Life of Ovum is 48 hours after ovulation while life of sperms is four days in female genital tract.

Ovulation is the process in which ova is shed from ovary so you should also know the date when ovulation will take place in your wife.

To Calculate the ovulation this method is preferred

1. Temperature Method: women’s body temperature is recorded every morning and plotted on a graph paper daily, the curve comes in shape of a valley between two mountains. The temperature is low during actual menstruation, subsequently it rises, at the middle of cycle there is fall in temperature followed by a rise. This rise indicates ovulation has occurred.

Since sperm life is 4 days and ovum life is 2 days so if person copulates before 4 days to 2 days after ovulation, she will conceive pregnancy and this period is known as Fertile Period.

Rest of the days other than fertile period is known as SAFE PERIOD.

There is one more way to calculate the Safe and Fertile period read below

Menstrual Cycle varies from 26 t0 31 days from female to female. So safe period is calculated as

Longest cycle days minus (-) 10 days gives you last day of fertile period.

Smallest cycle days minus (-) 18 days gives you first day of fertile period.

for example if menstrual cycle of your wife varies from 28 to 30 days

so 30-10= 20 th day is the last day of fertile period and 28-18=10th day is the first day of fertile period. And rest other days are Safe Period.

It is an autosomal dominant which means that if one parent is suffering from it chances to get inherited is 50 %.

If Neurofibroma are small in number they can be invaginated by the fingers to form button hole test is known as “button hole test”.

Typical Clinical History of a case of Neurofibromatosis

Types of Neurofibromatosis

Neurofibromatosis is divided into 2 types Type 1 is peripheral types and constitute more than 70 percent of cases and Type 2 is central form.

Peripheral form includes

Lisch Nodule of Iris

Soft Papillomas

Freckling of Axillary region

Plexiform Neurofibroma

Cafe au lait Patches

Optic Glioma

Spinal Neurofibroma

Endocrine Tumours

Type 2 which is central form includes Optic nerve glioma, few cutaneous lesions, meningioma , Acoustic Neuroma so hearing loss at the age of 20 years is considered to be the hallmark for type 2 neurofibroma.

Plexiform Neurofibroma of head and neck region in adult female

Back View showing Plexiform Neurofibroma of head and Neck region in adult female

plexiform-neurofibroma-close-view

Read more about Neurofibroma from emedicine

Watch out video of same patient adult female of 25 years with plexiform neurofibroma below

If testis is not able to descend, that condition is known as undescended testis, which is corrected by surgical procedure known as orchidopexy.

Steps of Orchidopexy Surgery.

1. Make an incision on the abdomen where testis is lying.

2. Seperate testis and vas deferens from the underlying connective tissue.

3. Make an incision on scrotum

4. From down or up side make path so that testis can be pulled down into scrotum see the video clip below

5. Pull the testis into scrotum and put it in scrotum, stitch with absorable sutures.

6. Stitch both incisions i.e abdominal and scrotal incision.

This surgery for undescended testis is usually at the age of four years.

Watch out the surgery below special thanks for Dr Ritesh Pathak for helping us this surgery.

You must also visit surgeryencyclopedia.com for good information on orchidopexy.

multiple-uterine-fibroids

They are the most common among black womens and around 30% women in their reproductive age are known to suffer from them.

Since oestrogen helps in their growth so their growth is seen during 15 to 45 years of women life, as during this time only the oestrogen is secreted in body.

So fatty women have more chances of getting fibroids as they have more oestrogen.

In 1% of cases leiomyoma can become malignant known as leiomyosarcoma.

On cutting the fibroids whorled pattern is visible.

Types of Fibroids

Fibroids are classified on the basis of their location into

1. Intramural fibroids

2. Subserosal fibroids

3. Submucosal fibroids

4. Cervical fibroids

5. Pedunculated fibroids

See the video below showing how fibroids are classified with  the help of papaya model (fantastic explanation).

You also watch this video for more understanding of fibroids

Sign and Symptoms

1. Abdomen Discomfort

2. Painful bleeding

3. Pain during coitus

4. Increased urinary frequecy

5. Retention of urine

6. Backache

7. Infertility

in pregnant women uterine fibroids can cause abortion, bleeding or premature labour.

Treatment

Endometrial ablation

Myolysis

Myomectomy

Hysterectomy

and Drugs which lower the oestrogen level in blood

watch out the surgery of fibroid removal below

Special thanks for Miss Seema Yadav, she is a good pharmacist and real sister of Dr vikram Singh Yadav, completed her education from DMA, and IIFTM moradabad.

