This 38 year old woman has increasingly intractable RUQ pain after cholecystectomy done one year prior. LFTs and pancreatic enzymes have been normal, and ducts are non-dilated, thus she is a Type III possible SOD patient. Initial goal is to define course of pancreatic duct for manometry. 5-4-3 Co...ntour catheter (Boston Scientific) is used to perform the pancreatogram which shows a small straight distal duct. The aspirating triple lumen manometry catheter (Wilson Cook) is used to cannulate the pancreatic duct, with continuous aspiration of fluid once the duct is entered. Careful stationed pullthrough manometry shows markedly abnormal basal pressures in both leads in the pancreatic sphincter. Plan is dual pancreatic and biliary sphincterotomy. Biliary manometry will not now change our plan therefore is omitted. Our first goal is to access the pancreatic duct so we can guarantee wire access for placement of a small caliber pancreatic stent which is critical for safety. Contrast is injected as the 0.018in Roadrunner wire (Wilson Cook) is advanced in order to outline the course of main duct. A separate biliary orifice is clearly seen, unusual in SOD patients. A soft 4Fr 3cm single inner flange pancreatic stent (Hobbs Medical) is placed. We did not want to use our typical 9cm long unflanged stent as even a 3 or 4 French stent might be traumatic to the tiny caliber of this duct out in the body of the gland. Next the bile duct is cannulated with a papillotome (Autotome 39, Boston Scientific), showing a small perhaps 6mm bile duct. Biliary sphincterotomy is performed in very careful stepwise fashion as landmarks are unclear and perforation is higher risk in small duct SOD patients. On the other hand, inadequate sphincterotomies offer limited chance of symptom relief. You can see here a patulous sphincterotomy. Next a pancreatic sphincterotomy is performed with the needle knife (Boston Scientific) over the pancreatic stent. Again this is performed cautiously due to the small size of the pancreatic duct. We are reaching along the stent and cutting the fibers deeply. This is a limited pancreatic sphincterotomy due to small pancreatic duct size, and concern for scarring of the pancreatic duct. It is important to document passage of the stent by xray or remove it endoscopically with two weeks or so. We and many other specialized centers perform dual sphincterotomies at the first ERCP in all SOD patients with abnormal pancreatic manometry and frequent or intractable symptoms based on the belief that response rates are better than for biliary sphincterotomy alone.

Animated video on otitis media, infection of the middle ear, which is common in children.

A Rapid mullerectomy procedure performed with a single double-armed 6-0 chromic suture and Berke ptosis clamp. No sound.

The endoscopic removal of a large intramaxillary sinus cyst which contained serous like fluid and many shiny flat white cholesterol crystals.

Fallopian Tube Diverticulus seen on Infertility workup Methylene Blue injected for tubal patency shows This. Edited by Dr Hemant Damle Prof & HOD Of Obs at SKN Medical College Pune India

DMC pediatric heart specialist uses less invasive technique to repair a child's Atrial Septal Defect ("Hole in the heart.".) ~ Detroit Medical Center

a great video showing the various techniques of stitches and suturing

A Video showing a fine needle biopsy guided with ultrasound of a thyroid nodule

Intercostal Chest Tube Insertion

Echocardiography showing an Embolus

The revision knee operation with real implants is completed and the wound is closed.

Mini Gastric ByPass after Lap Band Removal

DMC Sports Medicine Specialist Gary Gilyard, M.D., uses new OATS Procedure to repair knee injury and get hardcore hockey player back on the ice.

see http://nursing-resource.com for more info on the disease

A video showing Laparoscopic Resection of Splenic Artery Aneurysm

Showing a surgery of re-attaching a hand that was cut away

The Fibroids Project Interviews Dr. Brown. Haywood Brown, MD, is the chair of the Department of Obstetrics and Gynecology at Duke University Medical Center. He also is a nationally recognized specialist in maternal-fetal medicine.

