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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.
Ellis demonstrates how to insert and then remove an NG tube. This includes drawing gastric residual and checking the pH. After the demonstration, Ellis provides additional tips about clamping the NG tube and using the blue pigtail.
Our Critical Nursing Skills video tutorial series is taught by Ellis Parker MSN, RN-BC, CNE, CHS and intended to help RN and PN nursing students study for your nursing school exams, including the ATI, HESI and NCLEX.
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00:00 What to expect
00:30 Preparing NG tube patient
00:56 Preparing NG tube equipment
1:29 Measuring the NG tube
2:02 Preparing for NG tube insertion
2:28 Inserting the NG tube
3:17 Checking placement with pH
4:23 Anchoring with split-tape
5:32 Connecting to suction
6:05 Disconnecting from suction
6:17 What to do before removal?
7:03 Removing NG tube
7:40 Additional tips on clamping
8:31 The blue pigtail
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Children are special patients, and their medical needs are unique, including their surgical needs. At UNC Hospitals, an expert and experienced team of physicians treat children in a kid-friendly and family-centered environment. UNC Pediatric Surgeon Dr. Timothy Weiner explains
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An animation of blood flow inside the Hemodialysis circuit.
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There are several reasons that your doctor may recommend that you have your spleen removed. These include having: a spleen that’s damaged from injury an enlarged spleen or ruptured spleen, which can occur from trauma certain rare blood disorders cancer or large cysts of the spleen infection
An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and germs (bacteria). The usual cause of an abscess is an infection with bacteria. Certain bacteria are more likely to be 'pus-forming' as they make chemicals (toxins) that can damage the body's tissues.
The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.
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A wart is a skin growth caused by some types of the virus called the human papillomavirus (HPV). HPV infects the top layer of skin, usually entering the body in an area of broken skin. The virus causes the top layer of skin to grow rapidly, forming a wart. Most warts go away on their own within months or years.
Amniotomy is the official term for artificially breaking the bag of waters during labor. It is believed that breaking the bag of waters will help to speed up an otherwise slow labor. Amniotomy is part of the Active Management of Labor practiced in some hospitals. Amniotomy is performed by a midwife or doctor. A long, thin instrument with a hook on the end is inserted into the vagina and through the cervix so it can catch and rip the bag of waters. To perform an amniotomy, the cervix must be dilated enough to allow the instrument through the cervix, generally at least a two. Why choose Amniotomy? Unlike other medical methods of starting labor, amniotomy does not add synthetic hormones to your labor. Instead it seems to stimulate your body’s own labor process. Amniotomy allows the use of an internal electronic fetal monitor. How effective is Amniotomy? Amniotomy alone is unpredictable, it may take hours for labor to start with amniotomy. Because amniotomy increases the risk for infection, most caregivers use amniotomy in combination with synthetic oxytocin. Birth does happen faster when amniotomy is combined with synthetic oxytocin than when amniotomy is used alone. Risks of Amniotomy Risks for Mother Increases the risk for infection. This risk is increased with length of time the waters are broken and with vaginal exams. Because of the infection risk, a time limit is given by which the mother must give birth. As the time limit approaches attempts to progress labor will become more aggressive. The fore waters equalize pressure on the cervix so it will open uniformly. When they are broken, the mother increases her chances of having uneven dilation. Risks for Baby Increases the risk of umbilical cord compression. The fore waters equalize pressure on the baby’s head as it presses against the cervix. When they are broken, the pressure on the baby’s head may be uneven causing swelling in some parts.
A vaginoplasty is a surgical procedure that tightens the vagina. This is done by removing excess vaginal lining and tightening the surrounding soft tissues and muscles. During delivery of a baby the vagina and surrounding tissues and muscles become stretched. After delivery the vagina may return to a more “normal” size, but it often fails to return to its’ pre pregnancy diameter. Generally, the more vaginal deliveries, the worse the condition gets. Many women will complain of decreased sensation and sexual satisfaction during intercourse. Commonly this is due to a lack of friction. Often their partner may notice a change although he may say nothing. Kegel exercises are often recommended but rarely succeed in restoring vaginal tightness.
This animation demonstrates how a unilateral complete cleft lip repair is performed. This video is meant for educational purposes for patients and families. There are many ways to fix a complete cleft lip, but the technique shown here is the most common known as the Millard Rotation Advancement Repair.
Dr. Horacio Asbun, Mayo Clinic in Florida, explains the Whipple procedure using this animated graphic of a pancreas. Cancer of the pancreas affects 45,000 people every year in the U.S., and it is the fourth leading cause of cancer-related deaths. The five-year overall survival rate if a tumor is detected early and surgically removed is 22 percent, versus 6 percent without early detection and surgery. To learn more, visit http://mayocl.in/2zk7FDi.
This video in Spanish/español: https://www.youtube.com/watch?v=N_zWboNMKWk