This is the CT of a 43 year old male patiënt with infected necrotizing pancreatitis that will undergo a VARD procedure; Videoscopic Assisted Retroperitoneal Debridment. Two weeks before this procedure two large bore percutaneous drains were placed in the peripancreatic collection. The patient i...s placed in supine position with the left side 30 degrees elevated. A 5-7 cm subcostal incision is made in the left flank. With help of CT images and by following the percutaneous drain, the subcutaneous tissue and the fascia are dissected and we enter the retroperitoneal peripancreatic collection. First, with a regular suction device any pus encountered is removed. Two long sympathectomy hooks are inserted in order to keep in the incision open. We than insert the zero degree laparoscope. The first necrosis encountered is removed under direct sight with the use of long grasping forceps. Following the percutaneous drain deeper into the cavity, parts of loosely adherent necrotic material are removed. Gently pulling we remove the necrotic tissue. The suction device is helpful in removing any fluid obstructing the view. Complete necrosectomy is not the ultimate aim of this procedure. Only loosely adherent pieces of necrosis are removed thereby keeping the risk of tearing underlying blood vessels to a minimum. In the rare case of extensive bleeding, the retroperitoneal cavity can be easily packed, either awaiting the bleeding to definitely stop or to act as a bridge to angiographic coiling. This patient is now 6 weeks after onset of disease. We always try to postpone surgical intervention, if possible up to 30 days. On the left side of the collection is the percutaneous drain. In this patient the drain had worked well for 2 weeks. When the patient deteriorated again it was decided to perform the VARD procedure. Large pieces of necrotic pancreas can be removed with VARD. This is a big advantage ov VARD over pure endosopic or percutaneous techniques. When all the necrotic tissue is removed we clean the cavity. Two drains are left in situ as a postoperative lavage system. The VARD procedure is performed via a 6 cm incision, which is closed and continuous postoperative lavage started immediately.

A video shoing how to draw blood sample

Ankle and Foot Clinical Examination - Clinical Skills - Dr Gill

When it comes to joints of the body, the ankle is one of the joints most commonly injured. This is vitally important to be able to effectively examine a patient who is complaining of pain in the ankle and foot.

In this video we will perform a demonstration of the ankle and foot examination.

Examination of the foot, and the ankle joint, follows the standard orthopaedic approach of look, feel, move.

There is a connected video to the foot and ankle examination, on the causes of carpal tunnel syndrome - here

https://youtu.be/aXx6NfBWDSs

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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.

However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.

The examination demonstrated here is derived from Macleod's Clinical Examination - a recognized standard textbook for clinical skills.


#footpain #clinicalexamination #DrGill

Hip Examination

Dr. Ebraheim’s educational animated video describing the anatomy and associated injuries of the knee joint.
Disrupted quadriceps
•Patient is unable to actively extend the knee.
The most common cause of ACL ruptures:
•Traumatic force being applied during twisting motion.
•Side stepping or landing from a jump.
Patient complains of:
•Immediate pain
•Knee giving way
•Swelling
Aspiration of the knee
•If aspiration of the knee joint shows evidence of blood within the joint there is 75-80% chance of ACL and meniscal injury.
Lachamn’s test- ACL knee exam
•Knee is flexed at 30 degrees.
•ACL tear of the knee is identified by pulling on the tibia and examining the frontward motion of the lower leg in comparison to the upper leg.
Radiological exam – ACL
•MRI of the knee joint shows bone lesions or bruising associated with tears of the ACL. Injury is found in the typical location; middle of the femoral condyle and posterior part of the tibia laterally.
Posterior cruciate ligament tear (PCL)
•Common cause of injury is a bent knee hitting a dashboard in a car accident.
Tibial Sag Test –PCL knee exam
Quadriceps active test-PCL knee exam
•The examiner stabilizes the leg of the patient and then the patient is asked to actively contract the quadriceps muscle.
•The tibia is seen actively reduced from the posterior subluxed position.
Lachman’s test-PCL knee exam
•Knee is bent 20-30 degrees.
•The posterior drawer test is carried out while the patient is in a supine position and the knee is flexed to 90 degrees.
•The amount of translation of the tibia relative to the femur is observed.
The dial test is performed while the patient is in the supine or prone position and both knees are in 90 and 30 degrees of flexion. More than 10 degrees of external rotation indicates significant injury.
Common meniscal tears
Symptoms include
•Knee pain
•Pain with straightening the knee
•Swelling
•Locking
•Weakness

