Webster's New World Medical Dictionary
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Recognizing When a Child's Injury Or Illness Is Caused by Abuse
U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE U.S. Department of Justice Office of Justice Programs 810 Seventh Street NW. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Karol V. Mason Assistant Attorney General Robert L. Listenbee Administrator Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office for Victims of Crime; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE NCJ 243908 JULY 2014 Contents Could This Be Child Abuse? ..............................................................................................1 Caretaker Assessment ......................................................................................................2 Injury Assessment ............................................................................................................4 Ruling Out a Natural Phenomenon or Medical Conditions -
Nasolabial and Forehead Flap Reconstruction of Contiguous Alar
Journal of Plastic, Reconstructive & Aesthetic Surgery (2017) 70, 330e335 Nasolabial and forehead flap reconstruction of contiguous alareupper lip defects Jonathan A. Zelken a,b, Sashank K. Reddy c, Chun-Shin Chang a, Shiow-Shuh Chuang a, Cheng-Jen Chang a, Hung-Chang Chen a, Yen-Chang Hsiao a,* a Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan b Department of Plastic and Reconstructive Surgery, Breastlink Medical Group, Laguna Hills, CA, USA c Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA Received 4 May 2016; accepted 31 October 2016 KEYWORDS Summary Background: Defects of the nasal ala and upper lip aesthetic subunits can be Nasal reconstruction; challenging to reconstruct when they occur in isolation. When defects incorporate both Nasolabial flap; the subunits, the challenge is compounded as subunit boundaries also require reconstruc- Rhinoplasty; tion, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, Forehead flap we used nasolabial flaps for upper lip reconstructionandaforeheadflapforalarrecon- struction. Methods: Three men and three women aged 21e79 years (average, 55 years) were treated for defects of the nasal ala and upper lip that resulted from cancer (n Z 4) and trauma (n Z 2). Unaffected contralateral subunits dictated the flap design. The upper lip subunit was excised and replaced with a nasolabial flap. The flap, depending on the contralateral reference, determined accurate alar base position. A forehead flap resurfaced or replaced the nasal ala. Autologous cartilage was used in every case to fortify the forehead flap reconstruction. Results: Patients were followed for 25.6 months (range, 1e4 years). -
Endocrinology Resident Profile Jill Trinacty
Endocrinology Resident Profile Jill Trinacty July 2017 About me My name is Jill Trinacty, and I was raised in Berwick, Nova Scotia. I went completed my BSc. (Honours) at Saint Francis Xavier University in Antigonish, Nova Scotia. I spent a year as the Active Living Coordinator with the Town of Kentville then completed my MD at Dalhousie University. I moved to Ottawa, Ontario in 2013 for my residency in Internal Medicine at the University of Ottawa and am currently a PGY-5 in Endocrinology and Metabolism. Why I chose General Endocrinology In medical school I became interested in almost every area of medicine, but ultimately applied to internal medicine for a number of reasons. I have always been interested in Endocrinology, specifically diabetes. Diabetes affects so many people in our communities and can have significant morbidity and mortality. I liked the detail of internal medicine and the complexity of patients. Having some previous experience in public health, I knew that I wanted a career that would allow me to discuss lifestyle changes as an aspect of therapy – specifically nutrition and physical activity. I also wanted a career that would allow for work/life balance. Seeing the day-to-day lifestyle of each internal medicine subspecialty confirmed that Endocrinology was the right fit for me. Clinical Life What does a typical day of clinical duties involve? This is an example of my typical daily and weekly schedule: Endocrinology – A typical day 7:30 – 8:00 Clerical work / Chief resident duties. Review emails, follow up on patient results, approve vacation requests, make call schedule. -
Iliopsoas Tendonitis/Bursitis Exercises
