انواع بخیه

این نوع بخیه تحت نام بخیه ممتد یا همان continuous  هم در بخش بالینی ما شناخته شده است شکل کاملا واضح است اما اگر باز هم مشکلی بود پیغام بگذارید تا توضیح کامل فارسی بگذارم.

Running, or Continuous Stitch
The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges with the running stitch than with the interrupted stitch

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بخیه ای که در کشور ما با نام ساده یا simple شناخته شده است.

Interrupted Stitch
Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch

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Purse String
A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as hernia or an appendiceal stump

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Smead-Jones/Far-and-Near
A double loop technique alternating far and near stitches, and possessing greater mechanical strength than continuous or simple interrupted sutures. Commonly used for approximating fascial edges, especially for patients at risk for fascial disruption or infection

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Continuous Locking, or Blanket Stitch
A self-locking running stitch used primarily for approximating skin edges

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انواع نخ ها

Polypropylene: a nonabsorbable, monofilament material that is the least reactive of all suture materials; it is used with continuous percutaneous suturing. Its disadvantage is that it has coiled memory, making it difficult to handle


Nylon: a nonabsorbable suturing material that degrades in vivo by hydrolysis at a rate of about 125% annually. The advantages of nylon are good pliability and ease of handling. It is favored for interrupted percutaneous suture closures. Nylon sutures are available in monofilament and multifilament construction. Braided nylon sutures possess the same handling and knot construction characteristics as silk sutures, but unlike natural fiber, nylon is relatively nonreactive in tissue

Synthetic absorbable: absorbable refers to the degradation and loss of tensile strength within 60 days. Absorption and loss of tensile strength are not interchangeable. The former is important only with regard to late suture complications; the latter speaks to the primary function of the suture -- maintaining tissue approximation


Braided synthetic absorbable: useful for interrupted dermal suture and ligating bleeders

Monofilament synthetic absorbable: indicated for continuous dermal suture

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تصاویر و تکنیک های  قشنگی است ببینید!

Staples
Staples are less reactive than the least reactive suture. Deeply implanted staples do not affect tissue defenses, although staple cross members that are flush with the skin can produce cross-hatched scarring. The development of disposable staplers with absorbable tacks obviates the need for removal of staples. Subcuticular closure of skin is now also possible through the use of a disposable stapler that uses twin gripper blades to approximate and evert the wound edges and insert a disposable pin into the dermis

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Tape is the least reactive of man-made wound closure materials. Tape with hypoallergenic adhesive on spun bonded nylon without reinforcing filaments has the best record for avoiding premature detachment. It also reduces the incidence of stress blister formation

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Skin being harvested from the abdomen with a dermatome.	Types of Wound Closure: Skin Grafts Skin grafts are used only when the wound cannot be closed by direct approximation. They are usually classified as split-thickness or full-thickness. Split-thickness skin grafts (STSGs) include the epidermis and some portion of the dermis. Full-thickness skin grafts (FTSGs) include the epidermis and the dermis. Choice between them is based on the wound to be closed. Thin grafts take more easily and can be used on questionably reliable surfaces; thicker grafts maintain a more normal appearance and are particularly useful where a desirable cosmetic outcome is required, eg, the face
Split thickness graft is applied to debrided burn wound.
15 days after wound coverage. Epithelialization is evident between the interstices of the graft strip Sutures attached to needles are the most common method of approximating skin edges. Sutures are classified as absorbable or nonabsorbable and as either monofilament or multifilament. Sutures vary in their capability to provoke infection, with catgut being the most "reactive" and polypropylene being one of the least "reactive" suture materials

Orthodontics for Adults ارتودنسی بزرگسالان

1. Is it unusual for adults to have orthodontic treatment

• More and more adults are having orthodontic treatment to correct crooked or crowded teeth
• Orthodontics can make the teeth more attractive and more functional, by improving jaw alignment, and correcting "the bite"
• Improved techniques have been devised for treating adults
• Modern orthodontic braces are less obtrusive and adults are more willing to wear them

