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In this video, Dr. Robert Rozbruch, chief of Limb Lengthening and Complex Reconstruction at Hospital for Special Surgery performs an osseointegration after a primary amputation. The patient, a 40 year old woman, had chronic nerve pain and compromised function of her residual limb.
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key words: Osseointegration, Amputee, Amputation, Limb Replacement, Tibia, Osseointegration
Identify the anatomy and explain the physiology of the scrotum on diagrams and sonograms.
Describe and demonstrate the protocol for sonographic scanning of the scrotum.
Identify and describe sonographic images of congenital abnormalities of the scrotum.
Identify and describe sonographic images of pathologies of the scrotum.
Identify and describe sonographic images of extratesticular disease processes.
Identify the anatomy and explain the physiology of the prostate on diagrams and sonograms.
Describe and demonstrate the protocol for transabdominal and endorectal sonographic scanning of the prostate.
Identify and describe sonographic images of benign and malignant pathologies of the prostate, including benign hyperplasia, prostatitis, carcinoma, and calculi.
Explain the technique for prostate biopsy.
Define the criteria for an ultrasound appearance of prostate tumor staging.
Explain the technique for radiation seed implantation.
Explain the Patient Privacy Rule (HIPAA) and Patient Safety Act (see reference).
Hold your elbows at shoulder level and place the backs of your hands together with your wrists bent at 90 degrees. This position increases the pressure on the median nerve. If the test reproduces or worsens your symptoms (pain and tingling in your hands), you may have carpal tunnel syndrome.
To record the sequence, Stephan Gordts and Ivo Brosens of the Leuven Institute for Fertility & Embryology in Belgium performed transvaginal laparoscopy, which involves making a small cut in the vaginal wall and observing the ovary with an endoscope.
"This allows us direct access to and observation of the tubo-ovarian structures without manipulation using forceps," says Gordts.
For the photos of ovulation, which only accidentally captured the critical moment, Jacques Donnez at the Catholic University of Louvain (UCL) in Brussels, Belgium, used gas to distend the organs for photography. However, Gordts and Brosens planned the procedure to coincide with ovulation and used saline solution to "float" the structures.
Perfect timing
Observation was timed for the day of the peak of the patient's luteal hormone cycle. Ovulation was predicted to occur on the evening of the day of the LH peak, and the endoscope introduced at 6 pm.
A small amount of saline was used to float the opening of the fallopian tube, its fimbriae (the "fingers" that sweep the egg into the tube) and the ovary itself. This gives a more natural appearance than gas, says Gordts.
In the video, the fimbriae can be seen sweeping in time with the patient's heartbeat. A mucus plug can be seen protruding from the ovary – this contains the egg.
"The ovum is not captured 'naked'," says Gordts. "There is no eruption like a volcano."
Gordts says that in clinical practice it is not easy to organise the observation of ovulation. "We were probably lucky to be successful at our first attempt," he says.