ILIOPSOAS TENDONITIS / BURSITIS What is the Iliopsoas and Bursa? The iliopsoas is a muscle that runs from your lower back through the pelvis to attach to a small bump (the lesser trochanter) on the top portion of the thighbone near your groin. This muscle has the important job of helping to bend the hip—it helps you to lift your leg when going up and down stairs or to start getting out of a car. A fluid-filled sac (bursa) helps to protect and allow the tendon to glide during these movements. The iliopsoas tendon can become inflamed or overworked during repetitive activities. The tendon can also become irritated after hip replacement surgery. Signs and Symptoms Iliopsoas issues may feel like “a pulled groin muscle”. The main symptom is usually a catch during certain movements such as when trying to put on socks or rising from a seated position. You may find yourself leading with your other leg when going up the stairs to avoid lifting the painful leg. The pain may extend from the groin to the inside of the thigh area. Snapping or clicking within the front of the hip can also be experienced. Do not worry this is not your hip trying to pop out of socket but it is usually the iliopsoas tendon rubbing over the hip joint or pelvis. Treatment Conservative treatment in the form of stretching and strengthening usually helps with the majority of patients with iliopsoas bursitis. This issue is the result of soft tissue inflammation, therefore rest, ice, anti- inflammatory medications, physical therapy exercises, and/or injections are effective treatment options. -
Larynx Anatomy
LARYNX ANATOMY Elena Rizzo Riera R1 ORL HUSE INTRODUCTION v Odd and median organ v Infrahyoid region v Phonation, swallowing and breathing v Triangular pyramid v Postero- superior base àpharynx and hyoid bone v Bottom point àupper orifice of the trachea INTRODUCTION C4-C6 Tongue – trachea In women it is somewhat higher than in men. Male Female Length 44mm 36mm Transverse diameter 43mm 41mm Anteroposterior diameter 36mm 26mm SKELETAL STRUCTURE Framework: 11 cartilages linked by joints and fibroelastic structures 3 odd-and median cartilages: the thyroid, cricoid and epiglottis cartilages. 4 pair cartilages: corniculate cartilages of Santorini, the cuneiform cartilages of Wrisberg, the posterior sesamoid cartilages and arytenoid cartilages. Intrinsic and extrinsic muscles THYROID CARTILAGE Shield shaped cartilage Right and left vertical laminaà laryngeal prominence (Adam’s apple) M:90º F: 120º Children: intrathyroid cartilage THYROID CARTILAGE Outer surface à oblique line Inner surface Superior border à superior thyroid notch Inferior border à inferior thyroid notch Superior horns à lateral thyrohyoid ligaments Inferior horns à cricothyroid articulation THYROID CARTILAGE The oblique line gives attachement to the following muscles: ¡ Thyrohyoid muscle ¡ Sternothyroid muscle ¡ Inferior constrictor muscle Ligaments attached to the thyroid cartilage ¡ Thyroepiglottic lig ¡ Vestibular lig ¡ Vocal lig CRICOID CARTILAGE Complete signet ring Anterior arch and posterior lamina Ridge and depressions Cricothyroid articulation -
The Textual and Visual Uses of the Literary Motif of Cross-Dressing In
The Textual and Visual Uses of the Literary Motif of Cross-Dressing in Medieval French Literature, 1200–1500 Vanessa Elizabeth Wright Submitted in accordance with the requirements for the degree of PhD in Medieval Studies University of Leeds Institute for Medieval Studies September 2019 2 The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Vanessa Elizabeth Wright to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. 3 Acknowledgements I would like to thank my supervisors Rosalind Brown-Grant, Catherine Batt, and Melanie Brunner for their guidance, support, and for continually encouraging me to push my ideas further. They have been a wonderful team of supervisors and it has been a pleasure to work with them over the past four years. I would like to thank my examiners Emma Cayley and Helen Swift for their helpful comments and feedback on this thesis and for making my viva a positive and productive experience. I gratefully acknowledge the funding that allowed me to undertake this doctoral project. Without the School of History and the Institute for Medieval Studies Postgraduate Research Scholarship, I would not have been able to undertake this study. Trips to archives and academic conferences were made possible by additional bursaries and fellowships from Institute for Medieval Studies, the Royal Historical Society, the Society for the Study of Medieval Languages and Literatures, the Society for Medieval Feminist Scholarship’s Foremothers Fellowship (2018), and the Society for the Study of French History. -
TARİHSEL VE Mitolojikd) VERİLERİN IŞIĞINDA, DOĞU VE ORTA KARADENİZ BÖLGESİ UYGARLIKLARININ MADENCİLİK FAALİYETLERİ
