Deeply Place Knot

Continuous Everting Mattress Pattern Suture

Lembert Pattern Suture

How to Read ECG Part 3:
1-All
2-How to Read an ECG
3-ST Segment Changes
4-T Wave Changes
5-Effects of Drugs
6-Revision

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.

NTI Tension Suppression System

Clogged leg arteries can be opened through a minimally invasive procedure with the SILVERHAWK, a mini drill with a tiny rotating blade for cutting away plaque. The procedure only involves a tiny puncture in the patient's groin. ~ Detroit Medical Center

Introducing an IM Injection

Central Line Placement

The Miracle in the Human Brain

Views of the Brain

Swine Flu Avoid

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

Upper Endoscopy for a normal Esophagus

A revision knee replacement operation is shown in four parts. In this first part, an account of the patient is given on why he wanted a revision. This patient was dissatisfied with the range of movement that he got after a primary TKR. The first part shows the exposure and removal of the old implants. From www.kneeindia.com

The video will describe what is oxygen saturation? What is Oxygen content and what is oxygen capacity. Please see my web site for disclaimer.

Dr. Rutledge and Dr. Berendes talk about severe infections seen in patients going to other countries to get less expensive surgical procedures.

The third video about cell