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Handal Plastic Surgery at the Sanctuary Surgery Center is the leading cosmetic surgery center of the Southeast Florida region, providing excellent consultation, surgery, and post operative services. Headed by Doctor Arthur G. Handal, top plastic & cosmetic surgeon in Boca Raton, the professional staff of the Sanctuary Surgery Center offers the best in patient care.
An amputation is the removal of an extremity or appendage from the body. Amputations in the upper extremity can occur as a result of trauma, or they can be performed in the treatment of congenital or acquired conditions. Although successful replantation represents a technical triumph to the surgeon, the patient's best interests should direct the treatment of amputations. The goals involved in the treatment of amputations of the upper extremity include the following : Preservation of functional length Durable coverage Preservation of useful sensibility Prevention of symptomatic neuromas Prevention of adjacent joint contractures Early return to work Early prosthetic fitting These goals apply differently to different levels of amputation. Treatment of amputations can be challenging and rewarding. It is imperative that the surgeon treat the patient with the ultimate goal of optimizing function and rehabilitation and not become absorbed in the enthusiasm of the technical challenge of the replantation, which could result in poorer outcome and greater financial cost due to lost wages, hospitalization, and therapy.
Your baby's sex is set at conception. At around 7 weeks, your baby's internal sex organs – such as ovaries and testes – begin to form in the abdomen. Male and female sex organs and genitalia look the same at this stage because they're derived from the same structures. At around 9 weeks, boys and girls begin to develop differently. In girls, a tiny bud emerges between the tissue of the legs. This bud will become the clitoris. The membrane that forms a groove below the bud separates to become the labia minora and the vaginal opening. By 22 weeks, the ovaries are completely formed and move from the abdomen to the pelvis. They already contain a lifetime supply of 6 million eggs. In boys, the bud develops into the penis and starts to elongate at around 12 weeks. The outer membrane grows into the scrotal sac that will later house the testicles. By 22 weeks, the testes have formed in the abdomen. They already contain immature sperm. Soon they'll begin their descent to the scrotum, but it's a long journey. They'll reach their destination late in pregnancy, or for some boys, after birth. If you're eager to find out whether you're having a girl or a boy, you'll have to wait until you're at least 17 weeks pregnant. That's when the genitals have developed enough to be seen on an ultrasound.
Not every woman undergoes a traditional vaginal delivery with the birth of her child. Under conditions of fetal or maternal distress, or in the case of breech presentation (when a baby is turned feet first at the time of delivery), or if the woman’s first baby was born by cesarean delivery, a procedure called a cesarean section may be required. During a cesarean, a doctor will make either a lateral incision in the skin just above the pubic hair line, or a vertical incision below the navel. As the incision is made, blood vessels are cauterized to slow bleeding. After cutting through the skin, fat, and muscle of the abdomen, the membrane that covers the internal organs is opened, exposing the bladder and uterus. At this time the physician will generally insert his or her hands into the pelvis in order to determine the position of the baby and the placenta. Next, an incision is made into the uterus and any remaining fluids are suctioned from the uterus. The doctor then enlarges the incision with his or her fingers. The baby’s head is then grasped and gently pulled with the rest of its body from the mother’s uterus. Finally, the abdominal layers are sewn together in the reverse order that they were cut. The mother is allowed to recover for approximately three to five days in the hospital. She will also be quite sore and restricted from activity for the following several weeks. There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery.
