Massive bone defects (>8 cm) will not unite without an additional intervention. They require a predictable, durable, and efficient method to regrow bone. The Ilizarov method of tension stress, or distraction osteogenesis, first involves a low-energy osteotomy1 - 5. The bone segments are then pulled apart, most often using an external device at a specific rate and rhythm (distraction phase), after which the newly formed bone (the regenerate) requires time for consolidation. The consolidation phase is variable and usually requires a substantially greater amount of time before the external device can be removed. Our technique of tibial bone transport over an intramedullary nail using cable and pulleys combines internal and external fixation, allowing the external fixator to be removed at the end of the distraction phase. This increases the efficiency of limb reconstruction and decreases the external-fixator-associated complications.

Emphysema gradually damages the air sacs (alveoli) in your lungs, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease Smoking is the leading cause of emphysema. Your lungs' alveoli are clustered like bunches of grapes. In emphysema, the inner walls of the air sacs weaken and eventually rupture — creating one larger air space instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Treatment may slow the progression of emphysema, but it can't reverse the damage.

The average time from symptom onset to diagnosis has been reported to be approximately 2 years. Despite recent attempts at increasing the awareness of pulmonary arterial hypertension (PAH), especially associated PAH (APAH), this delay in diagnosis has not changed appreciably in recent years. Early symptoms are nonspecific. Often, neither the patient nor the physician recognizes the presence of the disease, which leads to delays in diagnosis. Complicating matters, idiopathic PAH (IPAH) requires an extensive workup in an attempt to elucidate an identifiable cause of the elevated pulmonary artery pressure. The most common symptoms and their frequency, reported in a national prospective study, are as follows: Dyspnea (60% of patients) Weakness (19%) Recurrent syncope (13%) Additional symptoms include fatigue, lethargy, anorexia, chest pain, and right upper quadrant pain. Cough, hemoptysis, and hoarseness are less common symptoms. Women are more likely to be symptomatic than men.

The virus was first discovered in 1964 when Sir Michael Anthony Epstein and Ms. Yvonne Barr found it in a Burkitt lymphoma cell line. In 1968, the virus was linked to the disease infectious mononucleosis. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood. EBV is the cause of infectious mononucleosis (also termed "mono"), an illness associated with fever, sore throat, swollen lymph nodes in the neck, and sometimes an enlarged spleen. It is also known as human herpes virus 4. Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. Less commonly, EBV can cause more serious disease. Symptoms caused by EBV are usually mild and self-limited, but the virus persists in the body for life. It can be reactivated quietly without causing symptoms and may contaminate saliva. Thus, otherwise healthy people can spread the virus to uninfected people through kissing or sharing

Cytomegalovirus (CMV) is a common virus that can infect almost anyone. Most people don't know they have CMV because it rarely causes symptoms. However, if you're pregnant or have a weakened immune system, CMV is cause for concern. Once infected with CMV, your body retains the virus for life. However, CMV usually remains dormant if you're healthy. CMV spreads from person to person through body fluids, such as blood, saliva, urine, semen and breast milk. CMV spread through breast milk usually doesn't make the baby sick. However, if you are pregnant and develop an active infection, you can pass the virus to your baby.

Genital warts are soft growths that appear on the genitals. Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). These skin growths can cause pain, discomfort, and itching. They are especially dangerous for women because some types of HPV can also cause cancer of the cervix and vulva.

A Pap smear (Papanicolau smear; also known as the Pap test) is a screening test for cervical cancer. The test itself involves collection of a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) during a routine pelvic exam

Different Types of Breasts

An orgasm is a feeling of intense sexual pleasure that happens during sexual activity. It's sometimes called "coming" or "climaxing". Both men and women have orgasms.

Genetic surfactant dysfunction disorders are caused by mutations in genes encoding proteins critical for the production and function of pulmonary surfactant. These rare disorders may produce familial or sporadic lung disease, with clinical presentations ranging from neonatal respiratory failure to childhood- or adult-onset interstitial lung disease. An overview of these disorders is presented in the table.. Interstitial lung diseases in children until recently were categorized by their histologic appearance in a manner similar to that used for adult forms of interstitial lung disease (ILD). In children, the lung histopathology findings associated with desquamative interstitial pneumonitis (DIP) are now known to often result from genetic mechanisms that disrupt normal surfactant production and metabolism. By contrast, DIP in adults is considered to represent a distinct type of ILD, which is strongly associated with cigarette smoking and carries a relatively favorable prognosis [1]. These genetic disorders also result in histopathologic patterns other than DIP, including findings of pulmonary alveolar proteinosis and chronic pneumonitis of infancy. An understanding of the pathogenesis of these disorders permits a mechanistic classification as genetic surfactant dysfunction disorders instead of their previous classification based upon histologic appearance.

