As man crosses the prime sexual period, 30 years in many cases, the male organ undergoes some significant changes. As men age, the testosterone level falls, and when this hormone level falls in the body, it takes more time to achieve erection and orgasm. Oh my gosh, are you seriously teaching something medical when you don’t even know about the foreskin? When i was child then i don’t know disadvantage of Hand Practice, I do so much hand practice, Now my penis goes down and it is bent towards left, It is not straight, Veins also appears on my penis, Please tell me how can i see it in straight form. Spontaneous pneumothorax is caused by the rupturing of a small bleb, commonly called a blister, along the surface of the lung. Classic symptoms include sudden, sharp pleuritic pain that worsens with chest movement, coughing, or breathing. In spontaneous pneumothorax with no signs of increased pleural pressure or dyspnea, or in which the lung collapse is less than 20%, the treatment of choice is bed rest and careful monitoring of vital signs.
Reassure clients by explaining the disease process and identifying precautions to take to avoid recurrence. Individuals with a history of spontaneous pneumothorax should not subject themselves to extremes of atmospheric pressure such as would be encountered by flying in a nonpressurized aircraft or during scuba diving.
This entry was posted in Respiratory System Diseases and Disorders and tagged RESPIRATORY SYSTEM on by Doctor. Communicating hydrocele: The fluid flows back and forth between the scrotum and the abdomen.
Hydrocele of the cord: The fluid is located in the spermatic cord, between the scrotum and the abdomen. The mitral valve is made up of the annulus, anterior and posterior leaflets, and chordae, which attach the leaflets to their respective papillary muscles. This chapter reviews three types of mitral valve disease: mitral stenosis (MS), mitral regurgitation (MR), and mitral valve prolapse (MVP). MS refers to narrowing of the mitral valve orifice, resulting in impairment of filling of the left ventricle in diastole. Patients identified as having mild valve doming during diastole are considered at risk of MS (Stage A). Although the incidence of rheumatic heart disease has steeply declined during the past 4 decades in the United States, it is still a major cause of cardiovascular disease in developing countries. Patients with MS may present with exertional dyspnea, fatigue, atrial arrhythmias, embolic events, angina-like chest pain, hemoptysis, or even right-sided HF. The characteristic findings of MS on auscultation are an opening snap, a mid-diastolic rumble and an accentuated first heart sound.
Echocardiography also allows assessment of pulmonary artery pressures, detection of other valve disease, visualization of left atrial thrombus, and identification of important differential diagnoses, such as left atrial myxoma. Transthoracic echocardiography is necessary to diagnose and determine the severity of mitral stenosis. Transesophageal echocardiography is indicated in patients before percutaneous mitral balloon valvotomy. Stress echocardiography and cardiac catheterization might be helpful in those cases in which there is a discrepancy between the severity of symptoms and baseline echocardiographic findings.
Medical therapy has no role in altering the natural history or delaying the need for surgery in patients with MS.
Tachycardia is typically poorly tolerated in patients with MS and can lead to an acute deterioration as diastolic filling time may be inadequate. Three invasive options are available for patients with MS: PMBC, surgical mitral commissurotomy, and mitral valve replacement (MVR).
PMBC is a catheter-based technique in which a balloon is inflated across the stenotic valve to split the fused commissures and increase the valve area.
Surgical mitral commissurotomy was first performed in 1925 as a closed technique (which does not necessitate the use of full cardiopulmonary bypass and is performed through an incision in the left atrial appendage) and is still widely used in many developing countries. PMBC and surgical mitral commissurotomy are palliative procedures and, in most cases, further intervention is eventually required, usually in the form of a MVR. Medical therapy in patients with mitral stenosis includes diuretic therapy, heart rate or rhythm control, anticoagulation to prevent thromboembolism, and antibiotic prophylaxis against recurrent rheumatic carditis. Antibiotic therapy of group A streptococcal tonsillo-pharyngitis, even delayed 9 days after the onset of symptoms, can prevent rheumatic fever and rheumatic carditis.10 Antibiotic therapy also reduces transmission to contacts. Patients with MS should at a minimum be followed-up with yearly history and physical examinations. During pregnancy, women with MS should receive appropriate medical therapy, including beta-blockers (Class IIa) and in certain cases, diuretics (Class IIb), but never angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (Class III), due to their teratogenic potential. MR is leakage of blood from the left ventricle backwards into the left atrium during systole.
