ACTUAL CATHETERIZATION A clinical view of insertion into the male urethra. A 14 french coude cath was used.

The language is chinese mandarin(Putonghua)

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At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

The pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects. The pelvic floor separates the pelvic cavity above from the perineal region (including perineum) below.

The right and left levator ani lie almost horizontally in the floor of the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal. The levator ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus. The pubococcygeus, the main part of the levator, runs backward from the body of the pubis toward the coccyx and may be damaged during parturition. Some fibers are inserted into the prostate, urethra, and vagina. The right and left puborectalis unite behind the anorectal junction to form a muscular sling . Some regard them as a part of the sphincter ani externus. The iliococcygeus, the most posterior part of the levator ani, is often poorly developed.

The coccygeus, situated behind the levator ani and frequently tendinous as much as muscular, extends from the ischial spine to the lateral margin of the sacrum and coccyx.

The pelvic cavity of the true pelvis has the pelvic floor as its inferior border (and the pelvic brim as its superior border.) The perineum has the pelvic floor as its superior border.

Some sources do not consider “pelvic floor” and “pelvic diaphragm” to be identical, with the “diaphragm” consisting of only the levator ani and coccygeus, while the “floor” also includes the perineal membrane and deep perineal pouch.

Amniotomy is the official term for artificially breaking the bag of waters during labor. It is believed that breaking the bag of waters will help to speed up an otherwise slow labor. Amniotomy is part of the Active Management of Labor practiced in some hospitals. Amniotomy is performed by a midwife or doctor. A long, thin instrument with a hook on the end is inserted into the vagina and through the cervix so it can catch and rip the bag of waters. To perform an amniotomy, the cervix must be dilated enough to allow the instrument through the cervix, generally at least a two. Why choose Amniotomy? Unlike other medical methods of starting labor, amniotomy does not add synthetic hormones to your labor. Instead it seems to stimulate your body’s own labor process. Amniotomy allows the use of an internal electronic fetal monitor. How effective is Amniotomy? Amniotomy alone is unpredictable, it may take hours for labor to start with amniotomy. Because amniotomy increases the risk for infection, most caregivers use amniotomy in combination with synthetic oxytocin. Birth does happen faster when amniotomy is combined with synthetic oxytocin than when amniotomy is used alone. Risks of Amniotomy Risks for Mother Increases the risk for infection. This risk is increased with length of time the waters are broken and with vaginal exams. Because of the infection risk, a time limit is given by which the mother must give birth. As the time limit approaches attempts to progress labor will become more aggressive. The fore waters equalize pressure on the cervix so it will open uniformly. When they are broken, the mother increases her chances of having uneven dilation. Risks for Baby Increases the risk of umbilical cord compression. The fore waters equalize pressure on the baby’s head as it presses against the cervix. When they are broken, the pressure on the baby’s head may be uneven causing swelling in some parts.

Macrobiopsy of breast lesions is a complicated procedure when performed with vacuum assisted biopsy tools. The Spirotome is a hand-held needle set that doesn’t need capital investment, is ready to use and provides tissue samples of high quality in substantial amounts. In this way quantitative molecular biology is possible with one tissue sample. The Coramate is an automated version of this direct and frontal technology

An excellent video demonstrating how a laparoscopy is performed to evaluate the uterus (note a small fibroid appearing as a bulge in the uterus), fallopian tubes and ovaries. Blue dye is injected into the uterus, entering the fallopian tubes and spilling from the end of the tubes into the abdominal cavity, confirming that both tubes are open

Lecture delivered by Dr. Mostafa Yakoot, MD, to the 12th Allergy Conference

An excerpt from the award-winning documentary “Exposure: Environmental Links to Breast Cancer” about the effects of radiation. Featuring Olivia Newton-John, Dr. Rosalie Bertell and Dr. Susan Love.

