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A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC

CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained.

Examination of Cranial nerves III, IV and V: occulomotor,trochlear and trigeminal

TPE removes large-molecular-weight substances such as harmful antibodies from the plasma. It is usually carried out using an automated blood cell separator to ensure fluid balance and maintain a normal plasma volume. This may require the insertion of a femoral or jugular line to allow adequate blood flow. Typically, 30–40 mL/kg of plasma (1–1.5 plasma volumes) are removed at each procedure and replaced with isotonic 4.5 or 5.0% human albumin solution (some services substitute 25–50% of replacement volume with 0.9% saline). Exchange with fresh frozen plasma (FFP) is reserved for the replacement of ADAMTS13 in thrombotic thrombocytopenic purpura (see below) or to replace clotting factors. A one plasma volume exchange removes about 66% of an intravascular constituent and a two plasma volume exchange approximately 85%. TPE is normally combined with disease modifying treatment, such as immunosuppressive drugs, for the underlying condition.

Watch that video to know if it is safe to have intercourse during her period

“Complete cure from groin hernia is now possible with Dr.Desarda's repair technique.......” Mesh is a foreign body. Therefore, its use in hernia repairs is known to cause all sorts of complications like pain, recurrence, infection etc. We have developed an innovative new technique of inguinal hernia repair without mesh. It uses your own body muscle for repair and gives virtually complete cure from inguinal hernia problem. An undetached strip of the external oblique aponeurosis is stitched on the weak area between the muscle arch and the inguinal ligament to form a new, strong and physiologically dynamic posterior wall that gives protection and prevents re-herniation. Normally patient goes home in a day after surgery and can drive car and go to office in 3-4 days time. This "Dr.Desarda's hernia repair" is now followed in many countries all over the world. We are surprised to see the enquiries from many patients in the developed countries asking for this repair in their country. This is because this operation does not use any foreign body like mesh for repair and therefore there are no complications that are seen in mesh repairs. A visit to Topix or other hernia forums show thousands of posts showing sufferings of many patients due to mesh repairs. But still why surgeons from developed countries are interested in mesh repairs is a big question for us. Please visit our website for more details: http://herniasurgery.tripod.com Our cell number: +91 9373322178

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Glomus tumors are rare soft tissue neoplasms that typically present in adults (ages 20-40 years) as small, blue-red papules or nodules of the distal extremities, with most cases involving subungual sites. These tumors are typically painful, often causing paroxysmal pain in response to temperature changes or pressure. Glomus tumors are thought to arise from the glomus body, a thermoregulatory shunt concentrated in the fingers and toes. Most lesions are solitary and localized to cutaneous sites; however, generalized glomuvenous malformations, or multiple glomangiomas, have also been described, and may have extracutaneous involvement.

Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. It is also used before surgery to reduce the risk of blood clots.

