Laparoscopic fixation of intraabdominal testis into the scrotum in a case of undescended testis.

Removal of pregnancy within the fallopain tube using laparoscopic keyhole surgery. A segment of the tube together with the pregnancy within is removed video.

Maintaining sufficient blood flow to the gastric tube after a subtotal esophagectomy for esophageal cancer is crucial for decreasing the esophagogastric anastomotic leakage. After subtotal esophagectomy for esophageal cancer, to additionally revascularize the gastric tube using the splenic artery a...nd vein, external carotid artery, and internal jugular vein, the supercharge technique was performed in esophageal reconstruction patients. Operative results of these patients (supercharge group) were retrospectively compared with those of patients not receiving the technique (control group). Both operation time and operative blood loss in the supercharge group were significantly longer and larger than those of the control group. However, the incidence of anastomotic leakage was significantly lower in the supercharge group than in the control group, and a 30-day reduction in the mean postoperative hospital stay was achieved with the supercharge group. This practical supercharge technique could be a breakthrough less to reduce leakage during esophageal anastomosis.

This 38 year old woman has increasingly intractable RUQ pain after cholecystectomy done one year prior. LFTs and pancreatic enzymes have been normal, and ducts are non-dilated, thus she is a Type III possible SOD patient. Initial goal is to define course of pancreatic duct for manometry. 5-4-3 Co...ntour catheter (Boston Scientific) is used to perform the pancreatogram which shows a small straight distal duct. The aspirating triple lumen manometry catheter (Wilson Cook) is used to cannulate the pancreatic duct, with continuous aspiration of fluid once the duct is entered. Careful stationed pullthrough manometry shows markedly abnormal basal pressures in both leads in the pancreatic sphincter. Plan is dual pancreatic and biliary sphincterotomy. Biliary manometry will not now change our plan therefore is omitted. Our first goal is to access the pancreatic duct so we can guarantee wire access for placement of a small caliber pancreatic stent which is critical for safety. Contrast is injected as the 0.018in Roadrunner wire (Wilson Cook) is advanced in order to outline the course of main duct. A separate biliary orifice is clearly seen, unusual in SOD patients. A soft 4Fr 3cm single inner flange pancreatic stent (Hobbs Medical) is placed. We did not want to use our typical 9cm long unflanged stent as even a 3 or 4 French stent might be traumatic to the tiny caliber of this duct out in the body of the gland. Next the bile duct is cannulated with a papillotome (Autotome 39, Boston Scientific), showing a small perhaps 6mm bile duct. Biliary sphincterotomy is performed in very careful stepwise fashion as landmarks are unclear and perforation is higher risk in small duct SOD patients. On the other hand, inadequate sphincterotomies offer limited chance of symptom relief. You can see here a patulous sphincterotomy. Next a pancreatic sphincterotomy is performed with the needle knife (Boston Scientific) over the pancreatic stent. Again this is performed cautiously due to the small size of the pancreatic duct. We are reaching along the stent and cutting the fibers deeply. This is a limited pancreatic sphincterotomy due to small pancreatic duct size, and concern for scarring of the pancreatic duct. It is important to document passage of the stent by xray or remove it endoscopically with two weeks or so. We and many other specialized centers perform dual sphincterotomies at the first ERCP in all SOD patients with abnormal pancreatic manometry and frequent or intractable symptoms based on the belief that response rates are better than for biliary sphincterotomy alone.

On screening colonoscopy, this abnormality was encountered in the cecum. This round worm is Ascaris Lumbricoides, one of the most common human parasites in the world. When ingested, the durable Ascaris eggs hatch in the small intestine releasing larva that migrate through the intestinal wall, and t...ravel both hematogenously and lymphatically to the heart and lungs. Over the next several days, the larva mature in the alveoli, then migrate up the trachea to be swallowed back into the gastrointestinal tract. These larva will then mature in the small bowel; adults couples will succeed in producing an extraordinary number of eggs, over 200,000 ova per day. The adults live one to two years. The majority of Ascaris infections are as in this example asymptomatic. Symptoms are a consequence of either the immunologic hypersensitivity of the host to the worm as in the pulmonary stage referred as Loffler's syndrome or to mechanical obstruction of lumen by the worm. Heavy worm burden can result in intestinal obstruction and migrating worms can cause pancreatitis and/or cholangitis when involving the pancreatobiliary tree. Multiple medical therapies are approved for its treatment including mebendazole. Epidemiologically, infections are most common in areas of lower socio-economic conditions. This man manages a pig farm in China that is used to test pharmaceutical agents. From an endoscopic standpoint it is noteworthy that the worms do not like light and will move away fro the attention it is receiving. In this example, the endoscopist was too slow to snare his prey which succeeded in escaping temporarily into the cooler and darker confines of the small bowel out of reach of the endoscope but not from the soon to be consumed anti-helminthic therapy.

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

Trabeculectomy surgery

teeth crowns

Arestin Antibiotic for Periodontal Disease

cardiac catheterization in the work up of heart disease.

Osteochondral Allograft

DMC Pediatric Heart Specialist Doctor Peter Karpawich is the first in the state to use minimally invasive surgery to repair a damaged pacemaker on a pediatric patient, helping her lead a more active, fulfilling lifestyle. ~ Detroit Medical Center

DMC Interventional Radiologist Doctor Bruce Wolf uses minimally invasive surgery called Balloon Kyphoplasty to bring relief to a patient suffering from severe back pain caused by spinal compression fractures. This new procedure is especially beneficial to patients suffering from osteoporosis. ~ Detroit Medical Center

DMC's Surgical Simulation Lab creates a virtual anatomy, allowing surgeons to train and enhance their skill before moving to live patients. ~ Detroit Medical Center

A discussion and demonstration of suturing techniques with Lee Dresang, MD from the University of Wisconsin Department of Family Medicine

This podcast, intended for the general public, demonstrates how to put on and take off disposable respirators that are to be used in areas affected by the influenza outbreak.

Simple surgery under a local anesthesia can help cluster headaches patients:
www.alisultaneh.8m.com
www.migrainesurgery.4t.com

The proper way to suture a wound for best healing and cosmetic results

Migraine patients and who have any kinds of vascular headaches as (tension, cluster, travel, computer, headaches) can stop the headache within only one minute if he does Dr. Sultaneh pressure points procedure in the correct way.
If migraine headache in the front he must close the artery in place # 1 as you can see. If the headaches in the back of the head he must close the artery in places # 3. When the artery is closed all the headache will stop. After this you have to see my video (How to do migraine devices): www.alisultaneh.8m.com or www.migrainesurgery.4t.com

Bunion Correction with Scarf Akin Procedure