A posterior Gastroenteral side to side anastomosis is presented. The procedure is made with circular stapler. After a good hemostasis of the suture has been obtained, the gastrotony is closed with linear stapler and running suture.

Laparoscopy in acute bowel obstruction following previous surgery is a difficult procedure and avoided by most of the surgeons due to the difficulty in obtaining pneumoperitoneum, port placement, lack of working space, adhesions and risk of bowel injury.
Here is a patient who had a previous laparotomy for trauma with a midline incision from xyphysternum to pubis; after unsuccessful conservative management he underwent a laparoscopy; a prior CT scan showed adhesions in the left side and a distal-mid small bowel obstruction. The pneumoperitoneum was obtained with the Visiport placed in the right lower quadrant; although the abdomen was grossly distended, under significant tension and distended loops of small bowel were occupying most the peritoneal cavity, with muscle relaxation there is usually enough space to perform a thorough inspection of the abdominal cavity. Port placement has to be done with special care as there is no room to push and usually a blunt trocar directed away from the bowel is employed in my practice. The collapsed loops of small bowel point quickly to the site of obstruction -- it is better to avoid manipulating the distended bowel as it is heavy, oedematous and prone to be lacerated with the instruments; once the pathology is identified, in this case the obstructive band, light packing is performed in order to expose the working space and protect the bowel from instruments like scissors or diathermy. In this case the band adhesion was slightly more difficult to separate from the bowel and required a combination of sharp and gentle blunt dissection.
Once the obstruction is release and the transit of contents is confirmed in the collapsed bowel the procedure is terminated. No abdominal drainage is usually necessary.

Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function. ARDS typically occurs in people who are already critically ill or who have significant injuries. Severe shortness of breath — the main symptom of ARDS — usually develops within a few hours to a few days after the original disease or trauma. Many people who develop ARDS don't survive. The risk of death increases with age and severity of illness. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs.

Worlds Most Amazing Medical Case

This animation describes surgery for patients with inflammatory bowel disease (IBD) -- IPAA, removal of colon, intestinal resection, & stricturoplasty.

Bilateral Laparoscopic Pyeloplasty in Children

LASER SURGERY Pilonidal Cyst removal

The maneuver is commonly used during some activities: Straining to have a bowel movement Blowing a stuffy nose Certain medical tests or exams As a pressure equalization technique by scuba divers, sky divers and airplane passengers The effect of the Valsalva Maneuver is a drastic increase in the pressure within the thoracic cavity.

Watch out which infections could affect your baby or tend to be worse for you during pregnancy period and how to reduce your risk of getting them.

Possible complications include: Cardiovascular disease. ... Nerve damage (neuropathy). ... Kidney damage (nephropathy). ... Eye damage (retinopathy). ... Foot damage. ... Skin conditions. ... Hearing impairment. ... Alzheimer's disease.

Nice surgery video

What are blackheads? Blackheads are small bumps that appear on your skin due to clogged hair follicles. These bumps are called blackheads because the surface looks dark or black. Blackheads are a mild type of acne that usually form on the face, but they can also appear on the following body parts: back chest neck arms shoulders Acne affects nearly 50 million Americans and is the most common skin disorder in the United States, according to the American Academy of Dermatology. What do blackheads look like? What causes blackheads? Blackheads form when a clog or plug develops in the opening of hair follicles in your skin. Each follicle contains one hair and a sebaceous gland that produces oil. This oil, called sebum, helps keep your skin soft. Dead skin cells and oils collect in the opening to the skin follicle, producing a bump called a comedo. If the skin over the bump stays closed, the bump is called a whitehead. When the skin over the bump opens, exposure to the air causes it to look black and a blackhead forms. Some factors can increase your chances of developing acne and blackheads, including: producing too much body oil the buildup of the Propionibacterium acnes bacteria on the skin irritation of the hair follicles when dead skins cells don’t shed on a regular basis undergoing hormonal changes that cause an increase in oil production during the teen years, during menstruation, or while taking birth control pills taking certain drugs, such as corticosteroids, lithium, or androgens Some people believe that what you eat or drink can affect acne. Dairy products and foods that increase blood sugar levels, such as carbohydrates, may play a part in triggering acne, but researchers aren’t convinced that there’s a strong connection. ADVERTISING What are symptoms of blackheads? Because of their dark color, blackheads are easy to spot on the skin. They’re slightly raised, although they aren’t painful because they aren’t inflamed like pimples. Pimples form when bacteria invade the blockage in the hair follicle, causing redness and inflammation. How are blackheads treated? Over-the-counter (OTC) treatments Many acne medications are available at drug and grocery stores and online without a prescription. These medications are available in cream, gel, and pad form and are put directly on your skin. The drugs contain ingredients such as salicylic acid, benzoyl peroxide, and resorcinol. They work by killing bacteria, drying excess oil, and forcing the skin to shed dead skin cells. Prescription medications If OTC treatment doesn’t improve your acne, your doctor may suggest that you use stronger prescription medications. Medications that contain vitamin A keep plugs from forming in the hair follicles and promote more rapid turnover of skin cells. These medications are applied directly to your skin and can include tretinoin, tazarotene, or adapalene. Your doctor may also prescribe another type of topical medication that contains benzoyl peroxide and antibiotics. If you have pimples or acne cysts in addition to your blackheads, this type of medication may be particularly helpful. Manual removal Dermatologists or specially trained skin care professionals use a special instrument called a round loop extractor to remove the plug causing the blackhead. After a small opening is made in the plug, the doctor applies pressure with the extractor to remove the clog. Microdermabrasion During microdermabrasion, a doctor or skin care professional uses a special instrument that contains a rough surface to sand the top layers of your skin. Sanding the skin removes clogs that cause blackheads. Chemical peels Chemical peels also remove clogs and get rid of the dead skins cells that contribute to blackheads. During a peel, a strong chemical solution is applied to the skin. Over time, the top layers of the skin peel off, revealing smoother skin underneath. Mild peels are available over the counter, while stronger peels are performed by dermatologists or other skincare professionals. Laser and light therapy Laser and light therapies use tiny beams of intense light to decrease oil production or kill bacteria. Both lasers and light beams reach below the surface of the skin to treat blackheads and acne without damaging the top layers of the skin. How can blackheads be prevented? You can prevent blackheads without spending a lot of money by trying a few of the following ideas: Wash regularly Wash your face when you wake up and before you go to bed to remove oil buildup. Washing more than twice each day can irritate your skin and make your acne worse. Use a gentle cleanser that doesn’t make your skin red or irritated. Some acne cleansing products have antibacterial ingredients that kill P. acnes bacteria. Consider washing your hair every day, too, particularly if it’s oily. Hair oils can contribute to clogged pores. It’s also important to wash your face after you eat oily foods such as pizza, because oil from these foods can clog pores. Use oil-free products Any product that contains oil can contribute to new blackheads. Choose oil-free or noncomedogenic makeup, lotions, and sunscreens to avoid making your problem worse. Try an exfoliating product Exfoliating scrubs and masks remove dead skin cells from your face and can help reduce blackheads. Look for products that don’t irritate your skin.

They were victims of caisson disease. This condition, also known as the bends or decompression sickness, is caused by the formation of gas bubbles in the body. Human body tissues contain small amounts of the gases present in the air.

A burn is tissue damage that results from scalding, overexposure to the sun or other radiation, contact with flames, chemicals or electricity, or smoke inhalation. Is it a major or minor burn? Call 911 or seek immediate care for major burns, which: Are deep Cause the skin to be dry and leathery May appear charred or have patches of white, brown or black Are larger than 3 inches (about 8 centimeters) in diameter or cover the hands, feet, face, groin, buttocks or a major joint A minor burn that doesn't require emergency care may involve: Superficial redness similar to a sunburn Pain Blisters An area no larger than 3 inches (about 8 centimeters) in diameter Treating major burns Until emergency help arrives: Protect the burned person from further harm. If you can do so safely, make sure the person you're helping is not in contact with the source of the burn. For electrical burns, make sure the power source is off before you approach the burned person. Make certain that the person burned is breathing. If needed, begin rescue breathing if you know how. Remove jewelry, belts and other restrictive items, especially from around burned areas and the neck. Burned areas swell rapidly. Cover the area of the burn. Use a cool, moist bandage or a clean cloth. Don't immerse large severe burns in water. Doing so could cause a serious loss of body heat (hypothermia). Elevate the burned area. Raise the wound above heart level, if possible. Watch for signs of shock. Signs and symptoms include fainting, pale complexion or breathing in a notably shallow fashion. Treating minor burns For minor burns: Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases. Remove rings or other tight items from the burned area. Try to do this quickly and gently, before the area swells. Don't break blisters. Fluid-filled blisters protect against infection. If a blister breaks, clean the area with water (mild soap is optional). Apply an antibiotic ointment. But if a rash appears, stop using the ointment. Apply lotion. Once a burn is completely cooled, apply a lotion, such as one that contains aloe vera or a moisturizer. This helps prevent drying and provides relief. Bandage the burn. Cover the burn with a sterile gauze bandage (not fluffy cotton). Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin. If needed, take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

This video teaches how to give an intramuscular injection shot

cleral tattooing is the practice of tattooing the sclera, or white part of the human eye. The dye is not injected into the tissue, but between two layers of the eye, where it spreads out over a large area. The process is not common

GALS Screening Examination