Examination of the lymph nodes of the head

Arterial Blood Gas Sampling

How To Save The Facial Nerve During Parotid Gland Surgery

A video showing the inspection of the nose

An animation illustrating carcinoma of the colon

Insertion of a CSF shunt

Loyola Respiratory System Exam Part 2 A video from Loyola Medical School, Chicago showing the medical and clinical examination of the respiratory system.

Endoscopic Atraumatic Coronary Artery Bypass EndoACA

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.

Access to processes within the skull base with lateral extension to the pterygopalatine fossa are reached by combined subfrontal osteotomy and Le Fort I osteotomy

Allograft material is placed submucosally to expand tissue to simulate turbinate tissue. It is placed in a location to direct the airstream toward "virgin" tissue that can sense airflow. Empty Nose Syndrome (ENS) is an iatrogenic disease characterized by paradoxical obstruction: a hugely patent no...

se with subjective "blockage" or poor nasal breathing.

The use of breast MRI as part of the screening for breast cancer.

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

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.

a great video showing the various techniques of stitches and suturing

Apprehension-Relocation Test

The video will describe anatomial structures in a thoracic cavity as seen on a CT scan. Please see my website for disclaimer.

Intercostal Chest Tube Insertion

Anterior vaginal wall relaxation (cystocele) is one of the most commonly diagnosed forms of pelvic organ prolapse in women. More than 200,000 cystocele repairs are completed yearly, however to date the procedures that are completed do not provide very high cure rates and/or poor anatomic outcomes. Successful treatment of anterior vaginal wall prolapse remains one of the most challenging aspects of pelvic reconstructive surgery we face. We have developed very good procedures that provide excellent support for the posterior wall (ie rectoceles) and the apex of the vagina (ie vaginal vault prolapse) and reproduce normal anatomy. We were one of the first centers in the country to utilize grafts in rectocele repairs and have seen improved cure rates to over 90% with minimal complications. It has been known for many years that abdominal sacralcolpopexy with placement of a mesh graft at the top of the vagina for vaginal vault prolapse is the most successful procedure in the literature. We have made advancements with this procedure as well in being able to offer our patients a laparoscopic minimally invasive approach for sacralcolpopexy, with the same excellent cure rates (>92%) and with hospital stays typically less than 24 hours and reduced complications. However the anterior wall has been one of the most difficult compartments in the vagina to get good anatomic results and high cure rates with traditional repairs and at the same time not cause sexual dysfunction, pain with intercourse, voiding dysfunction (ie incontinence or urgency/frequency syndrome), or a shortened or scarred down vagina. The transobturator approach was developed as a less invasive way to place an anterior wall graft (see below) however this still involved blind needle passes and the graft did not support the apex of the vagina, therefore the search for improvements in these procedures is ongoing.

This is another funny video we made regarding the use of Intermittent catheters. If you would like more information regarding our Service Plus Program( where we ship directly to your home and bill your Health Insurance), call 800-747-0246 or visit www.colonialmed.com