Cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy. Recurrent late miscarriages may be due to a weak (sometimes called an incompetent) cervix that shortens or opens too early in pregnancy. Cervical cerclage involves placing a stitch around the upper part of the cervix to keep it closed; the operation may be carried out through the vagina, or through the abdomen, as an open or laparoscopic ('keyhole') procedure.

At first, grasping the needle is difficult because it will have a tendency to want to jump around. What can oftentimes help is to get hold of the thread with the left-hand forceps at a point 2 to 3 cm away from the needle. Dangle the needle until it just comes to rest on the surface. This will then allow you to use the angulated needle holder to grab the needle easily. Your needle is in a stable position if it is set up to 90 degrees to the axis of the tips of the forceps. You can make minor corrections by touching the needle with your left-hand forceps, or by partially relaxing your grip and nudging the needle tip against another firm object. You should hold the needle just behind its midpoint (If you hold it too near the tip, it will point downward. If you hold it too near the thread end, it will point upward.).

A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through the esophageal hiatus because of a tear or weakness in the diaphragm. Hiatus hernias often result in heartburn but may also cause chest pain or pain with eating. The most common cause is obesity.

This video is demonstrating the Interscalene Block Video

Mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer. For those with early-stage breast cancer, mastectomy may be one treatment option. Breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast, may be another option.

Axillary Block with a Nerve Stimulator

Watch that video to know if it is safe to have intercourse during her period

Sepsis occurs when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body. This can cause a cascade of changes that damage multiple organ systems, leading them to fail, sometimes even resulting in death. Symptoms include fever, difficulty breathing, low blood pressure, fast heart rate, and mental confusion. Treatment includes antibiotics and intravenous fluids.

The video will describe how sarcoidosis my show up chest x-ray. Please see my website for disclaimer.

Thymoma is a tumor originating from the epithelial cells of the thymus. Thymoma is an uncommon tumor, best known for its association with the neuromuscular disorder myasthenia gravis; thymoma is found in 20% of patients with myasthenia gravis. Once diagnosed, thymomas may be removed surgically.

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities. If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Excision of Pilonidal Cyst. Open method.

Galactosemia

short review for ECG
https://www.youtube.com/watch?v=HP_geMHUHVU
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How to Read ECG Part 3:
1-All
2-How to Read an ECG
3-ST Segment Changes
4-T Wave Changes
5-Effects of Drugs
6-Revision

This is a Video in Clinical Medicine from the New England Journal of Medicine. Tympanocentesis in Children with Acute Otitis Media Overview Tympanocentesis is defined as needle aspiration of fluid from the middle ear. In children with acute otitis media, drainage of pus from the middle ear results in a rapid and marked improvement in symptoms and enables the clinician to prescribe tailored antimicrobial therapy. This video will demonstrate the technique of tympanocentesis. Indications Tympanocentesis is recommended in children with refractory acute otitis media, in immunocompromised children with otitis media, and in children with suppurative complications of acute otitis media, . . . .

Facial Tenderness
1. Ask the patient to tell you if these maneuvers causes excessive discomfort or pain. ++
2. Press upward under both eyebrows with your thumbs.
3. Press upward under both maxilla with your thumbs.
4. Excessive discomfort on one side or significant pain suggests sinusitis.

Sinus Trans illumination 1. Darken the room as much as possible. ++
2. Place a bright otoscope or other point light source on the maxilla.
3. Ask the patient to open their mouth and look for an orange glow on the hard palate.
4. A decreased or absent glow suggests that the sinus is filled with something other than air.

Temporomandibular Joint 1. Place the tips of your index fingers directly in front of the tragus of each ear. ++
2. Ask the patient to open and close their mouth.
3. Note any decreased range of motion, tenderness, or swelling.