- Stapedectomy.

**Stapedectomy**

-Def :-

is a surgical procedure of the middle ear

performed to improve hearing.

-Indications:-

• Conductive deafness due to fixation of stapes (Otosclerosis)
  
• Air bone gap of at least 40 dB.
  

-Contraindications:-

• Poor general condition of the patient.
• Only hearing ear.
• Poor cochlear reserve as shown by poor speech discrimination scores.
• Patient with tinnitus and vertigo.
• Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
• Conductive deafness due to Ehlers-Danlos Syndrome (EDS).
  

- Complications of stapedectomy:-

• Facial palsy.
• Vertigo.
• Vomiting.
• Floating foot plate.
• Tympanic membrane tear
• Dead labyrinth
• Labyrinthitis.
  

-surgery:-

*Preoperative:-

The patient will have a hearing test just prior

to or during admission to the hospital.

*The day of surgery:(technique):

Surgery can be done under local ansesthesia or

general anesthesia.

We prefer to use general anesthesia, i.e. the patient

is asleep during the operative procedure.

During the operative procedure the eardrum is gently lifted,

the diseased and fixed stapes is removed.

Next, a prosthesis is put in place.

The eardrum is gently put back into place and held

there by absorbable packing ointment.

*Postoperative:-

After awakening from anesthesia, the patient is

returned to his room and is usually discharged

the next morning. During this immediate post-operative

period, it is important NOT to blow the nose and

not to get the ear wet until the ear has completely healed.

This video is an Stapedectomy by Dr. Bliouras Konstantinos.

enjoy, see you...

-Seven basic types of smokers (By Russell).

Seven basic types of smokers  (By Russell)

-If you understand why you smoke, you will have a better chance to adopt appropriate strategies to stop your smoking behavior.

-According to motives for smoking smokers are:

1-sedative smokers:
As comfort in the face of unpleasant feelings or to relieve tension ....

2-Stimulative smokers:
To help thinking, increase concentration and overcome monotony .

3-psychsocial smokers:
As crutch to increase their confidence.

4-Sensory smokers:
Just satisfaction of feeling of a cigarette in mouth or fingers.

5-Indulgent smokers:
Use it for actual pleasure of smoking or to heighten enjoyment of an already pleasurable moment .

6-Addictive smokers:
To avoid the severe withdrawal symptoms of stopping .

7-Automatic smokers:
They Light cigarettes automatically whenever they face any situation.

Plz, kill yourself away from us...........

- Some Types of prints.

- Really there are many types of prints which help

in identification of individuals allover the world,

especially in the field of forensic medicine and crimes.

- We will take a quick review about some of them:

1- Fingerprints..from here.

2-DNA fingerprinting...from here.

3-Foot prints:

- are the impressions or images left behind by a

person walking made by sole of the foot and


skin pattern of toes and heel.

- WE can collect important information from them

that helps tell about the person that left them behind.

-Information concerning the approximate height of the

person and possibly the walking habits of the person

are two pieces of information that can prove useful

in a criminal investigation.

4-palm prints.

5-Iris print (recognition):

-Are used to screen individuals who are trying to gain

access to more highly secure places or accounts,

not to scan the general public at random.

-By using camera technology, with subtle infrared

illumination reducing specular reflection from

the convex cornea, to create images of the detail-rich,

intricate structures of the iris. Converted into

digital templates, these images provide

mathematical representations of the iris that yield

unambiguous positive identification of an individual.

6-Retinal print:the same idea of iris.

6-Voice print:

-The fact that voice follows a particular pattern,

whatever the language spoken.

- The FBI is trying to develop a system that

could make your voice as unique and recognizable

as your fingerprint called FASR system.


7-Ear print:

Burglars often listen at windows and doors,

leaving an earprint behind, which, just like

a finger print, can be used to trace them.

Ears are unique in size, shape and structure.

Scientists use these traits to develop biometric

scans of the ear. In ear scans, a camera creates

an image of the ear that is analyzed for

identifying characteristics.

8-Thermal footprint:

our bodies emit thermal energy which by special systems

can recognize the persons after their presence

in some places e.g scene if the crimes.


9- Air sinus print:

Pattern of skull's frontal air sinuses ,Outline is

unique and comparisons with antemortem X-rays are useful.

10-Lip print:-

lip print identification is generally acceptable

within the forensic science as a means of positive

identification because it appears in the scene of the crime.

see you, Dr Ibrahim

- Gastric Lavage.

- Gastric lavage:- also commonly called Stomach wash or Gastric suction, is the process of cleaning out the contents of the stomach. It has been used for eliminating poisons from the stomach.

- Indications:-

1. With patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion.
2. Cleaning the stomach before an upper endoscopy in someone who has been vomiting blood.
3. Collecting stomach acid for tests.
4. Relieving pressure in someone with a blockage in the intestines.

- Contraindications :-

1. Loss of airway protective reflexes, such as in a patient with a depressed state of consciousness.
2. Ingestion of a corrosive substance such as a strong acid or alkali.
3. Ingestion of a hydrocarbon with high aspiration potential.
4. Patients who are at risk of hemorrhage or gastrointestinal perforation due to pathology, recent surgery, or other medical condition, that could be further compromised by the use of gastric lavage.

- Complications:-

• Aspiration pneumonia.
• Laryngospasm.
• Hypoxia and hypercapnia.
• Mechanical injury to the throat, esophagus, and stomach.
• Fluid and electrolyte imbalance.
• Struggling patients may be at greater risk of complications

- Technique:-

1. Gastric lavage involves the passage of a tube via the mouth or nose down into the stomach, followed by sequential administration and removal of small volumes of liquid.
2. The placement of the tube in the stomach must be confirmed either by air insufflation while listening to the stomach, by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs.
3. Lavage is repeated until the returning fluid shows no further gastric contents.
4.  If the patient is unconscious or cannot protect their airway then the patient should be intubated before performing lavage.

- Finally there is video which learn you how to perform gastric lavage...

video: Nasogastric Intubation from New England Journal of Medicine..

Watch the video online.

Download - Windows Media version.

Dr Ibrahim

- Sir Hershel -1858 .

Sir William Herschel, Chief Magistrate of the Hooghly

district in Jungipoor, India, first used fingerprints on

native contracts.

On a whim, and with no thought toward personal

identification, Herschel had Rajyadhar Konai, a local

businessman, impress his hand print on a contract.

The idea was merely "... to frighten [him] out of

all thought of repudiating his signature." The native was

suitably impressed,