Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy

Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.

An Echocardiography showing an Acute Pulmonary Embolism

Watch that video of full Testicles Autopsy

examination of Cranial nerves IX, X, XI & XII: Glossopharyngeal,Vagus,Accessory and hypoglossal nerves

Difference between healthy lungs and smoker lungs

Short Version of Yag Laser Treatment of Capsule Opacity or "after cataract" Video Presentation by Tampa Bay Area Ophthalmologist Ahad Mahootchi, MD from the Eye Clinic of Florida.

Treatment of bowel injury by IUD

This is a video of a carpal tunnel release surgery

Hemorrhoidectomy Ligasure

An antecedent upper respiratory infection is present in 50% of patients. Abdominal pain is a presenting symptom in 1 0-15% of patients. The skin lesions are symmetric, involve dependent parts of the body, and classically progress from an erythematous, macular rash to papular purpura. The joints and kidneys are also commonly involved

See http://nursing-resource.com for more on debridement.

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Watch that video of a Black Salve Left an Inch Hole In Man's Hole

A man set to become the world’s first head transplant patient has scheduled the procedure for December 2017. Valery Spiridonov, 30, was diagnosed with a genetic muscle-wasting condition called Werdnig-Hoffmann disease, and volunteered for the procedure despite the risks involved, Central European News (CEN) reported. “When I realized that I could participate in something really big and important, I had no doubt left in my mind and started to work in this direction,” Spiridonov, a Russian computer scientist, told CEN. “The only thing I feel is the sense of pleasant impatience, like I have been preparing for something important all my life and it is starting to happen.”

Sealants

Baby Born Still Inside The Amniotic Sac

When positive, the patient's thumb will flex and adduct.
Production of this reflex is indicative of cervical cord compression or intracranial central nervous system disorders.

De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist. Although the exact cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse. Symptoms ShareTweet June 13, 2015 References Products and Services Mayo Clinic Sports Medicine Newsletter: Mayo Clinic Health Letter See also Prednisone risks, benefits Prednisone withdrawal: Why taper down slowly? Integrative approaches to treating pain Lifestyle strategies for pain management Nutrition and pain Pain rehabilitation Self-care approaches to treating pain Show more Advertisement Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Advertising & Sponsorship PolicyOpportunitiesAd Choices Mayo Clinic Store Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. NEW! – The Mayo Clinic Diet, Second Edition Healthy Heart for Life! Mayo Clinic on Better Hearing and Balance Treatment Strategies for Arthritis The Mayo Clinic Diet Online

Early labour contractions usually feel like period pain, or you might experience a lower backache at 20 to 30 minute intervals. Sometimes these pains radiate from back to front, or vice versa. There's no need to start timing the contractions straight away – if they are mild contractions, ignore them. The first stage of labor is the longest and involves three phases: Early Labor Phase –The time of the onset of labor until the cervix is dilated to 3 cm. Active Labor Phase – Continues from 3 cm. until the cervix is dilated to 7 cm. Transition Phase – Continues from 7 cm. until the cervix is fully dilated to 10 cm.

Giant cell tumors of the tendon sheath are common lesions and are the second most frequent tumors in the hand, after synovial cysts. They are diagnosed by means of clinical examination and complementary examinations (simple radiography and magnetic resonance). Erosion and invasion of the phalangeal bone affected may be seen on radiological examination. Magnetic resonance may show a “fluorescent or radiant effect” may be observed, caused by the high quantity of hemosiderin inside the tumor. Surgical treatment is the commonest practice, and complete excision is important for avoiding recurrence of the tumor, especially when bone invasion is observed on imaging examinations, which is generally related to greater tumor recurrence. In this paper, a case of a giant cell tumor of the tendon sheath in the middle phalanx of the third finger of a 45-year-old female patient is presented. This was successfully treated by means of surgery using a double access approach (dorsal and volar)