Top videos
Hypothyroidism and Hyperthyroidism Symptoms: Swollen Neck. A goiter is an enlargement of the thyroid gland. As shown here, an enlarged thyroid can be seen as a swelling in the front of the neck. A goiter can occur with either hypothyroidism or hyperthyroidism
In Almost All instances of Isolated Aortic Valve Disease, the Open Heart Procedure for Replacing the Aortic Valve can be performed with a Minimally-Invasive approach (Mini Sternotomy) the procedure is Safe,Easy and offers the patient Much Less Pain and a cosmetic Scar.
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.
Vanderbilt Medical Center neurosurgeons and neurologists will be online demonstrating their 4-stage innovative technique used for Deep Brain Stimulation (DBS). Deep brain stimulation therapy utilizes an implantable neuro-stimulator to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia.
trigeminal neuralgia can be caused by a vessel loop nearby the entry zone of the trigeminal nerve at the brainstem. a vessel loop is mobilized and transposed and secured with a teflon paddy. the paddy is fixed with tissucol , a fibrin glue without evident neurotoxicity. the long term result of the jannetta procedure regarding pain control is excellent
We noticed a blue-line in the endometrial cavity between the tubal ostiae after injection of methylene blue (to determine tubal patency). We have seen this “blue-line” even in cases with normal or unicornuate uterus and/or in cases with patent or occluded fallopian tubes(Picture 1). So the be...st explanation of this finding may be the high speed jet or turbulence of dye in the top or the deepest part of endometrial cavity. We simply postulated that the zone which holds the methylene blue is the zone where the flashing dye strikes vertically over there and the dye penatrates into the endometrial epithelium and glands. We used this line as a guide that shows midline during operative hysteroscopy ( especially in cases with septate uterus) and we don’t ecxatly know reason why it occurs. It is necessary to perform histologic, molecular or clinical studies on this subject. It may have a multifactorial aetiology. We performed a prospective case control study and will publish it soon after when we get the results.