.

Left Atrial Enlargement

2009-07-22T20:11:00.000-05:00

Left atrial enlargement can occur in association with systemic hypertension, aortic stenosis, mitral incompetence, and hypertrophic cardiomyopathy.

First Trimester Bleeding

2009-07-19T16:23:00.003-05:00

First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of <5 mm between the mean sac diameter and the CRL carries an 80% risk of spontaneous abortion. Approximately 20% of women with first trimester bleeding have a subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis. First trimester vaginal bleeding is very common, occurring in approximately 25% of patients who are known to be pregnant. In many patients the bleeding is self-limited and is probably due to implantation of the conceptus into the decidualized endometrium. If the bleeding is not self-limited and is accompanied by severe pain, uterine contractions, and a dilated cervix, the clinical changes are irreversible and the pregnancy is doomed to failure. Because these clinical changes are irreversible, ultrasound has little to offer. If bleeding and cramping are relatively mild and the cervix is long and closed, the diagnosis is threatened abortion. Analysis of this group reveals that 50% have an abnormal outcome, with the differential diagnosis encompassing a broad spectrum of conditions including a normal intrauterine pregnancy (IUP) (50% of patients), an abnormal living intrauterine pregnancy, a missed abortion, a blighted ovum, retained products of conception, ectopic pregnancy, and gestational trophoblastic disease. Ultrasound examination is especially important in these patients, because the findings may be pivotal not only for determining the precise cause of the bleeding but also for suggesting appropriate therapy. In comparison to abdominal imaging, the literature emphasizes that in patients with threatened abortion, vaginal sonography is more effective not only for making the specific diagnosis of ectopic pregnancy but also for clarifying indeterminate findings noted on transabdominal scans. In general, if the gestational age is less than 8 or 9 weeks, the sonographic examination should begin using a vaginal approach. If the study is incomplete or inconclusive, an abdominal approach may offer complementary information. A transabdominal approach is often satisfactory in the late first trimester of 9 weeks or more. Nonetheless, in difficult, abnormal, or inconclusive cases, a vaginal examination should also be done in an effort to clarify the findings. When evaluating a patient with threatened abortion, it is most important to determine if an intrauterine gestational sac is visible and whether or not it has a normal appearance. Using transabdominal ultrasound, an intrauterine sac should normally be visible when the beta hCG is >1800 mIU/mL (2nd International Standard [IS]) or >3240 mIU/mL (International Reference Preparation [IRP]), and a yolk sac and embryo should be detected when MSDs are 20 and 25 mm, respectively. Using a vaginal transducer, the discriminatory beta hCG level for sac detection is 1000 mIU/mL (2nd IS) or 1800 mIU/mL (IRP); and a yolk sac and embryo should be detected when their MSDs are 8 and 16 mm, respectively. In questionably abnormal cases, a follow-up ultrasound should be considered. Knowing that the MSD normally increases by 1 mm/day allows the sonologist to recommend an appropriate time interval between the initial and follow-up examination(s). Although not universally accepted, many sonologists also recommend a second trimester sonographic examination to screen for abnormalities that were unsuspected during the first trimester.

Once an embryo is detected, cardiac activity is normally visible by transabdominal imaging when the CRL is 9 mm; the corresponding CRL on a vaginal scan is 4-5 mm. Despite cardiac activity, sonography may reveal findings that suggest a poor outcome; these include bradycardia (abnormal at <6.2 weeks is <100 beats per minute (BPM); abnormal between 6.3-7 weeks is <120 BPM, an oligohydramniotic sac (abnormal = MSD - CRL <5 mm), or an abnormal appearing yolk sac (diameter >5 mm), and/or amnion (abnormally large amniotic cavity, or an "empty" amniotic cavity). Whether or not a subchorionic hemorrhage is associated with an abnormal outcome (either at the time of initial bleeding), or perinatally, is unclear. However, one study showed a correlation of size of subchorionic hemorrhage, age of patient, and time of bleeding with the likelihood of spontaneous abortion. Women who were over 35 years of age and had large bleeds before 8 weeks were most likely to spontaneously abort.

