GALS Screening Examination

Johns Hopkins Children’s Center Surgeon-in-Chief David Hackam provides information about general pediatric surgery and when it is time to see a general pediatric surgeon. #PediatricSurgery #JohnsHopkins

For more information on general pediatric surgery at Johns Hopkins Children's Center, visit https://www.hopkinsmedicine.or....g/johns-hopkins-chil

FAQ's
0:02 What is a general pediatric surgeon?
0:31 When is it time to see a pediatric surgeon?
1:02 What are some of the most common surgical problems seen by general pediatric surgeons?
1:43 Describe research being done in the field.
2:15 Why choose Johns Hopkins Children's Center for general pediatric surgery?

An example of a technique I use in my surgical practice

A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though rarely a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they're neither benign nor malignant but, rather, something in between.

Red eyes usually are caused by allergy, eye fatigue, over-wearing contact lenses or common eye infections such as pink eye (conjunctivitis). However, redness of the eye sometimes can signal a more serious eye condition or disease, such as uveitis or glaucoma.

A gastroscopy is a procedure where a thin, flexible tube called an endoscope is used to look inside the oesophagus (gullet), stomach and first part of the small intestine (duodenum). It's also sometimes referred to as an upper gastrointestinal endoscopy. The endoscope has a light and a camera at one end.

The Principles of Laparoscopic Suturing

Each month inside your ovaries, a group of eggs starts to grow in small, fluid-filled sacs called follicles. Eventually, one of the eggs erupts from the follicle (ovulation). It usually happens about 2 weeks before your next period. Hormones Rise After the egg leaves the follicle, the follicle develops into something called the corpus luteum. The corpus luteum releases a hormone that helps thicken the lining of your uterus, getting it ready for the egg. The Egg Travels to the Fallopian Tube After the egg is released, it moves into the Fallopian tube. It stays there for about 24 hours, waiting for a single sperm to fertilize it. All this happens, on average, about 2 weeks after your last period.

open multi puncture testicular biopsy to retrieve sperm for ICSI (IntaCytoplasmic Sperm Injection) Procedure video

Histology of Mucles Skeletal Smooth Cardiac

In this video, we show a sports hernia self treatment we give many of our clients. It is not the only part of treatment. Grabbing the skin around the region of the groin strain can reduce pain and stiffness with turning and twisting. Sports hernias are often misdiagnosed with hip labrum tears, hip impingement, adductor tendonitis and abdominal strains.

Option 1: Groin On-Demand Webinar https://bit.ly/37thtNF
Option 2: eBook Unveiling The Mystery Behind Groin Pain in Athletes https://www.p2sportscare.com/p....roduct/understanding
Option 2: Video Guide https://bit.ly/33aLIqC
Option 3 (the best): Work With Us https://www.p2sportscare.com/

Sports Hernia Diagnosis

What Is A Sports Hernia?

A sports hernia is tearing of the transversalis fascia of the lower abdominal or groin region. A common misconception is that a sports hernia is the same as a traditional hernia. The mechanism of injury is rapid twisting and change of direction within sports, such as football, basketball, soccer and hockey.

The term “sports hernia” is becoming mainstream with more professional athletes being diagnosed. The following are just to name a few:

Torii Hunter
Tom Brady
Ryan Getzlaf
Julio Jones
Jeremy Shockey
If you follow any of these professional athletes, they all seem to have the same thing in common: Lingering groin pain. If you play fantasy sports, this is a major headache since it seems so minor, but it can land a player on Injury Reserve on a moments notice. In real life, it is a very frustrating condition to say the least. It is hard to pin point, goes away with rest and comes back after activity, but is hardly painful enough to make you want to stop. It lingers and is always on your mind. And if you’re looking for my step-by-step sports hernia rehab video course here it is.

One the best definitions of Sport hernias is the following by Harmon:
The phenomena of chronic activity–related groin pain that it is unresponsive to conservative therapy and significantly improves with surgical repair.”

This is truly how sports hernias behave in a clinical setting. It is not uncommon for a sports hernia to be unrecognized for months and even years. Unlike your typical sports injury, most sports medicine offices have only seen a handful of cases. It’s just not on most doctors’ radar. The purpose of this article is not only to bring awareness about sports hernias, but also to educate.

Will you find quick fixes in this article for sports hernia rehab?
Nope. There is no quick fix for this condition, and if someone is trying to sell you one, they are blowing smoke up your you-know-what.

Is there a way to decrease the pain related to sports hernias?
Yes. Proper rehab and avoidance of activity for a certain period of time will assist greatly, but this will not always stop it from coming back. Pain is the first thing to go and last thing to come. Do not be fooled when you become pain-free by resting it. Pain is only one measure of improvement in your rehab. Strength, change of direction, balance and power (just to name a few) are important, since you obviously desire to play your sport again. If you wanted to be a couch potato, you would be feeling better in no time. Watching Sports Center doesn’t require any movement.

