Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age. Many things can cause an ingrown toenail, including: cutting toenails incorrectly (Cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin.) irregular, curved toenails footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly poor posture improper foot hygiene, such as not keeping your feet clean or dry genetic predisposition

Surgical technique: A 3cm skin incision under spinal or general anesthesia, depending on the patients’ preference, starts half way the line between the superior anterior iliac spine towards the midline in a 30° angle to the pubic tubercle. Scarpa’s fascia is opened as well as the external obliq...ue aponeurosis. By using this skin line incision the internal ring will be immediately visualized. Although it is important to look for both direct and indirect hernias evaluating the groin, we do not taper the cord and directly evaluate the ring for indirect hernias. In case of an indirect hernia the sac is reduced or resected according to the preference of the surgeon and the preperitoneal space is entered bluntly through the dilated internal ring. In case of a direct hernia the approach slightly differs. One could prefer to open the transversalis fascia through the internal ring over a few centimeters or you can open the fascia more medially, at the site of the direct hernia. As primary point of concern the epigastric vessels should be identified and retracted softly upwards. Then a gauze can be introduced into the preperitoneal space and by doing so most of the space needed medially will be created. Then one can already palpate Cooper’s ligament and the pubic bone. Laterally to the internal ring more digital dissection is needed to create just the appropriate space for the mesh. By placing the mesh it is important not to introduce the mesh too medially. Laterally of the internal ring an adequate overlap of the mesh is necessary, especially in indirect hernias. No splitting of the mesh seems necessary. The patient will be asked to strain and push on the ring to control its place and to check adequate spreading of the mesh to cover the whole myopectineum of Fruchaud. One single stitch of vicryl 3/0 is placed taking both the fascia transversalis and the mesh.

Device that keeps a donor heart beating

Watch that video to know How to get Pregnant Fast

Watch that video of Horrifying Creatures Found Living Inside Human Body

Bone Remodeling and Modeling

Acute intermittent porphyria (AIP) is a rare autosomal dominant metabolic disorder affecting the production of heme, the oxygen-binding prosthetic group of hemoglobin. It is characterized by a deficiency of the enzyme porphobilinogen deaminase.

Watch that video to know How to Stop Arterial Bleeding

Pancreatic pseudocyst drainage was the first therapeutic application of EUS. The cyst is punctured under ultrasound guidance, contrast injected, and a guidewire inserted. Initial dilation to 8mm is performed over the wire The EUS scope is then exchanged over the wire for a forward viewing endoscope.... A second dilation to 18mm is performed. This enables entry of the endoscope into the cyst perform cystoscopy, debridement if necessary, and insertion of multiple large bore double pigtail stents. The curved linear array-or CLA—echoendoscope has oblique viewing optics located proximal to an oblique scanning transducer. The accessory exits from the shaft of the echoendoscope at an ablique angle, adjustable between 15 and 30 degrees. There are several technical limitations using this echoendoscope. The oblique angle of exit results in a weekend transfer of force when advancing the accessory, difficult deployment of larger bore accessories, and in instrument tunneling effect relative to the bowel wall. There is the potential loss of access during endoscope exchange. A novel CLA echoendoscope was developed by the Olympus Corporation that shifts the orientation of endoscopic and ultrasound views from oblique to forward viewing. The channel is therapeutic at 3.7mm Note that the working channel is located adjacent to the ultrasound transducer at the endoscope tip. The accessory exits the working channel in the axis of the shaft. Shown here are balloon inflation and deployment of a Dormia basket. We report on the use of the prototype forward viewing echoendoscope in six consecutive patients who were referred for pancreatic cyst drainage. Here you see endoscopic view-indistinguisable from that of a gastroscope-showing a bulge where the cyst impinges against the posterior gastric wall. Power Doppler is switched on and highlights multiple vessels interposed in the wall This allows selection of a safe vessel-free window for a cyst puncture A 19 G needle is advanced into the cyst lumen. A sample of contents is aspirated for fluid analysis. A guidewire under ultrasound guidance into the cyst. An 18mm balloon is coaxially thread over the wire and advanced across the cyst wall, Note that resistance is encountered, but the forward transfer of force overcome this. The dilation is performed under forward viewing endoscopuc and ultrasound guidance. As the balloon is maximally inflated we see the cystgastrostomy open up. The balloon is then deflated while simultaneously advancing the scope into the cyst cavity. Cystoscopy isnow performed showing the cyst contents to be filled with pasty wall-adherent necroses. Pulsed power Doppler is switched on we can see and hear arterial flow vessels within the wall of the cyst. This identifies sensitive areas at bleeding risk when performing debridement In this case vigorous water jet irrigation is performed through an accessory water irrigation channel built into the echoendoscope. This issued to clear nonadherent debris. Our experience has shown that it is not necessary to actively remove wall-adherent debris using extraction tools as such Dormia or Roth net basket to achieve cyst resolution. Three large bore 10 Fr double pigtail stents are now inserted into the cyst under direct endoscopic guidance. The first stent is delivered over a guide catheter. The second stent. And the third stent All three stents are deployed. Finally, a nasocystic catheter is inserted for maintenance irrigation. In another patient we used the Cook Cystome to perform cystgastrostomy. We have found the Cystotome easy to delivery through the forward viewing echoendoscope. As shown, we advance the Cystotome into the cyst while applying diathermy. This is performed under and endoscopic guidance, entering the cyst at a near perpendicular orientation. After entry, the Cystotome is removed and cyst fluid gushes from the cystagastrotomy site.