Common causes of the knee pain
Knee pain is very common and in this video we will present the most common problems that can cause pain in the knee. (Patella) itself, which is in front of the knee, or from the tendons that are attached to the kneecap (patellar tendon and quadricep tendon). One of the most common problems is patellar chondromalacia which is chronic pain due to the softening of the cartilage beneath the kneecap. The cartilage of the kneecap will have some erosions, defects, or holes from mild to complete inside the joint (exactly in the back of the kneecap).
• Pain in the front of the knee
• Occurs more in young people
• Becomes worse from climbing up stairs and going downstairs
Treatment is usually nonsteroidal anti-inflammatory medication, physical therapy, and surgery is very rare. Also in front of the kneecap, the patient may get pain due to prepatellar bursitis.
When there is prepatellar bursitis, the patient will see that the swelling, the inflammation, and the pain is located over the front of the kneecap. The bursa becomes inflamed and fills with fluid at the top of the knee, causing pain, swelling, tenderness and a lump in that area on top of the kneecap. If the pain is in front of the knee but below or above the patella, this may indicate that the patient has tendonitis. Patellar tendonitis is an overuse condition that often occurs in athletes who perform repetitive jumping activities. Patellar tendonitis is a knee pain that is associated with focal patellar tendon tenderness and it is usually activity related. It is located below the kneecap and is called "jumper's knee". Patellar tendonitis affects approximately 20% of jumping athletes. There will be tenderness to palpation at the distal pole of the patella in extension and not in flexion. Quadriceps inflexibility, atrophy and hamstring tightness are predisposing factors for this condition. Treatment is rest, anti-inflammatory medication, stretching and strengthening of the hamstrings and quadriceps. Use an eccentric exercise program. The early stages of patellar tendonitis will respond well to nonoperative treatment. Another important cause of knee pain is a meniscal tear. The meniscus is the cushion that protects the cartilage in the knee. Injury will cause pain on the medial or the lateral side of the knee exactly at the level of the joint. The patient will complain of a history of locking, instability and swelling of the knee. McMurray test will be positive. A painful pop or click is obtained as the knee is brought from flexion to extension with either internal or external rotation of the knee. Arthritis of the knee Knee arthritis is very common. The cartilage cells die with age and its repair response decreases in the joint collapses with increased breakdown of the framework of the cartilage. The patient will have progressive blurring away of the cartilage of the joint with decreased joint space as seen on x-rays. Another source of pain is the Baker's cyst. The cyst is in the back of the knee between the semimembranosus yes and the medial gastrocnemius muscles. Another important source of knee pain is a ligament injury. Here is a normal knee without a ligament injury. Here you can see from the front, you can see the lateral and medial collateral ligament. You can see the ACL and PCL from the side view. These ligaments are usually injured as a result of a sports activity. Here is an example of a sports knee injury. Here is an example of the medial collateral ligament injury. This is the most commonly injury knee ligament injury to this ligament is on the inner part of the knee. Here is an example of an injury of the anterior cruciate ligament. It involves a valgus stress to the knee. Lachman test is usually positive, and MRI is diagnostic. Another important cause of knee pain is iliotibial band syndrome of the knee. Inflammation of the thickening of the iliotibial band results from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. And as the knee moves, the IT band was repeatedly shifted forwards and backwards across the lateral femoral condyle. The patient will complain of swelling, tenderness, and crepitus over the lateral femoral condyle. The condition occurs in the ITB S occurs in runners, cyclist and athletes that require repeated knee flexion and extension. The pain may be reproduced by doing a single-leg squat. The Ober's test is used to at assess tightness of the iliotibial band. MRI may show edema in the area of the ITB. Treatment is usually nonoperative with rest and ice, physical therapy, with stretching, proprioception, and improvement in neuromuscular coordination. Training modification and injections may be helpful. Surgery is a last resort. Surgical excision of the scarred inflamed part of the iliotibial band.

Porcelain gallbladder is a condition characterized by calcium salt deposits in the wall of a chronically inflamed gallbladder. The calcifications can be thin or faintly visible, or may be amorphous, patchy, and thick. The gallbladder is generally large, but its size can vary considerably. Most porcelain gallbladders are associated with gallstones. A plain radiograph generally detects these, but computed tomography (CT) has a higher specificity; therefore, a CT scan is performed to confirm the diagnosis. Due to their high risk of gallbladder carcinoma, all patients with porcelain gallbladder should have an elective cholecystectomy.

This is video 2 of 2 on diabetic ketoacidosis (DKA).

Top 10 Shocking Before And After Drug Use Photos

How to Start an IV Like a Pro (Nursing Skills)

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How to Start an IV Like a Pro (Nursing Skills):
This video covers the nursing skill of starting an IV. Here are some tips and tricks to hit that vein every time!

Bookmarks:
0:07 Introduction to starting an IV
0:32 First steps/ Locating a good vein
1:03 Preparing supplies
1:59 Tourniquet replacement
2:11 Cleaning the site
2:26 Inspecting the angiocath
2:46 How to insert the angiocath
3:19 Stabilizing the catheter
3:53 Dressing the catheter
4:19 Labeling the dressing
4:25 Sharps and trash disposal
4:34 Closing words of inspiration

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This system treats type 2 diabetes by promoting weight loss.

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.

peptic ulcer

A great video discussing ultrasound guidance of central venous catheter placement

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. There's no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms