Throughout the body, there are several points at which blood vessels unite. The junctions are termed anastomoses. In the simplest sense, an anastomosis is any connection (made surgically or occurring naturally) between tube-like structures. Naturally occurring arterial anastomoses provide an alternative blood supply to target areas in cases where the primary arterial pathway is obstructed. They are most abundant in regions of the body where the blood supply may can be easily damaged or blocked (such as the joints or intestines). This article focuses on the arterial anastomotic networks of the upper limb.

Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Although relatively rare, it is a potentially life-threatening condition. Broadly, AMI may be classified as either arterial or venous. AMI as arterial disease may be subdivided into nonocclusive mesenteric ischemia (NOMI) and occlusive mesenteric arterial ischemia (OMAI); OMAI may be further subdivided into acute mesenteric arterial embolism (AMAE) and acute mesenteric arterial thrombosis (AMAT). AMI as venous disease takes the form of mesenteric venous thrombosis (MVT).

Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions

Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in your hands and feet and may eventually affect larger areas of your arms and legs. Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb is sometimes necessary.

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.

This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway.

A cervical herniated disc may be treated by removing part of the disc through a small incision (microdiscectomy). If this is done from the back (posteriorly) rather than from the front of the neck, a spinal fusion is not necessary. The alternative is an anterior cervical discectomy and fusion procedure.

Compartment syndrome can develop in the foot following crush injury or closed fracture. Following some critical threshold of bleeding and/or swelling into the fixed space compartments, arterial pulse pressure is insufficient to overcome the osmotic tissue pressure gradient, leading to cell death. The complicating factor is related to the magnitude of the force of the crush injury. The amount of swelling or bleeding has to be sufficient to impair arterial inflow, while not being of sufficient magnitude to produce an open injury, which decompresses the pressure within the affected compartments. When the injury is open, we then attribute the late disability primarily to the crushing injury to the involved muscles.

Educational video describing injection techniques for painful conditions of the foot and ankle.

Biceps tenodesis is a common procedure performed for tendinopathy of the long head of the biceps brachii (LHB). Indications include partial-thickness LHB tear, tendon subluxation with or without subscapularis tear, and failed conservative management of bicipital tenosynovitis. Biceps tenodesis may also be performed for superior labrum anterior to posterior tears.

Diabetic ketoacidosis is an acute complication of uncontrolled hyperglycaemia characterised by high anion gap metabolic acidosis, dehydration and other metabolic abnormalities. Upto half of patients with Type 1 diabetes mellitus may have DKA. The incidence in T2DM is also rising. Precipitants include acute illness such as myocardial infarction, trauma and infection. Paitents of diabetic ketoacidosis may present with vomiting, pain abdomen and lethargy. Mental obtundation may also be present. Management of diabetic ketoacidosis revolves around administration of IV normal saline, insulin, replacement of potassium with frequent monitoring of sugars and electrolytes.

A diagnosis of sarcoidosis is established on the basis of compatible clinical and radiologic findings and histologic evidence of the presence of noncaseous epithelioid cell granulomas in one or more organs and the absence of causative organisms or particulates (16). Granulomas of known causes and local sarcoidlike reactions must be excluded. Granulomatous lesions may result from many conditions, including tuberculosis, berylliosis, leprosy, hypersensitivity pneumonitis, Crohn disease, primary biliary cirrhosis, and fungal disease. Moreover, local sarcoidlike reactions may be seen in lymph nodes that drain a neoplasm or a site of chronic inflammation (19). Such reactions also have been seen in patients who have undergone chemotherapy and radiation therapy (23). If biopsy of lymph nodes or pulmonary or pleural tissue is necessary for diagnosis, one of three techniques may be used: transbronchial biopsy, CT-guided biopsy, or surgical biopsy (24). The use of a surgical technique may be warranted when the results of biopsy with another procedure are not definitive and biopsy of mediastinal lymph nodes, lung, or both is required. This can generally be done with minimally invasive procedures, such as cervical mediastinoscopy, the Chamberlain procedure (a parasternal minithoracotomy for biopsy of the aortopulmonary window or para-aortic nodes), or video-assisted thoracoscopic surgical biopsy (25).

Hepatitis D, also known as the delta virus, is an infection that causes the liver to become inflamed. This swelling can impair liver function and cause long-term liver problems, including liver scarring and cancer. The condition is caused by the hepatitis D virus (HDV). This virus is rare in the United States, but it’s fairly common in the following regions: South America West Africa Russia Pacific islands Central Asia the Mediterranean

The Irish Thoracic Society explain the Active Cycle of Breathing Technique for patients with acute and chronic respiratory illnesses and diseases and respiratory distress

These air sacs make up most of the lung tissue. Lung diseases affecting the alveoli include: Pneumonia: An infection of the alveoli, usually by bacteria. Tuberculosis: A slowly progressive pneumonia caused by the bacteria Mycobacterium tuberculosis. Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung. Some of the most common are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension.

The Irish Thoracic Society speak about the importance of Exercise with Chronic or Acute Respiratory illnesses/ Diseases and respiratory distress

This video demonstrates why ears become clogged and why ear popping helps. The video also explains why ear popping may become difficult resulting in a persistent clogged or muffled ear especially after an ear infection.

Tick Twister is the best way to remove ticks.