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Does Size Really Matter?
Does Size Really Matter? samer kareem 3,183 Views • 2 years ago

Of the many factors that affect your compatibility with a man, one of the biggest (or smallest) is in his pants. As with humour, interests or habits, the wrong fit can leave you cold. Or traumatised. In a study of 1,661 penises, Dr Debby Herbenick, author of Sex Made Easy, found an almost nine-inch difference in erection size: from 1.6 inches to 10.2. And since absolutely nothing outside the package tells you what to expect with the package, you have to test compatibility the hard way. Sometimes you hit your jackpot, sometimes it's just fine, and sometimes he's the guy on either end of that erection spectrum. These writers have been there, so here's what they learned - and how you can deal (without the gasp reflex).

Complex cataract and glaucoma surgery
Complex cataract and glaucoma surgery Scott 7,045 Views • 2 years ago

Phacolytic glaucoma usually is associated with a mature or hypermature cataract and typically occurs in elderly patients. Today, phacolytic glaucoma is rare in the United States, found primarily in areas where access to care is poor. Will the increase in the number of under- and uninsured patients lead to an increase in this condition? Evaluation and Diagnosis Signs and symptoms. Patients typically report acute-onset pain, decreased vision, tearing and photophobia. Examination will reveal injection, corneal edema, elevated IOP, anterior chamber reaction with or without pseudohypopyon, particles on the lens capsule and anterior capsule wrinkling. Patient history. The duration of symptoms should be elicited; a delayed presentation of more than five days since onset can result in glaucomatous disc damage and poorer prognosis.¹ The ocular history may reveal that the patient decided against removal of an advanced cataract. Prior intraocular surgery or trauma may have left residual lens material that could cause phacoanaphylactic glaucoma or exacerbate infectious endophthalmitis. Visual acuity and visual potential should be assessed. Exam essentials. A complete ophthalmologic examination should be done. The eye should be inflamed, and the cornea may be edematous due to the high IOP. The anterior chamber will demonstrate massive inflammation and/ or pseudohypopyon. Gonioscopy is essential; it will help rule out angle closure due to phacomorphic glaucoma or neovascularization of the angle. Assess ment of the posterior pole should be performed to rule out vitreous hemorrhage (which can result in ghost-cell glaucoma) or vitritis (which may be associated with infectious endophthalmitis or panuveitis). If the view to the fundus is obstructed, B-scan ultrasonography also should be performed. Differential diagnosis. The differential diagnosis includes infectious endophthalmitis, phacoanaphylactic glaucoma, inflammatory glaucoma, glaucoma secondary to intraocular tumor, phacomorphic glaucoma, acute-angle closure glaucoma and neovascular glaucoma. Management Medication. Medical management is used to temporarily control the glaucoma and inflammation. Initial treatment consists of hyperosmotic agents, aqueous suppressants, anti-inflammatory drugs and cycloplegics. Surgery. Definitive treatment is removal of the lens via extracapsular cataract extraction with or without an IOL. Some ophthalmologists defer placement of an IOL until after the inflammation subsides; however, there is no significant difference in final visual acuity between those patients who did receive an IOL and those who did not.¹ If the phacolytic glaucoma is of long duration (more than seven days), a combined trabeculectomy may be needed to prevent postoperative IOP spikes.² In eyes with hypermature Morgagnian cataracts, one must be especially careful, as the capsule is fragile, the zonules are weak and the view is difficult due to the white, milky cortex. Vision limited to light perception on presentation is not a contraindication to performing cataract extraction. Surgical Tips For a planned extracapsular cataract extraction with a posterior chamber IOL, fashion a superior fornix-based conjunctival flap.³ Make a partial-thickness incision along the sclerolimbal junction superiorly for 120 degrees with a No. 69 blade. Forty-five degrees away, a paracentesis should be done to decompress the eye. The anterior chamber fluid can be withdrawn for analysis, to look for macrophages and high molecular-weight proteins. Inject balanced salt solution in a cannula to wash out any residual particulate matter, then inject Healon or viscoelastic into the anterior chamber. Make an incision entering the anterior chamber at the 12 o’clock position with a keratome. A 26-gauge cystotome mounted on a syringe is then introduced through the 12 o’clock incision and used to puncture the capsular bag. The milky cortex should be aspirated as much as possible, until the nucleus is visible. Withdraw the needle through the keratome incision, then inject Healon through the 12 o’clock incision into the capsular bag. Next, enlarge the corneoscleral keratome incision with curved Westcott scissors to 120 degrees. Perform a partial V-shaped capsulotomy; this can be done either with the cystotome or with an angled Vannas scissors. Place viscoelastic under the nucleus to float the nucleus and sever any adhesions between the nucleus and the capsule. The nuclear portion of the lens can then be removed with an irrigating vectis (lens loop) with or without gentle pressure at the inferior limbus (6 o’clock). Irrigate and aspirate the residual cortex with the Simcoe cannula. Inspect the capsular bag; if it is intact, place a posterior chamber IOL into the bag. Close the incision with several interrupted 10-0 monofilament nylon sutures and reattach the conjunctival flap. Potential Sequelae and Prognosis Postoperatively, the patient should be managed with topical steroids and/or aqueous suppressants and hyperosmotics if necessary. Vitreous opacification behind the posterior capsule occurs in a small percentage of eyes. These vitreous opacities are typically absorbed by one to two weeks postoperatively. IOP usually is controlled without antiglaucoma medications after the cataract removal. A detailed glaucoma evaluation (including repeat gonioscopy to assess for peripheral anterior synechiae, visual field and optic nerve status) should be done to assess the extent of glaucomatous damage. The prognosis is dependent on the duration of elevated IOP, PAS and optic nerve damage. In one study, patients who were older than 60 and whose glaucoma was present for more than five days did significantly worse than a comparison group of younger individuals with shorter disease duration.

Baby Born Still Inside The Amniotic Sac
Baby Born Still Inside The Amniotic Sac samer kareem 22,368 Views • 2 years ago

Baby Born Still Inside The Amniotic Sac

Hearing and How it Works.
Hearing and How it Works. samer kareem 11,779 Views • 2 years ago

Video to help understand hearing loss and hearing impairment by explaining how hearing works. Cochlear implants can help children and adults with hearing loss

Humerus Fracture
Humerus Fracture samer kareem 5,248 Views • 2 years ago

Distal Humerus Fractures of the Elbow. A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make elbow motion difficult or impossible.

Dystrophic Ingrown Toenail
Dystrophic Ingrown Toenail Alicia Berger 13,353 Views • 2 years ago

Given the common presentation of onychodystrophy, physicians should have a firm grasp of common presentations of conditions like onychomycosis, trachyonychia and psoriasis. Accordingly, this author reviews keys to effective diagnosis and pertinent treatment considerations. Nail cosmesis and discomfort are the main motivators for most of our patients to schedule a podiatric consultation. During that patient visit, it is important for the podiatric practitioner to delve into the cause of the problematic nail change, known as onychodystrophy. Onychodystrophy, which is any alteration of nail morphology, encompasses a wide spectrum of nail disorders. Caused by either exogenous or endogenous factors, nail dystrophy may manifest as a misshapen, damaged, infected or discolored nail unit that may affect the toenails, fingernails or both.

Complete Blood Count
Complete Blood Count samer kareem 1,766 Views • 2 years ago

Learn the CBC once and for all!

Heart Failure (part 3)
Heart Failure (part 3) samer kareem 1,254 Views • 2 years ago

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute). Heart failure signs and symptoms may include: Shortness of breath (dyspnea) when you exert yourself or when you lie down Fatigue and weakness Swelling (edema) in your legs, ankles and feet Rapid or irregular heartbeat Reduced ability to exercise Persistent cough or wheezing with white or pink blood-tinged phlegm Increased need to urinate at night Swelling of your abdomen (ascites) Sudden weight gain from fluid retention Lack of appetite and nausea Difficulty concentrating or decreased alertness Sudden, severe shortness of breath and coughing up pink, foamy mucus Chest pain if your heart failure is caused by a heart attack

Flexor Tendon Surgical Repair
Flexor Tendon Surgical Repair samer kareem 30,687 Views • 2 years ago

Flexor Tendon Repair

Epstein Barr Virus
Epstein Barr Virus samer kareem 1,639 Views • 2 years ago

Epstein-Barr is the virus that causes mononucleosis. You might know this disease better by its nickname, "mono." It's also called the "kissing disease" because of one way you can spread it to someone else. Even though Epstein-Barr virus (EBV) isn't a household name, you've probably been infected without knowing it. Lots of people carry the virus but don't get sick

Knife is Stuck in Hand!
Knife is Stuck in Hand! samer kareem 2,059 Views • 2 years ago

This video may contain images of a medical doctor providing emergency care for a patient.

Intraocular tumor Surgery( Melanoma)
Intraocular tumor Surgery( Melanoma) samer kareem 11,121 Views • 2 years ago

Eye cancers can be primary (starts within the eye) and metastatic cancer (spread to the eye from another organ). The two most common cancers that spread to the eye from another organ are breast cancer and lung cancer. Other less common sites of origin include the prostate, kidney, thyroid, skin, colon and blood or bone marrow. Melanomas (choroidal, ciliary body and uveal) -Early stages has no symptoms (the person does not know there is a tumor until an ophthalmology examination). As the tumor grows, symptoms can be blurred vision, decreased vision, double vision, eventual vision loss and if they continue to grow the tumor can break past the retina causing retinal detachment.

Animation of Scarless Varicose Vein Treatment
Animation of Scarless Varicose Vein Treatment Scott 2,020 Views • 2 years ago

Animation of Scarless Varicose Vein Treatment No Knife Endovenous Laser

Human heart & Electric Beat-Pacemakers
Human heart & Electric Beat-Pacemakers samer kareem 7,253 Views • 2 years ago

Vediographic-Electric Beat-Pacemakers and the human heart

Interventricular Heart Pump
Interventricular Heart Pump samer kareem 3,731 Views • 2 years ago

This device could save thousands of lives from heart failure.

Classical Complement Pathway
Classical Complement Pathway samer kareem 1,669 Views • 2 years ago

See inside the lungs!
See inside the lungs! samer kareem 17,354 Views • 2 years ago

Bronchoscopy Procedure - See inside the lungs!

Terrifying Sinus Infection
Terrifying Sinus Infection samer kareem 1,810 Views • 2 years ago

Terrifying Sinus Infection - Disturbing - Must Watch

Ridge split technique
Ridge split technique samer kareem 1,964 Views • 2 years ago

Ridge splitting with bone expansion is a technique of manipulation of bone to form receptor site for implant without removing any bone from the implant site.

Future Baby
Future Baby samer kareem 10,670 Views • 2 years ago

Future Baby

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