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Dr. Jawad has been performing Bariatric Surgery in Central Florida since 1984, and Laparoscopic Bariatric Surgery since 1999, having completed over 2000 Bariatric Surgical Cases safely, and with great success. Here you can watch Dr. Jawad performing a Laparoscopic Adjustable Gastric Band procedure, with audio commentary describing the procedure.
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.
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.
Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), which is an endocrine disorder that affects 5--10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS.
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.