Radial Artery Harvest with Tourniquet
Radial Artery Harvest without Tourniquet
Endoscopic Harvesting System - Artery
Endoscopic Harvesting System - Vein
DoctorsVideos Search
Different Types Of Harvesting For Bypass Surgery
Radial Artery Harvest with Tourniquet
Radial Artery Harvest without Tourniquet
Endoscopic Harvesting System - Artery
Endoscopic Harvesting System - Vein
PAS-Port Connector For Bypass
New FDA approved device to anastomose saphenous vein grafts to the aorta with out sidebitting or clamping the aorta.
Melanoma
Melanoma exision
Histopathology Of Malignant melanoma
Duchenne's Muscular Dystrophy
Duchenne muscular dystrophy (DMD) is a severe recessive X-linked form of muscular dystrophy characterized by rapid progression of muscle degeneration, eventually leading to loss of ambulation and death. This affliction affects one in 3500 males, making it the most prevalent of muscular dystrophies. In general, only males are afflicted, though females can be carriers. The disorder is caused by a mutation in the gene DMD, located in humans on the X chromosome. The DMD gene codes for the protein dystrophin, an important structural component within muscle tissue. Dystrophin provides structural stability to the dystroglycan complex (DGC), located on the cell membrane.
Symptoms usually appear in male children before age 6 and may be visible in early infancy. Progressive proximal muscle weakness of the legs and pelvis associated with a loss of muscle mass is observed first. Eventually this weakness spreads to the arms, neck, and other areas. Early signs may include pseudohypertrophy (enlargement of calf muscles), low endurance, and difficulties in standing unaided or inability to ascend staircases. As the condition progresses, muscle tissue experiences wasting and is eventually replaced by fat and fibrotic tissue (fibrosis). By age 10, braces may be required to aide in walking but most patients are wheelchair dependent by age 12. Later symptoms may include abnormal bone development that lead to skeletal deformities, including curvature of the spine. Due to progressive deterioration of muscle, loss of movement occurs eventually leading to paralysis. Intellectual impairment may or may not be present but if present, does not progressively worsen as the child ages. The average life expectancy for patients afflicted with DMD varies from early teens to age mid 30s. There have been reports of DMD patients surviving past the age of 40 and even 50.
Gower's Sign
Stretches for Duchenne Muscular Dystrophy
Retinoblastoma
Retinoblastoma (Rb) is a rapidly developing cancer which develops in the cells of the retina, the light sensitive cells of the eye. In the developed world, Rb has one of the best cure rates of all childhood cancers (95-98%), with more than nine out of every ten sufferers surviving into adulthood. Retinoblastoma is a very treatable cancer.
Histopathology Of Retinoblastoma
There are two forms of the disease; a genetic heritable form and a non-genetic non-heritable form. Approximately 55% of children with Rb have the non-genetic form. If there is no history of the disease within the family, the disease is labelled "sporadic", but this does not necessarily indicate that it is the non-genetic form. In about two thirds of cases, [1] only one eye is affected (unilateral retinoblastoma); in the other third, tumours develop in both eyes (bilateral retinoblastoma). The number and size of tumours on each eye may vary. The position, size and quantity of tumours are considered when choosing the type of treatment for the disease.
Angelman Syndrome
Angelman syndrome is a rare condition which used to be called the "happy puppet" syndrome because the children behave as though they are a "puppet-on-a-string". However, Angelman syndrome is the name used today.
Children have learning difficulties and speech delay that are usually severe. They also have jerking movements, tongue-thrusting, a characteristic (typical) facial appearance, and a happy mood with sudden bursts of laughter and epilepsy. Many children also have a fascination for water, and usually running water.
The condition is due to an abnormality on chromosome 15. The condition is usually diagnosed between four and 10 years of age, but sometimes earlier.
Limb Examination
Talley's Physical Examination-The Shoulders
Talley's Physical Examination-Upper Limb
Talley's Physical Examination-The Hands and Wrists
lower limb examination
Upper / Lower Limb Assessment
Examination Of the Perephral Vascular System
Bates-Peripheral Vascular system Examination
Base of Tongue Reduction for Obstructive Sleep Apnea
Base of tongue reduction is demonstrated here using coblation for patients with severe obstructive sleep apnea.
All Videos Of Cardiovascular Exam
Mark H Swartz-Examination of Heart & Lungs (lying)
cardiology Examination
Cardiovascular Exam
Examination of the Heart
Bates-Cardio vascular system Examination
Talley's Physical Examination-Cardiovascular System
All Videos Of Carotid & JVP examination
Carotid and Jugular exam
Estimation Of jugular venous pressure
All Videos Of Abdominal Examination
Bates-Abdomen Examination
Talley's Physical Examination-GastroIntestinal System
Abdominal Exam
Asbestos(The Hidden Killer)
Asbestos is a tough, heat-resistant mineral that was added to the building materials of many older homes. It can pose health hazards to workers and homeowners who renovate or demolish those homes. ...