 
2. Is adult orthodontic treatment successful

• Adult orthodontics is particularly successful for correcting crowding and jaw problems
• Healthy teeth can be moved with braces at any age
• Very similar treatments and appliances are used for children and adults

Before

after

 
3. I've always had crooked teeth. Does it really matter

•  Crooked teeth can prevent you from chewing properly, and lead to jaw joint problems
• Improving "the bite" can make eating more efficient and comfortable
• Crooked teeth affect your appearance and most people want to look their best at any age
• People with unattractive teeth are often too embarrassed to smile. Orthodontic treatment enables you to smile with confidence
• Looking better can make you feel better about yourself, and can increase your self-confidence

 
4. What are the most common orthodontic treatments for adults

• Correcting crowding or crooked teeth

  Crowding

• Closing newly developed or old spaces between teeth

  Before

  Treatment

  After

• Correcting the position and alignment of teeth
  Teeth often tilt into gaps left by extractions. These teeth have to be moved into a more upright position
  This correction makes it possible to use replacement crowns, implants, fixed bridges, or removable partial dentures to replace the missing teeth
• The photographs below explain what can be done for an adult, when the orthodontist, periodontist and prosthodontist all work together

Before		Upper crowns Lower brace		Lower teeth straightened
Final result

 
5. What problems could make orthodontic treatment for adults more difficult

• Periodontal Disease
  • Adults may suffer from periodontal disease, which is a deterioration of the gums and underlying bone
  • Periodontal treatment will be necessary before the orthodontic treatment can start
• Tooth decay
  • All dental decay should be treated before orthodontic treatment starts
  • It is less comfortable to have dental treatment after braces have been fitted
• Abnormal jaw relationships
  • The growth of the jaws has been completed in adults, and so this treatment is not always possible
  • In children, the ongoing growth of the jaw can be directed to correct the abnormalities that are present

  Lower jaw protrusion

  Lower jaw protrusion

• Worn down or broken teeth
  • These must be built up or restored before orthodontic treatment can start
• Lack of commitment
  • Adult patients may find it hard to commit to long term treatment, especially to wearing braces for long periods

 
6. Can an orthodontist help my painful jaw muscles and joints

• Your orthodontist or dentist will be able to diagnose the problem
• This problem can be caused by the grinding and clenching of teeth
• The action is unconscious and involuntary
• The technical name for it is "bruxism"
• Bruxism usually happens during sleep
• It wears down the teeth, and causes stress and trauma to the jaw muscles and the teeth
• The orthodontist will probably suggest a splint, bite plate or a nightguard to protect the teeth during sleep. This will also relax the muscles of the jaw
• These devices should relieve and prevent the results of tooth grinding
• The cause of the bruxism may be psychological, and may have to be treated by a suitable therapist

Nightguard

Nightguard in place

Periapical pathosis

Description: Well-delineated ovoid-shaped radiolucency at the apex of the lateral incisor.

Location: Periapical area of maxillary lateral incisor

هماتوم ساب دورال حاد

Acute Subdural Hematoma

Subacute subdural hematoma

سالم(شکل بیماری در پایین همین صفحه)

The brain is covered by a membrane (layer of tissue) called the dura.  If the veins located below the dura (subdural area) leak blood, then pressure in this area may build up and injure the brain.  Head injuries may injure these veins, causing them to be torn and leak.  This blood collects into a mass called a hematoma. Hence the name, Subdural Hematoma.  For an acute hematoma, symptoms generally occur in the first 24 hours, while for a subacute Hematoma, they occur in the first 2-10 days after a head injury.