Patients identified as having mild abnormalities of mitral valve structure or function (mild prolapse, thickening or leaflet restriction) are considered at risk of MR (Stage A). Patients with coronary disease or cardiomyopathy with normal mitral valve anatomy are considered at risk of MR (Stage A). Significant mitral valve regurgitation occurs in about 2% of the population with a similar prevalence in males and females.11 Myxomatous disease is the most common cause of primary MR in the United States (Figure 4). Significant MR leads to volume overload of the left ventricle, because it has to accommodate both the stroke volume and regurgitant volume with each heartbeat. Patients with chronic, severe MR may remain asymptomatic for years because the regurgitant volume load is well tolerated as a result of compensatory ventricular and atrial dilation. The characteristic finding in a patient with MR is a blowing holosystolic murmur heard best at the cardiac apex. Determining the severity of mitral regurgitation requires knowledge regarding the underlying etiology of the mitral regurgitation and an integrated assessment of several echocardiographic parameters. Additional noninvasive and invasive testing is useful as part of a complete preoperative assessment of patients with severe mitral regurgitation. In patients with acute severe MR, afterload reduction with intravenous nitroprusside and nitroglycerin reduces the regurgitant fraction and pulmonary pressures. In patients with chronic asymptomatic MR caused by primary valve disease, there is no evidence for the routine use of vasodilator therapy given normotension and normal systolic LV function.13 The management of these patients is focused on deciding the appropriate timing of surgery, before the development of irreversible LV dysfunction as discussed below. In patients with ischemic heart disease or dilated cardiomyopathy, MR portends a poor prognosis.14 MR in these patients is called functional or secondary MR and is caused by global or regional changes in LV geometry as well as annular dilation.
In patients with primary mitral regurgitation, surgery is indicated in the presence of symptoms or, in asymptomatic patients, if there is evidence of secondary left ventricular dysfunction. Mitral valve repair is the procedure of choice for the surgical management of mitral regurgitation and is associated with lower mortality and better preservation of left ventricular function. Patients with established MR should at a minimum be followed-up with yearly history and physical examination.
Patients with MR generally tolerate pregnancy better than patients with MS do, because the decrease in after-load means that increased cardiac output does not necessarily cause a rise in ventricular filling pressures or pulmonary pressures. MVP is the systolic billowing of one or both mitral leaflets into the left atrium during systole.16 It may occur in the setting of myxomatous valve disease or in persons with normal mitral valve leaflets.
MVP is the most common valvular disorder in the United States, occurring in 2% to 3% of the general population.
Many patients with MVP have normal mitral leaflets, with little or no MR, and a benign prognosis. The causes of myxomatous mitral valve disease are not certain, but appear to involve dysregulation of extracellular matrix proteins.
Mitral valve prolapse is present if there is more than 2 mm displacement of the mitral valve leaflets into the left atrium during systole in a parasternal long-axis or apical three-chamber view on echocardiography. Asymptomatic patients require no specific treatment and they should be reassured of their excellent prognosis. In MVP patients with severe MR, the indications for mitral valve surgery are similar to those for patients with other primary causes of severe regurgitation. Mitral valve prolapse is a benign condition in most cases with similar surgical indications as those for patients with other causes of primary mitral regurgitation.
The labeled areas represent the most common locations observed with insufficiency fractures of the pelvis. Any of the above noted regions could be present with pelvic insufficiency fracture, alone or incombination with one another.


Splenic calcifications usually represent sequelae of a previous acute lesions and are a nonspecific finding. Dr Tan and his team of physiotherapists have designed a home based self management program you can try.
While there are sometimes dangerous reasons such as an infection, tumors, and fractures, most causes are mechanical. While mechanical causes of knee pain such as sprains, degenerative knee osteoarthritis (wear and tear), meniscus and ligament injuries are usually not dangerous, they can cause significant distress, making it hard to walk, causing time off work, affect a person’s social interactions and result in poor mood.
Where the pain is severe, or when there is an obvious emergency such as an accident causing a potential fracture, it is important to consult a doctor urgently. In long standing conditions which have been properly assessed by your doctor to not be dangerous or in mild cases of knee sprain, rest and self-help measures can be useful.
Many mild cases can usually be well managed by an experienced doctor who can provide a clinical diagnosis based on a patients clinical history and physical examination. In cases where the initial treatments have not been effective, an X-ray would be a cost effective way to rule out most dangerous underlying problems. Using techniques such as manual therapy, medical massage, ultrasound, stretches and exercises, it can have a good result in many cases.
However recent medical opinion indicate that the benefit of viscosupplementation on pain and function in patients is minimal.
However, years of clinical experience have also now shown them to be of very limited benefit.
