ENDOSCOPIC (NON-SURGICAL) REMOVAL OF MULTIPLE LARGE TUMORS FROM STOMACH IN A PATIENT WITH PEUTZ-JEGHERS SYNDROME
PEUTZ-JEGHERS SYNDROME: Peutz-Jeghers syndrome (PJS) is a familial syndrome consisting of mucocutaneous pigmentation, gastrointestinal polyposis and cancers of gut & other sites like breast, ovary, and testes. PJS has an autosomal dominant inheritance with variable and incomplete penetrance. Germline mutations of STK11/LKB1 gene on 19p cause this syndrome. Mucocutaneous pigmentation may be noted in early infancy. These deposits of melanin are most commonly found around the mouth, nose, lips, buccal mucosa, hands, and feet, and may also be present in perianal and genital areas. PJS polyps may be found in stomach, small intestine, or colon, but they tend to be prominent in the small intestine. These polyps may increase in size and cause small intestinal obstruction or intussusceptions that may occur in early infancy. Acute upper gastrointestinal bleeding and chronic faecal blood may complicate the disease.
PATIENT: The patient was a 25 yr male who had mucocutaneous pigmentation and multiple polyps in the stomach and duodenum. He presented with bleeding from gastric polyps. As the polyps in stomach were numerous, (more than 20 in number) and were large in size (some equal to small egg size), he had been advised to undergo surgery. Surgery planned was total gastrectomy.
PROCEDURE: The patient underwent video-endoscopy of the esophagus, stomach and duodenum. All polyps were examined for size and presence or absence of stalk. A plan to remove all the gastric polyps at endoscopy was made in the same sitting. He received light conscious sedation. Flat polyps were raised form the gastric wall by injection of saline in to polyp base to let these lesions have a stalk. This was done by needle injector. Each polyp was engaged in a snare and the polyp stalk was cut by coagulation cutting current. The cuts were clean without any bleeding. All polyps were recovered for histology. The histology revealed all polyps to be hamartomous lesions. None of the polyps were cancerous. Patient has been followed up for over one year and is doing fine without any further bleeding or pain.
Video shows the procedure of videoendoscpy and endoscopic removal of polyps.

This endoscopy shows a patient with cancer of the larynx, Laryngeal cancer is the most common cancer of the upper respiratory tract. The incidence of laryngeal tumors is closely correlated with smoking, as head and neck tumors occur 6 times more often among cigarette smokers than among nonsmokers. The age-standardized risk of mortality from laryngeal cancer appears to have a linear relationship with increasing cigarette consumption. Death from laryngeal cancer is 20 times more likely for the heaviest smokers than for nonsmokers. It should be suspected in any patient with hoarseness of the voice for three weeks or longer until proven otherwise.

The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a colonic diverticula. Diverticulosis is a common, acquired, age-related occurrence affecting over 50% of the... western adult population over the age of 50. It is seen rarely in Africa and Asia where the dietary fiber content is traditionally higher. Thus most investigators feel that low fiber diets are related to the development of this condition. Ironically, colonic diverticula are not true diverticula but rather pseudodiverticula in that the sac includes layers of the mucosa and submucosa that push through rather than include the outer muscular layer. As with the small bowel the colon has an inner circular muscular layer, but the outer longitudinal layer is composed of three bands of muscle that run the length of the colon known as teniae. Diverticula occur in rows between the mesenteric and two antimesenteric teniae where the colonic wall is further weakened by the defect caused by the perforating vasa recti artery which supplies the colonic mucosa. Occasionally, the anatomic propensity of diverticula to form in rows is quite apparent as seen when this clip is replayed in slow motion. Most often, however, the arrangement of the diverticula appears random due to the angulation of the bowel and thickening of the semi lunar folds. The conditions that cause these pulsion diverticula are not know with certainty but may include high intrahaustral pressures, muscular hypertrophy, and age related alterations in collagen cross linking. Diverticula can bleed or can abscess and perforate. The incidence of diverticulitis or diverticular bleeding is in the range of 1:1,000 patients with diverticulosis.

Cholecystectomy & Retroperitoneal Tumor Removal

Complete Pineal Tumor excision by using Supracerebellar Infratentorial approach in sitting position was performed. The young adult male is up and about after surgery.

Tracheal Deviation Technique

Preparing Syringes for Injections

The video will describe possible reasons of raised hemidiaphragm. It will also show some good examples. Please see my website for discalimer.

Ultrasound Guided Sclerotherapy for Varicose Veins

Bleeding during the ligation of an artery during right hemicolectomy

indicated in Radius and Ulna Fractures

this video is showing the laparoscopic transabdominal preperitoneal herina repair for direct inguinal herina

A video showing thyroidectomy surgery

the short video will describe four layers of connective tissue. Please see disclaimer on my website. www.academyofprofessionals.com

Video about cardiovascula medical examination

Some bodybuilders, particularly at professional level, use substances such as "site enhancement oil", commonly known as synthol, to mimic the appearance of developed muscle where it may otherwise be disproportionate or lagging. This is known as "fluffing". Synthol is 85% oil, 7.5% lidocain, and 7.5% alcohol.Use is legal and many brands are available on the internet.The use of injected oil to enhance muscle appearance had previously been used in the late 19th century before being abandoned due to health risks such as sclerosing lipogranuloma. Its use was revived more recently by bodybuilders. Use can cause pulmonary embolisms, nerve damage, infections, stroke, and the formation of oil-filled oleomas, cysts or ulcers in the muscle. Sesame oil is often used, which can cause allergic reactions such as vasculitis. An aesthetic issue is drooping of muscle under gravity. Surgical methods are also often employed to remove steroid-related gynecomastia in male bodybuilders, and breast implants in female bodybuilders who wish to retain a feminine physique, which can be compromised in terms of breast reduction by intense dieting.

An animation showing the corticospinal tract. Please read your notes while watching the video because it is not narrated.

Vaginal Hysterectomy using Thermal Hemostasis

Grisp Reflex

Pediatric Neurological Examination Introduction