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腹腔镜右斜疝修补术+胆囊切除术

Breast reconstruction 3D Animation
on Friday, December 17, 2010




The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, patients with significant medical comorbidities (high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. Patients expected to receive external beam radiation as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries. Outcomes based research on quality of life improvements and psychosocial benefits associated with breast reconstruction served as the stimulus in the United States for the 1998 Women's Health and Cancer Rights Act which mandated health care payer coverage for breast and nipple reconstruction, contralateral procedures to achieve symmetry, and treatment for the sequelae of mastectomy. This was followed in 2001 by additional legislation imposing penalties on noncompliant insurers. Similar provisions for coverage exist in most countries worldwide through national health care programs. There are many methods for breast reconstruction. The two most common are: * Tissue Expander - Breast implants This is the most common technique used in worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction. o In a process that can take weeks or months, saline solution is percutaneously injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size. * Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected. o The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant. o Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEP flaps. Both use the abdominal tissue between the umbilicus and the

Most intact aortic aneurysms do not produce symptoms. As they enlarge, symptoms such as abdominal pain and back pain may develop. Compression of nerve roots may cause leg pain or numbness. Untreated, aneurysms tend to become progressively larger, although the rate of enlargement is unpredictable for any individual. Rarely, clotted blood which lines most aortic aneurysms can break off and result in an embolus. They may be found on physical examination. Medical imaging is necessary to confirm the diagnosis. Symptoms may include: anxiety or feeling of stress; nausea and vomiting; clammy skin; rapid heart rate. In patients presenting with aneurysm of the arch of the aorta, a common symptom is a hoarse voice as the left recurrent laryngeal nerve (a branch of the vagus nerve) is stretched. This is due to the recurrent laryngeal nerve winding around the arch of the aorta. If an aneurysm occurs in this location, the arch of the aorta will swell, hence stretching the left recurrent laryngeal nerve. The patient therefore has a hoarse voice as the recurrent laryngeal nerve allows function and sensation in the voicebox. Abdominal aortic aneurysms, hereafter referred to as AAAs, are the most common type of aortic aneurysm. One reason for this is that elastin, the principal load-bearing protein present in the wall of the aorta, is reduced in the abdominal aorta as compared to the thoracic aorta (nearer the heart). Another is that the abdominal aorta does not possess vasa vasorum, hindering repair. Most are true aneurysms that involve all three layers (tunica intima, tunica media and tunica adventitia), and are generally asymptomatic before rupture. The most common sign for the aortic aneuysm is the Erythema nodosum also known as leg lesions typically found near the ankle area. The prevalence of AAAs increases with age, with an average age of 65–70 at the time of diagnosis. AAAs have been attributed to atherosclerosis, though other factors are involved in their formation. An AAA may remain asymptomatic indefinitely. There is a large risk of rupture once the size has reached 5 cm, though some AAAs may swell to over 15 cm in diameter before rupturing. Before rupture, an AAA may present as a large, pulsatile mass above the umbilicus. A bruit may be heard from the turbulent flow in a severe atherosclerotic aneurysm or if thrombosis occurs. Unfortunately, however, rupture is usually the first hint of AAA. Once an aneurysm has ruptured, it presents with a classic pain-hypotension-mass triad. The pain is classically reported in the abdomen, back or flank. It is usually acute, severe and constant, and may radiate through the abdomen to the back. The diagnosis of an abdominal aortic aneurysm can be confirmed at the bedside by the use of ultrasound. Rupture could be indicated by the presence of free fluid in potential abdominal spaces, such as Morison's pouch, the splenorenal space (between the spleen and left kidney), subdiaphragmatic spaces (underneath the diaphragm) and peri-vesical spaces. A contrast-enhanced abdominal CT scan is needed for confirmation. Only 10–25% of patients survive rupture due to large pre- and post-operative mortality. Annual mortality from ruptured abdominal aneurysms in the United States alone is about 15,000. Another important complication of AAA is formation of a thrombus in the aneurysm.

Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus (see image below), is one of the more common congenital heart defects.