Types of Syndactyly

1. Simple Syndactyly: condition in which extremities are fused by soft tissues.

2. Complex Syndactyly: condition in which bones of fingers are joined.

3. Complete or Incomplete: skin is joined all through and through, however in incomplete finger tips are free

4. Fenestrated Syndactyly: when there is a gap between skin is know as fenestrated syndactyly

In this patient you see complex syndactyly as two bones are fused see the x ray below

Complex Syndactyly X ray showing fusion of bones of fingers of hands

see the hand of four year old SADIA being operated on 24feb2010, generally syndactyly is treated by plastic surgery, bones are cut skin fusion removed either graft is applied from groin or anterior elbow or simply graftless sundactyly correction is done by mobilising the skin.

Syndactyly hand with dye painted before surgery

and another picture of hand from dorsum side see below

syndactyly hand from back view, dorsum of hand

See the surgical correction of syndactyly in the video below

Complications:

Hairs can grow on graft area

Finger can deviate

Graft darken and become noticable

Complex syndactyly occurs as a part of Apert Syndrome.

Must also read from emedicine about syndactyly and apert syndrome with nice pics.

Following video from medclip.com explains the pathophysiology of acne in form of animation.

Acne Vulgaris is formed due to 3 processes

1. Increased sebum production

2. Pilosebaceous duct hyperkeratosis

3. Infection of Propioniobacterium Acne in pilosebaceous unit.

Treatment and pathophysiology is being explained in video below

Four fundas (principles) of treating acne are

1. Reverse the hypercornification of pilosebaceous duct

2. Antibiotics to kill Propioniobacterium Acnes

3. Decrease sebum production

4. Subside the inflammation

watch out the video to know about drugs used in treating acne vulgaris

Special Thanks to Dr Ashutosh Kumar for his kind support.

Home Remedies for Acne Vulgaris

1. Applying paste of honey and cinnamon powder before going to sleep and washing face in morning with warm water.

2. Drink lot of water, do exercises daily improves blood circulation, so keeps skin healthier.

3. Before bathing, apply a mixture of tomato pulp, rose water and honey and apply of 30 minutes.

4. Eat fresh fruits because they contain vitamin E (natural antioxidant) and vitamin A help in skin regeneration,  keep skin healthy and glowing.

Watch out the video from howcast.com about home treatment of acne, remember you must consult a dermatologist before applying any cream because its a matter of face.

Read More About Acne Vulgaris

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For Free Mnemonics you can get here at  medicalmnemonics

Book has been written by Dr Ankit Gupta from Era’s Lucknow medical college and Hospital, Lucknow

dr-ankit-gupta

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Circumcision is performed following causes

1. Religious

2. Diseases like Phimosis: Phimosis is the condition in which foreskin of penis can not be retracted back, how ever when retracted skin is not be able to reverted back condition is known as Para-Phimosis.

circumcision helps in preventing cancer as penis can be kept clean however sexual excitement is decreased after keratinisation of mucosa of glans. Since throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury. Read about sexual effects of circumcision.

Watch out the video below showing phimosis and full surgery for circumcision.

How to care for penis after circumcision read at familydoctor.org

Due to some trauma, cut,  infection, scratch mark, bacteria invades, which leads to inflammation of scrotum leading to obliterative arterities which causes fournier’ gangrene.

With in 2-3 days scrotum is sloughed off exposing testicles, luckily testicles are not involved due to thick albuginea.

Watch out the video on causes and treatment of Fournier’s Gangrene below

fourniers-gangrene-scrotum-skin-sloughed-off

fourniers-gangrene-scrotum-back

Principles of Peritonitis Surgery are:

Open abdomen cavity with midline or paramedian incision, if purulent fluid comes out send it for  culture & senstivity, explore the cause & perform procedure like appendicectomy for appendicits, bowel resection for gangrene, closure of any perforation of small and large bowel or uterus.

Remember closing of perforation should be done with non absorbable  sutures, because catgut get easily digested and may reopen perforation.

Give peritioneal wash, drain the fluid out and give tension sutures on abdominal wall.

Watch out the principles of peritonitis surgery in video below

Surgeons operating in above video are Dr Prasad Bhukebag, Dr Ashwini Kumar Singh and Dr Vikram Singh Yadav

What are the clinical features of peritonitis?

Watch out the video below about signs and symptoms of peritonitis explaining cough tenderness, Blumberg’s Sign or Rebound Tenderness, Hippocratic Facies which is the end stage of peritonitis.