Case of ITP with persistent very low platelet count despite best medical management

Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.

Watch that video of a Model's Leg and Butt Cosmetic Implants Exploded Inside Her

Nasal catheter YAMIK - is a new drug delivery sistem for topical treatment for sinusitis. The introduction of a large volume of the #drugsolution directly into all the paranasal #sinuses - provides new opportunities in the #treatment of #sinusitis! #YamikprocedureNasal catheter YAMIK is a new device for topical sinonasal delivery of medication during rhinosinusitis treatment. Administration of therapeutic solution with YAMIK catheter is called YAMIK procedure. The following features differs YAMIK procedure from all other topical sinonasal delivery techniques: - Medication is delivered into the all paranasal sinuses at one side of nose regardless of their involvement in the inflammatory disease. -Specific position of patient’s head. Patient should lay on the side of of the sinuses, into which solution will be administered. This position is physiological and comfortable for patients, including children and elders. The LHL position was suggested to be the most favorable position for patients to adopt - Therapeutic solutions reliably penetrates into without previous sinus surgery sinuses with natural ostia size. - Paranasal sinuses are filling with medicinal solution by gravity. To accelerate process, it is used small pressure gradient, which created by motion of syringe plunger with amplitude 1 - 2 ml during administration of solution. - It is provided contact of the whole sino-nasal mucosa with medication. - Prolonged time of the contact of sino-nasal mucosa with medicine provides administration of the therapeutically significant dose. Therapeutic solution administered into paranasal sinuses is considered as a STORE. Thanks to affect mucociliary clearance, therapeutic solution is gradually evacuated from sinuses through ostia. Thereby, prolonged nasal irrigation is performed. - Due to extended contact with saline (NaCl 0,9%), viscous colloidal pathological substance filling paranasal sinuses is dissolved. As a result, its viscosity decreases, and substance is removing by mucociliary clearance. Thereby, drainage function of the ostia are returned some time after finish YAMIK method procedure. -The procedure is performing under local anesthesia. - There is no need in active involvement of the patient. Blowing, pronouncing any sounds like “cuckoo”, holding any things and so on is unnecessary. If is performed by a qualified medical professional the procedure is more effective. - Medication contacts only with nasal passages and paranasal sinuses. Thus, it is provided topical drug therapy. - YAMIK procedure is call sinonasal delivery techniques of a therapeutic solution. It differs from nasal techniques, because medicinal solution contacts not only with nasal mucosa, but with mucous membrane of paranasal sinuses. - The only used drug formulation is a solution. - It is possible non-invasive sample extraction from mucosa of paranasal sinuses (for bacteriological, immunological, cytological and a number of others investigation methods).

Today I will discuss about hemodialysis.
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00:00 Introduction
02:53 Hemodialysis
06:06 Dialysis Apparatus
07:59 Dialysis Mechanism
13:27 Vascular Access
18:55 Nursing Considerations
25:07 Nursing Management for HD
27:57 NCLEX Practice Questions

Hemodialysis is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood.

I will also discuss about hemodialysis procedure, how hemodialysis machine works and its benefits for patients.

If you're interested in learning more about hemodialysis, or if this just seems like something you should know for nursing school or for the NCLEX exam, check out this video!

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An animation of blood flow inside the Hemodialysis circuit.

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Dr. Ahmad Oussama Rifai is certified by the American Board of Internal Medicine (ABIM) in the specialty of Internal Medicine and the sub-specialty of Nephrology.

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Mr Andrew Clarke, a leading surgeon and expert in laparoscopic techniques, explains how laparoscopic surgery allows a much quicker and less painful recovery than with open surgery.

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What to expect during the day of a pediatric surgery at Sutter Children's Center Sacramento.

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NG (Nasogastric) Tube Insertion Techniques (Nursing Skills)

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NG (Nasogastric) Tube Insertion Techniques (Nursing Skills)

In this video we’re going to show you the correct technique for insertion of an NG tube or Nasogastric tube). We’ll also give you a few tips and tricks we use. Of course, before you get started, make sure you’ve determined which nare is more patent and that the patient doesn’t have a deviated septum. Before you start, lay a towel across the patient’s chest – I’m telling you I’ve had patients throw up on me – this step is WORTH IT!! We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction to NG Tube Insertion techniques
0.25 Towel placement
0.32 Measuring NG tube length
1.04 Tape preparation
1.27 Give patient water
1.34 NG Tube lubrication
1.42 NG Tube insertion technique
2.25 Securing the NG tube
2.36 Checking placement/ aspiration
2.55 Assessing pH
3.08 Confirming placement
3.22 Waiting for abdominal X-ray
3.35 Supply clean-up
3.48 NG Tube insertion outro

