular case is more reminiscent of a complicated hip arthroplasty.

 

The retaining ring is floating anterior to the shoulder in the pseudo-capsule immediately adjacent to the reverse prosthetic humeral head.

 

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and here are 3-D reconstructions demonstrating the fiasco

 

 

 

 

     Companion Case