Alexandra J. Golby, MD, Director, Image-guided Neurosurgery at Brigham and Women’s Hospital, discusses technological advancements to improve the precision of surgery to remove brain tumors.

It’s estimated that each year nearly 80,000 people are diagnosed with primary brain tumors and 100,000 with metastatic brain tumors. Nearly everybody is at risk for developing a brain tumor. Brain tumors can affect people from childhood to the last years of their lives. Men are slightly more affected than women and the causes of most brain tumors are not known.

There are a number of unique challenges in treating brain tumors. One challenge is that primary tumors can have indistinct margins that are difficult to see. Another challenge is that the tissue around a brain tumor is uniquely important and may impact things like language, visual and motor function.

The AMIGO Suite, opened in 2011 at Brigham and Women’s Hospital, is the Advanced Multimodality Image Guided Operating Suite. It's an NIH-funded national center which was developed with the goal of translating technological advances into improvements in surgical and interventional care for patients. In the AMIGO Suite, there is an intraoperative MRI scanner which can be brought in and out of the operating room during surgery to help surgeons visualize a patient’s tumor better.

Image-guided surgery uses the information obtained from advanced imaging and translates that into the planning and execution of surgery by acquiring high resolution and specialty structural images of the brain and also functional images of the brain. These images can be registered to one another and then to the patient's head during surgery. This allows surgeons to pinpoint the location of the tumor as well as the areas that we would like to preserve, areas that serve critical brain functions are located.

One of the big challenges, even with image-guided surgery, is that as we perform the surgery, the configuration of the brain is changing, and we call that brain shift. And it's due to changes in the brain itself and also as we remove tissue, things are constantly shifting and moving. When we're talking about doing brain tumor surgery, a few millimeters of movement can be a big difference. How to measure and track brain shift is an important area of research and a number of technologies are being studied to understand how to measure brain shift during surgery.

The development of various intraoperative imaging technologies allows surgeons to provide the most accurate surgical treatment for each individual patient.

Learn more about precision brain surgery at Brigham and Women’s Hospital:
https://www.brighamandwomens.o....rg/neurosurgery/brai

Dr. Alex Campbell and Dr. Carolina Restrepo of Premium Care Plastic Surgery in Cartagena, Colombia perform a Mommy Makeover on an international patient. Watch the procedure as Dr. Campbell and Dr. Restrepo work together to offer this patient more surgery in less time, which leads to a quicker recovery and better results.

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?

I talk about 5 Essential Skills you need as a nurse. These skills are timeless in the fat that you will always need to use them at some level. Of course specific skills are good to have as well but these skills are universal and can help you in other areas of life as well.

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Hi Guys! My name is Crosby Steen. I am a Nursing Educator, and ER Travel Nurse. I do videos on daily science based news and travel, with the goal of providing value for you in science based education and travel nursing. Any questions hit me up in the comments or Email below.....

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Elbow Exam - Orthopaedic OSCE - Clinical Skills - Dr Gill

The elbow examination is a core skill - in this video, we demonstrate how to perform an elbow EXAM for an Orthopaedic Clinical Skills OSCE, which should be one of the more accessible examination stations for medical students.

For a passing grade in your Clinical Skills OSCE, an elbow assessment should follow the LOOK, FEEL, MOVE approach

Initially looking for erythema, scars, swelling and position

Palpating the elbow - specifically the olecranon, medial and lateral epicondyles, and radial head for heat, oedema and crepitus

Finally assess range of movement with flexion and extension at the elbow, before determining for tennis and golfers' elbows

Watch further orthopaedic examinations for your OSCE revision:

The Elbow - Deep Dive
https://youtu.be/SX5buhtCVDw

The Spine Examination:
https://youtu.be/pJxMHa6SCgU

The Knee examination
https://youtu.be/oyKH4EYfJDM

The Hip examination
https://youtu.be/JC9GKq5nSdQ

The GALS examination
https://youtu.be/5qJaf7gW-B0 - Gait, Arms, Legs, Spine - GALS screen

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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.

However during OSCE assessments. Different medical schools, nursing colleges and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.

The examination demonstrated here is derived from Macleods Clinical Examination - a recognised standard textbook for clinical skills.

Some people viewing this medical examination video may experience an ASMR effect

#clinicalskills #Elbow #DrGill

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Site enhancement oil, often called "santol" or "synthol" (no relation to the Synthol mouthwash brand), refers to oils injected into muscles to increase the size or change the shape. Some bodybuilders, particularly at the professional level, inject their muscles with such mixtures to mimic the appearance of developed muscle where it may otherwise be disproportionate or lagging. This is known as "fluffing".Synthol is 85% oil, 7.5% lidocaine, and 7.5% alcohol. It is not restricted, and many brands are available on the Internet. The use of injected oil to enhance muscle appearance is common among bodybuilders, despite the fact that synthol can cause pulmonary embolisms, nerve damage, infections, sclerosing lipogranuloma,[60] stroke,[55] and the formation of oil-filled granulomas, cysts or ulcers in the muscle. Rare cases might require surgical intervention to avoid further damage to the muscle and/or to prevent loss of life. Sesame oil is often used in such mixtures, which can cause allergic reactions such as vasculitis.

http://www.utexas.edu

Nursing students practice their skills on mannequins and each other in the Nursing Skills Lab.

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Patient Glenn Williams had a hernia measuring 20cm x 30cm. Consultant Graham Offer has performed ground breaking surgery to help Glenn.

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Lung cancer starts when cells of the lung become abnormal and begin to grow out of control. As more cancer cells develop, they can form into a tumor and spread to other areas of the body. To learn more about how cancers start and spread

Wow! Ultrasound guided internal jugular vein cannulation (long axis approach)

Shane Shapiro, M.D., orthopedic physician at Mayo Clinic in Florida, performs a bone marrow aspiration and concentration for BMAC/stem cell injection into arthritic knees. This procedure is part of a Mayo Clinic IRB approved, FDA monitored clinical research trial which can be searched on at http://ClinicalTrials.gov.

Mayo Clinic and the Mayo Center for Regenerative Biotherapeutics is studying biologically based non-surgical treatments for osteoarthritis. One such treatment is the harvesting of the patient's own stem cells from their bone marrow.

"In our procedure we draw cellular rich bone marrow from both sides of the pelvis. We then filter the resulting product and concentrate the stem cells and their corresponding growth factors. Using an ultrasound to image the knee joint, we are then able to precisely inject the cells into the arthritic knee. We are currently demonstrating that this procedure is safe and can relieve pain. We also hope to be able to slow the progression of the degenerative joint disease and perhaps one day regrow cartilage in the arthritic joint."

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Hear Dr. Shapiro discus this procedure in detail here: http://youtu.be/8Djpsc66hKI

Learn more about the Mayo Clinic Center for Regenerative Biotherapeutics here: http://goo.gl/rnRdtU
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