Initial Assessment

Rest
Ice
Compression
Elevation

A video from Loyola medical school, Chicago showing the cardiovascular medical and clinical examination

Surgical Knot

Scalpel Holding and Cutting

Use of Skin Stapler Remover

Interscalene Block

Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy

Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.

Endoscopic third ventriculostomy in a patient with obstructive hydrocephalus

trigeminal neuralgia can be caused by a vessel loop nearby the entry zone of the trigeminal nerve at the brainstem. a vessel loop is mobilized and transposed and secured with a teflon paddy. the paddy is fixed with tissucol , a fibrin glue without evident neurotoxicity. the long term result of the jannetta procedure regarding pain control is excellent

A video showing how to insert an intravenous line also called intravenous drip

Video demonstration of proper CPR for a child

This high technology apparatus for the forearm is helping to restore hand movement in stroke patients. ~ Detroit Medical Center

A patient suffering from Trigeminal Neuralgia (extreme facial pain) has breakthrough neurosurgery, microvascular decompression, to resolve the pain & restore quality of life.~ Detroit Medical Center

Hip Dislocation Reduction

living with chronic fatigue syndrome

a very funny video of ultrasound

A very funny video by Michael Moore showing a brief history of America

Revision knee replacement. After removal of the old implants, bone is prepared for re-implantation.

Axillary Block with a Nerve Stimulator