An example of a technique I use in my surgical practice

Intramedullary nailing of the tibia with suprapatellar entry and semi-extended positioning makes it technically easier to nail the proximal and distal fractures. The purpose of this article was to describe a simple method for suprapatellar nailing (SPN). A step-by-step run through of the surgical technique is described, including positioning of the patient. There are as yet only a few clinical studies that illustrate the complications with this method, and there has been no increased frequency of intraarticular damage. Within the body of the manuscript, information is included about intraarticular damage and comments with references about anterior knee pain.

Ear irrigation is a routine procedure used to remove excess earwax, called cerumen, or foreign materials from the ear. The ear naturally secretes earwax to protect, lubricate, keep debris out, and regulate bacterial growth. Under normal conditions, the body keeps the amount of earwax in the ears .

Sengstaken Blakemore tube Insertion Video

systemic inflammatory response syndrome (SIRS). This is most likely secondary to sepsis from an infection of the patient's Hickman catheter given the associated skin findings, although culture results are needed to confirm this diagnosis. The patient's low blood pressure is likely secondary to developing septic shock, and he has already appropriately been treated with intravenous fluids. Catheter removal is indicated given his hemodynamic instability. Catheter removal is also indicated in patients with severe sepsis with organ hypoperfusion, endocarditis, suppurative thrombophlebitis, or persistent bacteremia after 72 hours of appropriate antibiotic therapy. Long term catheters should also be removed if culture results are positive for S. aureus, P. aeruginosa, fungi, or mycobacteria.

Watch that video to know How to Remove Teeth Plaque Naturally

This hormone, insulin, causes the liver to convert more glucose into glycogen (this process is called glycogenesis), and to force about 2/3 of body cells (primarily muscle and fat tissue cells) to take up glucose from the blood through the GLUT4 transporter, thus decreasing blood sugar.

Before deciding how to treat one episode of high blood glucose, it is important to figure out why the number is high. Some possible causes include eating a heavy meal, not getting enough physical activity, forgetting to take diabetes medication, and dealing with illness and stress. Insulin is the medication that will bring blood glucose down the fastest. Someone who uses mealtime insulin can take correction doses to lower blood glucose. This requires a thorough understanding of when to inject, how often to give correction doses, and how much insulin to use. You will need to work with your doctor or diabetes educator to learn how to do this. Apart from administering insulin, the fastest way to lower your blood glucose is to engage in physical activity. Exercise results in an increased sensitivity to insulin. It causes your muscle cells to take up more glucose, leaving less of it to circulate in your bloodstream during and after the physical activity (which means a lower blood glucose when you test). Frequent, regular exercise is very important to good blood glucose control no matter what type of diabetes you have. Research has shown that it is vital in warding off long-term complications like neuropathy, retinopathy, and heart and kidney diseases. Don't forget to check with a doctor, though, before making any major changes to your exercise routine. And, if you have type 1 diabetes and your glucose is 250 mg/dl or higher, check for urine ketones. You should not exercise if ketones are present.

Tracheostomy in the ICU

Embospheres Microspheres are round particles which give them some extra advantages when they are used in embolization. This video gives a full idea about their advantages and use

LIVE VIDEO: IMMEDIATE ANATOMIC CERAMIC IMPLANT IN 3 MINUTES! dentistry

Nice surgery video

A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall. This is usually defined as at least two fractures per rib (producing a free segment), in at least two ribs. A segment of the chest wall that is flail is unable to contribute to lung expansion. Large flail segments will involve a much greater proportion of the chest wall and may extend bilaterally or involve the sternum. In these cases the disruption of normal pulmonary mechanics may be large enough to require mechanical ventilation.

Hepatitis E is a virus that can infect the liver. Unlike other forms of hepatitis, the hepatitis E virus usually doesn't lead to long-term illness or serious liver damage. Most people get well within a few months.

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

A brief demonstration of the different types of epileptic seizures based on the International Classification of Epileptic Seizures.

Stay active and push your body to its limit – tips on how you can mend strained muscles and prevent injury.

Central Venous Catheter Placement & Pulmonary Artery Catheter Video

Anatomy of The Upper Limb Joints