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To record the sequence, Stephan Gordts and Ivo Brosens of the Leuven Institute for Fertility & Embryology in Belgium performed transvaginal laparoscopy, which involves making a small cut in the vaginal wall and observing the ovary with an endoscope.
"This allows us direct access to and observation of the tubo-ovarian structures without manipulation using forceps," says Gordts.
For the photos of ovulation, which only accidentally captured the critical moment, Jacques Donnez at the Catholic University of Louvain (UCL) in Brussels, Belgium, used gas to distend the organs for photography. However, Gordts and Brosens planned the procedure to coincide with ovulation and used saline solution to "float" the structures.
Perfect timing
Observation was timed for the day of the peak of the patient's luteal hormone cycle. Ovulation was predicted to occur on the evening of the day of the LH peak, and the endoscope introduced at 6 pm.
A small amount of saline was used to float the opening of the fallopian tube, its fimbriae (the "fingers" that sweep the egg into the tube) and the ovary itself. This gives a more natural appearance than gas, says Gordts.
In the video, the fimbriae can be seen sweeping in time with the patient's heartbeat. A mucus plug can be seen protruding from the ovary – this contains the egg.
"The ovum is not captured 'naked'," says Gordts. "There is no eruption like a volcano."
Gordts says that in clinical practice it is not easy to organise the observation of ovulation. "We were probably lucky to be successful at our first attempt," he says.
Here Drs Oetting and Shriver of the University of Iowa demonstrate the McCannel technique of fixing an IOL to the iris. In this video both the standard McCannel suture retrieval technique and the Siepser/Chang modifed technique are demonstrated. A 10-O prolene with a long curved ctc-6 needle is u...sed to place a suture through the iris and under an 3 piece IOL haptic. Using the standard technique the two ends of the suture are retrieved through a common paracentesis near the fixation site and tied externally. The other haptic is tied using the Siepser sliding knot technique as described by Chang for this indication with an internal knot. The standard technique is a bit easier but does not allow as thight a knot for fixation of the iris to the haptic.
http://segreti-per-dimagrire.plus101.com
---Camminare Fa Dimagrire. Ho sempre lottato con il mio peso. Ho sempre provato un programma di dimagrimento per qualche mese ma poi niente, non ho mai perso più di 2-3 kg. Vi posso assicurare che il programma Formula per dimagrire mi ha cambiato la vita. I miei amici e parenti mi chiedono continuamente come ho fatto..non potrei essere più felice di ora, quando mi guardo allo specchio vedo un'altra persona Mirko Calì
http://www.youtube.com/watch?v=qPmqxvzwyTs
Camminare Fa Dimagrire
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Routine pelvic exams are important for good reproductive health. A woman should have her first GYN exam when she first thinks about becoming sexually active, when she becomes sexually active or when she turns 18.
At the gynecologist, you will have a short general physical exam, including a breast exam. You will wear a hospital gown and nothing else. For the actual pelvic examination, you will lie down on an examination table with your feet resting in elevated “stirrups” (props that support your legs in the air). Stirrups might look a little scary, but they are there to keep you comfortable. Your legs will be spread apart, with your knees falling to each side so that your vagina is exposed. You may feel uncomfortable, but relax and realize that everyone goes through this.
External Exam
The practitioner will visually examine your vulva for discoloration, irritation, swelling and other abnormalities, and will gently feel for glands.
Internal Exam
There are two parts to the internal exam. The first involves a speculum, a metal or plastic instrument that the practitioner inserts into the vagina. The speculum is shaped like a duck’s bill, and once it is inserted into the vaginal canal, it is gently widened to spread the interior vaginal walls (this is not painful). As the vaginal walls are spread, the practitioner is able to see the walls of the vagina itself, and up the vaginal canal to the cervix. When viewing the vaginal canal and the cervix, the practitioner can look for discoloration, abnormal discharge, lesions, growths and signs of infection. It is possible for you to look at your own cervix during this process by propping yourself up on your elbows and using a mirror. Some practitioners ask if you would like to do this, but feel free to ask to if she doesn’t mention it first.
Pap Smear
Next the practitioner will take a pap smear. She/he uses a long-stemmed cotton swab to collect a sample of cells in the cervix. Some women feel a slight cramping sensation when their cervix is touched. The collected cells are smeared onto a slide and sent to a lab for testing and examination. The pap smear is extremely important for spotting abnormalities in the cervix which may indicate infection or disease.
STD Testing
If you are sexually active, the practitioner will test for STDs. The gynecologist will swab the inside of the cervix with a long cotton swab. The speculum is then taken out of the vagina. The samples are sent to a laboratory for various STD testing. The tests will probably take a couple days. Ask when your results will be available so you can call. If you want to be tested for HIV, syphilis, genital herpes or hepatitis you need to have blood taken. They can do that as well, but you will need to ask since it is not usually routine.
Manual Exam
The second part of the pelvic exam is called the manual or bi-manual exam. The practitioner will insert one or two fingers into your vagina and press with her/his other hand on the outside of your lower abdomen. They will use a lubricant on their fingers so it is more comfortable. The person can then feel the uterus, fallopian tubes and ovaries, and check for any swelling or tenderness. Once the doctor is finished checking your uterus and ovaries, the exam is complete. The entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) takes 3 to 5 minutes to complete.