Dacryocystorhinostomy (DCR) is a procedure performed for the treatment of tearing (epiphora) due to blockage of the nasolacrimal duct. Tears originate in the lacrimal gland, located at the upper outer margin of the eye. As tears cross the eye with each blink, they are directed into small openings in the eyelids called puncta. From this point, tears travel through a pathway known as the canalicular system into the lacrimal sac. The lacrimal sac is located between the eye and the nose, and funnels tears into the nasal cavity through the nasolacrimal duct (Figure 1). As this is quite a long path for tears to travel, there can be many causes of excessive tearing. Blockage of the nasolacrimal duct is one common cause, and can be treated by creating a direct opening from the lacrimal sac into the nasal cavity in a procedure known as DCR. The evaluation and management of tearing may involve both an ophthalmologist and an otolaryngologist.

Results Sinusitis was characterized as acute in 26 patients, subacute in 5 (including 1 pyocele), and chronic in 8 (including 2 fungal infections). No tumors were found. Isolated sinus cysts were excluded from the study. Headache, the main symptom in 32 patients (82%), was localized most commonly on the vertex. Other common complaints were rhinitis, dizziness, eye symptoms, and fever. In 2 patients, the finding was occult. Eight patients (21%) presented with cranial nerve deficits, and 1 patient had an intracranial complication. Sinus irrigation was performed in 16 patients (41%) and sphenoidotomy was performed in 10 (26%). Fifteen patients (38%) were treated with antibiotic drugs alone. Within 3 months, 31 (84%) of 37 patients had recovered from the illness; 5 still experienced headaches despite having normalized radiographic findings; and 1 had permanent unilateral visual loss. Two patients were lost to follow-up.

General Considerations Because a discussion of reproductive issues may be difficult for some women, it is important to obtain the history in a relaxed and private setting. The patient should be clothed, particularly if she is meeting the provider for the first time. Ordinarily, the patient should be interviewed alone. Exceptions may be made for children, adolescents, and mentally impaired women, or if the patient specifically requests the presence of a caretaker, friend, or family member. However, even in these circumstances, it is desirable for the patient to have some time to speak with the clinician privately. The manner of address should be formal using the title Mrs., Ms., Miss, or Dr. with the patient’s surname, unless the patient requests otherwise. In some settings, it may be appropriate for nursing staff to be involved with history taking. A nurse may be perceived as less threatening, and may be able to take the history in a less hurried manner.1 The provider can verify the history and focus on areas of concern. Alternatively, it may be helpful to ask the patient to complete a self-history form on paper or by computer prior to speaking with the provider. This allows the provider to devote time to addressing positive responses, and ensures that important questions are not missed. Hasley2 showed that responses to a computer-based questionnaire designed to update a patient’s gynecologic history were equivalent to those obtained during a personal interview. Several studies involving patients in non-gynecologic settings have shown that patients are more likely to provide sensitive information when responding to a computer-based questionnaire as opposed to a personal interview or even a paper questionnaire.3 In order to increase a patient’s level of comfort during the interview, questions should be asked in an open-ended and nonjudgmental way. Assumptions should not be made about aspects of the patient’s background such as sexual orientation. At the conclusion of the interview, patients should be asked whether there are concerns that they would like to discuss that were not addressed previously in the interview.

Obstetrical emergencies of pregnancy ECTOPIC PREGNANCY. ... PLACENTAL ABRUPTION. ... PLACENTA PREVIA. ... ECTOPIC PREGNANCY. ... PLACENTAL ABRUPTION. ... PLACENTA PREVIA. ... Amniotic fluid — The liquid in the placental sac that cushions the fetus and regulates temperature in the placental environment.

