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A spontaneous vaginal delivery (SVD) occurs when a pregnant woman goes into labor with or without use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section. Assisted vaginal delivery (AVD) occurs when a pregnant woman goes into labor with or without the use of drugs or techniques to induce labor, and requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally.
The cervix is fully dilated to about 10 cm,with the baby's head moving beyond the cervical opening , into the birth canal. The mother is encouraged to push during contractions,and rest in between them. In a normal delivery, the head rotates to face the mother's back
Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.
A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.
They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.
At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.
Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.
If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.
At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.
VISIT https://www.gillettechildrens.org/ to learn more
0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?
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History, Examination and Management of Hernia
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Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ED fail. There are two main types of penile implants, semirigid and inflatable.
Watch as Dr. Diaz performs a tummy tuck procedure on one of our patients!
A tummy tuck, also known as abdominoplasty, removes excess fat and skin and restores weakened muscles to create a smoother, firmer abdominal profile.
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A hematoma is a collection of blood outside of a blood vessel. There are several types of hematomas and they are often described based on their location. Examples of hematomas include subdural, spinal, under the finger or toenail bed (subungual), ear, and liver (hepatic). Some causes of hematomas are as pelvic bone fractures, fingernail injuries (subungual), bumps, passing blood clots, blood clot in the leg (DVT), blood cancers, and excessive alcohol use. Symptoms of hematomas depend upon their location and whether adjacent structures are affected by the inflammation and swelling associated with the bleeding and may include
The male orgasm is a common subject but usually misunderstood at the same time. Men are sometimes led to believe that ejaculating often is a bad thing, particularly if you masturbate. The truth is that ejaculation is important to every man due to a number of reasons. The main goal of this post is to shed some light on reasons why men need to ejaculate.
This video provides a demonstration of how to assess for transillumination when assessing scrotal swelling.
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