Lunotriquetral coalition

Lunotriquetral coalition is the most common type of carpal coalition and represents a congenital fusion of the lunate and triquetral bones of the carpus;  prevalence of 0.1%. It is more common in females and African Americans.


A setup for mesenteric ischemia

ER case.  Likely unimportant in the current presentation but potentially important down the road.  2 vessel comp.png

  • Salient Points
    • Chronically occluded proximal SMA
    • >50% and probably 70% stenosis of Celiac origin
  • My recall from Sabistons book says that a single vessel can be ligated with impunity.  2 Vessels and the patient is on the threshold.  If this patient were to thrombose a collateral reconstituting the SMA or the Celiac, there could be a large territory of dead bowel.

Python 3.6 Install on DietPi

Debian repos don’t have python 3.6 ready to go at this time but thanks to the awesome dudes at HA forums, the guide to replacing your venv with 3.6 works to install also.

Step 1.

sudo apt-get install build-essential tk-dev libncurses5-dev libncursesw5-dev libreadline6-dev libdb5.3-dev libgdbm-dev libsqlite3-dev libssl-dev libbz2-dev libexpat1-dev liblzma-dev zlib1g-dev


wget tar
xzvf Python-3.6.0.tgz cd Python-3.6.0/
sudo make install

Allergic Fungal Rhinosinusitis



The majority of sinuses show near complete opacification. On unenhanced CT, the sinuses are typically opacified by centrally hyper-dense material with a peripheral rim of hypo-dense mucosa.

Approximately 40% of patients may have each of the following features:

  • expansion of an involved sinus
  • remodeling and thinning of the bone sinus walls
  • erosion of the sinus wall


  • Hypointensity on T1WI and T2WI is the most common finding.
  • T1: hypointense inflamed mucosal thickness. It can have multiple T1 appearances.
  • T2usually a hyperintense peripheral inflamed mucosal thickness
  • low T2 signal or signal void is due to high concentration of various metals such as iron, magnesium and manganese concentrated by fungal organisms as well as high protein and low free water content in allergic mucin
  • T1 C+ (Gd): an inflamed mucosal lining has contrast enhancement
  • no enhancement in the center or majority of the sinus contents

Classic Imaging Presentation


Self Ejection – Bifrontal Hemorrhagic Contusions

This is a bad injury to be sure.  Very unfortunate.


First time I recall hearing that term but it’s dead on in this case. I really enjoyed the phone call with my ER colleague despite delivering the bad news.  In this case as in many cases of head bleeds the AMS is a striking feature.  And while the patient may not be the most pleasant to begin with, blood on the brain really brings out the worst.


These injuries often lead to persistent frontal lobe dysfunction with impulsiveness, lack of executive function, presidency of a superpower, a twitter account, and lots of charts and maps.  Also, a pretty hot wife, and a pretty hot daughter…(did he really say that out loud…about his own daughter?)


President Trump, I call on you to help these, the least of our brethren.  Not by grabbing them in the ***** but by giving a comprehensive rehab program including a phone, a twitter account and two scoops of ice cream while everyone around them only gets one.


We need TRUMP!


Rehabilitation (for)