Squamous cell carcinomas typically appear as persistent, thick, rough, scaly patches that can bleed if bumped, scratched or scraped. They often look like warts and sometimes appear as open sores with a raised border and a crusted surface. In addition to the signs of SCC shown here, any change in a preexisting skin growth, such as an open sore that fails to heal, or the development of a new growth, should prompt an immediate visit to a physician.

Brain Surgery: Microvascular Decompression of facial nerve for hemifacial spasm

Pediatric Cardiovascular Examination

an. 4, 2017 -- Scientists say they've identified a new organ in the body -- a swath of tissue dubbed the mesentery that connects the intestine to the abdomen and holds everything in place. For years, anatomical experts have thought the organ was composed of several different segments of tissue, as opposed to being one single structure, according to Discover magazine. Since an organ must be one structure that performs a vital function, it was not deemed worthy of organ status. But recent research from doctors at the University Hospital Limerick in Ireland shows that the mesentery is actually one single band of tissue, the magazine reported Tuesday. It begins at the pancreas and wraps around the small intestine and colon. Its purpose: to hold these organs in position so they can perform their respective functions. "Without it you can't live," lead researcher Dr. J. Calvin Coffey, a colorectal surgeon at Limerick, told the magazine. "There are no reported instances of a Homo sapien living without a mesentery." "Understanding how and why our digestive system is arranged the way it is could be crucial to our understanding of diseases like Crohn's and irritable bowel syndrome," Coffey added. "There are a lot of diseases that we are stalled on, and we need to refresh our approach to these diseases," Coffey said. "Now that we've clarified its [the mesentery's] structure, we can systematically examine it. We're at a very exciting place right now." The discovery was published recently in the Lancet Gastroenterology & Hepatology journal.

Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria. Rheumatic fever is most common in 5- to 15-year-old children, though it can develop in younger children and adults. Although strep throat is common, rheumatic fever is rare in the United States and other developed countries. However, rheumatic fever remains common in many developing nations. Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.

Obstetrical emergencies of pregnancy ECTOPIC PREGNANCY. ... PLACENTAL ABRUPTION. ... PLACENTA PREVIA. ... ECTOPIC PREGNANCY. ... PLACENTAL ABRUPTION. ... PLACENTA PREVIA. ... Amniotic fluid — The liquid in the placental sac that cushions the fetus and regulates temperature in the placental environment.

Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. EDH results from traumatic head injury, usually with an associated skull fracture and arterial laceration.The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull. Blood vessels in close proximity to the fracture are the sources of the hemorrhage in the formation of an epidural hematoma. Because the underlying brain has usually been minimally injured, prognosis is excellent if treated aggressively. Outcome from surgical decompression and repair is related directly to patient's preoperative neurologic condition. [1]

The term trisomy is used to describe the presence of three chromosomes, rather than the usual matched pair of chromosomes. For example, if a baby is born with three #21 chromosomes, rather than the usual pair, then the baby would be said to have "trisomy 21." Trisomy 21 is also known as Down syndrome. Other examples of trisomy include syndromes like trisomy 18 and trisomy 13. Again, trisomy 18 or trisomy 13 simply means the child has three copies of the #18 chromosome (or of the #13 chromosome) present in each cell of the body, rather than the usual pair.

Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability.

Every owner of a building where asbestos abatement activity occurs is responsible for the performance of the asbestos abatement activities by his/her agent, contractor, employee, or other representative. Each building owner is responsible for determining the amount of asbestos-containing material that may be disturbed during the course of work. The size and scope of the overall project, with particular reference to the total amount of asbestos-containing material that will be disturbed determines the reporting or filing requirements established in the Asbestos Control Program Rules. An asbestos project is defined as any form of work that will disturb more than 25 linear feet or more than 10 square feet of asbestos-containing material.