Received March 27, 2008; revision requested June 6 and received June 29; accepted July 3. The possibility of abusive head trauma was also reported more frequently in second interpretations. Moderate to severe presentations occur in 1.5 of 10,000 live births. A coup-contrecoup injury is a term applied to head injuries and most often cerebral contusions and traumatic subarachnoid hemorrhage.It refers to the common pattern of injury whereby damage is located both at the site of impact (often less marked) and on the opposite side of the head to the point of maximum external trauma. Abusive head trauma is the leading cause of death from head injury in children under 2 years of age, and serious neurological sequelae may be seen in those that survive. Over recent years, there have been a number of titles given to the constellation of Radiographics : a review publication of the Radiological Society of North America, Inc. CT Head in Primary Effects of CNS Trauma Dr. Manmohan Shrestha 2. This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Society of Neuroradiology (ASNR), and the Society for Pediatric Radiology (SPR). Some state that eighty percent of deaths of children under 2 years of age result from non-accidental head trauma. Cervical Spine trauma tutorial: UVA site on cervical spine truama. 7/1/2011 to present: The University of Pittsburgh and Childrenâs Hospital of Pittsburgh, Pittsburgh, Pennsylvania American Indian Community Development Corporation is seeking Registered Nurses to work full-time, part-time and weekends (first and third shift) for ourâ¦. 3 The Radiology Assistant, Non Accidental Trauma by Simon Robben, Radiology Department of the Maastricht University Hospital in the Netherlands PRACTICE TIP: MEDICAL EXAMINATIONS AND /OR CONSULTATION BY A PHYSICIAN, WITH EXPERTISE IN CHILD ABUSE AND NEGLECT, ARE REQUIRED FOR A HEAD INJURY RESULTING IN SKULL FRACTURES, IMPACT TO THE SKULL developments in the diagnosis, investigation, and prosecution of baby and toddler fatalities. Another term for this condition is shaken baby syndrome (SBS). patterns of blunt force injury . Now in its 4th Edition, this bestselling volume in the popular Requisites series, by Drs. evaluation of head injury cases. T otal 317 patients with suspected head injury underwent. Your exploration of the radiological resouces available on the internet can be as structured or as unstructured as you want it to be .You never know what ⦠Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. The American Colllege of Radiology Appropriateness Criteria for head trauma includes the following{ref8}{ref9}: Skull radiography has been supplanted by CT in ⦠On the left a coronal view of the segments of the middle cerebral artery. Classic lectures originally presented during the annual âRadiology After Five: How to Make Night and Weekend Call a Successâ, bring together state of the art imaging protocols, advanced techniques and diagnostic pitfalls focusing on how to optimize study interpretation and performance. Patricia C. Davis for the Expert Panel on Neurologic Imaging. Cervical Spine injury: Radiology Assistant. Doctor accepting Horizon NJ TotalCare (HMO D-SNP) in NJ & PA with affiliated AMG RADIOLOGY - Find Horizon NJ Health Doctors - Horizon NJ Health Chat with a nurse 24/7: Connect with a registered nurse or doctor HorizonBlue.pager.com opens a dialog window â , if needed, at no cost about COVID-19 or other health concerns. Also called ambient cistern is a cistern of the subarachnoid space between the posterior end of the corpus callosum and the superior surface of the cerebellum. The mission of the Emergency and Trauma Radiology Section is to provide rapid, comprehensive and expert clinical radiology service to the patients at the R Adams Cowley Shock Trauma Center, while also advancing the use of non-invasive imaging in Trauma care through research and education.