Today, hair transplant physicians are able to make use of different techniques to extract and transplant large numbers of hair follicles (follicular units). There are two primary techniques for hair transplantation currently in use. The FUE (Follicular Unit Extraction) and the FUT (Follicular Unit Transplantation) methods. They differ primarily in the way hair follicles are extracted from the donor area. Follicular Unit Transplantation (FUT) The FUT process involves removing a small strip of tissue from the back of the head, from which the donor hair follicles will be extracted. The hair follicles are harvested from the strip by a skilled clinical team before being individually transplanted to the recipient areas. In most cases, and especially cases of advanced hair loss, FUT is the preferred method because it allows the physician to fully utilize the scalp area to deliver results consistent with patient expectations. FUT typically allows for the greatest number of grafts to be transplanted in a single session. Pain Management Some patients report higher levels of discomfort with FUT procedures compared to FUE due the potential swelling in the area where the strip of tissue was removed, but both methods have a very manageable recovery period and pain medication can be prescribed by your physician if needed. Both techniques of hair transplantation are relatively simple. Hair transplantation procedures are outpatient surgeries with some patients going back to work as soon as the very next day. Scarring The FUT strip extraction method typically results in a very narrow linear scar in the back of the head (typically 1mm in diameter or less in size). Since the scar is very thin, it’s easily concealed by all but the shortest of haircut styles. A short to moderate crop setting on most clippers is sufficient to conceal the scar for the majority of patients, and over time the scar will become less noticeable as it fades. Costs The industry norm for pricing is on a per-graft basis. This allows each individual to pay for only what they need and receive in number of grafts, and not a flat rate that in the end may cost you more. The per-graft cost of a FUT procedure is generally lower than that of a FUE procedure. Lately however, in response to the rising popularity of the FUE technique, many hair transplantation clinics have started lowering the per graft cost on FUE procedures, so that the cost difference between the two types of procedure are not as much as most people think. The costs of medical procedures always vary by patients’ conditions, needs and objectives. For the most accurate assessment of your hair loss and the associated cost of your hair restoration, you will need to speak to a physician. Follicular Unit Extraction (FUE) In an FUE hair transplantation, each follicular unit is individually taken directly from the scalp with no strip of tissue being removed. Hair follicles are removed in a random fashion and the result is less density in the donor area that many say is not even noticeable. This is the main difference between FUE & FUT. Since follicles are removed one at a time, fewer follicles can be harvested during a typical session, making FUE a better option to restore hair in smaller cases (number of grafts) compared to the traditional FUT method. FUE is constantly evolving and what was once utilized for only smaller cases is now being utilized for larger and larger cases. Some people that prefer the FUE method may have the option of splitting their procedure into two days in order to complete their recommended transplantation goals. Pain Management With no stitches required and no linear scar left to heal, FUE procedures do have a faster healing time and less post-procedure discomfort compared to the traditional FUT procedure. Scarring Since FUE procedures involve removing hairs individually from the scalp, there is no linear scar left behind. However, there will be tiny 1mm in diameter or less puncture marks that tend to heal by themselves after scabbing-over in the days following the procedure. These tiny wounds typically heal within three to seven days. Costs Since the physician must remove each hair follicle individually, the time-sensitive nature of an FUE procedure typically makes it more expensive than an FUT procedure. As stated earlier, FUE technology is improving as well as gaining popularity and many hair restoration practices (including Bosley) have started to lower the cost per graft price for FUE procedures. Nowadays, the cost difference between a FUE and a FUT procedures is less disparate.
Myocardial infarction (MI), commonly known as a heart attack, is defined pathologically as the irreversible death of myocardial cells caused by ischemia. Clinically, MI is a syndrome that can be recognized by a set of symptoms, chest pain being the hallmark of these symptoms in most cases, supported by biochemical laboratory changes, electrocardiographic (ECG) changes, or findings on imaging modalities able to detect myocardial injury and necrosis. According to the third universal definition of MI, implemented by a joint task force from the European Society of Cardiology (ESC), American College of Cardiology (ACC) Foundation, American Heart Association (AHA), and the World Heart Federation (WHF), MI is diagnosed when either of the following two criteria are met
Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes — such as exercising, reducing salt in your diet, managing stress and losing weight — can improve your quality of life. One way to prevent heart failure is to control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.
A carotid endarterectomy is performed in a sterile surgical suite or standard operating room. You may go home the same day or stay 1–2 nights after the procedure depending on your medical condition. You receive a local anesthetic or general anesthesia. Your vascular surgeon makes an incision at the front of your neck. After removing the plaque from the artery your vascular surgeon repairs the artery by stitching in a natural graft (formed from a piece of vein from elsewhere in your body) or a woven patch. The incision is closed