In most other cases, even where pain and stiffness are severe or have been present for a long time, there are multiple non-surgical options that a patient should first consider. As surgery can have significant risks and cost, it is important to balance this carefully against the potential benefits expected.
In rare cases, patients may continue to suffer from symptoms of pain and stiffness after surgery. In some instances, the body has not had enough time to fully recover and symptoms will improve with rest. At times, there could be some technical aspects of surgery that should best be discussed with your surgeon. There are also cases where a patient’s original symptoms are caused by multiple factors such as inflammation, joint dysfunction, degeneration, and muscular trigger points.
Surgery may correct one specific cause of the patient’s symptoms but not be able to address the other causes. At The Pain Relief Clinic, we adopt a biomedical targeted approach that addresses how the multiple component causes of knee pain affect you.
This allows us to provide treatment strategy that targets the root causes of your condition using medical technology in a comprehensive and cost-effective way. If you are suffering from knee pain, or if your condition has not improved despite other treatments, we are able to help. Dr Tan and his team of physiotherapists have designed a home based self management program you can try. The penis head gradually loses its color due to reduced blood flow, and pubic hair loss can be observed in some cases. One, the slow deposition of fatty substances (plaques) inside tiny arteries in the penis, which impairs blood flow to the organ.
In the image on the left, the flaccid penis, there should be foreskin hanging over the glans. What causes these blebs to form is not known, but they tend to form near the apex (bottom tip) of each lung. In traumatic pneumothorax, a chest tube is inserted for drainage and to allow the collapsed lung to expand. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. A normally functioning valve allows blood to flow unimpeded from the left atrium to the left ventricle during diastole and prevents regurgitation during systole. Those with more advanced (progressive) rheumatic valve changes such as commissural fusion and at least moderate diastolic doming of the mitral valve leaflets are defined as Stage B. Single or recurrent bouts of rheumatic carditis cause progressive thickening, scarring, and calcification of the mitral leaflets and chordae (Figure 1). Previously asymptomatic or stable patients may decompensate acutely during exercise, emotional stress, pregnancy, infection, or with uncontrolled atrial fibrillation. The first heart sound may be diminished in intensity if the valve is heavily calcified, with limited mobility.
On chest radiography, characteristic findings of MS are enlargement of the left atrium without cardiomegaly, enlargement of the main pulmonary arteries, and pulmonary congestion (Figure 1).
Medical treatment is directed toward alleviating pulmonary congestion with diuretics, treating atrial fibrillation, and anti-coagulating patients who are at increased risk of arterial embolic events. Hemodynamic as well as clinical improvements may be seen immediately and the results are typically comparable with those achieved with open mitral commissurotomy, although less invasive and less costly.7,8 Mitral valve morphology is an important predictor of successful PMBC. Open surgical mitral commissurotomy involves the use of cardiopulmonary bypass and the surgical repair of a diseased mitral valve by direct visualization. In addition, MVR may be necessary as a first line procedure in patients with either heavily calcified valves, or significant MR. Routine screening or treatment of asymptomatic contacts of persons with group A streptococcal tonsillo-pharyngitis is not recommended.
These features will tend to increase the transmitral gradient (sometimes to double that of baseline), leading to increased left atrial pressures and elevated pulmonary pressures, which can result in pulmonary edema. It is caused by various mechanisms related to structural or functional abnormalities of the mitral apparatus (primary) or the left ventricle (secondary) (Figure 3). Those with more severe valvular abnormalities (severe prolapse, rheumatic changes with loss of central coaptation, or prior infective endocarditis) are considered as having progressive MR (Stage B).
Those with regional wall motion abnormalities with mild mitral leaflet tethering or annular dilation with mild loss of central coaptation of the mitral leaflets are considered as having progressive MR (Stage B). The rationale for this was largely based upon the clear adverse prognostic impact of even lesser degrees of secondary (vs. When symptoms do develop, the most common are dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea, and palpitations caused by atrial fibrillation. When ventricular enlargement is present, the apical impulse may be diffuse and laterally displaced, and a third heart sound may be heard.
