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Dr. Shaun Kunisaki is an Associate Professor of Surgery at The Johns Hopkins University and Associate Chief of Strategy and Integration in the Division of General Pediatric Surgery at the Johns Hopkins Children's Center. His clinical practice spans the full breadth of pediatric general surgery, but he is recognized both regionally and nationally for this expertise in complex thoracic surgical problems in the fetus and young child. As Director of Pediatric Esophageal Surgery, he specializes in the management of long-gap esophageal atresia. In this role within the Johns Hopkins Children Center Fetal Program, he helps counsel parents with pregnancies complicated by fetal anomalies.
Learn more about Dr. Kunisaki at https://www.hopkinsmedicine.or....g/profiles/results/d
The Knee Exam
Observation:
1. Make sure that both knees are fully exposed. The patient should be in either a gown or shorts. Rolled up pant legs do not provide good exposure!
2. Watch the patient walk. Do they limp or appear to be in pain? When standing, is there evidence of bowing (varus) or knock-kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a common cause of bowing. Varus Knee Deformity, more marked on the left leg. 3. Make note of any scars or asymmetry. Chronic/progressive damage, as in degenerative joint disease, may lead to abnormal contours and appearance. Is there obvious swelling as would occur in an effusion? Redness suggesting inflammation? 4. Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to wasting of the muscles.
While both legs have well developed musculature,
the left calf and hamstring are bulkier than the right. 5. Look at the external anatomy, noting structures above and below the knee itself: 1. Patella 2. Patellar tendon 3. Quadriceps/Hamstring/Calf muscles 4. Medial and lateral joint lines. 5. Femur and Tibia 6. Tibial tuberosity
Ballotment (helpful if the effusion is large) 1. Slightly flex the knee which is to be examined.
2. Place one hand on the supra-pateallar pouch, which is above the patella and communicates with the joint space. Gently push down and towards the patella, forcing any fluid to accumulate in the central part of the joint.
3. Gently push down on the patella with your thumb.
4. If there is a sizable effusion, the patella will feel as if it's floating and "bounce" back up when pushed down.
Prostate Cancer spreads in 3 ways. First is spreads by local growth. Second it spreads through the lymphatic system, and lastly, it spreads through the blood stream. Dr. Patrick Swift, a radiation oncologist, discusses how prostate cancer spreads.
TEE of a giant LV thrombus as well as other, smaller thrombi in a 51 year-old man who came to the hospital complaining of chest pain. He was subsequently taken to the cardiac cath lab and was found to have clean coronary arteries. Surprisingly, he was clinically stable despite his TEE findings and an EF of 20%.
Prostatitis is an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. The term prostatitis is defined as microscopic inflammation of the tissue of the prostate gland and is a diagnosis that spans a broad range of clinical conditions. The National Institutes of Health (NIH) has recognized and defined a classification system for prostatitis in 1999.[1] The 4 syndromes of prostatitis are as follows: I - Acute bacterial prostatitis II - Chronic bacterial prostatitis III - Chronic prostatitis and chronic pelvic pain syndrome (CPPS; further classified as inflammatory or noninflammatory) IV - Asymptomatic inflammatory prostatitis