A bandage is a material that supports the body and allows it to heal itself. A compression bandage is a little different from the ordinary bandage as it is used to apply pressure to the area that is healing. The pressure thus applied performs a number of functions. It prevents swelling and edema. It increases blood circulation and allows the patient to manage their condition better.

Compression bandages are of two kinds.

Short stretch compression bandages: These bandages are commonly worn on the limbs, like the fingers and areas of the leg. They are generally used to treat venous ulcers, lymphedema, leg ulceration and even small wounds. Short stretch compression bandages have a property that allows them to shorten around the area, thus applying consistent pressure. Since the bandage does not exert increased pressure during periods of inactivity (which can lead to the accumulation of fluids in the area of application), these bandages are well suited for long term healing. What’s more, the design of these compression bandages is such that they resist pressure that is applied when an internal muscle contracts or moves. So, these ban adages can be worn even when the patient is asleep, though this is not always recommended.

Long stretch compression bandages: As the name suggests, these bandages can be applied over large areas, like a portion of the limb. These bandages apply pressure over the area but have a high resting pressure. Therefore, it is necessary for patients to remove these bandages when the body is at rest. Long stretch compression bandages are so called because they can be stretched to almost three times their size. These bandages are an important part of the healing process in many conditions like Complex Physical Therapy, venous leg ulceration and lymphoedema. Patients who need to use long stretch compression bandages while they are recovering from a condition need to take care that the compression bandages come off at night because these bandages become too tight to allow comfortable sleep.

may look like a simplestretch of material, but a lot of design goes into their manufacture. Some of the most important characteristics of compression bandages are elastic properties, pressure, components and layers. Compression bandages are medically prescribed in long term treatments because they help preserve the elasticity of the skin, maintain the improvements that have been gained by therapies like massage therapy, reshape and maintain the shape of the limb and accommodate the difference in size between the different areas. For instance, the bandage will wrap around a bulge in the same way as it will accommodate a constricted area.

Compression is generally recommended by doctors because they help reverse the accumulation of fluids. They also increase the flow of blood through the venous system and boost fibrinolytic activity. So, compression is an important treatment for various conditions.

Forceps are hand-held instruments used for grasping and holding the objects. They are similar to tweezers and tongs and can be longer or smaller in size. There are more than 700 types, which are used as per the need of the situation. Usually, they are used when singleton fetus in cephalic position fails to develop. Another condition can be when the delivery is required to be done at its second stage.



It is used for the surgery or for medical procedures are known as surgical forceps. They are mainly used during the delivery of the child. There blades are made of rigid material and their contact surface helps in grasping the baby’s head.



It can be used for grasping dressings, needles or handling tissues. For handling tissues they have small teeth on their tips so that they do not have to apply pressure while handling. The dressing instruments are larger and look very much like tongs. There are four main components of forceps:



1. Blades: This oval and elliptical blade helps in grasping fetus.


2. Handles: The person operating holds the instrument through the handles and applies traction to the fetal head.


3. Lock: There are different types of locks available and are used as an articulation between the shanks.


4. Shanks: Shanks are either parallel or crossed for connecting the blades to the handles.



Forceps delivery is dependent on the level and the position of the head in the birth canal. According to the gynecologists, they are classified into low, mid and high forceps. The low forceps are applied only when the fetal scalp is visible and has reached the pelvic floor. The mid forceps can be used at many points of fetal head.

It is very important to understand when to use forceps so as to avoid any complications.

The cervix must be fully dilated and retracted.
The operator should know the Pelvis category.
The head must be engaged.
The membrane should be ripped apart.
The operator should be competent and should not use aggressively forceps and vacuum.
There should be adequate facilities and support available for the patient convenience.



Forceps surgery is an alternative to caesarean delivery. It can be done even when then the baby is not in the right position but not in the condition when the head of the baby is towards the vaginal canal. There are many negative aspects it. Yes, it can cause mild to severe metal retardation, skull fractures or even nerves can be damaged. If there are both positive and negative aspects then sufficient thought and care should be taken before using the forceps.

Introduction
 
Bladder injury is very serious complication of lap assisted vaginal hysterectomy
Method of analysis retrospective analysis



Type of operative procedure laparoscopic assisted vaginal hysterectomy laparoscopic assisted vaginal hysterectomy performed using three port sign symptom of bladder injury During surgery balloon like distention of bladder catheter bag with gas or co2 discharge of clear fluid into the operative field haematuria management of bladder injury during surgery cause of bladder injury primary and secondary trocar perforation .hasson technique for open laparoscopy may reduce three type of injury .2nd and 3rd trocar should be inserted under  vision previous surgery increase the risk of in advertent cystostomy by placing the bladder on traction close to umbilicus or because adhesion place it in the path of secondary trocar .in addition previous surgery can result in adhesion formation which obliterator the position of the bladder adhesion can for in the area of cervico-vaginal junction as result of previous cesarean section and extend the attachment of the bladder beyond lower uterine segment .other cause of mechanical injury .sharp scissors or blunt dissection of adhesion or seen near the dame of bladder may be adhesion from previous infection surgery relating to the bowel ,appendix or peritonitis .



Thermal injury



Excessive coagulation may be responsible for thermal bladder necrosis .use of unipolar cautry in proximity to the bladder surface should be avoided. Vesico vaginal fistula can occur following operative laparoscopy .it uterus is detached from bladder using unipolar or bipolar cautry excessive thermal coagulation may be responsible for thermal bladder necrosis .thermal necrosis may be some apparent only in post operative period when a vesico-vaginal fistula occurs –fistula can also occur if bladder is taken up when vagina is sutured  from below .



Diagnosis



Injection of methylene blue via a bladder catheter will conform the diagnosis of vesico-vaginal fistula .I.V. P. Retrograde Cystography should also be done for through revaluation



Presentation of Bladder injury 



To minimize bladder injury in patient with previous cesarean section Tran’s vaginal lateral intervention should be used to enter the anterior cul-de-sac during laparoscopic interfacial hysterectomy lateral window of vesico vaginal space aware opened first. Management of trocar veress needle injury .may be managed with folly catheter for one week with no subsequent complication .injury to bladder during laparoscopy assisted vaginal hysterectomy is small and loaded some distance away from trigone of bladder it can be retired laparoscopically two layer closer with delayed absorbable suture material and check that the bladder is water tight by injection 300 ml of methylene blue via the bladder catheter.



