Knee replacement involves replacing a knee joint that has been damaged or worn away, usually by arthritis or injury. Find out more here: http://bit.ly/MAdfmE

The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Dr. Shaun Kunisaki is an Associate Professor of Surgery at The Johns Hopkins University and Associate Chief of Strategy and Integration in the Division of General Pediatric Surgery at the Johns Hopkins Children's Center. His clinical practice spans the full breadth of pediatric general surgery, but he is recognized both regionally and nationally for this expertise in complex thoracic surgical problems in the fetus and young child. As Director of Pediatric Esophageal Surgery, he specializes in the management of long-gap esophageal atresia. In this role within the Johns Hopkins Children Center Fetal Program, he helps counsel parents with pregnancies complicated by fetal anomalies.

Learn more about Dr. Kunisaki at https://www.hopkinsmedicine.or....g/profiles/results/d

Complete clinical examination of the ears with all the associated tests

This is a educational video for the prostate cancer patient and their family. Depending on the individual patient, a radical prostatectomy, might a procedure that your urologist could recommend as treatment.

The complex circuitry interconnecting different areas in the brain, known collectively as white matter, is composed of millions of axons organized into fascicles and bundles. Upon macroscopic examination of sections of the brain, it is difficult to discern the orientation of the fibers. The same is true for conventional imaging modalities. However, recent advancements in magnetic resonance imaging (MRI) make such task possible in a live subject. By sensitizing an otherwise typical MRI sequence to the diffusion of water molecules it is possible to measure their diffusion coefficient in a given direction1. Normally, the axonal membrane and myelin sheaths pose barriers to the movement of water molecules and, thus, they diffuse preferentially along the axon2. Therefore, the direction of white matter bundles can be elucidated by determining the principal diffusivity of water. The three-dimensional representation of the diffusion coefficient can be given by a tensor and its mathematical decomposition provides the direction of the tracts3; this MRI technique is known as diffusion tensor imaging (DTI). By connecting the information acquired with DTI, three-dimensional depictions of white matter fascicles are obtained4. The virtual dissection of white matter bundles is rapidly becoming a valuable tool in clinical research.

Our journey begins with a transverse section of tightly packed axons as seen through light microscopy. Although represented as a two-dimensional "slice", we see that these axons in fact resemble tubes. A simulation of water molecules diffusing randomly inside the axons demonstrates how the membranes and myelin hinder their movement across them and shows the preferred diffusion direction --along the axons. The tracts depicted through DTI slowly blend in and we ride along with them. As we zoom out even more, we realize that it is a portion of the corpus callosum connecting the two sides of the brain we were traveling on and the great difference in relative scale of the individual axons becomes evident. The surface of the brain is then shown, as well as the rest of the white matter bundles--a big, apparently chaotic tangle of wires. Finally, the skin covers the brain.

With the exception of the simulated water molecules, all the data presented in the animation is obtained through microscopy and MRI. Computer algorithms for the extraction of the cerebral structures and a custom-built graphics engine make our journey through the brain's anatomy possible in a living person.

Micrograph courtesy of Dr. Christian Beaulieu, University of Alberta.
Music by Mario Mattioli.

References:
1. Stejskal, E.O., et al., J. Chem. Phys., 1965. 42:
2. Beaulieu, C., NMR Biomed., 2002. 15:435-55.
3. Basser, P.J., et al., J. Magn. Reson. B, 1994. 103:247-54.
4. Mori, S., et al., NMR Biomed., 2002. 15:468-80.

Subcuticular Pattern Continuous Suture

Background: The number of patients demanding endoscopic neck surgery is rising. The access trauma of the axillary, breast and chest approaches is bigger than in open or video assisted surgery. We tested the feasibility of he sublingual transoral access which is in our opinion the only real minimally...-invasive extracollar endoscopic access to the thyroid gland Methods: We performed an experimental investigation in a porcine model. In 10 pigs we made 10 endoscopic transoral thyroidectomys with a modified axilloscope with the help of ultrasonic scissors and a neuro-monitoring system for identification of the recurrent laryngeal nerve. Results: The average operation time from the introduction to the removal of the obturator just above the larynx was 57 seconds. The mean operation time was 43 minutes. With the help of the neuro-monitoring system we proved in all cases the function of the recurrent laryngeal nerve on both sides. The pigs were observed for another two hours after operation. During and after the operation no complications appeared. Conclusions: We could show that the endoscopic transoral thyroid resection in pigs is possible and save. Our results might be useful for using this access for endoscopic thyroid resection in humans.

Mesh repair is based on the anatomical principle with associated complications of a foreign body and recurrence. Use of an un-detached strip of the external oblique aponeurosis in place of mesh between the muscle arch and the inguinal ligament gives a strong and physiologically dynamic posterior wal...l that gives radical cure.

Pseudo-exfoliation with small pupil

The trypan blue-stained viscoelastic is removed in its entirety using a Simcoe cannula. A stream of Healonid GV can be seen flowing into the cannula with some residual viscoelastic remaning, which is subsequently removed. Without the dye, much of the viscoelastic might have been left in the anterior... chamber – a risk factor for an acute rise in intra ocular pressure.

Appendectomy operation

Prostate Cancer spreads in 3 ways. First is spreads by local growth. Second it spreads through the lymphatic system, and lastly, it spreads through the blood stream. Dr. Patrick Swift, a radiation oncologist, discusses how prostate cancer spreads.

Open rhinoplasty without oseotomies peformed by Dr. Robert Dryden and Dr. Brett Kotlus. Basic steps for rasping of dorsal hump and cephalic trim with septoplasty and tip strut.

This minimally invasive procedure for the replacement of a defective aortic valve has many advantages over traditional open heart surgery. ~ Detroit Medical Center

DMC Huron Valley-Sinai Hospital offers hope for severe sinus sufferers through new image-guided surgery that opens up passages, allowing freer breathing and higher quality of life. See two patients who have undergone the procedure and hear about their new lease on life. ~ Detroit Medical Center

esophago-gastro- duodinoscopy
Gastroduodinoscopy requires special training and considerable experience but affords valuable information.
By its implement the whole of the interior of the stomach as well as esophagus, the first part and the proximal section of the second part of the duodenum and both efferent and afferent loops of the gastrojujenostomy if present can be scrutinized.
Gastroscopy is valuable in the diagnosis of gastric ulcers, in checking the results of medical treatment of chronic gastric ulcer. Gastroduodinoscopy is valuable in differential diagnosis between chronic peptic ulcer and gastric carcinoma, in diagnosis of small gastric neoplasm, in the detection of certain forms of gastritis, in examination of a stoma, in cases of gastrojujenostomy, in cases of duodinitis and duodenal ulcer.
Now its' the Era of
VIDEOGASROSCOPE
Direct means of diagnosis of upper G.I. diseases
Continuous Video recording of the entire procedure is there by which
we can review the whole procedure by playing the Video.
We are doing final diagnosis of upper G.I. lesions with biopsy.
Treatment becomes easy and to the point.
Early detection of pre malignant and malignant lesions is appreciable.

DMC Specialists use minimally invasive surgery to remove an extremely large uterine fibroid from a patient. ~ Detroit Medical Center

Medically: How common do females orgasm? From the medical point of view

Ovarian pregnancy: an unusual location of ectopic pregnancy

Current treatment is a combination of pegylated interferon-alpha-2a or pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype. In a large multicenter randomized control study among genotype 2 or 3 infected patients (NORDymanIC),[35] patients achieving HCV RNA below 1000 IU/mL by day 7 who were treated for 12 weeks demonstrated similar cure rates as those treated for 24 weeks.[36][37]

Pegylated interferon-alpha-2a plus ribavirin may increase sustained virological response among patients with chronic hepatitis C as compared to pegylated interferon-alpha-2b plus ribavirin according to a systematic review of randomized controlled trials .[38] The relative benefit increase was 14.6%. For patients at similar risk to those in this study (41.0% had sustained virological response when not treated with pegylated interferon alpha 2a plus ribavirin), this leads to an absolute benefit increase of 6%. About 16.7 patients must be treated for one to benefit (number needed to treat = 16.7; click here [39] to adjust these results for patients at higher or lower risk of sustained virological response). However, this study's results may be biased due to uncertain temporality of association, selective dose response.

Treatment is generally recommended for patients with proven hepatitis C virus infection and persistently abnormal liver function tests.

Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment; however, this must be balanced against the 15-40% chance of spontaneous clearance without treatment (see Acute Hepatitis C section above).

Those with low initial viral loads respond much better to treatment than those with higher viral loads (greater than 400,000 IU/mL). Current combination therapy is usually supervised by physicians in the fields of gastroenterology, hepatology or infectious disease.

The treatment may be physically demanding, particularly for those with a prior history of drug or alcohol abuse. It can qualify for temporary disability in some cases. A substantial proportion of patients will experience a panoply of side effects ranging from a 'flu-like' syndrome (the most common, experienced for a few days after the weekly injection of interferon) to severe adverse events including anemia, cardiovascular events and psychiatric problems such as suicide or suicidal ideation. The latter are exacerbated by the general physiological stress experienced by the patient.