Most folks remember puberty – and not always in a good way. It can be an awkward stage of budding breasts, unwanted hair, acne and unexpected body odor. Puberty, when a child undergoes physical changes and becomes sexually mature, typically begins around age 8 in girls and age 9 in boys. But imagine, say, a 6- or 7-year-old undergoing such changes? Studies are showing that the onset of puberty for both boys and girls is occurring earlier and earlier, a phenomenon defined as precocious puberty. A study published in Pediatrics in 2010 found that among a population of 1,200 American girls, about 23 percent of African-Americans,15 percent of Latinas and 10 percent of Caucasian girls had begun puberty (marked by breast development) at age 7. In 2012, another study published in Pediatrics found that puberty in American boys – measured by testicular enlargement and pubic hair growth – was beginning six months to two years earlier than what research in previous decades had documented, particularly among African-American children.

Clinical Examination - Gait, Arms, Legs, Spine

Pericardiocentesis is the aspiration of fluid from the pericardial space that surrounds the heart. This procedure can be life saving in patients with cardiac tamponade, even when it complicates acute type A aortic dissection and when cardiothoracic surgery is not available. [1] Cardiac tamponade is a time sensitive, life-threatening condition that requires prompt diagnosis and management. Historically, the diagnosis of cardiac tamponade has been based on clinical findings. Claude Beck, a cardiovascular surgeon, described 2 triads of clinical findings that he found associated with acute and chronic cardiac tamponade. The first of these triads consisted of hypotension, an increased venous pressure, and a quiet heart. It has come to be recognized as Beck's triad, a collection of findings most commonly produced by acute intrapericardial hemorrhage. Subsequent studies have shown that these classic findings are observed in only a minority of patients with cardiac tamponade. [2] The detection of pericardial fluid has been facilitated by the development and continued improvement of echocardiography. [3] Cardiac ultrasound is now accepted as the criterion standard imaging modality for the assessment of pericardial effusions and the dynamic findings consistent with cardiac tamponade. With echocardiography, the location of the effusion can be identified, the size can be estimated (small, medium, or large), and the hemodynamic effects can be examined by assessing for abnormal septal motion, right atrial or right ventricular inversion, and decreased respiratory variation of the diameter of the inferior vena cava.

Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

How to place an NG tube in a baby,

Holter monitoring, electrocardiogram or echocardiogram are only recommended if a cardiac cause (e.g., arrhythmias, possible cardiac syncope, myocardial ischemia) is suspected.

Sexual Desire & our Eating

Developmental Delay at Age 3 | Child Development

fingerprints and sweat glands

Red blood cells, most white blood cells, and platelets are produced in the bone marrow, the soft fatty tissue inside bone cavities. Two types of white blood cells, T and B cells (lymphocytes), are also produced in the lymph nodes and spleen, and T cells are produced and mature in the thymus gland.

The pituitary is a small gland found inside the skull just below the brain and above the nasal passages, which are above the fleshy back part of the roof of the mouth (known as the soft palate). The pituitary sits in a tiny bony space called the sella turcica. The nerves that connect the eyes to the brain, called the optic nerves, pass close by it.

The abortion pill is a medicine called mifepristone that ends an early pregnancy.In general, it's used up to 70 days — 10 weeks — after the first day of a woman's last period. Patients over this mark can have an in-clinic abortion procedure.

Emergency Contraception is a way to prevent pregnancy AFTER unprotected sex. Lots of people have questions about it: What does the morning after pill do? How does emergency contraception work to prevent pregnancy? What are the different types of emergency contraception? This video answers these questions and more.

Learn how LifeVac works through this training demonstration.

32 weeks pregnant, your baby has now nails on the toes and fingers. Watch this video to get detailed information of baby's development during this 33 week of pregnancy,

A lot of women want to know what type of vaginal discharge is normal during pregnancy, and when you're not pregnant. So let's start out by talking about what's normal when you're not pregnant. It's normal to have about 1/2 teaspoon to 1 teaspoon of whitish, creamy, tannish discharge on most days of your cycle in between periods, with the exception of the time of ovulation. Actually, around the time of ovulation, it's normal to notice the discharge becoming more slippery and clear, almost like egg whites. And this is actually a sign that you can watch for to know when you're ovulating. And if you're seeing this type of discharge and you're trying to have a baby, then you should start to time intercourse with ovulation to increase your chances of conceiving.