Watch that video to know How To Firm And Lift Your Sagging Chest Naturally

A detailed description of the Hepato-pulmonary syndrome including its definition, pathophysiology, diagnosis and treatment. The pathophysiology includes nitric oxide in the pulmonary vasculature which results in intrapulmonary vasodilatation. This causes the classical and unique symptom of platypnea and orthodeoxia.

Carotid Stenosis and what it means. The detection and treatment of carotid artery disease for the prevention of stroke is one of the most effective treatments in all of medicine.

A rare view into fertilization, embryo development, and laboratory procedures performed during an IVF cycle. Take an exclusive look inside one of the most advanced, state-of-the-art in vitro fertilization (IVF) laboratories to see how RMA of New York performs IVF and other advanced reproductive technologies using strict identification standards.

Medical and laboratory video footage documents egg retrieval, insemination, embryo development from cleavage stage (day 2-3) to blastocyst stage (day 5-6), intracytoplasmic sperm injection (ICSI), assisted hatching, embryo transfer and embryo cryopreservation.

Reproductive Medicine Associates of New York
www.rmany.com

635 Madison Avenue, 10th floor
New York, New York 10022
Telephone: (212) 756-5777
Facsimile: (212) 756-5770

15 North Broadway, Garden Level - Suite G
White Plains, New York 10601
Telephone: (914) 997-6200
Facsimile: (914) 997-8111

Reproductive Medicine Associates of New York, Long Island
400 Garden City Plaza, Suite 107
Garden City, NY 11530
Telephone: (516) 746-3633
Facsimile: (516) 746-3622

Reproductive Medicine Associates International Mexico, S.C.
Prolongacion Paseo de la Reforma 1232, Oficina 1213
Colonia Lomas de Bezares
Delegacion Miguel Hidalgo
Mexico, Distrito Federal 11910
Telephone: 011-52-55-2167-2515
Fax: 011-52-55-2167-6434

Laparostomy is a surgical condition in which the abdomen is left open to contrast a condition named Abdominal Compartment Syndrome

The video will describe how lung consolidation appears on a chest x-ray. Please see my website for disclaimer.

Overweight does not necessarily equal unhealthy. There are actually plenty of overweight people who are in excellent health (1). Conversely, many normal weight people have the metabolic problems associated with obesity (2). That’s because the fat under the skin is actually not that big of a problem (at least not from a health standpoint, it’s more of a cosmetic problem). It’s the fat in the abdominal cavity, the belly fat, that causes the biggest issues (3). If you have a lot of excess fat around your waistline, even if you’re not very heavy, then you should take some steps to get rid of it. Belly fat is usually estimated by measuring the circumference around your waist. This can easily be done at home with a simple tape measure. Anything above 40 inches (102 cm) in men and 35 inches (88 cm) in women, is known as abdominal obesity. There are actually a few proven strategies that have been shown to target the fat in the belly area more than other areas of the body.

Croup is a common respiratory camera.gif problem in young children. It tends to occur in the fall and winter. Its main symptom is a harsh, barking cough. Croup causes swelling and narrowing in the voice box, windpipe, and breathing tubes that lead to the lungs. This can make it hard for your child to breathe. An attack of croup can be scary, but it is rarely serious. Children usually get better in several days with rest and care at home.

USMLE Step 2 CS - Numbness Weakness This is just preview video. To get full access please visit our website : www.usmletutoring.com

USMLE Step 2 CS - Wrist Pain This is just preview video. To get full access please visit our website : www.usmletutoring.com

The only sure way to prevent genital warts is to not have sex. But everyone wants sex, so here is how to have safe sex if you are living with Genital Warts.

Learn more about Merit Medical's ProGuide™ Chronic Dialysis

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.