A video showing how to elicit the ankle clonus sign

Vasectomy is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied or sealed in a manner such to prevent sperm from entering the seminal stream (ejaculate). Typically done in an outpatient setting, a traditional vasectomy involves numbing (local anesthetic) of the scrotum after which 1 (or 2) small incisions are made, allowing a surgeon to gain access to the vas deferens.

Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

Watch that Skin Jiggers Removal Procedure

A hematoma is a collection of blood outside of a blood vessel. There are several types of hematomas and they are often described based on their location. Examples of hematomas include subdural, spinal, under the finger or toenail bed (subungual), ear, and liver (hepatic). Some causes of hematomas are as pelvic bone fractures, fingernail injuries (subungual), bumps, passing blood clots, blood clot in the leg (DVT), blood cancers, and excessive alcohol use. Symptoms of hematomas depend upon their location and whether adjacent structures are affected by the inflammation and swelling associated with the bleeding and may include

Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients. Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems. As with all invasive procedures, the patient should first discuss medications they are taking with their doctor, most especially blood thinners or anticoagulants, such as warfarin (Coumadin), or aspirin. These may need to be discontinued prior to surgery. Postop complications include bleeding (most common), clotting and hyponatremia (due to bladder irrigation).

Additionally, transurethral resection of the prostate is associated with low but important morbidity and mortality.

Chinese Complete Physical Clinical Exam

this video about identifying a hernia vs a cyst

Surgeons in London removed a woman's brain tumor during a very unusual procedure. CBS News' Tina Kraus reports, the patient's love of music helped guide the surgery.

Subscribe to the CBS News Channel HERE: http://youtube.com/cbsnews
Watch CBSN live HERE: http://cbsn.ws/1PlLpZ7
Follow CBS News on Instagram HERE: https://www.instagram.com/cbsnews/
Like CBS News on Facebook HERE: http://facebook.com/cbsnews
Follow CBS News on Twitter HERE: http://twitter.com/cbsnews

Get the latest news and best in original reporting from CBS News delivered to your inbox. Subscribe to newsletters HERE: http://cbsn.ws/1RqHw7T

Get your news on the go! Download CBS News mobile apps HERE: http://cbsn.ws/1Xb1WC8

Get new episodes of shows you love across devices the next day, stream CBSN and local news live, and watch full seasons of CBS fan favorites like Star Trek Discovery anytime, anywhere with CBS All Access. Try it free! http://bit.ly/1OQA29B

---
CBSN is the first digital streaming news network that will allow Internet-connected consumers to watch live, anchored news coverage on their connected TV and other devices. At launch, the network is available 24/7 and makes all of the resources of CBS News available directly on digital platforms with live, anchored coverage 15 hours each weekday. CBSN. Always On.

a video of abdominal physical examination including all the required items:
-Inspection
-Palpation
-Percussion
-Auscultation

The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.

Subscribe to AMBOSS YouTube for the latest clinical examination videos, medical student interviews, study tips and tricks, and live webinars!

Free 5 Day Trial: https://go.amboss.com/amboss-YT
Instagram: https://www.instagram.com/amboss_med/
Facebook: https://www.facebook.com/AMBOSS.Med/
Twitter: https://twitter.com/ambossmed
Blog: https://blog.amboss.com/us

#AMBOSSMed #ClinicalExamination

How Male to Female Sex Gender Reassignment Surgery Really Works

In patients age ;::25, HPV DNA testing is the preferred next step in management if the initial cytology shows ASC-US. In this method, samples are collected for both cytology and reflex HPV DNA. If cytology results are positive, HPV DNA testing is performed. If cytology results are negative, the sample for HPV DNA is discarded. HPV DNA testing along with Pap smear at 3 years is recommended if initial cytology shows ASC-US but HPV DNA testing is negative

Ettore Vulcano, MD, Foot and Ankle Orthopedic Surgeon at Mount Sinai West, discusses a new minimally invasive bunion surgery that has patients walking immediately after surgery, and getting back to an active lifestyle much quicker than with the traditional surgery.

Watch that video of Creation and Pathway of Sperm During Ejaculation

Mothers can do everything for her baby

What Is a Paronychia (Nail Infection)? An infection that develops along the edge of the fingernail or toenail is called a paronychia (pear-ah-NIK-ee-ah). It is the most common hand infection and, if left untreated, can progress to a more severe infection of the entire finger or toe. Paronychia is distinguished from other infections such as onychomycosis and herpetic whitlow by its location and appearance.

The is a time lapse video animation of a complicated ear infection with a ruptured eardrum causing drainage with eventual healing. The video also shows why a period of hearing loss and clogged/muffled ear sensation may occur.

This 3D animation of brain surgery, shows how a ventriculostomy is performed, which is a neurosurgical procedure of creating a hole within a cerebral ventricle for drainage. It is most commonly performed on those with hydrocephalus, an abnormal buildup of fluid in the ventricles (cavities) deep within the brain. It's done by surgically penetrating the skull, dura mater, and brain such that the ventricular system ventricle of the brain is accessed.

When catheter drainage is temporary, it is commonly referred to as an external ventricular drain (EVD). When catheter drainage is permanent, it is usually referred to as a shunt.

There are many catheter-based ventricular shunts that are named for where they terminate, for example, a ventriculi-peritoneal shunt terminates in the peritoneal cavity, a ventriculoarterial shunt terminates within the atrium of the heart, etc. The most common entry point on the skull is called Kocher's point. An EVD ventriculostomy is done primarily to monitor the intracranial pressure as well as to drain cerebrospinal fluid (CSF), primarily, or blood to relieve pressure from the central nervous system (CNS).

For more information about custom medical animation, please visit https://www.amerra.com/.

Watch additional medical animations:

Craniectomy brain surgery - 3D animation: https://youtu.be/1RkseDeYS9g

Accessing an implantable port training - 3D animation: https://youtu.be/xSTpxjyv4O4

Open Suctioning with a Tracheostomy Tube - 3D animation: https://youtu.be/wamB7jpWCiQ

Suctioning the endotracheal tube - medical animation: https://youtu.be/pN6-EYoeh3g

Functional endoscopic sinus surgery (FESS) - 3D animation: https://youtu.be/qKTRyowwaLA

How to insert a nasogastric tube for NG intubation - 3d animation: https://youtu.be/Abf3Gd6AaZQ

Oral airway insertion - oropharyngeal airway technique - 3D animation: https://youtu.be/caxUdNwjt34

Nasotracheal suctioning (NTS) - 3D animation: https://youtu.be/979jWMsF62c

Learn about hemorrhoids with #3d #animation: https://youtu.be/R6NqlMpsiiY

LASIK eye surgery - 3D animation: https://youtu.be/Bb8bnjnEM00

CPR cardiopulmonary resuscitation - 3D animation: https://youtu.be/G87knTZnhks

What are warts (HPV)? - 3D animation: https://youtu.be/guJ1J7rRs1w

How Macular Degeneration Affects Your Vision - 3D animation: https://youtu.be/ozZQIZ_52YY

NeoGraft hair transplant procedure – animation: https://youtu.be/C-eTdH2UPXI

Imperforate Hymen