Why is this article so long?
There is a lot of information on sports hernias available to you on the web. However, much of the information is spread out all over the internet and hard for athletes to digest due to complicated terminology. This article lays out the foundational terminology you will need to understand what options you have with your injury. We will go over anatomy, biomechanics, rehab, surgery, and even the fun facts. The information I am using is from the last ten years of medical research, up until 2016. We will be making updates overtime when something new is found as well. So link to this page and share with friends. This is the best source for information on sports hernias you will find.

Common Names (or Aliases?) for Sports Hernias
Sportsman’s Hernia
Athletic Pubalgia
Gilmore’s Groin
How Do You Know If You Have A Sports Hernia?
Typical athlete characteristics:
Male, age mid-20s

#sportsherniadiagnosisselftreatment #sportshernia #california

Leopold's Maneuvers are difficult to perform on obese women and women who have hydramnios. The palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empy it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised slightly on a pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. First maneuver: Fundal Grip While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk. Second maneuver After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. Third maneuver: Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part. Fourth maneuver The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. Cautions Leopold's maneuvers are intended to be performed by health care professionals, as they have received the training and instruction in how to perform them. That said, as long as care taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine the fetal position.

Breast reconstruction 3D Animation
on Friday, December 17, 2010




The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, patients with significant medical comorbidities (high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. Patients expected to receive external beam radiation as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries. Outcomes based research on quality of life improvements and psychosocial benefits associated with breast reconstruction served as the stimulus in the United States for the 1998 Women's Health and Cancer Rights Act which mandated health care payer coverage for breast and nipple reconstruction, contralateral procedures to achieve symmetry, and treatment for the sequelae of mastectomy. This was followed in 2001 by additional legislation imposing penalties on noncompliant insurers. Similar provisions for coverage exist in most countries worldwide through national health care programs. There are many methods for breast reconstruction. The two most common are: * Tissue Expander - Breast implants This is the most common technique used in worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction. o In a process that can take weeks or months, saline solution is percutaneously injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size. * Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. o The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant. o Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEP flaps. Both use the abdominal tissue between the umbilicus and the

Old Blister Popping

A stepwise approach to the causes and diagnosis of Anaemia in clinical practice. This presentation includes the all important concept of the Reticulocyte production index. Discussion of Hereditary and acquired causes of Anaemia has been included in detail.

What Happens During an Erection?
In order to attain an erection, messages from the brain and other sense organs trigger the arteries of the penis to dilate. This allows an increased amount of blood to flow into three columns of spongy tissue in the penis.

As the arteries supplying blood to the corpus spongiosum and to the two larger columns, the corpus cavernosa, become filled with blood; the penis grows and becomes rigid. Pressure of the engorged tissue against the veins in the penis effectively traps blood within the penis until climax is reached or the sensation wanes.

What Are Penile Implants?
Impotence, or the inability to attain or maintain an erection, can be caused by a disruption at any stage in this process. Several types of penile implants are available that create an artificial erection. Two common types of implants are the semi-rigid malleable rod and the inflatable implant.

•The semirigid malleable rod is usually made of plastic with a core of flexible wire. These rods can be bent down to conceal the penis under clothing or raised to form an artificial erection.


•The inflatable implant is more complex and involves several working parts: a reservoir of fluid that is implanted into the abdomen, a pump system located in the scrotal sac near the testes, and two inflatable cylinders.
How Penile Implants Help Erectile Fuctioning
In order to attain an erection, the scrotal pump must be squeezed repeatedly to propel fluid into the penile cylinders. When an erection is no longer desired, a release valve is pressed on the side of the pump and the cylinders deflate.
Before Having Penile Implant Surgery
Persons considering these types of implants should speak with their physician or healthcare professional about possible risks and complications.

Central Venous Catheter Placement & Pulmonary Artery Catheter Video

Rhabdomyolysis is a condition in which damaged skeletal muscle (Ancient Greek: rhabdomyo-) tissue breaks down rapidly (Greek –lysis). This damage may be caused by physical (e.g. crush injury), chemical, or biological factors. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidney and may lead to kidney dysfunction. The severity of the symptoms (which may include muscle pains, vomiting and confusion) depends on the extent of the muscle damage, and whether kidney failure develops. The mainstay of treatment is generous intravenous fluids, but could include dialysis or hemofiltration.

Rhabdomyolysis and its complications are significant problems for those injured in disasters such as earthquakes and bombing. Relief efforts in areas struck by earthquakes often include medical teams with skills and equipment for treatment of survivors with rhabdomyolysis. The disease and its mechanisms were first fully elucidated during the Blitz of London in 1941.

Examination of Varicose Veins

Mechanism of action of a novel HIV drug called Tipranavir