Hypoglycemia is a common and serious medical emergency which may occur in both daibetic and non-diabetic patients. The signs and symptoms of hypoglycaemia may be present in many individuals, but may also be masked in several individuals due to a condition called hypoglycaemia induced autonomic failure. This presentation aims to deal with the causes, clinical features, diagnosis and management of various causes of hypoglycaemia. The causes of hypoglycaemia may be divided into hypoglycaemia in ill or medicated individuals and hypoglycaemia in previously asymptomatic individuals. A variety of causes are discussed under both headings. Management of hypoglycaemia is also discussed in detail. There is also a brief discussion about management of insulinoma.

Are most spiders poisonous? The majority of the 3,000 spiders in the United States aren’t poisonous. Even if most spiders did bite, their fangs are too small or weak to puncture human skin. Their bites may leave itchy, red wounds that heal within a week or so. The spiders that do manage to bite through our skin and insert toxic venom can cause serious health complications. Read on to learn what spider bites look like, what spider varieties leave certain bites, and how to treat spider bites. What do spider bites look like? Identifying a spider bite is easier if you saw the spider that bit you, but it’s possible that you won’t notice the wound until hours later. Look for things like: swelling a red welt skin damage any troubling symptoms that accompany the bite Other possible symptoms that may accompany a spider bite include: itching or rash pain around the area of the bite muscle pain or cramping blister that’s red or purple in color sweating difficulty breathing headache nausea and vomiting fever chills anxiety or restlessness rashes swollen lymph glands high blood pressure Spider bites often take longer to heal than other insect bites, and they may affect skin tissues. It’s important to keep the bite clean to reduce the risk of infection. How to treat a spider bite at home In some cases, you can treat spider bites at home. For nonvenomous spider bites, follow these steps: Apply an ice pack on and off the bite for 10 minutes at a time. Elevate the area to reduce swelling. Take an antihistamine, such as diphenhydramine (Benadryl), to help with itching. Clean the area with soap and water to prevent infection. Apply antibiotic ointment to the area if blisters develop. Seek medical attention if you’re showing symptoms of a spider bite or if the symptoms don’t go away over time. Always seek medical attention if you suspect you’ve been bitten by one of the following species: brown recluse black widow hobo spider tarantula Brazilian wandering spider

Keratoderma Blennorrhagicum is a manifestation on the skin that appears in patients diagnosed with reactive arthritis (this condition was previously known as Reiter syndrome). The condition manifests itself by lesions that appear on the skin, initially on the palm of the hands and soles of the feet. The lesions have the tendency to spread, affecting other parts of the body, such as the scrotum, scalp or trunk. Because of their appearance, the lesions might be easily confused with the ones from psoriasis. Keratoderma blennorrhagicum is one of the symptoms that can be used for the clinical diagnosis of reactive arthritis.

The period between stages one and two of labour

A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC

CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained.

Short video of tension free repair of indirect inguinal hernia using a prolene mesh after herniotomy

this video shows the Supine assessment of reflexes

Various laparoscopic techniques have been described for the insertion of peritoneal dialysis catheters. However, most use 3 to 4 ports, thus multiplying the potential risk for abdominal wall complications (hemorrhage, hernia, leaking). With the technique presented herein a Tenckhoff catheter is plac...ed laparoscopically, using just 1 port, in 13 consecutive patients with end-stage renal failure. The catheter is fixed in the abdominal cavity with no additional ports for this purpose. The simplicity and the rapidity of the method justifies serious consideration for its use as the standard Tenckhoff catheter placement.

lesions at the anterior skull base invading the paranasal area and the paracavernous area can be reached without brain retraction by the shown subfrontal approach. it enables to control the paranasal sinus, optic nerve, periorbital tissue, carotid artery and pituary gland. reconstruction is not easy... but cosmetically appealing. CSF leaks are rare with the use of fascia lata and tissucol ( fibrin glue). osseous reconstruction is done by microsrews and calciumpyrophosphate ( norian, synthes).

Endoscopic third ventriculostomy in a patient with obstructive hydrocephalus

Resection of a glioblastoma multiforme, a very malignant, aggressive brain tumor.

J Vasc Surg. 2009 Jul;50(1):134-9. Celiac artery compression syndrome managed by laparoscopy. Baccari P, Civilini E, Dordoni L, Melissano G, Nicoletti R, Chiesa R. Department of General Surgery, Scientific Institute San Raffaele University Hospital, Milan, Italy. paolo.baccari@hsr.it Abstr...

act OBJECTIVE: Celiac artery compression syndrome (CACS) is an unusual condition caused by abnormally low insertion of the median fibrous arcuate ligament and muscular diaphragmatic fiber resulting in luminal narrowing of the celiac trunk. Surgical treatment is the release of the extrinsic compression by division of the median arcuate ligament overlying the celiac axis and skeletonization of the aorta and celiac trunk. The laparoscopic approach has been recently reported for single cases. Percutaneous transluminal angioplasty (PTA) and stenting of the CA alone, before or after the surgical relief of external compression to the celiac axis, has also been used. We report our 7-year experience with the laparoscopic management of CACS caused by the median arcuate ligament. METHODS: Between July 2001 and May 2008, 16 patients (5 men; mean age, 52 years) were treated. Diagnosis was made by duplex ultrasound scan and angiogram (computed tomography [CT] or magnetic resonance). The mean body mass index of the patients was 21.2 kg/m(2). One patient underwent laparoscopic surgery after failure of PTA and stenting of the CA, and two patients after a stenting attempt failed. RESULTS: All procedural steps were laparoscopically completed, and the celiac trunk was skeletonized. The laparoscopic procedures lasted a mean of 90 minutes. Two cases were converted to open surgery for bleeding at the end of the operation when high energies were used. The postoperative course was uneventful. Mean postoperative hospital stay was 3 days. On follow-up, 14 patients remained asymptomatic, with postoperative CT angiogram showing no residual stenosis of the celiac trunk. One patient had restenosis and underwent aortoceliac artery bypass grafting after 3 months. Another patient had PTA and stenting 2 months after laparoscopic operation. All patients reported complete resolution of symptoms at a mean follow-up of 28.3 months. CONCLUSIONS: The laparoscopic approach to CACS appears to be feasible, safe, and successful, if performed by experienced laparoscopic surgeons. PTA and stenting resulted in a valid complementary procedure only when performed after the release of the extrinsic compression on the CA. Additional patients with longer follow-up are needed.

Colon - Chromoendoscopy during Ulcerative Colitis Surveillance

Recurrent varicose veins are a common problem. The patient in this video was operated for great saphenous vein insufficiency and a “neocrosse” occurred after few years. Surgical exploration revealed a “cavernoma” just over the nodes of the crural area, feeding varicose veins of thigh and leg.

1800Endoscope.com Equine Video Endoscope Endoscopy Systems

د.أحمد عزوعبد الله- د.حسين الحمود- د.حازم العجيلي- د.حسان الضويحي- د.أحمد العيسى
hassandouayhi@yahoo.com

"The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913)

Robotics is the engineering science and technology of robots, and their design, manufacture, application, and structural disposition.

MPG Video for purpose