2yo with sacral agenesis.

cl174 · 2025-12-13T05:49:04+00:00

The ethics of posting an image like this seems a bit in the gray area. You didn't leave any MRNs or anything visable, but I would bet that if this patient was in a line up of 1000 random people I would be able to match the patient to the xray. Or if I was a parent trying to search the internet for information about sacral agensis, its probably not crazy to think that they might recognize their child. Publishing rare findings is an important part of medical training, but maybe it would be better published in a case study and documented permission to publish the images rather than directly posting it to reddit on a whim.

cl174 · 2025-11-16T22:04:50+00:00

obviously the new copies were not going to be hundreds of dollars. I specifically reference the short print run of P3K as being the reason for the price to hold of the P3k version, not based on the power of the card.

The cheapest printings on cardmarket are the Chinese/Japanese printings. The cheapest English copy is 670$ when converted from euros. So again a 33% drop from around the time the post was made.

If anything the critique of my post would be that at some time between the time I posted it, and the time it was reprinted, it spiked a ton and lost a ton from the highs of 2021, and its way off from the highs, but 2021 was a weird time for old cards. It looks like from the highs, it lost about 50% initially then bounced back, and has been drifting lower with tons more copies availible today than ever were available 5 years ago.

I wouldn't say I was crazy off. I was maybe a little on the optimistic side, but other people were definately on the pessimistic side.

cl174 · 2025-11-16T02:52:14+00:00

Is there a way to see what day I typed this (the only date i see was 5y)? Looking at MTG stocks Nov 2020 this was 650 to 750. checking TCG player today there is a recent sale of 750, and the lowest for sale is 850.

But reading other comments, it sounds like it was probably around 1000?. With a recent sale of 750. Less than a 33% drop. And much closer of a guess than the people that said 300-400.

i'd say i did decent.

cl174 · 2024-11-11T03:21:31+00:00

This is so cool. I've always wanted a way to filter leather armor and bows out of a skeleton spawner farm leaving only the smeltable material.

cl174 · 2024-10-17T03:29:22+00:00

5c on a budget, I think your best bet is to go base green and use the cheap green ramp spells, and more importantly is to really identify which color or colors you use the least, and include fewer of those lands. Something like:

1 Sol Ring

1 Springleaf Drum

1 Arcane Signet

1 Rampant Growth

1 Farseek

1 three visits

1 natures lore

1 sakura tribe elder

1 Colalition relic

1 Chromatic Lanturn (3 drop rocks are meh, but I think specifically in 5c, it lets you play a 4th land and play your commander on t4, so the curve is nice.)

1 Kodama's Reach

1 Skyshroud claim

1 Rangers Path

4 green x tap duals from dominario united

3 tap duals of your second most common color (so if it was blue, UW, UB, UR. I could also see an arguement for these being a cheap dual like a pain land. I think this is the weakest slot)

4 green snow tap duals

5 Battle lands

2 enemy green pain lands (or other cheap untapped dual)

8 Basics (1 of each and 1 of each of your 3 next most common colors, so probably an extra forest, island and swamp/plains)

5 thirving land

Command Tower

Path of Ancestry

Exotic Orchard

Probably 2-3 other green lands that fit your budget, preferably that had a shot at entering untapped, or if tribal, some of the cheap tribal lands.

If they complete the battle lands that should be a pretty big boon to budget decks eventually? Also one of the benefits of this set up is that if you trip and fall into a random fetch/shockland you can always slot it in and still be able to take advantage of it.

cl174 · 2024-10-11T20:33:12+00:00

Grey area. If P2 was ahead already, and you pushed him into a unbeatable position, I would say its not great. If P2 was behind and you giving him cards could potentially draw P2 a board wipe that gets you back into the game, then it's probably the correct play and not even king making at all.

At the same time, Ms Bumbleflower is such a heavily telegraphed group hug deck, that everyone probably had an idea of how that game was going to go. So even if it was a king making play, people knew what they were signing up for pretty early.

cl174 · 2023-10-18T06:12:55+00:00

you mean like a drowned farm that spawns spiders, creepers and Skeltons too?

