Every year, thousands of conventional total shoulder replacements are successfully done in the United States for patients with shoulder arthritis. This type of surgery, however, is not as beneficial for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called "cuff tear arthropathy." For these patients, conventional total shoulder replacement may result in pain and limited motion, and reverse total shoulder replacement is a better option.

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.

Visualization of the larynx by direct or indirect means is referred to as laryngoscopy and is the principal aim during airway management for passage of a tracheal tube. This paper presents a brief background regarding the development and practice of laryngoscopy and examines the equipment and techniques for both direct and indirect methods. Patient evaluation during the airway examination is discussed, as are predictors for difficult intubation. Laryngoscope blade design, newer intubating techniques, and a variety of indirect laryngoscopic technologies are reviewed, as is the learning curve for these techniques and devices.

Primary sclerosing (skluh-ROHS-ing) cholangitis (koh-lan-JIE-tis) is a disease of the bile ducts, which carry the digestive liquid bile from your liver to your small intestine. In primary sclerosing cholangitis, inflammation causes scars within the bile ducts. These scars make the ducts hard and narrow and gradually cause serious liver damage. In most people with primary sclerosing cholangitis, the disease progresses slowly and can lead to liver failure, repeated infections, and tumors of the bile duct or liver. Liver transplant is the only known cure for primary sclerosing cholangitis. The search for other treatments to slow or stop primary sclerosing cholangitis is ongoing, and scientists have turned up many promising leads. Until better treatments are proved safe and effective, though, care for primary sclerosing cholangitis focuses on monitoring liver function, managing symptoms and, when possible, doing procedures that temporarily open blocked bile ducts.

A VCUG (Voiding Cystourethrogram) is a test that looks at how well your child's kidneys, ureters and bladder are working. Your child's kidneys make urine. The urine flows from the kidneys through thin tubes (called ureters) into your child's bladder.

This video is really sad. You can literally watch this man dying. He was shot in the chest and rushed to the emergency room. His heart has stopped beating or has arrested. As a last resort, surgeons did an extreme procedure called an open thoracotomy which is that crazy tool you see there that basically splits the ribs open and allows easy open access to the heart. They did this so they could give him a cardiac massage. A cardiac massage is when surgeons are manually trying to pump the heart after it has stopped working on its own (cardiac arrest). Unfortunately he lost so much blood from his gun shot wound and he was pronounced dead. There are cases of patients surviving after having this kind of invasive resuscitation but it is rare.

Barbed sutures first received US Food and Drug Administration approval for soft tissue approximation in 2005 and early adopters readily embraced this device to develop new techniques. It has become apparent that the advantages are more than just "skin deep." Superficial and deep fascia, cartilage, tendon, joint capsule, and fibrous periprosthetic capsules can also be manipulated. Barbed sutures have revolutionized our approach to facial rejuvenation and body contouring by enhancing our ability to quilt and powerfully lift tissue. The elimination of surgical drains and shorter surgical times has made this a true boon for plastic surgeons as well as many other surgical specialists. This article summarizes some of the current and evolving applications of this exciting new tool.

http://www.wss4m.com/vb

Watch that video to know the Difference Between White and Clear Sperm

The Combitube is a twin lumen device designed for use in emergency situations and difficult airways. It can be inserted without the need for visualization into the oropharynx, and usually enters the esophagus. It has a low volume inflatable distal cuff and a much larger proximal cuff designed to occlude the oro- and nasopharynx.

If the tube has entered the trachea, ventilation is achieved through the distal lumen as with a standard ETT. More commonly the device enters the esophagus and ventilation is achieved through multiple proximal apertures situated above the distal cuff. In the latter case the proximal and distal cuffs have to be inflated to prevent air from escaping through the esophagus or back out of the oro- and nasopharynx.

The big bang is the moment when the uterus, vagina, and anus contract simultaneously at 0.8-second intervals. A small orgasm may consist of three to five contractions; a biggie, 10 to 15. Many women report feeling different kinds of orgasms

Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop." Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded. Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Too much cholesterol in the blood can lead to cardiovascular disease. Heart disease is the No. 1 cause of death in the United States. Over 2,100 Americans die of cardiovascular disease each day, an average of one death every 40 seconds. The good news is, you can lower your cholesterol and reduce your risk of heart disease and stroke. Working with your doctor is key. It takes a team to develop and maintain a successful health program. You and your healthcare professionals each play an important role in maintaining and improving your heart health. Work with your doctor to determine your risk and the best approach to manage it. In all cases, lifestyle changes are important to reduce your risk for heart attack and stroke. In some cases, cholesterol-lowering statin medicines may also provide benefit. Learn how to make diet and lifestyle changes easy and lasting. Also make sure you understand instructions for taking medication because it won't work if you don't take it as directed. Lifestyle Changes Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level. Know Your Fats Knowing which fats raise LDL cholesterol and which ones don't is the first step in lowering your risk of heart disease.

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An animation of blood flow inside the Hemodialysis circuit.

About Dr. Rifai:
Dr. Ahmad Oussama Rifai is certified by the American Board of Internal Medicine (ABIM) in the specialty of Internal Medicine and the sub-specialty of Nephrology.

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Removal of large epidermoid cyst from floor of the mouth

Dont worry sister!

Although techniques of vascular anastomosis after trauma are numerous in type and form, most surgeons will default to the one associated with the greatest comfort and ease. This report offers a rapid and reliable repair using a conceptually and operationally simple technique. Its methodology is appropriate for all repairs, including cases mandating the insertion of vascular conduit. We have employed this technique for the past 15 years in nearly all patients with vascular injuries, regardless of the site and size of the vessel. This has included vessels of the neck, torso, upper and lower extremities. There have been no obvious complications associated with its use. Major advantages include: 1) the operating system is always oriented towards the surgeon, 2) the posterior row of sutures is placed as both ends are readily visualized, avoiding the need for potentially obscuring traction stitches, and 3) flushing is easily performed prior to completing the anterior suture row.

Vaginal Hysterectomy Procedure of a 42 years old female patient with a 3 months history of symptomatic vaginal bulge