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I am done Guys! - drmaxdias
#51
Laparoscopy during pregnancy

Laparoscopy has become increasingly popular in the treatment and evaluation of acute abdomen. In the past, pregnancy was considered a contraindication for laparoscopy, although multiple reports of the successful use of diagnostic and therapeutic laparoscopy have been published more recently (Mazze, 1989; Gadacz, 1991).

The Hasson technique, an open approach to entering the abdomen, has been suggested to avoid potential injury to the gravid uterus with the Veress needle or trocar. Advantages of laparoscopy over laparotomy include shortened hospital stay, less need for narcotics, easier postoperative ambulation, and earlier tolerance of oral intake postoperatively. Care must be taken to minimize manipulation of the uterus. Adjust the location of trocar placement based on uterine size. Monitor fetal heart tones during the surgical procedure. The surgeon must work closely with the obstetrician to maintain fetal well-being during the surgical procedure. An experienced laparoscopist is important to keep surgical times as short as possible (Gurbuz, 1997). Although generally accepted as safe, reports of fetal demise after laparoscopy continue to occur in the literature (Carver et al, 2005).

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#52
Ultrasonography, as yet not fully evaluated, was found helpful during the first trimester, but less useful as pregnancy progressed due to displacement of the appendix.10 It was helpful in excluding other pathology,12 but not useful for diagnosing appendicitis in most cases in another study.2 Laparoscopy has been described as useful,13 particularly when diagnosis is uncertain.9,10 One retrospective case review found helical computed tomography to be 100% sensitive in diagnosing appendicitis in seven pregnant patients.14


so CT in pregnancy?
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#53
What can I do to relieve the pain?
If possible, avoid any activity that requires forceful, repetitive hand movements. Although these movements may not have caused your carpal tunnel syndrome, they can make your symptoms worse.

If your job requires this kind of movement and you must continue it, consider wearing wrist or hand braces while you work.

If you're working at a computer, adjust the height of your chair so your wrists aren't bent downward as you type. Using a special ergonomic keyboard can help in some cases. Remember to take breaks to stretch your hands.

If your symptoms bother you at night, shift your sleeping position and try to prop up your arm with a pillow or two when you feel the twinges. Avoid sleeping on your hands. If you wake up with pain, try shaking your hands until the pain or numbness goes away.

If you have a lot of discomfort at night, try stabilizing your wrist in a neutral position (not bent) with a splint or brace. A neutral position allows the carpal tunnel to be slightly wider.

Practicing yoga can help relieve the pain and increase hand strength. You may have heard that taking extra vitamin B6 can help, but two small clinical trials have shown no immediate benefit from this treatment.


If these conservative treatments don't help, the next step might be to get injections of cortisone. In severe cases, a simple surgery may be necessary to relieve the pressure on your median nerve.

so initialy splinting then if it fail CTSD injection
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#54
listen dr max u know the questions exactly and a single word can change the complete question the posibility of getting your questions is much better then our opinion becoz u have faced the complete encounter and we are hitting our arrows blindly
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#55
The maintenance of a head position with face turned to one side, as occurs in children with congenital muscular torticollis, can lead to positional deformation of the skull [21]. In one review, all infants who presented with torticollis had at least mild craniofacial asymmetry [18]. Affected patients had frontal plagiocephaly consisting of recession of the ipsilateral zygoma and forehead and reduction of the vertical facial height on the affected side. Treatment of the torticollis improved facial appearance in most cases, although surgical intervention was needed to correct the skull deformity in severely affected children who presented later in childhood.

so long term complication of torticolis is positional deformation of skull
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#56
good luck ,
you are 99er for sure
go ahead and relax
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#57
thx a lot drmaxidas.....amazing experience......best of luck for the perfect score!!

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#58
Thank you ronaldo!

bondjamesbond; I agree with what you have said about the questions. I just wanted to discuss the close ones. That is it. As regards to Nigro regime, what you said holds true. But the person here is HIV positive. I doubt if we shall subject him to further chemoradiation, and subsequent immunesuppression.

Also, CMV was not an option (it gives periventricular calcifications). These were, as you have reiterated, intraparenchymal, and the retina had 'central yellow' description to it. So, I picked Congenital Toxoplasmosis.

I picked Short Arm Cast initially for the Stress Fracture, but while I were revising the same, changed to rest, and follow up in two weeks. I think I read this somewhere; I am checking this, although I also back my initial answer, and your option. Probably, we must get brother darkhorse's review on this one.

Yes, I got the Carpal Tunnel Syndrome in Pregnancy incorrect :-(

vitamins; thank you for the supportive journal articles! Skull deformity was not an option; the closest was facial asymmetry, so I picked that.
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#59
agreed with above....toxo...short period of cast....facial asymmetry....splint for carpal tunnel
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#60
Thanks Sir! So, I get two of them incorrect :-( I could have got them correct, especially the Short Leg (not Arm) Cast, as I had picked that initially.

Got a question on febrile transfusion reaction; I picked leukocyte-depleted packed RBCs (other close one was irradiated blood products). I request your opinion on this one as well Sir!
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