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When the colon and rectum are removed (due to ulcerative colitis or familial adenomatous polyposis), another reservoir must be created for bowel contents (stool) to exit the body. Surgically creating a “J” shaped reservoir (called a J-pouch) is an option for selected patients to store and pass stool.
Function and Anatomy: The hip is a ball and socket type joint, formed by the articulation of the head of the femur with the pelvis. Normal range of motion includes: abduction 45 degrees, adduction 20-30 degrees, flexion 135 degrees, extension 30 degrees, internal and external rotation. Hip pathology can cause symptoms anywhere around the joint, though frequently pain is anterior and radiates to the groin region. Additionally, pathology outside of the hip can be referred to this region. History and exam obviously help in making these distinctions.
Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion. In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction
OB_A_1013
3D animation depicting the operating room and initial procedure preparing the patient for a laparoscopic hysterectomy. The patient is prepped and draped in the usual fashion and surrounded by the surgeon and surgical assistants. The skin is elevated, an infraumbilical incision is made, a trocar port is inserted through the incision and the abdomen is insufflated. Finally, a laparoscope is inserted into the port to allow for direct visualization of the uterus and the surgery can begin.
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When you’re trying to conceive a baby it is worth giving anything a go which you think will boost your chances. This includes considering that there may be better positions for getting pregnant. But it pays to bear in mind that the human race has been around for over 200,000 years and most of us were probably conceived without our ancestors investing too much thought into the mechanics. Science has proven that successful conception isn’t so much about sexual position as the frequency of sex between a fertile couple. Basically, if you want to fall pregnant, don’t use contraception and have frequent, active and enjoyable sex. Importantly, don’t stress too much about whether you’re doing it the right way. Women can, and do, conceive in any position. Nature has a way of making sure of that.
Dr. Ed Tingstad, Orthopedic Surgeon with Pullman Regional Hospital’s Orthopedic Center of Excellence and Inland Orthopaedic Surgery & Sports Medicine Clinic performs a total knee replacement using orthopedic robotics – VELYS. The VELYS Robotic-Assisted Solution technology makes for a more exact fitting knee replacement and uses intra-operative data to inform the surgeon during surgery. In this full-length total knee replacement video, Dr. Tingstad narrates a procedure from start to finish.
Learn more: pullmanregional.org/orthopedics
The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.
In this video, Dr. Robert Rozbruch, chief of Limb Lengthening and Complex Reconstruction at Hospital for Special Surgery performs an osseointegration after a primary amputation. The patient, a 40 year old woman, had chronic nerve pain and compromised function of her residual limb.
For more information, visit: https://www.limblengthening.com/
https://www.hss.edu/limblengthening
https://www.hss.edu/LSARC
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key words: Osseointegration, Amputee, Amputation, Limb Replacement, Tibia, Osseointegration