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Bacterial abscess of the liver is relatively rare; however, it has been described since the time of Hippocrates (400 BCE), with the first published review by Bright appearing in 1936. In 1938, Ochsner's classic review heralded surgical drainage as the definitive therapy; however, despite the more aggressive approach to treatment, the mortality remained at 60-80%. [1] The development of new radiologic techniques, the improvement in microbiologic identification, and the advancement of drainage techniques, as well as improved supportive care, have reduced mortality to 5-30%; yet, the prevalence of liver abscess has remained relatively unchanged. Untreated, this infection remains uniformly fatal.
Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier. It may be done to determine the cause of your pleural effusion. Some conditions such as heart failure, lung infections, and tumors can cause pleural effusions.
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?
The Fibroids Project Interviews Dr. Brown. Haywood Brown, MD, is the chair of the Department of Obstetrics and Gynecology at Duke University Medical Center. He also is a nationally recognized specialist in maternal-fetal medicine.
Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn. Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint.
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.
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A Bone scan or bone scintigraphy is a nuclear scanning test to find certain abnormalities in bone which are triggering the bone's attempts to heal. It is primarily used to help diagnose a number of conditions relating to bones, including: cancer of the bone or cancers that have spread (metastasized) to the bone, locating some sources of bone inflammation (e.g. bone pain such as lower back pain due to a fracture), the diagnosis of fractures that may not be visible in traditional X-ray images, and the detection of damage to bones due to certain infections and other problems.
Nuclear medicine bone scans are one of a number of methods of bone imaging, all of which are used to visually detect bone abnormalities. Such imaging studies include magnetic resonance imaging (MRI), X-ray computed tomography (CT) and in the case of 'bone scans' nuclear medicine. However, a nuclear bone scan is a functional test, which means it measures an aspect of bone metabolism, which most other imaging techniques cannot. The nuclear bone scan competes with the FDG-PET scan in seeing abnormal metabolism in bones, but it is considerably less expensive.
Nuclear bone scans are not to be confused with the completely different test often termed a "bone density scan," DEXA or DXA, which is a low exposure X-ray test measuring bone density to look for osteoporosis and other diseases where bones lose mass, without any bone re-building activity. The nuclear medicine scan technique is sensitive to areas of unusual bone re-building activity because the radiopharmaceutical is taken up by osteoblast cells which build bone. The technique therefore is sensitive to fractures and bone reaction to infections and bone tumors, including tumor metastases to bones, because all these pathologies trigger bone osteoblast activity. The bone scan is not sensitive to osteoporosis or multiple myeloma in bones, and therefore other techniques must be used to assess bone abnormalities from these diseases.
Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way. When the neural tube doesn’t close all the way, the backbone that protects the spinal cord doesn’t form and close as it should. This often results in damage to the spinal cord and nerves. Spina bifida might cause physical and intellectual disabilities that range from mild to severe. The severity depends on: The size and location of the opening in the spine. Whether part of the spinal cord and nerves are affected.
A pneumothorax occurs when some of the tiny air sacs (alveoli) in a baby's lung become overinflated and burst. This causes air to leak into the space between the lung and chest wall (pleural space). The most common cause of pneumothorax is respiratory distress syndrome. This is a condition that occurs in babies who are born too early (premature). The baby's lungs lack the slippery substance (surfactant) that helps them stay open. Therefore, the tiny air sacs are not able to expand as easily. If the baby is put on a breathing machine (mechanical ventilator), there is extra pressure on the baby's lungs, which can sometimes burst the air sacs.
Frontotemporal dementia is the name for a range of conditions in which cells in the frontal and temporal lobes of the brain are damaged. These lobes control behaviour, emotional responses and language. This means that people will experience changes in personality and behaviour, or may struggle with language – for example, in finding the right word. Frontotemporal dementia is a less common form of dementia which is more likely to affect younger people – those under 65.