Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

The infection is generally transmitted by direct contact with the mucus or sores of someone else with strep. Common symptoms include sore throat, fever, and swollen lymph nodes in the neck. Rarely, complications can involve the heart or kidneys. Treatment is important to reduce complications. Oral antibiotics like penicillin, amoxicillin, cephalexin, or azithromycin are commonly used. Other medicines such as acetaminophen or ibuprofen can help with pain and fever.

Furosemide is used to reduce extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen. This drug is also used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Furosemide is a "water pill" (diuretic) that causes you to make more urine. This helps your body get rid of extra water and salt.

Midline Episiotomy

Upper right quadrant: The right upper quadrant contains the liver and gallbladder, which are protected by the lower right part of the ribcage. The large intestine, or colon, also spends a little time in this section. Upper left quadrant: The left upper quadrant contains part of the stomach and the spleen.

The gastric balloon procedure (endoscopic intragastric balloon) leaves an inflated silicon balloon in the stomach for 6 months, making less room for food. As a result, patients: Feel full sooner while eating and therefore eat less. Lose about 30% of their excess weight in 6 months.

http://www.landging.com/accident-animation-sports-injury-soccer.html
This accident animation demonstrates sports injury in soccer game.

VirtaMed's new laparoscopy simulator starts with patient safety.

VirtaMed LaparoS™
-Starts at the beginning and covers crucial procedure preparation steps
- Innovative skills training derived from validated concepts
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Numerous medical training institutions have found that integrating simulation into their curriculum both improves training outcomes and ultimately supports better patient care. Benefit from VirtaMed’s decades of experience and expertise in laparoscopy training and education.

www.diabetes.org > Living With Diabetes > Treatment and Care > Medication > Insulin & Other Injectables Share: Print PageText Size:A A A Listen How Do Insulin Pumps Work? If you have been diagnosed with diabetes, you may feel overwhelmed by all the new information you have learned and will continue to learn about managing your diabetes. You already know your main goal should be to get your blood glucose (sugar) levels under control in order to increase your chances of a complication-free life. Many people know this, but need to know how to achieve good diabetes management, while balancing the day-to-day demands of diabetes with other life demands. An insulin pump can help you manage your diabetes. By using an insulin pump, you can match your insulin to your lifestyle, rather than getting an insulin injection and matching your life to how the insulin is working. When you work closely with your diabetes care team, insulin pumps can help you keep your blood glucose levels within your target ranges. People of all ages with type 1 diabetes use insulin pumps and people with type 2 diabetes have started to use them as well. - See more at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html?referrer=https://www.google.com/#sthash.XD56v351.dpuf

Watch that video of a Newborn Baby Medical Autopsy

Watch that video to know if it is safe to have anal Intercourse?

This video shows the delivery of the placenta after delivery of the fetus

Dr. Matthew Slater talks about why cardiac surgery may be necessary if medications aren't an effective treatment option.

Health Assessment: Musculoskeletal System- Nursing Skills

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Get the full lesson on musculoskeletal assessment here:
https://nursing.com/lesson/02-11-musculoskeletal/

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Health Assessment: Musculoskeletal System- Nursing Skills:

In this video we’re going to review a Musculoskeletal Assessment. The Musculoskeletal system involves the muscles, bones, and joints. This means we must assess structure AND function! If the patient cannot stand, assessments should be performed in the bed to the best of your ability. If they cannot perform Active Range of Motion (ROM), use Passive movements to determine ROM.
We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction
0:34 Spine assessment
1:02 Range of motion
1:39 Extremity assessment
1:52 Shoulder range of motion
2:10 Elbow & wrist range of motion
2:25 Hand range of motion
2:34 Upper extremity strength
2:54 Lower extremity range of motion
3:02 Hips range of motion
3:20 Knees range of motion
3:30 Ankles range of motion
3:38 Toes range of motion
3:42 Lower extremity strength
4:05 Outro

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A very funny video

Bradyarrythmias

This is a 60 year man having large swelling of size 7cm x 5 cm behind neck for one year. Patient complained pain and tenderness over local area for 7 days and came to us.On examination punctum found in the centre of swelling and fluctuation positive.Infected sebaceous cyst diagnosis made. /nIncision and drainage surgery done under local anesthesia.all infected pultaceous material evacuated.Pus culture sent and antibiotics given as per sensitivity report./nPatient improved with daily dressing.

