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A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained. (Source Records from Dr. Khuroo's Medical Clinic. Review prepared by Mehnaaz Sultan Khuroo Host website www.drkhuroo.org , E-mail: mkhuroo@yahoo.com ).
The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a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.
A 49-year old female patient complainig of cough. X-ray and chest CTscan showed a 2.5cm nodule in the left upper lobe. Transthoracic biopsy was consistent with adenocarcinoma. PET-Scan and CT Scan showed no mediastinal disease. The procedure was performed through three incisions.
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
أ.د/ سمير عبد الغفار في برنامج الصحة و الجمال يتحدث عن الطرق العلاجية المختلفة لعلاج الأورام الليفية في الرحم و خاصة بالطرق التي تتفادى استئصال الرحم.
أ.د/ سمير عبد الغفار هو استشاري العمليات التداخلية بدون جراحة في كلية الطب بجامعة عين شمس
للمزيد من المعلومات عن الأورام الليفية في الرحم:
http://www.Fibroidstoday.com
Associate Professor Dr. Samir Abd Elghaffar spekaing in the famous TV show "Health and Beauty" discussing various non invasive techniques of curing fibroids and leiomyomas stressing on the interventional radiology techniques.
Dr. Samir Abd Elghaffar is the consultant of interventional radiology and non invasive procedures in Ain Shams Faculty of medicine.