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Patient 65-year-old of age who comes to the medical consultation with pain moderated pain in the right hypochondrium of “several years of evolution” but that it increased one week ago. Also, she shows pain in the umbilical region of “many years of evolution”, that is supported according to the patient - in a constant way.rnTo the examination, we observe an umbilical hernia, apparently divided into two parts. The hernia of the external region measures 25.1 centimeters x 18.0 centimeters and the one that occupies the average region measures 12.0 centimeters x 10.0 centimeters.rnPatient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck.rnIn the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters.rnOn having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several “echogenics points” in the interior (”Biliary Mud”).
The measurements of the gallbladder were: 39.0 x 17.4 millimeters.rnWe can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days.
Acalculous cholecystopathy which means disease or condition of the gallbladder without the presence of gallstones. You might also call it functional gallbladder disorder or impaired gallbladder emptying. Some causes may be chronic inflammation, a problem with the smooth muscles of the gallbladder or the muscle of the Sphincter of Oddi being too tight.
REMEMBER:
Umbilical hernia is a congenital malformation, especially common in infants of African descent, and more frequent in boys. An Acquired umbilical hernia directly results from increased intra-abdominal pressure and are most commonly seen in obese individuals.
Presentation:A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissued is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate).
Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.
Differential diagnosisrnImportantly this type of hernia must be distinguished from a paraumbilical hernia which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.
The obstetric examination is distinct from other examinations in that you, the clinician, are trying to assess the health of two individuals – the mother and the fetus – simultaneously. From the initial history, you should be able to judge the health of the pregnancy, any risk factors that need to be addressed, and any concerns from the parents. The history is an opportunity for you to find out how much the parents know about pregnancy, labour and delivery and if they have any preferences to which these events are carried out. A carefully taken history will also direct your attention to specific signs during the examination. As such, it is important that you develop a concise and systematic method of taking the history and carrying out the examination so that you do not miss any important information. This article focuses primarily on the examination. Pregnancy is a sensitive issue, especially for the primigravida’s. Therefore, extra care is needed when you approach a pregnant woman. Always obtain expressed informed consent before examining her and have a chaperone accompany you throughout the examination. A walk-through of what you will be doing is a good way of reassuring the patient and allows the examination to go on smoothly. It is also important to let your patient know that if the examination is too painful, she can stop at any time she wants. Finally, before you begin, you should always wash your hands, especially at an OSCE station.
Pulmonary edema is usually caused by a heart condition. Other causes include pneumonia, exposure to certain toxins and drugs, and being at high elevations. Depending on the cause, pulmonary edema symptoms may appear suddenly or develop over time. Mild to extreme breathing difficulty can occur. Cough, chest pain, and fatigue are other symptoms. Treatment generally includes supplemental oxygen and medications.
A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall. This is usually defined as at least two fractures per rib (producing a free segment), in at least two ribs. A segment of the chest wall that is flail is unable to contribute to lung expansion. Large flail segments will involve a much greater proportion of the chest wall and may extend bilaterally or involve the sternum. In these cases the disruption of normal pulmonary mechanics may be large enough to require mechanical ventilation.
Massive PE causing hemodynamic instability (shock and/or low blood pressure, defined as a systolic blood pressure <90 mmHg or a pressure drop of 40 mmHg for >15 min if not caused by new-onset arrhythmia, hypovolemia or sepsis) is an indication for thrombolysis, the enzymatic destruction of the clot with medication.
This implantation method is very common and used in both FUE hair transplant surgery and strip surgery (FUSS). During this implantation method, site creation and graft implantation are performed simultaneously as part of a one or two step process.
The most popular and one of the principal stains in histology is hematoxylin and eosin stain. It gives us an overview of the tissue and its structure. Hematoxylin binds with basophilic structures – for example DNA and RNA. So we can observe nuclei stained in blue or purple color. Eosin binds to acidophilic substances such as positively charged amino acid side chains. So as the result cytoplasm is pink or orange. All samples in laboratory are stained with H&E. There are several different types of hematoxylins and eosins used in histology which will give us different results.
In this video you will see, how we stain slides with different types of hematoxylins and eosins. Finally, we will compare the results.
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A natural, unmedicated approach to labor and birth will suit you best if you want to remain in control of your body as much as possible, be an active participant throughout labor, and have minimal routine interventions such as continuous electronic monitoring. If you choose to go this route, you accept the potential for pain and discomfort as part of giving birth. But with the right preparation and support, women often feel empowered and deeply satisfied by natural childbirth.