We herein describe endoscopic treatment of symptomatic pancreatic pseudocyst with significant necrosis and a fistula. Fifty eight year old man had presented to us with a large pseudocyst following an episode of acute pancreatitis. He was complaining of significant abdominal pain for two months. A... CT scan abdominal had revealed a large retro-gastric pseudocyst with necrosis and portal venous thrombosis. An upper GI endoscopy had revealed small linear fundal varcies. Endoscopic as well as surgical treatment for the cyst was discussed with the patient. Patient wished not to undergo surgical treatment and therefore endoscopic treatment was selected after a proper consent. EUS was performed to see for the interposed vessel prior to the pseudocyst puncture. Needle knife puncture was made and a guide wire was passed in the pseudocyst cavity. After confirming the wire placement in the cyst, the tract was dilated up to 20 mms using a CRE balloon. Fluid from the cyst was emptied out in the stomach. An ERCP scope was passed in to the cyst cavity, which revealed a significant necrotic material (much more than what the CT scan had revealed). All the free lying necrotic material was taken out with the help of a snare and a dormia basket. A lot of necrotic was stuck to the cyst wall, which was removed with the help of water jet, mechanical scooping and cutting through using a needle knife papillotome. Three 10 fr. Pigtail stents were placed at the end of the procedure. Further necrosectomy was carried out on alternate days for three more sessions. Dilation was required prior to each session three pigtail trans-gastric stents were placed at the end of each session. Single stent was kept in situ during each procedure to guide the path (the position of the stoma changed dramatically once the cyst was empty). During the last lesion (session four), a pancreatogram was taken. It revealed a mildly dilated CBD in the head, normally duct in the proximal body with a leak from the distal body, and contrast was seen going in to the pseudocyst cavity. The duct could not be opacified distally. A 7 fr. 15 cms stent was placed trans-papillary. When the cyst cavity was reentered through trans-gastric route, the trans-papillary pancreatic stent was clearly visible with soft necrotic material around it. In fact, the stent guided further necrosis removal. It also helped in diverting the pancreatic juice to the duodenum rather than in the pseudocyst cavity. Patient was discharged after this session and was followed up regularly. A CT scan was obtained after three months, which revealed a complete resolution of the necrosis and pseudocyst. There was a possibility of a persistent fistula after the removal of trans-papillary stent and a recurrence of the pseudocyst. Fistula closure with cyanoacrylate glue is well described in the literature. The procedure can have obvious complications secondary to accidental blockage of the main pancreatic duct. So, we thought it prudent to use a safer alternative to treat the condition. We removed the longer pancreatic stent and replaced it with a shorter pancreatic stent occupying only the head region. The patient was followed up after a month; sonography of the abdomen did not reveal any recurrence of the pseudocyst. All the stents were removed at this examination.

The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a colonic diverticula. Diverticulosis is a common, acquired, age-related occurrence affecting over 50% of the... western adult population over the age of 50. It is seen rarely in Africa and Asia where the dietary fiber content is traditionally higher. Thus most investigators feel that low fiber diets are related to the development of this condition. Ironically, colonic diverticula are not true diverticula but rather pseudodiverticula in that the sac includes layers of the mucosa and submucosa that push through rather than include the outer muscular layer. As with the small bowel the colon has an inner circular muscular layer, but the outer longitudinal layer is composed of three bands of muscle that run the length of the colon known as teniae. Diverticula occur in rows between the mesenteric and two antimesenteric teniae where the colonic wall is further weakened by the defect caused by the perforating vasa recti artery which supplies the colonic mucosa. Occasionally, the anatomic propensity of diverticula to form in rows is quite apparent as seen when this clip is replayed in slow motion. Most often, however, the arrangement of the diverticula appears random due to the angulation of the bowel and thickening of the semi lunar folds. The conditions that cause these pulsion diverticula are not know with certainty but may include high intrahaustral pressures, muscular hypertrophy, and age related alterations in collagen cross linking. Diverticula can bleed or can abscess and perforate. The incidence of diverticulitis or diverticular bleeding is in the range of 1:1,000 patients with diverticulosis.

If this is the first time visiting us, make sure to subscribe to our channel here: https://bit.ly/2yXNBYp

What does a fistula for dialysis look like?
A fistula for dialysis is a surgical connection between a vein and an artery.
In this video, I will show you a real fistula and how we should evaluate it before a dialysis connection.

Additional videos:
💉How to properly cannulate a fistula: https://youtu.be/IqoHnzFyhJQ
💉 What is a fistula for dialysis treatment: https://youtu.be/B5EEf-MklFk
💉 The 10-second assessment for fistulas: https://youtu.be/Uqo0LhjZSI8

💉 If you would like to be trained as a dialysis professional focused on offering quality of care to renal patients, visit our program details here: https://utopiahcc.com/hemodialysis-technician/

For nursing and technician schools😷 🩺 🎓, we can offer a special renal failure class to your students. For inquiries please contact us: info@utopiahcc.com

Where to find us:
Facebook: https://www.facebook.com/utopiahealth​
Email: info@utopiahcc.com
Website: utopiahcc.com

🤔 Looking for renal and dialysis continuing education for your certification renewal? Check out our CE package where you will get a little over 40 contact hours for a small price and receive your certificates immediately.
Here's the link: https://bit.ly/3dbPvDZ​

Want to watch *Free Dialysis Training Videos*?
https://utopiahcc.com/free-dia....lysis-video-training
__________________________________________________________
Additional resources:

What Does a Healthy AV Fistula Look Like? | Azura Vascular ...
www.azuravascularcare.com infodialysisaccess healt...
Jul 17, 2018 — An AV fistula is a surgically-created permanent access located under the skin, making a direct connection between a vein and an artery. An AV fistula is typically created in the non-dominant arm. If the veins in your arm are not large or healthy enough to support a fistula, it may be created in your leg.

Preparing for Dialysis (AV Fistula) Fact Sheets Yale ...
www.yalemedicine.org › conditions › preparing-dialysi...
To undergo dialysis, patients need a surgical procedure to create an access point for the dialysis machine. An AV fistula is the most common access point.

Vascular Access for Hemodialysis - Life Options
lifeoptions.org living-with-kidney-failure vascular-a...
Jump to How a Catheter Looks and Feels — This makes a pattern that looks a bit like a rope ladder. The next best way—for fistulas ONLY—is the “Buttonhole ...
‎Fistula or Graft Surgery · ‎Needle Fear · ‎How a Fistula or Graft Looks...

Taking Care of Your Fistula - DaVita
www.davita.com dialysis preparing-for-dialysis › ta...
An arteriovenous (AV) fistula is a type of access used for hemodialysis. ... access because it utilizes the patient's own vessels and does not require permanent placement of foreign materials such ... Look for redness or swelling around the fistula area. ... This sound may change from a whooshing noise to a whistle-like sound.

Vascular Access for Hemodialysis - Department of Surgery
surgery.ucsf.edu conditions--procedures vascular-ac...
The patient does not need anesthesia for this procedure. ... A vascular surgeon performs AV graft surgery, much like AV fistula surgery, in an outpatient center or ...

Frequently Asked Questions about Dialysis Access Surgery ...
www.bidmc.org transplant-institute frequently-aske...
Dialysis access surgery creates the vascular opening so a needle can be inserted for ... fluid and to correct electrolytes like potassium, sodium, phosphate and calcium, to name a few. ... Where are AV fistulas located and how long do they last?

Fistula and Graft Placement (Eric K. Peden, MD) - YouTube
www.youtube.com watch
Mar 28, 2016 — ... Bootcamp 2015 August 14 - 16, 2015 "Dialysis Access" Fistula and Graft Placement (Eric K. Peden, MD) DICET@Houstonmethodist.org.

Watch that video of Creation and Pathway of Sperm During Ejaculation

Best facial cosmetic surgeons Best facial plastic surgeon Browlift Charlotte endoscopic brow lift Charlotte’s top facial plastic surgeon Facial plastic surgeons Facial plastic surgery Face lifts Facial mini-tuck Lip enhancement Lip augmentation Nose job Nose job cost Nose surgery Rhinoplasty Rhinoplasty Expert Rhinoplasty and teens Revision rhinoplasty Teen Rhinoplasty, Charlotte Teen Rhinoplasty, North Carolina Teen Rhinoplasty Expert Top rhinoplasty surgeons Best Charlotte rhinoplasty surgeons: C local listings,#8, 9 organic listings Most experienced rhinoplasty surgeons

Removal of adrenal gland

Histology of Vocal Cords

For open hernia repair surgery, a single long incision is made in the groin. If the hernia is bulging out of the abdominal wall (a direct hernia), the bulge is pushed back into place. If the hernia is going down the inguinal canal (indirect), the hernia sac is either pushed back or tied off and removed.

Tie

Histology of Secretory Endometrium