Jeoloji Mühendisliği s. 39, 72-82, 1991 Geological Engineering,,, n. 39,72-82, 1991 TARİHSEL VE MİTOLOJİKd) VERİLERİN IŞIĞINDA, DOĞU VE ORTA KARADENİZ BÖLGESİ UYGARLIKLARININ MADENCİLİK FAALİYETLERİ Ahmet Hikmet KOSE Jeolqji Yüksek Mühendisi, TRABZON .A- GİRİŞ İL Neolitik Dönem. Yazıda ele alınan, bölge, yaklaşık olarak, 36°-42° Tarım ve hayvancılığın başladığı, keramiğin ve de- doğu boylamları ile 40°-42c" kuzey enlemleri arasında yer vamlı yerleşmelerin ortaya, çıktığı Neolitik, döneme. (MÖ almakta ve Doğu (ve Orta) Karadeniz coğrafi bölgesi ile 8.000-5,000) ait kalıntılardan bölgeye en yakın olan- Gürcistan Cumhuiiyetfnin bir bölümünü kapsamak- larına, Gürcistan. Cumhuriyeti'nde rastlanmıştır. Güney tadır. Osetia ve Merkezi Gürcistan'ın yanısıra Kolkhis'de^ de Bu bölge, ilk insanlardan günümüze, onlarca halka, Neolitik dönem, yerleşimi belirlenmiştir. bir o kadar da inanca, bazan anayurttuk, bazan da geçici bir konak yeri görevini üstlenen Küçük Asya'mın tümü III) Kalkolitik ve diğer maden dönemleri kadar olmasa bile, yine de çok sayıda halk ve uygarlığı bünyesinde barındırmıştır. Bu halklar ve madencilik faa- Samsung Amasya<4>, Tokat®, Ordu^, Sivas<7\ liyetleri üzerine yapılacak bir çalışmanın, ciltlerle ifade Erzincan^, Bayburt^, Erzurum<10\ Artvin ve Kars1'11) edilebilecek hacmi bir yana, genel bir özetinin bile bu illerinde. Kalkolitik dönemden (MÖ 5.000-3.000) derginin sınırlarını aşacak olması nedeniyle, bu yazıda, başlayan çeşitli izlere rastlanmıştır., yalnızca bazı konular ele alınarak, oldukça kısa bir Bu izler, küçük bir bölge söz konusu olmasına özetleme yapılmıştır, rağmen, tek bir kültüre ait değildir., Bölgenin batısında ele geçen buluntular "Orta Anadolu Kültürü"""' ile büyük B- İLK İNSANLARDAN BÖLGE benzerlik taşırken,, doğudakilerin, Transkafkasya-İran HALKLARINA AzerbaycanVDoğu Anadolu-Malatya ve Amik ovaları - Suriye ve İsrail'i" kapsayan bölge kültürü île ilişkili I- Paleolitik Dönem olduğu öne sürülmüştür. -
The Cyclist's Vulva
The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al. -
Congenital Problems in the Pediatric Breast Disclosure
3/20/2019 Congenital Problems in the Pediatric Breast Alison Kaye, MD, FACS, FAAP Associate Professor Pediatric Plastic Surgery Children’s Mercy Kansas City © The Children's Mercy Hospital 2017 1 Disclosure • I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation 1 3/20/2019 Pediatric Breast • Embryology • Post-natal development • Hyperplasia • Hypoplasia • Deformation Embryology 4th week of gestation: 2 ridges of thickened ectoderm appear on the ventral surface of the embryo between the limb buds 2 3/20/2019 Embryology By the 6th week ridges disappear except at the level of the 4th intercostal space Breast Embryology In other species multiple paired mammary glands develop along the ridges – Varies greatly among mammalian species – Related to the number of offspring in each litter 3 3/20/2019 Neonatal Breast • Unilateral or bilateral breast enlargement seen in up to 70% of neonates – Temporary hypertrophy of ductal system • Circulating maternal hormones • Spontaneous regression within several weeks Neonatal Breast • Secretion of “witches’ milk” – Cloudy fluid similar to colostrum – Water, fat, and cellular debris • Massaging breast can exacerbate problem – Persistent breast enlargement – Mastitis – Abscess 4 3/20/2019 Thelarche • First stage of normal secondary breast development – Average age of 11 years (range 8-15 years) • Estradiol causes ductal and stromal tissue growth • Progesterone causes alveolar budding and lobular growth Pediatric Breast Anomalies Hyperplastic Deformational Hypoplastic 5 3/20/2019 Pediatric Breast Anomalies Hyperplastic Deformational Hypoplastic Polythelia Thoracostomy Athelia Polymastia Thoracotomy Amazia Hyperplasia Tumor Amastia Excision Thermal Tumors Poland Injury Syndrome Tuberous Gynecomastia Penetrating Injury Deformity Adapted from Sadove and van Aalst. -
How the Larynx (Voice Box) Works