Laparoscopic Hysterectomy
Hysterectomy done laparoscopically is a relative new approach to the classical hysterectomy procedure, the advantages are better anatomic views, less bleeding, less surgical time and less recovery ...
Exchangeable Cardiac Valves from ValveXchange
Yesterday, at the 2009 Frost & Sullivan Excellence in Medical Technologies & Life Sciences Awards Banquet, we discovered an interesting new technology from an Aurora, Colorado based startup ValveXchange, Inc. The company is trying to implement a bioprosthetic valve system, designed for both mitral and aortic positions, that can last a lifetime, albeit an occasional tuneup. Here's how the two-component system works. One component is a permanent docking station, a valve ring, and the other one is a bovine pericardium valve that can be replaced at a future date by separating the valve from the docking station, and reinserting the replacement either via an inter-costal approach similar to other minimally invasive procedures, or via a transapical approach on a beating heart, off cardiopulmonary bypass.
Here are details of how the system, which is yet to undergo regulatory approval, would function, according to the company:
The design of the VXi exchangeable valve grows out of the proven design features of the latest generation bovine pericardial heart valves. It is a two-component device consisting of a permanent “docking station”, and a collapsible inner frame. The collapsible frame contains leaflets, made from chemically preserved bovine pericardium, that can be delivered in a collapsed state, expanded and seated in the permanent docking station, then re-collapsed several years later when replacement is required. The exchangeable components collapse into a size small enough to be inserted and removed percutaneously or through an incision in the aorta. Different leaflet designs and materials can be incorporated into the exchangeable component, allowing the patient to benefit from the latest biomaterials.
The VALVEXCHANGE procedure is performed using a range of approaches, ranging from open surgical to minimally invasive, to transcatheter, depending on the clinical indication of the patient and physician experience. The exchange tools are scalable between surgical and percutaneous approaches, and robust enough to extract the wireform regardless of the degree of fibrotic overgrowth.
Product brochure (.pdf)...
Company website: ValveXchange Inc...
Press release: Frost & Sullivan Recognizes ValveXchange's Pioneering Heart Valve Technology for Unique Long-term Management and Future Replacement Advantages...
CT Scan Cancer non-hodgekins lymphoma
CT ABDOMEN WITH CONTRAST- Confirmed cancer non-hodgekins lymphoma.
Indication- Epigastric pain.
History- Breast ca and mastectomy.
Findings- Bilateral breast prostheses are noted. There is no
pericardial or pleural fluid. The lung bases are unremarkable. The
osseous structures demonstrate a scoliosis but no suspicious lytic
or blastic lesions are identified.
Abnormal ill-defined soft tissue density is seen infiltrating the
epigastric region encasing the portal vein, and left renal vein.
This most likely represents adenopathy. A large mantle of
adenopathy on image #26 measures 4cm x 4.4cm and is centered in the
porta hepatis region. Probable adenopathy is also seen just
superior to the pancreatic body as well as in the gastrohepatic
ligament. There are no focal intrahepatic lesions identified.
There has been prior cholecystectomy with associated prominence of
the common bile duct, likely relating to the prior cholecystectomy.
The adrenal glands and kidneys and spleen are unremarkable. No free
fluid or free air or inflammatory bowel wall changes.
On image #40, there is a 6mm abnormal soft tissue density nodule
seen in the anterior peritoneal cavity adjacent a loop of colon.
This is of uncertain clinical significance. There is a similar
appearing small nodule seen measuring 5mm in size just anterior to
the superior tip of the right iliac wing. A smaller similar
appearing nodule is seen more inferiorly within the right iliac
fossa measuring only 2mm in size.
IMPRESSION-
1. Abnormal epigastric adenopathy. There is a nonspecific
appearance. The appearance alone would suggest lymphadenopathy
associated to lymphoma, but given the history of breast cancer,
metastatic adenopathy cannot be excluded. Several prominent
retrocrural lymph nodes are also noted and likely associated with
the same process.
2. There are several small peritoneal sub-cm nodules that are
suspicious for adenopathy but less pronounced in size when compared
to the epigastric process.
Impella 2.5 Heart Pump Performs Well in a Feasibility Trial
A multicenter prospective feasibility study of the Impella 2.5 temporary cardiac assist device (The PROTECT I Trial), published in Journal of the American College of Cardiology, has found that the device is "easy to implant, and provides excellent hemodynamic support during high-risk PCI." That is good news for Abiomed, the manufacturer of the device which is designed to pump blood out of the left ventricle and augment cardiac output by up to 2.5 liters per minute, to provide assistance to patients with severely compromised, depressed hearts. The big trick is now for the company to convince cardiologists that its device is better, and maybe even safer, than commonly used Intra Aortic Baloon Pumps (IABPs). We, of course, have been following the Impella system for many years now, ever since it was a German invention.
