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Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy

Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia. Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12.

Epididymitis is infection or less frequently, inflammation of the epididymis (the coiled tube on the back of the testicle). The majority of men that develop epididymitis develop it because of a bacterial infection. Although males of any age can develop epididymitis, it occurs most frequently between ages of 20 to 39.

Dr. James Wall performs a bilateral inguinial hernia repair surgical procedure.

Featured:
James Wall, MD
Assistant Professor of Surgery, Pediatric Surgery
Assistant Professor of Bioengineering (By Courtesy)
Lucile Salter Packard Children's Hospital

Micaela Esquivel, MD
Chief Resident of General Surgery

This clip shows the adenoids as seen endoscopically. You can also see the clefts of the adenoids clearly demonstrated.

Retinoblastoma is an eye cancer that begins in the retina — the sensitive lining on the inside of your eye. Retinoblastoma most commonly affects young children, but can rarely occur in adults. Your retina is made up of nerve tissue that senses light as it comes through the front of your eye. The retina sends signals through your optic nerve to your brain, where these signals are interpreted as images. A rare form of eye cancer, retinoblastoma is the most common form of cancer affecting the eye in children. Retinoblastoma may occur in one or both eyes.

If you’re considering an epidural to help manage the pain of childbirth, you’re not alone. More than 60 percent of women delivering at hospitals elect for an epidural during labor. And with good reason: An epidural is considered one of the safest methods of pain control, with just one in 3,000 pregnancies experiencing serious complications. It’s also good for you, since you’ll remain awake and alert during the birth, as well as for your baby, since the drugs will barely reach your bloodstream (so they can’t get into hers).

Osteoarthritis is a degenerative joint disease that is caused by the chronic breakdown and eventual loss of cartilage within the joints. As the cartilage wears away, the bones that meet at the joint begin to rub against each other. This can cause extreme pain and can severely reduce movement and flexibility of the joint. Growths of bone, called bone spurs, can also form around the edges of the joint and cause pain. Joint swelling can also occur if the synovial membrane lining the joint becomes irritated, producing excess fluid that collects inside the joint. What Causes Osteoarthritis? More than half of the population age 65 or older have osteoarthritis in at least one joint. Osteoarthritis usually results from injury to a joint or from wear and tear over time. Heredity, lack of use, and being overweight also contribute to the development of osteoarthritis. Treating Osteoarthritis Treatment can include weight loss, physiotherapy, and medication. If the condition becomes severe and mobility is greatly reduced, hip replacement surgery may be necessary.

This new surgical technique provide good stability for all type of fracture even severe comminution. Each fragment are reduced and several pin sleeves are inserted circumferentially and tighten by braded cable through the sleeve box. The final features of surgery seems blooming sunflower 'Himwari in Jananese'.

Chronic obstructive pulmonary disease Email this page to a friend Print Facebook Twitter Google+ Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves damage to the lungs over time Most people with COPD have a combination of both conditions. Causes Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Emphysema Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of a cooking fire without proper ventilation Symptoms Symptoms may include any of the following: Cough, with or without mucous Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity Trouble catching one's breath Wheezing Because the symptoms develop slowly, some people may not know that they have COPD.

What Is a Paronychia (Nail Infection)? An infection that develops along the edge of the fingernail or toenail is called a paronychia (pear-ah-NIK-ee-ah). It is the most common hand infection and, if left untreated, can progress to a more severe infection of the entire finger or toe. Paronychia is distinguished from other infections such as onychomycosis and herpetic whitlow by its location and appearance.

Cholelithiasis involves the presence of gallstones (see the image below), which are concretions that form in the biliary tract, usually in the gallbladder. Choledocholithiasis refers to the presence of 1 or more gallstones in the common bile duct (CBD).

What causes rheumatic fever? Rheumatic fever is not an infection itself, but rather the result of an untreated strep infection. When your body senses the strep infection, it sends antibodies to fight it. Sometimes, these antibodies attack the tissues of your joints or heart instead. If the antibodies attack your heart, they can cause your heart valves to swell, which can lead to scarring of the valve "doors" (called leaflets or cusps). Who is at risk for rheumatic fever? Fewer than 0.3% of people who have strep throat also get rheumatic fever. Rheumatic fever is most common among children aged 5 to 15, but adults may have the condition as well. Doctors think that a weakened immune system may make some people more likely to get rheumatic fever. And, although antibiotic medicines have reduced the number of cases of rheumatic fever in developed countries, there are still thousands of reported cases. What are the symptoms of rheumatic fever and how is it diagnosed? Symptoms of rheumatic fever usually begin 1 to 6 weeks after you have had a strep infection. They are Fever Joint pain or swelling in your wrists, elbows, knees, or ankles Small bumps under the skin over your elbows or knees (called nodules) A raised, red rash on your chest, back, or stomach Stomach pain or feeling less hungry Weakness, shortness of breath, or feeling very tired Your doctor will begin by doing a throat culture to find out if you have a strep infection. Then, your doctor will use a stethoscope to listen to your heart. He or she will also look for nodules on your joints. Sometimes, blood tests, chest x-rays, or an electrocardiogram (ECG or EKG) may be needed for a more definite diagnosis. How is rheumatic fever treated? Rheumatic fever must be treated right away. If you have a sore throat that lasts longer than 3 days, or if you have a fever and headache along with your sore throat, you should see your doctor for a throat culture. Even if you do not have a sore throat but have a fever and a skin rash, this could also mean a strep infection, and you should get tested. Remember rheumatic fever can result from an untreated strep infection, so it is very important to treat the infection before it leads to a worse condition.

The video is about the evolution of the anatomic UCLA laparoscopic technique over 1325 cases and demonstrates the key steps of our operation to improve patient safety and outcomes.

Learn more at http://urology.ucla.edu

Vasculitis is an inflammation of your blood vessels. It causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. These changes restrict blood flow, resulting in organ and tissue damage. There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, such as your skin, or it may involve several. The condition can be short term (acute) or long lasting (chronic). Vasculitis can affect anyone, though some types are more common among certain groups. Depending on the type you have, you may improve without treatment. Or you will need medications to control the inflammation and prevent flare-ups. Vasculitis is also known as angiitis and arteritis.

http://www.wss4m.com/vb

During a surgical procedure to set a fracture, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special implants, such as plates, screws, nails and wires.

Hemorrhoidectomy Operation Video

Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest: Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process. Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. Shoulder manipulation. In this procedure, you receive a general anesthetic, so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically).