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En Bloc Esophageal Mucosectomy, an experimental technique for the endolumenal management of Barrett's related dysplasia and neoplasia. High grade dysplasia is in indication for esophagectomy; however esophagectomy has a mortality rate up to 12 percent, and up to 56 percent of patients may develop s...erious post-operative complications. Multiple ablated lesions can progress under the neo-squamous layer, leading to buried Barrett's mucosa. With conventional piecemeal EMR, cautery effect limits evaluation in areas of interest, Barrett's epithelium is left behind, tissue is not evaluated in situ and invasive lesions may be missed due to incomplete sampling. A new technique, en bloc esophageal mucosectomy, or EEM, was developed. The technique begins with conventional EMR in the proximal esophagus to access the submucosal space. Conventional EMR is being performed here. The mucosa is resected using an electrothermal snare. The mucosal defect from the first EMR is seen here. EMR is then repeated on the opposing wall. Sequential EMR creates a complete concentric mucosal defect. In the following sequence the completely detached column of mucosa can be seen, bounded by submucosa and muscularis propria layers. Here in the stomach, the endoscope is retroflexed and is covered by a sleeve of esophageal mucosa which has been freed to the GE junction and inverted. This sequence demonstrates a double snare technique. This snare is alongside the endoscope. The snare has been passed through the working channel. The working channel snare is pulled back, and the snare alongside the scope is used to grasp the mucosal column. With tension on the column the working channel snare can be threatened and advanced. This sequence shows the snare as it is being passed down to the GE junction. At the GE junction, the snare is tightened and cautery is applied. This frees the column of mucosal tissue from the remaining attachment. The endoscope is then withdrawn. Then detached mucosal column can be grasped with a snare and retrieved. In the following sequence, the long column of mucosa is being withdrawn via the overtube. Here, endoscopic forceps have been passed through the column to demonstrates the concentric nature of the specimen. The length of mucosa can be seen here alongside 2 conventional EMR specimens. Approximately 15cm of tissues was removed in this case. On endoscopy immediately following the resection, there is no bleeding or evidence of perforation in the area of resection. The endoscope is advanced and the exposed submucosa can be appreciated down to the GE junction. This is the low power view of the histologic specimen generated by EEM. Metaplastic tissue adjacent to a dysplastic focus would be completely removed. With a high power view, the layers of the esophagus can be appreciated. The epithelium, lamina propria, muscularis mucosa and submucosa are visible, with no cautery artifact in the area of interest. The technique would remove metplasia, low grade dysplasia, high grade dysplasia, and intramucosal carcinoma, as well a T 1 a lesions. All the animals in this series tolerated the procedure well. A total of five non-survival procedures and 4 survival procedures were performed. In the survival procedures, all four swine thrived in the post-operative period. Two swine were then survived for 9 days following the procedure. On post —op day nine, after passing into the upper esophagus, the proximal margin of the mucosectomy is seen here. Healing appears to be occurring. There is no evidence of leak, and no stricting is seen at 9 days down to the GE junction Passing into the stomach, some residual feed can be seen. Two swine were then survived for 13 days. On this follow-up endoscopy, the area of the mucosectomy is again healing. There was a loose stricture in both animals and both were easily traversed with a 9.8 mm gastroscope. There was a gross appearance of re-epitheliazation in some areas. It is notable that the stricture was present in the proximal esophagus with no narrowing distally. At necropsy there was not eviden
Insulin Processes Mechanism Animation 3D
The Mini Gastric Bypass (MGB) is a short, simple, successful and inexpensive laparoscopic gastric bypass weight loss surgery. The operation usually takes only 30 min., hospitalization less than 24 hours. The Mini Gastric Bypass is low risk, has excellent long term weight loss, minimal pain and can b...e easily reversed or revised.
This is my ethnic rhinoplasty before and after video.
www.rhinoplastyspecialist.com
Watch my experience from initial consult to final result as I have an ethnic rhinoplasty procedure performed by Dr. Paul S. Nassif of Spalding Drive Cosmetic Surgery & Dermatology located in Beverly Hills.
The results are incredible! It's like a dream come true. I am so happy that I chose Dr. Nassif as my surgeon. He is truly a gifted and wonderful surgeon.
Beverly Hills Rhinoplaty surgeon also specializes in ethnic rhinoplasty for African American, Hispanic and Asian patients. As part of his information campaign on cosmetic surgery in Beverly Hills, those who are interested in rhinoplasty and plastic surgery can get loads of up-to-date information straight from Dr. Nassif through his websites Media Page. This web page contains articles written by Dr. Nassif that have been published in famous plastic surgery journals and books.
The Media Page also contains actual rhinoplasty and revision rhinoplasty surgery captured on video. These videos were aired in Discovery Channel, ET, and other shows. Patients who want to know more about Dr. Paul Nassif can check out his curriculum vitae. Whether you decide to attempt this procedure or not, rhinoplastyspecialist.com can give you an accurate and detailed perspective.
Video Produced by SPORE Medical
Nice surgery video
This patented device replaces cumbersome metal retractors for a variety of surgical procedures. The surgeon has maximum unobstructed exposure and the size of the required incision is minimized.
This is part 2 Herbal Medicine. Lecture presented to the International Congress of Pediatric Hepatology Sharm 2009. It is one of a series of lectures discussing the Alternative medicine practices with critical appraisal and measure the evidence.
Liposuction for weight loss with Abdominoplasty and Body Lifting
some knowledge
At Children's Hospital, Dr. Mary Bedard and the NICU nursing staff save the life of a tiny infant struggling from a serious intestinal infection. ~ Detroit Medical Center
To avoid pregnancy and STDs, always remember to use a condom every time you have sex — including oral, vaginal, or anal sex. Whenever oral sex is being performed on a girl, a dental dam should be used. A guy receiving oral sex should wear a latex condom — or, if he or his partner is allergic to latex, a polyurethane condom.
Gall Stones
Male Breast Liposuction Reduction
Tonsil Stones Caseum
LIZ: The first time the doctor made my tip too narrow and I didnt look like myself. The second time the doctor made my tip too wide, and actually took out (removed) extra bone from the side of my nose. That didnt need to be taken out (removed)
My initial consultation with Dr. Nassif was fantastic! He treated me liker his own daughter, and was very caring and thorough. He went over everything!
DR. NASSIF: Liz came into me for a revision rhinoplasty. She told me that shes had two previous rhinoplasties. She was unhappy with the way her nose appeared on her face. She felt it was asymmetric, the tip was kind of bulbous, or large appearing, especially when she looked up, this view, it was very asymmetric. And so, her whole goal was to make it look better, hopefully make it her LAST surgery, and also to help with her breathing.
One of the things thats very important about revision rhinoplasty that you always have to consider is; What are you going to find in there? Even though you can feel the nose, you can palpate it, you can look at it, and you can guess what the other doctors have performed; your first up-hill battle is to see how much scar tissue youre going to be able to identify with. So when you have to open up the nose, you have to remove the scar tissue, identify it: whats there, whats present, whats been removed. Then after you do that, and you have cartilage now ready for grafting, or fascia, or perichondrium, you have to start rebuilding it. Rebuilding it (cartilage) is the second big stage after weve already carved everything; weve carved the cartilage. In that scenario when Im playing with the nose, in regards to staring at the profile, staring at the front of the nose, I go back and forth and look inside and outside of the nose to make sure its as symmetric as possible. That takes a long time One of Lizs main complaints was that on her profile, that her tip stuck out too far. And so one of the things I had to do in surgery is called a medial cura tuck-up, I had to push the tip back, by pushing the tip back, it can make the tip look a little bit wider. But in this situation, I was able to bring everything in as much as I can. After Im finished with everything, and Im happy, then we go ahead and we start to close the nose. Thats putting every little small stitch in perfectly, so that the scar will be minimally visible.
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]
This shows an animated procedure for Interventional Cardiologists in injecting stemcells.
Histology of Active Breast
This brief exam will help you to quickly detect major risks and prompt you to refer patients to appropriate specialists.
