En Bloc Esophageal Mucosectomy, an experimental technique for the endolumenal management of Barrett's related dysplasia and neoplasia. High grade dysplasia is in indication for esophagectomy; however esophagectomy has a mortality rate up to 12 percent, and up to 56 percent of patients may develop s...erious post-operative complications. Multiple ablated lesions can progress under the neo-squamous layer, leading to buried Barrett's mucosa. With conventional piecemeal EMR, cautery effect limits evaluation in areas of interest, Barrett's epithelium is left behind, tissue is not evaluated in situ and invasive lesions may be missed due to incomplete sampling. A new technique, en bloc esophageal mucosectomy, or EEM, was developed. The technique begins with conventional EMR in the proximal esophagus to access the submucosal space. Conventional EMR is being performed here. The mucosa is resected using an electrothermal snare. The mucosal defect from the first EMR is seen here. EMR is then repeated on the opposing wall. Sequential EMR creates a complete concentric mucosal defect. In the following sequence the completely detached column of mucosa can be seen, bounded by submucosa and muscularis propria layers. Here in the stomach, the endoscope is retroflexed and is covered by a sleeve of esophageal mucosa which has been freed to the GE junction and inverted. This sequence demonstrates a double snare technique. This snare is alongside the endoscope. The snare has been passed through the working channel. The working channel snare is pulled back, and the snare alongside the scope is used to grasp the mucosal column. With tension on the column the working channel snare can be threatened and advanced. This sequence shows the snare as it is being passed down to the GE junction. At the GE junction, the snare is tightened and cautery is applied. This frees the column of mucosal tissue from the remaining attachment. The endoscope is then withdrawn. Then detached mucosal column can be grasped with a snare and retrieved. In the following sequence, the long column of mucosa is being withdrawn via the overtube. Here, endoscopic forceps have been passed through the column to demonstrates the concentric nature of the specimen. The length of mucosa can be seen here alongside 2 conventional EMR specimens. Approximately 15cm of tissues was removed in this case. On endoscopy immediately following the resection, there is no bleeding or evidence of perforation in the area of resection. The endoscope is advanced and the exposed submucosa can be appreciated down to the GE junction. This is the low power view of the histologic specimen generated by EEM. Metaplastic tissue adjacent to a dysplastic focus would be completely removed. With a high power view, the layers of the esophagus can be appreciated. The epithelium, lamina propria, muscularis mucosa and submucosa are visible, with no cautery artifact in the area of interest. The technique would remove metplasia, low grade dysplasia, high grade dysplasia, and intramucosal carcinoma, as well a T 1 a lesions. All the animals in this series tolerated the procedure well. A total of five non-survival procedures and 4 survival procedures were performed. In the survival procedures, all four swine thrived in the post-operative period. Two swine were then survived for 9 days following the procedure. On post —op day nine, after passing into the upper esophagus, the proximal margin of the mucosectomy is seen here. Healing appears to be occurring. There is no evidence of leak, and no stricting is seen at 9 days down to the GE junction Passing into the stomach, some residual feed can be seen. Two swine were then survived for 13 days. On this follow-up endoscopy, the area of the mucosectomy is again healing. There was a loose stricture in both animals and both were easily traversed with a 9.8 mm gastroscope. There was a gross appearance of re-epitheliazation in some areas. It is notable that the stricture was present in the proximal esophagus with no narrowing distally. At necropsy there was not eviden

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

A DMC patient suffering from an abdominal aortic aneurysm receives an endovascular graft to alleviate the potentially deadly problem, performed by DMC cardiac specialist Dr. Ali Kafi. ~ Detroit Medical Center

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

a very funny video of ultrasound

Learn ECG in a dance..lol

The video will describe what is sarcoidosis. Please see my website for disclaimer.

Dr. Rutledge and Dr. Berendes talk about severe infections seen in patients going to other countries to get less expensive surgical procedures.

The video will describe difference between oxidation and oxygenation. Please see my website for disclaimer.

Axillary Block with a Nerve Stimulator

anatomy of neck muscles

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In this video a real case of the extremely rare disease "Fibrodysplasia ossificans progressiva" or what is called the "FOP" This disease is commonly misdiagnosed and usually end up by unnecessary surgery which exaggerate the disease. Children born with FOP characteristically have deformed great toes, possibly missing a joint or simply presenting with a notable lump at the minor joint. The first "flare-up" that leads to the formation of FOP bones usually occurs before the age of 10. FOP is a genetic disease. The bone growth progresses from the top downward, just as bones grow in fetuses. A child with FOP will typically develop bones starting at the neck, then on the shoulders, arms, chest area and finally on the feet. However it does not necessarily occur in this order due to injury-caused flare-ups. Often, the tumor-like lumps that characterize the disease appear suddenly. The gene that causes ossification is normally deactivated after a fetus' bones are formed in the womb, but in patients with FOP, the gene keeps working. Aberrant bone formation in patients with FOP occurs when injured connective tissue or muscle cells at the sites of injury or growth incorrectly express an enzyme for bone repair during apoptosis (self-regulated cell death), resulting in lymphocytes containing excess bone morphogenetic protein 4 (BMP4) provided during the immune system response. Since the incorrect enzyme remains unresolved within the immune response, the body continues providing the incorrect BMP4-containing lymphocytes. BMP4 is a product that contributes to the development of the skeleton in the normal embryo.

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With the patient in the supine position; apply the antiseptic agent (betadine). Video is uploaded on www.MedicalVideos.us In this video the subclavian vein will be placed on the left side.

Medispa offers Titan Skin tightening, laser skin tightening, eyetight laser blepharoplasty in NJ, Monmouth, and Shrewsbury. For more information on Titan Laser visit www.bnbmedispa.com

Squmaous Cell Carcinoma Of Scalp Challenging Cases & Controversial Questions with a focus on Mohs frozen section histology and pathology. Visit us @ www.skincancercentre.com.

A funny animation showing A Stupid Surgeon and MedicalVideos.US

You can see more videos on ENT channel.

Fundoplication HD GERD Surgery 3D Animation