Neurotransmitter 3D Animation
on Tuesday, December 21, 2010




Neurotransmitters are endogenous chemicals which transmit signals from a neuron to a target cell across a synapse. Neurotransmitters are packaged into synaptic vesicles clustered beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to receptors in the membrane on the postsynaptic side of the synapse. Release of neurotransmitters usually follows arrival of an action potential at the synapse, but may also follow graded electrical potentials. Low level "baseline" release also occurs without electrical stimulation. Neurotransmitters are synthesized from plentiful and simple precursors, such as amino acids, which are readily available from the diet and which require only a small number of biosynthetic steps to convert. The chemical identity of neurotransmitters is often difficult to determine experimentally. For example, it is easy using an electron microscope to recognize vesicles on the presynaptic side of a synapse, but it may not be easy to determine directly what chemical is packed into them. The difficulties led to many historical controversies over whether a given chemical was or was not clearly established as a transmitter. In an effort to give some structure to the arguments, neurochemists worked out a set of experimentally tractable rules. According to the prevailing beliefs of the 1960s, a chemical can be classified as a neurotransmitter if it meets the following conditions: * There are precursors and/or synthesis enzymes located in the presynaptic side of the synapse. * The chemical is present in the presynaptic element. * It is available in sufficient quantity in the presynaptic neuron to affect the postsynaptic neuron; * There are postsynaptic receptors and the chemical is able to bind to them. * A biochemical mechanism for inactivation is present. There are many different ways to classify neurotransmitters. Dividing them into amino acids, peptides, and monoamines is sufficient for some classification purposes. Major neurotransmitters: * Amino acids: glutamate, aspartate, D-serine, γ-aminobutyric acid (GABA), glycine * Monoamines and other biogenic amines: dopamine (DA), norepinephrine (noradrenaline; NE, NA), epinephrine (adrenaline), histamine, serotonin (SE, 5-HT), melatonin * Others: acetylcholine (ACh), adenosine, anandamide, nitric oxide, etc. In addition, over 50 neuroactive peptides have been found, and new ones are discovered regularly. Many of these are "co-released" along with a small-molecule transmitter, but in some cases a peptide is the primary transmitter at a synapse. β-endorphin is a relatively well known example of a peptide neurotransmitter; it engages in highly specific interactions with opioid receptors in the central nervous system. Single ions, such as synaptically released zinc, are also considered neurotransmitters by some[by whom?], as are some gaseous molecules such as nitric oxide (NO) and carbon monoxide (CO). These are not classical neurotransmitters by the strictest definition, however, because although they have all been shown experimentally to be released by presynaptic terminals in an activity-dependent way, they are not packaged into vesicles. By far the most prevalent transmitter is glutamate, which is excitatory at well over 90% of the synapses in the human brain. The next most prevalent is GABA, which is inhibitory at more than 90% of the synapses that do not use glutamate. Even though other transmitters are used in far fewer synapses, they may be very important functionally—the great majority of psychoactive drugs exert their effects by altering the actions of some neurotransmitter systems, often acting through transmitters other than glutamate or GABA. Addictive drugs such as cocaine and amphetamine exert their effects primarily on the dop

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مركز افارا لجراحات التجميل في مصر هو مركز متخصص في جراحة التجميل بكافة فروعها تصغير المؤخرة تصغير الارداف تنسيق القوام شد المؤخرة و جراحة الثدي تكبير الثدي تكبير الصدر تجميل الثدي تجميل الصدر شد الثدي شد الصدر تصغير الثدي تصغير الصدر رفع الثدي رفع الصدر شد الترهلات شد الجسم شد البطن شد الارداف شد المؤخرة رفع المؤخرة تجميل الانف تصغير الانف زراعة الشعر شد الجفون تجميل الجفن تجميل العين شد الوجة تجميل الاذن شفط الدهون شفط الشحوم بالليزر تصغير الساق نحت الجسم ازالة الشعر بالليزر علاج الهالات السوداء تجميل الوجة تجميل البشرة تجميل الجسم بدون جراحة حقن الدهون نفخ الوجة حقن السيايكون جقن الفيليرز حقن البوتكس علاج تجاعيد الوجة تقوية الشعر تكبير الخدود تكبير الشفايف

Squmaous Cell Carcinoma Of Scalp Challenging Cases & Controversial Questions with a focus on Mohs frozen section histology and pathology. Visit us @ www.skincancercentre.com.