Top videos
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.
Knee replacement, also called arthroplasty, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.
Superior capsule reconstruction (SCR) is a promising alternative treatment for irreparable posterosuperior rotator cuff tears (Figure 1). It utilizes a graft from the superior glenoid to the greater tuberosity to stabilize the humeral head. In a study by Mihata and colleagues of 23 patients who underwent SCR with a fascia lata autograft at a minimum of 2 years follow-up, the American Shoulder and Elbow Surgeons (ASES) score improved significantly from 23.5 preoperatively to 92.9. Postoperative MRI showed 83% of patients had intact reconstructions with no progression of muscle atrophy.
What are the best positions for labour? When your labour starts, you'll probably feel restless and want to move around and keep busy. Just take care that you don't get over-tired before your labour is properly under way. s your contractions get stronger, concentrate on them. Focus on what's happening to your body and your baby, and practise your breathing and relaxation exercises. Now is the time to find the positions and movements that help you to cope with your contractions. Your midwife should encourage and help you to keep moving around and find comfortable positions, preferably ones that are upright. You may think that you'll be most comfortable lying on the bed. But keeping as upright as possible will help: you to cope with your contractions you and your baby to cope better during labour You'll be able to keep moving by shifting your weight from one foot to another, or by rocking your pelvis. Some positions make it easier for your birth partner to massage your back, or breathe with you through the contractions. You could: Lean on a work surface, or on the back of a chair. Put your arms around your partner's neck or waist, and lean on him. Lean on the bed, with the height adjusted for your comfort, or on a window-sill. Kneel on a large cushion or pillow on the floor, and lean forwards on to the seat of a chair. Sit astride a chair, resting on a pillow placed across the top. Sit on the toilet, leaning forwards, or sit astride, leaning on to the cistern. Go on to all fours. Kneel on one leg, with the other leg bent..
Vaginoplasty is a surgical procedure designed to rejuvenate and tighten a woman’s vagina, by removing excess lining and repairing the surrounding soft tissues. It is designed to decrease the diameter of the vagina, resulting in increased friction during intercourse to make the experience more pleasurable for both partners.
To facilitate the delivery of fluids during labour, obstetric anaesthetists from Coventry designed a triple IV peripheral connector with a central high-flow anti-reflux valve. This connector, now rightly known as the Coventry valve, can be used for all theatre settings and is especially useful in obstetrics, ICU, HDU and orthopaedics. More details on www.mediplus.co.uk