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A surgeon begins the PPH stapled hemorrhoidectomy by inserting a circular anal dilator and obturator into the anal canal and then securing the dilator in place with four sutures. The surgeon then inserts a PPH anoscope into the obturator. Next, he places a circumferential purse-string suture of 2-0 Monocryl on a UR-6 needle 4 cm proximal to the dentate line. The surgeon opens a PPH stapler and places its anvil across the purse string. The stapler is then closed and fired; it is held closed for two minutes to improve hemostasis. Prior to firing the stapler in a female patient, the surgeon places a gloved finger in the vagina to ensure the vaginal mucosa and rectal-vaginal septum are not trapped within the jaws of the closed stapler. The surgeon then opens and removes the stapler.

A uterine fibroid (also uterine leiomyoma, myoma, fibromyoma, leiofibromyoma, fibroleiomyoma, and fibroma) (plural of ... myoma is ...myomas or ...myomata) is a benign (non-cancerous) tumor that originates from the smooth muscle layer (myometrium) and the accompanying connective tissue of the uterus. Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. While most fibroids are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Uterine fibroids is the major indication for hysterectomy in the US.[2] Fibroids are often multiple and if the uterus contains too many leiomyomatas to count, it is referred to as uterine leiomyomatosis. The malignant version of a fibroid is uncommon and termed a leiomyosarcoma.

Comprehensive physical examination

Examination of Peripheral Vascular System - Clinical Skills OSCE Revision - Dr Gill

In this video, we demonstrate the peripheral vascular examination - a less common examination, but still vitally important, particularly amongst the older population

Starting with the examination of the hands looking for clinical signs of vascular compromise, we then check the pulses of the major arteries of the upper body - the radial, brachial and carotid arteries, before moving down to assess for an abdominal aortic aneurysm.

At this point, I feel it's a practical step to check the femoral pulses before doing the overview of the legs.

After visually assessing we must examine the major vascular areas of leg.- namely the popliteal pulses, before wrapping up around the ankle with the posterior tibial and dorsalis pedis pulses

For completeness, the cardiovascular examination is demonstrated here
https://www.youtube.com/watch?v=ECs9O5zl6XQ&t=2s

#PeripheralVascular #ClinicalSkills #DrGill

Diabetic ketoacidosis is an acute complication of uncontrolled hyperglycaemia characterised by high anion gap metabolic acidosis, dehydration and other metabolic abnormalities. Upto half of patients with Type 1 diabetes mellitus may have DKA. The incidence in T2DM is also rising. Precipitants include acute illness such as myocardial infarction, trauma and infection. Paitents of diabetic ketoacidosis may present with vomiting, pain abdomen and lethargy. Mental obtundation may also be present. Management of diabetic ketoacidosis revolves around administration of IV normal saline, insulin, replacement of potassium with frequent monitoring of sugars and electrolytes.

Heart Valves

The G-SHOT® (clinical description: G-Spot Amplification™ or GSA™), is a simple, nonsurgical, physician-administered treatment that can temporarily augment the Grafenburg spot (G-Spot) in sexually active women with normal sexual function.

A video showing the surgery of vaginal hysterectomy Operation

⁣Immune Responses During a Lupus Flare Video

If a fetal lung lesion is causing heart failure, fetal surgery may be performed to remove the CCAM before birth. http://fetalsurgery.chop.edu

N. Scott Adzick, MD, Mark Johnson, MD, and Holly Hedrick, MD, experts from the Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia, explain when fetal intervention for CCAM is recommended, the various approaches that may be used to treat the most complex fetal lung lesions before birth, and how these procedures are performed.

One concern with fetal lung lesions is that they take up space in the chest. If the lung mass grows and pushes the heart and other organs out of place, it can lead to complications such as fetal hydrops (heart failure in the fetus). If this happens, a fetal surgery procedure may be performed to remove the CCAM before birth.
In other cases, an EXIT procedure may be performed to partially deliver the baby, so the team can remove the mass before the baby is fully delivered.

In this video series, parents, nurses and doctors from Children’s Hospital of Philadelphia’s Center for Fetal Diagnosis and Treatment talk about the different types of fetal lung lesions like congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS), the importance of accurate diagnosis and monitoring, and the most advanced treatment options currently available. They also discuss follow-up care and long-term outcomes for babies diagnosed with fetal lung lesions.

