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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
Small cell lung cancer, which occurs almost exclusively in smokers, is a malignancy characterised by rapid doubling time, high growth fraction and widespread metastasis at presentation. In this presentation, we will briefly discuss the classification of pulmonary Neuro-endocrine tumours by the World Health Organisation followed by a detailed discussion of the clinical features, lab evaluation and management of SCLC, both limited and extended stage. The frontline therapy in small cell lung cancer is etoposide and cisplatin along with thoracic radiotherapy and prophylactic cranial irradiation in patients who have a good response to therapy. Hyperfractionation of radiotherapy may provide some benefit but is also associated with increase incidence of complications. Newer agents for SCLC include Vandetanib and immunotherapy molecules, such as Iplimumab and nivolumab.
This procedure describes proximal humeral fracture fixation with an angular stable plate (A). Sometimes, these implants are not available. Standard plates provide an alternative option, for example the modified cloverleaf plate (B). Presently, the specific indications, advantages, and disadvantages of angular stable and standard plates are being clarified. There is some evidence that angular stable plate provide better outcomes. In addition to type and technique of fixation, the quality of reduction, the soft-tissue handling, and the characteristics of the injury and patient significantly influence the results. There is no evidence that the use of angular stable plates will overcome these other factors.
Hypoglycemia is a common and serious medical emergency which may occur in both daibetic and non-diabetic patients. The signs and symptoms of hypoglycaemia may be present in many individuals, but may also be masked in several individuals due to a condition called hypoglycaemia induced autonomic failure. This presentation aims to deal with the causes, clinical features, diagnosis and management of various causes of hypoglycaemia. The causes of hypoglycaemia may be divided into hypoglycaemia in ill or medicated individuals and hypoglycaemia in previously asymptomatic individuals. A variety of causes are discussed under both headings. Management of hypoglycaemia is also discussed in detail. There is also a brief discussion about management of insulinoma.
An ectopic pregnancy results when a fertilized egg implants outside the uterus. Unfortunately, there's no way to transplant an ectopic pregnancy into your uterus, so ending the pregnancy is the only option. About 2 percent of pregnancies are ectopic. Because ectopic pregnancy is potentially dangerous for you, it's important to recognize the early signs and get treatment as soon as possible.
Oral therapy has potential for symptom relief. It has the advantage of no surgery. Disadvantages include ongoing medication therapy, risks of side effects, high out of pocket cost, and sometimes over time effectiveness diminishes. Certain men also do not like to take medications. This is the most common way to treat BPH. Medicines like Flomax, Cardura, Hytrin and Uroxatral have proven to be effective in the treatment of most cases. Alpha Blockers relieve the obstruction by trying to stop the process by which the construction occurs. They basically relax the smooth muscle cells in the prostate to relieve urinary obstruction. Like most medicines side effects can occur. They are mild in most cases and include dizziness on standing, feeling fatigued, loss of ability to ejaculate with orgasm.
Pulmonary circulation is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated (oxygen-rich) blood back to the heart. The function of pulmonary circulation is to exchange carbon dioxide for oxygen in the blood. It is the passage of blood from the heart to the capillaries of the lungs, where the gases are exchanged, and back to the heart to be pumped around the body.
Papillary fibroelastoma is the third most common primary tumor of the heart and is most likely to involve the cardiac valves. Like myxomas, they arise from the endocardium in most patients and since these tumors are often incidental findings at echocardiography or autopsy, the true incidence is difficult to estimate. Most patients are older than 60 years, which also contrasts with myxomas. Papillary fibroelastomas can embolize, leading to severe neurological complications and therefore, surgical removal is advised, although there is controversy regarding small incidental lesions and the need for surgery.
The discussion begins with a basic explanation of Bone biology taking into consideration the osteoblast and osteoclast balance. Concepts of RANK, RANK ligand and Osteoprotegerin are included. Risk factors for Osteoporosis such as Age, alcohol, smoking, sedentary lifestyle are also discussed.
During surgery to repair the hernia, the bulging tissue is pushed back in. Your abdominal wall is strengthened and supported with sutures (stitches), and sometimes mesh. This repair can be done with open or laparoscopic surgery. You and your surgeon can discuss which type of surgery is right for you.