We herein describe endoscopic treatment of symptomatic pancreatic pseudocyst with significant necrosis and a fistula. Fifty eight year old man had presented to us with a large pseudocyst following an episode of acute pancreatitis. He was complaining of significant abdominal pain for two months. A... CT scan abdominal had revealed a large retro-gastric pseudocyst with necrosis and portal venous thrombosis. An upper GI endoscopy had revealed small linear fundal varcies. Endoscopic as well as surgical treatment for the cyst was discussed with the patient. Patient wished not to undergo surgical treatment and therefore endoscopic treatment was selected after a proper consent. EUS was performed to see for the interposed vessel prior to the pseudocyst puncture. Needle knife puncture was made and a guide wire was passed in the pseudocyst cavity. After confirming the wire placement in the cyst, the tract was dilated up to 20 mms using a CRE balloon. Fluid from the cyst was emptied out in the stomach. An ERCP scope was passed in to the cyst cavity, which revealed a significant necrotic material (much more than what the CT scan had revealed). All the free lying necrotic material was taken out with the help of a snare and a dormia basket. A lot of necrotic was stuck to the cyst wall, which was removed with the help of water jet, mechanical scooping and cutting through using a needle knife papillotome. Three 10 fr. Pigtail stents were placed at the end of the procedure. Further necrosectomy was carried out on alternate days for three more sessions. Dilation was required prior to each session three pigtail trans-gastric stents were placed at the end of each session. Single stent was kept in situ during each procedure to guide the path (the position of the stoma changed dramatically once the cyst was empty). During the last lesion (session four), a pancreatogram was taken. It revealed a mildly dilated CBD in the head, normally duct in the proximal body with a leak from the distal body, and contrast was seen going in to the pseudocyst cavity. The duct could not be opacified distally. A 7 fr. 15 cms stent was placed trans-papillary. When the cyst cavity was reentered through trans-gastric route, the trans-papillary pancreatic stent was clearly visible with soft necrotic material around it. In fact, the stent guided further necrosis removal. It also helped in diverting the pancreatic juice to the duodenum rather than in the pseudocyst cavity. Patient was discharged after this session and was followed up regularly. A CT scan was obtained after three months, which revealed a complete resolution of the necrosis and pseudocyst. There was a possibility of a persistent fistula after the removal of trans-papillary stent and a recurrence of the pseudocyst. Fistula closure with cyanoacrylate glue is well described in the literature. The procedure can have obvious complications secondary to accidental blockage of the main pancreatic duct. So, we thought it prudent to use a safer alternative to treat the condition. We removed the longer pancreatic stent and replaced it with a shorter pancreatic stent occupying only the head region. The patient was followed up after a month; sonography of the abdomen did not reveal any recurrence of the pseudocyst. All the stents were removed at this examination.

Chromoendoscopy of Colon Polyps

Purpose The complication rate in patients treated with the Linton procedure was unacceptably high. SEPS is minimal invasive treatment modality for chronic venous insufficiency and venous ulcers. Materials and Methods252 limbs of 229 patients who underwent SEPS procedure and/or safenous vein ablati...on from May 2003 to January 2008. Tourniquet was not used and two-port technique was preferred for operation. Skin graft was not used. Honeysoft (medical honey) was used for wound care in selected cases. Results According to CEAP clinical Classification 112 limbs were class 6, 70 limbs (class 5), 70 limbs (Class4) respectively. Greater saphenous vein stripping and/or high ligation, and varicose vein excision accompanied SEPS in 241limbs who had combined Sapheno-femoral junction and perforator vein insufficiencyand SEPS was performed alone 23 limbs who had recanalised deep venous thrombosis (19) and PVI alone(4). Mean patient follow-up was 35 months. No early deaths or thromboembolism occurred. Complications included severe subcutaneous emphysema(1), neuralgia (7), 1 year later cellulites (1). Ulcers healed in 124 limbs in two months and 58 limbs in 3 months. ulcer recurrence was seen on 12(%6.6) limbs. Clinical severity and disability scores improved significantly after surgery. Conclusion All venous ulcers healed with SEPS combined or not ablation of superficial venous reflux and remain healed 5 year period and symptom-free except recurrent ulcers during the long-term follow-up. SEPS is an effective and safety treatment modality.

Total laparoscopic hysterectomy using staples to secure major blood vessels. Vaginal colpotomy and mobilization of bladder performed initally with suture line at junction of vagina and cervix visualized laparoscopically.

Removal of 5 Releasable sutures from the Eye

Bilateral High flex knee replacements for British patient. 81 year old Ken Perris is highly satisfied after double flexible knee replacements in Chennai hospital by Orthopaedic surgeon Dr.A.K.Venkatachalam of www.kneeindia.com. High flex or flexible knee replacements confer the ability to kneel, squat, sit cross legged. Minimally invasive surgical approaches reduce pain and hasten recovery.

How pregnancy can affect gingivitis

A LASAG Yag laser is in thermal mode, 1.5 Joules/pulse to treat the trabecular meshwork between the cornea and iris for glaucoma. The view is of the inside anterior eyeball.

Microkeratome in Lasik

Using a common laser for treatment of eye cancer may benefit some patients by preserving site.

Laparoscopic Gastric Bypass Surgery

Laser Liposuction for Weight Loss

nurses removing chest tube from surgery after spontaneous pneumothorax

This video features a testimonial of Okino Mosses from Nigeria recovers from nerve decompression after his Lumber spine decompression surgery at Mumbai in India who recovered from nerve decompression after his lumber spine surgery at Mumbai in India. Okino was suffering from nervous spine decompression and was in need of a good doctor plus medical solution and then he came to know of international quality spine treatment available in India at a reduced cost. Availing the assistance of medical tourism in India Okino was able to get an international quality and cost effective lumber spine decompression surgery at Mumbai in India. Lumber spine decompression surgery is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement). This surgery provides assured medical recovery to medical patients who suffer from nervous decompression disorder. In the procedure of lumber spine decompression surgery a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. Several conditions may cause neural impingement, including spinal stenosis, a disc herniation, isthmic spondylolisthesis, degenerative spondylolisthesis, or (rarely) a spinal tumor. And lumber spine decompression surgery provides medical recovery from these spine disorders. Indian spine surgery hospitals of Delhi, Mumbai and Chennai have got good medical state of art facilities for abroad patients who want to get lumber spine surgery in India at a reduced price budget. The price of spine surgery procedure in India is affordable and the best doctors operate them to give patients a positive medical feed back after the surgery. 24/7 hours patient care provided by well trained Indian medical staff makes India a reliable medical destination. Medical tourism in India provides good care and assistance to patients who far in abroad to plan a cost effective medical trip to India. You may get more details about lumber spine surgery in India at http://www.dheerajbojwani.com or mail your queries at contact@dheerajbojwani.com

DMC Wound Care Specialist Doctor Bob Wilson uses the Hyperbaric Oxygen Therapy Chamber to supercharge the body's healing process from wounds, burns and infections. This new therapy works miracles on a young patient threatened with paralysis, and gets her back on the dance floor. ~ Detroit Medical Center

DMC Eye specialist restores a woman's vision by removing cataracts and installing an artificial lens. ~ Detroit Medical Center

Preparing the Syringe for Injection

A music video describing the life of a medical student

This podcast discusses the use of antiviral drugs for treating and preventing the H1N1 flu virus.

Urinary System Structure and Function