Thursday, August 2, 2012

Childbirth is the culmination of a human pregnancy or gestation period with the expulsion of one or more newborn infants from a woman's uterus. The process of normal human childbirth is divided  in to  three stages: the shortening and dilation of the cervix, descent and birth of the infant, and delivery of the placenta.
The first stage of labor is generally defined as starting when the effaced (thinned) cervix is 3 cm or 4 cm dilated. Women may or may not have active contractions prior to reaching this point. Rupture of the membranes or a bloody show may or may not occur at or around this stage.
This stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the pelvic inlet.
Third stage is the  period from just after the fetus is expelled until just after the placenta is expelled is called the third stage of labor.
In many cases, with increasing frequency, childbirth is achieved through caesarean section, rather than through vaginal birth.In the U.S. and Canada it represents nearly 1 in 3 (31.8%) of all childbirths, respectively.More than 22% of women undergo induction of labor and childbirth in the United States, doubling the rate in 2006 from 1990.Medical professional policy makers find that induced births and elective cesarean can be harmful to the fetus and neonate without benefit to the mother, and have established strict guidelines for non-medically indicated induced births and elective cesarean before 39 weeks.

Mechanism of Vaginal Childbirth

Wednesday, June 6, 2012


A suprapubic cystostomy is a surgically created connection between the urinary bladder and the skin which is used to drain urine from the bladder in patients with lower urinary tract obstruction. Urinary flow may be blocked by pathology in prostate (benign prostatic hypertrophy,Prostate carcinoma),Urethral trauma, congenital defects of the urinary tract, or by obstructions such as kidney stones passed into the urethra. It is also a common treatment used among spinal cord injury patients who are unable or unwilling to use intermittent catheterization to empty the bladder, and cannot otherwise void due to detrusor sphincter dyssynergia.

Initially, a catheter is placed through the skin just above the pubic bone into the bladder, often with ultrasound guidance.This catheter initially remains in place for up to a month while the tissue around it scars and forms a sinus between the bladder and the body exterior. After the formation of scar tissue is complete, the catheter is replaced periodically in order to help prevent infections.
Indications for suprapubic catheters include: 1. failed urethral catheter, 2. long term usage (if left in urethral long terms catheters can lead to acquired hypospadias and recurrent/chronic UTIs, urinary tract infections) Contraindications: 1. need to rule out bladder cancer in cases of clot retention, 2. lower abdominal incisions with likelihood of adhesions, 3. pelvic fracture

Suprapubic Cystostomy

Monday, June 4, 2012



The intrauterine contraceptive device (IUCD) is a long acting reversible contraceptive, with different IUCDs intended to last for different lengths of time, between 3 and 10 years.The mechanism of IUCDs is not well understood. It is known however that the presence of a device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium. By triggering a decidual reaction, the IUCD puts up a "no vacancy" sign to any fertilized embryos. The uterus only nurtures one site that has activated the decidual reaction. These substances are hostile to both sperm and eggs; the presence of copper increases the spermicidal effect.
Both insertion and removal is performed by a medical professional, and informed consent may be required. Before placement of an IUD, a medical history and physical examination by a medical professional is useful to check for any contraindications or concerns.A copper IUCD can be inserted at any phase of the menstrual cycle, but the optimal time is right after the menstrual period, when the cervix is softest and the woman is least likely to be pregnant.Uterine sounding may be used to measure the length and direction of the cervical canal and uterus in order to decrease the risk of uterine perforation.A speculum is used to hold the vagina open, a tenaculum is used to steady the cervix and uterus, and a tube is used to place the IUCD.
Intrauterine devices can be used as emergency contraception to prevent pregnancy up to 5 days after unprotected sexual intercourse, or sexual intercourse during which the primary contraception is believed to have failed.Insertion of a copper-T IUCD as emergency contraception is more than 99% effective, making it more effective than emergency contraceptive pills.

Intra-Uterine contraceptive Device (IUCD) Insertion

Saturday, June 2, 2012


Ventouse is a vacuum device used to assist the delivery of a baby when the second stage of labour has not progressed adequately. It is an alternative to a forceps delivery and caesarean section. It cannot be used when the baby is in the breech position or for premature births. This technique is also called vacuum extraction. The use of VE is generally very safe, but it can occasionally have negative effects on either the mother and the child(chignon formation,possibility of cephalohematoma formation, or subgaleal hemorrhage.
Indications for use of vacuum
There are several indications to use a ventouse to aid delivery:
    Maternal exhaustion
    Prolonged second stage of labor
    Foetal distress in the second stage of labor, generally indicated by changes in the foetal heart-rate (usually measured on a CTG)
    Maternal illness where prolonged "bearing down" or pushing efforts would be risky (e.g. cardiac conditions, blood pressure, aneurysm, glaucoma). If these conditions are known about before the birth, or are severe, then an elective caesarean section may be performed.
The woman is placed in the lithotomy position and assists throughout the process by pushing. A suction cup is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the flexion point, about 3 cm anterior from the occipital (posterior) fontanelle, is critical to the success of a VE.[2] Ventouse devices have handles to allow for traction. When the baby's head is delivered, the device is detached, allowing the accoucheur and the mother to complete the delivery of the baby.
For proper use of the ventouse, the maternal cervix has to be fully dilated, the head engaged in the birth canal, and the head position known. If the ventouse attempt fails, it may be necessary to deliver the infant by forceps or caesarean section.

Vacuum Extraction 3D Animation

Wednesday, May 30, 2012



Summary of the Pediatric Neurological Examination

General: Skull (bruits)
    Head Circumference
    Mastoids/sinuses
    Neck
    Liver/spleen
    Spine
    Skin

Cranial Nerves
    II Visual acuity; visual fields; PERRLA, pupils; disc; SVPs; fundus
    III, IV, VI EOMs in 9 fields of gaze
    V Facial sensation; chewing
    VI I Facial movement [peripheral 7th involves forehead]
    VIII Hearing
    IX, X Gag
    XI Trapezius/SCM
    XII Tongue [fasciculations in anterior horn cell disease]

Motor: Manual motor testing (> 5 years old)
    drift
    flexion/ext. at each joint, starting with muscle at disadvantage
    especially triceps, ankle and toe dorsiflexors
    tone
    Functional testing
    observation
    walking/crawling (having mother extend arms elicits drift)
    stairs
    Gower's
    parachute/wheelbarrow

Sensory: Light touch (least reliable)
    pinprick/temperature
    position sense/vibration
    cortical sensation (2 pt discrimination; graphesthesia, stereognosis)

Reflexes: DTRs
    Babinski response

Cerebellar: Finger to nose
    Heel to shin
    Rapid alternating movements (test each side separately)

Gait: Regular, toe, heel, tandem, running, turning

Pediatric Neurological Examination

Wednesday, May 23, 2012



LASIK (laser-assisted in situ keratomileusis), commonly referred to simply as laser eye surgery, is a type of refractive surgery for correcting myopia, hyperopia, and astigmatism.This surgery reshapes corneas to sharpen vision.
The operation is performed with the patient awake and mobile; however, the patient is sometimes given a mild sedative and anesthetic eye drops.
LASIK is performed in three steps. The first step is to create a flap of corneal tissue. The second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is repositioned.
A corneal suction ring is applied to the eye, holding the eye in place. This step in the procedure can sometimes cause small blood vessels to burst, resulting in bleeding or subconjunctival hemorrhage into the white (sclera) of the eye, a harmless side effect that resolves within several weeks. Increased suction typically causes a transient dimming of vision in the treated eye. Once the eye is immobilized, the flap is created. This process is achieved with a mechanical microkeratome using a metal blade, or a femtosecond laser microkeratome that creates a series of tiny closely arranged bubbles within the cornea.A hinge is left at one end of this flap. The flap is folded back, revealing the stroma, the middle section of the cornea. The process of lifting and folding back the flap can sometimes be uncomfortable.
The second step of the procedure is to use an excimer laser (193 nm) to remodel the corneal stroma. The laser vaporizes tissue in a finely controlled manner without damaging the adjacent stroma. No burning with heat or actual cutting is required to ablate the tissue. The layers of tissue removed are tens of micrometres thick.
After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper fit on the eye. The flap remains in position by natural adhesion until healing is completed.

LASIK Eye Surgery 3D Animation

Tuesday, May 22, 2012


Mitral valve prolapse (MVP) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole.In its nonclassic form, MVP carries a low risk of complications. In severe cases of classic MVP, complications include mitral regurgitation, infective endocarditis, congestive heart failure.Prolapse occurs when the mitral valve leaflets are displaced more than 2 mm above the mitral annulus high points. The condition can be further divided into classic and nonclassic subtypes based on the thickness of the mitral valve leaflets: up to 5 mm is considered nonclassic, while anything beyond 5 mm is considered classic MVP.Classical prolapse may be subdivided into symmetric and asymmetric, referring to the point at which leaflet tips join the mitral annulus. In symmetric coaptation, leaflet tips meet at a common point on the annulus. Asymmetric coaptation is marked by one leaflet displaced toward the atrium with respect to the other. Patients with asymmetric prolapse are susceptible to severe deterioration of the mitral valve, with the possible rupture of the chordae tendineae and the development of a flail leaflet.
Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus.
Individuals with mitral valve prolapse, particularly those without symptoms, often require no treatment.In rare instances when mitral valve prolapse is associated with severe mitral regurgitation, mitral valve repair or surgical replacement may be necessary. Mitral valve repair is generally considered preferable to replacement. Current ACC/AHA guidelines promote repair of mitral valve in patients before symptoms of heart failure develop.