Incident of Bladder Injury 4-7 out of 1000



Sign to recognize bladder injury intraopeartive including following



1.      CO2 catheter bag during insufflations



2.      Bladder appears to be pushed by the accessory trocar as it is advanced through the abdominal well



3.      Blood in Urine



4.      Urine drainage from accessory trocar incision



5.      Post operative urinary retention



6.      Post operative signs of peritonitis



7.      Leakage of Indigo carmine from the injured site



Prevention of Bladder Injury Insert is secondary Trocar under direct vision.



1.      Separate bladder from lower uterine segment by using sharp dissection never dissect the bladder bluntly



2.      Make sure the bladder is not inside the gain of laparoscopic stapling device before firing it.



3.      Avoid excessive electro surgery around the bladder



Treatment



1.      Repair is dependent upon whether injury is thermal or Mechanical



2.      Whether injury is at the base of dome of bladder



3.      Proximity of injury to trigone and ureteric opening



 



 



Treatment



If diagnosed at the time of surgery. Bladder injury at the dome can be repaired in a straight forward manner in two layer C PDS. Is layer should be continuous containing Muscular is Mucosal layers. Instillation of Indigo carmine dye assist identification of bladder boundaries laparoscopic repair of vesico vaginal fistula if presented after surgery is done after about 12 weeks. Vesico-vaginal space was developed both bladder vaginal were closed separately bladder with vicryl vagina with PDS. A peritoneal flash was used to separate vesico vaginal space and sutured with vicryl. Abdominal approach should be used for following indications.



1.      Inadequate exposure because of high or retracted fistula in a narrow vagina.



2.      Proximity of fistula to the ureter



3.      Multiple fistula



4.      Associated pelvic pathology bladder should be empted prior to surgery



New Technique



A new technique for dissecting    the bladder laparoscopically was detected by James Cook University Hospital during laparoscopic assisted vaginal hysterectomy in department of minimal access surgery. 130 lavh were reviewed bladder was dissected laparoscopically a metal catheter was used to stretch Identification of bladder edge and a sponge forceps was inserted virginally to mark the site for anterior Colpotomy monopalar scissor were used to open virginal there was one   bladder trauma 0.7% Which was recognized immediately and repaired with laparoscopy intra corporeal knot mean operating time was 198.7 minute recorded mean hospital stay was 2.7 days with range of 2 to 5 days dissection of bladder laparoscopically adds 5 to 10 minutes to operative time but significantly facilited identifying Appropriate plane it is an easy technique to learn and teach it is associated with minimal complication With no increase in incidence of bladder injury or dysfunction injury to bladder with laparoscopy Is rare said et al reported 1.6% incidence of serious urinary complications after major operative? Laparoscopy majority being bladder perforation or fistula there are four case of bladder injury in a series of 900 laparoscopic hysterectomy three of this for woman had under gone 2 or 3 c sections woman under going vaginal  hysterectomy  are more likely to sustain bladder injury if they have had previous c section. In this study these reporting 130 consecutive lavh in which bladder were dissected and ureteric vaginal pouch then opened laparoscopically. This technique was initially designed for woman who had previous c section in whom bladder was adherent and difficult to identify and dissect vaginally technique was later adopted in all cases because it appear ed to be easier and safer then vaginal route this technique was used in 130 lavh performed at james cook hospital technique was used in all patient in the same o t high pressure entry technique 25 mm hg using 3 port in addition to 10 mm umbilical port with 5 mm port inserted under direct vision in right and left iliac fosse later to deep epigastric vessels and are one inserted supra pubically. Bipolar diathermy and scissor were used to secure pedicles down to but not including uterine vessels both round ligaments were secured with bipolar diathermy peritoneum was dissected from one round ligament to other side. A metal catheter was then inserted in the bladder catheter was rotated so the tip was pointed up ward to stretch the bladder pillars bladder was dissected with monopolar scissor with catheter in place. A sponge forceps was then pushed in to vagina in to anterior fornix to stretch the vagina and mark the site for colpotomy monopolar scissor were used to open vagina and use of cutting diathermy and firing just prior to contact with vaginal tissue helped to achieve haemostatic without significant coagulation vagina opened in layers until sponge forceps was reached which was pushed in ward and blade opened widely to stretch the colpotomy procedure was completed vaginally. A Wertheim retractor was placed through to protect bladder uterine vessels were first secured with clamps and secured with vicryl followed by cardinal and utero sacral ligament and intra peritoneal drain as well as urinary catheter until following day result out of 130 patients 12 had C sections mean operative time was 98.7 minute. There was one bladder trauma which was recognized immediately and repair with laparoscopic intra corporeal knots. Cystoscopy was performed to ensure proper bladder repair and to exclude any other injuries. Patients has bladder catheter for 7 days at follow up 6 months post operatively she was well with no residual bladder dysfunction.



