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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.
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Heavy period blood can be especially alarming if it contains clots. In most cases, though, red, brown, or even black menstrual blood clots are normal—just bits of the endometrium (the lining of the uterus) that are shed during menstruation.
This is a surgery showing the removal of a large exostosis. Exostoses are bony growths in the ear canal from chronic exposure to cold water/air, most commonly from surfing. This patient had growths in both ears, which were completely obstructing the ear canals. This patient had a single exostosis that was blocking this side (the right side).
Indwelling urinary catheters are commonly used in hospitals and can lead to preventable catheter-associated UTI. How can rates of catheter-associated UTI be reduced in hospitals? New research findings are summarized in a new NEJM Quick Take. Learn more at http://nej.md/1WoeHdF SHOW MORE
Shoutout to director/videographer Valentina Vee and producer Sean Tien for helping me bring this to life.
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nee joint aspiration and injection are performed to aid in diagnosis and treatment of knee joint diseases. The knee joint is the most common and the easiest joint for the physician to aspirate. One approach involves insertion of a needle 1 cm above and 1 cm lateral to the superior lateral aspect of the patella at a 45-degree angle. Once the needle has been inserted 1 to 1½ inches, aspiration aided by local compression is performed. Local corticosteroid injections can provide significant relief and often ameliorate acute exacerbations of knee osteoarthritis associated with significant effusions. Among the indications for arthrocentesis are crystal-induced arthropathy, hemarthrosis, unexplained joint effusion, and symptomatic relief of a large effusion. Contraindications include bacteremia, inaccessible joints, joint prosthesis, and overlying infection in the soft tissue. Large effusions can recur and may require repeat aspiration. Anti-inflammatory medi
The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis