This is the CT of a 43 year old male patiënt with infected necrotizing pancreatitis that will undergo a VARD procedure; Videoscopic Assisted Retroperitoneal Debridment. Two weeks before this procedure two large bore percutaneous drains were placed in the peripancreatic collection. The patient i...s placed in supine position with the left side 30 degrees elevated. A 5-7 cm subcostal incision is made in the left flank. With help of CT images and by following the percutaneous drain, the subcutaneous tissue and the fascia are dissected and we enter the retroperitoneal peripancreatic collection. First, with a regular suction device any pus encountered is removed. Two long sympathectomy hooks are inserted in order to keep in the incision open. We than insert the zero degree laparoscope. The first necrosis encountered is removed under direct sight with the use of long grasping forceps. Following the percutaneous drain deeper into the cavity, parts of loosely adherent necrotic material are removed. Gently pulling we remove the necrotic tissue. The suction device is helpful in removing any fluid obstructing the view. Complete necrosectomy is not the ultimate aim of this procedure. Only loosely adherent pieces of necrosis are removed thereby keeping the risk of tearing underlying blood vessels to a minimum. In the rare case of extensive bleeding, the retroperitoneal cavity can be easily packed, either awaiting the bleeding to definitely stop or to act as a bridge to angiographic coiling. This patient is now 6 weeks after onset of disease. We always try to postpone surgical intervention, if possible up to 30 days. On the left side of the collection is the percutaneous drain. In this patient the drain had worked well for 2 weeks. When the patient deteriorated again it was decided to perform the VARD procedure. Large pieces of necrotic pancreas can be removed with VARD. This is a big advantage ov VARD over pure endosopic or percutaneous techniques. When all the necrotic tissue is removed we clean the cavity. Two drains are left in situ as a postoperative lavage system. The VARD procedure is performed via a 6 cm incision, which is closed and continuous postoperative lavage started immediately.

Thoracoscopic Discectomy

We noticed a blue-line in the endometrial cavity between the tubal ostiae after injection of methylene blue (to determine tubal patency). We have seen this “blue-line” even in cases with normal or unicornuate uterus and/or in cases with patent or occluded fallopian tubes(Picture 1). So the be...st explanation of this finding may be the high speed jet or turbulence of dye in the top or the deepest part of endometrial cavity. We simply postulated that the zone which holds the methylene blue is the zone where the flashing dye strikes vertically over there and the dye penatrates into the endometrial epithelium and glands. We used this line as a guide that shows midline during operative hysteroscopy ( especially in cases with septate uterus) and we don’t ecxatly know reason why it occurs. It is necessary to perform histologic, molecular or clinical studies on this subject. It may have a multifactorial aetiology. We performed a prospective case control study and will publish it soon after when we get the results.

39 Yr. Male with Aortic Stenosis and Incompetance and Good LV Function. The Patient is an athlete and did not want to take oral anticoagulants so opted out for a Bio-prosthesis. A 23mm Hancock II Porcine Xenograft was used in this operation. Usually central aortic and Rt. Atrial cannulation is per...formed with this procedure, however on occasions Percutaneous (Seldinger Technique) Femoro Femoral artery cannulation is used. The Kit is manufactured by DLP and consists of a 20mm Arterial cannula and a 29mm two stage Rt. Atrial Cannula.

Rhumatic fever has almost been eraicated in the developed world, however it remains prevelent in many under developed countries and causes devastating damage to heart valves. Up till recently valve replacement was the treatment of choice. The long term results and sequelae of valve replacement are...

common knowledge. Mitral and tricuspid valve replacement results are on the whole far worse than for example Aortic valve. Mitral valve replacement should be the last resort and patients with very severe valvular and sub valvular mitral disease can nowadays be helped by mitral valve repair. NO MITRAL OR TRICUSPID VALVE SHOULD BE REPLACED IF IT CAN BE REPAIRED

Appendectomy operation

Ectopic Pregnancy

The endoscopic resection of a sharp bony nasal septal spur video

patient underwent complete thyroidectomy
ionized calcium 0.93 mmol/L
sphygmomanometer cuff inflated to 200 mmHg

Its technical name is selective laser trabeculoplasty or SLT. It's a virtually painless, minimally invasive procedure that provides several benefits over conventional treatments for glaucoma. ~ Detroit Medical Center

DMC Orthopedic Specialist and Detroit Tigers team physician Dr. Stephen Lemos repairs a young patient's damaged shoulder using a minimally-invasive arthroscopic technique. ~ Detroit Medical Center

DMC Neurosurgeon Sandeep Mittal uses EEG and brain surgery to decode the secrets of adult epilepsy - Part I of a two-part series. ~ Detroit Medical Center

After a bad fall, a patient suffering from spinal fusion seeks help from a DMC Neurosurgery specialist.
~ Detroit Medical Center

how is vidoe

How to test radial & ulnar artery circulation

Walk through your mouth with Intra Oral Technology and see the unseen! Most of us can't really see what is going on in our mouths because it is a very small, and shadowed area. What we don't know is that many situations and conditions in the mouth and painless and not always visible to the naked eye.

The Intra Oral Camera is a fascinating innovation in dentistry that allows the client and our clinicians to look deep into the mouth and observe the teeth at a very close angle. This wand like camera which transfers images to a television, can see so close to a tooth that it can see mini fractures, chips, secondary decay, wear down of the teeth, damaged and broken fillings and crowns and even gum disease. At Yaletown we believe that people can decide what is best for their own health. The Intra Oral Camera is a wonderful educational tool for clients so they can learn about their mouths to help them on their journey to overall dental wellness.

The Digging and Peeling off method is of absolute value to the laparoscopic myomectomy since that can provide time necessary to remove the large and multiple leiomyoma and suture the uterus. Please do not hesitate to contact us if you require any further information or help, it will be a pleasure for mr to assist you. e-mail : eunds1212@yahoo.co.kr homepage : www.eunhospital.co.kr

In this podcast, CDC's Dr. Barbara Reynolds discusses best practices in crisis and emergency risk communication. She characterizes the initial phase of the crisis communication lifecycle and describes the five most common mistakes made in emergency communication to the public and how to counter them.

The video is a clip from ABC 7 News, KGO-TV. The video details the new FDA approved device Insight eNO system which uses exhaled nitric oxide for effective asthma management, in both adults and children.
Insight eNO has revolutionized asthma treatment. Apieron’s asthma products help in managing asthma for patients suffering from acute asthma attacks by detecting exhaled nitric oxide (eNO) present in the human breath.

Arterial line insertion usually involves cannulation of the radial artery with a 20 gauge catheter for the purposes of beat-by-beat blood pressure monitoring all along with arterial blood gas monitoring.