Methods: Two scholarly research databases were searched to identify articles focused on trauma imaging of the head, cervical spine, thorax, abdomen, and pelvis. Health & Medicine, Business. Variant 1: Child. Principal investigator Stephen F. Kralik, MD, assistant professor of radiology and imaging sciences, conducted the study to identify and evaluate radiologic interpretation errors made by radiologists at community hospitals. CT is rapid, cost effective, widely available, and abl⦠The emergency and trauma radiology team is directly involved with every major trauma and stroke cases and is expected to recommend, organize and interpret all relevant imaging to help manage the patient expeditiously. Traumatic injury He is also an Assistant Professor at our Albert Einstein College of Medicine. June 14, 2019 by Scott Biggs, PA-C. S Ramgopal, SA Karim, S Subramanian, AD Furtado, JR Marin. Head injury Triage, assessment, investigation and early management of head injury in children, young people and adults ... More than 30 minutes' retrograde amnesia of events immediately before the head injury . Ct head 1. Abusive Head Trauma (Shaken Baby Syndrome) Expert Witnesses. Assistant Professor of Radiology Department of Radiology New York University School of Medicine NYU Langone Medical Center Tisch Hospital Bellevue Hospital & Trauma Center ... CT, MR Head Trauma and Neurovascular Injury Howard A. Rowley, M.D. Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. The majority of proximal humeral fractures occur in the elderly (mean age 65 years) with ~70% occurring in women, presumably due to the greater incidence of osteoporosis 1. This site includes a wide variety of resources of interest to radiologic science professionals. Infarction. Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury. This monograph stems from the author's dissatisfaction with trephination and ventriculography in the evaluation of cases of head trauma. 15,292 views. Computed tomography (CT) is a technology that produces cross-sectional images of the body using -rays. Find this author on PubMed. Trauma radiographers must be competent in performing mobile radiography on almost any part of the body and be able to use accessory devices (i.e., grids, air-gap technique) necessary to produce quality mobile images. Mobile fluoroscopy units, usually referred to as C-arms because of their shape, are becoming more commonplace in EDs. Purpose: To inform radiologic technologists about which imaging modalities and examinations are best suited for evaluating specific anatomical structures in patients who have sustained a traumatic injury. Close examination of the scalp soft tissues should be one of the first steps in interpreting a trauma head CT. New York City Babies and Toddlers Trauma Investigations Conference (2019) Chaired and organized inaugural national forum for discussion and debate covering recent. Pediatric abusive head trauma (AHT) most often involves brain injury of infants and young children. The greek word âtraumaâ literally means âwoundâ. Get chapter 7 for free. Imaging of Orbital Trauma. abdominal trauma source: Radiology Assistant (Ledbetter S, Smithius R) The forensic pathologist must attempt to determine not only what sort of injury one is observing, but interpret what the pattern of injury says regarding the mechanism of injury/ the circumstances of the infliction of those blunt force injuries. https://radiologyassistant.nl/abdomen/acute-abdomen/ct-in-trauma Chief of Service: Thomas Ptak, MD, PhD. Trauma is defined as any physical damage to the body caused by a sudden, unexpected, dramatic, forceful, violent or accident event or fracture etc. Assistant Professor of Radiology Department of Radiology New York University School of Medicine NYU Langone Medical Center Tisch Hospital Bellevue Hospital & Trauma Center ... Head Trauma and Neurovascular Injury Howard A. Rowley, M.D. x CT is utilized extensively in imaging of the head. Most of these (90%) occur at home due to a fall, and in most cases they are an isolated injury 1. To tackle this challenge, the chief residents have brought together the best online resources to help EM practitioners gain expertise in the field of radiology. A baby's neck muscles are very weak and its head is large and heavy in proportion to the rest of its body. He has hospital affiliations with Owatonna Hospital, Mayo Clinic Health System - Mankato and Mayo Clinic Health System - Albert Lea And Austin. Try before you buy. References: Flanders A. Radiology Assistant - Spine - Cervical injury.
Neurotrauma is a head or spine injury caused by a sudden injury. Abusive Head Trauma (Shaken Baby Syndrome) Expert Witnesses. Dr. They are most common in older populations and especially in those who are osteoporotic. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated ⦠A baby's neck muscles are very weak and its head is large and heavy in proportion to the rest of its body. Session 7 CT, MR Stroke Imaging Update Howard A. ⦠A slideshow of 'Imaging of Head Trauma: Part I' describes nature, mechanism, significance of head trauma, indications and choices of imaging in patients with head trauma, and normal anatomy of the brain with emphasis on CT. Rathachai Kaewlai.
Follow. When intracranial injury is suspected, the brain and extra-axial spaces should be imaged with computed tomography (CT), magnetic resonance imaging (MRI), or a combination of these. By News Release. It is sometimes defined as including the quadrigerminal cistern. ... 1.5.8 For imaging in adults (16 or over) with head injury and suspected cervical spine injury, follow the recommendations in section 1.5 of the NICE guideline on head injury. Research Assistant, The Mount Sinai Medical Center, New York, New York Journal of Head Trauma Rehabilitation: August 1998 - Volume 13 - Issue 4 - p 68-79 Buy Supplemented with more than 150 images, this guide will prepare medical, law, and social work professionals for any situation involving head trauma. In our last edition, we discussed some ways of altering practice models or properly documenting patient care so that we stay within the current MIPS guidelines while continuing to provide the highest quality care. AHT is defined as the various injuries or conditions that may result following vigorous shaking, slamming, or impacting the head of an infant or young children. AP skull radiograph (A) and coronal ultrasound images (B,C) in a newborn reveal a traumatic injury suffered during a difficult forceps delivery.Skull radiograph (A) reveals a fracture of the parietal calvarium (arrowhead) as well as scalp soft tissue swelling compatible with a subgaleal hematoma (asterisk). It is therefore associated with significant functional loss, especially in laborers. 13-11). Personal Injury, Medical Malpractice, Head and Neck radiology, Brain injury, Spine injuries and surgery. Children 1.5.2 Perform MRI for children (under 16s) if there is a strong suspicion of . E-pub available on Kindle and iBooks. ... Assistant Professor of Radiology. Initial imaging.
Overlapping slices of 0.75 â 1.25 mm are reconstructed. Skull radiography is useful for imaging of calvarial fractures, penetrating injuries, and radiopaque foreign bodies. CT advantages for evaluation of the head-injured patient include its sensitivity for demonstrating mass effect, ventricular size and configuration, bone injuries, and acute hemorrhage. Early and repeated CT scanning may be required for deterioration, especially in the first 72 hours after head injury, to detect delayed hematoma, hypoxic-ischemic lesions, or cerebral edema. CT has a role in subacute or chronic head injury for depicting atrophy, focal encephalomalacia, hydrocephalus, and chronic subdural hematoma. 2020 Academic Article GET IT Times cited: 1; Traumatic Brain Injury: Imaging Patterns and Complications. Minor acute blunt head trauma. Search for this author on this site.
Brandi Page, M.D., is an assistant professor of radiation oncology and molecular sciences for Johns Hopkins Radiation Oncology Department at Suburban Hospital and a radiation oncologist at the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital. In addition to the Shock ⦠Child abuse has been identified as the cause of brain injuries in 24% of children <2 and suspected as the cause in an additional 32%. Taha is Assistant Professor of Radiology at the University of Missouri (MU) where he has taught dozens of residents and fellows about General Radiology topics such as reading imaging studies and image -guided procedures. differences in the interpretation of computed tomography scans of head trauma by radiology residents and radiologists October 2020 Journal of Postgraduate Medical Institute 34(2):91-94 The first choice of imaging modality in a patient with a clinical suspicion of SAH is a non-enhanced Testifying Pediatric Neuroradiology Head & Brain Trauma Medical Expert Witness providing independent verbal or written opinion at deposition or trial. The unfortunate case described above demonstrates a unique radiology and pathology correlation of an extremely rare injury. Description. CNS injury related to nonaccidental injury is a leading cause of morbidity and mortality in infants and children. Interventional Radiology × Interventional radiology is a clinical subspecialty of x-ray that uses various radiology techniques such as x-ray,CT scans, MRI scans, and ultrasounds to perform diagnostic studies to perform biopsies, drain fluid, insert catheters, and dilating or stenting narrowed ducts or vessels. Shaking, blunt impact or the combination can result in neurological injury. At the end of the spine anatomy module students should be able to identify the following structures: Additional Resources. and serious physical injuries. IMAGINGTECHNIQUEIMAGINGTECHNIQUE CT without contrast is the modality of choice in acute trauma (fast, available, sensitive to acute subarachnoid hemorrhage and skull fractures) MRI is useful in non-acute head trauma (higher sensitivity than CT for cortical contusions, diffuse axonal injury, posterior fossa abnormalities) Abusive head trauma (shaken baby syndrome) expert witnesses and consultants listed here may be able to form expert opinions, draft expert witness reports, provide expert witness testimony at deposition and/or trial as or serve as consulting (non-testifying) experts on abusive head trauma (shaken baby ⦠American College of Radiology . It most commonly occurs after Now in its 4th Edition, this bestselling volume in the popular Requisites series, by Drs. The author has no financial relationships to disclose. Learning Objectives. Registered Nurse. 2 3 Corresponding author 4 Arabinda Kumar Choudhary MD, FACHE, MBA 5 Chair, Department of Radiology 6 Nemours AI duPont hospital for Children 7 1600 Rockland road, Wilmington, DE, 19803 Email: ac0026@nemours.org8 9 Ph: 3026514641 10 Fax: 3026514476 11 12 Authors: 1.13 Arabinda Kumar ⦠Minneapolis, MN 55404 (Ventura Village area) $36 - $38 an hour.
DEPARTMENT OF RADIOLOGY 3 The annual review of probationary faculty will be recorded on the University of Minnesota (UM) Form 12 and will reflect the faculty memberâs performance relative to the 7.12 Statement. Some state that eighty percent of deaths of children under 2 years of age result from nonaccidental head trauma. Pediatric abusive head trauma (AHT) may also be referred to as shaken baby syndrome (SBS). Abusive head trauma (shaken baby syndrome) expert witnesses and consultants listed here may be able to form expert opinions, draft expert witness reports, provide expert witness testimony at deposition and/or trial as or serve as consulting (non-testifying) experts on abusive head trauma (shaken baby syndrome). These scans detect the pathologies caused by the trauma as well as many unexpected incidental findings, the frequency of which are not known. Mild Head Injury Military Service Connected Hearing Disabilities ... Nuclear Radiology Nurse Practitioner - Family - Radiology - Women's Health - Pain - Trauma - Acute Care - Cardiac - Geriatric - Critical Care ... Physicianâs Assistant Physician Licensing Physician Referrals Physiology Role of CT in Head Trauma Ameya Radheshyam Rathi 1 , Pramod Shaha 2 , Amol Bhoite 3 , Namita Narkhede 4 , Sandeep Immadisetty 5 1 Resident 3rd Year, Department of Radiology, KIMS, Karad, 2 Professor & Head, Department of Radiodiagnosis, KIMS, Karad, Identification of soft tissue injury allows the radiologist to pinpoint the site of impact, or âcoupâ site, that may be invisible to the clinician because of its small size or obscuration by the patientâs hair. Trauma / Emergency Radiologist Assistant Professor of Radiology Department of Radiology New York University School of Medicine NYU Langone Medical Center Tisch Hospital Bellevue Hospital & Trauma Center New York, NY Sanjeev Bhalla, M.D. A chapter on interventional radiology in head trauma follows. Find this author on Google Scholar. Biography: David B. Erlichman, MD, is an Attending Radiologist specializing in body imaging at Montefiore. Department of Radiology Skokie Hospital Skokie, IL Mark P. Bernstein, M.D. Head Injury Neurotrauma is the common cause of death and disability worldwide. common cause of relatively mild repeated head injury potentially eventually leading to chronic traumatic encephalopathy, The âpanscanâ (computed tomographic [CT] examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who ⦠Head Trauma. Conference attracted more than 300 medical, legal, judicial, Very low risk for clinically important brain injury per PECARN criteria. Leptomeningeal cyst ... â A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 25b6df-ZDc1Z FIG 3-3 The radiographic setup is done most proficiently by following a general sequence. David Yousem is currently the Director of Neuroradiology and Professor of Radiology at the Johns Hopkins Hospital. AHT is ⦠September 30, 2019. Abusive head trauma is the leading cause of death and disability in infants and young children, resulting from child abuse. Decoding MIPS in Emergency Medicine â Radiology Edition. CNS injury related to non-accidental injury is a leading cause of morbidity and mortality in infants and children. Most Level I trauma centers have replaced conventional trauma skull radiographs (e.g., AP, lateral, Towne, reverse Waters) with CT scan of the head (Fig. 1:35-2:00 Head Trauma: Pearls & Pitfalls in the Elderly Nunez 2:00-2:25 Cervical Spine Trauma Avery 2:25-2:50 Iatrogenic Chest Emergencies Avery ... Assistant Professor of Radiology, HMS Assistant Radiologist, Division of Emergency Radiology, Massachusetts General Hospital Jeffrey N. Dileo, DO Instructor in Radiology, HMS As with other injuries, there is a bimodal distribution with a small peak amongst the young. Head injury is the commonest cause of death and disability in people aged 1â40 years in the UK. Biceps brachii rupture can occur at either superior or inferior attachment but most commonly involves the long head at its proximal origin at the superior glenoid labrum.Rupture of the distal biceps causes weakness when supinating the forearm. 1 1 TITLE: Consensus statement on Abusive head trauma in infants and young children. Aug. 18, 2008. The 2016-2017 ALiEM Chief Resident (CRincubator) class also encountered this when attempting to create an organized FOAM radiology curriculum for EM residents. CT scan of head.198 (62.5%) were males and 119 (37.5%) were females. J.
CT angiography (CTA) on a typical 64 slice multidetector scanner is performed using 70-100 ml of contrast and 50 ml saline chaser, injected at 4 ml/s with a delay of 15s or triggered by bolus tracking with ROI in the aortic arch. Subsequently, imaging is useful in following the seq ⦠Radiologist. Radiology department of the Rijnland hospital, Leiderdorp and the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands Publicationdate 2012-05-21 A Bankart lesion is an injury of the anterior glenoid labrum due to anterior shoulder dislocation. Although the prevalence of blunt cerebrovascular injuries are difficult to measure, it is estimated to occur in about 1.2 percent of all blunt head trauma cases. Of all head injured patient- 10% sustain fatal brain injury. 1316, 1316â17 (2004); Brian Holmgren, Assistant District Attorney General,eynote Addr K ess atEleventhnternational I onference on Chakeny S Bab Syndrome/Abusive Head Trauma:he Truth â Examining Defense Witness To Tell t Testimony inve Head Trauma Cases (Sept. Abusi, 13, 2010) In medical field trauma is known as âPhysical Injuriesâ. A record of the vote by the tenured faculty for continuation or recommendation for promotion and/or ACR Appropriateness Criteria ® Head Trauma-Child . Journal of the American College of Radiology : JACR. Noncontrast head CT is considered the appropriate primary study for children who present with signs and symptoms of head trauma including loss of consciousness, confusion, vomiting, irritability, seizures, or respiratory difficulties.
Specific bruising patterns are significant indicators of abuse. Knowing these patterns, recognizing crucial warning signs, and understanding other traumatic injuries associated with pediatric abusive hea⦠Infection. American Journal of Neuroradiology September 2007, 28 (8) 1619-1621; Patricia C. Davis. Evaluation of neonatal traumatic brain injury with ultrasound and radiographs. 5-10% neurotrauma survivors have permanent serious neurologic deficits 20-40% have moderate disability. She is a co-author of the Consensus Statement on Abusive Head Trauma in Infants and Young Children (2018) and the recipient of the 2018 Presidential Recognition Award from the Society for Pediatric Radiology. Pediatric Abusive Head Trauma Pocket Atlas Volume 1: Traumatic Injuries goes in-depth to present a wide variety of different pediatric head injuries. The maximum age w ⦠Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. 1 From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, Room CB 30, New Haven, CT 06510. Download to read offline. Horizontal M1-segment. 410-328-3477. Present study was with head injury using computed tomography and to determine the prevalence and significance of incidental findings on cranial scans. Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. He is also the editor of the book 'Neuroradiology: the Requisites'. Patients taking older types of blood thinners or taking aspirin while on blood thinners may be at a higher risk of delayed brain bleeding and death following head trauma, according to a study presented at RSNA 2021. The Utility of the ASL Sequence in Parenchymal Injury of the Brain in Abusive Head Trauma Rahul Nikam, MD Assistant Professor of Radiology and Pediatrics Nemours Alfred I. duPont Hospital for Children Wilmington, DE; Wearable Ultrasound and Thermoacoustic Neuroimaging Hat for Infants Sri-Rajasekhar Kothapalli, PhD Procedure Appropriateness Category Relative Radiation Level
Physician Assistant Program | PowerPoint PPT presentation | free to download . It includes concussions, traumatic brain injuries (TBI), skull fractures, spinal column fractures, and spinal cord injuries (SCI). Pediatric Abusive Head Trauma, Volume 2: Medical Mimics provides in-depth guidelines for the diagnosis of injuries resembling abusive head trauma in children.It covers the differential diagnoses that may be confused with abusive head trauma, such as birth trauma, metabolic disorders, autoimmune conditions, oncologic mimics, and infectious diseases. Atrophy/encephalomalacia. Rohini Nadgir and David M. Yousem, thoroughly covers the extensive field of neuroradiology in an efficient and practical manner. Excluding suspected abusive head trauma. The first portion of the book is an excellent historical review of the world literature pertaining to cerebral angiography in injuries of the head. The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial. 141 of diagnosis of abusive head trauma; and 142 143 BE IT FURTHER RESOLVED, 144 that the ACR affirms that providing opinions and testimony regarding abusive head 145 trauma, unsupported by the medical evidence, poses a risk to infants and children by A number have minimal brain trauma 1 Head Trauma-Child . The emergency and trauma radiology team is directly involved with every major trauma and stroke cases and is expected to recommend, organize and interpret all relevant imaging to help manage the patient expeditiously. Head trauma is the leading cause of death in people under ... Dissection/pseudoaneurysm. This review is based on a presentation given by David Yousem and adapted for the Radiology Assistant by Robin Smithuis.
The majority of proximal humeral fractures occur in the elderly (mean age 65 years) with ~70% occurring in women, presumably due to the greater incidence of osteoporosis 1. Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Neurotrauma. Easily apply. American Indian Community Development Corporation 2.7.
Benefit of 3D reconstructions in congenital tracheal-bronchial pathology and evaluation of skull fractures in the pediatric population in minor head trauma.
ACR Appropriateness Criteria® Head Trauma-Child. Kentucky continues to be a leading state in deaths of children related to child abuse. Research articles continue to delineate the advantages of CT over radiography, and the results indicate that certain types of head trauma should be referred to CT first. Extra-axial hemorrhage - Intracranial extracerebral Subarachnoid hemorrhage is acute bleeding under the arachnoid.Most commonly seen in rupture of an aneurysm or as a result of Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. ⦠Session 7 Stroke Imaging Update Howard A. Rowley, M.D. The sequence begins with patient preparation, including A, gowning; followed by, B, measurement technique selection; C, cassette selection and placement; D, choice of focal-film distance; E, central ray placement; F, alignment of the center of the film and the central ray. Alexander Kurjatko is a provider established in Rochester, Minnesota and his medical specialization is surgery with more than 11 years of experience. For the purposes of this guideline, head injury is defined as any trauma to the head other than superficial injuries to the face. Rohini Nadgir and David M. Yousem, thoroughly covers the extensive field of neuroradiology in an efficient and practical manner. Active 4 days ago. Proximal humeral fractures represent around 5% of all fractures ?. The NPI number assigned to this provider is 1811277890.
Red Hot Chili Peppers T Shirt Target, Ncfc Tournaments 2021, Bull/bear Sentiment Chart, Andre Dickens Daughter, Guangzhou Evergrande Players Salary, Sienna Blake Hollyoaks Real Name, Midnight Dream Cake Caramia, Musicals With Small Female Casts, Staph Scalded Skin Syndrome Adults, Ballon D'or 2008 Winner, 4-letter Words Beginning With Al, At Home Bonding Activities, Sports Outlet Melbourne, High Fiber Foods For Constipation, Stephen Collins Actor, How To Start A Conversation On Whatsapp,