a video showing fiberoptic laryngoscopy and bronchoscopy

The device has as great advantage that the accessibility increases in the hand, it maximizes the surgical area free of obstacles, it increases its functional versatility, for the material with the one that this made a maximum of durability is guaranteed, so that it can be sterilized in any team and it facilitates that the thumb is supported in relaxation state.
The considerable reduction of the surgical time of each intervention is inside the advantages that it provides this valuable instrument, also facilitating that they are executed with more security. For the stability that provide, it can also be used in bony fabrics of the hand. The instrument is both handle, of very easy use and great comfort in its handling. The standardization of most of its pieces makes it very simple. The solutions that are offered in this device for the subjection of the fingers and other parts of the hand are a novelty, but they also have the advantage that it commits very little surgical area and it guarantees a maximum of subjection staying the totally stable hand facilitating in great measure the surgeon's work. These pieces adapt to any diameter of fingers.

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.

Breast reduction can relieve strain from shoulder straps, neck, back, and upper arms.
It can provide an uplift to help clothes fit and look better. Traditionally, insurance companies would provide benefits for a broad range of breast sizes and gram weight of tissue to be removed from each breast. At present most insurance companies limit authorization when the doctor plans to remove less than 500gm weight per breast. Since many patients present with symptoms in a D cup to DD cup, often, the very removal of over 500 grams weight may reduce the breasts too much. This amount of reduction may not be in harmony with body shape. Newer methods of breast assembly after reduction, will tighten things using internal brassiere techniques that also compact and reduce breast volume. Therefore, a gram weight reduction of 500gms in some patients combined with internal tightening efforts, could pose an over-reduction. With the unreliability of insurance support in some cases, it is best not to look solely at gram weight in the surgical planning of breast reduction. When excess skin and weight is removed, the improved location of the breasts on the chest will give marked relief of symptoms.

Surgery takes from 2 to 5 hours and can be done as an outpatient or with a brief overnight stay. When possible, no scarring other than around the areola can be planned which follows the Brazilian and French methods (Goes and Benelli). For very large reductions, a vertical method, or T pattern approach is offered. Recovery is a few days, with special care to avoid strain for 4 to 6 weeks. Some soreness may persist for a few weeks. The breasts can appear tight, swollen, and bruised at first, but will usually settle to their near final look by 6 weeks. There may be sutures to be removed in some cases. Costs relate to the severity of the sag, and weight of the breasts.

The operation can make a stunning change in body image, relief of upper body symptoms, and offer a cosmetic lift to naturally sloping breasts.

A video showing the correct way to hold a forceps

Axillary Cannulation: Antegrade Flow and Brain Protection

Hand Assisted Nephrectomy

Various laparoscopic techniques have been described for the insertion of peritoneal dialysis catheters. However, most use 3 to 4 ports, thus multiplying the potential risk for abdominal wall complications (hemorrhage, hernia, leaking). With the technique presented herein a Tenckhoff catheter is plac...ed laparoscopically, using just 1 port, in 13 consecutive patients with end-stage renal failure. The catheter is fixed in the abdominal cavity with no additional ports for this purpose. The simplicity and the rapidity of the method justifies serious consideration for its use as the standard Tenckhoff catheter placement.

Repair techniques for various types of asymmetric pectus excavatum are illustrated. Morphology-tailored bar shaping and selecting the hinge points are key elements of the technique. Repair of two cases on an eccentric type and unbalanced type according to "Park Classification" was demonstrated.

This shows a full Abdominoplasty surgery performed by Dr. Art Foley in Olympia Washington. Abdominoplasty is also commonly referred to as a "Tummy Tuck." Tummy tuck is a surgical procedure also known as abdominoplasty to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar.

Teeth Whitening

Laparoscopy in acute bowel obstruction following previous surgery is a difficult procedure and avoided by most of the surgeons due to the difficulty in obtaining pneumoperitoneum, port placement, lack of working space, adhesions and risk of bowel injury.
Here is a patient who had a previous laparotomy for trauma with a midline incision from xyphysternum to pubis; after unsuccessful conservative management he underwent a laparoscopy; a prior CT scan showed adhesions in the left side and a distal-mid small bowel obstruction. The pneumoperitoneum was obtained with the Visiport placed in the right lower quadrant; although the abdomen was grossly distended, under significant tension and distended loops of small bowel were occupying most the peritoneal cavity, with muscle relaxation there is usually enough space to perform a thorough inspection of the abdominal cavity. Port placement has to be done with special care as there is no room to push and usually a blunt trocar directed away from the bowel is employed in my practice. The collapsed loops of small bowel point quickly to the site of obstruction -- it is better to avoid manipulating the distended bowel as it is heavy, oedematous and prone to be lacerated with the instruments; once the pathology is identified, in this case the obstructive band, light packing is performed in order to expose the working space and protect the bowel from instruments like scissors or diathermy. In this case the band adhesion was slightly more difficult to separate from the bowel and required a combination of sharp and gentle blunt dissection.
Once the obstruction is release and the transit of contents is confirmed in the collapsed bowel the procedure is terminated. No abdominal drainage is usually necessary.

Cataract surgery with dense arcus

Atrial Fibrillation is the most common heart rythmn abnormatlity and is very common as you age. Atrial fibrillation is a condition in which the top chambers of the heart, the Atrium are fibrillating, rather than having a regular synchronized contraction. One of the worst complications of Atrial Fibrillation can be Stroke. There are very good treatments of Atrial Fibrillation. This animated video is an overview of Atrial Fibrillation.

Ingrown Toenail

Oral Surgery and Dental Implants

Laparoscopic Sleeve Gastrectomy

A knee replacement operation from India shows a Gender specific knee replacement implanted through a subvastus approach. Surgery performed by Dr.Venkatachalam of Madras Joint Replacement center www.kneeindia.com

Liposuction for weight loss with Abdominoplasty and Body Lifting

Hip Dislocation Reduction