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This video contains five segments with best practices on how to prevent infection in patients with catheters, fistulas or grafts. It also includes segments on hand hygiene and glove use and dialysis station disinfection. The video is intended to be used by outpatient hemodialysis facilities as an educational tool to help remind their frontline staff, including technicians and nurses, about infection prevention measures. It can be used as an orientation video for new staff and as an annual in-service training tool to remind staff of proper protocols.
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Curious about LASIK eye surgery? NVISION's Dr. Richard Mauer talks risks, life-changing benefits, and outcomes (plus why he loves what he does!).
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NVISION: The Eye Doctors' #1 Choice in LASIK and Laser Cataract Surgery
Debridement is the removal of necrotic tissue, foreign debris, bacterial growth, callus, wound edge, and wound bed tissue from chronic wounds in order to stimulate the wound healing process. Stimulation of wound healing mediated by debridement is thought to occur by the conversion of a chronic non-healing wound environment to an acute healing environment through the removal of cells that are not responsive to endogenous healing stimuli. Debridement is used commonly in standard wound treatment of diabetic foot ulcers (DFUs). Methods of debridement include surgery (sharp debridement), chemical debridement (antiseptics, polysaccharide beads, pastes), autolytic (hydrogels, hydrocolloids and transparent films), biosurgery (maggots), mechanical (hydrodebridement), and biochemical debridement (enzyme preparations). Callus is a buildup of keratinized skin formed under conditions of repeated pressure or friction and may contribute to ulcer formation by creating focal areas of high plantar pressure. The debridement of callus has been proposed to be relevant for both treatment and prevention of DFU. The purpose of this report is to retrieve and review existing evidence of comparative clinical effectiveness of different methods of debridement for the treatment of DFUs. Additionally examined in this report is the clinical effectiveness for treatment and prevention of DFU using callus debridement. Cost-effectiveness, and existing debridement guidelines for the treatment of DFUs will also be reviewed.
METHODS:
Previously existing methods are characterized by unpleasant scars that, despite surgeons promises, remain for life.
Incisions are:
- around the areola (Round block) leading to a flat areola, often unpleasant hypertophic skars, skin rippling.
- inverted T (around the areola, vertically down and in the fold under the breast).
- Vertical (around the areola and vertically down). Due to the extess skin, incisions often turn into inverted L or T. Rearrangement of glandular tissue and skin changes the shape of the breasts and may be different from expectations. Scars worry patients and sometimes cause disturbances in the relationship with their partner.
- No scars. The "Serdev Suture" lifting technique for breast lifting without scars (only points - needle perforations in the skin) is created by the Bulgarian cosmetic surgeon Prof. Dr. Nikolay Serdev. It is a novelty that had changed the cosmetic surgery world in the last 10-14 years for young patients. The technique is especially important in Asia and Latin America, for Asians, African-Americans, Indians, and others who form keloids and lumpy scars after operations.
The Serdev suture method can achieve lift upto and over 14 centimeters and is most suitable for the following types of breasts:
- not very heavy full breasts.
- in the presence of subpectoral implants with subsequent drooping of the breasts after childbirth and lactation.
- empty and loose breasts after childbirth and breastfeeding. In such cases this technique is combined with subpectoral implants. In sagging breasts implants should not be placed in the skin over the pectoral muscles, because thus will lead to even more drooping. Therefore, breast lift requires breast fixation to the level of the pectoral muscle (the normal position in young women), and then placement of appropriate implants under the muscle, to hold them in the appropriated position.
- in drooping breasts after subglandular augmentation (over the muscle). In such cases, patients should not wait until the skin elongation becomes visible. The implants should be removed, the capsule removed - a difficult but a necessary operation, preventing postop seromas and infection. Implants should be placed under the pectoralis muscle to wear them. Patients should orient the cosmetic surgeon at what level they want the nipples - in the middle of the implant, higher or lower.
Implants should be generally replaced - below the muscle implants should be smooth, move naturally without hurting the muscle.
Because of modern anesthetics and new methods without trauma, pain and swelling after surgery are not significant. In 3-4 days, patients can return to social life, even the next day, but it is preferable to rest for 2-3 days.
Exercises with the arms and weight lifting is prohibited for a month and a half.
Due to lack of scars, the breast lift using the Serdev sutures can be repeated to maintain the aesthetic appearence of the breasts even in advanced age.
Gigantomastia i.e. very large, very heavy and drooping breasts can not be operated in this manner, because of gravity and overskin.
Early mastopexy using Serdev sutures is recommended before too much changes in the tissues. If late, more and more complex interventions are required.
"A lot of people are opting for various breast procedures and one of the most common among them is “mastopexy”. This is the surgery that involved uplifting of sagging breasts and, in certain cases, repositioning of the nipple and areola in order to restore normality and beauty. The excess skin is removed and firmness is provided to the breasts. Though mastopexy can be done as a stand alone surgery, many people combine it with breast augmentation which involves inserting implants inside the b
Patient Greg Grindley communicates with host Bryant Gumbel and his wife for the first time while undergoing deep brain stimulation surgery at University Hospital's Case Medical Center in Cleveland, Ohio.
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Greg's First In-Surgery Conversation | Brain Surgery Live
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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.
Common Benign Pain Syndromes--Symptoms and Etiology:
1. Non-specific musculoskeletal pain: This is the most common cause of back pain. Patients present with lumbar area pain that does not radiate, is worse with activity, and improves with rest. There may or may not be a clear history of antecedent over use or increased activity. The pain is presumably caused by irritation of the paraspinal muscles, ligaments or vertebral body articulations. However, a precise etiology is difficulty to identify.
2. Radicular Symptoms: Often referred to as "sciatica," this is a pain syndrome caused by irritation of one of the nerve roots as it exits the spinal column. The root can become inflamed as a result of a compromised neuroforamina (e.g. bony osteophyte that limits size of the opening) or a herniated disc (the fibrosis tears, allowing the propulsus to squeeze out and push on the adjacent root). Sometimes, it's not precisely clear what has lead to the irritation. In any case, patient's report a burning/electric shock type pain that starts in the low back, traveling down the buttocks and along the back of the leg, radiating below the knee. The most commonly affected nerve roots are L5 and S1.
3. Spinal Stenosis: Pain starts in the low back and radiates down the buttocks bilaterally, continuing along the backs of both legs. Symptoms are usually worse with walking and improve when the patient bends forward. Patient's may describe that they relieve symptoms by leaning forward on their shopping carts when walking in a super market. This is caused by spinal stenosis, a narrowing of the central canal that holds the spinal cord. The limited amount of space puts pressure on the nerve roots when the patient walks, causing the symptoms (referred to as neurogenic claudication). Spinal stenosis can be congenital or develop over years as a result of djd of the spine. As opposed to true claudication (pain in calfs/lower legs due to arterial insufficiency), pain resolves very quickly when person stops walking and assumes upright position. Also, peripheral pulses should be normal.
4. Mixed symptoms: In some patients, more then one process may co-exist, causing elements of more then one symptom syndrome to co-exist.