Repeat echo should be considered every 3 to 5 years for those with mild MR and every 1 to 2 years for those with moderate MR. However, patients with severe pre-existing regurgitation who are already symptom-limited, have a reduced LVEF or pulmonary hypertension may develop HF symptoms because of the volume load of pregnancy. Survival rates among affected patients are similar to those of age- and gender-matched individuals without MVP.18 In other patients, MVP is caused by myxomatous valve disease, with typical findings of elongated and thickened leaflets, interchordal hooding, and chordal elongation (Figure 6). Myxomatous mitral valve disease usually occurs sporadically, although there are well-described cases of familial clustering that involve an autosomal dominant mode of inheritance.16 Three genetic loci for autosomal dominant myxomatous mitral valve disease have been described, but the precise genes and mutations have not yet been identified. In the past, multiple nonspecific symptoms (atypical chest pain, dyspnea, palpitations, anxiety, and syncope) and clinical findings (low body weight, low blood pressure, and pectus excavatum) were associated with MVP and termed mitral valve prolapse syndrome. Because the mitral annulus is known to have a saddle shape, a normal mitral valve can appear to prolapse in certain echocardiographic views, most notably in the apical two- and four-chamber views. Although antibiotic prophylaxis for endocarditis was once advocated for certain patients with MVP, more recent guidelines do not recommend antibiotic prophylaxis in this group of patients.1,6 Beta blockers may be useful for alleviating symptoms of palpitations, anxiety, and chest pain in certain patients. Echocardiography should be performed if the patient has new cardiovascular symptoms or if the physical examination suggests that significant MR has developed. Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Dilated cardiomyopathy with mitral regurgitation: Decreased survival despite a low frequency of left ventricular thrombus.
Sustained reverse left ventricular structural remodeling with cardiac resynchronization at one year is a function of etiology: quantitative Doppler echocardiographic evidence from the MulticenterInSync Randomized Clinical Evaluation (MIRACLE). Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures.
Common examples include being offered expensive and frequent treatments for extended periods.


Whether single, married, healthy or unhealthy, a man’s body will eventually go through some changes. This process, known as atherosclerosis, is the same one that contributes to blockages inside the coronary arteries — a leading cause of heart attack.
As men reach 40, semen production start getting lower, and the erection quality also starts going down. Changes in atmospheric pressure (flying, scuba diving, mountain climbing) can put individuals at risk. In moderate to severe pneumothorax, there may also be profound respiratory distress accompanied by pallor, weak and rapid pulse, and anxiety.
A thoracoscopy procedure allows a surgeon to place a fiberscope into a tube between the ribs and surgical instruments into another tube to close the leak.
A large pneumothorax can impair cardiac function and result in pulmonary and circulatory impairment without proper treatment. Normal mitral valve function is dependent not only on the integrity of the underlying valvular structure, but on that of the adjacent myocardium as well. Less common causes include severe calcification of the mitral annulus, infective endocarditis, systemic lupus erythematosus, rheumatoid arthritis, and carcinoid heart disease. Severe MS is now defined by a mitral valve area (MVA) of 1.5 cm2 or less (normal valve area 4-5 cm2) and is staged according to whether patients are asymptomatic (Stage C) or symptomatic (Stage D).
If the patient is in sinus rhythm, there is presystolic accentuation of the murmur during atrial contraction. Transthoracic echocardiography is indicated for all patients with suspected MS to establish the diagnosis, quantify hemodynamic severity (mean pressure gradient, MVA, and pulmonary artery pressure), assess for concomitant valvular lesions, and demonstrate valve morphology to determine suitability for mitral commissurotomy (Class I).1 Characteristic findings of MS include valve thickening, restricted valve opening, anterior leaflet doming, and fusion of the leaflets at the commissures. An attempt to restore sinus rhythm with direct current electrical cardioversion or antiarrhythmic drugs may be considered. It may be considered in patients with MS if the valve anatomy is unsuitable for PMBC, in the presence of a left atrial thrombus or significant MR, or for patients that require surgery for other concomitant valvular disease or coronary artery disease. Both mechanical and biological prostheses are used for MVR; the choice of valve often depends on factors such as age, need for concomitant anticoagulation, and left ventricular (LV) size.
Increased left atrial pressures often lead to atrial arrhythmias (such as atrial fibrillation), which are not well-tolerated by patients with MS, frequently resulting in clinical decompensation. The most common causes of MR in the United States are myxomatous degeneration, chordal rupture, rheumatic heart disease, infective endocarditis, coronary artery disease, and cardiomyopathy.
In acute severe MR, the left atrial and pulmonary venous pressures increase quickly, leading to pulmonary congestion and pulmonary edema.
Acute severe MR, as occurs with chordal rupture or papillary muscle rupture, is almost always symptomatic because the sudden regurgitant volume load in the nondilated left ventricle and atrium leads to pulmonary venous hypertension and congestion. Patients with myxomatous MVP are at increased risk for cardiovascular complications, particularly when prolapse is associated with at least moderate MV or LV dysfunction.
Myxomatous MVP also may occur in conjunction with certain connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome.