How the Larynx (Voice Box) Works Charles R. Larson, PhD If you love opera, or if you admire the voices of pop singers such as Celine Dion or Barbra Streisand, you may have wondered how it is these marvelous singers are able to create such beautiful music with this instrument we call the human voice. You may also know of someone who has a bad voice or has had to have their voice box, or larynx, removed because of illness or injury. The larynx is a critical organ of human speech and singing, and it serves important biological functions as well. Let's have a look at the larynx to understand its functions, what it looks like and how it works. It is thought that the same factors that favored the evolution of air‐breathing animals on earth led to the evolution of the larynx. Lungs are comprised of very delicate tissues that must be maintained within strict biological limits, that is, temperature, humidity and freedom from foreign particles. Thus, along with the first air‐breathing animals, there appeared a primitive sort of larynx, whose one and only function was protection of the lung. This function remains the most important of those the larynx has assumed in subsequent evolutionary developments. Now, of course we recognize that the larynx is critical for human speech and singing. But we also should realize that the larynx is important for swallowing, coughing, vomiting and eliminating contents of the abdomen. If you have ever felt your 'Adam's Apple', then you know where the larynx is. -
Culdocentesis in Diagnosis of Disturbed Ectopic Pregnancy Still a Useful Procedure in Developing Countries
CULDOCENTESIS IN DIAGNOSIS OF DISTURBED ECTOPIC PREGNANCY STILL A USEFUL PROCEDURE IN DEVELOPING COUNTRIES Pages with reference to book, From 5 To 6 Tasneem Aslam Tariq ( Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. ) Razia Korejo ( Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. ) ABSTRACT Over a period of 5 years culdocentesis was carried out in 156 cases of suspected ectopic pregnancy using needle aspiration through the pouch of Douglas. The result was positive in 134 cases, with 131 being true positive and 3 false positive. In 22 cases the result was negative, 6 of which were false negative. It is concluded that culdocentesis is an effective method of diagnosing disturbed ectopic pregnancy (JPMA 42: 5, 1992). INTRODUCTION Ectopic pregnancy, a clinical diagnosis in majority of cases is infrequently seen in our hospital. Since it can present with varied symptoms, diagnosis can be difficult in some cases. To increase the accuracy rate of preoperative diagnosis in suspected cases of ectopic pregnancy, various diagnostic procedures have been employed over the years. The purpose of this study was to evaluate the efficacy of culdocentesis for the diagnosis of ectopic pregnancy. PATIENTS AND METHOD The present study included 156 suspected cases of ectopic pregnancy admitted to the Department of Obstetrics and Gynaecology between January, 1985 to December 1989. Culdocentesis was done in the operating theatre under aseptic precautions with or without general anaesthesia depending on the certainty of the diagnosis. Urinary bladder was catheterized and gentle bimanual vaginal examination was done to confirm the previous vaginal findings. Sims speculum was introduced in the vagina and posterior lip of cervix was held gently with a Vulsellum forceps, pulled upwards and forwards exposing the posterior fornix. -
Women's Health Course Guide
Course Guide for Women’s Health 1 Approach to the Patient The OB/GYN History Rationale: A gynecological evaluation is an important part of primary health care and preventive medicine for women. A gynecological assessment should be a part of every woman’s general medical history and physical examination. Certain questions must be asked of every woman, whereas other questions are specific to particular problems. To accomplish these objectives, optimal communication must be achieved between patient and physician. The student will demonstrate the ability to: A. Perform a thorough obstetric-gynecologic history as a portion of a general medical history, including: 1. Chief complaint 2. Present illness 3. Menstrual history 4. Obstetric history 5. Gynecologic history 6. Contraceptive history 7. Sexual history 8. Family history 9. Social history B. Interact with the patient to gain her confidence and to develop an appreciation of the effect of her age, racial and cultural background, and economic status on her health; C. Communicate the results of the obstetric-gynecologic and general medical history by well-organized written and oral reports. The OB/GYN Examination Rationale: An accurate examination complements the history, provides additional information and helps determine diagnosis and guide management. It also provides an opportunity to educate and reassure the patient. The student will demonstrate the ability to: A. Interact with the patient to gain her confidence and cooperation, and assure her comfort and modesty B. Perform a painless obstetric-gynecologic examination as part of a woman’s general medical examination, including: 1. Breast examination 2. Abdominal examination 3. Complete pelvic examination 4.