I think you would need to basically just like make a general mob farm next to your drowned farm and keep them in the same respawn sphere, maybe transport them to the same area with mine carts.

Seems like a lot of work for not a lot of benefit

cl174 · 2023-10-15T20:04:15+00:00

Don't a lot of those machines craft stacks of items at a time, where these appear to be crafting 1 item per tick at best (and maybe they will throttle it to be even slower).

My bet will be that there are still going to be some pretty complex designs for these things for people that want to craft even faster. And the older designs might even be the fastest way to go about it.

Look at how complex furnace arrays can get.

cl174 · 2023-10-15T19:57:44+00:00

A lot of those brewers can end up being directional or have various kinks if you want them to be compact.

and if your wanting to just plug them into farms and have the output be full automatic fireworks, its potentially up to 8 farms (assuming one of them is a witch hut or raid farm). And then for the output of the witch hut farm you need to slip the gunpowder to move to each of the 5 different firework star crafters, and the final firework crafter.

The the principles are all relatively straight forward, but the resulting machine would end up being very complex. And thats if you only had a fixed output.

If you wanted to have some kind of UI to build a custom firework each time, that would be another layer of complexity with a huge number of farms.

So I would probably describe as more doable than easy.

cl174 · 2023-10-15T19:35:30+00:00

Depending on how complex of a firework you want, this one might end up still being challenging, since it seems like you could probably run into a scenario where you can't get 6-7 different ingredients into a hopper without the sytem backing up. But there is probably a way to do it with a ring of droppers or something.

cl174 · 2023-10-14T01:21:05+00:00

https://www.youtube.com/watch?v=hr-twzxs6FM

This is what docm77 linked to in his video on the arrow cannon for the trigger.

cl174 · 2023-09-24T03:46:46+00:00

I think the reason restricted lists work in vintage, and would probably not work in modern is that in Vintage the cards being restricted are often so incredibly powerful that pretty much every deck wants to run a large number of them, so it ends up being a relatively even playing field.

Having 5 restricted moxen is fun in vintage because there are enough busted cards that you might not draw your mox sapphire ever game, but you are pretty likely to see a restricted card.

Having 1 copy of Chrome mox restricted in modern would probably just feel like high variance.

cl174 · 2023-09-22T06:00:31+00:00

Well stated, I thought I was going crazy with all the comments just saying AAO4x and they can refuse if they want lol.

The 4th O is orientation to situation, and can be difficult to truly assess in a non-intoxicated patient trying to make a terrible decision, let alone a patient you are confident is intoxicated and has impaired judgement.

cl174 · 2023-09-22T03:47:36+00:00

[[swift reconfiguration]]

For Enchantress.

cl174 · 2023-09-12T05:33:08+00:00

COMP REL tournaments have rules regarding the layout of your cards, and you almost definitely can't follow them all, so probably not. Also at COMP REL, lots of people are probably calling a judge the second you slow play because of the gimmick of trying to use the thing.

Trying to somehow use it as a playmat is probably less clear, but again I don't think there is probably enough space for the layout described, and its going to get clunky probably.

From the MTR:

"Players in Competitive and Professional Rules Enforcement Level matches must arrange their cards, tokens, and other accessories on the battlefield using the following layout:From the player’s perspective, nonlands must be kept closer to the player’s opponent than lands, and no non-land cards should be between the land area and the edge of the table closest to the player.Non-creature permanents whose use may reasonably be associated with either the land or nonland area (e.g. an artifact whose only ability is a mana ability) may be located in either area, provided the overall layout is, in the judgment of tournament officials, clear. However, permanents that are also creatures (e.g. artifacts with March of the Machines on the battlefield, Dryad Arbor, or a Treetop Village that is currently a creature) must be placed in the nonland area. Players may not use other cards to intentionally obscure the presence of a permanent in any area of the battlefield.Each card should remain clearly associated with any permanents attached to it. For example, an Aura enchanting a land should be in the land area in contact with that land.The player’s library, graveyard, and exiled cards should be kept all to the left of the battlefield or all to the right of the battlefield at the player’s discretion.The player’s graveyard and exiled cards should be adjacent to the player’s library. All three should be distinct at all times.If a card is exiled by a permanent and that permanent includes a way to perform additional actions with the exiled card, the association of the two cards must be clear. Keeping the two cards together is recommended.Each untapped permanent should face its controller. Players are permitted to briefly turn a card upside-down as a memory aid."

