A clinical examination of the hands using the standard Look, Feel, Move approach. Specific​ examination structure derived from MacLeod's Clinical Examination 14th edition. Performed by Dr James Gill

Care must be taken to prevent stenosis at the anastomotic site. If the diameter of the anastomosis is less than 2 cm, the anastomosis should be taken down and resected. A classic end-to-end anastomosis should be performed to ensure adequate diameter to the intestine. If the posterior wall of the colon has been preserved, care should be taken to close the colostomy prior to opening the peritoneal cavity. This will reduce intraperitoneal contamination from the stoma site. Copious irrigation of the wound should be made prior to primary closure. If gross contamination has occurred, delayed closure of the wound should be considered.

Given the common presentation of onychodystrophy, physicians should have a firm grasp of common presentations of conditions like onychomycosis, trachyonychia and psoriasis. Accordingly, this author reviews keys to effective diagnosis and pertinent treatment considerations. Nail cosmesis and discomfort are the main motivators for most of our patients to schedule a podiatric consultation. During that patient visit, it is important for the podiatric practitioner to delve into the cause of the problematic nail change, known as onychodystrophy. Onychodystrophy, which is any alteration of nail morphology, encompasses a wide spectrum of nail disorders. Caused by either exogenous or endogenous factors, nail dystrophy may manifest as a misshapen, damaged, infected or discolored nail unit that may affect the toenails, fingernails or both.

#GIT#Abdominalexamination#AETCM

Open appendectomy (simulated)

Your body's immune system protects you from disease and infection. But if you have an autoimmune disease, your immune system attacks healthy cells in your body by mistake. Autoimmune diseases can affect many parts of the body. No one is sure what causes autoimmune diseases. They do tend to run in families. Women - particularly African-American, Hispanic-American, and Native-American women - have a higher risk for some autoimmune diseases. There are more than 80 types of autoimmune diseases, and some have similar symptoms. This makes it hard for your health care provider to know if you really have one of these diseases, and if so, which one. Getting a diagnosis can be frustrating and stressful. Often, the first symptoms are fatigue, muscle aches and a low fever. The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain and swelling. The diseases may also have flare-ups, when they get worse, and remissions, when symptoms get better or disappear. Treatment depends on the disease, but in most cases one important goal is to reduce inflammation. Sometimes doctors prescribe corticosteroids or other drugs that reduce your immune response.

There's only one group of people who really know what happens when you die: the dead. And since the dead won't be revealing their secrets anytime soon, it's up to scientists to explain what happens when a person dies. Death, just like life, is a process, scientists say. The first stage of this process is known as clinical death. It lasts from four to six minutes, beginning when a person stops breathing and the heart stops pumping blood. During this time, there may be enough oxygen in the brain that no permanent brain damage occurs. Other organs, such as the kidneys and eyes, also remain alive throughout clinical death.

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On this week's episode of Macro Beauty, we follow a young woman on her journey to getting Lasik eye surgery. She opts for this corrective vision procedure and we captured it up close. Watch this video to see what the process is really like!

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The anatomy of the direct and indirect inguinal hernia.


Music:
Berries and Lime by Gregory David
https://www.epidemicsound.com/track/z6iCiiyCPm/

Brief animation demonstrating emergency surgical cricothyrotomy; created with Lightwave 9.3

Closed Reduction of Distal Radius Fractures - Discussion: (distal radius fracture menu) - closed reduction & immobilization in plaster cast remains accepted method of treatment for majority of stable distal radius frx; - unstable fractures will often lose reduction in the cast and will slip back to the pre-reduction position; - patients should be examined for carpal tunnel symptoms before and after reduction; - carpal tunnel symptoms that do not resolve following reduction will require carpal tunnel release; - cautions: - The efficacy of closed reduction in displaced distal radius fractures. - Technique: - anesthesia: (see: anesthesia menu) - hematoma block w/ lidocaine; - w/ hematoma block surgeon should look for "flash back" of blood from hematoma, prior to injection; - references: - Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia. - Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia. - methods of reduction: - Jones method: involves increasing deformity, applying traction, and immobilizing hand & wrist in reduced position; - placing hand & wrist in too much flexion (Cotton-Loder position) leads to median nerve compression & stiff fingers; - Bohler advocated longitudinal traction followed by extension and realignment; - consider hyper-extending the distal fragment, and then translating it distally (while in extended position) until it can be "hooked over" proximal fragment; - subsequently, the distal fragment can be flexed (or hinged) over the proximal shaft fragment; - closed reduction of distal radius fractures is facilitated by having an assistant provide counter traction (above the elbow) while the surgeon controls the distal fragment w/ both hands (both thumbs over the dorsal surface of the distal fragment); - flouroscopy: - it allows a quick, gentle, and complete reduction; - prepare are by prewrapping the arm w/ sheet cotton and have the plaster or fibroglass ready; - if flouroscopy is not available, then do not pre-wrap the extremity w/ cotton; - it will be necessary to palpate the landmarks (outer shaped of radius, radial styloid, and Lister's tubercle, in order to judge success of reduction; - casting: - generally, the surgeon will use a pre-measured double sugar sugar tong splint, which is 6-8 layers in thickness; - more than 8 layers of plaster can cause full thickness burns: - reference: Setting temperatures of synthetic casts. - position of immobilization - follow up: - radiographs: - repeat radiographs are required weekly for 2-3 weeks to ensure that there is maintenance of the reduction; - a fracture reduction that slips should be considered to be unstable and probably require fixation with (pins, or ex fix ect.) - there is some evidence that remanipulation following fracture displacement in cast is not effective for these fractures; - ultimately, whether or not a patient is satisfied with the results of non operative treatment depends heavily on th

Watch that video of The World's Worst Spider Bites

Mechanical Circulatory Support

DMC Neurosurgeon Sandeep Mittal maps the brain and performs delicate surgery to remove epileptic tissue, and stop a patient's seizures. ~ Detroit Medical Center

Watch that video of Human Body Autopsy for Poison

Comprehensive physical examination

This video demonstrates a manual small incision cataract surgery using a Blumenthal technique, in a white cataract.

Surgeon: Dr. Rishi Swarup, FRCS, Medical Director & Senior Consultant, Swarup Eye Centre, India

Neer's Sign