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after birth care for babies,a small glimpse just to let you know what happens

Surgery during a Pancreatectomy. One can see the pancreas half extracted. This is Experimental Surgery, taken during a Pancreas transplantation

Surgical Knot

We herein describe endoscopic treatment of symptomatic pancreatic pseudocyst with significant necrosis and a fistula. Fifty eight year old man had presented to us with a large pseudocyst following an episode of acute pancreatitis. He was complaining of significant abdominal pain for two months. A... CT scan abdominal had revealed a large retro-gastric pseudocyst with necrosis and portal venous thrombosis. An upper GI endoscopy had revealed small linear fundal varcies. Endoscopic as well as surgical treatment for the cyst was discussed with the patient. Patient wished not to undergo surgical treatment and therefore endoscopic treatment was selected after a proper consent. EUS was performed to see for the interposed vessel prior to the pseudocyst puncture. Needle knife puncture was made and a guide wire was passed in the pseudocyst cavity. After confirming the wire placement in the cyst, the tract was dilated up to 20 mms using a CRE balloon. Fluid from the cyst was emptied out in the stomach. An ERCP scope was passed in to the cyst cavity, which revealed a significant necrotic material (much more than what the CT scan had revealed). All the free lying necrotic material was taken out with the help of a snare and a dormia basket. A lot of necrotic was stuck to the cyst wall, which was removed with the help of water jet, mechanical scooping and cutting through using a needle knife papillotome. Three 10 fr. Pigtail stents were placed at the end of the procedure. Further necrosectomy was carried out on alternate days for three more sessions. Dilation was required prior to each session three pigtail trans-gastric stents were placed at the end of each session. Single stent was kept in situ during each procedure to guide the path (the position of the stoma changed dramatically once the cyst was empty). During the last lesion (session four), a pancreatogram was taken. It revealed a mildly dilated CBD in the head, normally duct in the proximal body with a leak from the distal body, and contrast was seen going in to the pseudocyst cavity. The duct could not be opacified distally. A 7 fr. 15 cms stent was placed trans-papillary. When the cyst cavity was reentered through trans-gastric route, the trans-papillary pancreatic stent was clearly visible with soft necrotic material around it. In fact, the stent guided further necrosis removal. It also helped in diverting the pancreatic juice to the duodenum rather than in the pseudocyst cavity. Patient was discharged after this session and was followed up regularly. A CT scan was obtained after three months, which revealed a complete resolution of the necrosis and pseudocyst. There was a possibility of a persistent fistula after the removal of trans-papillary stent and a recurrence of the pseudocyst. Fistula closure with cyanoacrylate glue is well described in the literature. The procedure can have obvious complications secondary to accidental blockage of the main pancreatic duct. So, we thought it prudent to use a safer alternative to treat the condition. We removed the longer pancreatic stent and replaced it with a shorter pancreatic stent occupying only the head region. The patient was followed up after a month; sonography of the abdomen did not reveal any recurrence of the pseudocyst. All the stents were removed at this examination.