Prospective testing has failed to confirm most of these associations.17 The classic findings of MVP on physical examination are a mid-systolic click, with a late systolic murmur from MR (Figure 7), heard best at the cardiac apex. Therefore, the diagnosis of MVP should be based on a parasternal long-axis or apical three-chamber view. Patients with severe MR or high-risk features should be reviewed with an echocardiogram yearly or more often if their clinical condition warrants it. Guidelines on the management of valvular heart disease (version 12) [published online ahead of print August 24, 2012]. They are difficult to diagnose clinically, are often not appreciated on plain film, and may have history of minor or no trauma.
In many cases, the prostate enlarges which weakens the urine flow and may cause other complications. Smoking marijuana is a risk factor when individuals inhale deeply, then slowly breathe out against partially closed lips, forcing the marijuana smoke deeper into the lungs. This new valve staging classification (similar to how heart failure [HF] is classified) provides a means to integrate all forms of valve disease in a unified way.
This obstruction results in the development of a pressure gradient across the valve in diastole and causes an elevation in left atrial and pulmonary venous pressures.
With increasingly severe stenosis, the duration of the murmur increases and the opening snap occurs earlier during diastole as a result of higher left atrial pressure.
The mean pressure gradient across the mitral valve on Doppler echocardiography (echo) in MS is at least 5 mm Hg; in severe stenosis, it is usually higher than 10 mm Hg. PMBC should also not be performed in patients who have left atrial thrombus or more than 2+ (moderate) MR, because the degree of MR usually increases following the procedure.
Surgical mitral commissurotomy (either open or closed) may be carried out through a median sternotomy or left thoracotomy incision.
Morbidity and mortality are higher with prosthetic valve replacement than with surgical or balloon valvotomy. Indeed, patients with asymptomatic moderate to severe MS may decompensate during periods of increased physiologic stress, such as pregnancy or non-cardiac surgery. However, this may be a moot point as prognosis in secondary MR is more related to the underlying pathology than the degree of MRa€”typically prognosis alters little even if you fix secondary MR. In chronic MR, a gradual increase in left atrial size and compliance compensate so that left atrial and pulmonary venous pressures do not increase until late in the course of the disease.
These patients require hemodynamic stabilization in the cardiac intensive care unit as emergent surgery is arranged.
In patients with MVP, echocardiography is also useful in determining the presence and severity of MR and assessing left atrial and ventricular chamber size, LV function, and leaflet thickening and redundancy.
There is nothing to worry about if you notice the reduction in the size, since it simply happens due to reduced blood flow. Pneumothorax also may be econdary to other lung diseases, such as asthma, emphysema, lung abscess, or lung cancer.
In this procedure, two or three tubes are placed between the ribs under general anesthesia.
Elevated left atrial pressures lead to left atrial enlargement, predisposing the patient to atrial fibrillation and arterial thromboembolism. Because the gradient across the mitral valve is flow dependent, the severity of MS is more accurately defined by the MVA.
Antibiotic therapy is important for the secondary prevention of rheumatic carditis, de-novo rheumatic valvular disease or worsened rheumatic valvular disease. A criticism of this guideline change has been that MR is now the only valve disease where you first need to describe the etiology before you can assess the severity. Then, progressive LV dilation eventually leads to an increase in afterload, contractile dysfunction, and HF. Unless severe MR is present, findings on the chest radiograph and electrocardiogram are typically unremarkable.
Traumatic pneumothorax may result from inserting a central venous line, from thoracic surgery, or from penetrating chest trauma, such as a knife wound or fractured rib.
Rarely, when this is not successful, a surgical procedure with an incision in the wall of the chest (thoracotomy) and surgical excision of a portion of the pleura (pleurectomy) may be necessary.
If flow across the mitral valve is reduced because of HF, pulmonary hypertension, or aortic stenosis, the murmur of MS may be reduced in intensity or may be inaudible. The valve area may be measured by tracing the mitral valve opening in cross section by 2D or 3D echo. The new guidelines stress the importance of dedicated centers of excellence in which "Heart Valve Teams" of relevant specialists with expertise come together to guide complex decision making and to provide care particularly for high-risk patients. How widespread this change will be adopted is as yet unclear and it also remains to be seen whether the American Society of Echocardiography will also adopt this change in their echocardiographic definition of severe MR in their upcoming new valve guidelines.
Left atrial enlargement predisposes the patient to atrial fibrillation and arterial thromboembolism. Long-term secondary prophylaxis, preferentially with penicillin, is therefore recommended for all patients with a history of rheumatic fever, rheumatic carditis or rheumatic valve disease.



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