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To use the diaphragm, first cover the inside of it with spermicide. Then insert it into your vagina so that it covers your cervix. You can insert the diaphragm up to 6 hours before sex. You should leave it in for at least 6 hours after the last time you have sex.
Face transplant candidates go through an extensive screening process that is likely to last several months. This screening includes a psychiatric and social support evaluation and a series of imaging tests to help determine a patient’s physical and mental readiness for the procedure. If, upon completion of the screening process, it is determined that a patient is a suitable candidate, we will place the patient on a transplant waiting list. We will then begin working with the New England Organ Bank (NEOB) team to find a donor who matches the recipient’s tissue requirements – e.g., similar age, right blood type. This search could take many months, and, if a suitable donor is not found within one year, we will speak with the patient to determine whether they’re willing to continue waiting. When a donor is found, we will immediately inform the patient about when to arrive at the hospital for the operation. As the timing for this type of procedure is extremely important, patients are expected to be readily available, i.e., reside within a 12-hour travel radius of BWH.
The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.
The hepatic portal system is the system of veins comprising the hepatic portal vein and its tributaries. It is responsible for directing blood from the region of the gastrointestinal tract between the esophagus and rectum and also includes venous drainage from the supplementary organs such as the spleen and pancreas.
External cephalic version is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. External cephalic version (ECV) is a manual procedure that is advocated by national guidelines for breech presentation singleton pregnancy, in order to enable vaginal delivery.
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth. Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.
Microcalcifications in the breast can be the first sign of cancer. They are, as the name says, very small and clustered. A precise biopsy without pain under stereotactic guidance is the standard procedure. What makes this Spirotome different from the vacuum assisted biopsies is that only a few biopsies are needed and that the approach of the needle towards the microcalcifications is direct and frontal. There is no damage to the surrounding tissues making this procedure rather painfree and with minimal bleeding.