Normal Heart Sounds With the aid of a stethoscope you can hear the characteristic sounds of the normal heartbeat, typically described as a "lub-dub." These sounds are produced by the closure of the heart valves. The first heart sound or "lub" results from closure of the tricuspid and mitral valves. It is a rather low-pitched and a relatively long sound which, as indicated in, represents the beginning of ventricular systole. The second heart sound, or "dub," marks the beginning of ventricular diastole. It is produced by closure of the aortic and pulmonary (pulmonic) semilunar vanes when the intraventricular pressure begins to fall. This "dub" sound is typically heard as a sharp snap because the semilunar valves tend to close much more rapidly than the AV valves. Because diastole occupies more time than systole, a brief pause occurs after the second heart sound when the heart is beating at a normal rate. Therefore, the pattern that one hears is one of: "lub-dub" pause, "lub-dub" pause, and so on. Sometimes, especially in young normal individuals, a third heart sound can be heard. This sound is produced by the very rapid influx of blood into the partially filled ventricle. It is typically very faint and as such difficult to hear.

With an Ophthalmoscope, light is shone into the eye and the retina and the optic nerve is examined. This is called as Examination of the Fundus. This is what the eye-doctor sees when he peeps into your eye! Through the transparent cornea, into the dark interior. The Fundus Exam When he looks into the eye with the Ophthalmoscope, he sees a orange glowing interior. That is the retina. The retina is actually transparent. It appears bright because of blood vessels in the choroid layer below. It is like looking at your ear against the bright sunlight. The yellow circle is the Optic Nerve, the cable of vision! A red, shiny dot attracts attention. That is the macula. If indicated, the exam of periphery of the retina is done with an Indirect ophthalmoscope. The ophthalmologist wears this instrument on the head and focuses the light into the eye with a lens held in his hand. This is usually done in a dark room.

Endoscopic Carpal Tunnel Release Surgery

This task requires streching a rubber band around 16 nails on a wooden board. A penalty is calculated when the rubber band is not streched around a nail at the end of the task. Score = time (seconds) + number of missed nails x 10. Performance standard: Score = 62 sec [Kolkman 2008]

Here we show the placement and removal of the maluygin ring in cataract sugery on a patient on Flomax to control intraoperative floppy iris syndrome (IFIS). The video shows the technique of placing the initial eyelet onto the iris, then toeing down on the inserter to open the lateral eyelets to all...ow them to grad the iris. the trailing haptic is placed with a kuglen hook.

A 55-year-old man presented with recurrent epistaxis. After endoscopic sphenopalatine artery cauterization, the bleeding stopped. The patient was doing well at last follow up.

Lap Band Procedure done on a patient with a BMI of 45. Minimal editing and includes narration.

University Hospitals Neurological Institute will host a live webcast to demonstrate the removal of a brain tumor that doctors believe is causing epileptic seizures in a middle-aged man.

An MRI showed what appears to be a glioma (tumor) near a part of the brain that controls muscle movement, called the motor strip. Studies have shown that complete removal can cure the seizures and improve quality of life and survival, but this is difficult to do with conventional technology without harming the surrounding normal brain because it's difficult to determine where tumor ends and normal brain begins.

Proximal Hypospadias repaired by Tube Onaly Urethroplasty

laparoscopic left adrenalectomy in 150kg patient with Cushings

Otto Placik MD. a board certified Chicago based plastic surgeon presents Vulvar Vaginal Genital anatomy lesson reviewing the Vulva, Mons Pubis, clitoral hood, prepuce, frenulum, labia minora & majora, vagina, urethra and fourchette with surgical implications and techniques. Photos pictures and video of anatomic models are reviewed in detail on different models. Great for patients thinking about or planning before labiaplasty or vaginal cosmetic surgery

Urethroplasty is a surgical procedure to correct scar tissue blockage of the urethra called urethral stricture. ~ Detroit Medical Center

As one of the first pediatric centers in the United States to use a new state-of-the-art MRI machine designed especially for kids, Children's Hospital of Michigan continues to deliver world-class, patient-friendly health care. ~ Detroit Medical Center

A new and safer method of inserting a Foley catheter suprapubically. The technique allows the insertion to be carried out in an Outpatient setting, thus saving time, cost and effort. By using the Seldinger technique, the product reduces the chances of bowel or bladder perforation and resultant morbidity.
The product has been chosen by The NHS National Technology Adoption Centre to help facilitate adoption of the product.
See www.mediplus.co.uk for more information

Surgery to treat men with prostate cancer is often followed by months of difficulty controlling urine flow, a condition known as urinary incontinence. But new research suggests that this problem may go away more quickly if the men perform certain exercises to strengthen their pelvic floor muscles.
Researchers from the Kaiser Permanente Medical Center in Los Angeles, California, found that men who were taught how to perform pelvic floor exercises before and after surgery were more likely to have regained continence three months later.

Men Doing Pelvic Exercises Recover Earlier

In the current study, the researchers randomly assigned 38 men scheduled for radical prostatectomy to either a treatment group or a control group. The men in the treatment group were referred to a physical therapist. They were instructed how to do Pelvic Floor Exercises both before and after surgery, using biofeedback to ensure they were using the proper muscles. The control group did not receive any formal instruction. All of the men completed questionnaires regarding bladder function at regular intervals over the next year.
Overall, 82% of the patients had regained continence (defined as not needing to use any absorbent pads) by the end of the year, including about equal numbers in both groups. But on average the men who had been educated about Pelvic exercises regained continence about one month earlier than those in the control group (at 12 weeks vs. 16 weeks).
Most of the men who did not regain continence within a year were still using at least three absorbent pads a day, indicating continued severe incontinence. The study authors explained that these men probably had extensive damage to the bladder sphincter or severe dysfunction of the bladder after surgery, and the exercises alone were unable to compensate for this.
But the exercises seemed to be effective. Pelvic floor exercise and education initiated prior to surgery is an effective noninvasive intervention useful for improving early return of urinary continence, the authors concluded. It would certainly have a positive impact on our patients undergoing radical prostatectomy in an effort to improve quality of life after major urological surgery.

The results of the study were published in the Journal of Urology (Vol. 170, No. 1: 130-133)

Treatment of Penis Deep Dorsal Venous Leakage of Erectile Dysfunction by Embedding the Deep Dorsal Vein

Vaginismus Pain Management

This minimally invasive technique allows surgeons to remove skull base tumors as large as softballs through the nose, with less trauma to the brain and critical nerves than with a traditional craniotomy.

To learn more, please visit https://www.upmc.com/

急性坏疽性阑尾炎并穿孔de 腹腔镜手术治疗

TV interview with Dr. Mostafa Yakoot, MD discussing the published study for efficacy of a new local cream for diabetic foot ulcers. دكتور مصطفى ياقوت علاج جديد للقدم السكرى