Healthcare providers are in the best position to assess for domestic violence, yet have obstacles to doing so. See the benefits to moving beyond these obstacles for those you serve. And discover an accurate, convenient and confidential way to assess for domestic abuse.

Cervical Cap for Birth Control

Otto Placik MD. a board certified Chicago based plastic surgeon presents Vulvar Vaginal Genital anatomy lesson reviewing the Vulva, Mons Pubis, clitoral hood, prepuce, frenulum, labia minora & majora, vagina, urethra and fourchette with surgical implications and techniques. Photos pictures and video of anatomic models are reviewed in detail on different models. Great for patients thinking about or planning before labiaplasty or vaginal cosmetic surgery

DMC Plastic Surgeon Doctor Bruce Chau uses minimally invasive surgery called Liposelection to ultrasonically "melt" fat and remove it, resulting in smoother, younger-looking skin and body. Watch as one patient feels transformed through a procedure to revitalize her breasts and her outlook. ~ Detroit Medical Center

How to infuse a local anesthetic into a wound.

This podcast discusses the actions and goals of the Centers for Disease Control and Prevention, related to the current outbreak of H1N1 flu (swine flu).

Surgery to treat men with prostate cancer is often followed by months of difficulty controlling urine flow, a condition known as urinary incontinence. But new research suggests that this problem may go away more quickly if the men perform certain exercises to strengthen their pelvic floor muscles.
Researchers from the Kaiser Permanente Medical Center in Los Angeles, California, found that men who were taught how to perform pelvic floor exercises before and after surgery were more likely to have regained continence three months later.

Men Doing Pelvic Exercises Recover Earlier

In the current study, the researchers randomly assigned 38 men scheduled for radical prostatectomy to either a treatment group or a control group. The men in the treatment group were referred to a physical therapist. They were instructed how to do Pelvic Floor Exercises both before and after surgery, using biofeedback to ensure they were using the proper muscles. The control group did not receive any formal instruction. All of the men completed questionnaires regarding bladder function at regular intervals over the next year.
Overall, 82% of the patients had regained continence (defined as not needing to use any absorbent pads) by the end of the year, including about equal numbers in both groups. But on average the men who had been educated about Pelvic exercises regained continence about one month earlier than those in the control group (at 12 weeks vs. 16 weeks).
Most of the men who did not regain continence within a year were still using at least three absorbent pads a day, indicating continued severe incontinence. The study authors explained that these men probably had extensive damage to the bladder sphincter or severe dysfunction of the bladder after surgery, and the exercises alone were unable to compensate for this.
But the exercises seemed to be effective. Pelvic floor exercise and education initiated prior to surgery is an effective noninvasive intervention useful for improving early return of urinary continence, the authors concluded. It would certainly have a positive impact on our patients undergoing radical prostatectomy in an effort to improve quality of life after major urological surgery.

The results of the study were published in the Journal of Urology (Vol. 170, No. 1: 130-133)

WORLD'S FIRST TRULY ANATOMIC MULTI-ROOTED ZIRCONIA DENTAL IMPLANT SOLUTION dentistry video

Video demonstrates the action of the isolated lumbar multifidis muscle

Femoral Hernia Repair with Prosthetic PHS repair placed on anterior way

Conjoined Twins

Purse String Suture

Orchidectomy and Orchidopexy in Testicular Torsion

Midline Episiotomy

A video produced by the Society of Interventional Radiology discussing the solutions that interventional radiology has to offer.

A video showing the process of childbirth via vaginal delivery.

At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

Treatment of pelvic fractures with a dynamic Ilizarov external fixator

Amniotomy is the official term for artificially breaking the bag of waters during labor. It is believed that breaking the bag of waters will help to speed up an otherwise slow labor. Amniotomy is part of the Active Management of Labor practiced in some hospitals. Amniotomy is performed by a midwife or doctor. A long, thin instrument with a hook on the end is inserted into the vagina and through the cervix so it can catch and rip the bag of waters. To perform an amniotomy, the cervix must be dilated enough to allow the instrument through the cervix, generally at least a two. Why choose Amniotomy? Unlike other medical methods of starting labor, amniotomy does not add synthetic hormones to your labor. Instead it seems to stimulate your body’s own labor process. Amniotomy allows the use of an internal electronic fetal monitor. How effective is Amniotomy? Amniotomy alone is unpredictable, it may take hours for labor to start with amniotomy. Because amniotomy increases the risk for infection, most caregivers use amniotomy in combination with synthetic oxytocin. Birth does happen faster when amniotomy is combined with synthetic oxytocin than when amniotomy is used alone. Risks of Amniotomy Risks for Mother Increases the risk for infection. This risk is increased with length of time the waters are broken and with vaginal exams. Because of the infection risk, a time limit is given by which the mother must give birth. As the time limit approaches attempts to progress labor will become more aggressive. The fore waters equalize pressure on the cervix so it will open uniformly. When they are broken, the mother increases her chances of having uneven dilation. Risks for Baby Increases the risk of umbilical cord compression. The fore waters equalize pressure on the baby’s head as it presses against the cervix. When they are broken, the pressure on the baby’s head may be uneven causing swelling in some parts.

"The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913)