Ectopic pregnancy must be considered if a gestational sac is absent when the beta hCG level exceeds the discriminatory level for detecting a sac (especially if significant vaginal bleeding has not occurred), or historically, by 4 to 5 weeks gestational age. At least one investigator concludes that in patients with suspected ectopic pregnancy, vaginal sonography can and should be used alone for these examinations.

The role of Doppler ultrasound for evaluating patients with first trimester bleeding remains unclear. In the experience of some investigators, measuring the Resistive Index (RI) to evaluate uteroplacental blood flow has proven effective for differentiating normal from abnormal intrauterine pregnancies; the findings of other investigators, however, have not been similar. Color and pulsed Doppler have also been advocated by some investigators to improve the sensitivity for diagnosing ectopic pregnancy; this too, is not universally accepted. Some clinical and sonographic predictors of ectopic pregnancy outcome include longer times from last menstrual period (LMP), lower beta hCG, absence of gestational sac, and higher resistive indexes. In women with possible gestational trophoblastic disease, Doppler of trophoblastic tissue reveals a low impedance, high-flow state that differs from the lower-flow, higher impedance pattern seen in women with nonviable gestations or degenerating fibroids. Doppler may prove to be especially useful to evaluate myometrial invasion and during follow-up examinations for women receiving chemotherapy.

Abbreviations

* BhCG, beta human chorionic gonadotropin
* CR, crown-rump
* CRL, crown-rump length
* D & C, dilation and curettage
* FHM, fetal heart movement
* MSD, mean sac diameters
* TA, transabdominal
* TV, transvaginal
* US, ultrasound

Free Weight Loss Charts

2009-07-13T06:25:00.000-05:00

bit.ly/cEVTb Free Printable Weight Loss Charts

H. pylori Urea Breath Test

2009-07-09T07:34:00.000-05:00

Basic Opioid Pharmacology

2009-06-18T13:23:00.000-05:00

• Analgesia produced by mu (μ) opioid receptor agonism

in the brain (periaquaductal gray matter) and spinal

cord (substantia gelatinosa).

• Well-known side effect profile:

– Sedation, respiratory depression

– Itching, nausea, ileus, urinary retention

– Bradycardia, hypotension

– Miosis, chest wall rigidity

• Opioids are hemodynamically stable when given alone,

but cause 􀃐CO, SV, and BP in combination with other

anesthetics.

• Reduces MAC of volatile anesthetics.

Opioids

Morphine

– Slowpeak time (~80% effect at 15 minutes, but peak analgesic

effect is at ~90 minutes).

– Active metabolite, morphine-6-glucuronide, has analgesic

properties and is renally excreted (not clinically relevant unless

patient has renal failure)

– Can cause histamine release.

Hydromorphone (Dilaudid)

– “A rapid onset morphine.” Peak effect in 5-10 minutes.

– About 8-fold more potent than morphine (i.e. 1 mg Dilaudid = 8

mg morphine)

– No active metabolites, no histamine release.

– Good choice for postop analgesia and PCA.

Opioids

Fentanyl

– Fast onset & short duration of action (peak effect at 3-5

minutes; effect site half-life ~30 minutes.

– ~100-fold more potent than morphine.

– Very cheap.

Sufentanil

– Fast onset, but slightly slower than fentanyl

– 10-fold more potent than fentanyl (i.e. 5 mcg sufentanil = 50

mcg fentanyl).

– More rapid recovery than fentanyl.

Opioids

Alfentanil

– Fastest onset time of all opioids (~90 seconds); pKa = 6.5,

so it crosses the blood-brain barrier rapidly.

– Also causes more N/V, chest wall rigidity, and respiratory

depression.

– Brief duration of action due to redistribution.

Remifentanil

– Peak effect time ~90 seconds

– Unique pharmacokinetics - metabolized by plasma

esterases.

– Short context-sensitive half-time after termination of infusion

with predictable offset in ~5-10 minutes.

Opioids

Meperidine (Demerol)

– Originally discovered as a local anesthetic (“pethidine”)

– Peak effect in 15 minutes, lasts 2-4 hours.

– Active metabolite (normeperidine) lowers the seizure

threshold; renally excreted.

