Cholestatic liver disease is a condition that results from an impairment of bile formation or bile flow to the gallbladder and duodenum (first section of the small intestine). ... The effects of cholestasis are profound and widespread, leading to worsening liver disease and systemic illness.

There’s a strange, mysterious world inside us, an alien-looking environment that turns the food we eat into nutrients that keep us alive. Michael Mosley swallows a camera to take a closer look.

Certain high-surgical-risk patients with severe degenerative mitral regurgitation (DMR) now have a minimally invasive treatment option. MitraClip® therapy is a minimally-invasive transcatheter mitral valve repair (TMVr) procedure that has been established as a proven option with demonstrated safety and clinically important improvements. Used in more than 25,000 patients worldwide, MitraClip® is a well-established therapy. The MitraClip® device received CE Mark approval in Europe in 2008 and U.S. FDA approval in 2013, and has been approved for commercial use in 50 countries throughout the world.

Nose Plastic Surgery: Open Rhinoplasty

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.

Most intact aortic aneurysms do not produce symptoms. As they enlarge, symptoms such as abdominal pain and back pain may develop. Compression of nerve roots may cause leg pain or numbness. Untreated, aneurysms tend to become progressively larger, although the rate of enlargement is unpredictable for any individual. Rarely, clotted blood which lines most aortic aneurysms can break off and result in an embolus. They may be found on physical examination. Medical imaging is necessary to confirm the diagnosis. Symptoms may include: anxiety or feeling of stress; nausea and vomiting; clammy skin; rapid heart rate. In patients presenting with aneurysm of the arch of the aorta, a common symptom is a hoarse voice as the left recurrent laryngeal nerve (a branch of the vagus nerve) is stretched. This is due to the recurrent laryngeal nerve winding around the arch of the aorta. If an aneurysm occurs in this location, the arch of the aorta will swell, hence stretching the left recurrent laryngeal nerve. The patient therefore has a hoarse voice as the recurrent laryngeal nerve allows function and sensation in the voicebox. Abdominal aortic aneurysms, hereafter referred to as AAAs, are the most common type of aortic aneurysm. One reason for this is that elastin, the principal load-bearing protein present in the wall of the aorta, is reduced in the abdominal aorta as compared to the thoracic aorta (nearer the heart). Another is that the abdominal aorta does not possess vasa vasorum, hindering repair. Most are true aneurysms that involve all three layers (tunica intima, tunica media and tunica adventitia), and are generally asymptomatic before rupture. The most common sign for the aortic aneuysm is the Erythema nodosum also known as leg lesions typically found near the ankle area. The prevalence of AAAs increases with age, with an average age of 65–70 at the time of diagnosis. AAAs have been attributed to atherosclerosis, though other factors are involved in their formation. An AAA may remain asymptomatic indefinitely. There is a large risk of rupture once the size has reached 5 cm, though some AAAs may swell to over 15 cm in diameter before rupturing. Before rupture, an AAA may present as a large, pulsatile mass above the umbilicus. A bruit may be heard from the turbulent flow in a severe atherosclerotic aneurysm or if thrombosis occurs. Unfortunately, however, rupture is usually the first hint of AAA. Once an aneurysm has ruptured, it presents with a classic pain-hypotension-mass triad. The pain is classically reported in the abdomen, back or flank. It is usually acute, severe and constant, and may radiate through the abdomen to the back. The diagnosis of an abdominal aortic aneurysm can be confirmed at the bedside by the use of ultrasound. Rupture could be indicated by the presence of free fluid in potential abdominal spaces, such as Morison's pouch, the splenorenal space (between the spleen and left kidney), subdiaphragmatic spaces (underneath the diaphragm) and peri-vesical spaces. A contrast-enhanced abdominal CT scan is needed for confirmation. Only 10–25% of patients survive rupture due to large pre- and post-operative mortality. Annual mortality from ruptured abdominal aneurysms in the United States alone is about 15,000. Another important complication of AAA is formation of a thrombus in the aneurysm.

Gunshot wounds have become increasing common in urban cities and many such cases can lead to undesirable outcomes. While gunshot wounds to the head are considered most lethal, gunshot wounds to the chest too may be dangerous. Gunshot wound to the chest is challenging owing to the presence of vital organs like lungs, heart and their surrounding structures including major blood vessels. Gunshot wound is caused by penetration of the bullet, which travels through a projectile path after being shot from a firearm. The bullet, on hitting the chest, punctures the tissue it first encounters with, the bones or the muscular chest wall. The extent and severity of the injury depends on the characteristics of the bullet and the firearm, the position and the distance of the victim, the projectile path and the nature of the tissue penetrated.

The oral contraceptive pill, commonly known as "the pill," is a hormone-based method of preventing pregnancy. It can also help resolve irregular menstruation, painful or heavy periods, endometriosis, acne, and premenstrual syndrome (PMS). Birth control pills work by preventing ovulation. No egg is produced, so there is nothing for the sperm to fertilize. Pregnancy cannot occur. "The pill" is used by nearly 16 percent of women aged 15 to 44 years in the United States, and it has both advantages and disadvantages. People with different risk factors may be advised to use a particular kind of pill. There are different types of contraceptive pills. They all contain synthetic forms of the hormones estrogen, progesterone, or both. Synthetic progesterone is called progestin. Combination pills contain progestin and estrogen. The "mini pill," contains only progestin. Monophasic pills all contain the same balance of hormones. With phasic pills, two or three different types of pill are taken each month, each with a different balance of hormones.