Bronchiectasis is an abnormal dilation of the proximal and medium-sized bronchi (>2 mm in diameter) caused by weakening or destruction of the muscular and elastic components of the bronchial walls. Affected areas may show a variety of changes, including transmural inflammation, edema, scarring, and ulceration, among other findings. Distal lung parenchyma may also be damaged secondary to persistent microbial infection and frequent postobstructive pneumonia. Bronchiectasis can be congenital but is most often acquired.[9] Congenital bronchiectasis usually affects infants and children. These cases result from developmental arrest of the bronchial tree. Acquired forms occur in adults and older children and require an infectious insult, impairment of drainage, airway obstruction, and/or a defect in host defense. The tissue is also damaged in part by the host response of neutrophilic proteases, inflammatory cytokines, nitric oxide, and oxygen radicals. This results in damage to the muscular and elastic components of the bronchial wall. Additionally, peribronchial alveolar tissue may be damaged, resulting in diffuse peribronchial fibrosis.[12] The result is abnormal bronchial dilatation with bronchial wall destruction and transmural inflammation. The most important functional finding of altered airway anatomy is severely impaired clearance of secretions from the bronchial tree. Impaired clearance of secretions causes colonization and infection with pathogenic organisms, contributing to the purulent expectoration commonly observed in patients with bronchiectasis. The result is further bronchial damage and a vicious cycle of bronchial damage, bronchial dilation, impaired clearance of secretions, recurrent infection, and more bronchial damage
Severe combined immunodeficiency (SCID) is a life-threatening syndrome of recurrent infections, diarrhea, dermatitis, and failure to thrive. It is the prototype of the primary immunodeficiency diseases and is caused by numerous molecular defects that lead to severe compromise in the number and function of T cells, B cells, and occasionally natural killer (NK) cells. Clinically, most patients present before age 3 months. Without intervention, SCID usually results in severe infection and death in children by age 2 years. A committee of experts, initially sponsored by the World Health Organization (WHO), meets every 2 years with the goal to classify the group of primary immunodeficiency diseases according to current understanding of the pathways that become defective in the immune system.[1] Eight classification groups have been determined, with SCID being one of the best studied. Over the past few decades, the diverse molecular genetic causes of SCID have been identified with progress from studies of the immune system.[2] SCID is considered a pediatric emergency because survival depends on expeditious stem cell reconstitution, usually by bone marrow transplantation (BMT). Appropriate diagnosis is essential because instituting proper treatment is lifesaving. Despite the heterogeneity in the pathogenesis of immune defects, common cutaneous manifestations and typical infections can provide clinical clues in diagnosing this pediatric emergency.[3] Skin manifestations were prevalent in primary immunodeficiency disorders studied in 128 pediatric patients in Kuwait; skin infections were the most prevalent findings, seen in 39 patients (30%), followed by dermatitis in 24 (19%).[4] Skin infections were significantly more prevalent in those with congenital defects in phagocyte number, function, or both, as well as in those with well-defined immunodeficiencies. Dermatitis was evident in all patients with hyper–immunoglobulin (Ig) E syndrome and Wiskott-Aldrich syndrome.[4] Erythroderma of infancy with diffuse alopecia was seen exclusively in patients with SCID disorders, and telangiectasia in patients with ataxia telangiectasia; and partial albinism with silvery gray hair was associated with Chediak-Higashi syndrome. With the advances in BMT and gene therapy, patients now have a better likelihood of developing a functional immune system in a previously lethal genetic disease. However, once an infant develops serious infections, intervention is rarely successful.
In neonates, hypocalcemia is more likely to occur in infants born of diabetic or preeclamptic mothers. Hypocalcemia also may occur in infants born to mothers with hyperparathyroidism. Clinically evident hypocalcemia generally presents in milder forms and is usually the result of a chronic disease state. In emergency department patients, chronic or subacute complaints secondary to mild or moderate hypocalcemia are more likely to be a chief complaint than severe symptomatic hypocalcemia. Once laboratory results demonstrate hypocalcemia, the first question is whether the hypocalcemia is true—that is, whether it is representative of a decrease in ionized calcium. The presence of chronic diarrhea or intestinal disease (eg, Crohn disease, sprue, chronic pancreatitis) suggests the possibility of hypocalcemia due to malabsorption of calcium and/or vitamin D. The patient's past medical history should be explored for pancreatitis, anxiety disorders, renal or liver failure, gastrointestinal disorders, and hyperthyroidism or hyperparathyroidism. Previous neck surgery suggests hypoparathyroidism; a history of seizures suggests hypocalcemia secondary to anticonvulsants. The patient may have a recent history of thyroid, parathyroid, or bowel surgeries or recent neck trauma. The length of time that a disorder is present is an important clue. Hypoparathyroidism and pseudohypoparathyroidism are lifelong disorders. Instead, acute transient hypocalcemia may be associated with acute gastrointestinal illness, nutritional deficiency, or acute or chronic renal failure. In an elderly patient, a nutritional deficiency may be associated with a low intake of vitamin D. A history of alcoholism can help diagnose hypocalcemia due to magnesium deficiency, malabsorption, or chronic pancreatitis. Inquire about recent use of drugs associated with hypocalcemia, including the following: Radiocontrast Estrogen Loop diuretics Bisphosphonates Calcium supplements Antibiotics Antiepileptic drugs Cinacalcet Other considerations in the history include the following: Family history of hypocalcemia Low-calcium diet Lack of sun exposure
A leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin. In most people such an injury will heal up without difficulty within a week or two. However, when there is an underlying problem the skin does not heal and the area of breakdown can increase in size. This is a chronic leg ulcer.
The Zika virus, first identified in Uganda in 1947, is transmitted by the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific.