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Basal Joint Arthroscopic Debridement samer kareem 1,257 Views • 3 years ago

The procedure was performed under wrist block regional anesthesia with tourniquet control. A single Chinese finger trap was used on the thumb with 5 to 8 lb of ongitudinal traction. The arm was held down with wide tape around the tourniquet securing it to the hand table to serve as countertraction. A shoulder holder, rather than a traction tower, was used to facilitate fluoroscopic intervention more easily. The Trapeziometacarpal joint was detected by palpation. Joint distension was achieved by injecting 1 to 3 mL of normal saline (Fig. 1). It is important to distally direct the needle approximately 20 degrees to clear the dorsal flare of the metacarpal base and enter the joint capsule. This course should be reproduced upon entering with arthroscopic sleeve/ trocar assembly to minimize iatrogenic cartilage injury. Fluid distention is important to facilitate this. The incision for the 1-R (radial) portal, used for proper assessment of the dorsoradial ligament, posterior oblique ligament, and ulnar collateral ligament, was placed just volar to the abductor pollicis longus tendon. The incision for the 1-U (ulnar) portal, for better evaluation of the anterior oblique ligament and ulnar collateral ligament, was made just ulnar to the extensor pollicis brevis tendon. A short-barrel, 1.9-mm, 30- degree inclination arthroscope was used for complete visualization of the CMC joint surfaces, capsule, and ligaments, and then appropriate management was done, as dictated by the stage of the arthritis detected (Fig. 2A). A full-radius mechanical shaver with suction was used in all the cases, particularly for initial debridement and visualization. Most of the cases were augmented with radiofrequency ablation to perform a thorough synovectomy and radiofrequency was also used to perform chondroplasty in the cases with focal articular cartilage wear or fibrillation. Chondroplasty refers to thedebridement of the fibrillated cartilage to improve vascularity of the cartilage and enhance the growth of fibrocartilage. Ligamentous laxity and capsular attenu- ation were treated with thermal capsulorraphy using a radiofrequency shrinkage probe. We were careful to avoid thermal necrosis; hence, a striping technique was used to tighten the capsule of the lax joints. The striping technique refers to thermal shrinkage performed in longitudinal stripes on the lax capsule, so as to leave vascular zones between the stripes; hence, thermal necrosis is prevented. Arthroscopic stage I disease was characterized by synovitis without any cartilage wear, wherein a synovectomy coupled with thermal capsulor- raphy as described was performed.

Sex health education samer kareem 2,651 Views • 3 years ago

Although most women have had enough experience to know how to pleasure a man in the bedroom, but you can be sure that are several girls who would be virgins when you first take them to bed. Though most Indian men actually prefer to make love with a virgin. There are also numerous men who dislike the idea due to the pressure of making love to someone with no experience. So if you happen to be dating a virgin then there are a few important things that you should always keep in mind when you take her to bed. Though you have made love to different women before, you need to understand that this one being a virgin will know little or nothing about what is expected of her in bed. Because she will be anxious and nervous, you have to be all the more careful to ensure that she gets to enjoy her first time with you. Kiss her Whether you are doing it with a virgin or someone with a record that would put Pam Anderson to shame, you should take your time to make love to her just with your lips. Use your lips with passion, and kiss her parts that other guys tend to ignore. Kiss her lips, her hips, her shoulders, her hands, nuzzle her ears - parts which aren’t necessary sexual. Give your girl a hand Okay this one may look straight out of a B-grade south Indian movie, but starting off with a sensual full body massage is an excellent way of warming her up. So use some nice aromatic oils like lavender or Yang-Yang to massage her body. If you are more experienced, you would be aware the various erogenous zones of a woman’s body. Start with the nape of her neck and slowly work your way down to her back, gently knead her breasts and play with her nipples, gently flick at them and manipulate them to erection. Get her to lie on her stomach and massage her inner thighs. Lovingly caress her buttocks and move your hands close to her valley of pleasure. She might be too shy to tell you, but her ultimate pleasure point would be dying for your attention. Gently, stroke her outer lips or the labia. Whatever, apprehensions or fears she may have had about sex will all disappear once your finger start creating magic in her nether regions. Never criticise her Remember, she has never felt a man’s body before, which essentially means that when she tries to explore your body you may not necessarily enjoy it. So let her hold your penis and fondle it, let her lick and nibble you and tickle you body. You may not find her amateurish attentions very arousing but don’t make her feel like an amateur in bed. If she does something right let her know how much you are enjoying it. Guide her fingers to your pleasure points and tell her what you would like a girl to do in bed. Being the more experienced partner you should be like her loving mentor, and teach her the intricacies of pleasuring a man. Make her touch herself While she may or may not have masturbated before, by getting her to touch herself you would be able to make her feel the unknown. Tell her how badly you want to see her masturbate. The idea is open her to own sexuality. Its time to penetrate When you think that she is finally ready to be penetrated, enter her as gently as possible. Also make sure that she is producing enough lubrication to facilitate the act. Keep your strokes slow and shallow and avoid pushing too deep during your first few strokes. If you are able to make her feel comfortable and safe, any pain that she may experience in the beginning will soon disappear, and be replaced by moans of ecstasy. The first time can be nerve racking for most men. Just remember how nervous you were when you had sex for the first time. So when your take your virginal girlfriend to bed for first time makes the experience as pleasurable for her as possible.

What Is Hemodialysis and How Does It Work? Scott 105 Views • 3 years ago

What is hemodialysis and how does it work? Who needs it? How do you prepare for it? In the United States, over 30 million Americans have kidney disease, and sometimes, kidney disease progresses to kidney failure or end-stage renal disease. When this happens, you cannot survive unless you have a kidney transplant or some form of dialysis. So today we're going to talk about hemodialysis.

Your kidneys are the two kidney bean-shaped organs that are located in your lower back, or in your flanks. And the kidneys are responsible for filtering out or cleaning your blood. They get rid of excess waste, excess toxins, and excess fluids. If your kidneys stop functioning, then you develop renal failure or end-stage renal disease.

What is Hemodialysis?
Hemodialysis, or blood dialysis, is the filtering of your blood outside of your body. So, if your kidneys stop working properly, the hemodialysis acts as a substitute kidney. Now it's important to note that hemodialysis does not actually correct your own kidney function. It does not fix or treat your kidneys.

#hemodialysis #drfrita

What is The Dialyzer?
The dialyzer is actually the filter. It's the main powerhouse of the hemodialysis system, and it is what actually acts as the substitute kidney. In the dialyzer, you have these hollow fibers that run through it, and these fibers are bathed in something called dialysates, or dialysis fluid.

How Often Are Patients Treated With Hemodialysis?
Most patients who are on hemodialysis are on it between three and six hours, about three days a week, especially if they go to a center.

How Does Hemodialysis Work?
So when you are on dialysis, how does your blood get from your body to the hemodialysis machine and then back to your body? Well, it does so through tubes, and those tubes are connected to your access, and we'll talk about access in just a moment. But as far as the tubing, the tubing is connected to your body.

Types Of Hemodialysis Access
Arteriovenous Fistula or AV Fistula
The AV fistula is the gold standard as far as hemodialysis access is concerned because it gives you the most efficient hemodialysis and it is the least likely to be infected.

Arteriovenous Graft or AV Graft
The AV graft is very similar to the AV fistula in that you still have a surgically connected artery and a vein, usually in the arm, but in the case where if you have veins that are rather thin or arteries that are thin and maybe too weak in order to really give you a properly functioning, substantial AV fistula, then the vascular surgeon may opt to add an artificial material in order to make that shunt a little stronger, or little more durable. And so, an AV graft is another option for dialysis access.

Catheter
If you're in a situation where you need temporary dialysis, or if you have acute kidney injury, then you may have a temporary Vascath placed, and it's usually placed in a vein of the neck, the internal jugular vein, or it can be placed in the groin, or in the femoral vein.

Who Needs Hemodialysis Treatment?
How do you know if you need hemodialysis, and when is it time to prepare? Well, if you follow up with your kidney doctor (nephrologist) regularly, he or she will be watching your labs. They'll be able to see those signs of your kidneys not functioning properly.

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