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For more information please visit: https://www.yalemedicine.org/c....onditions/acl-injury
Serious injuries, by and large, cause a lot of swelling in the knee. Especially in younger patients. Now, someone could be arthritic and they overdo it going for a big long hike and they get some swelling the next day. But rapid onset of swelling, it's like hard to make out where your kneecap is, is a pretty big cardinal sign that there's something serious that's happened to your knee. Rapid onset swelling is usually due to blood in the joint. "A meniscus that really tears and flips in the front. You tear your quad or your patellar tendon, your kneecap dislocates, you tear a little blood vessel, your ACL tears, a piece of cartilage in bone gets knocked off and causes bleeding. So a lot of the really significant injuries, people get rapid onset swelling within three to four hours and they should seek attention There's always exceptions to rules, but if your knee looks like a grapefruit, you should go get it checked.
In this video, learn how to suture like a plastic surgeon! We'll go over the different types of sutures, appropriate needle sizes, and the correct technique for suturing different types of wounds. Whether you're a medical student or just interested in improving your suturing skills, this video is for you! Join us and start mastering this essential surgical skill.
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[GRAPHIC CONTENT WARNING: Images of a Surgical Procedure]
In 2011, our doctors performed more than 880 open-heart surgeries and 6,100 catheter-based procedures, including nearly 2,000 angioplasties. MedStar Union Memorial performs a higher percentage (94 percent) of beating-heart bypass surgeries than any other hospital in the nation.
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Vanderbilt Medical Center neurosurgeons and neurologists will be online demonstrating their 4-stage innovative technique used for Deep Brain Stimulation (DBS). Deep brain stimulation therapy utilizes an implantable neuro-stimulator to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia.
Biliary and Pancreatic Sphincterotomies for Sphincter of Oddi Dysfunction
This 43 year old woman has severe recurrent RUQ pain post cholecystectomy. Liver and pancreatic chemistries and duct size are normal, but pancreatic manometry is abnormal. The plan is to perform dual biliary and pancreatic sphincterotomy. The pancreatic duct is cannulated with a 3.9 French tip tr...iple lumen papillotome loaded with a 0.025 inch Jagwire. Contrast is injected to outline the course of the duct. The wire is passed to the tail. Notice the knuckling of the wire into the tail. This provides a safety loop, but is only safe in a small duct with use of a smaller caliber wire. Then with the wire securely in PD, papillotome is used to cannulate the bile duct. Placement of the wire in PD guarantees access for pancreatic stent placement, which is mandatory in these patients to reduce risk, it also facilitates difficult biliary cannulation. Here is the fluoroscopic view as the papillotome is passed deep into bile duct. This shows wires in the CBD and PD. Now a biliary sphincterotomy is performed, with the pancreatic guidewire in place beside the papillotome. The scope is pushed into a longer position to orient up the middle of the papilla. The sphincterotomy is done in very careful stepwise fashion to avoid perforation. Now the biliary wire is removed and the papillotome passed over the pancreatic wire for pancreatic sphincterotomy. The incision is aimed back up towards the biliary sphincterotomy to ensure the septum only is cut. Note the large pancreatic orifice. Last, a 4 French 9cm unflanged soft material pancreatic stent is placed. We always use single pigtail design to avoid inward migration of the stent. The long unflanged design allows spontaneous passage within a few weeks.
Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy
Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.
The Pulsed Electron Avalanche Knife, a new electrosurgical knife for “cold” and traction-less cutting, was successfully used for a variety of surgical maneuvers commonly encountered in patients undergoing ocular surgery.