The hepatitis E virus, responsible for major epidemics of viral hepatitis in subtropical and tropical countries, was cloned only 7 years ago.1 Hepatitis E was found to belong to the family of Caliciviridae, which includes the Norwalk virus—a common cause of gastroenteritis in humans—and consists of a single, plus-strand RNA genome of approximately 7.2 kb without an envelope (Fig. 1). The virus contains at least three open reading frames encoding viral proteins against which antibodies are made on exposure. These antibodies, especially those against the capsid protein derived from the second open reading frame2 and a protein of unknown function derived from the third open reading frame, are detected by currently available serologic assays. Retrospective studies on stored sera of past epidemics of viral hepatitis in Mexico, Africa, Afghanistan, Pakistan, India, Bangladesh, Burma, Nepal, and Borneo have revealed that all were caused by strains of hepatitis E. In addition, hepatitis E was found to be responsible for the hepatitis epidemic in the southern part of Xinjiang, China, in which 120,000 persons became infected between September 1986 and April 1988.3 Hepatitis E predominantly affects young adults (15 to 40 years old). The symptoms of hepatitis E are similar to those of hepatitis A. Frequently, a prodrome consisting of anorexia, nausea, low-grade fever, and right upper abdominal pain is present 3 to 7 days before jaundice develops. Aminotransferase levels peak (usually between 1,000 and 2,000 U/L) near the onset of symptoms; bilirubin levels (10 to 20 mg/dL) peak later. Jaundice usually resolves after 1 to 2 weeks. In about 10% of cases, the disease is fulminant—especially in pregnant women, among whom mortality rates as high as 20% due to hemorrhagic and thrombotic complications have been reported. No evidence has suggested that hepatitis E can cause chronic infection. Transmission is by the fecal-oral route, predominantly through fecally contaminated drinking water supplies. In addition, however, preliminary reports have suggested transmission of the hepatitis E virus through blood transfusions. Volunteer studies confirmed the presence of the virus in serum and feces before and during clinical disease.4 The virus is shed into feces approximately 1 week before symptoms develop. The incubation period varies from 2 to 9 weeks (mean duration, approximately 45 days). Until now, a few reports had described symptomatic hepatitis E acquired in Europe;5, 6 all patients with symptomatic hepatitis E in the United States were travelers returning from Mexico, Africa, or the Far East, in whom hepatitis E developed after their return home.7 In this issue of the Mayo Clinic Proceedings (pages 1133 to 1136), Kwo and associates describe a case of hepatitis E in a man who had not left the United States during the previous 10 years. Specific serologic tests for hepatitis E virus IgG (enzyme immunoassays and a fluorescent antibody blocking assay) and IgM8 (US strain-specific enzyme-linked immunosorbent assay with use of synthetic polypeptides deduced from the viral genome, as shown in Figure 1), developed at Abbott Laboratories (IgG and IgM) as well as at the Centers for Disease Control and Prevention (IgG), were used to prove that the patient indeed had acute hepatitis E. Researchers at Abbott Laboratories have prepared a report that describes most of the viral genome in this patient (Fig. I).8 Their results are interesting because this strain from the United States differs considerably from hepatitis E strains isolated in Mexico, Burma, Pakistan, or China. Furthermore, the sequence of the US strain is highly homologous (98% and 94% homology at the amino acid level to the second and third open reading frames, respectively) to a recently isolated hepatitis E strain from American swine.9 This finding suggests that, in the United States, hepatitis E is a zoonosis with the swine population as one of its hosts. This relationship would confirm earlier studies in Asia, where swine were also found to carry variants of the hepatitis E virus.10 Why are these two recent discoveries important for medicine in the United States? First, other sporadic, locally acquired cases of acute hepatitis may be caused by hepatitis E. Second, these back-to-back discoveries strongly suggest that a common natural host for hepatitis E is present in countries with more moderate climates. Because swine do not seem to experience any symptoms associated with infection and because symptoms in humans can be minor or absent, we now may also have an explanation for the 1 to 2% of positive hepatitis E serologic results in blood donors in the United States,11 Netherlands,12 and Italy,6 countries with large swine staples. Clearly, more research needs to be done to confirm this hypothesis. Third, in countries with more moderate climates, hepatitis E may often result in a subclinical infection. Is this variation in manifestation due to less virulent strains, and do sequence variations determine virulence? Fourth, swine may be used as an animal model for study of the disease as well as vaccine development.

Dr. Ailawadi, M.D., the Chair of Cardiac Surgery at Michigan Medicine, specializes in minimally invasive valve surgery as well as complex cardiac operations. This video shows step by step footage of a Coronary Artery Bypass Graft (CABG) in a complex patient. In this case, CABG was performed through a sternotomy (through the breast bone) using the internal thoracic artery and saphenous leg veins to bypass obstructed coronary arteries. In this video, Dr. Ailawadi will perform a triple vessel bypass (CABG) which has been shown to minimize the risk of future heart attack and help patients live longer in the setting of complex coronary artery disease.

To learn more about cardiac surgery at Michigan Medicine, visit: https://medicine.umich.edu/dept/cardiac-surgery

To learn more about Frankel Cardiovascular Center, visit: https://www.umcvc.org/

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show your patients how to use an inhaler