– Useful for treating shivering.

– Anticholinergic side effects: tachycardia

– Avoid using with MAOIs; can cause CNS excitation

(agitation, hyperpyrexia, rigidity) and/or CNS depression

(hypotension, hypoventilation, coma)

– Causes histamine release.

– Has a euphoric effect with less respiratory depression than

other opioids.

Rational Opioid Use

Note: All anesthesiologists (attendings & residents

alike) have different theories and opinions on the

optimal choice and dose of opioids in different

situations. The strategies presented here are simply

suggestions, something to get you thinking rationally

about how and when you use opioids for analgesia.

Discuss the merits of these strategies with your

attending before or during each case, but do not take

these suggestions as firm guidelines for how all

anesthetics should be done!

With that disclaimer in mind, continue reading…

Strategies for Opioid Use

• For a standard GETA induction, use fentanyl to blunt the

stimulation caused by DL and intubation.

• For brief, intense stimulation (e.g. retrobulbar block, Mayfield

head pins, rigid bronchoscopy), consider a bolus of short-acting

opioid like remifentanil or alfentanil.

• For intraop analgesia:

– Fentanyl is rapidly titratable, but requires frequent redosing; it may be

more “forgiving” if overdosed.

– Morphinehas a long onset time to peak effect, but gives prolonged

analgesia during the case and into the postop period.

– Hydromorphone is rapidly titratable (like fentanyl) with prolonged

analgesia (like morphine).

Strategies for Opioid Use

• For ENT cases, consider an opioid infusion (e.g. remifentanil,

alfentanil, sufentanil, or fentanyl):

– Stable level of analgesia

– Induced hypotension

– “Narcotic wakeup” reduces bucking on ETT

– Smooth transition to postop analgesia

• For chronic opioid users (e.g. methadone, MS Contin,

OxyContin, etc.), continue the patient’s chronic opioid dose

intraop PLUS expect higher opioid requirements for their acute

pain.

• Use morphine and meperidine cautiously in renal patients (renal

excretion of active metabolites)!

Strategies for Opioid Use

• Meperidine is usually reserved for treatment/prevention

of postoperative shivering.

• For postop pain control (i.e. PACU):

– Consider fentanyl (rapid onset, easily titratable, cheap,

and the nurses are familiar with its use).

– Consider hydromorphone (rapid onset, easily titratable,

prolonged effect, nurses are familiar with its use, and it is

a good transition to PCA).

– If surgery is ambulatory and/or patient is tolerating POs,

give Vicodin.

References

• Fukuda K. Intravenous opioid anesthetics. In Miller RD (ed),

Miller’s Anesthesia, 6th ed. Philadelphia: Elsevier Churchill

Livingstone, 2005.

• Gustein HB and Akil H. Opioid analgesics. In Hardmann JG,

Limbird LE, and Goodman Gilman A (eds), Goodman &

Gilman’s The Pharmacological Basis of Therapeutics, 10th ed.

New York: McGraw-Hill, 2001.

• Saidman L and Shafer S. 2005. “Rational Use of Opioids:

Intraoperative and Postoperative,” presented at Stanford

University Department of Anesthesia Grand Rounds, July 18,

2005.

Methods of Maintaining Equilibrium (hemostasis)

2009-06-18T13:00:00.000-05:00

Common Conditions and the body's response:

A. Vomiting -- causes body to lose excessive amounts of acids. To counteract this, your kidneys secrete bicarbonate and reabsorb hydrogen ions.
B. Diarrhea -- causes body to lose excessive amounts of bicarbonate. to counteract, your kidneys secrete hydrogen ions and reabsorb bicarbonate.
C. Hyperventilation-- causes body to lose excessive amounts of carbon dioxide (an acid). Again, kidneys secrete bicarbonate and reabsorb hydrogen ions.

II. Possible causes of excess amylase in blood, saliva and/or urine:

A. Mumps -- highly contagious, viral disease (paramyxovirus), which infects the salivary glands causing painful enlargement. Elevated amylase levels are found in the blood.
B. Pancreatitis -- inflammation of the pancreas due to alcohol abuse (40%), gallstones (40%), or idiopathic (unknown) cause. Elevated amylase and lipase levels found in the blood.

Alcohol abuse causes calcified protein plugs to form in the pancreatic ducts causing atrophy of ducts. As a result, pancreatic secretions cannot pass out of the pancreas causing inflammation, selling and leakage.
Gallstones block the pancreatic duct, causing inflammation, selling and leakage in pancreas.

C. Intestinal Infarction -- lack of blood supply reaching the intestines causes damage and death of intestinal cells, releasing amylase.
D. Renal failure -- no filtration of the blood into the kidneys. Amylase builds up in the blood.

III. Other Enzyme Blood Tests

A. Alkaline Phosphatase -- high levels indicate either problems with bones or bile ducts.

Cancer in bones.
Obstruction of bile ducts.

B. Alanine Amino Transferase and Aspartate Amino Transferase -- high levels indicate liver cell injury

hepatitis.
Alcohol abuse

C. Creatinine Kinase -- high levels indicate muscle injury

1. Heart attack

2. Skeletal Muscle Damage

D. Lactate Dehydrogenase -- high levels indicate heart attack or blood cell disease (i.e. hemolytic anemia)

Lidocaine - Maximum Dosing Recommendations

2009-06-13T12:21:00.002-05:00

Joan Murhammer, R.Ph., Mary Ross, R.Ph., M.B.A., Kevin Bebout, R.Ph.

Lidocaine is an anti-arrhythmic agent and a local anesthetic that is used for infiltration, nerve block, epidural and subarachnoid anesthesia, and topical anesthesia. To minimize systemic exposure and toxicity, the smallest dose and the lowest concentration of lidocaine required to produce the desired effect should be used. Maximum recommended doses should not be exceeded and the total dose of lidocaine should be calculated from all sources of lidocaine exposure (e.g., injection, topical). Signs and symptoms of lidocaine toxicity are dose related and include dizziness, nausea, drowsiness, speech disturbances, periorbital numbness, muscle twitching, confusion, vertigo, and tinnitus. More serious signs of toxicity are difficulty breathing, seizures, psychosis, and bradycardia.

The dose of lidocaine needed for anesthesia depends on the type of procedure, degree of anesthesia required, and the patient’s response. The dose should generally be reduced in children, elderly, or debilitated patients. In normal healthy adults, the maximum recommended dose of lidocaine injection with epinephrine for local anesthesia other than spinal should not exceed 7 mg/Kg, and the maximum total dose should not exceed 500 mg. Lidocaine injection with epinephrine should not be used on fingers and toes. The maximum recommended dose of lidocaine injection without epinephrine should not exceed 4.5 mg/Kg, and the maximum total dose should not exceed 300 mg. Once given the maximum dose of lidocaine, it should not be repeated for 2 hours.

Viscous lidocaine 2% is typically dosed as 15 ml (300 mg) orally swish and spit/swallow every 3 hours as needed in adults. Patients should not exceed 8 doses in 24 hours. Adverse effects such as dizziness, light-headedness, and numbness of the tongue have been reported with 500 mg oral doses of lidocaine. Topical administration of lidocaine in adults and children should not exceed 3 mg/Kg/dose (e.g., 4.2 gm of a 5% ointment for a 70 Kg patient). The dose should not be repeated within 2 hours.

The maximum adult dose for the lidocaine 5% patch (Lidoderm) is up to 3 patches may be applied at a time for no more than 12 hours per 24-hour period. Lidocaine 4% cream (L.M.X.4) should not be applied to an area over 100 cm2 for patients under 10 Kg and an area over 600 cm2 for patients between 10 and 20 Kg. The amount absorbed systemically is determined by the area over which it is applied and the duration of application, particularly if it is left on for longer than 2 hours to a large surface area.

The recommended maximum dose, application area, and application time of lidocaine 2.5% with prilocaine 2.5% cream (EMLA), depend upon the weight and age of the patient. Children under 3 months of age or less than 5 Kg can receive up to 1 gm over 10 cm2 for up to 1 hour. Children 3 to 12 months of age and over 5 Kg can receive up to 2 gm per dose over 20 cm2 for up to 4 hours. Children 1 to 6 years of age and more than 10 Kg can receive up to 10 gm per dose over 100 cm2 for up to 4 hours, and children 7 to 12 years old and greater than 20 Kg can receive up to 20 gm per dose over a 200 cm2 area for up to 4 hours.

