Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy

Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.

Join Dr. Parsia Vagefi, Chief of Surgical Transplantation and Dr. Steven Hanish, Surgical Director of Liver Transplantation, as they grant unprecedented access to the OR while performing a #Liver #Transplant #Surgery.
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Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest: Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process. Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. Shoulder manipulation. In this procedure, you receive a general anesthetic, so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically).

Dilatation and curretage technique.

腹腔镜十二指肠球部溃疡穿孔修补术

Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. In most cases, the cause cannot be found. This is called idiopathic pulmonary fibrosis

Claudication, which is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow. Examination of a patient with claudication should include a complete lower-extremity evaluation and pulse examination, including measuring segmental pressures. Attempt to palpate pulses from the abdominal aorta to the foot, with auscultation for bruits in the abdominal and pelvic regions. When palpable pulses are not present, a handheld Doppler device may be used to assess circulation.

You may have recently found out that you are deficient or know someone who is. It's shocking for most people when they have never had a problem before and believe nothing has changed to make it a problem now. The truth is that a lot has changed, and vitamin D deficiency and insufficiency is now a global public-health problem affecting an estimated 1 billion people worldwide. The most well-known consequences to not having enough vitamin D are rickets in children and osteomalacia in adults. These are far from the only problems associated with a vitamin D deficiency.

ThermiVa is a non-surgical vaginal tightening treatment for women who want to reclaim what childbirth or aging may have taken away. Using the same technology that’s used in ThermiTight and ThermiSmooth, radiofrequency energy is sent to the desired area (internally or externally), heating the tissue and stimulating the body’s own collagen. ThermiVa is performed in three treatments over the course of three months.

Obstructive lung diseases include conditions that make it hard to exhale all the air in the lungs. People with restrictive lung disease have difficulty fully expanding their lungs with air. Obstructive and restrictive lung disease share the same main symptom: shortness of breath with exertion.

Watch this video to learn how and when to change a dressing for a child with a hemodialysis catheter. You should change your child's dressing if it becomes soiled with water or blood or if it comes off at home. Keeping a clean dressing on your child will limit risk of infection.

A surgeon creates an arteriovenous fistula by making a connection between an artery (which carries blood away from the heart) and a vein (which carries blood back to the heart). This artificial connection allows the vein to become larger and for the walls of the vein to thicken, a process termed maturation. A mature fistula makes it easier for the vein to be punctured repeatedly for dialysis. Maturation typically takes three to six months to occur, but in rare cases, can take up to a year. This makes advance planning for an arteriovenous fistula important. When a patient is felt to be approximately a year away from requiring dialysis, the patient should be referred for evaluation for possible creation of an arteriovenous fistula.

UPMC liver surgeons are among the most experienced in the world in performing minimally invasive liver surgery. Most patients benefit from less trauma and pain, minimal scarring, a shorter hospital stay, and faster recovery than from traditional surgery.
To learn more, please visit https://www.upmc.com/services/....liver-cancer/treatme

Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by an inherited abnormal hemoglobin (the oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted (sickled) red blood cells.

ACTUAL CATHETERIZATION A clinical view of insertion into the male urethra. A 14 french coude cath was used.

Vatche, Minassian, MD, MPH, Chief of Urogynecology, and Sarah Cohen, MD, MPH, Director of the Minimally Invasive Gynecologic Surgery Fellowship Program at Brigham and Women’s Hospital, perform a laparoscopic burch colposuspension, a procedure used to correct stress urinary incontinence.

Stress urinary incontinence is one of the most common types of incontinence and is characterized by urinary leakage during physical activities including coughing, sneezing, exercising, lifting, and laughing. As the condition progresses, it can become severe enough to happen with simple acts such as bending and walking. This condition is due to an anatomic weakness of the bladder neck which typically maintains the seal of urine during activity. Stress incontinence can result from a variety of conditions including vaginal childbirth, aging, menopause and obesity. As this is an anatomic condition, primary treatment may involve pelvic floor exercises and/or minimally invasive surgery.

Learn more about treatment for stress urinary incontinence:
Division of Urogynecology: http://www.brighamandwomens.or....g/Departments_and_Se

Division of Minimally Invasive Gynecologic Surgery: http://www.brighamandwomens.or....g/Departments_and_Se

A craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done.

Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease. Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease that causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum. Crohn's disease is an IBD that cause inflammation of the lining of your digestive tract. In Crohn's disease, inflammation often spreads deep into affected tissues. The inflammation can involve different areas of the digestive tract — the large intestine, small intestine or both. Collagenous (kuh-LAJ-uh-nus) colitis and lymphocytic colitis also are considered inflammatory bowel diseases but are usually regarded separately from classic inflammatory bowel disease.

Shamika Burrage survived a near-fatal car accident two years ago, but not without losing something pretty important: her left ear. Now, thanks to a novel procedure performed at an Army medical center in Texas, Burrage is getting that ear back in a most unusual way. Plastic surgeons harvested cartilage from Burrage's ribs to create a new ear and then grew it under the skin of her forearm. Then the doctors at William Beaumont Army Medical Center in El Paso successfully transplanted the ear from her arm to her head. The technique -- a first time in the Army -- is called prelaminated forearm free flap, said Lt. Col. Owen Johnson III, chief of plastic and reconstructive surgery at William Beaumont Army Medical Center. Some of the big advantages of it is that it reduced the chance of more scarring around Burrage's ear. Also, growing the ear under the skin of her forearm allows new blood vessels to form. "(The ear) will have fresh arteries, fresh veins and even a fresh nerve so she'll be able to feel it," Johnson said on the US Army's website. Burrage, a 21-year-old private, still has to endure two more surgeries, but she's feeling more optimistic about the future than ever in the years since her accident. "It's been a long process for everything, but I'm back," said Burrage.

Rectal Examination