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.

Acoustic Neuroma

Descemet’s stripping automated endothelial keratoplasty (DSAEK) avoids a full-thickness corneal procedure and provides rapid visual rehabilitation. Successful graft positioning while minimizing intraoperative donor endothelial trauma may determine long-term graft survival. Previously described t...echniques for graft insertion may be problematic in some patients with intraoperative floppy iris syndrome (IFIS), anatomically shallow or unstable anterior chambers, or intraoperative increased posterior pressure. This video displays alternative method called the suture drag technique, which may facilitate lamellar endothelial graft insertion under these special circumstances.

Trabeculectomy surgery

Bilateral High flex knee replacements for British patient. 81 year old Ken Perris is highly satisfied after double flexible knee replacements in Chennai hospital by Orthopaedic surgeon Dr.A.K.Venkatachalam of www.kneeindia.com. High flex or flexible knee replacements confer the ability to kneel, squat, sit cross legged. Minimally invasive surgical approaches reduce pain and hasten recovery.

NTI Tension Suppression System

Arestin Antibiotic for Periodontal Disease

Osteochondral Allograft

Laparoscopic Gastric Bypass Surgery

Baby CPR

Clonus is tested for in the ankles by rapidly dorsiflexing the relaxed ankle joint.

DMC Wound Care Specialist Doctor Bob Wilson uses the Hyperbaric Oxygen Therapy Chamber to supercharge the body's healing process from wounds, burns and infections. This new therapy works miracles on a young patient threatened with paralysis, and gets her back on the dance floor. ~ 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

Central Line Placement

The Miracle in the Human Brain

Views of the Brain

Swine Flu Avoid

A video showing bone marrow biopsy

Una revision unica de fertilizacion, desarrollo embrionario y de los procedimientos llevados acabo durante un ciclo de fertilizacion invitro. Tome un tour virtual exclusivo de unos de los laboratorios de fertilizacion invitro mas avanzados del mundo y con tecnologia de punta en reproduccion asistida para que conozca con mas detalle como RMA de NY realiza estos procedimientos bajo control estricto de calidad.
Este video proporciona documentacion acerca de la aspiracion de ovulos, inseminacion de ovulos, desarrollo embrionario desde etapa de clivaje (2-3 dias) hasta etapa de blastocisto (5-6 dias), inyeccion intracitplasmatica de esperma (ICSI)), eclosion asistida, transferencia embrionaria y congelacion de embriones.

Mexico City
Dr. Benjamin Sandler
Reproductive Medicine Associates International
http://www.rmany.com/mexicointernatio...
Prolongacion Paseo de la Reforma 1232, Oficina 1213
Colonia Lomas de Bezares
Delegacion Miguel Hidalgo
Mexico, Distrito Federal 11910
Tel: 011-52-55-2167-2515
Fax: 011-52-55-2167-6434

3D Knee Replacement Surgery