This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring Labor Analgesia.
Depicted are a montage of images illustrating Epidural analgesia, a commonly employed technique which provides pain relief during labor. Epidural analgesia is a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord.
The epidural space is the space inside the bony spinal canal but outside the membrane called the dura mater (sometimes called the “dura”). In contact with the inner surface of the dura is another membrane called the arachnoid mater (“arachnoid”). The arachnoid encompasses the cerebrospinal fluid that surrounds the spinal cord.
This illustration was commissioned for Arthroscopically Assisted Conversion of Total Shoulder Arthroplasty to Hemiarthroplasty With Glenoid Bone Grafting by Surena Namdari, MD, MSc; and David Glaser, MD for publication in ORTHOPEDICS October 2011 issue (ORTHOPEDICS November 2011;34(11):862).
Aseptic loosening of the glenoid component after total shoulder arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss. Glenoid component explantation and bone grafting of defects has become a common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary. While this has been traditionally accomplished via open techniques, an arthroscopic-assisted method of glenoid explantation and bone grafting can be used for cases of aseptic glenoid loosening with contained bone defects.
Editorial illustration for Lahey Clinic Magazine Spring 2001 Issue. This illustration summarizes a glossary of headache types which are described in the feature article. Depicted are the sites of common headaches: migraine (blue arrow) cluster (red arrows) and tension type (yellow arrow).
This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring The Evaluation of Syncope.
Syncope is a brief and transient loss of consciousness with complete return to pre-existing neurologic function. It is classified as neurally-mediated, orthostatic, cardiac and neurogenic. The elderly are likely to have orthostatic, carotid sinus hypersensitivity or cardiac syncope, whereas, younger patients are more likely to have neurally-mediated syncope. Common non-syncope syndromes with similar presentations include seizures, metabolic syndromes, acute intoxication,psychiatric disorders and cerebrovascular events.
The majority of patients presenting with unexplained syncope will require admission. Several risk stratification tools have been investigated to assess the risk of short-term death and need for immediate hospitalization. All patients presenting with syncope except vasovagal are at increased risk of death from any cause. The AHA/ACCF syncope guidelines present an algorithmic approach for the evaluation of syncope.
The most important diagnostic tool remains the history and physical examination. All patients presenting with syncope require an electrocardiogram, orthostatic vital signs and interval monitoring. Patients diagnosed with neurally-mediated or orthostatic syncope usually require no additional testing. In cases of unexplained syncope, further testing such as electrocardiographic monitoring, echocardiogram, ischemic evaluation and electrophysiological studies may be required. Although a small subset of patients will remain undiagnosed, those undergoing comprehensive evaluation are unlikely to have a recurrent syncope event.
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This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring Health Maintenance in School-aged Children.
Abstract: The goals of the well-child examination in school-aged children (kindergarten through early adolescence) are promoting health, detecting disease, and counseling to prevent injury and future health problems. A complete history should address any concerns from the patient and family and screen for lifestyle habits, including diet, physical activity, daily screen time (e.g., television, computer, video games), hours of sleep per night, dental care, and safety habits. School performance can be used for developmental surveillance. A full physical examination should be performed; however, the U.S. Preventive Services Task Force recommends against routine scoliosis screening and testicular examination. Children should be screened for obesity, which is defined as a body mass index at or above the 95th percentile for age and sex, and resources for comprehensive, intensive behavioral interventions should be provided to children with obesity. Although the evidence is mixed regarding screening for hypertension before 18 years of age, many experts recommend checking blood pressure annually beginning at three years of age. The American Academy of Pediatrics recommends vision and hearing screening annually or every two years in school-aged children. There is insufficient evidence to recommend screening for dyslipidemia in children of any age, or screening for depression before 12 years of age. All children should receive at least 400 IU of vitamin D daily, with higher doses indicated in children with vitamin D deficiency. Children who live in areas with inadequate fluoride in the water (less than 0.6 ppm) should receive a daily fluoride supplement. Age-appropriate immunizations should be given, as well as any missed immunizations.
From “Health Maintenance in School-aged Children“: Part I. History, Physical Examination, Screening, and Immunizations, Riley M , Locke A B, Skye E P (March 15 2011 Vol. 83 No. 6)
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