The camera sends images to an external monitor so the doctor can study the inside of your colon. The doctor can also insert instruments through the channel to take tissue samples (biopsies) or remove polyps or other areas of abnormal tissue. A colonoscopy typically takes about 20 minutes to an hour.

مرکز ایمپلنت و زیبایی دندان شیراز دکتر محمد امین دین پرور

Systemic Lupus Erythematosus Animation 3d

The spleen is an organ in the upper far left part of the abdomen, to the left of the stomach. The spleen varies in size and shape between people, but it’s commonly fist-shaped, purple, and about 4 inches long. Because the spleen is protected by the rib cage, you can’t easily feel it unless it’s abnormally enlarged. The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis.

Simple microinstruments and a medical school laboratory microscope were used for anastomosis training. Chicken blood vessels were used as a material for this study. A long segment of blood vessel from the proximal brachial artery to the distal radial artery was used for training. End-to-side anastomosis was practiced first, and the training continued with end-to-end anastomosis of the appropriate segments.

Implantation of a long-lasting implant for diabetic macular edema (DME)- steroidal implants

Myeloma is a cancer of the plasma cell, a type of white blood cell that is part of the immune system. This animation explains how a plasma cell can become cancerous and turn into a myeloma cell.

Masturbating is totally healthy, and totally normal. There are tons of myths out there meant to scare you into thinking masturbation is wrong or bad. But the truth is masturbation is perfectly safe. Masturbating won't make you blind, crazy, or stupid. It won’t damage your genitals, cause pimples, or stunt your growth. It doesn’t use up all your orgasms or ruin other kinds of sex. In fact, masturbation can actually be good for you. Here are some benefits of masturbation: Masturbation is safer than any other type of sex. You can’t get pregnant or get any sexually transmitted infections from masturbating. Masturbation can help you learn what you like and don’t like sexually. And if you decide to have sex with someone, you can know what you do/don’t want to do. BONUS: getting comfortable talking about sex and your body with your partner makes it easier to talk about protecting yourself against STDs and pregnancy, too. Exploring your body and learning how to give yourself sexual pleasure can be empowering and help improve your body image. Masturbation can lower stress and help you relax. It even helps some people fall asleep. Having an orgasm releases endorphins — feel good chemicals in your brain. Orgasms can be a natural painkiller and can even help with period cramps. Mutual masturbation (masturbating with a partner) is a really safe way to have sex and let the other person know what feels good to you. If you share a sex toy, use condoms on the toy and clean it before swapping. And if you touch each other’s genitals, wash your hands before touching your own. Can I get an STD from masturbating? Nope. Masturbating is the safest sexual activity out there. There is virtually NO chance of getting an STD or any other infection from touching your own genitals (and there’s also no chance of pregnancy). STDs have to be passed from one person to another, so you can’t give yourself an STD. The one exception to this is herpes - so if you have any cold sores on your mouth and touch them, make sure to wash your hands before masturbating. But it IS possible to get an STD if you’re masturbating with another person and touching each other’s genitals. Anytime semen (cum) or vaginal fluids are spread to someone else’s body, or your genitals rub against each other, there’s a risk of STDs. So if you touch each other’s genitals, wash your hands before touching your own. STDs can also be spread by sharing sex toys with another person. You can help protect yourself by using condoms on any toys that you share (even if they’re not shaped like a penis). Put a new condom on anytime a different person uses it. If you’re the only one using your sex toys, you don’t have to worry about STDs. But if you use them with other people, protect those sex toys just like you’d protect your own genitals — put a condom on ‘em! It’s possible for masturbation to cause irritation or infections if your body is sensitive to the way you masturbate or the things you masturbate with — but this isn’t the same thing as an STD. Lotions, Vaseline, oils, and scented or flavored stuff may irritate your vulva and vagina. Masturbating roughly and not using lubrication can also lead to irritation because of friction. And germs from the anus can cause vaginal infections — so never put something in your vagina that’s been in your butt without washing it or covering it with a condom. If you’re worried that you have an STD because of pain, itching, or discomfort in your genitals, go to your doctor or your local Planned Parenthood health center.

Clinical Review First aid and treatment of minor burns BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.1487 (Published 17 June 2004) Cite this as: BMJ 2004;328:1487 Article Related content Metrics Responses Jackie Hudspith, clinical nurse lead, Sukh Rayatt, specialist registrar, plastic and reconstructive surgery Author affiliations Introduction Some 250 000 burns occur annually in the United Kingdom. About 90% of these are minor and can be safely managed in primary care. Most of these will heal regardless of treatment, but the initial care can have a considerable influence on the cosmetic outcome. All burns should be assessed by taking an adequate history and examination.

Superior capsule reconstruction (SCR) is a promising alternative treatment for irreparable posterosuperior rotator cuff tears (Figure 1). It utilizes a graft from the superior glenoid to the greater tuberosity to stabilize the humeral head. In a study by Mihata and colleagues of 23 patients who underwent SCR with a fascia lata autograft at a minimum of 2 years follow-up, the American Shoulder and Elbow Surgeons (ASES) score improved significantly from 23.5 preoperatively to 92.9. Postoperative MRI showed 83% of patients had intact reconstructions with no progression of muscle atrophy.

Eric knew he needed help when an old knee injury began worsening over the course of time and was significantly affecting his quality of life. That’s when he turned to his hometown orthopedic experts at Mayo Clinic Health System in Mankato, who recommended a total knee replacement. After overcoming some initial fears, Eric decided it was time to have the operation — a fuller and more active life with his family depended on it.