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.

Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017

AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.

Cranial nerves exam 1st to 7th from the USMLE collection

http://permanently-cure-your-ulcer.info-pro.co/ Symptoms Of An Ulcer, H Pylori Natural Treatment, H Pylori Treatment Natural, Diet For H Pylori. Are You Sure You Have An Ulcer? There are many symptoms that are associated with ulcers. Some ulcer sufferers only experience mild symptoms while others experience more severe. The more common symptoms of an ulcer are listed below. Abdominal discomfort is the most common symptom of an ulcer. This discomfort usually: is a dull, gnawing ache. • comes and goes for several days or weeks. • occurs 2 to 3 hours after a meal. • occurs in the middle of the night (when the stomach is empty). • is relieved by eating. • is relieved by antacid medications. Other symptoms include: • weight loss • poor appetite • bloating • burping • nausea • vomiting If you have some or all of these symptoms, it’s a good indicator that you may have an ulcer or be developing an ulcer. Discover my 100% natural cure for ulcers. click here. http://permanently-cure-your-ulcer.info-pro.co/

A video shows how to deal with thermal burns

Butt implants are a popular plastic surgery procedure among those who wish to enhance the appearance, shape, and size of their rear ends. Buttock augmentation involves the surgical insertion of artificial body implants into a patient’s buttocks to create a larger, shapelier, and more sensuous rear end. Patients who have underdeveloped buttocks can achieve a more proportionate figure with butt implants. Women who wish to achieve an “hour glass” figure or are unhappy with the size of their buttocks can benefit from female butt implants. Men with flat or poorly developed buttocks can enhance the shape of the area to their liking with male butt implants. Many buttock augmentation patients say that their clothes fit better, they feel more attractive, and their confidence levels have improved.

Male Urethral Prostate Stent/Catheter.Removal and insertion.

Watch that Large Jelly Like Hematoma Extraction

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Soft tissue biopsy from osteolytic lesions is a challenge for the interventionist. The Spirotome Bone is conceived for this intervention. The procedure is straigthforward and produces tissue specimens of high quality in sufficient amounts to allow quantitative molecular biology.

How to prepare for your bone density scan

USMLE Step 2 CS - LGIB This is just preview video. To get full access please visit our website : www.usmletutoring.com

Small cell lung cancer, which occurs almost exclusively in smokers, is a malignancy characterised by rapid doubling time, high growth fraction and widespread metastasis at presentation. In this presentation, we will briefly discuss the classification of pulmonary Neuro-endocrine tumours by the World Health Organisation followed by a detailed discussion of the clinical features, lab evaluation and management of SCLC, both limited and extended stage. The frontline therapy in small cell lung cancer is etoposide and cisplatin along with thoracic radiotherapy and prophylactic cranial irradiation in patients who have a good response to therapy. Hyperfractionation of radiotherapy may provide some benefit but is also associated with increase incidence of complications. Newer agents for SCLC include Vandetanib and immunotherapy molecules, such as Iplimumab and nivolumab.

MRI-guided laser ablation for minimal invasive Neurosurgery.

Histology of Uterus

Ellis demonstrates how to perform a sterile wound dressing change. It would be appropriate to perform hand hygiene between glove changes.

Our Critical Nursing Skills video tutorial series is taught by Ellis Parker MSN, RN-BC, CNE, CHS and intended to help RN and PN nursing students study for your nursing school exams, including the ATI, HESI and NCLEX.

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00:00 What to expect
00:51 Prepping for wound dressing change
1:15 Removing the old wound dressing
1:40 Assessing a wound
2:05 Setting up sterile field
2:49 Sterile gloving
4:02 Preparing equipment for wound dressing change
5:09 Cleaning a wound
6:13 Drying a wound
6:28 Packing a wound
7:19 Covering a wound
7:47 Labeling a wound dressing

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The most common symptoms of infection from animal bites are redness, pain, swelling, and inflammation at the site of the bite. You should seek immediate medical treatment if any of these symptoms continue for more than 24 hours. Other symptoms of infection include: pus or fluid oozing from the wound

Throughout the body, there are several points at which blood vessels unite. The junctions are termed anastomoses. In the simplest sense, an anastomosis is any connection (made surgically or occurring naturally) between tube-like structures. Naturally occurring arterial anastomoses provide an alternative blood supply to target areas in cases where the primary arterial pathway is obstructed. They are most abundant in regions of the body where the blood supply may can be easily damaged or blocked (such as the joints or intestines). This article focuses on the arterial anastomotic networks of the upper limb.

Totally US Guided PCNL in Flank Position