Tylenol Overdose

2009-05-29T00:48:00.001-05:00

Tylenol (acetaminophen) overdose is one of the most common poisonings worldwide. People often think that tylenol (acetaminophen), a pain-relieving medicine, is extremely safe.
However, a very large overdose of acetaminophen can lead to liver failure and death in a few days.

REVLIMID (LENALIDOMIDE) CHEMICAL STRUCTURE

2009-05-27T00:01:00.000-05:00

REVLIMID® (lenalidomide) is a thalidomide
analogue which is an immunomodulatory
agent with antiangiogenic and antineoplastic
properties.

The chemical name is 3-(4-amino-1-oxo
1,3-dihydro-2H-isoindol-2-yl) piperidine-
2,6-dione and it has the following chemical
structure.

The empirical formula for lenalidomide is
C13H13N3O3, and the gram molecular
weight is 259.3.

5 Falsehoods Regarding Protecting Yourself from Skin Cancer

2009-05-26T00:01:00.000-05:00

by: Emily Clark

Sara spends much of her summer near the beach. She lives in a
mild climate and is very athletic. She loves to swim, bike and
play games outdoors. Sara knows the dangers of the sun and so she
opts for tanning salons to get her 'golden glow' while being sure
to apply sunscreen every day before heading out.

Joseph lives in a cooler, northern climate. The summers can be
very humid, but most of the year is mild or even below freezing
during the harshest winter months. The beach has never been much
of a draw for him and he spends most of his time doing indoor
activities or at his job. Joseph doesn't worry about sunscreen
and only had one sunburn that he can remember and that was when
he was a child.

Which of these examples do you most associate yourself with? Did
you know that Sara and Joseph are both at risk of developing skin
cancer? We have all heard the warnings about the dangers of sun
exposure. We know all about the importance of wearing sunscreen
and hats. But are YOU protected from skin cancer? Consider these
myths and facts [read more]

ZINC DEFICIENCY STATES?

2009-05-25T00:01:00.000-05:00

Zinc is an important cofactor in numerous enzyme systems such as those involved in healing. Patients who are very catabolic, have chronic diarrhea or who are on parenteral feeds or tube feed can develop deficiencies. A normal adult with normal stools require 3 to 6 mg of elemental Zinc each day.

Patients with short bowel syndrome or chronic diarrhea require 12 to 20 mg per day. Patients with deficiencies can get a characteristic periorbital pustular rash, darkening of skin creases and neuritis. It is also associated with poor epithelialization and chronic, nonhealing wounds.

Zinc deficiencies also may be associated with post-operative loss of taste and therefore, appetite. This especially occurs in patients with diarrhea whose zinc stores are chronically low. Zinc replacement may cause a return in taste and therefore appetite if given over 10 days to 3 weeks. Deficiencies can most often be seen in patients on TPN or tube feedings.

Carpal Tunnel Exercise

2009-05-24T00:36:00.000-05:00

Carpal Tunnel Exercise:

Carpal tunnel Exercise like the wrist and hand exercises can help to minimize the effect of Carpal Tunnel syndrome. By performing the Carpal tunnel Exercise for five minutes in every hours can help a lot in minimizing the risk of Carpal tunnel syndrome.

The Carpal tunnel exercise like the stretching exercise strengthens the wrist muscles, hand muscles, neck and shoulder and there by improving the flow of blood.

Carpal Tunnel Exercise For Wrist:
Carpal tunnel exercise for Wrist is that, first make a loose fist with your right hand, then keep the palm in upward position and after that use the left hand to press it gently down against the clenched hand. Now resist the force of the left hand with the closed right hand for five seconds, but be sure that the wrist is kept straight.

After that turn the right hand fist palm downwards and press it against the knuckles with the left hand for five seconds and after that finally, turn the right palm in such a way that the thumb-side of the fist is up and press down again for five seconds. After this repeat the same process with the left hand.