USMLE Step 2 CS - Ankle Pain -This is just preview video. To get full access please visit our website : www.usmletutoring.com

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Inguinal and femoral hernias need not be confusing. In this tutorial you will be presented with colourful diagrams and animations to cover important areas, such as the anatomy of what goes on in these two conditions, the examination of groin hernias and a simple explanation of the difference between incarceration, strangulation and obstruction, in and amongst a systematic look at the clinical topic. More tutorials at www.boxmedicine.com.

breast self examination

METHODS:
Previously existing methods are characterized by unpleasant scars that, despite surgeons promises, remain for life.
Incisions are:

- around the areola (Round block) leading to a flat areola, often unpleasant hypertophic skars, skin rippling.
- inverted T (around the areola, vertically down and in the fold under the breast).

- Vertical (around the areola and vertically down). Due to the extess skin, incisions often turn into inverted L or T. Rearrangement of glandular tissue and skin changes the shape of the breasts and may be different from expectations. Scars worry patients and sometimes cause disturbances in the relationship with their partner.

- No scars. The "Serdev Suture" lifting technique for breast lifting without scars (only points - needle perforations in the skin) is created by the Bulgarian cosmetic surgeon Prof. Dr. Nikolay Serdev. It is a novelty that had changed the cosmetic surgery world in the last 10-14 years for young patients. The technique is especially important in Asia and Latin America, for Asians, African-Americans, Indians, and others who form keloids and lumpy scars after operations.

The Serdev suture method can achieve lift upto and over 14 centimeters and is most suitable for the following types of breasts:
- not very heavy full breasts.
- in the presence of subpectoral implants with subsequent drooping of the breasts after childbirth and lactation.
- empty and loose breasts after childbirth and breastfeeding. In such cases this technique is combined with subpectoral implants. In sagging breasts implants should not be placed in the skin over the pectoral muscles, because thus will lead to even more drooping. Therefore, breast lift requires breast fixation to the level of the pectoral muscle (the normal position in young women), and then placement of appropriate implants under the muscle, to hold them in the appropriated position.
- in drooping breasts after subglandular augmentation (over the muscle). In such cases, patients should not wait until the skin elongation becomes visible. The implants should be removed, the capsule removed - a difficult but a necessary operation, preventing postop seromas and infection. Implants should be placed under the pectoralis muscle to wear them. Patients should orient the cosmetic surgeon at what level they want the nipples - in the middle of the implant, higher or lower.
Implants should be generally replaced - below the muscle implants should be smooth, move naturally without hurting the muscle.

Because of modern anesthetics and new methods without trauma, pain and swelling after surgery are not significant. In 3-4 days, patients can return to social life, even the next day, but it is preferable to rest for 2-3 days.

Exercises with the arms and weight lifting is prohibited for a month and a half.

Due to lack of scars, the breast lift using the Serdev sutures can be repeated to maintain the aesthetic appearence of the breasts even in advanced age.

Gigantomastia i.e. very large, very heavy and drooping breasts can not be operated in this manner, because of gravity and overskin.

Early mastopexy using Serdev sutures is recommended before too much changes in the tissues. If late, more and more complex interventions are required.

"A lot of people are opting for various breast procedures and one of the most common among them is “mastopexy”. This is the surgery that involved uplifting of sagging breasts and, in certain cases, repositioning of the nipple and areola in order to restore normality and beauty. The excess skin is removed and firmness is provided to the breasts. Though mastopexy can be done as a stand alone surgery, many people combine it with breast augmentation which involves inserting implants inside the b

In this medical video: This 72-year-old patient was unable to resist blinking when we tapped on the glabella. This is the glabellar reflex or Myerson's sign . It is often an early sign of Parkinson's disease, but can also be seen in early dementia as well as other progressive neurologic illness. Note the left (i.e., asymmetrical) hand resting tremor.

Appendicitis is caused by an infected appendix and requires appendectomy surgery. Here's more information on appendicitis and appendectomy.

HD Hip Replacement Surgery

Watch that video to know the Causes of Pain During Intercourse

LAPAROSCOPIC END TO END URETERAL ANASTOMOSIS

Thyroid Exam Physical Exam

watch to see the Large Clot in the heart

Mode of action of NNRTIs

As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due to a build-up of fluid (oedema) swelling in your abdomen, due to a build-up of fluid known as ascites.