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A uterine fibroid (also uterine leiomyoma, myoma, fibromyoma, leiofibromyoma, fibroleiomyoma, and fibroma) (plural of ... myoma is ...myomas or ...myomata) is a benign (non-cancerous) tumor that originates from the smooth muscle layer (myometrium) and the accompanying connective tissue of the uterus. Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. While most fibroids are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Uterine fibroids is the major indication for hysterectomy in the US.[2] Fibroids are often multiple and if the uterus contains too many leiomyomatas to count, it is referred to as uterine leiomyomatosis. The malignant version of a fibroid is uncommon and termed a leiomyosarcoma.
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Tracheotomy and tracheostomy are surgical procedures that create an opening in the trachea (windpipe) to help patients breathe when they have difficulty doing so through the nose or mouth. Though they are similar in purpose, there are some key differences between them.
Tracheotomy is a temporary procedure that involves creating a small incision in the trachea to insert a breathing tube. The tube is typically removed once the patient no longer requires it, and the incision heals on its own. Tracheostomy, on the other hand, is a more permanent solution that involves creating a hole in the trachea and inserting a tracheostomy tube, which remains in place for an extended period.
Indications for these procedures include:
Airway obstruction due to trauma, tumors, or infection
Severe respiratory distress or failure
Prolonged mechanical ventilation
Inability to protect the airway due to neurological disorders or impaired consciousness
Steps for performing a tracheotomy and tracheostomy:
Preparation: The patient is positioned, and the neck area is cleaned and draped. Local anesthesia is often administered, although general anesthesia may be used in some cases.
Incision: A small incision is made in the neck, and the muscles and tissues are carefully separated to expose the trachea.
Tracheal opening: A small opening is made in the trachea, typically between the second and third tracheal rings.
Tube insertion: A tracheotomy tube is inserted through the incision and into the trachea for a tracheotomy, while a tracheostomy tube is inserted for a tracheostomy. Both tubes are secured in place.
Confirmation: Proper placement of the tube is confirmed by listening for breath sounds and checking for adequate ventilation.
Pre-operative care typically involves a thorough assessment of the patient's medical history, as well as any necessary imaging studies or lab tests to ensure the procedure is appropriate and safe. Informed consent should be obtained from the patient or their legal representative.
Post-operative care includes monitoring the patient's vital signs, ensuring the tube remains secure and patent, and managing any pain or discomfort. For tracheostomy patients, regular cleaning and maintenance of the stoma (the opening in the trachea) and the tracheostomy tube are essential to prevent infection and other complications. Long-term care may involve speech therapy, respiratory therapy, and support from a multidisciplinary team to address any ongoing needs.
It's crucial to remember that these procedures should only be performed by trained medical professionals in a clinical setting.
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A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though rarely a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they're neither benign nor malignant but, rather, something in between.
What Is It? Your wisdom teeth (third molars) usually start to erupt (enter your mouth) during the late teen years. Sometimes, there's not enough room for them. They may come into your mouth partially or not at all. Partial eruption of a wisdom tooth can create a flap of gum tissue next to the tooth. The flap can trap bits of food and debris. It can turn into a hotbed for bacteria. It's called pericoronitis if the tissue around the tooth becomes inflamed. Pericoronitis also can occur around a wisdom tooth that is still completely under the gums. Symptoms Symptoms include: Painful, swollen gum tissue in the area of the affected tooth. It can be difficult to bite down comfortably without catching the swollen tissue between your teeth. A bad smell or taste in the mouth Discharge of pus from the gum near the tooth More serious symptoms include: Swollen lymph nodes under your chin (the submandibular nodes) Muscle spasms in the jaw Swelling on the affected side of the face Diagnosis Usually, someone with pericoronitis goes to the dentist, complaining of pain in the area of the back tooth. Pericoronitis is diagnosed during the clinical exam. Your dentist will see inflamed gum tissue in the area of the unerupted or partly erupted wisdom tooth. The gums may be red, swollen or draining fluid or pus. Expected Duration Pericoronitis can be managed with antibiotics and warm salt water rinses. It goes away in about one week. However, it can return. This is likely to happen if the tooth does not completely enter the mouth and food and bacteria keep building up under the gum. Prevention You can help to prevent pericoronitis by brushing any erupting wisdom tooth and flossing around it. This will help make sure that food and bacteria do not build up under the gums. However, sometimes these steps do not work. If pericoronitis returns, you may need to have the flap of gum tissue removed. In some cases, the flap of tissue grows back and the wisdom tooth will need to be extracted. Treatment Pericoronitis can be tricky to treat. That's because the flap of gum tissue won't go away until the wisdom tooth emerges naturally, the tissue is removed or the tooth is removed. Your dentist will clean the area thoroughly by rinsing under the flap with water to remove bits of food and pus. Your dentist also may need to remove damaged tissue. If the area is infected, you'll most likely be given antibiotics. Your dentist will explain how to keep the area clean, which is the best way to prevent the problem from returning. This usually involves brushing and flossing daily and rinsing your mouth with water several times a day. These steps will help to prevent food from getting stuck under the gum flap. In some cases, your dentist may suggest removing the erupting tooth. Or the dentist may want to remove the tooth above it, which bites down on the gum below. If your dentist thinks the tooth may erupt fully into the mouth without problems, he or she may leave it alone. However, if pericoronitis comes back, the tooth may be extracted. Pericoronitis that causes symptoms should be treated as soon as possible. If it is not, the infection can spread to other areas of your mouth. The most severe cases are treated in a hospital. They sometimes require intravenous antibiotics and surgery. When To Call a Professional If you have symptoms of pericoronitis, make an appointment to see your dentist. If your wisdom teeth are coming in, visit your dentist at least twice a year for regular checkups. During those visits, the dentist can check on the progress of your wisdom teeth. Prognosis Pericoronitis does not cause any long-term effects. If the affected tooth is removed or erupts fully into the mouth, the condition cannot return.
Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve removing excess skin, muscle and fat. As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes. Besides making you look older, severely sagging skin around your eyes can reduce your side vision (peripheral vision), especially the upper and outer parts of your field of vision. Blepharoplasty can reduce or eliminate these vision problems and make your eyes appear younger and more alert. To help decide if blepharoplasty is right for you, find out what you can realistically expect and explore the benefits and risks of blepharoplasty.
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The cardiac examination is one of the earliest clinical skills that medical students learn. As a junior doctor, the examination of the cardiovascular system can be almost a dreaded examination, as cardiac murmurs can literally take years of exposure in order to gain confidence with their identification through cardiac auscultation.
This video demonstrates not merely the examination of the heart, but the complete cardiovascular system including peripheries.
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A surgeon creates an arteriovenous fistula by making a connection between an artery (which carries blood away from the heart) and a vein (which carries blood back to the heart). This artificial connection allows the vein to become larger and for the walls of the vein to thicken, a process termed maturation. A mature fistula makes it easier for the vein to be punctured repeatedly for dialysis. Maturation typically takes three to six months to occur, but in rare cases, can take up to a year. This makes advance planning for an arteriovenous fistula important. When a patient is felt to be approximately a year away from requiring dialysis, the patient should be referred for evaluation for possible creation of an arteriovenous fistula.
When placement of a urethral catheter is contraindicated or unsuccessful, percutaneous suprapubic urinary bladder catheterization is a commonly performed procedure to relieve urinary retention. [1, 2] This topic describes the Catheter over needle technique. The Seldinger technique is described in the Clinical Procedures topic Suprapubic Aspiration.