Discussion



It is difficult to detect the incidence of bladder injury with laparoscopic surgery in general LAVH specially GILMOUR et al (9) reported that major gynecological surgery the incident of bladder injury varied from 0.2 -19.5/ per one thousand with over all frequency of 2.6 per one thousand based on medlinereach for all reports between 1996 and 1998. The found a higher incidence of bladder injury when routine cystoscopic was perform with range from 0 to 29.2 and over all frequency of 10.4 per one thousand.  Author commented that only 51.6% of bladder injury were identify and managed intraoperatively. Ostrzenski et al (10) reported the overall incidence of bladder injury during laparoscopic procedure to range from 0.022% to 8.3 % of cases. These injuries most frequently occurred during LAVH.  Sharp electro surgical dissection was leading instruments cause in injury. Intra operatively diagnosis of bladder injury was made in 53.24% of all bladder injuries cases with bladder dome being most commonly injured structure. Less than half 29.87% of bladder injuries were corrected laparoscopically. In this series one bladder trauma occurred when catheter was pushed into bladder wall thus perforated through. The injury was identified immediately and successfully repaired laparoscopically with no residual permanent bladder dysfunction. Uses of metal catheter to stretch the bladder help in identify the boundary to bladder and pillars. Which significantly facilitate recognizing where to dissect and release bladder especially in patients with extensive scarring dissection should be carried out until one is satisfied that bladder has been completely freed of the vagina and use of sponge forceps to stretch the vaginal wall clearly Marks the site for colpotomy. Further largest studies are needed to obtain more accurate estimate of bladder trauma. Cystoscopy was not performed routinely unless bladder injury was suspected indigo carmine was injected intravenously a few minute prior to Cystoscopy. Some Author recommend routine use of Cystoscopy with hysterectomy because of high incidence of undetected bladder injury vakili at al (11) recently reported a 4.8% incident of urinary injury during hysterectomy  and therefore concluding that routine Cystoscopy should be considered. Harkki-Siren at al (12) reported complication rate of for per one thousand laparoscopy procedure but a rate of major complication of 10 per one thousand  with operative laparoscopy 19% percent major complication in these serious was ureteric  injury  46% was intestinal injury. They found that 75% of the major complication were associated with LAVH and commentated that many of these may be due to technique as the uterine vessel were coagulated and cut laparoscopically 86% of the time and attempt to secure uterine vessel with diathermy or staples may result in significantly more ureteric injuries (13). In these series no ureteric injury as laparoscopy dissection stopped above uterine vessel and procedure was then completed vaginally. A recent systemic review and Meta analysis of randomized controlled trial of comparing abdominal vaginal and LAVH was published by Johnson at al (14). They reported a significant increase in urinary tract injury for laparoscopic compared with abdominal hysterectomy odd ratio 2.6; 95% therefore no significant difference when comparing laparoscopic versus vaginal or laparoscopic hysterectomy versus LAVH. In this series opted for LAVH visco et al reported 2.6% of LAVH damage to urinary tract occurred among total 2998 cases. Evaluate study published by Ginny et al (17) reported 2.1% bladder injury in laparoscopic hysterectomy compared to 1% in abdominal Hysterectomy. Comparison of laparoscopic and vaginal hysterectomy bladder injury reported were 0.9% and 1.2% respectively. Incidence of bladder injury in gasser series was lower 0.7% due to ease of identify and dissecting bladder.



Conclusion



If one is careful one can easily avoid bladder injury by obeying the above mentioned principals. This Gasser study describe dissection of bladder laparoscopically adds 5-10 minutes to the operating time. Use of metal catheter help to identify bladder margin and by stretching of bladder pillar plane are easily recognized. Use of sponge forceps vaginally clearly m arks the vagina and thus site for colpotomy. It is easy technique to learn and adopt specially in patients with previous c section. Incident of bladder is low main advantage is facilitating bladder dissection when there are significant adhesion. Technique is associated with low incidence of bladder injury.



 



Reference



1)      Schutz K, Possover M, Merker A, Michels W, Schneider A(2002) Prospective randomized comparison of laparoscopic assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200g. Surg Endosc 16: 121-125.



2)      Stovall T, Elder R, Ling F (1989) Predictors of pelvic adhesions. J Report Med 34: 345-348.



3)      Zapico A, Fuentes P, Grassa A, Arnans F, Otazua J, Cortes-Prieto J (2005) Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in stages I and II endometrial cancer: operating data, follow-up, and survival, Gynecol Oncol 98: 222-227.



4)      Harkki- Siren P, Kurki T (1997) A nationwide analysis of laparoscopic complications. Obstet Hynecol 89: 108-112



5)      Harkki-Siren P, Sjoberg J, Titinen A (1998) Urinary tract injuries after hysterectomy,  Obstet Gynecol 92: 113-118



6)      Ostrzenski A, Ostrzenska KM (1998) Bladder injury during laparoscopic surgery, Obstet Gynecol Surv 53: 175-180



7)      Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM (2005) is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study, Am J Obstet Gynecol 193:2041-2044



8)      Armenakas NA, Pareek G, Fracchia JA (2004) Iatrogenic bladder perforations: Long-term follow-up of 65 patients. J Am Coll Surg 198: 78-82



9)      Matheved P, Valencia P, Cousin C, Mellier G, Dargent D (2001) Operative injuries during vaginal hysterectomy, Europ J Obstet Gynecol Repord Biol 97: 71-75



10)  Berek & novak’s gynecology (2007) Lippincott Williams & Wilkins, Philadelphia, 14th ed, pp. 805-811



11)  Vessy M, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D (1992). The epidemiology of hysterectomy: finding in a large cohort study. Br J Obsted Gynaecol 99: 402-407



12)  Cosson M, Lambaudie E, Boukerrou M, Querleu D, Crepin G (2001) Vaginal, Laparoscopic, or abdominal hysterectomies for benign bisorders: immediate and early postoperative complications. Eur J Obstet Gynecol Reprod Biol 98: 231-236



13)  Sheth SS, Malpani AN (1995) Vaginal hysterectomies following previous cesarean section. Int J Gynecol Obsted 50: 165-169



14)  Hsu WC, Chang WC, Huang SC, Torng Pl, Chang Dy, Sheu BC (2006) Visceral sliding technique is useful for detecting abdominal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Invest 62: 75-78



15)   Chang WC, Huang SC, Sheu BC, Chen Cl, Torng PL, Hsu WC, Chang DY (2005) Transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for nonprolapsed uteri. Obstet  Gynecol 106: 321-326



16)  Chang WC Torng PL, Hunag SC, Sheu BC, Hsu WC, Chen RJ, Chow SN, Chang DY (2005) Laparoscopic-assisted vaginal hysterectomy with uterine artey ligation through retrograde umbilical ligament tracking. J Minim Invasive Gynecol 12: 336-342



17)  Aronson MP, Bose Tm (2002) preoperative bladder injury in pelvic surgery. Clin Obsted Gynecol 45: 428-438



18)  Neumann G, Raswmussen KL, Lauszus FF (2004) Peroperative bladder injury during hysterectomy for benign disorders. Acta Obstet Gynecol Scand 83: 1001-1002



 



 

A surgical instrument can be defined as a tool specially designed to perform different actions of a surgery or an operation. These include a lot of tools such as forceps, scalpel, hemostat, tracheotome etc. All these tools are used for operations such as modifications of a biological tissue. These can also be used for obtaining access or viewing certain tissues present in human body.