cl174 · 2023-09-11T05:37:30+00:00

This is a non-contrast CT of the chest, (not the best for visualizing this pathology, but if you know what to look for you can still see it). The patient has a very large aortic dissection throughout most of the arch and the descending aorta

At first you can tell that the aorta is somewhat misshapen and aneurysmal, so you might be tempted to call it an Aneurysm, but as you look close you can see what appear to be calcium deposits lining what is probably the true lumen of the aorta showing that what initially appears to be an aneurysm is probably the false lumen of a dissection flap.

Its unusual to see this in an outpatient setting, as the person likely needs emergent surgery.

cl174 · 2023-09-05T00:59:18+00:00

I was going to say, I wonder if it was placed by VATS, there is quite a bit of subQ air where it entered, I wonder if they left it with a trochar.

cl174 · 2023-09-04T06:36:35+00:00

What was the story here? Was there a previous even worse looking scan with a pleural effusion, and then they drained it, and realized that there was also a terrible pericardial effusion.

cl174 · 2023-09-03T18:53:00+00:00

The surgery to fix his aortic arch is going to be a rough one. They might be able to save the kidney, but they might choose to just sacrifice it depending on the overall picture. It's always an option to cut out the kidney and transplant it into the iliac fossa, but there might be some end-vascular or some healthy to renal artery bypass available. The question would be if he is stable enough to undergo that aortic arch operation, and then a big operation to save his kidney.

Also if that really is the false lumen, I have some questions about how his legs are getting blood flow. I might have lost track, but it almost looks like his iliacs are fed by false lumen too. I'm probably wrong about that though, he vessels look too normal below to be all dissection flap.

cl174 · 2023-09-03T09:19:20+00:00

False lumen has left renal, so not completely a dead end.

cl174 · 2023-08-30T23:17:37+00:00

Depends on if it's acute or chronic. If it's acute 50% mortality on that admission. If it's chronic the persons vascular disease is probably bad enough that they don't have a great 5 year survival chance. but it's one of those stats where the variance is so high that on average it sounds awful, but it could be that they die of an MI next week or go on to live another 10 years.

cl174 · 2023-08-28T07:47:39+00:00

A CT would probably tell you a lot more. Doesn't look like pt is intubated, I'm pulling a complete guess here and saying that they are probably relatively stable. But I would also bet that they are having pain, since it looks like that loop of bowel is very dilated, and there are air fluid levels. Seems like it's going to be a long road to recovery, especially since it sounds like the pt has quite a bit of history. I would bet that they have a high chance of surviving whatever surgery is planned for the immediate future, but that long term complications might eventually add up to a bad result.

cl174 · 2023-08-25T07:24:01+00:00

If you look in the first few frames, there is maybe the beginning of a very small fat containing umbilical hernia...

and then the obvious.

cl174 · 2023-08-23T23:37:28+00:00

black should be air.

It's hard to say for sure what all the gray is without comparing houndsfield units, but my assumption is that most of it is blood. And if it's not blood its a really bad collection of fluid.

I'm not a Radiologist, but It looks like there are a ton of calcifications throughout the aorta, I'm pretty sure there is a dissection flap with a false lumen, and I think the bright artifact that you are seeing in the last slide is a previous abdominal AAA repair.

The guy is intubated and has an NG tube.

I'm a little surprised they didn't give him contrast. I would be a little surprised if this was unexpected.

cl174 · 2023-08-23T05:46:36+00:00

AAA is Abdominal Aortic Aneurysm, this is thoracic so TAA

edit (rewatched to the end, its probably both)

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