Coin extraction from the upper esophagus in a child.

Dr. Mohamed Abeid

From the " Endoscopy Atlas " :
http://www.facebook.com/group.php?gid=16900943915&ref=ts

Infant Cardio-pulmonary Resuscitation

Shoulder Exam
I think that the most daunting aspect of the shoulder exam is appreciating the functional anatomy of this incredibly mobile joint. The primary benefit of the ball and socket arrangement is that it allows the hand to be positioned precisely in space, maximizing our ability to function. In terms of functionality, the shoulder might be best described as having a golf ball-on-a-tee design.
Location Of The Muscle Groups Is Approximated In The Pictures Above.

Start by looking at the normal (or more normal) side. Note any scars, obvious asymmetry, discoloration, swelling, or muscle asymmetry.

Palpation
Gently palpate around the shoulder, touching each of the landmarks noted above. Make note of pain.

Mesenteric Vessel Ligation Operation

An overview of stomach cancer

Ileocolectomy for Crohn's Disease

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

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

In PRK the epithelium (top layer of the cornea) is scraped off and then the laser treatment is applied. A contact lens is used as a "bandage" to decrease discomfort. The epithelium then grows back over the bare area during the next few days.

In LASEK the epithelium is exposed to 20% alcohol which helps separate epithelium from the cornea. The epithelium is pushed to one side and laser treatment applied. The epithelial layer is replaced back onto the eye and held in place with a contact lens. The contact lens is then removed a few days later. LASEK is hence a "no knife"/flap operation.

Epi-Lasik is a similar procedure that uses a keratome like that used for Lasik, but engineered to only separate the epithelium. The epithelium is left on a hinge, laser treatment applied and flap replaced.

Although the success rate of dental implant is very high, there are about 10% of failure in all dental implantation. The cause is usually related to the bone quality of the implant site. Once the implant failed, it can be easily removed, wait for 6 weeks and re-implant again. It is easier to remove a failed implant than a natural tooth.

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

Mole Removal using Punch Biopsy

Hip Dislocation Reduction

This podcast discusses the actions and goals of the Centers for Disease Control and Prevention, related to the current outbreak of H1N1 flu (swine flu).

Lateral Cervical Epidural Anaesthesia

Check new lightweight laptop being flown in air by bees amazingly! A funny advertisement shoot for laptop!

The video will shed some light on fungal infections. Please see disclaimer on my website.

subscapularis muscle tear with secondary subdeltoid bursitis

TV Interview with Dr. Mostafa Yakoot, MD about the novel Influenza H1N1 (Swine Flu)
Updates in triage and management.

Lecture delivered by Dr. Mostafa Yakoot, MD, to the 12th Allergy Conference