Chronic myeloid leukaemia is a common malignancy worldwide. We have come a long way from the limited treatment options and survival in this condition. Today, CML is a treatable malignancy with more than 80% patients surviving beyond 10 years after diagnosis, in absence of complications. This presentation deals with the definition, diagnostic criteria of chronic phase, accelerated and blastic phase (MD Anderson cancer centre, International bone marrow transplant registry and the WHO for the latter two) and management (first and second generation tyrosine kinase inhibitors) of this condition. Finally, a stepwise approach to chronic myeloid leukaemia is also presented including the definitive modality of treatment, allogeneic stem cell transplantation.

Biliary and Pancreatic Sphincterotomies for Sphincter of Oddi Dysfunction

This 43 year old woman has severe recurrent RUQ pain post cholecystectomy. Liver and pancreatic chemistries and duct size are normal, but pancreatic manometry is abnormal. The plan is to perform dual biliary and pancreatic sphincterotomy. The pancreatic duct is cannulated with a 3.9 French tip tr...iple lumen papillotome loaded with a 0.025 inch Jagwire. Contrast is injected to outline the course of the duct. The wire is passed to the tail. Notice the knuckling of the wire into the tail. This provides a safety loop, but is only safe in a small duct with use of a smaller caliber wire. Then with the wire securely in PD, papillotome is used to cannulate the bile duct. Placement of the wire in PD guarantees access for pancreatic stent placement, which is mandatory in these patients to reduce risk, it also facilitates difficult biliary cannulation. Here is the fluoroscopic view as the papillotome is passed deep into bile duct. This shows wires in the CBD and PD. Now a biliary sphincterotomy is performed, with the pancreatic guidewire in place beside the papillotome. The scope is pushed into a longer position to orient up the middle of the papilla. The sphincterotomy is done in very careful stepwise fashion to avoid perforation. Now the biliary wire is removed and the papillotome passed over the pancreatic wire for pancreatic sphincterotomy. The incision is aimed back up towards the biliary sphincterotomy to ensure the septum only is cut. Note the large pancreatic orifice. Last, a 4 French 9cm unflanged soft material pancreatic stent is placed. We always use single pigtail design to avoid inward migration of the stent. The long unflanged design allows spontaneous passage within a few weeks.

Every day, specialists deliver high-quality care in 68 disciplines in health centres across Canada. Yet many Canadians know very little about what many specialists actually do, and the important role these disciplines play in Canada’s health care system.

Off-Pump CABG in Dextrocardia; A New Challenge for a New Era

Aortic Valve-Sparing Operation in a Patient with Aortic Root Aneurysm using a new Prosthesis for Anatomical Reconstruction of the Sinuses of Valsalva

So you want to be a cardiothoracic surgeon. You like the idea of open heart surgery and the glory that comes with being a CT surgeon. Let’s debunk the public perception myths of what it means to be a cardiothoracic surgeon, and give it to you straight. This is the reality of cardiothoracic surgery.

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TIME STAMPS:
00:41 - What is Cardiothoracic Surgery?
04:08 - How to Become a Cardiothoracic Surgeon
06:29 - Subspecialties within Cardiothoracic Surgery
07:49 - What You’ll Love About Cardiothoracic Surgery
09:10 - What You Won’t Love About Cardiothoracic Surgery
10:04 - Should You Become a Cardiothoracic Surgeon?

