ow does a perforation of the eardrum occur? There are many ways an eardrum perforation can occur. An infection behind the eardrum in the middle ear may cause a rupture of the eardrum. Trauma to the ear may result from an object entering the ear canal and puncturing the eardrum. A traumatic blow to the ear with a cupped hand can rupture the eardrum. Hot welding slag can burn a hole through the eardrum. After a ventilation tube has been extruded or is removed, the opening usually closes; in some cases a permanent opening of the eardrum may occur. Chronic ear problems such as deep retraction pockets and cholesteatoma​​ can weaken and erode the eardrum, resulting in a defect or perforation.

Multiple sclerosis causes many different symptoms, including vision loss, pain, fatigue, and impaired coordination. The symptoms, severity, and duration can vary from person to person. Some people may be symptom free most of their lives, while others can have severe chronic symptoms that never go away. Physical therapy and medications that suppress the immune system can help with symptoms and slow disease progression.

Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT. Clinical evaluation alone cannot be relied on for patient management, but when carefully performed, it remains useful in determining the need for additional testing (like D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography) [1][2].

Multiple sclerosis causes many different symptoms, including vision loss, pain, fatigue, and impaired coordination. The symptoms, severity, and duration can vary from person to person. Some people may be symptom free most of their lives, while others can have severe chronic symptoms that never go away.

Hirschsprung's (HIRSH-sproongz) disease is a condition that affects the large intestine (colon) and causes problems with passing stool. The condition is present at birth (congenital) as a result of missing nerve cells in the muscles of the baby's colon. A newborn who has Hirschsprung's disease usually can't have a bowel movement in the days after birth. In mild cases, the condition might not be detected until later in childhood. Uncommonly, Hirschsprung's disease is first diagnosed in adults.

A bone-anchored hearing aid (BAHA) or bone-anchored hearing device,is a type of hearing aid based on bone conduction. It is primarily suited for people who have conductive hearing losses, unilateral hearing loss, single-sided deafness and people with mixed hearing losses who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids. They are more expensive than conventional hearing aids, and their placement involves invasive surgery which carries a risk of complications, although when complications do occur, they are usually minor. Two of the causes of hearing loss are lack of function in the inner ear(cochlea) and when the sound has problems in reaching the nerve cells of the inner ear. Example of the first include age-related hearing loss and hearing loss due to noise exposure. A patient born without external ear canals is an example of the latter for which a conventional hearing aid with a mould in the ear canal opening would not be effective. Some with this condition have normal inner ear function, as the external ear canal and the inner ear are developed at different stages during pregnancy. With normal inner anatomy, sound conducted by the skull bone improves hearing.

Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Most often seen in older people with atherosclerosis (hardening of the arteries), renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage.

Small cell lung cancer, which occurs almost exclusively in smokers, is a malignancy characterised by rapid doubling time, high growth fraction and widespread metastasis at presentation. In this presentation, we will briefly discuss the classification of pulmonary Neuro-endocrine tumours by the World Health Organisation followed by a detailed discussion of the clinical features, lab evaluation and management of SCLC, both limited and extended stage. The frontline therapy in small cell lung cancer is etoposide and cisplatin along with thoracic radiotherapy and prophylactic cranial irradiation in patients who have a good response to therapy. Hyperfractionation of radiotherapy may provide some benefit but is also associated with increase incidence of complications. Newer agents for SCLC include Vandetanib and immunotherapy molecules, such as Iplimumab and nivolumab.

Histology of Aorta

This 38 year old woman has increasingly intractable RUQ pain after cholecystectomy done one year prior. LFTs and pancreatic enzymes have been normal, and ducts are non-dilated, thus she is a Type III possible SOD patient. Initial goal is to define course of pancreatic duct for manometry. 5-4-3 Co...ntour catheter (Boston Scientific) is used to perform the pancreatogram which shows a small straight distal duct. The aspirating triple lumen manometry catheter (Wilson Cook) is used to cannulate the pancreatic duct, with continuous aspiration of fluid once the duct is entered. Careful stationed pullthrough manometry shows markedly abnormal basal pressures in both leads in the pancreatic sphincter. Plan is dual pancreatic and biliary sphincterotomy. Biliary manometry will not now change our plan therefore is omitted. Our first goal is to access the pancreatic duct so we can guarantee wire access for placement of a small caliber pancreatic stent which is critical for safety. Contrast is injected as the 0.018in Roadrunner wire (Wilson Cook) is advanced in order to outline the course of main duct. A separate biliary orifice is clearly seen, unusual in SOD patients. A soft 4Fr 3cm single inner flange pancreatic stent (Hobbs Medical) is placed. We did not want to use our typical 9cm long unflanged stent as even a 3 or 4 French stent might be traumatic to the tiny caliber of this duct out in the body of the gland. Next the bile duct is cannulated with a papillotome (Autotome 39, Boston Scientific), showing a small perhaps 6mm bile duct. Biliary sphincterotomy is performed in very careful stepwise fashion as landmarks are unclear and perforation is higher risk in small duct SOD patients. On the other hand, inadequate sphincterotomies offer limited chance of symptom relief. You can see here a patulous sphincterotomy. Next a pancreatic sphincterotomy is performed with the needle knife (Boston Scientific) over the pancreatic stent. Again this is performed cautiously due to the small size of the pancreatic duct. We are reaching along the stent and cutting the fibers deeply. This is a limited pancreatic sphincterotomy due to small pancreatic duct size, and concern for scarring of the pancreatic duct. It is important to document passage of the stent by xray or remove it endoscopically with two weeks or so. We and many other specialized centers perform dual sphincterotomies at the first ERCP in all SOD patients with abnormal pancreatic manometry and frequent or intractable symptoms based on the belief that response rates are better than for biliary sphincterotomy alone.

What is a Whipple procedure?
Also called a pancreaticoduodenectomy, the Whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. The Whipple procedure involves removing the cancerous parts of the pancreas, duodenum, common bile duct, and if required, part of the stomach.

Anatomy of The Peritoneal Cavity

Histology of Spongy Bone

Histology of Inner Ear 2

This video demonstrates tongue piercing procedure done OUTSIDE a clinical setting

Flexible bronchoscopy is a procedure that allows a clinician to examine the breathing passages (airways) of the lungs (figure 1). Flexible bronchoscopy can be either a diagnostic procedure (to find out more about a possible problem) or a therapeutic procedure (to try to treat an existing problem or condition).

This animated video covers statins, fibrates, niacin, bile resins, and ezetimibe. We will discuss mechanisms of action, which part of the lipid profile is affected by each drug, and common side effects.