Saturday, October 23, 2010

Intraocular Lens Implant


Huntington Disease

Huntington Disease is an autosomal dominant inherited disease, when the patient begins to exhibit symptoms at 20s and 30s.Initially the patients have a tendency to fidget which over months or years develops into jerky, choreiform movements. Huntington Disease usually progresses over a 10 to 25 year period. As the disease progresses it leads to ..........

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Local anaesthesia technique for Middle ear and Mastoid

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Color Atlas of Cytology, Histology, and Microscopic Anatomy

This timeless pocket atlas is the ideal visual companion to histology and cytology textbooks. First published in 1950 and translated into eight languages, Kuehnel’s Pocket Atlas of Cytology, Histology and Microscopic Anatomy is a proven classic.
The fully revised and updated fourth edition contains 745 full-color illustrations – almost 200 more than were included in the third edition. Superb, high-quality microphotographs and pathologic stains are accompanied by legends, informative texts, and numerous cross-references.

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Episiotomy during Childbirth Delivery

Principles of Soft Tissue Coverage for Tumor Reconstruction (Hand)

Reconstruction of defects produced after tumor extrication differs significantly from that which is normally encountered in the treatment of traumatic defects. Immediate reconstruction should be anticipated and planned in most instances. The use of two surgical teams is advantageous. This avoids the tendency of the surgeon to compromise the resection or remove less tissue out of concern for maintaining reconstruction options.

Operating room personnel must adhere to strict precautions to prevent cross contamination of operative fields. This includes the use of separate draping, instruments, operative clothing, and personnel. The planning for reconstruction should include the possibility that the margins of resection might be positive.
If a local or rotation flap is to be performed, the potential for spread of the tumor to the donor site must be considered. Groin flaps should be avoided. The use of distant or free tissue transfer increases reconstruction complexity but reduces the risk of donor field contamination and is more frequently used after tumor reconstruction.

Vascularized bone transfer or soft tissue coverage may be particularly beneficial and may improve healing in those patients who need postoperative chemotherapy or radiation.
 Wide excision soft tissue sarcoma from the dorsum of the hand (A,B) with radial forearm flap for soft tissue coverage (C).
Principles of Soft Tissue Coverage for Tumor Reconstruction (Hand)

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ABC of Pediatric Surgical Imaging (ABC series)

This book has been specifically designed to serve as a quick reference that will be of immediate help in decision making. The book is ordered alphabetically according to diagnoses. The intention is that the clinican consults the information on a suspected diagnosis, and then considers the surgical and radiological differential diagnoses that are listed. A total of 80 common diagnoses are covered. For each diagnosis, the left-hand page presents information relevant to the surgeon, while the right-hand page is designed for the radiologist. The information for the surgeon comprises clinical insights, including symptoms, warnings, controversies, important facts of which the surgeon should be aware, and the surgical differential diagnosis. The intention is to enable the surgeon to request the most suitable investigation using the appropriate terminology, ensuring that the correct test is done within the correct time frame. The radiologist is provided with lists of the primary and follow-on investigations, the imaging findings, and helpful tips, as well as the radiological differential diagnosis. Informative supporting images are included for each diagnosis. The authors are all experts in their fields, with extensive practical experience and in-depth knowledge of new imaging techniques. This book belongs in the pocket of every student, house officer, resident, medical officer, or generalist consultant who may be the first practitioner to see the patient.


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May-Thurner syndrome

The May-Thurner syndrome is the symptomatic compression of the left common iliac vein between the right common iliac artery and the lumbar vertebrae.

The normal anatomy is that the artery which runs to the right leg (= right common iliac artery) lies on top of the vein coming from the left leg (= left common iliac vein). This close proximity leads, in some people, to pressure of the artery onto the vein and to varying degrees of narrowing of the vein. This is referred to as "May Thurner syndrome". It is not a disease but a congenital anatomic variant. Mild and moderate degrees of narrowing are typically asymptomatic. More severe degrees can lead to obstruction of blood flow from the leg and thus to leg swelling and pain. The narrowed vein can also clot, resulting in left leg DVT.

The syndrome is named after the authors R. May and J. Thurner, who first described this phenomenon in 1957. It has also been termed the iliac compression syndrome. It is probably the reason why more DVTs occur in the left than in the right leg.

Compression of the iliac vein has been documented in approximately 50% of patients with left iliac vein thrombosis.

Several surgical treatment strategies have been employed in the past:
  1. venous bypass surgery of the narrowed area;
  2. cutting of the iliac artery and repositioning of the artery behind the iliac vein;
  3. construction of a tissue sling or flap to lift it off the iliac vein;
Since 1995 venous stents have been placed into the narrowed area, to pry them open . Unfortunately, there are no large studies that
(a) investigate the long-term success of the procedure, i.e. how often the stents improve symptoms and remain patent.
(b) whether patients should remain on long-term (lifelong) coumadin (warfarin) or not. Stents appear beneficial at least in the short-term improvement of symptoms, within the first 1-2 years of stent placement .

May-Thurner syndrome

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