Patients are generally placed in a supine position with the head in an extended position. As noted above, Gardner-Wells tongs can be used for additional cervical traction. The hands can also be tied downward to increase the operative exposure. Once the surgical site is properly prepared with cleansing material, the appropriate surgical level is identified with intraoperative radiographs. A scalpel is used to make a linear longitudinal incision just medial to the body of the sternocleidomastoid muscle. The incision is made long enough to include at least 2 vertebral levels if a 1-level discectomy is being performed. Alternatively, transverse skin incisions over the targeted vertebral level can also be performed. The platysmal muscle is identified and incised. The platysmal incision can be extended if a multilevel decompression is the surgical aim. Extensive subplatysmal dissection is performed to reduce retraction injury.

Comas are caused by an injury to the brain. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible. It also can be permanent.

Sodium levels are tightly controlled in a healthy individual by regulation of urine concentration and an intact thirst mechanism. Hypernatremia (defined as a serum sodium level >145 mEq/L) is rare in patients with preserved thirst mechanism. When hypernatremia does occur, it is associated with a high mortality rate (>50% in most studies). Given this high mortality rate, the emergency physician must be able to recognize and treat this condition. This article discusses the patients in whom hypernatremia should be suspected and how to initiate workup and administer appropriate treatment. In general, hypernatremia can be caused by derangement of the thirst response or altered behavioral response thereto (primarily psychiatric patients, and elderly patients who are institutionalized), impaired renal concentrating mechanism (diabetes insipidus [DI]) secondary to kidney pathology (nephrogenic DI) or difficulty with the neurohormonal control of this concentrating mechanism (central DI), or by losses of free water from other sources.

SINUS LIFT SURGERY surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane (sinus membrane) and placing a bone graft.

Cystinuria is a condition characterized by the buildup of the amino acid cystine, a building block of most proteins, in the kidneys and bladder. As the kidneys filter blood to create urine, cystine is normally absorbed back into the bloodstream. People with cystinuria cannot properly reabsorb cystine into their bloodstream, so the amino acid accumulates in their urine. As urine becomes more concentrated in the kidneys, the excess cystine forms crystals. Larger crystals become stones that may lodge in the kidneys or in the bladder. Sometimes cystine crystals combine with calcium molecules in the kidneys to form large stones. These crystals and stones can create blockages in the urinary tract and reduce the ability of the kidneys to eliminate waste through urine. The stones also provide sites where bacteria may cause infections.

Stop and chop surgery on a hard cataract on a small pupil.

Pectus excavatum repair is surgery to correct pectus excavatum. This is a congenital (present at birth) deformity of the front of the chest wall that causes a sunken breastbone (sternum) and ribs. Pectus excavatum is also called funnel or sunken chest. It may worsen during the teen years.

one of the best videos I've ever seen..

Face transplant allows this man to live a normal life. Hats off to all the surgeons involved!

Coolsculpting, for non-invasive fat reduction of the upper arms is now available at Dr.Ron Shelton's Midtown Manhattan office

Smoking kills, but what exactly is smoking doing to your body that kills it?

Surgery is an elective procedure done in people who have had extensive testing to decide if they are potential candidates. The following criteria are considered when determining if a person may be a good candidate for surgery. Person has failed adequate trials of two first-line seizure medicines (ones that are commonly effective in controlling the type of seizures the person is experiencing) and one combination of at least two drugs. A trial of a medication is considered adequate when it has been increased gradually to the maximum dosage that does not cause serious side effects. If the person has frequent seizures, any improvement will be obvious after a short time. If the seizures generally occur far apart, however, it may take months to determine whether a medication is helping. At some epilepsy centers, patients are offered additional conventional or experimental medications before surgery is considered. But research suggests that each time a trial of medication fails to control a person's seizures, it becomes less likely that a different medicine or combination will be successful. Since uncontrolled seizures present serious physical risks and social and psychological consequences, the trend these days is to proceed with surgery much sooner than in the past if it seems appropriate for that person.

A cervical herniated disc may be treated by removing part of the disc through a small incision (microdiscectomy). If this is done from the back (posteriorly) rather than from the front of the neck, a spinal fusion is not necessary. The alternative is an anterior cervical discectomy and fusion procedure.

In neonates, hypocalcemia is more likely to occur in infants born of diabetic or preeclamptic mothers. Hypocalcemia also may occur in infants born to mothers with hyperparathyroidism. Clinically evident hypocalcemia generally presents in milder forms and is usually the result of a chronic disease state. In emergency department patients, chronic or subacute complaints secondary to mild or moderate hypocalcemia are more likely to be a chief complaint than severe symptomatic hypocalcemia. Once laboratory results demonstrate hypocalcemia, the first question is whether the hypocalcemia is true—that is, whether it is representative of a decrease in ionized calcium. The presence of chronic diarrhea or intestinal disease (eg, Crohn disease, sprue, chronic pancreatitis) suggests the possibility of hypocalcemia due to malabsorption of calcium and/or vitamin D. The patient's past medical history should be explored for pancreatitis, anxiety disorders, renal or liver failure, gastrointestinal disorders, and hyperthyroidism or hyperparathyroidism. Previous neck surgery suggests hypoparathyroidism; a history of seizures suggests hypocalcemia secondary to anticonvulsants. The patient may have a recent history of thyroid, parathyroid, or bowel surgeries or recent neck trauma. The length of time that a disorder is present is an important clue. Hypoparathyroidism and pseudohypoparathyroidism are lifelong disorders. Instead, acute transient hypocalcemia may be associated with acute gastrointestinal illness, nutritional deficiency, or acute or chronic renal failure. In an elderly patient, a nutritional deficiency may be associated with a low intake of vitamin D. A history of alcoholism can help diagnose hypocalcemia due to magnesium deficiency, malabsorption, or chronic pancreatitis. Inquire about recent use of drugs associated with hypocalcemia, including the following: Radiocontrast Estrogen Loop diuretics Bisphosphonates Calcium supplements Antibiotics Antiepileptic drugs Cinacalcet Other considerations in the history include the following: Family history of hypocalcemia Low-calcium diet Lack of sun exposure

Disordered Eater vs. Eating Disorder - What's the difference?

seroma 3 years after surgery

Human Glue used to repair a cut in the chin of a toddler

TRANSUMBILICAL SINGLE SITE LAP CHOLYCYSTECTOMY