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Gallstone ileus is an important, though infrequent, cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by impaction of a gallstone in the ileum after being passed through a biliary-enteric fistula. The diagnosis is often delayed since symptoms may be intermittent and investigations fail to identify the cause of the obstruction. The mainstay of treatment is removal of the obstructing stone after resuscitating the patient. Gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.

In this podcast, CDC's Dr. Barbara Reynolds discusses best practices in crisis and emergency risk communication. She characterizes the initial phase of the crisis communication lifecycle and describes the five most common mistakes made in emergency communication to the public and how to counter them.

Electrical injuries can present with a variety of problems, including cardiac or respiratory arrest, coma, blunt trauma, and severe burns of several types. It is important to establish the type of exposure (high or low voltage), duration of contact, and concurrent trauma. Low-voltage AC injury without loss of consciousness and/or arrest These injuries are exposures of less than 1000V and usually occur in the home or office setting. Typically, children with electrical injuries present after biting or chewing on an electrical cord and suffer oral burns. Adults working on home appliances or electrical circuits can also experience these electrical injuries. Low-voltage AC may result in significant injury if there is prolonged, tetanic muscle contraction. Low-voltage AC injury with loss of consciousness and/or arrest In respiratory arrest or ventricular fibrillation that is not witnessed, an electrical exposure may be difficult to diagnose. All unwitnessed arrests should include this possibility in the differential diagnosis. Query EMS personnel, family, and coworkers about this possibility. Inquire if a scream was heard before the patient’s collapse; this may be due to involuntary contraction of chest wall muscles from electrical current. High-voltage AC injury without loss of consciousness and/or arrest Usually high-voltage injuries do not cause loss of consciousness but instead cause devastating thermal burns. In occupational exposures, details of voltage can be obtained from the local power company. High-voltage AC injury with loss of consciousness and/or arrest This is an unusual presentation of high-voltage AC injuries, which do not often cause loss of consciousness. History may need to come from bystanders or EMS personnel. Direct current (DC) injury These injuries typically cause a single muscle contraction that throws the victim away from the source. They are rarely associated with loss of consciousness unless there is severe head trauma, and victims can often provide their own history. Conducted electrical devices Conducted electrical weapons (CEWs) such as tasers are weapons used by law enforcement that deliver high-voltage current that is neither true AC or DC but is most like a series of low-amplitude DC shocks.[16] They can deliver 50,000 V in a 5-second pulse, with an average current of 2.1 mA.[17] Though they have been temporally associated with deaths in the law enforcement setting, conducted electrical devices (CEDs) in healthy volunteers have been shown to be safe without evidence of delayed arrhythmia or cardiac damage as measured by troponin I.[18, 17] One study of their use in 1201 law enforcement incidents showed mostly superficial puncture wounds from the device probes, and significant injuries only from trauma subsequent to shock, not from the device itself. Of 2 deaths in custody, neither was related to CEW exposure.[19]

The baby suffered from ectopia cordis, a rare condition where a baby's heart is located either partially or totally outside the chest. Only 8 out of 1 million babies are born with the condition, and 90 percent of those babies are either stillborn or die within the first three days of life.

If you’re considering an epidural to help manage the pain of childbirth, you’re not alone. More than 60 percent of women delivering at hospitals elect for an epidural during labor. And with good reason: An epidural is considered one of the safest methods of pain control, with just one in 3,000 pregnancies experiencing serious complications. It’s also good for you, since you’ll remain awake and alert during the birth, as well as for your baby, since the drugs will barely reach your bloodstream (so they can’t get into hers).

COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include A cough that produces a lot of mucus Shortness of breath, especially with physical activity Wheezing Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD.

Nosebleeds common. Most often they are a nuisance and not a true medical problem. But they can be both. Nosebleed care Sit upright and lean forward. By remaining upright, you reduce blood pressure in the veins of your nose. This discourages further bleeding. Sitting forward will help you avoid swallowing blood, which can irritate your stomach. Pinch your nose. Use your thumb and index finger to pinch your nostrils shut. Breathe through your mouth. Continue to pinch for five to 10 minutes. Pinching sends pressure to the bleeding point on the nasal septum and often stops the flow of blood. To prevent re-bleeding, don't pick or blow your nose and don't bend down for several hours after the bleeding episode. During this time remember to keep your head higher than the level of your heart. If re-bleeding occurs, blow out forcefully to clear your nose of blood clots and spray both sides of your nose with a decongestant nasal spray containing oxymetazoline (Afrin, Mucinex Moisture Smart, others). Pinch your nose again as described above and call your doctor. When to seek emergency care The bleeding lasts for more than 20 minutes The nosebleed follows an accident, a fall or an injury to your head, including a punch in the face that may have broken your nose

Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff — sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable.

The type of operation performed for removal of pancreatic cancer is based on the location of the tumor. For tumors of the head and neck of the pancreas a Whipple procedure, (also called a pancreaticoduodenectomy) is performed. This is a complex operation perfected at Johns Hopkins. This video will explain the surgery and what patients can expect.