Second simple Carpal tunnel exercise is that which is called as wrist circles. According to this wrist circle draw clockwise circles in air with the tips of second and third fingers, which are kept up and close together. After that repeat the same process with left hand.

Third easy Carpal tunnel exercise is that first hold a hand straight up next to the shoulder with fingers together and palm facing outward, somewhat like a shoulder-high salute position. After that, bend the hand backward with the fingers still held together with the help of another hand and hold it for five seconds. After that open the fingers and thumb with the hand being in the same bent back position and hold it for five seconds. Now repeat the same process with another hand.

Carpal Tunnel Exercise For Neck and Shoulders:
Carpal tunnel exercise for neck and shoulder is that, first sit in upright position and then place the left hand on top of the right shoulder, then hold that shoulder down and slowly tip the head down toward the left, after that keep the face in pointed forward position or even in a slightly turned towards left and hold this stretch position gently for five seconds. Now repeat the same process with the other side.

An Another Carpal tunnel exercise for neck and shoulder is that to stand in a relaxed position with the arms at the side and raise the shoulders. After that squeeze the shoulders back and stretch them down. Finally press the shoulders forward.

Carpal Tunnel Exercise For Forearms:
Carpal tunnel exercise for forearms is that, first stretch the forearm muscles which will reduce this tension prevailing the muscles. Now place the hands together in front of the chest with the fingers pointing upward just like in a prayer position. After that keep the palms flat together and raise the elbows to stretch the forearm muscles for ten seconds. Finally for few seconds shake the hand limps gently to loosen them. Repeat this carpal tunnel exercise frequently.

Carpal Tunnel Exercise For Fingers and Hand:
Carpal tunnel Exercise for fingers and hand is that first bend and stretch the finger. After that clench the fingers of right hand into a fist tightly and then release them. Do this exercise for five times. Now repeat the process with the left hand.

Carpal tunnel exercise for thumb is that, first bend the thumb against the palm beneath the little finger for seconds. After that spread the fingers apart with the palm in upward position for five more seconds. Finally pull the thumb out gently and back for five seconds. Repeat the exercise for 10 times with each of the hands.

General Carpal Tunnel Exercise:
Carpal Tunnel Exercise in general is using a combination of aerobic and resistance-training techniques that strengthen the muscles of back, arms and shoulders, there by reducing the weight, and ultimately improving the overall health of the body. As said by some experts the physically fit persons like the athletes, swimmers, joggers etc., are at lower risk to Carpal Tunnel Syndrome.

http://cio.energy.gov/documents/wrists.pdf

WHAT ARE POWERFUL HINTS TO STOP SMOKING?

2009-05-23T00:01:00.000-05:00

Do You Enjoy Smoking? YES! Then Do Not Click Here.

Whether you are using Nicotine
Replacement Therapy, Hypnosis
or just Cold Turkey, these strategies
and hints for aiding you in stopping
smoking are sure to assist.

It is up to you to ensure that you do
these things to really enhance what
you are doing, the more effort you
put into these exercises, the easier
it is to stop smoking for good. [...]

CAN SMOKING CAUSE ED?

2009-05-22T00:01:00.000-05:00

Do You Enjoy Smoking? YES! Then Do Not Click Here.

A study done at Boston University
showed that men who smoked one
pack of cigarettes a day for five years
were 15 percent more likely to develop
clogging in the arteries that serve the
penis, a situation that can cause impotence.

In addition, heavy smoking decreases
sexual capability by damaging the tiny
blood vessels in the penis.

The use of marijuana and cocaine also
can result in impotence. [...]

WHAT ABOUT ADULT ACNE?

2009-05-21T00:01:00.000-05:00

Do You Enjoy Smoking? YES! Then Do Not Click Here.

Picture this; the snow-white clear
skin that you have been proud of
since your teen years has suddenly
poofed into a wicked witch's warty
face upon reaching the age of 30!

"Acne, at my age?"

This is often the distressed statement
of pockmarked men and women in their
30's to 40's afflicted with adult acne. [...]

