Vetical Mattress Suture

Interrupted Simple Suture

Figure of Eight 8 Suture

Drs. Moore and Miklos are very excited to be one of the first centers in the US to offer the next step in minimally invasive treatment for Stress Urinary Incontinence, the single incision Mini-sling. The procedure utilizes the same concepts of the tension-free tape mid-urethral slings, however only one incision is needed and the procedure can be completed in as little as 5-10 minutes under local anesthesia.

The procedure was initially released in September of 2006 by Gynecare with a procedure called the TVT-Secure and Dr Miklos and Moore were some of the first surgeons to evaluate and study the procedure. They liked the concept of a single incision sling, however were not enthused by the engineering and design of the Secure sling. In early 2007, with development input from Dr Moore and Miklos, American Medical Systems made several improvements to the procedure and in April, Dr Moore was the first surgeon in the United States to place the Mini-Arc mini-sling. Dr Moore’s and Miklos’s center in Atlanta, because of their reputation of being world leader’s in treatment for Stress Urinary Incontinence, was chosen as the lead center in the USA to evaluate and study the Mini-Arc procedure. Dr Moore was chosen as principal investigator, leading 5 centers in the USA and the world, to study and present the initial results in the USA, which have been excellent and very exciting!

Endotracheal Intubation During General Anaesthesia

Secondary Cataract

Recto-vaginal medical examination

Prostate anatomy

Caesarean section is the most common way to deliver a breech baby in the USA, Australia, and Great Britain. Like any major surgery, it involves risks. Maternal mortality is increased by a Caesarean section, but still remains a rare complication in the First World. Third World statistics are dramatically different, and mortality is increased significantly. There is remote risk of injury to the mother’s internal organs, injury to the baby, and severe hemorrhage requiring hysterectomy with resultant infertility. More commonly seen are problems with noncatastrophic bleeding, postoperative infection and wound healing problems. It should be added that the increase in maternal mortality rates could be slightly skewed due to the fact that Caesarean sections are often used during high-risk pregnancies and/or when mortality is already a strong possibility.

One large study has confirmed that elective cesarean section has lower risk to the fetus and a slightly increased risk to the mother, than planned vaginal delivery of the breech however elements of the methodology used have undergone some criticism.

The same birth injuries that can occur in vaginal breech birth may rarely occur in Caesarean breech delivery. A Caesarean breech delivery is still a breech delivery. However the soft tissues of the uterus and abdominal wall are more forgiving of breech delivery than the hard bony ring of the pelvis. If a Caesarean is scheduled in advance (rather than waiting for the onset of labor) there is a risk of accidentally delivering the baby too early, so that the baby might have complications of prematurity. The mother’s subsequent pregnancies will be riskier than they would be after a vaginal birth (uterine rupture). The presence of a uterine scar will be a risk factor for any subsequent pregnancies.

A hystroscopy showing a case of 2 intramural fibroids

HCC-Ain Shams Clinic video showing percutaneous RFA from ainshams university. A case of male patient 70 years old, He is complaining of a pain in the right hypochondrium of 6 months duration, The patient is a known case of chronic liver disease, He had an attack of hematemesis 2 years ago, Upper GIT Endoscopy was performed and esopageal varices were revealed and were injected by a sclerosing material.

Pulmonary alveolar proteinosis. Please see disclaimer on my website. www.academyofprofessionals.com. MCQs are also available.

At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

Embolization is a medical advance that shrinks uterine fibroids. One tiny incision allows us to solve the problem quickly, safely and without surgery

Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. This loss of consciousness is usually brief. Fainting can have no medical significance, or the cause can be a serious disorder. Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known. Discuss recurrent fainting spells with your doctor. If you feel faint Lie down or sit down. To reduce the chance of fainting again, don't get up too quickly. Place your head between your knees if you sit down. If someone else faints Position the person on his or her back. If the person is breathing, restore blood flow to the brain by raising the person's legs above heart level — about 12 inches (30 centimeters) — if possible. Loosen belts, collars or other constrictive clothing. To reduce the chance of fainting again, don't get the person up too quickly. If the person doesn't regain consciousness within one minute, call 911 or your local emergency number. Check the person's airway to be sure it's clear. Watch for vomiting. Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 911 or your local emergency number. Continue CPR until help arrives or the person responds and begins to breathe.

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress. Stress incontinence differs from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting, usually associated with a sense of urgency. Stress incontinence is much more common in women than men. If you have stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life, especially exercise and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.

Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood. Sometimes triggered by a heart attack, ventricular fibrillation causes your blood pressure to plummet, cutting off blood supply to your vital organs. Ventricular fibrillation, an emergency that requires immediate medical attention, causes the person to collapse within seconds. It's the most frequent cause of sudden cardiac death. Emergency treatment includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called a defibrillator. Treatments for those at risk of ventricular fibrillation include medications and implantable devices that can restore a normal heart rhythm.

Wound | Suturing Techniques

Traumatic penile injury can be due to multiple factors. Penile fracture, penile amputation, penetrating penile injuries, and penile soft tissue injuries are considered urologic emergencies and typically require surgical intervention. The goals of treatment for penile trauma are universal: preservation of penile length, erectile function, and maintenance of the ability to void while standing. Traumatic injury to the penis may concomitantly involve the urethra.[1, 2] Urethral injury and repair is beyond the scope of this article but details can be found in Urethral Trauma. Penile fracture Penile fracture is the traumatic rupture of the corpus cavernosum. Traumatic rupture of the penis is relatively uncommon and is considered a urologic emergency.[3] Sudden blunt trauma or abrupt lateral bending of the penis in an erect state can break the markedly thinned and stiff tunica albuginea, resulting in a fractured penis. One or both corpora may be involved, and concomitant injury to the penile urethra may occur. Urethral trauma is more common when both corpora cavernosa are injured.[4] Penile rupture can usually be diagnosed based solely on history and physical examination findings; however, in equivocal cases, diagnostic cavernosography or MRI should be performed. Concomitant urethral injury must be considered; therefore, preoperative retrograde urethrographic studies should generally be performed. See the images below.