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Stress-relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects. The aim of this study was to evaluate the efficiency of the TopClosure TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress-relaxation. We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress-relaxation, and following surgery as skin-secure system until complete wound closure. All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress-relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved. In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress-relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range of applications on a global scale.

Virtual Ports, Ltd. (http://www.virtual-ports.com) is a medical device company developing and marketing instruments to improve minimally invasive laparoscopic procedures.
The EndoGrab retraction system reduces the number of ports needed for surgery by eliminating the need for traditional hand held retraction. For the surgeon, this simple solution results in the need for less auxiliary personnel, a decreased overall surgery cost, and more control over the surgery. The EndoGrab also offers added benefit to the patient who will experience less post-operative discomfort and scarring.

The EndoGrab is an internally anchored, hands-free retracting device that is introduced at the start of surgery through a 5mm trocar by means of a proprietary Applier tool. The Surgeon uses the Applier to attach the EndoGrab to both the organ requiring retraction and to the internal abdominal wall, thereby removing the organ from the operative field. The Applier is then removed and the port is free for use by other instruments.
3D video animation produced by Virtual Point Multimedia (http://virtual-point.com)

A Medical Video showing an overview of the endocrine and gland system of the human body

Coronary Artery Bypass Surgery CABG Heart

Flexible bronchoscopy is a procedure that allows a clinician to examine the breathing passages (airways) of the lungs (figure 1). Flexible bronchoscopy can be either a diagnostic procedure (to find out more about a possible problem) or a therapeutic procedure (to try to treat an existing problem or condition).

Antisocial personality disorder (ASPD) is defined by the American Psychiatric Association's Axis II (personality disorders) of the Diagnostic and Statistical Manual (DSM-IV-TR) as "a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood." Antisocial personality disorder is sometimes wrongly referred to as psychopathy or sociopathy. Currently, neither psychopathy nor sociopathy are valid diagnoses described in the Diagnostic and Statistical Manual of Mental Disorders, and the ICD-10 of the World Health Organization also lacks psychopathy as a diagnostic disorder. Psychopathy is normally seen as a subset of the antisocial personality disorder, but Blair believes that the antisocial personality disorder and psychopathy may be separate conditions altogether.

Pediatric Neurological Examination Introduction

Most people start smoking when they are in their teens and are addicted by the time they reach adulthood. Some have tried to quit but have returned to cigarettes because smoking is such a strong addiction. It is a habit that is very difficult to break. There are many different reasons why people smoke.

Scleroderma and systemic sclerosis

Histology of Female Urethra

Modified Milch method of relocating a dislocated shoulder

A stye (also called a hordeolum) is a small, red, painful lump that grows from the base of your eyelash or under the eyelid. Most styes are caused by a bacterial infection. There are two kinds of styes: External hordeolum: A stye that begins at the base of your eyelash. Most are caused by an infection in the hair follicle. It might look like a pimple. Internal hordeolum: A stye inside your eyelid. Most are caused by an infection in an oil-producing gland in your eyelid.

Open reduction and internal fixation (ORIF) is surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken thighbone (femur). The femur is the large bone in the upper part of your leg. Different kinds of trauma can damage this bone, causing it to fracture into 2 or more pieces. This might happen to the part of the femur near your knee, near the middle of the femur, or in the part of the femur that forms part of your hip joint. In certain types of femur fractures, your femur has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the trauma moves the bone fragments out of alignment. If you fracture your femur, you usually need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery, so that they are back in their proper alignment. This contrasts with a closed reduction, in which a healthcare provider physically moves your bones back into place without surgically exposing your bone.

Mitral Valve Prolapse and Mitral Regurgitation. Review of mitral valve anatomy and function, including papillary muscle structure and function, with severe mitral valve prolapse and mitral regurgitation due to a flail segment caused by ruptured papillary muscle and chorda tendinae attachment.

Vaginoplasty is a surgical procedure designed to rejuvenate and tighten a woman’s vagina, by removing excess lining and repairing the surrounding soft tissues. It is designed to decrease the diameter of the vagina, resulting in increased friction during intercourse to make the experience more pleasurable for both partners.