Anatomical Names of Parts of the Ear

2009-05-20T00:50:00.000-05:00

The diagram shows the shape and location of these components:

* Anthelix (antihelix) forms a 'Y' shape where the upper parts are:
o Superior crux (to the left of the fossa triangularis in the diagram)
o Inferior crux (to the right of the fossa triangularis in the diagram)
* Antitragus is below the tragus
* Auricular sulcus is the depression behind the ear next to the head
* Concha is the hollow next to the ear canal
* Conchal angle is the angle that the back of the concha makes with the side of the head
* Crus of the helix is just above the tragus
* Cymba conchae is the narrowest end of the concha
* External auditory meatus is the opening to the ear canal
* Fossa triangularis is the depression in the fork of the anthelix
* Helix is the folded over outside edge of the ear
* Incisura anterior (auris) is between the tragus and the antitragus
* Lobe (lobule) - attached or free according to a classic single-gene dominance relationship
* Scapha
* Tragus

The Truth About Cholesterol

2009-05-19T07:52:00.000-05:00

Cholesterol is critical to the normal function of every cell in the body. http://bit.ly/cholesterol

2009-05-14T07:48:00.000-05:00

Angels & Demons The Science Behind The Movie http://bit.ly/angels-demons

How To Grow Taller?

2009-05-13T05:36:00.000-05:00

How To Grow Taller http://bit.ly/growingtaller

Weight Loss Diet Plan

2009-05-12T00:06:00.000-05:00

Lose 9 pounds every 11 days http://bit.ly/losetheweight

How The Flu Works?

2009-05-11T00:13:00.002-05:00

Photo Credit Howstuffworks.com

SWINE FLU DEATHS INCREASE

2009-05-10T08:09:00.000-05:00

Washington state health officials say a man in his 30s is the first person in the state to die from what appears to be complications of swine flu. The United States has 1,639 confirmed human A(H1N1) cases in 43 states, including three deaths, overtaking Mexico as the country having the most confirmed cases in the world, the US Centers for Disease Control and Prevention (CDC) said Friday. [read more]

Suicide Is Never The Answer

2009-05-08T04:14:00.002-05:00

Suicide is never the answer no matter what - http://tinyurl.com/notosuicide

Vitamin E Slows Alzheimer's Disease

2009-05-06T00:05:00.001-05:00

Vitamin E and other anti-inflammatory like drugs may slow the decline in Alzheimer's patients according to recent Harvard University study. [read more]

Tracking Swine Flu Cases Map

2009-05-06T00:00:00.002-05:00

http://www.nytimes.com/interactive/2009/04/27/us/20090427-flu-update-graphic.html

Links for 2009-04-19 [Digg]

2009-04-20T00:00:00-07:00

An effectively disturbing bedding ad (PIC)
Holy fuck. Why did I have to see this before bedtime?!

Links for 2009-04-18 [Digg]

2009-04-19T00:00:00-07:00

10 Youtube URL Tricks You Should Know About
Youtube - You know that site with videos and all. Yeah! It turns out that its quite popular and you happen to visit and use it quite often. Instead of just searching and playing here are some top Youtube URL tricks that you should know about.

Links for 2009-04-02 [Digg]

2009-04-03T00:00:00-07:00

Doctors Opting out of Medicare at an Alarming Rate
More and more doctors -- especially internists, gastroenterologists, gynecologists, and psychiatrists -- are refusing to accept Medicare. Why? The reimbursement rates are too low, and paperwork is too much of a hassle, they say. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare.

Links for 2009-03-30 [Digg]

2009-03-31T00:00:00-07:00

If bit.ly Is Worth $8M, TinyURL Is Worth At Least $46M
In a world gone mad...

Links for 2009-02-27 [Digg]

2009-02-28T00:00:00-08:00

The panhandler's secret
There is nothing like a good story to drive a good point home.

Links for 2008-12-21 [Digg]

2008-12-22T00:00:00-08:00

The Obesity Problem in China?
Chinese are now getting fatter.

Links for 2008-12-20 [Digg]

2008-12-21T00:00:00-08:00

Give This Man an Oscar. (PIC)
It's a funny world we live in.