From the current study abstract:
The PROTECT I trial enrolled 20 patients undergoing high-risk PCI at seven centers between July 2006 and April 2007. Eligible patients had left ventricular ejection fraction (EF) of less than 35% and were required to undergo PCI on either an unprotected left main coronary artery or the last patent coronary conduit
Methods: In a prospective, multicenter study, 20 patients underwent high-risk PCI with minimally invasive circulatory support employing the Impella 2.5 system. All patients had poor left ventricular function (ejection fraction ≤35%) and underwent PCI on an unprotected left main coronary artery or last patent coronary conduit. Patients with recent ST-segment elevation myocardial infarction or cardiogenic shock were excluded. The primary safety end point was the incidence of major adverse cardiac events at 30 days. The primary efficacy end point was freedom from hemodynamic compromise during PCI (defined as a decrease in mean arterial pressure below 60 mm Hg for >10 min).
Results: The Impella 2.5 device was implanted successfully in all patients. The mean duration of circulatory support was 1.7 ± 0.6 h (range: 0.4 to 2.5 h). Mean pump flow during PCI was 2.2 ± 0.3 l/min. At 30 days, the incidence of major adverse cardiac events was 20% (2 patients had a periprocedural myocardial infarction; 2 patients died at days 12 and 14). There was no evidence of aortic valve injury, cardiac perforation, or limb ischemia. Two patients (10%) developed mild, transient hemolysis without clinical sequelae. None of the patients developed hemodynamic compromise during PCI.
Conclusions: The Impella 2.5 system is safe, easy to implant, and provides excellent hemodynamic support during high-risk PCI. (The PROTECT I Trial; NCT00534859)
Animation demonstrating the functioning of the pump...
Press release: Journal of the American College of Cardiology Publishes PROTECT I Study Results for Abiomed Impella 2.5
Abstract in Journal of the American College of Cardiology...
Product page: Impella 2.5
chalazion
This video shows a chalazion, a non-infectious bump that can form on the eyelids, and is usually secondary to meibomian gland dysfunction. This particular chalazion is somewhat atypical in that
chalazion operation
Chest x-ray interpretation, Respiratory distress syndrome
Chest x-ray shows diffuse atelectasis classically described as having a ground-glass appearance with visible air bronchograms; appearance correlates loosely with clinical severity.
Chest x-ray interpretation, subphrenic abscess
The space between the diaphragm, which separates the chest cavities from the abdominal cavity, and the transverse colon is called the "subphrenic space". If there is an abscess developing in this space, this is called a subphrenic abscess. As there is a right and a left chest cavity, there can be from an anatomical point of view a right-sided and a left-sided subphrenic abscess.
Routine Lap Chole/cholangiogram
Routine laparoscopic cholecystectomy and operative cholangiogram is 15-20minutes procedure in my practice; the pneumoperitoneum is created with an optical trocar within seconds; The Calot triangle
Season 5 Episode 18[Here Kitty ]
OROR
OR
Laparoscopy -- perforated DU and septic shock
A 40 years old female recently diagnosed with Child C liver cirrhosis and portal hypertension was brought to the Emergency Department with an acute abdomen; she was in septic shock, anaemic (Hb 82)
Negative Pressure Wound Therapy Goes Mobile with RENASYS GO
Smith & Nephew has released a new negative pressure wound therapy (NPWT) device specifically designed for people who want/need to ambulate. Unlike its larger cousins, the RENASYS GO can be worn around the neck like a fashionable MP3 player. Except, it sucks at your gross wound, but no one has to know.
From the press release announcing the product:
The RENASYS GO is intuitive, lightweight, portable and quiet, and can be used with the RENASYS-F foam and RENASYS-G gauze wound interfaces, the broadest selection of interfaces available from a single supplier. This enables clinicians to tailor NPWT to meet their patients’ unique needs and the specific requirements of their wounds, with clear improvements in patient comfort, ease of use, and cost-effectiveness.
Southern Ontario-based Nursing Practice Solutions Inc. conducted a study in Canada comparing average total costs required to treat patients with conventional dressings to the same costs required to treat patients with gauze- and foam-based NPWT, in cases for which NPWT was appropriate. The study found that the cost-per-patient treated with NPWT was 55% less than the cost-per-patient treated with conventional dressings, and that wounds treated with NPWT healed more quickly than wounds treated with conventional dressings. Among patients treated with NPWT, there was no difference in healing times between wounds dressed with foam and those dressed with gauze.
In addition to its small, easy to carry footprint and quiet operation, Smith & Nephew designed RENASYS GO with the additional features customers want to support the patient’s dignity and facilitate its ease of use.
* It is lightweight – weighing less than three pounds and comes with an attractive, discrete carrying case.
* The frosted 300cc canister minimizes the visibility of exudate.
* Multiple alarms and the patient lock-out feature enhance patient safety.
* An extended, 20-hour battery life and less than four-hour charge-up time extend mobility.
* User-friendly digital settings reduce the risk of error.
Press release: Smith & Nephew introduces RENASYS* GO portable NPWT for mobile, active patients
Product page: RENASYS GO
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