What is vascular access? What are the different types of accesses for hemodialysis? Does vascular access require surgery? Adina Voiculescu, M.D., FASDIN, General and Interventional Nephrologist at Brigham and Women's Hospital and Assistant Professor at Harvard Medical School, discusses the different types of vascular access, such as AV fistulas and AV grafts, and how to stay healthy while on hemodialysis.

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0:00 - Intro
0:29 - Peritoneal dialysis & Hemodialysis
0:44 - Types of access to perform dialysis
1:48 - Recommendations

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Hemodialysis: Types of Accesses for Kidney Dialysis and How to Stay Healthy | Mass General Brigham
https://youtu.be/_bxLpudpqnc

In dark or dim light, the pupil dilates to allow more light into the eye to improve vision. Normal pupil size tends to range between 2.0 and 5.0 millimeters, depending on the lighting. The younger you are, the larger your pupils tend to be.

A salivary gland stone -- also called salivary duct stone -- is a calcified structure that may form inside a salivary gland or duct. It can block the flow of saliva into the mouth. The majority of stones affect the submandibular glands located at the floor of the mouth.

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The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.

CPAP is a treatment that uses mild air pressure to keep your breathing airways open. It involves using a CPAP machine that includes a mask or other device that fits over your nose or your nose and mouth, straps to position the mask, a tube that connects the mask to the machine’s motor, and a motor that blows air into the tube. CPAP is used to treat sleep-related breathing disorders including sleep apnea. It also may be used to treat preterm infants who have underdeveloped lungs.

Acute respiratory distress syndrome is characterised by rapid onset dyspnea, bilateral infiltrates on chest x-ray and respiratory failure. This may be due to conditions which directly affect the lung such as pneumonia, aspiration and near drowning. It may also be due to indirect lung injury, as in conditions like sepsis, pancreatitis, trauma and poisoning. The diagnostic criteria of ARDS, often described as the Berlin criteria is discussed in this presentation along with various management aspects of ARDS including ventilation strategies and use of antibiotics and diuretics. Finally prognostic features and alternative strategies are also discussed.

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Giant cell arteritis is an inflammation of the lining of arteries. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis. Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. If left untreated, it can lead to stroke or blindness. Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and may prevent loss of vision. You'll likely begin to feel better within days of starting treatment. But even with treatment, relapses are common. You'll need to visit your doctor regularly for checkups and treatment of any side effects from taking corticosteroids.

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This video: Rhomboid muscle strain and spasm causes upper back pain between the shoulder blades. Some patients describe the muscle spasms and discomfort as knots in the back. Early treatment is important to speed healing and recovery. Ice therapy for the first few days followed by moist heat can help relieve symptoms.Oct 12, 2015

Demonstration of simple interrupted suturing technique for laceration repair.

Urological surgeons have become proficient at performing complex pelvic urological procedures, such as radical prostatectomy, using the laparoscopic approach. Declan Murphy and Daniel Moon share their experience of four less common procedures they have performed recently using laparoscopic techniques. These include: excision of a urachal cyst; partial cystectomy for endometriosis (combined endoscopic-laparoscopic approach); repair of an intra-peritoneal bladder rupture; and repair of a ureteric injury (combined endoscopic-laparoscopic approach).

New Minimally Invasive Procedure with No Pain or Downtime… From Dr. Michael Goodman, Caring For Women Wellness Center Laser Vaginal Tightening for Improved Sexual Pleasure and Relief from Minimal Urinary Incontinence Laser Vaginal Therapy for reversing Vaginal Atrophy (Good also for Breast Cancer Survivors with Vaginal Atrophy)

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Examination of Varicose Veins

Anatomy of The Ear

Visit http://www.vipmedicalgroup.com or call us at (877) 739-5306 for more information on minimally invasive pain management treatments. At VIP Centers, we offer pain management services such as treatment for neck pain, back pain, shoulder pain, hip pain, knee pain, or any other joint pain related injury. Our highly skilled team of doctors are Harvard trained and Board Certified. They have a wealth of experience in pain medicine, sports medicine, bone and joint inflammation. The procedures we offer do not require a hospital stay, general anesthesia, or painful surgery. This means you can return to your normal activities immediately after your treatment.