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Dr. Celia Divino, Chief, Division of General Surgery at The Mount Sinai Hospital, performs a laparoscopic appendectomy. Visit the Division of General Surgery at http://bit.ly/18z944M. Click here to learn more about Dr. Celia Divino http://bit.ly/12RF0ee

MASSIVE Goose Egg Drained

STITCHES: Cleaning, Numbing, & Suturing the Wound

Bugs Removal from Ear Canal

Lipid-Lowering Agents HMG-CoA reductase inhibitors (statins) These agents inhibit the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase. Note the following: Low-density lipoprotein (LDL) reduction of 25%-60% Examples include Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin Contraindications include hypersensitivity, active liver disease, pregnancy, lactation, coadministration with strong CYP3A4 inhibitors (selected statins) Vitamin B3 Vitamin B3 inhibits very-low-density lipoprotein (VLDL) synthesis. Note the following: LDL reduction of 10% High-density lipoprotein (HDL) increase of 20% Example includes Niacin (nicotinic acid) Contraindications include hypersensitivity, liver disease, active peptic ulcer, severe hypotension, arterial bleeding Fibrates Fibrates enhance lipoprotein lipase, resulting in increased VLDL catabolism, fatty acid oxidation, and triglycerides elimination. They decrease hepatic extraction of free fatty acids. Note the following: LDL reduction of 15% Triglyceride reduction of 35% Examples include Gemfibrozil, fenofibrate, fenofibrate (micronized), fenofibric acid Contraindications include active liver disease, renal disease, primary biliary cirrhosis, gallbladder disease 2-Azetidiones These agents inhibit sterol transporter at brush border and, consequently, intestinal absorption of cholesterol. LDL reduction of 15% Example includes Ezetimibe Contraindications include hypersensitivity, coadministration with statins (if active liver disease) Bile acid sequestrants These agents lower cholesterol and LDL via bile duct sequestration. Note the following: LDL reduction of 15% Examples include Cholestyramine, colesevelam, colestipol Contraindications include biliary/bowel obstruction, serum triglycerides >300-500 mg/dL, history of hypertriglyceridemia-induced pancreatitis

What is Osteoporosis

Pharyngitis is caused by swelling in the back of the throat (pharynx) between the tonsils and the voice box (larynx). Most sore throats are caused by colds, the flu, coxsackie virus or mono (mononucleosis). Bacteria that can cause pharyngitis in some cases: Strep throat is caused by group A streptococcus.

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A lipoma is a growth of fat cells in a thin, fibrous capsule usually found just below the skin. Lipomas aren't cancer and don't turn into cancer. They are found most often on the torso, neck, upper thighs, upper arms, and armpits, but they can occur almost anywhere in the body. One or more lipomas may be present at the same time.

Chiari malformation (kee-AH-ree mal-for-MAY-shun) is a condition in which brain tissue extends into your spinal canal. It occurs when part of your skull is abnormally small or misshapen, pressing on your brain and forcing it downward.

PARAPHARYNGEAL SPACE TUMORS: SURGICAL APPROACH

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This video, created by Nucleus Medical Media, shows the function of white blood cells in normal immunity. It also portrays how the human immunodeficiency virus (HIV) affects the immune system and causes acquired immunodeficiency syndrome (AIDS). Common types of antiretroviral medications used to treat HIV and AIDS are also shown.

#HIV #AIDS #HumanImmunodeficiencyVirus
ANH13111

This video discusses knee arthritis, and when to do osteotomy, partial knee replacement, or total knee replacement.

Lumbar puncture is a common emergency department procedure used to obtain information about the cerebrospinal fluid (CSF) for diagnostic and, less commonly, therapeutic reasons. Please refer to the full article on Lumbar Puncture for more details on the lumbar puncture procedure. Lumbar puncture is typically performed via “blind” surface landmark guidance. The surface landmark technique is reported to be successful in a high percentage of attempted lumbar punctures; however, surface landmark identification of underlying structures has been shown to be accurate only 30% of the time. [1] Unsuccessful identification of proper landmarks often leads to increased difficulty in obtaining CSF, if the procedure is performed, and a higher rate of complications. Few alternatives are available in these cases. If available, fluoroscopic-guided lumbar puncture may be performed. If not, treatment is sometimes initiated empirically without obtaining CSF. Disadvantages of using fluoroscopy include limited availability or necessary transport of the patient outside of the emergency department, inability to directly visualize the spinal canal, and inherent radiation exposure

The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.

Idiopathic thrombocytopenic purpura (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot. Idiopathic thrombocytopenic purpura, which is also called immune thrombocytopenia, affects children and adults. Children often develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term. If you don't have signs of bleeding and your platelet count isn't too low, you may not need any treatment. In rare cases, the number of platelets may be so low that dangerous internal bleeding occurs. Treatment options are available.

Most folks remember puberty – and not always in a good way. It can be an awkward stage of budding breasts, unwanted hair, acne and unexpected body odor. Puberty, when a child undergoes physical changes and becomes sexually mature, typically begins around age 8 in girls and age 9 in boys. But imagine, say, a 6- or 7-year-old undergoing such changes? Studies are showing that the onset of puberty for both boys and girls is occurring earlier and earlier, a phenomenon defined as precocious puberty. A study published in Pediatrics in 2010 found that among a population of 1,200 American girls, about 23 percent of African-Americans,15 percent of Latinas and 10 percent of Caucasian girls had begun puberty (marked by breast development) at age 7. In 2012, another study published in Pediatrics found that puberty in American boys – measured by testicular enlargement and pubic hair growth – was beginning six months to two years earlier than what research in previous decades had documented, particularly among African-American children.

It involves placing a small, expandable tube called a stent in the narrowed artery. This procedure is also called carotid angioplasty and stenting. There are two carotid arteries-one on each side of the neck-that supply blood to the brain. These arteries can be narrowed and damaged by fatty deposits called plaque.