Laparoscopy in acute bowel obstruction following previous surgery is a difficult procedure and avoided by most of the surgeons due to the difficulty in obtaining pneumoperitoneum, port placement, lack of working space, adhesions and risk of bowel injury.
Here is a patient who had a previous laparotomy for trauma with a midline incision from xyphysternum to pubis; after unsuccessful conservative management he underwent a laparoscopy; a prior CT scan showed adhesions in the left side and a distal-mid small bowel obstruction. The pneumoperitoneum was obtained with the Visiport placed in the right lower quadrant; although the abdomen was grossly distended, under significant tension and distended loops of small bowel were occupying most the peritoneal cavity, with muscle relaxation there is usually enough space to perform a thorough inspection of the abdominal cavity. Port placement has to be done with special care as there is no room to push and usually a blunt trocar directed away from the bowel is employed in my practice. The collapsed loops of small bowel point quickly to the site of obstruction -- it is better to avoid manipulating the distended bowel as it is heavy, oedematous and prone to be lacerated with the instruments; once the pathology is identified, in this case the obstructive band, light packing is performed in order to expose the working space and protect the bowel from instruments like scissors or diathermy. In this case the band adhesion was slightly more difficult to separate from the bowel and required a combination of sharp and gentle blunt dissection.
Once the obstruction is release and the transit of contents is confirmed in the collapsed bowel the procedure is terminated. No abdominal drainage is usually necessary.

The HEENT, or Head, Eye, Ear, Nose and Throat Exam is usually the initial part of a general physical exam, after the vital signs. Like other parts of the physical exam, it begins with inspection, and then proceeds to palpation. It requires the use of several special instruments in order to inspect the eyes and ears, and special techniques to assess their special sensory function. This module reviews some of the relevant surface anatomy and describes the basic HEENT exam. The module includes an introduction to use of the ophthalmoscope.

Aortic Valve-Sparing Operation in a Patient with Aortic Root Aneurysm using a new Prosthesis for Anatomical Reconstruction of the Sinuses of Valsalva

Surgical procedure of Tonsillectomy and Adenoidectomy

The male reproductive system includes the scrotum, testes, spermatic ducts, sex glands, and penis. These organs work together to produce sperm, the male gamete, and the other components of semen.

Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1). MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum.

Scientists have developed a wireless brain implant that enabled a paralyzed monkey to walk again.

Does Knee Replacement Surgery Meet Patient Expectations? In this video, I discuss knee replacement surgery or total knee arthroplasty expectations. A recent study reported that 1 in 4 patients who underwent knee replacement did not have their expectations met. The video reviews the differences in outcomes and satisfaction levels between satisfied and unsatisfied patients and identifies the key expectations that must be met for patients to be satisfied after knee replacement.

https://pubmed.ncbi.nlm.nih.gov/36740633/

► Things my patients have found helpful:
Please note that I get a lot of requests and questions about what equipment is ‘best’ for treating a variety of conditions. The following is not meant to be an exhaustive or definitive list. Please use it as a starting point. If you have questions, please discuss with your healthcare provider. With that said, I have tried a number of the products below, but not all. I have included some based on positive feedback from many of my patients. As an Amazon Associate, Dr Peng earns from qualifying purchases. If you purchase any product using the below affiliate links, you are helping Dr Peng maintain this channel.

*Soft Tissue & Rehab*
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► ABOUT ME

Jeffrey Peng MD is a nonoperative orthopedist and sports medicine specialist. He created a YouTube channel and blog to translate cutting edge medical knowledge and clinical research to benefit all those looking to live an active and healthy lifestyle. He focuses on maximizing non-surgical treatments for sports injuries and orthopedic conditions. He specializes in using orthobiologics and ultrasound guided minimally invasive techniques to treat osteoarthritis, tendinopathies, and musculoskeletal disorders.

Dr. Peng is board certified in sports medicine and family medicine. He completed residency with the Stanford family medicine residency program and completed his sports medicine training with the Stanford primary care sports medicine fellowship in San Jose. He is an active faculty member for both programs and is excited about training the next generation of physicians.

Dr. Peng’s sports medicine clinic is located in Campbell, California.
Twitter: @JeffreyPengMD; https://twitter.com/JeffreyPengMD
Website: https://www.jeffreypengmd.com/

► Disclaimer

My content reflects my own opinion and does not represent the views or opinions of my employers or hospital systems I am affiliated with. They are meant for educational purposes only. They do not substitute for the medical advice of a physician. Always seek the advice of your physician with any questions you may have regarding your health.

In this video, Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.

Importance of Regular Dental Exams

CRT provides a cost-effective measure for industry to reduce workplace injuries before they occur. CRT uses the latest Isokinetic Testing technology and equipment to match the physical capability of the worker with the physical demands of the job.

Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.

Encephalopathy means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can have many different organic and inorganic causes.

After the cell membranes are dissolved, the typical branching and budding yeast cells can be seen. Sometimes, it has the appearance of a tangled web of threads. At other times, only small branches will be seen.Yeast are normal inhabitants of the vagina, but only in very small numbers. If you visualize any yeast in your sample, it is considered significant.

Common Benign Pain Syndromes--Symptoms and Etiology:
1. Non-specific musculoskeletal pain: This is the most common cause of back pain. Patients present with lumbar area pain that does not radiate, is worse with activity, and improves with rest. There may or may not be a clear history of antecedent over use or increased activity. The pain is presumably caused by irritation of the paraspinal muscles, ligaments or vertebral body articulations. However, a precise etiology is difficulty to identify.
2. Radicular Symptoms: Often referred to as "sciatica," this is a pain syndrome caused by irritation of one of the nerve roots as it exits the spinal column. The root can become inflamed as a result of a compromised neuroforamina (e.g. bony osteophyte that limits size of the opening) or a herniated disc (the fibrosis tears, allowing the propulsus to squeeze out and push on the adjacent root). Sometimes, it's not precisely clear what has lead to the irritation. In any case, patient's report a burning/electric shock type pain that starts in the low back, traveling down the buttocks and along the back of the leg, radiating below the knee. The most commonly affected nerve roots are L5 and S1.
3. Spinal Stenosis: Pain starts in the low back and radiates down the buttocks bilaterally, continuing along the backs of both legs. Symptoms are usually worse with walking and improve when the patient bends forward. Patient's may describe that they relieve symptoms by leaning forward on their shopping carts when walking in a super market. This is caused by spinal stenosis, a narrowing of the central canal that holds the spinal cord. The limited amount of space puts pressure on the nerve roots when the patient walks, causing the symptoms (referred to as neurogenic claudication). Spinal stenosis can be congenital or develop over years as a result of djd of the spine. As opposed to true claudication (pain in calfs/lower legs due to arterial insufficiency), pain resolves very quickly when person stops walking and assumes upright position. Also, peripheral pulses should be normal.
4. Mixed symptoms: In some patients, more then one process may co-exist, causing elements of more then one symptom syndrome to co-exist.

9 Months In The Womb: A Remarkable Look At Fetal Development Through Ultrasound

The heart and circulatory system (also called the cardiovascular system) make up the network that delivers blood to the body's tissues. With each heartbeat, blood is sent throughout our bodies, carrying oxygen and nutrients to all of our cells.

The brain is made up of billions of nerve cells that are specially designed to communicate with each other. They form many connections with one another, creating an intricate network between cells.

Biceps tendonitis, also called bicipital tendonitis, is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities.

AFib is caused by abnormal electrical impulses in the atria, which are the upper chambers of the heart. The result is a rapid and irregular pumping of blood through the atria. These chambers fibrillate, or quiver, rapidly.