Learn more about the Whipple procedure at Johns Hopkins:
http://www.hopkinsmedicine.org..../pancreatic_cancer_c

In this video, Professor Dan Reinstein performs a bilateral LASIK procedure filmed in real-time to demonstrate the full 8 and-a-half minute procedure from multiple angles. The superior design and experience of the Carl Zeiss Meditec Visumax femtosecond Laser for flap creation is seen, where the patient is only in contact with the device for about 30 seconds with extremely low contract force such that the patient feels effectively nothing, there are no red splodges (subconjunctival haemorages) left behind. From the surgeons' standpoint there is no device that is easier to use or faster for LASIK flap creation. The Carl Zeiss Meditec MEL80 excimer laser portion of the procedure is seamlessly integrated and incorporates all the features that make clinical outcomes so reproducible including the unique cone-for-controlled-atmosphere (CCA) and high efficiency, high sensitivity calibration test which can be performed for each individual patient to compensate for minor changes in energy that occur with excimer laser devices during the course of a day.

For reference to the clinical outcomes for LASIK with the MEL80 in presbyopia using PRESBYOND Laser Blended Vision see:

Reading glasses presbyopia (ageing eyes) only:
LASIK for presbyopia correction in emmetropic patients using aspheric ablation profiles and a micro-monovision protocol with the Carl Zeiss Meditec MEL 80 and VisuMax.
J Refract Surg. 2012 Aug;28(8):531-41. Reinstein DZ, Carp GI, Archer TJ, Gobbe M.
http://www.ncbi.nlm.nih.gov/pubmed/22869232

Short sighted, astigmatism and presbyopia (ageing eyes)
LASIK for Myopic Astigmatism and Presbyopia Using Non-Linear Aspheric Micro-Monovision with the Carl Zeiss Meditec MEL 80 Platform.
J Refract Surg. 2011 Jan;27(1):23-37. Epub 2010 Mar 1.
Reinstein DZ, Archer TJ, Gobbe M.
http://www.ncbi.nlm.nih.gov/pubmed/20205360

Long-sighted, astigmatism and presbyopia (ageing eyes)
LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform.
J Refract Surg. 2009 Jan;25(1):37-58. Reinstein DZ, Couch DG, Archer TJ.
http://www.ncbi.nlm.nih.gov/pubmed/19244952

For more information about laser eye surgery and PRESBYOND Laser Blended Vision, please contact the London Vision Clinic on 020 7224 1005.

Watch that Real Human Body Decomposing Process On Video

Demonstration of Burke-Baier wound closure forceps on simulated wound near eyebrow.

CPAP is a treatment that uses mild air pressure to keep your breathing airways open. It involves using a CPAP machine that includes a mask or other device that fits over your nose or your nose and mouth, straps to position the mask, a tube that connects the mask to the machine’s motor, and a motor that blows air into the tube. CPAP is used to treat sleep-related breathing disorders including sleep apnea. It also may be used to treat preterm infants who have underdeveloped lungs.

Carpal tunnel release (part 1). Skin incision and retraction. Procedure performed by Deepak Kapila, MD, Broward Health, Fort Lauderdale, FL. Courtesy of BroadcastMed (http://ortho.broadcastmed.com/....4229/videos/carpal-t

There are hundreds more procedural videos as well as news, features, resources and references on Medscape.com. Join today for free.

But here's the good news: it is possible to prevent prediabetes from developing into type 2 diabetes. Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range.

Menstruation is the time of month when the womb (uterus) sheds its lining and vaginal bleeding occurs. This is known as a menstrual period. Periods vary widely from woman to woman. Some periods are punctual, some are unpredictable. On average, a woman gets her period every 24 to 38 days. A period usually lasts about two to eight days. Irregular periods may require treatment. What Are Irregular Periods? You may have irregular periods if: The time between each period starts to change. You are losing more or less blood during a period than usual. The number of days that your period lasts varies significantly. There are different terms for different types of irregular periods: Irregular Menstrual Bleeding (IrregMB): Bleeding of more than 20 days in individual cycle lengths over a period of one year. Absent Menstrual Bleeding (amenorrhea): No bleeding in a 90-day period. Heavy Menstrual Bleeding (HMB): Excessive menstrual blood loss that interferes with the woman’s physical, emotional, social, and material quality of life and can occur alone or in combination with other symptoms. Heavy and Prolonged Menstrual Bleeding (HPMB): Less common than HMB. It is important to make a distinction from HMB given they may have different etiologies and respond to different therapies. Light Menstrual Bleeding: Based on patient complaint, rarely related to pathology.

A brief video demonstrating an Open Cholecystectomy surgery

This video shows Prof Dan Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth FEBO performing a ReLEx SMILE keyhole LASIK procedure using the latest surgical instrument that he helped to develop (Malosa MMSU1297 - Reinstein Lenticule Separator: http://www.malosa.com/en/reinstein-le...). This instrument enables the procedure to be performed with one instrument, through one 2mm incision, using only one sweep per plane, and taking about 30 seconds to separate and withdraw the lenticule, improving day 1 uncorrected vision over other lenticule extraction techniques that require more corneal manipulation.

Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD) Guide. During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle.