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The pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects. The pelvic floor separates the pelvic cavity above from the perineal region (including perineum) below.

The right and left levator ani lie almost horizontally in the floor of the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal. The levator ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus. The pubococcygeus, the main part of the levator, runs backward from the body of the pubis toward the coccyx and may be damaged during parturition. Some fibers are inserted into the prostate, urethra, and vagina. The right and left puborectalis unite behind the anorectal junction to form a muscular sling . Some regard them as a part of the sphincter ani externus. The iliococcygeus, the most posterior part of the levator ani, is often poorly developed.

The coccygeus, situated behind the levator ani and frequently tendinous as much as muscular, extends from the ischial spine to the lateral margin of the sacrum and coccyx.

The pelvic cavity of the true pelvis has the pelvic floor as its inferior border (and the pelvic brim as its superior border.) The perineum has the pelvic floor as its superior border.

Some sources do not consider “pelvic floor” and “pelvic diaphragm” to be identical, with the “diaphragm” consisting of only the levator ani and coccygeus, while the “floor” also includes the perineal membrane and deep perineal pouch.

A local doctor says that the new pap smear guidelines makes sense for many women

Although it demands an advanced set of skills that remain substantially hard to do, many of the salient steps of “open” surgery, including suturing, are credibly “replicated” in its laparoscopic counterpart with the intention of achieving similar optimal results. This video demonstrates how to tie Laparoscopic Roeder's Knot. Laparoscopic Roeder's Knot is one of the oldest knots used in laparoscopic surgery. It is used most commonly during laparoscopic appendectomy surgery. Recent literature, though abundant with numerous reports pertaining to a variety of endoscopic knotting techniques and technologies, appears to lack scientific data but Roeder's knot is a time tasted extracorporeal slip knot that is secure for 6-8 mm diameter tubular structure.

For more information please contact:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR DELHI
INDIA 122002
Phone & WhatsApp: +919811416838, + 91 9999677788

Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient's internal organs on a television monitor.

Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS). The CNS is made up of the brain, spinal cord and optic nerves.

The brain is that part of the CNS contained within the cranial cavity (figure 13.1). It is the control center for many of the body's functions. The brain is much like a complex central computer but with additional functions that no computer can as yet match. Indeed, one goal in computer technology is to make computers that can function more like the human brain. The brain consists of the brainstem, the cerebellum, the diencephalon, and the cerebrum (table 13.1). The brainstem includes the medulla oblongata, pons, midbrain, and reticular formation. The structure of the brain is described in this chapter. Its functions are primarily discussed in chapter 14. Twelve pairs of cranial nerves, which are part of the PNS, arise directly from the brain. Two pairs arise from the cerebrum, nine pairs arise from the brainstem, and one pair arises from the spinal cord.

A 3D video clip showing anatomy and physiology of the heart

Liposuction is a surgical procedure that is done to remove fat deposits from underneath the skin. Common areas that are treated: the abdomen, buttocks, thighs, upper arms, chest and neck. (use medical graphic of body with labeled parts) The procedure is usually done as an outpatient under some combination of local anesthesia and/or sedation:. This means you are awake but relaxed and pain free. Depending on the number of areas to be treated and the specific technique selected, it may take from one to several hours. A small incision (cut) is made through the skin near the area of the fat deposit. Multiple incisions may be needed if a wide area or multiple areas are being done. A long hollow tube called a cannula will be inserted through this incision. Prior to inserting the cannula, the doctor may inject a solution of salt water that contains an anesthetic (numbing) medication and another medication to decrease bleeding. The cannula is then inserted and moved under the skin in a way to loosen the fat deposits so they may be suctioned out. Because a significant amount of body fluid is removed with the fat, an intravenous (through the veins) fluid line will be kept going during the procedure.

A recent technique called “ultrasound-assisted lipoplasty” uses a special cannula that liquefies the fat cells with ultrasonic energy. You should ask your doctor which technique he/she will use and how it will affect the type of anesthesia you will need and the length of the procedure.

Why is this procedure performed?
Liposuction is done to restore a more normal contour to the body. The procedure is sometimes described as body sculpting. It should be limited to fat deposits that are not responsive to diet and exercise. It is suggested that you should be within 20of your ideal body weight at the time of surgery. If you are planning to lose weight you should delay this procedure. This is not obesity surgery. The maximum amount of fat that can be removed is usually less than 10 pounds. The best results are achieved in people who still have firm and elastic skin. Although rare, there are risks and complications that can occur with liposuction. You should be aware that all the complications are increased if you are a smoker. You will need to quit smoking or at least avoid smoking for a month before and after surgery. If you have had prior surgeries near any of the areas to be treated, this may increase the risk of complications and you should discuss this with your doctor. Any history of heart disease, diabetes, bleeding problems or blood clots in your legs may make you more prone to post-operative problems and you should discuss these with your doctor. Finally, as with any cosmetic procedure it is important to have realistic expectations. The goals, limitations, and expectations of the procedure should be discussed openly and in detail with your doctor. Most insurance companies do not cover cosmetic surgery.

What should I expect during the post-operative period?
After surgery you should be able to go home but you will need someone to drive you. In the first few days after surgery it is common for the incisions to drain fluid and you will have to change dressings frequently. Fresh blood is not usual and if you have any bleeding you should call your doctor immediately. In some cases a small tube may have been placed through the skin to allow drainage. You will be limited to sponge baths until the drains and dressings are removed. After that you may take showers but no baths for 2 weeks. You may experience pain, burning, and numbness for a few days. Take pain medicine as prescribed by your doctor. You may notice a certain amount of bruising and swelling. The bruising will disappear gradually over 1 to 2 weeks. Some swelling may last for up to 6 months. If you have skin sutures they will be removed in 7 to 10 days. You should be able to be up and moving around the house the day after surgery but avoid any strenuous activity for about 1

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.

They might not sound very life threatening, but a blood clot that develops in the deep veins of your leg, if left untreated and unable to dissolve of its own volition, may detach and travel to your lungs, causing a pulmonary embolism (or PE). In most cases, a leg blood clot will form due to lengthy periods of travel, for example if you remain immobile in cramped spaces—such as an airplane or bus—with few opportunities to stretch your legs or get up and walk around. Here are ten signs that you may have a dangerous blood clot in your leg

Surgical procedure of Tonsillectomy and Adenoidectomy

IMPLANT POCKETS - an educational animation explaining the different implant pockets

Aplastic anemia is a hematopoietic disorder caused due to T lymphocyte mediated destruction of stem cells resulting in pancytopenia with a cellular bone marrow and normal cell cytogenetics. The causes of aplastic anaemia may be inherited or acquired. The causes and the diagnostic approach, along with spectrum of severity of this disorder is discussed in this presentation. A detailed discussion of the management options, along with pharmacological therapy and supportive therapy in these cases is also discussed. The treatment options include, in addition to a stem cell transplant, anti-thymocyte globulin, cyclosporine, methyprednisolone and eltrombopag (for patients who have failed treatment on combined modality therapy with ATG and cyclosporine)

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Distal Urethroplasty with Dorsal Dartos Flap

A rare video showing the flail chest which is traumatic condition during which the chest wall shows paradoxical movement i.e. in with expiration and out with inspiration

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however. One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles -- hence the name "Colles" fracture.