A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC

CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained.

Lipid-Lowering Agents HMG-CoA reductase inhibitors (statins) These agents inhibit the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase. Note the following: Low-density lipoprotein (LDL) reduction of 25%-60% Examples include Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin Contraindications include hypersensitivity, active liver disease, pregnancy, lactation, coadministration with strong CYP3A4 inhibitors (selected statins) Vitamin B3 Vitamin B3 inhibits very-low-density lipoprotein (VLDL) synthesis. Note the following: LDL reduction of 10% High-density lipoprotein (HDL) increase of 20% Example includes Niacin (nicotinic acid) Contraindications include hypersensitivity, liver disease, active peptic ulcer, severe hypotension, arterial bleeding Fibrates Fibrates enhance lipoprotein lipase, resulting in increased VLDL catabolism, fatty acid oxidation, and triglycerides elimination. They decrease hepatic extraction of free fatty acids. Note the following: LDL reduction of 15% Triglyceride reduction of 35% Examples include Gemfibrozil, fenofibrate, fenofibrate (micronized), fenofibric acid Contraindications include active liver disease, renal disease, primary biliary cirrhosis, gallbladder disease 2-Azetidiones These agents inhibit sterol transporter at brush border and, consequently, intestinal absorption of cholesterol. LDL reduction of 15% Example includes Ezetimibe Contraindications include hypersensitivity, coadministration with statins (if active liver disease) Bile acid sequestrants These agents lower cholesterol and LDL via bile duct sequestration. Note the following: LDL reduction of 15% Examples include Cholestyramine, colesevelam, colestipol Contraindications include biliary/bowel obstruction, serum triglycerides >300-500 mg/dL, history of hypertriglyceridemia-induced pancreatitis

Infant Airway Obstruction and how to deal with

An omentectomy is a surgical procedure designed to remove the omentum, which is a thin fold of abdominal tissue that encases the stomach, large intestine and other abdominal organs. This fatty lining contains lymph nodes, lymph vessels, nerves and blood vessels.

Watch as Dr. Benjamin Carson performs risky brain surgery on young Payton to remove a brain tumor. Dr. Carson, director of pediatric neurosurgery, is just one of the many reasons why Johns Hopkins Children's Center was recently ranked #1 in neurology and neurosurgery in America's Best Children's Hospitals 2008

Carotid Stenosis and what it means. The detection and treatment of carotid artery disease for the prevention of stroke is one of the most effective treatments in all of medicine.

Symptoms of dizziness can result from many conditions such as; (vestibular) inner ear disorders, neck injuries or muscle tightness, neuropathy, central nervous system problems, metabolic issues, or psychological disorders. Our therapists are trained to screen for more serious conditions (such as neurological and cardiovascular disorders) as well as effectively evaluate and treat conditions which are appropriate for physical therapy intervention.

Watch that video to know How to Get Pregnant with Twins

Recurrent Giant Cell Tumor of Tendon Sheath

Lipomas are slow-growing soft tissue tumours that rarely reach a size larger than 2 cm. Lesions larger than 5 cm, so-called giant lipomas, can occur anywhere in the body but are seldom found in the upper extremities. The authors present their experiences with eight patients having giant lipomas of the upper extremity. In addition, a review of the literature, and a discussion of the appropriate evaluation and management are included.

A very simplified method giving information about cystic fibrosis

Endoscopic picture of turban epiglottis in patient of epiglottitis

26 years old man lost his right hand thumb and index fingers with an industrial machine.the thumb amputated part was not found. the thumb is much more important of any other finger in the hand and should be reconstructed by any means. so the index amputated part was filleted and replanted over the thumb stump. the video is taken 1 year after replantation. You can see another videos in my site: https://drliaghatclinic.com, https://instagram.com/liaghatclinic, https://t.me/liaghatclinic

Watch that video of 232 Teeth Removal From Indians' Boy Mouth

Bunions can be very painful. ... Bunion removal is a surgical procedure that corrects a deformed area of the foot near the big toe. Bunion removal is sometimes called a bunionectomy, bunion surgery, or hallux valgus correction. Hallux valgus is a Latin phrase that means “foot deformity

Watch that video to know How to Treat Premature Ejaculation Naturally

USMLE Step 2 CS - LOC This is just preview video. To get full access please visit our website : www.usmletutoring.com

http://www.mediplus.co.uk A new and safer method of inserting a Foley catheter suprapubically. The technique allows the insertion to be carried out in an Outpatient setting, thus saving time, cost and effort. By using the Seldinger technique, the product reduces the chances of bowel or bladder perforation and resultant morbidity.
The product has been chosen by The NHS National Technology Adoption Centre to help facilitate adoption of the product.

Neurological Examination