Pancreatic pseudocyst drainage was the first therapeutic application of EUS. The cyst is punctured under ultrasound guidance, contrast injected, and a guidewire inserted. Initial dilation to 8mm is performed over the wire The EUS scope is then exchanged over the wire for a forward viewing endoscope.... A second dilation to 18mm is performed. This enables entry of the endoscope into the cyst perform cystoscopy, debridement if necessary, and insertion of multiple large bore double pigtail stents. The curved linear array-or CLA—echoendoscope has oblique viewing optics located proximal to an oblique scanning transducer. The accessory exits from the shaft of the echoendoscope at an ablique angle, adjustable between 15 and 30 degrees. There are several technical limitations using this echoendoscope. The oblique angle of exit results in a weekend transfer of force when advancing the accessory, difficult deployment of larger bore accessories, and in instrument tunneling effect relative to the bowel wall. There is the potential loss of access during endoscope exchange. A novel CLA echoendoscope was developed by the Olympus Corporation that shifts the orientation of endoscopic and ultrasound views from oblique to forward viewing. The channel is therapeutic at 3.7mm Note that the working channel is located adjacent to the ultrasound transducer at the endoscope tip. The accessory exits the working channel in the axis of the shaft. Shown here are balloon inflation and deployment of a Dormia basket. We report on the use of the prototype forward viewing echoendoscope in six consecutive patients who were referred for pancreatic cyst drainage. Here you see endoscopic view-indistinguisable from that of a gastroscope-showing a bulge where the cyst impinges against the posterior gastric wall. Power Doppler is switched on and highlights multiple vessels interposed in the wall This allows selection of a safe vessel-free window for a cyst puncture A 19 G needle is advanced into the cyst lumen. A sample of contents is aspirated for fluid analysis. A guidewire under ultrasound guidance into the cyst. An 18mm balloon is coaxially thread over the wire and advanced across the cyst wall, Note that resistance is encountered, but the forward transfer of force overcome this. The dilation is performed under forward viewing endoscopuc and ultrasound guidance. As the balloon is maximally inflated we see the cystgastrostomy open up. The balloon is then deflated while simultaneously advancing the scope into the cyst cavity. Cystoscopy isnow performed showing the cyst contents to be filled with pasty wall-adherent necroses. Pulsed power Doppler is switched on we can see and hear arterial flow vessels within the wall of the cyst. This identifies sensitive areas at bleeding risk when performing debridement In this case vigorous water jet irrigation is performed through an accessory water irrigation channel built into the echoendoscope. This issued to clear nonadherent debris. Our experience has shown that it is not necessary to actively remove wall-adherent debris using extraction tools as such Dormia or Roth net basket to achieve cyst resolution. Three large bore 10 Fr double pigtail stents are now inserted into the cyst under direct endoscopic guidance. The first stent is delivered over a guide catheter. The second stent. And the third stent All three stents are deployed. Finally, a nasocystic catheter is inserted for maintenance irrigation. In another patient we used the Cook Cystome to perform cystgastrostomy. We have found the Cystotome easy to delivery through the forward viewing echoendoscope. As shown, we advance the Cystotome into the cyst while applying diathermy. This is performed under and endoscopic guidance, entering the cyst at a near perpendicular orientation. After entry, the Cystotome is removed and cyst fluid gushes from the cystagastrotomy site.

On screening colonoscopy, this abnormality was encountered in the cecum. This round worm is Ascaris Lumbricoides, one of the most common human parasites in the world. When ingested, the durable Ascaris eggs hatch in the small intestine releasing larva that migrate through the intestinal wall, and t...ravel both hematogenously and lymphatically to the heart and lungs. Over the next several days, the larva mature in the alveoli, then migrate up the trachea to be swallowed back into the gastrointestinal tract. These larva will then mature in the small bowel; adults couples will succeed in producing an extraordinary number of eggs, over 200,000 ova per day. The adults live one to two years. The majority of Ascaris infections are as in this example asymptomatic. Symptoms are a consequence of either the immunologic hypersensitivity of the host to the worm as in the pulmonary stage referred as Loffler's syndrome or to mechanical obstruction of lumen by the worm. Heavy worm burden can result in intestinal obstruction and migrating worms can cause pancreatitis and/or cholangitis when involving the pancreatobiliary tree. Multiple medical therapies are approved for its treatment including mebendazole. Epidemiologically, infections are most common in areas of lower socio-economic conditions. This man manages a pig farm in China that is used to test pharmaceutical agents. From an endoscopic standpoint it is noteworthy that the worms do not like light and will move away fro the attention it is receiving. In this example, the endoscopist was too slow to snare his prey which succeeded in escaping temporarily into the cooler and darker confines of the small bowel out of reach of the endoscope but not from the soon to be consumed anti-helminthic therapy.

Descemet’s stripping automated endothelial keratoplasty (DSAEK) avoids a full-thickness corneal procedure and provides rapid visual rehabilitation. Successful graft positioning while minimizing intraoperative donor endothelial trauma may determine long-term graft survival. Previously described t...echniques for graft insertion may be problematic in some patients with intraoperative floppy iris syndrome (IFIS), anatomically shallow or unstable anterior chambers, or intraoperative increased posterior pressure. This video displays alternative method called the suture drag technique, which may facilitate lamellar endothelial graft insertion under these special circumstances.

Hip Examination

A video of modern cataract surgery employing a temporal, clear-corneal approach with topical anesthesia and ultrasound phacoemulsification; an aspheric silicone lens implant is inserted

A thin polymer film that seals surgical wounds could make sutures a relic of medical history.

Measuring just 50 microns, the film is placed on a surgical wound and exposed to an infrared laser, which heats the film just enough to meld it and the tissue, thus perfectly sealing the wound. Known as Surgilux, the device's raw material is extracted from crab shells and has Food and Drug Administration approval in the US