ENDOSCOPIC (NON-SURGICAL) REMOVAL OF MULTIPLE LARGE TUMORS FROM STOMACH IN A PATIENT WITH PEUTZ-JEGHERS SYNDROME
PEUTZ-JEGHERS SYNDROME: Peutz-Jeghers syndrome (PJS) is a familial syndrome consisting of mucocutaneous pigmentation, gastrointestinal polyposis and cancers of gut & other sites like breast, ovary, and testes. PJS has an autosomal dominant inheritance with variable and incomplete penetrance. Germline mutations of STK11/LKB1 gene on 19p cause this syndrome. Mucocutaneous pigmentation may be noted in early infancy. These deposits of melanin are most commonly found around the mouth, nose, lips, buccal mucosa, hands, and feet, and may also be present in perianal and genital areas. PJS polyps may be found in stomach, small intestine, or colon, but they tend to be prominent in the small intestine. These polyps may increase in size and cause small intestinal obstruction or intussusceptions that may occur in early infancy. Acute upper gastrointestinal bleeding and chronic faecal blood may complicate the disease.
PATIENT: The patient was a 25 yr male who had mucocutaneous pigmentation and multiple polyps in the stomach and duodenum. He presented with bleeding from gastric polyps. As the polyps in stomach were numerous, (more than 20 in number) and were large in size (some equal to small egg size), he had been advised to undergo surgery. Surgery planned was total gastrectomy.
PROCEDURE: The patient underwent video-endoscopy of the esophagus, stomach and duodenum. All polyps were examined for size and presence or absence of stalk. A plan to remove all the gastric polyps at endoscopy was made in the same sitting. He received light conscious sedation. Flat polyps were raised form the gastric wall by injection of saline in to polyp base to let these lesions have a stalk. This was done by needle injector. Each polyp was engaged in a snare and the polyp stalk was cut by coagulation cutting current. The cuts were clean without any bleeding. All polyps were recovered for histology. The histology revealed all polyps to be hamartomous lesions. None of the polyps were cancerous. Patient has been followed up for over one year and is doing fine without any further bleeding or pain.
Video shows the procedure of videoendoscpy and endoscopic removal of polyps.

Squared Notch

Use of Skin Stapler Remover

Fistulectomy surgery procedure video

Removal of pregnancy within the fallopain tube using laparoscopic keyhole surgery. A segment of the tube together with the pregnancy within is removed video.

We noticed a blue-line in the endometrial cavity between the tubal ostiae after injection of methylene blue (to determine tubal patency). We have seen this “blue-line” even in cases with normal or unicornuate uterus and/or in cases with patent or occluded fallopian tubes(Picture 1). So the be...st explanation of this finding may be the high speed jet or turbulence of dye in the top or the deepest part of endometrial cavity. We simply postulated that the zone which holds the methylene blue is the zone where the flashing dye strikes vertically over there and the dye penatrates into the endometrial epithelium and glands. We used this line as a guide that shows midline during operative hysteroscopy ( especially in cases with septate uterus) and we don’t ecxatly know reason why it occurs. It is necessary to perform histologic, molecular or clinical studies on this subject. It may have a multifactorial aetiology. We performed a prospective case control study and will publish it soon after when we get the results.

The challenge of position a patient with severe kyphosis for cataract extraction and lens implantation is met with a team effort and ingenuity.

Hip Examination

Repair of the umbilical hernia, and placing the omentum back in

Demonstration of a one-hand tie for suturing in the operating room.

Demonstration of a two-hand tie for wound closure

This revolutionary new procedure is generally recommended for patients with hip arthritis who are less than 60 years old. ~ Detroit Medical Center

At Children's Hospital, Dr. Mary Bedard and the NICU nursing staff save the life of a tiny infant struggling from a serious intestinal infection. ~ Detroit Medical Center

A DMC patient with urinary stress incontinence regains control with less-invasive surgery at DMC Sinai-Grace, performed by DMC Ob/Gyn specialist Dr. Korial Atty. ~ Detroit Medical Center

A "Hallux Valgus" or "Hallux Abducto-Valgus" deformity, is commonly referred to as a "Bunion." This describes a pathological condition involving the position of the "hallux" in relation to the first metatarsal.

A bunion deformity can clinically present with a variety of characteristics. The foot itself may present with a wide splaying of the forefoot and a painful bump on the medial aspect of the first metatarsal phalangeal joint. In addition, the hallux may be abducted from the midline of the body, with a valgus rotation in the frontal plane.

A radiographic analysis of a bunion deformity in the Anterior/Posterior or Dorsal/Plantar view will reveal a variety of pathological components. Most notably so, is the exaggerated inter-metatarsal angle between the first and second metatarsal. This may be accompanied by a displacement of the first metatarsal from its position over the sesamoids, such that the metatarsal demonstrates a medial alignment away from the sesamoids which lie to the lateral side.

In some cases, the proximal articular set angle at the head of the first metatarsal may be off-set. This "PASA" is one of the factors which determines the position of the proximal phalanx on the metatarsal during movement as well as at rest.

Although conservative care may involve shoe modifications, padding, strapping, and custom orthosis; surgical reconstruction may be required to alleviate painful and immobilizing bunion conditions.

Soft tissue components of the bunion deformity are primarily addressed by means of a capsular modification, as well as a tenotomy of the adductor tendon at its insertion on the base of the proximal phalanx. The fibular sesamoid may be repositioned by a release of the surrounding ligaments.

Surgical management of the bone or osseous components of a bunion deformity will commonly include an osteotomy and correction to re-establish a more functional position of the first metatarsal within the forefoot. This capital fragment of bone is held in place with hardware fixation in order to secure a proper alignment during the healing phase, thus allowing the hallux to return to a more functionally useful position in the sagittal plane.

DMC Specialists use minimally invasive surgery to remove an extremely large uterine fibroid from a patient. ~ Detroit Medical Center

laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy video

Migraine patients and who have any kinds of vascular headaches as (tension, cluster, travel, computer, headaches) can stop the headache within only one minute if he does Dr. Sultaneh pressure points procedure in the correct way.
If migraine headache in the front he must close the artery in place # 1 as you can see. If the headaches in the back of the head he must close the artery in places # 3. When the artery is closed all the headache will stop. After this you have to see my video (How to do migraine devices): www.alisultaneh.8m.com or www.migrainesurgery.4t.com

basic circular cast for Radius and Ulna Fractures

An animation showing the Electrode insertion in Radiofrequency Ablation of HCC