ENDOSCOPIC (NON-SURGICAL) REMOVAL OF MULTIPLE LARGE TUMORS FROM STOMACH IN A PATIENT WITH PEUTZ-JEGHERS SYNDROME
PEUTZ-JEGHERS SYNDROME: Peutz-Jeghers syndrome (PJS) is a familial syndrome consisting of mucocutaneous pigmentation, gastrointestinal polyposis and cancers of gut & other sites like breast, ovary, and testes. PJS has an autosomal dominant inheritance with variable and incomplete penetrance. Germline mutations of STK11/LKB1 gene on 19p cause this syndrome. Mucocutaneous pigmentation may be noted in early infancy. These deposits of melanin are most commonly found around the mouth, nose, lips, buccal mucosa, hands, and feet, and may also be present in perianal and genital areas. PJS polyps may be found in stomach, small intestine, or colon, but they tend to be prominent in the small intestine. These polyps may increase in size and cause small intestinal obstruction or intussusceptions that may occur in early infancy. Acute upper gastrointestinal bleeding and chronic faecal blood may complicate the disease.
PATIENT: The patient was a 25 yr male who had mucocutaneous pigmentation and multiple polyps in the stomach and duodenum. He presented with bleeding from gastric polyps. As the polyps in stomach were numerous, (more than 20 in number) and were large in size (some equal to small egg size), he had been advised to undergo surgery. Surgery planned was total gastrectomy.
PROCEDURE: The patient underwent video-endoscopy of the esophagus, stomach and duodenum. All polyps were examined for size and presence or absence of stalk. A plan to remove all the gastric polyps at endoscopy was made in the same sitting. He received light conscious sedation. Flat polyps were raised form the gastric wall by injection of saline in to polyp base to let these lesions have a stalk. This was done by needle injector. Each polyp was engaged in a snare and the polyp stalk was cut by coagulation cutting current. The cuts were clean without any bleeding. All polyps were recovered for histology. The histology revealed all polyps to be hamartomous lesions. None of the polyps were cancerous. Patient has been followed up for over one year and is doing fine without any further bleeding or pain.
Video shows the procedure of videoendoscpy and endoscopic removal of polyps.

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.

Normal and Adventitious Breath Sounds

Histology of Fibrocartilage

Histology of Sublingual Gland

In most instances, STDs are passed from an infected person to another person during sexual activities, through contact with the mucous membranes of the penis, vagina, mouth and rectum. Such activity includes vaginal, oral and anal intercourse. Gonorrhea and chlamydia also can be transmitted by fingers to eyes. A sexually transmissible infection (STI) is any infection or disease that can be passed from one person to another during sexual activity. Sexually transmissible infections include chlamydia, herpes, gonorrhoea, syphilis, genital herpes, scabies, pubic lice (crabs), hepatitis and HIV (the virus that causes AIDS).

The eyes A close up of a young person's eyes. The eyes are responsible for four-fifths of all the information our brain receives. Here you can find out a bit more about how they work, common problems that affect vision and the work Sightsavers does to treat and prevent avoidable blindness. You can also find out more about the people whose lives have been changed thanks to donations from people like you. How do eyes work? (click image to see enlarged version or click here for text alternative) Graphic of an eye with information about its different parts The images we see are made up of light reflected from the objects we look at. This light enters the eye through the cornea. Because this part of the eye is curved, it bends the light, creating an upside down image on the retina (this is eventually put the right way up by the brain). The retina is a complex part of the eye, but only the very back of it is light sensitive. This part of the retina has roughly the area of a 10p coin, and is packed with photosensitive cells called rods and cones. Cones are the cells responsible for daylight vision. There are three kinds – each responding to a different wavelength of light: red, green and blue. The cones allow us to see images in colour and detail. Rods are responsible for night vision. They are sensitive to light but not to colour. In darkness, the cones do not function at all. How do we see an image? The lens focuses the image. It can do this because it is adjustable – using muscles to change shape and help us focus on objects at different distances. The automatic focusing of the lens is a reflex response and is not controlled by the brain. Once the image is clearly focused on the sensitive part of the retina, energy in the light that makes up that image creates an electrical signal. Nerve impulses can then carry information about that image to the brain through the optic nerve.

Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases. Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of people with the disease have early onset Alzheimer's (also known as younger-onset), which often appears when someone is in their 40s or 50s.

A heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies. Symptoms include tightness or pain in the chest, neck, back, or arms, as well as fatigue, lightheadedness, abnormal heartbeat, and anxiety. Women are more likely to have atypical symptoms than men. Treatment ranges from lifestyle changes and cardiac rehabilitation to medications, stents, and bypass surgery.

Mini-invasive surgical repair of a ruptured Achilles tendon

Bilirubin In Urine: Bilirubin and Bilirubin Levels

Red blood cells, which form one of the major constituents of blood, are characterized by the absence of nuclei, hence they are unable to undergo cellular division or generate new erythrocytes from old ones. This eventually leads to cell disintegration, which typically occurs 4 months after the fully developed red blood cells have been in circulation within the bloodstream. During the degeneration of the red blood cells, some components of the hemoglobin are excreted from the body while other parts are conserved.

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs. Hemoglobin is made up of four protein molecules (globulin chains) that are connected together.

If it gets more severe and causes symptoms, your low hemoglobin count may indicate you have anemia. A low hemoglobin count is generally defined as less than 13.5 grams of hemoglobin per deciliter (135 grams per liter) of blood for men and less than 12 grams per deciliter (120 grams per liter) for women.

The Babies Hooked On Heroin |

How to Tell if Knee Pain is Meniscus or Ligament Injury

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Bob and Brad discuss how to tell if you are having a meniscus or ligament injury. They also include some tests you can try at home to distinguish the two.

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Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. Nephrotic syndrome causes swelling (edema), particularly in your feet and ankles, and increases the risk of other health problems. Treatment for nephrotic syndrome includes treating the underlying condition that's causing it and taking medications. Nephrotic syndrome can increase your risk of infections and blood clots. Your doctor may recommend medications and dietary changes to prevent these and other complications of nephrotic syndrome.

Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

If your levels are too low, you have hypothyroidism and may not be ovulating as you should. Taking the right dose of thyroxine, the hormone you lack, can restore your fertility. You may have discovered your underactive thyroid as a result of trying to get pregnant.

Possible complications include: Cardiovascular disease. ... Nerve damage (neuropathy). ... Kidney damage (nephropathy). ... Eye damage (retinopathy). ... Foot damage. ... Skin conditions. ... Hearing impairment. ... Alzheimer's disease.