Rhumatic fever has almost been eraicated in the developed world, however it remains prevelent in many under developed countries and causes devastating damage to heart valves. Up till recently valve replacement was the treatment of choice. The long term results and sequelae of valve replacement are...

common knowledge. Mitral and tricuspid valve replacement results are on the whole far worse than for example Aortic valve. Mitral valve replacement should be the last resort and patients with very severe valvular and sub valvular mitral disease can nowadays be helped by mitral valve repair. NO MITRAL OR TRICUSPID VALVE SHOULD BE REPLACED IF IT CAN BE REPAIRED

Clinical Examination - Gait, Arms, Legs, Spine

Anatomy of Love

A 55-year-old man presented with recurrent epistaxis. After endoscopic sphenopalatine artery cauterization, the bleeding stopped. The patient was doing well at last follow up.

Gunshot Wound to the Abdomen: Laparoscopic Exploration and Repair of Small Bowel Injury.

After the nose surgery the patients are advised to keep their nose taped for 2 weeks to 2 months. During the first two weeks, the surgery tapes influence both swelling and forming. From the second week on however, the nose tapes are applied just to reduce the swelling.

The obstetric examination is distinct from other examinations in that you, the clinician, are trying to assess the health of two individuals – the mother and the fetus – simultaneously. From the initial history, you should be able to judge the health of the pregnancy, any risk factors that need to be addressed, and any concerns from the parents. The history is an opportunity for you to find out how much the parents know about pregnancy, labour and delivery and if they have any preferences to which these events are carried out. A carefully taken history will also direct your attention to specific signs during the examination. As such, it is important that you develop a concise and systematic method of taking the history and carrying out the examination so that you do not miss any important information. This article focuses primarily on the examination. Pregnancy is a sensitive issue, especially for the primigravida’s. Therefore, extra care is needed when you approach a pregnant woman. Always obtain expressed informed consent before examining her and have a chaperone accompany you throughout the examination. A walk-through of what you will be doing is a good way of reassuring the patient and allows the examination to go on smoothly. It is also important to let your patient know that if the examination is too painful, she can stop at any time she wants. Finally, before you begin, you should always wash your hands, especially at an OSCE station.

A cricothyrotomy (also called crike, thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by ...

Initial treatment of a deviated septum may be directed at managing the symptoms of the tissues lining the nose, which may then contribute to symptoms of nasal obstruction and drainage. Your doctor may prescribe: Decongestants. Decongestants are medications that reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent and continued use can create dependency and cause symptoms to be worse (rebound) after you stop using them. Decongestants have a stimulant effect and may cause you to be jittery as well as elevate your blood pressure and heart rate. Antihistamines. Antihistamines are medications that help prevent allergy symptoms, including obstruction and runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require physical coordination, such as driving. Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor's directions in using them. Medications only treat the swollen mucus membranes and won't correct a deviated septum.

Vasectomy is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied or sealed in a manner such to prevent sperm from entering the seminal stream (ejaculate). Typically done in an outpatient setting, a traditional vasectomy involves numbing (local anesthetic) of the scrotum after which 1 (or 2) small incisions are made, allowing a surgeon to gain access to the vas deferens.

Baby is born with 2 faces: 4 eyes,2 mouth orifices,2 noses, 2 ears

32 year old Dede Kosawa, also known as 'Tree Man', is one of the world's most extraordinary people. He lives in a remote village in Indonesia with his two children, trying to care for them. Dede, a former fisherman, has an incredible skin condition: he has root like structures growing out of his body - branches that can grow up to 5cm a year and which protrude from his hands and feet, and welts covering his whole body.
He is known locally as ‘Tree Man’ and his condition has baffled local doctors for 20 years. In an attempt to earn a living to support his family, he is part of a circus troupe, displaying his 'Tree Man' limbs along with others afflicted with skin deformities in ‘freak’ shows.
Dr Anthony Gaspari, a world expert in skin conditions from the University of Maryland travels to Indonesia to attempt to diagnose 'Tree Man' Dede’s mysterious condition. He takes skin samples for biopsies back in the USA. What will he discover?
We go on an intimate journey with the extraordinary 'Tree Man' Dede, as he tries to eek out a living in a circus troupe to support his family, and as he is given medical help by Dr Gaspari. The identification and possible cure of his condition, could change his whole life.
Half way across the world, in Romania, farmer Ion Toader is discovered to have a similar extraordinary ‘Tree Man’ condition, with growths all over his hands. He has not been able to drive a tractor for five years. A Romanian surgeon offers to give him an operation to remove his growths.
Will it be successful, and how will it change Ion’s life?

This is an educational medical video for Medical Students showing how to examine a hernia swelling

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LIS Closed done at 5 O clock position, using Scalpel blade 15. After feeling the groove between internal and external anal sphincter, the blade is passed in and the lower 1/2 of Internal anal sphincter is cut. Remain below dentate line. If anal mucosa is accidently cut suture with 4-0 rapid vicryl. In event of bleeding, pinchcock for 5 minutes.

Thoracentesis is a procedure used to obtain a sample of fluid from the space around the lungs. Normally, only a thin layer of fluid is present in the area between the lungs and chest wall. However, some conditions can cause a large amount of fluid to accumulate. This collection of fluid is called a pleural effusion.

Local anaesthetic injection prior to tumescence ready for varicose vein surgery

Leopold's Maneuvers are difficult to perform on obese women and women who have hydramnios. The palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empy it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised slightly on a pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. First maneuver: Fundal Grip While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk. Second maneuver After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. Third maneuver: Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part. Fourth maneuver The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. Cautions Leopold's maneuvers are intended to be performed by health care professionals, as they have received the training and instruction in how to perform them. That said, as long as care taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine the fetal position.