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http://www.NoseSinus.com/ https://www.google.com.sg/maps/place/Dr+Kevin+Soh,+Ear+Nose+Throat+Sinus+Head+%26+Neck+Clinic/@1.3049229,103.8331258,17z/data=!4m5!1m2!2m1!1skevin+soh+review!3m1!1s0x31da1992e3f9ff57:0x61af1e7fa8129600 3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510 Dr Kevin Soh describes how a neck mass or lymph node excision is performed. He uses interesting graphics, animation and video to demonstrate the operation. If you have any comments, PLEASE do not be afraid to ask. Please SUBSCRIBE, SHARE, and COMMENT on this video. If you prefer to read, rather than watch the video, here’s the transcript. 0:09 – Case Presentation: A 40 year old lady has a mass on the left side of her neck, measuring 3 cm in size. The mass lies close to the external jugular vein. I can hide her scar by making my incision on the lower skin crease. 0:35 –Surgery video demo: I inject lignocaine (to reduce post-operative pain) and adrenaline (to induce vasoconstriction and reduce bleeding during surgery). I stretch the skin tight in order to facilitate neat skin incision. Because of the adrenaline, the incision is dry and bloodless. 1:11 – I have just cut through the epidermis and dermis. Next, I have to go through the platysma muscle, and search for the mass in the subcutaneous fat. The mass lies in the subcutaneous fat. 1:34 – Surgery is like painting. I use fine gentle strokes. Now I am identifying the platysma muscle. I cut through the platysma muscle. 2:18 – There are important structures in the neck that I need to look out for. Spinal accessory nerve supply motor fibers to the sternomastoid and trapezius muscles. Greater auricular nerve receives sensation from the skin below the ears. 2:44 – I dissect the subcutaneous fat to remove the mass. The mass has to be separated from all its attachments before it can be delivered. 4:41 – I close the wound in layers. I start by suturing the platysma muscle. I suture the platysma muscle in such a way that the knot is buried deep in the wound. 5:33 – Next, I suture the dermis. The needle must bite just the right amount of dermis in order to obtain perfect skin apposition. It is very important to bury the knot. The sutures used for platysma and dermis closure are absorbable sutures. They do not need to be removed. They are absorbed through the process of inflammation. 6:17 – Finally I close the epidermis. Instead of interrupted sutures, I use a continuous subcuticular suturing technique. The epidermis closes when I pull both ends of the suture. For the epidermis, I use non-absorbable sutures that need to be removed 7 days later. Non-absorbable sutures cause less inflammation and scarring. The end result is a very nice cosmetic aesthetic concealed invisible scar. 7:17 – All suture knots (especially absorbable sutures) have to be buried. Unburied absorbable suture knots will result in suture abscess, pain and redness. I also avoid interrupted sutures for the epidermis, because they cause ugly rail-road track or caterpillar marks. Steristrips are applied to provide strength to the wound. They also cover the wound and prevent contamination.

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The question asked here is there is this lady who has been diagnose with HIV 8 years back and has been on medication but all of aa sudden for the last 6 months she has lost weight, feels very tired, and has fever on and off. She wants to know what is happening with her. So I can imagine how you must be feeling because you have been on medication for last 8 years, which means you would have expected that you should have been more healthier and mow suddenly you find that you are losing weight and you have fever on and off you feel very tired. These things can happen when the medicines stop working on the person. It does not happen all the time It does not happen all of a suddenly. It could be that you would have missed your HIV pills sometime or may be more often which results in the drugs or the medicines not acting so well in the viruses so well, which is called as a HIV drug resistance or a failure, failure of the drugs to act. It is like when you take antibiotics for a long time and suddenly you find that the doctor changes you antibiotics because these antibiotics have stopped working on a particular infections. So similarly, these medicines also might have stopped working for which you need to undergo certain tests to know if there is a failure. The first would be a viral load to assess if the virus level is going up because if you have been om medicines for last 8 years, which means the viruses would be undetectable, which means even though the viruses would be there, it will not be visible even though the test is done. So it is on that very low level and the second test would be genotyping. Supposing the viruses are not present, but we find certain number of viruses, then you have to undergo something called as the genotyping, which will tell you as to what type of resistance you have developed, that means which type of drugs have stopped working on you out of the drugs you are taking and which drugs will act better and we will change the medication according to the result. So I suggest that you see an HIV specialist and visit a place where there is a team of doctors who is bets in HIV and there is a person who does the test called as viral load and genotyping because this genotyping is done only in very few labs, 4 or 5 laboratories all over India. So it is best to seek help and get it diagnosed early.
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ABC News’ Will Ganss is here with the Instagram post by singer Lizzo that shocked her fans by ending with the words “I quit.” SUBSCRIBE: https://bit.ly/2Zq0dU5 SIGN UP to get the daily GMA Wake-Up Newsletter: https://gma.abc/2Vzcd5j VISIT GMA: https://www.goodmorningamerica.com FOLLOW: TikTok: https://tiktok.com/@gma Instagram: https://instagram.com/GoodMorningAmerica Facebook: https://facebook.com/GoodMorningAmerica Threads: https://www.threads.net/@goodmorningamerica X: https://twitter.com/gma
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This is an intense workout called "The Bear" using a weighted barbell. It consists of 5 sets of seven repetitions. Each repetition consists of: Cleans, Front Squat, Push Press, Back Squat, Push Press. The bar is not allowed to rest on the ground, however resting the bar on the shoulders is allowed. Take the time you need to rest between sets - YOU'LL NEED IT!! Excellent for Fatloss, Strength and fitness training
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