If we talk about the history of these instruments, they have been created from the starting of pre–historical period or to be more specific, millions of years ago. First, rough trephines were discovered for performing round craniotomies in many places. According to a popular research, these instruments were utilized by shamans in order to release evil spirits, head related problems or to alleviate headaches resulted by words inflicted by war.



Many surgeons & physicians of Indian origin used sophisticated instruments from ancient period. Sushruta was known to be the most famous surgeon in ancient history. He is also referred to as ‘father of surgery’. In his text, he has successfully described about 120 surgical instruments 300 surgical procedures. He had also classified human surgery in eight different categories.



Surgical instruments are provided in a huge range for a number of applications. It is important to provide these instruments with great care and under most hygienic condition in order to be used in a safety condition to be used for medical & clinical purposes. Medical practitioners are supposed to wear protective gloves under risky environments in order to reduce risk of exposure. These are disposable surgical gloves offered with powdered and non-powdered condition for a huge range of applications such as surgery orthopedics, gynecology & ophthalmology. Some of the disposable surgical instruments include twin bone nasal catheter, nasal oxygen catheter, oxygen mask, suction catheter and tracheas tony tubes.



If you want to choose the best of surgical equipments, you should consider certain things. Most people think that they only require clamps, scalpels & other general items under this category. However, you also need to consider equipments such as surgical lights, autoclaves & other specialized surgical tools.



People also don’t consider surgical lights as an important item. These are really important when it comes to getting the adequate & perfect lighting for a place where a surgical application is required. These lights ensure correct surgical outcome. In addition to perfect lighting conditions, you also require correct specialized equipments such as ophthalmic surgical equipment. This makes sure that you are equipped with proper supplies just when you require them.



You need to contact a reputed surgical provider who keeps good stocks of most surgical instruments required for certain special types of surgery.



There are several other things you need to keep in mind when it comes to choosing surgical equipments, especially if the type of surgery needed to be conducted is of a specialized nature. Take enough time to conduct some research prior to choosing an equipment that can provide you that specific type of surgical equipment you need.


We are manufacturer and supplier of Pharmaceuticals, ophthalmic, ENT, hospital furnishers, IOL & contact lenses, optical equipments and surgical instruments.

When the big day arrives, surprises are not welcome. From the moment a customer enters the tattoo shop to the moment he or she leaves, there is a typical process that is virtually scripted in the minds of many tattoo artists, and it helps a prospective tattooee to know in advance what that script involves.



Several steps of preparation involving the workstation, equipment, and pigments take place and may mean some waiting time spent idly gazing at flash or watching somebody else get tattooed. The design is prepared with either a transfer or a stencil.



The skin, no matter the part of the body involved, is shaved and given an alcohol wipe. A temporary ink outline of the design is placed on the surface of the skin and checked in a mirror. And all of these steps take place before a single part of actual tattooing begins.



This article is designed to relieve the natural anxiety that any new experience brings, by demystifying it and laying it bare. Knowing exactly what to expect, in the order it will likely happen, and the amount of time it will likely last, can mean the difference between a nerve-racking experience and an enriching one.



This article advises tattooees of some of the potential regulations involved, their responsibilities, the responsibilities of the tattoo shop or artist, and the requirements of payment up front and signing contracts. In addition, the prospective tattooee will learn that tattoo artists also have their own expectations, and that fulfilling these can make for an even better experience and better tattoo.



Before You Get There



You’ve done all your research, made all your decisions, and have your appointment … what, no appointment? Part of the decision-making process was picking your tattooist someone in whose technical and artistic skill you have confidence, with whom you have some rapport—someone that you trust. Will he or she be at the shop that day or not? Assuming so, will he or she he busy when you arrive? If that is the case, are you going to wait? How long? But why leave any of this to chance? The first thing, then, that you need to do before you actually arrive for your tattoo is to have made an appointment beforehand. (It’s not as spur-of-the-moment as some tattoos, hut the perfect tattoo rarely is.) The second thing to do is to take a bath or shower. Whether you’ve had your bath for the week already or not, be clean and presentable. Don’t come directly from the gym in your workout clothes or after you’ve been digging trenches in the hot sun. Your tattoo artist is going to sit close to you and work with your skin. Don’t give him or her a reason to hurry.



On your checklist of things not to do before your tattoo appointment is taking any aspirin or drinking alcohol. In both cases, the blood is thinned, which makes for more bleeding and possibly impaired healing. In the second case, though, it’s simply poor form to show up faced. You are entering a tattoo artist’s place of work and creativity. Is that how you’d wad somebody to come to your place of work? Save the drinking for later, when your friends take you out. Besides, you wouldn’t want to miss out on a single part of your tattoo experience. When you look back on it, you’ll know that you earned your tattoo the way millions of people have for thousands of years.



Dress appropriately for the placement of your tattoo, which you have already discussed with the tattoo artist. If you know you’re getting a tattoo on your upper arm, then wear something sleeveless or with sleeves that can be rolled up high enough. If you’re getting something on your lower leg, then wear shorts. If you’re getting something on your lower back, then wear a shirt that you can lift and pants that are low enough or which can be lowered enough. If you’re getting something on your back, girls, consider wearing a button-up shirt which you can then wear backwards and leave open in the hack. All tattoo shops will have at least a bathroom where you can change your clothes. Tattoo shops also have areas with more and less privacy. The front of the shop will almost always have a chair or two but also, usually there will be an area that is screened off from the view people in the front and the general public who are looking at flash. If you have questions about what would be good to wear, ask your tattoo artist. You don’t want to wear clothing (like briefs or a bra) that will leave an impression in your skin in the exact place where you’re planning on having a tattoo.



With all of that in mind, do your best to dress comfortably. There’s no point in complicating matters by wearing something in which you can’t breathe. Keep in mind the possibility that some stray ink might get on your clothes. It doesn’t happen all the time, but it does happen. Some people who are in the process of getting a very large tattoo, over the course of several sessions, may even have a certain set of clothes that they wear for tattooing and may even bring their own towel or pillow for extra comfort. For most people getting their first tattoo, though, this would probably be completely unnecessary. Don’t even think about bringing your teddy hear.



What to Bring



Make sure that you bring some form of identification with you, no matter your age. Depending on local regulations, many tattoo shops will have a contract for you to sign. As with any contract, you should read it. Unlike most, it’ll probably be pretty brief. You can expect issues of responsibility to come up (for example, allergic reactions to inks aren’t the responsibility of the tattoo artist) or the legal age limit for tattooing (different in different areas).



In essence, the tattoo shop and tattoo artist are going to limit the amount of responsibility that they are willing to accept to things that they can control: a sterile environment, satisfaction with the work, and the like. They are not going to take responsibility for things that they can’t control: your allergic reactions, the particulars and peculiarities of how your skin heals. In order to sign a contract with you, they have to know who you are. The identification that you bring will be used to that end, and to verify your age if you look close to the legal limit.



Bring your money. You’ve already discussed your design in detail with the tattoo artist. Once the artist has seen the design, and knows how big it will be and where on your body it will go, he or she can give you a price. Body location will change the price since some parts of the body simply mean more work and time for the artist than others. You know what forms of money they’ll take: cash, maybe checks (but you should ask), and credit cards. Make sure to bring enough with you for the tattoo and your tip, if you’re thinking of giving one after being pleased with the final product. You may he asked for the fee up front, so that they can be sure you’ve got the money.



Be on time for your appointment. Not only is it courteous and good business practice—it also helps to have as much time as possible for your tattoo. There may be more appointments after you. Even if you’re on time, though, prepare yourself to wait anyway. Tattooing is a people business and people can be unpredictable. Some tattoo clients may need more breaks during their tattoo process than others or may simply need to take the whole thing a little more slowly. Others simply sit down, sit like a rock, and get up when it’s done. Of course, even if everything is on time, waiting during preparations is part of the normal process.



Preparations



The following scenario can only be a general guideline since it will most definitely vary from place to place and artist to artist. But in its broad outlines, this is pretty much what you can expect.



When you arrive and are greeted by your tattoo artist, he or she will confirm the tattoo with you (design, placement, colors), see your ID, have you sign the contract, take your money, and then make the preparations. You can watch, you can look at Rash, or you can probably watch somebody else getting tattooed. You might have seen all of this before when you made your grand tour of local tattoo shops or when you looked at your artist’s portfolio. Your artist will now create the artwork for the outline of your tattoo design, if it hasn’t already been done. A simple, clean, black-and-white version of the outline of your tattoo will be drawn or traced. This paper version might be held up against your body for position and placement, helping with that final visualization process of how your finished tattoo will look. Don’t have any ink or temporary tattoos at all in the area where you’ll be getting your tattoo. Once the outline is finalized, the tattoo artist will make a transfer, essentially xeroxing the outline onto special transfer paper.



At this point, tattoo artists prepare the work area by wiping the chair or table down with a disinfectant. They may also use Saran wrap to cover these same areas. Then they’ll do the same for the surface on which their equipment rests, again wiping it down with a disinfectant and putting down Saran wrap, especially over anything in the area that might be particularly sensitive (like the power supply for the tattoo machine, for example, if it happens to be located on the worktable—you wouldn’t want to get any liquid on that sucker). At some point your artist will don sterile latex gloves. These are worn at all times when touching your skin or anything that will be touching your skin. If your artist has to answer the phone or fetch more ink or whatever, he or she will need to put on new gloves each time before sitting down to tattoo you.



Next, the equipment is brought out to the work area. The tattoo machine itself, unopened packages of sterilized tubes and needles, and a disposable razor are placed on the disinfected worktable. You’ll be invited to assume the position—take a seat or lie down, whichever is appropriate for your tattoo placement. Before the transfer can go On, your skin will be cleaned with alcohol, using new tissues or cotton balls, and then it will be shaved. No matter if you’re a guy or a girl or what part of the body we’re talking about (since there is body hair everywhere, even though it’s hard to see), your skin will be prepared by removing as much body hair as possible with a single gentle shave. The artist will wipe (town the area with alcohol and place the outline of your tattoo, now on the special transfer paper into contact with your wet skin. When the transfer paper is removed, it leaves behind a purple outline on the skin that your artist will use as a guide to create the outline of the tattoo. You should check this in a mirror, using a handheld mirror along with the ones on the wall if it’s on your back. What you’re seeing is a very close approximation of how your finished tattoo will appear in the context of the rest of your body—although it’s a far cry from the black outline and shading that will obliterate the transfer ink. Also, don’t worry if the transfer seems messy. It’s not permanent ink and it only serves as a guideline. If, at this point, you want something changed about location, size, or design, now is the time to say so.



If the transfer looks good to you both, you’ll be asked to resume your position. The artist will then set up a palette of inks. Generally a new paper plate or a sterile tray serves to hold the inks that will be used for your tattoo. Inks are stored in sterile plastic bottles with conical tips. The inks for your tattoo will be dispensed from these bottles into new and disposable plastic caps. A mound of Vaseline can be placed on the plate with a sterile wooden tongue depressor and the caps may be dabbed in it so that they stick to the palette. The cap of an ink bottle is removed and wiped with a tissue, and then ink is squeezed directly into the small cup on the palette. Although this process might be repeated later, generally an artist will put down enough cups to hold enough ink for the entire tattoo if it’s a small one. Then the tip is wiped again and the cap and bottle replaced. The palette with Vaseline and inks will be placed close at hand at the worktable.



Once the palette is in place, it’s time to load the needles into the tattoo machine. While you may not see the inks dispensed the most important part of the sterilization procedure should he done in front of you: opening the autoclave bags. The tubes are first removed from their autoclave bags and fitted into the opening in the tattoo machine. Many artists have particular favorites among tube styles and they likely own their tubes, matched to their machines, and they may purchase and manufacture their own needles as well (soldering needles to the bars). The needles are removed from the autoclave bag and inspected by the artist with a loupe. They are inserted into the tubes and attached to the machine.



Finally, the machine is hooked up to the power cord, which generally has a foot switch in it for the artist to turn the tattoo machine on and off, hands free. Once the machine is turned on, the artist may fiddle with it or the power supply, and you’ll hear it make a distinct buzzing sound—not so loud that a normal conversation voice is easily heard above it. though. When the machine is running to the artist’s satisfaction, he or she will dip the running machine into the first ink cup (generally black to create the outline) and let you know that things are about to start and that you’ll be feeling a brisk sensation.



The style of different tattoo artists when interacting with customer varies greasily, but this is why you spent some amount of time considering them in the first place. In addition, many tattoo artists will modify their approach or style and tailor it to their clients’ needs (a first-time customer may need much more time than a repeat “offender”). They may offer you a moment to reconsider the tattoo before they begin … or not. They may ask you if you’re ready to begin … or not. At this point, or at any time really, if you feel nervous or anxious, that’s perfectly natural. Just let your artist know. Artists help hundreds if not thousands of people through the process of getting their first tattoo. Because you’re embarking on something that will permanently be displayed on your skin for the rest of your life, it’s not uncommon for that realization to come to you in that moment. Rather than worrying about pain, you’re worrying about your decision. However, the point of this book is to make sure that you’ve done everything that you can to be prepared for this moment. Anxiety and nervousness are just a part of the tattoo process, part of the ritual in a sense, and part of every important ritual in the most universal sense. If, however, you’re having serious second thoughts, say so. If your gut instinct is that you’re making a mistake, then stop. Tattoo artists have seen that happen as well. You need to feel good about what you’re doing in the big picture, even if you’re nervous at the time. If you need to cancel, then do it, before the outline begins. There’s always another day.



Let’s assume that all systems are go. Your tattooist may begin with a small line, just a little bit of the outline, and then check on you. Do your best riot to move, but don’t hold your breath either. At this point, after that first bit of outline, you’ve felt and now have experience with the pain level. This is the pain, whether you experience it as a stinging sensation or a rubber band snapping against your skin, that you will likely be experiencing for the rest of the tattoo process depending on the size and complexity of your design. It is a pain that the majority of tattoo clients would describe as manageable or moderate. Many first-time tattoo clients are actually relieved at this point to know that this whole tattoo thing is definitely doable. A smaller percentage grit their teeth and start a breathing exercise. If, however, you decide that the pain is manageable, then your tattoo artist will proceed, taking the tattoo machine away only briefly for more ink. Longer breaks will come as the needles need to be changed (different needle configurations are used for different parts of the design) and also to change ink colors (generally achieved by rinsing the needles in clean water in a small disposable cup set aside for that purpose).



Your job now is to sit like a rock, without flinching or squirming. Go ahead and talk if you like, but don’t whine. Most tattoo artists are quite used to chatting with their clients during the process. If they need you to be quiet, like when they’re doing the eyes on your pinup cutie, they’ll let you know. Generally your tattoo artist will also let you know when the outline is done. Most people find the outlining more painful than the shading which follows. As the tattoo process proceeds, however, you may find that you need to take a break, maybe because of the discomfort, maybe to switch positions, or just to have a cigarette. Perhaps your tattooist will need a break as well, to take a phone call or see a client who has stopped by the shop. If you want a break, then ask for one. It’s part of the routine. Your artist will wipe off the excess ink and body fluids, smooth on some Vaseline, and you can get up and check out the work in progress and have some water or your smoke. The position in which you sit or lie for your tattoo may not be the most comfortable. But your tattooist needs to get the right angle on your skin to do the tattoo well. Be as understanding as possible when it conies to being in an uncomfortable position. Tattooists battle repetitive motion injuries such as carpal tunnel syndrome like everybody else.



The Party’s Over



Well, despite how much you’d like the hot needle massage to continue, eventually your tattooist announces that your tattoo is finished, just when you were getting into the Zen of the whole thing. Finally you get up and look at your finished tattoo in the mirror. Don’t be surprised if your skin is red and a little puffy. Lymph fluid and blood may bead up, ever so slightly. The colors often look darker and have more contrast at this early stage than when the tattoo is completely healed. The reddish swelling of the skin is one contributor to that darker effect. Also, the epidermis is full of ink as well, but we know that eventually the epidermis layer will be replaced with a new clear one, just as before. As you look in the mirror, though, what you see is pretty much your new tattoo and how it will look for many years to come. If you’ve done your homework and you’ve picked your design, body location, and artist well, then you’re likely not looking at just any tattoo, but the perfect one—for you. No matter the size of your tattoo, you have joined the tribe as fully as it can be joined. Welcome and well done.

There are several surgical and destructive treatments available for the treatment of genital warts, including cryotherapy, surgical excision, electrosurgery, and laser vaporization. All are very effective treatments of genital warts. However, after surgical intervention or chemical acids are used, one can expect a scar in that area.

Surgical removal of genital warts can be performed either with scissors, a scalpel, or by electrocautery. It is appropriate for any genital wart, but especially for large lesions causing obstruction. Scissors or scalpel excision is best mode of treatment when a tissue specimen to be submitted for histopathological examination is needed to rule out malignancy.

Larger lesions may require adequate anesthesia (local, regional, or general) and surgical instruments for hemostasis, because large genital warts are highly vascular. Patients also may experience significant post-procedure pain, especially when there is a large treatment area.

Electrosurgery involves either thermal coagulation or electrocautery, to destroy HPV affected lesions. Local anesthesia is needed to perform electrosurgery. There are two forms of electrosurgery. In the direct-current form of electrosurgery, termed electrocautery, electricity flows only through the instrument producing heat that is applied to the lesion.

In the alternating-current form of electrosurgery?electricity flows from the instrument through the patient to a grounding plate. The alternating current systems produce cutting, coagulation, or a blend of both. Fine-wire loops can be used for excision. Studies show a 61-94 percent clearance within 3-6 weeks of treatment.

Despite their effectiveness, electrosurgery should be considered second-line treatment. Two randomized trials show slightly greater efficacy for electrotherapy compared with cryotherapy; however, the differences in outcome is only short term and does not persist after 3 months of follow-ups.

The loop electrosurgical excision procedure (LEEP) has been compared with laser treatment for genital warts. Schoenfeld et al. studied 28 women and showed 86 percent of lesions treated with LEEP and 75 percent of lesions treated with a laser showed no HPV DNA within a 20-mm circumference of the treated lesion.

In clinical studies, 14-22 percent of patients have recurrences. They were reexamined for recurrence after 3 months; there were 4 patients who harbored HPV-DNA genomes on the laser-treated side, adjacent to the original lesion, compared to 1 patient who developed recurrence on the LEEP side in a more distant, previously untreated area.

Among all the types of genital warts cures, genital surgery subjects the patient to a highly invasive procedure. This method can be most unpleasant and ineffective, and can also create genital scarring. An alternative antiviral treatment is now available which represents a very promising solution to the growing epidemic of genital warts.

HPVCurative is a new, highly effective and potent way to cure genital warts. It is valued for its role in the realm of genital warts cures, and has provided total clearance of the infection time after time. It contains certified organic medicinal plant extracts and antiviral essential oils, which have demonstrated the ability to act as an HPV cure in laboratory tests.

Traditional theories postulated that once a person is infected, HPV remained in the body for a lifetime. However, new studies using sensitive DNA techniques have shown that an HPV cure is possible through immunological response. For example, studies on compounds to cure genital warts demonstrate that HPVCurative extracts created “significant destruction of HPV cells as evidenced from DNA tests.”

These studies further concluded that among other genital warts cures, HPVCurative best extracts “inhibited skin papillomas (HPV) and decreased the conversion of papillomas to carcinomas” which resulted in “significant apoptosis (disintegration) of HPV cells in DNA tests” without damaging surrounding healthy tissue.

HPVCurative has powerful medicinal properties that give it an amazing ability to reduce tumor growths resulting from HPV. The organic extracts in this treatment also stimulate immune functionality, thereby strengthening the immune system. To learn more, please go to http://www.bcured.net.

The choice of a vasectomy is often rejected because of the prospect of surgery and anesthesia, the needles and scalpels deemed necessary to perform such a delicate procedure.

However, there is a relatively new and widely accepted vasectomy procedure which involves no needles for anesthesia and no scalpel or stitches. It is different from a conventional vasectomy in the way the doctor seals off the vas deferens. It also involves an improved method of anesthesia to help make the procedure less painful.

The procedure is called the No Needle, No-Scalpel vasectomy.

No Needle

The No Needle vasectomy uses a relatively new device which applies high pressure to deliver anesthetic through the skin and directly into the tissue around the vas deferens.

In a traditional vasectomy, a small needle is used to give a lot of local anesthetic in the area of the vas deferens. This may be somewhat uncomfortable and intimidating for many men.

No-Scalpel

The No-Scalpel vasectomy procedure eliminates the need to cut the patient’s skin in order to reach the vas deferens. Instead the physician identifies the tubes under the skin and then isolates them with a specialized clamp – after the anesthesia has been given.

He then makes a tiny puncture and stretches the opening so the vas deferens can be reached. The vas deferens from each side is pulled through the hole and one at a time are cut and blocked. Unlike a conventional vasectomy, there is very little bleeding and scarring and no stitches are required.

Recovering from the No-Scalpel Vasectomy
As mentioned above, it is important to rest for a few days after the No Needle, No-Scalpel Vasectomy. It is often recommended to wear a supportive jockstrap in order to feel comfortable. Place ice on the surgical site immediately after the procedure, this will greatly reduce swelling. It is also recommended to refrain from exercise for a few days.

Is a man sterile immediately after the vasectomy?

Once the tubes have been interrupted, there should be no new sperm released into ejaculated fluid.  However, the reservoir of fluid that has already passed the point where the tube is interrupted may contain a sufficient amount of motile sperm.  A man will not be sterile until the reservoir is flushed out. Starting at six weeks after the vasectomy, semen is evaluated, to determine if sperm is still present in the ejaculate. Once the physician determines there are no sperm in the ejaculate, a man will be considered sterile.

What are the potential complications?

Although vasectomies are low risk procedures, and the No-Scalpel vasectomy even lower, there are some complications that may arise.

Infections – as with any procedure involving cutting of the skin or open wounds there is a risk of bacterial or viral infections. Congestion – Is discomfort due to pressure caused by sperm in the testes and lower vas deferens. Sperm Granuloma – This occurs because sperm is leaking from the cut vas deferens, which then hardens to form a lump (often the size of a pea). Although the lump is not dangerous and almost always flushed out by the body over time, it often causes pain and discomfort. Internal Bleeding (Hematoma) – Can occur spontaneously at the site of any surgery, however it is rare in the case of vasectomies. It may also occur if a man strains or exerts himself after the procedure. Resting, especially the first day, is the best prevention.

No Needle, No-Scalpel Vasectomy – A bit of history

The No Needle, No-Scalpel vasectomy developed by Dr. Shunqiang Li in 1974 in China. With over 1,340,000,000 people, approximately 51% male, and the vasectomy being the most common method of birth control. By 1998 over 10 million No-Scalpel vasectomies were performed in China.

The procedure was first introduced to Western physicians in 1985, when the “Association for Voluntary Surgical Contraception” (now AVSC International) sponsored an international team to visit China. At this time the technique was referred to as “The ligation of vas deferens under the direct vision”.

In 1985 Dr. Marc Goldstein of the New York-Presbyterian Hospital-Weill Medical College of Cornell University was the first to perform the No-Scalpel Vasectomy procedure in the U.S.A.

Can a vasectomy be reversed?

A vasectomy is not a permanent procedure. Reversing the vasectomy is far more complicated and time-consuming than the No Needle vasectomy.

The vasectomy reversal procedure is performed under an “operating microscope”, this is a microscope that stands over the patient. During the procedure, the physician relies on the highly magnified view in order to manipulate the small, fine instruments by hand.

Theoretically, it seems the vasectomy reversal should be the process of reconnecting the two severed ends of the vas deferens (or anastamosis). However this is a very complicated task for a physician to fulfill.

Read about the success rates of the No Needle, No-Scalpel Vasectomy.

[http://www.wernermd.com/vasectomy-article.html]

Schaumburg, IL – March 19, 2008 –Gray Peaks (GRPK.OB), a leading green technology provider in global transportation, today announced the release of a breakthrough technology which will revolutionize the way companies track their goods shipped by air, land and sea. The technology, TRAMS, is a sixth generation, portable wireless device that gives global companies on-demand visibility into their mobile goods across six continents on a pay-per-use basis.



Gray Peaks soon expects to announce major global deals in the pipeline for railroad systems and intermodal traffic and pharmaceutical distribution.



The Gray Peaks management team is nothing less than all-star. Combined they have more than three hundred years expertise in logistics, cold chain, digital and wireless communication industries. Together they have managed some of the world’s largest wireless installations, built market leader transportation software and have a proven track record of success in global markets.



Gone are the days when companies simply tracked the whereabouts of their mobile assets; welcome the days of complete mobile transparency. With TRAMS, any company worldwide that manages large fleets – such as those in the chemicals and pharmaceuticals, oil and gas, construction, food and beverage, airport and municipality, supply chain and automotive OEM’s sectors – will be able to tell if their items have been tampered with, transferred, removed from climate control areas, and of course, delivered on-schedule.



“Globalization and security have been opposing forces until now,” says Tim Sensenig, CEO and Chairman of Gray Peaks. “Now with one device, TRAMS, companies can ensure the integrity, condition and location of their goods throughout 170 countries in real-time. This product is poised to set a new standard in global transportation.”



This news is hugely important to global enterprises, such as automotive companies, who invest $20 million per plant per year to ensure parts containers are available for just-in-time deliveries and over $1.5 billion per year in North America alone. These companies do not know when trailers are opened each day or if they have been tampered with, so visibility and security of 100 million shipping containers are still a concern. Now, one single device, TRAMS, will change all of that.



“With the rising cost of fuel, better management and control of these assets have become an important requirement to retain customers so this solution is something companies have been seeking for years,” continued Sensenig. “TRAMS is already ahead of any competitor in green tracking technology and cost. This coupled with high demand for the product positions us for dramatic growth in the global transportation industry.”



For more information, visit www.graypeaks.com.



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Our body has given has sufficient means to protect us from problems which we may face in our daily life’s. Ear wax is one those things which is useful and if in excess there can be some trouble for our ears. It is a liquid which is secreted by cerumen glands which are present only in the ear canals. If it is not treated it can cause deafness, irritation and soreness to your ear which is not at all pleasant. It is an ‘in-house production’ and has to be cleared on a regular basis. Because once there is accumulation of wax you could see accumulation of problems also.

Symptoms of having ear wax

* Continuous pain in your ears

* Difficulty in hearing

* Happen to hear a ringing noise in your ears

* A feeling as your ears has been blocked due to something

Problems with ear wax

* Ear wax can block the ear which can disturb or reduce the hearing capacity

* The bacteria is trapped behind the ear wax leading to infection with graver problems

* There would a short period of deafness while bathing or swimming

Some of the methods to remove the ear wax

Ear syringe can be used in your ears to squirt warm water to irrigate the accumulated wax

Use of olive oil in your ears can smoothen the ear wax to be removed easily

Avoid using ear buds which can push ear wax inside rather than removing it

You can also use baby oil which has to warmed up till room temperature and should be done at least twice a day

Avoid picking or poking your ear canal as this may damage your ears

By going to a specialist

*You can also use Vaseline which has to be pasted to the outer edges of the ear opening and be cleaned the next day.

Fuller, poutier lips have become a rage among both men and women and lip augmentation surgery is quickly skyrocketing as the new ‘facelift’ surgery. The implant procedure is not complicated and it can very easily be down in your physician’s office under local anesthetic. There is very little involved in having this done and when your lips have healed properly, you will notice the difference right away.


The implant surgery works by first injecting the patient’s lips with Lidocaine. This is a pain reliever and it works similar to the Novocain used in a dentist’s office. Epinephrine is also injected into the lips to constrict blood flow, which is why there is very little blood during the procedure and little to no bruising afterwards. The doctor will then make four very small incisions at the corner of the mouth right before where the lips meet. That means one on the upper lip and one on the lower lip on each side.


Once the incisions are made, the implants are then inserted using a pair of alligator forceps or a tool called a trocar, which is a hollow cylinder with a sharp end that the implant is threaded on. Upon insertion, the implants are then trimmed to the right size and length of your lips and the incisions are closed with dissolving sutures. As long as you leave the sutures alone and let the incision heal without picking at them or touching them, your lips should heal quickly with minimal to no scarring.


After the lip augmentation surgery, you can expect your mouth to be swollen and tender. Your lips will also be ‘fat’ from swelling so eating or drinking will prove to be a bit difficult. You will have some pain if any pressure is applied to your lips and there may be numbness in them for a few days. It is advisable to take the pain relievers your doctor prescribes because as the swelling goes down, the more tender your lips will get. If the doctor used sutures that need to be removed, you’ll have a follow-up appointment for around seven to ten days after the procedure.


In about a week most of the swelling will have gone down, but don’t be alarmed if your lips are sensitive to pressure for a few weeks. This is common and they will get used to the implants pressing against the nerves in time. Bruising is usually minimal, but every person is a little different and some may bruise more than others. The doctor may prescribe a topical ointment to use on and around your lips to help decrease the bruising and swelling.


The results of the procedure will be visible after the swelling subsides and you may initially be disappointed in what you see. You may wish some of the swelling didn’t go away even though in the back of your mind you knew your lips were not supposed to be quite that big. Look at your before pictures and then look at yourself after the surgery. You will see a marked difference in your lips. Plus, if your implant stimulates the growth of your own collagen, it will take few weeks to see more pronounced results. But it will come. Your lip augmentation surgery will not have been in vain and if you want your lips a little fuller, be assured that it’s easier to add more fullness than take it away.