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Ingrown Toenail Surgery HD

Sleepiness, tiredness and fatigue are complaints which must be thoroughly analyzed to eliminate blur and ambiguity.
Physiological sleepiness (“sleep pressure”) increases while being awake and additionally underlies the circadian rhythm with a lower threshold to fall asleep during night time.
Excessive daytime sleepiness (EDS) is considered normal only after sleep deprivation. Clinically, EDS manifests by frequents daytime napping and/or reduced alertness with automatic behavior or - in its extreme form - in recurrent attacks of sudden, uncontrollable compulsion to sleep also in inappropriate situations (= “sleep attacks”).
EDS is “objectively” addressed by measuring the mean sleep latency to four to five nap opportunities throughout the day using the multiple sleep latency test (MSLT) or the maintenance of wakefulness test (MWT).
EDS denotes both, a ready entrance into sleep as well as difficulty in staying awake during daytime or accordingly in inappropriate situations. These two partially independent aspects of EDS are separately assessed by the “passive” MSLT and the “active” MWT respectively.
For that reason the MSLT and MWT only weakly correlate with each other when tested over a broad range of patients with EDS. It is important to keep in mind, that these tests are importantly influenced by a great variety of factors such as mood, anxiety, and motivation.
“Vigilance” comprises wakefulness, alertness and attention and therefore is more than just the reciprocal to sleepiness. Cognitive performance tasks such as Steer Clear Reaction Time Test (SCRTT) or driving simulators require the complete integrity of vigilance to achieve normal results. Hypersomnia is usually broadly defined as the combination of abnormally prolonged night-time sleep (regularly >10 h) with EDS during ≥1 months.
On the other hand, the term hypersomnia has also been used in a narrower scene for the isolated abnormality of a prolonged night-time sleep need (>10 h). “Tiredness”, also in colloquial language often used for sleepiness, in a broader sense also describes the feeling of lack of energy, motivation and initiative.

These patients seek rest rather than sleep. They often cannot fall asleep when given the opportunity in spite of feeling tired, and hence, in an MSLT, do not show an abnormally short sleep latency. Furthermore, tiredness (and fatigue) as opposed to sleepiness has a mental (“central”) and physiological (bodily or “peripheral”) component, which the patients can readily distinguish. Patients with insomnia, mild sleep apnea syndrome, or depression rather suffer from mental tiredness than sleepiness during the day.
The simple subjective self-assessment using the Epworth Sleepiness Scale (ESS) quite reliably differentiates between sleepiness and mental tiredness (without sleepiness), which makes it a widely used test. The term “fatigue” is also heterogeneously used.
In physiology the “fatigue” implied a “time on task performance decrement” to describe decreasing muscle force during a sustained physical effort. In clinical medicine one distinguishes physical (“peripheral”) from mental (“central”) fatigue and the term usually denotes a chronic and more abnormal situation than tiredness.
In a broad sense “fatigue” implies a deficiency in coping satisfactorily with mental and physical work load. The chronic fatigue syndrome entails both mental as well as a physical fatigue (so called “leaden paralysis” of limbs). Depressive states are often associated with insomnia and fatigue, but there are also cases with hypersomnia rather than insomnia ( non organic hypersomnia , “atypical depression” or “hypersomnolent depression”)
Sometimes these patients have a tendency to spend much of the day lying in the bed without actually sleeping (so called clinophilia). The basic and clinical aspects of fatigu

Dr. Matthew Slater talks about why cardiac surgery may be necessary if medications aren't an effective treatment option.

Dr. Joanna Chikwe, explains how patients may feel after heart surgery.

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Transverse Colostomy Closure

Take a trip around the world while ensuring healthy eye habits and optimal vision

The term mallet finger has long been used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint. Mallet finger is the most common closed tendon injury that is seen in athletes; this injury is also common in nonathletes after "innocent" trauma. Mallet finger has also been referred to as drop, hammer, or baseball finger (although baseball accounts for only a small percentage of such injuries).

Lateral internal sphincterotomy

Part 3: from Loyola Medical School, Chicago showing clinical examination of the neurological system.

"I’m essentially taking care of the baby right now to give them 60 or 70 or 80 years of life so I have to perform my best every time. Every single time. That is a commitment that I have to the parents."

The highest standard. That’s what cardiothoracic surgeon Sergio Carrillo demands of himself every time he steps into the OR. Dr. Carrillo and his Heart Center team at Nationwide Children’s Hospital treat patients with congenital heart disease with the simplest to the most complex procedures.

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The Smallest Ultrasound device in the world

A video showing simple skin suture

Part 2: from Loyola Medical School, Chicago showing clinical examination of the neurological system.