This is the incredible moment a new-born baby arrived still inside its amniotic sac, completely intact. The tiny infant can be seen moving and stretching still inside the sac, as medics prepare to snip the new born free. The amniotic sac is a thin but durable membrane filled with fluid which helps keep a baby warm and safe from bumps during pregnancy. When it breaks, this is typically referred to as a woman's 'waters breaking' shortly before she gives birth. But in rare cases, less than 1-in-80,000 births, the baby is delivered with the membranes still intact and this is known as a 'caul birth'. Some babies are born with part of the membrane still attached to them, but to be born completely encased in the intact membrane is incredibly rare. Many people still believe the phenomenon to be a good omen for the child's infancy and it is has even been suggested, but not proven, that caul babies will always have a natural affinity for water. The video was taken in Spain on Saturday and captures the rare moment the baby was born with the membrane covering its entire body, just minutes after its twin was delivered normally.

protecting the body from damage caused by hyperglycemia cannot be overstated. In the United States, 57.9% of diabetic patients have one or more diabetes complications, and 14.3% have three or more.1 Strict glycemic control is the primary method of reducing the development and progression of microvascular complications, such as retinopathy, nephropathy, and neuropathy. Aggressive treatment of dyslipidemia and hypertension decreases macrovascular complications.2-4 Glycemic Control There are two primary techniques available for physicians to assess the quality of a patient’s glycemic control: self-monitoring of blood glucose (SMBG) and interval measurement of hemoglobin A1c (HbA1c).

Asplenia is the absence of spleen and/or its functions. Abnormalities of the spleen may be classified on a pattern oriented approach, based on splenic imaging.[1] These include anomalies of the following: Shape (clefts, notches, lobules) Location (wandering spleen) Number (asplenia, polysplenia) Size (splenomegaly, atrophy) Solitary lesions (cysts, lymphangiomas, hemangiomas, hamartomas) Multiple lesions (trauma, infections, neoplasms, storage disorders) Diffuse disease (infarction, heavy metal deposition, peliosis) Absence of splenic tissue can be total (congenital asplenia) or partial (hypoplastic) from birth. Loss of splenic tissue due to surgical removal may occur later in life as a result of trauma that causes rupture of the organ. The spleen may be removed in other conditions (eg, hemoglobinopathies) to improve the red cell life expectancy. Removal of the spleen may be undertaken as a result of being involved in a neoplastic processor as a staging procedure in some cancers. Occasionally, the spleen may be removed to address the sheer mass effect of a massive enlargement (such as in storage disorders), which can cause mass effects. Autosplenectomy is the process where the spleen loses its function due to multiple and repeated infarctive episodes, as in sickle hemoglobinopathies. See the image below.

Respiratory syncytial virus (RSV) is a virus that causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults. In adults and older, healthy children, the symptoms of respiratory syncytial virus are mild and typically mimic the common cold. Self-care measures are usually all that's needed to relieve any discomfort. Infection with respiratory syncytial virus can be severe in some cases, especially in premature babies and infants with underlying health conditions. RSV can also become serious in older adults, adults with heart and lung diseases, or anyone with a very weak immune system (immunocompromised).

Dilated cardiomyopathy is a disease of the heart muscle, usually starting in your heart's main pumping chamber (left ventricle). The ventricle stretches and thins (dilates) and can't pump blood as well as a healthy heart can. The term "cardiomyopathy" is a general term that refers to the abnormality of the heart muscle itself. Dilated cardiomyopathy might not cause symptoms, but for some people it can be life-threatening. A common cause of heart failure — the heart's inability to supply the body with enough blood — dilated cardiomyopathy can also contribute to irregular heartbeats (arrhythmias), blood clots or sudden death. The condition affects people of all ages, including infants and children, but is most common in men ages 20 to 60.

Why is this medication prescribed? Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles. How should this medicine be used? Amiodarone comes as a tablet to take by mouth. It is usually taken once or twice a day. You may take amiodarone either with or without food, but be sure to take it the same way each time.Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amiodarone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

50 Orgasms A Day

New CPR Guidelines For Adults

Amenorrhea is the absence of menstrual bleeding.[1] Amenorrhea is a normal feature in prepubertal, pregnant, and postmenopausal females. In females of reproductive age, diagnosing amenorrhea is a matter of first determining whether pregnancy is the etiology. In the absence of pregnancy, the challenge is to determine the exact cause of absent menses.[2] Primary amenorrhea is the failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics. If by age 13 menses has not occurred and the onset of puberty, such as breast development, is absent, a workup for primary amenorrhea should start. Secondary amenorrhea is defined as the cessation of menses sometime after menarche has occurred. Oligomenorrhea is defined as menses occurring at intervals longer than 35 days apart. No consensus has been reached regarding the point at which oligomenorrhea becomes amenorrhea. Some authors suggest the absence of menses for 6 months constitutes amenorrhea, but the basis for this recommendation is unclear. For a post-menarchal girl or a reproductive-aged woman to experience a menstrual cycle interval of more than 90 days is statistically unusual. Practically speaking, this should be an indication for an evaluation to seek the cause.

Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.