Head injury (may be severe or a minor) Nausea Headache Personality changes Confusion Decreased level of consciousness Impaired vision Eye droop Speech difficulties Paralysis Numbness or decreased sensation in a limb  Seizures Coma Other neurological problems Symptoms may initially improve, but then dramatically worsen

Neurological exam by a physician Complete blood count, Chemistry panels, a PT, and a PTT should be performed CT scan of the head

Very young (infants) or the elderly Use of blood thinners such as aspirin or Coumadin  Alcoholism Diseases that increase the risk of falls such as Alzheimer's disease or narcolepsy.

Goal is to reduce pressure on the brain Circulation support (intravenous fluids and medications to maintain blood pressure) Respiratory support (oxygen and mechanical ventilation if necessary) Dexamethasone (a corticosteroid medication) may be used to decrease the inflammation of the brain Mannitol (a diuretic) may be used to decrease the swelling of the brain Dilantin (a seizure medication) may be used to prevent or control Seizures Reversal of blood thinning agents such as Coumadin or Heparin Emergency Surgery may be needed to drain the hematoma (blood clot), and relieve the pressure on the brain.  The hematoma is outside the brain, but still puts pressure on it.  Therefore, the surgery involves drilling small holes in the skull and evacuating the blood.  Occasionally, if the hematoma is very large or has solidified, a large opening in skull may be needed (this is called a craniotomy).

The individual needs immediate emergency medical treatment.  Untreated, this condition often leads to death.

Meningitis  Encephalitis  Subarachnoid Hemorrhage  Chronic Subdural Hematoma  Stroke

acute sinusitis

عکسی شماتیک و زیبا از سینوزیت حاد

توصیف بیماری

Sinuses are open cavities.  An infected sinus is known as sinusitis.  The maxillary and frontal sinuses are the two main sinuses that become infected.  The maxillary sinuses are located on the inside cheeks of both sides of the nose.  The maxillary sinuses drain through the nose.  In addition, the ears drain fluid into the maxillary sinuses by way of the eustachian tube. The eustachian tube may become blocked or inflamed from a sinus infection, resulting in pressure, pain, or fullness in the ears.  The frontal sinuses are located in the lower part of the forehead just above the bridge of nose. Sinusitis usually occurs either after a viral infection (cold/runny nose) or after allergy symptoms begin.  This occurs because of swelling in the nasal tract tissue, which drains the sinuses, causing them to become swollen.  The sinuses accumulate fluid and mucous, allowing bacteria to grow in the sinuses, which causes the sinusitis.

نشانه ها

Pain/pressure over the sinuses Occasional upper tooth pain Pain and tenderness over the forehead Ear pressure If symptoms do note resolve in three weeks, or do not respond to antibiotics, this may represent Chronic Sinusitis.  Please see the section on Chronic Sinusitis for more details.

عوامل مسبب

Streptococcus pneumoniae Hemophilus Influenza Moraxella catarrhalis Staphylococcus aureus

تشخیص ما چگونه باشد؟

Transilluminator may show a fluid collection Sinus X-Rays A CT scan of the sinuses is more accurate than an X-Ray Cultures are not helpful unless done by a needle placed into the sinuses (and this is not done unless the case is extreme)

درمان

Oral antibiotics are usually administered for 10 to 14 days.  Commonly used antibiotics include Ceftin, augmentin, or cipro. Older antibiotics, such as Amoxicillin and Erythromycin may be prescribed, but you should be aware that they do not provide the same scope of coverage that Ceftin, augmentin, or cipro.  They have poor coverage when dealing with Haemophilus Influenza as well. Oral Decongestants, such as Sudafed, and nasal sprays such as Afrin, for the first 3 days may be helpful (after 3 days a "rebound" may occur, and the decongestants may no longer be effective). Take a warm shower twice a day, and blow out your excessive mucous. Saline nasal sprays may be used multiple times during the day to loosen nasal secretions.

شرایط مساوی(similar condition)

Tooth  Abscess Mucormycosis Sinus cancer

متفرقه و گوناگونll

Predisposing Causes Viral Rhinitis (Cold) Allergies Dental problems nasal polyps