The majority of fetuses are in a breech presentation early in pregnancy. By week 38th week of gestation, however, the fetus normally turns to a cephalic presentation. Although the fetal head is the widest single diameter, the fetus’s buttocks [ breech], plus the lower extremities, actually takes up more space. The fundus, being the largest part of the uterus, probably accounts for the fact that in approximately 97% of all pregnancies, the fetus turns so that the buttocks and lower extremities are in the fundus. Vaginal delivery of a breech presentation requires great skill if the fetus is not to be damaged. With the low rate of vaginal breech deliveries in the developed world, experience is being lost. 6% of women with breech presentation still have a vaginal breech delivery as they present too late - so units need to retain a high level of preparedness. Types of breech presentation: I. Complete breech [ flexed breech]: The fetal attitude is one of complete flexion, with hips and knees both flexed and the feet tucked in beside the buttocks. The presenting part consists of two buttocks, external genitalia and two feet. It is commonly present in multiparae. II. Incomplete breech: This is due to varying degrees of extension of thighs or legs at podalic pole. Three varieties are possible; - Breech with extended legs [ frank breech ]: The breech presents with the hips flexed and legs extended on the abdomen. 70% of breech presentations are of this type and it is particularly common in primigravidae whose good uterine muscle tone inhibits flexion of the legs and free turning of the fetus. - Footling breech: This is rare. One or both feet present because neither hips nor knees are fully flexed. The feet are lower than the buttocks, which distinguishes it from the complete breech. - Knee presentation: This is very rare. Thighs are extended but the knees are flexed, bringing the knees down to present at the brim.

This new surgical technique provide good stability for all type of fracture even severe comminution. Each fragment are reduced and several pin sleeves are inserted circumferentially and tighten by braded cable through the sleeve box. The final features of surgery seems blooming sunflower 'Himwari in Jananese'.

Lattrell Wells was a perfect candidate for the MACI procedure. Dr. Michael O'Malley is a sports medicine surgeon at Carilion Clinic, "It’s a two stage procedure. So what we do is we actually harvest a small portion of the patient's cartilage and bone cells and we send it to a lab where the lab then that grows additional cartilage cells. It comes back to us in a little sheet and six weeks after that initial surgery, we re-implant the cartilage in a second surgery where we implant that sheet depending on the size of lesion right where his defect. This the only option where there’s virtually no risk of any kind of graft rejection or anything of that nature.

Learn more about Merit Medical's ProGuide™ Chronic Dialysis

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This video details the layered closure of a through-and-through facial laceration

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If your kidney function is declining and medications and other treatments aren’t working, dialysis can offer life-saving care. UVA has one of the largest dialysis programs in the country. Nephrologist Daphne Knicely, MD, explains the types of home dialysis and how they can work to fit your life.

Find out more at: https://uvahealth.com/services/dialysis

Transcript

Dialysis is just a way to replace the kidneys when they're not working anymore. So when the kidneys stop working, they stop getting rid of water, stop balancing the chemistry, stop getting rid of the toxins. Then dialysis does its job by balancing the chemistries, getting rid of the toxins, and help remove fluid. It doesn't fix the kidneys. It just replaces them.

I usually think of dialysis as two components. There's hemodialysis and peritoneal dialysis. So peritoneal dialysis can only be done at home. Hemodialysis can be done in a center, or it can be done at home.

Hemodialysis is where you have some sort of access to the blood. Either some sort of shunt in the arm that connects an artery and vein, or a catheter. And it allows for blood to leave you, go through a machine, get cleaned, chemistries balanced, and then comes back to you.

For home hemodialysis, the patient actually learns how to do that treatment. It's a very simple machine, very user-friendly. Training is usually about anywhere from four weeks up to eight weeks, and you work one-on-one with a nurse. You still see the physician. You come in about once a month, maybe twice a month, to get labs. You'll see a social worker, and a nutritionist at the same time.

Peritoneal dialysis takes place by putting a tube into your abdomen. And we take dialysis fluid that's chemically balanced. When we put it into the abdomen, it uses those little blood vessels to pull toxins out, to balance chemistries, kind of like little filters. Now, after it sits in there for several hours, we drain it out.

Anyone that needs dialysis is a candidate for home dialysis. There's not one type of dialysis that's going to make you live longer. They're all equal. The goal is to pick the type of dialysis that fits with your life.

Palpation for Abdominal Masses

Hip Examination

popliteal embolectomy; medial approach using a 4 f fogarty catheter

USMLE Step 2 CS - Wrist Pain This is just preview video. To get full access please visit our website : www.usmletutoring.com

When the hematocrit rises to 60 or 70%, which it often does in polycythemia, the blood viscosity can become as great as 10 times that of water, and its flow through blood vessels is greatly retarded because of increased resistance to flow. This will lead to decreased oxygen delivery.

A water birth means at least part of your labor, delivery, or both happen while you’re in a birth pool filled with warm water. It can take place in a hospital, a birthing center, or at home. A doctor, nurse-midwife, or midwife helps you through it. In the U.S., some birthing centers and hospitals offer water births. Birthing centers are medical facilities that offer a more homelike setting than a hospital and more natural options for women having babies. The use of a birthing pool during the first stage of labor might: Help ease pain Keep you from needing anesthesia Speed up your labor The American College of Obstetricians and Gynecologists (ACOG), which sets guidelines for pregnancy and childbirth care in the U.S., says a water birth during the first stage of labor may have some benefits but delivering your baby underwater should be considered an experimental procedure with risks. The first stage is from when contractions start until your cervix is fully dilated.

this video he is demonstrating how to apply Kinesiology Tape for a patient that presents with rib or intercostal pain

Most people develop several moles (nevi) throughout adulthood. Moles can be found anywhere on the body, usually in sun-exposed areas, and are usually brown, smooth, and slightly raised. In most cases, a nevus is benign and doesn't require treatment. Rarely, they turn into melanoma or other skin cancers. A nevus that changes shape, grows bigger, or darkens should be evaluated for removal.

Talley + O'Connor's essential video guide to Abdominal Examination is here! Brush up on your skills and be sure to ace your OSCEs!

Pyogenic liver abscesses are mainly treated by percutaneous aspiration or drainage under antibiotic cover. If interventional radiology fails, surgical drainage becomes necessary. Recently, we performed laparoscopic liver abscess drainage successfully, and we aimed to focus on the topic in light of a systematic review of the literature.

Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Some people refer to AF as a quivering heart. An estimated 2.7 million Americans are living with AF.