After MacKenzie Walker lost 100 pounds, her "after" picture remained elusive. So she asked plastic surgeon Dr. Anthony Youn to perform an abdominoplasty.

Testing for the four features of Gerstmann Syndrome in this patient with two separate left sided strokes (left frontoparietal ischaemic stroke followed by left posterior parietal haemorrhagic stroke). He exhibits (i) acalculia, (ii) agraphia, (iii) left-right disorientation, and (iv) finger agnosia. Complicating the issue is his obvious nonfluent aphasia (expressive dysphasia) with paraphasic errors (replacing words with associated words (e.g. says 'fork' instead of 'spoon')) and some comprehension issues.

Watch that video to know How Does Circumcision Affect Your Sexual Functions ?

Popping GIANT Pimple at Girl's arm, Finally pop it.

A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures, or damage from underlying lung disease. Or it may occur for no obvious reason. Symptoms usually include sudden chest pain and shortness of breath. On some occasions, a collapsed lung can be a life-threatening event.

Tighten Sagging Breasts

Stress-related mucosal disease (SRMD) is an acute, erosive gastritis representing conditions ranging from stress-related injury to stress ulcers (1, 2). Stress-related injury is superficial mucosal damage that presents primarily as erosions, whereas stress ulcers are deep, focal mucosal damage penetrating the submucosa with high risk for gastrointestinal bleeding (2, 3). Mucosal damage has been reported to occur during the first 24 hours of hospital admission in 75% to 100% of intensive care unit (ICU) patients (4, 5). Clinically important gastrointestinal bleeding can cause hemodynamic instability and increase the need for red blood cell transfusions (1). Significant bleeding may also increase the length of stay in the ICU and mortality (1).

How to remove the Intra Uterine Device (IUD)

An educational case of removing jigger fleas (tungiasis) and treating the affected tissue. Educational only — not medical advice.

What is polycystic kidney disease? Polycystic kidney disease (also called PKD) causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure. How common is PKD? In the United States about 600,000 people have PKD. It is the fourth leading cause of kidney failure. It is found in all races and occurs equally in men and women. It causes about 5% of all kidney failure. What other organs besides the kidney are affected by PKD? PKD can affect other organs besides the kidney. People with PKD may have cysts in their liver, pancreas, spleen, ovaries, and large bowel. Cysts in these organs usually do not cause serious problems, but can in some people. PKD can also affect the brain or heart. If PKD affects the brain, it can cause an aneurysm. An aneurysm is a bulging blood vessel that can burst, resulting in a stroke or even death. If PKD affects the heart, the valves can become floppy, resulting in a heart murmur in some patients. What are the clues that someone has PKD? Most people do not develop symptoms until they are 30 to 40 years old. The first noticeable signs and symptoms may include: Back or side pain An increase in the size of the abdomen Blood in the urine Frequent bladder or kidney infections High blood pressure High blood pressure is the most common sign of PKD. Occasionally, patients may develop headaches related to high blood pressure or their doctors may detect high blood pressure during a routine physical exam. Because high blood pressure can cause kidney damage, it is very important to treat it. In fact, treatment of high blood pressure can help slow or even prevent kidney failure. Fluttering or pounding in the chest About 25% of PKD patients have a so-called floppy valve in the heart, and may experience a fluttering or pounding in the chest as well as chest pain. These symptoms almost always disappear on their own but may be the first hint that someone has PKD. How is PKD diagnosed? Ultrasound is the most reliable, inexpensive and non-invasive way to diagnose PKD. If someone at risk for PKD is older than 40 years and has a normal ultrasound of the kidneys, he or she probably does not have PKD. Occasionally, a CT scan (computed tomography scan) and MRI (magnetic resonance imaging) may detect smaller cysts that cannot be found by an ultrasound. MRI is used to measure and monitor volume and growth of kidneys and cysts. In some situations, genetic testing might also be done. This involves a blood test that checks for abnormal genes that cause the disease. Genetic testing is not recommended for everyone. The test is costly, and it also fails to detect PKD in about 15% of people who have it. However, genetic testing can be useful when a person: has an uncertain diagnosis based on imaging tests has a family history of PKD and wants to donate a kidney is younger than 30-years old with a family history of PKD and a negative ultrasound, and is planning to start a family