How Bone Fractures Are Repaired

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Symptoms of dizziness can result from many conditions such as; (vestibular) inner ear disorders, neck injuries or muscle tightness, neuropathy, central nervous system problems, metabolic issues, or psychological disorders. Our therapists are trained to screen for more serious conditions (such as neurological and cardiovascular disorders) as well as effectively evaluate and treat conditions which are appropriate for physical therapy intervention.

Thrombosis of the venous channels in the brain is an uncommon cause of cerebral infarction relative to arterial disease, but it is an important consideration because of its potential morbidity. (See Prognosis.) Knowledge of the anatomy of the venous system is essential in evaluating patients with cerebral venous thrombosis (CVT), since symptoms associated with the condition are related to the area of thrombosis. For example, cerebral infarction may occur with cortical vein or sagittal sinus thrombosis secondary to tissue congestion with obstruction. (See Presentation.) Lateral sinus thrombosis may be associated with headache and a pseudotumor cerebri–like picture. Extension into the jugular bulb may cause jugular foramen syndrome, while cranial nerve palsies may be seen in cavernous sinus thrombosis as a compressive phenomenon. Cerebral hemorrhage also may be a presenting feature in patients with venous sinus thrombosis. (See Presentation.) Imaging procedures have led to easier recognition of venous sinus thrombosis (see the images below), offering the opportunity for early therapeutic measures. (See Workup.) Left lateral sinus thrombosis demonstrated on magn Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities. View Media Gallery Axial view of magnetic resonance (MR) venogram dem Axial view of magnetic resonance (MR) venogram demonstrating lack of flow in transverse sinus. View Media Gallery The following guidelines for CVT have been provided by the American Heart Association and the American Stroke Association [1] : In patients with suspected CVT, routine blood studies consisting of a complete blood count, chemistry panel, prothrombin time, and activated partial thromboplastin time should be performed. Screening for potential prothrombotic conditions that may predispose a person to CVT (eg, use of contraceptives, underlying inflammatory disease, infectious process) is recommended in the initial clinical assessment. Testing for prothrombotic conditions (including protein C, protein S, or antithrombin deficiency), antiphospholipid syndrome, prothrombin G20210A mutation, and factor V Leiden can be beneficial for the management of patients with CVT. Testing for protein C, protein S, and antithrombin deficiency is generally indicated 2-4 weeks after completion of anticoagulation. There is a very limited value of testing in the acute setting or in patients taking warfarin. In patients with provoked CVT (associated with a transient risk factor), vitamin K antagonists may be continued for 3-6 months, with a target international normalized ratio of 2.0-3.0. In patients with unprovoked CVT, vitamin K antagonists may be continued for 6-12 months, with a target international normalized ratio of 2.0-3.0. For patients with recurrent CVT, venous thromboembolism (VTE) after CVT, or first CVT with severe thrombophilia (ie, homozygous prothrombin G20210A; homozygous factor V Leiden; deficiencies of protein C, protein S, or antithrombin; combined thrombophilia defects; or antiphospholipid syndrome), indefinite anticoagulation may be considered, with a target international normalized ratio of 2.0-3.0. For women with CVT during pregnancy, low-molecular-weight heparin (LMWH) in full anticoagulant doses should be continued throughout pregnancy, and LMWH or vitamin K antagonist with a target international normalized ratio of 2.0-3.0 should be continued for ≥6 weeks postpartum (for a total minimum duration of therapy of 6 months). It is reasonable to advise women with a history of CVT that future pregnancy is not contraindicated. Further investigations regarding the underlying cause and a formal consultation with a hematologist or maternal fetal medicine specialist are reasonable. It is reasonable to treat acute CVT during pregnancy with full-dose LMWH rather than unfractionated heparin. For women with a history of CVT, prophylaxis with LMWH during future pregnancies and the postpartum period is reasonable. Next: Etiology What to Read Next on Medscape Related Conditions and Diseases Quiz: Do You Know the Complications, Proper Workup, and Best Treatment Practices for Ischemic Stroke? Quiz: How Much Do You Know About Hypothyroidism? Quiz: Do You Know the Risk Factors, Symptoms, and Potential Treatments for Alzheimer Disease? Quiz: How Much Do You Know About Hypertension? 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