The placement of a percutaneous expandable biliary endoprosthesis was first reported in 1985 by Carrasco et al. in a canine model,[1] and the endoscopic placement of expandable metal stents to relieve biliary strictures in patients was first described in 1989.[2,3] Over the past two decades, the endoscopic approach to biliary endoprosthesis placement has largely supplanted the percutaneous approach. Self-expanding metal stents (SEMS) have traditionally been used for palliation of obstructive jaundice in patients with unresectable pancreaticobiliary tumors. However, SEMS are increasingly being used in patients with resectable cancers[4] and benign biliary strictures.[5] Uncovered SEMS (uSEMS) have been shown to have longer patency periods than plastic stents when used for malignant biliary obstruction and to be cost effective if the patient's life expectancy is greater than 4–6 months.[6–8] The common causes of malignant biliary obstruction are pancreatic cancer and cholangiocarcinoma.[9–11] Biliary drainage prior to surgical resection is controversial; several investigators have reported it to be beneficial owing to the improved tissue healing with reduced bilirubin levels,[12,13] but others have also reported its deleterious effects secondary to the additional intervention..

Prompted by the hormone prolactin, the alveoli take proteins, sugars, and fat from your blood supply and make breast milk. A network of cells surrounding the alveoli squeeze the glands and push the milk out into the ductules, which lead to a bigger duct.

A club foot, or congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both. The affected foot appears rotated internally at the ankle. TEV is classified into 2 groups: Postural TEV or Structural TEV.

Without treatment, persons afflicted often appear to walk on their ankles, or on the sides of their feet. It is a common birth defect, occurring in about one in every 1,000 live births. Approximately 50% of cases of clubfoot are bilateral. In most cases it is an isolated dysmelia. This occurs in males more often than in females by a ratio of 2:1. A condition of the same name appears in animals, particularly horses.

Ultrasound or ultrasonography is a medical imaging technique that uses high frequency sound waves and their echoes. The technique is similar to the echolocation used by bats, whales and dolphins, as well as SONAR used by submarines. In ultrasound, the following events happen: The ultrasound machine transmits high-frequency (1 to 5 megahertz) sound pulses into your body using a probe. The sound waves travel into your body and hit a boundary between tissues (e.g. between fluid and soft tissue, soft tissue and bone). Some of the sound waves get reflected back to the probe, while some travel on further until they reach another boundary and get reflected. The reflected waves are picked up by the probe and relayed to the machine. The machine calculates the distance from the probe to the tissue or organ (boundaries) using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of the each echo's return (usually on the order of millionths of a second). The machine displays the distances and intensities of the echoes on the screen, forming a two dimensional image like the one shown below.

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Suprapubic Catheterization / Cystostomy

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Flexor Digitorum Profundus (FDP) Finger Tendon Repair

Vaginal Speculum and Bimanual Exam

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How a Clot Can Become a Pulmonary Embolism

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External jugular vein cannulation is an integral part of modern medicine and is practiced in virtually every health care setting. Venous access allows sampling of blood, as well as administration of fluids, medications, parenteral nutrition, chemotherapy, and blood products. [1] This topic describes placement of an intravenous (IV) catheter into the external jugular vein. A similar technique can be used for placement of IV catheters at different anatomic sites.

Step by step description of lower eyelid repair via skin flap and wedge resection

Breast Exam Demonstration

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Tonsil Stones Caseum