Mitral Valve Repair of Posterior Leaflet Prolapse HD

Sunday, May 20, 2012


Amblyopia, also known as lazy eye,is a disorder of the visual system that is characterized by a vision deficiency in an eye that is otherwise physically normal, or out of proportion to associated structural abnormalities of the eye. Amblyopia is a developmental problem in the brain, not any intrinsic, organic neurological problem in the eyeball (although organic problems can lead to amblyopia which can continue to exist after the organic problem has resolved by medical intervention).The part of the brain receiving images from the affected eye is not stimulated properly and does not develop to its full visual potential. This has been confirmed by direct brain examination.
Amblyopia means that visual stimulation either fails to transmit or is poorly transmitted through the optic nerve to the brain for a continuous period of time. It can also occur when the brain "turns off" the visual processing of one eye, to prevent double-vision, for example in strabismus (crossed-eyes). It often occurs during early childhood, resulting in poor or blurry vision. Amblyopia normally affects only one eye in most patients. However, it is possible, though rare, to be amblyopic in both eyes, if both fail to receive clear visual images. Detecting the condition in early childhood increases the chance of successful treatment, especially if detected before the age of five. The earlier it is detected, and the underlying cause corrected with spectacles and/or surgery, the more successful the treatment in equalizing vision between the two eyes.
Amblyopia can be caused by deprivation of vision early in life by vision-obstructing disorders such as congenital cataracts, by strabismus (misaligned eyes), anisometropia (different degrees of myopia or hypermetropia in each eye), or by a significant amount of astigmatism in one or both eyes.

How amblyopia develops in children

Thursday, May 17, 2012


Water birth is a method of giving birth that involves immersion in warm water. The immersion can mean giving birth to the infant in the water or using it as a tool during the labor process. Proponents believe that this method is safe and provides many benefits for both mother and infant, including no need for a Episiotomy, pain relief and a less traumatic birth experience for the baby.
The main advantage of waterbirth is that research shows that there is no or lowered need in performing a Episiotomy. Water birth is believed to aid stretching of the perineum and decrease the risk of skin tears. Support from the water slows crowning of the infant's head and offers perineal support, which decreases the risk of tearing and reduces the use of episiotomy, a surgical procedure which can cause a number of complications. Some clinics have after some years concluded that besides being unpractical, performing a Episiotomy at a waterbirth does not result in any fewer lacerations, and no longer perform them at waterbirths.
Harper reports that water birth is an effective form of pain management during labor and delivery. Water birth is a form of hydrotherapy which, in studies, has been shown to be an effective form of pain management for a variety of conditions especially lower back pain (a common complaint of women in labor).
Childbirth is believed to be a strenuous experience for the baby. Properly heated water is claimed by proponents to help ease the transition from the birth canal to the outside world because the warm liquid is thought to resemble the intrauterine environment. In addition, the umbilical cord pulsates for longer, helping to remove damaged red blood cells from the baby's circulation and replaces them with fresh, undamaged red blood cells thus reducing neonatal jaundice and increasing the transmission of fetal stem cells.

Water Birth Video HD

Monday, May 14, 2012


Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated.The nerve damage involves loss of retinal ganglion cells in a characteristic pattern.
The major risk factor for most glaucomas, and focus of treatment, is increased intraocular pressure, i.e. ocular hypertension. Intraocular pressure is a function of production of liquid aqueous humor by the ciliary processes of the eye, and its drainage through the trabecular meshwork. Aqueous humor flows from the ciliary processes into the posterior chamber, bounded posteriorly by the lens and the zonules of Zinn, and anteriorly by the iris. It then flows through the pupil of the iris into the anterior chamber, bounded posteriorly by the iris and anteriorly by the cornea. From here the trabecular meshwork drains aqueous humor via Schlemm's canal into scleral plexuses and general blood circulation.
Glaucoma can be roughly divided into two main categories, "open angle" and "closed angle" (or "angle closure") glaucoma. The angle refers to the area between the iris and cornea, through which fluid must flow to escape via the trabecular meshwork.
In open angle glaucoma, there is reduced flow through the trabecular meshwork; This reduced flow is due to the cellular processes which cause the breakdown of the trabecular meshwork, whose original function is to absorb the aqueous humor. Because the aqueous humor is no longer absorbed, this leads to increased resistance and thus a buildup of pressure in the eye.in angle closure glaucoma, the iridocorneal angle is completely closed because of forward displacement of the final roll and root of the iris against the cornea resulting in the inability of the aqueous fluid to flow from the posterior to the anterior chamber and then out of the trabecular network.

How does Glaucoma Develop

Sunday, May 13, 2012


Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous.
Surgical procedures in Glaucoma
A trabeculoplasty is a modification of the trabecular meshwork. Laser trabeculoplasty (LTP) is the application of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas.The two types of laser trabeculoplasty are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).
An iridotomy involves making puncture-like openings through the iris without the removal of iris tissue. Performed either with standard surgical instruments or a laser, it is typically used to decrease intraocular pressure in patients with angle-closure glaucoma.
An iridectomy, also known as a corectomy or surgical iridectomy, involves the removal of a portion of iris tissue.
Filtering surgeries are the mainstay of surgical treatment to control intraocular pressure.An anterior sclerotomy or sclerostomy is used to gain access to the inner layers of the eye in order to create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, allowing aqueous to seep into a bleb from which it is slowly absorbed. Filtering procedures are typically divided into either penetrating or non-penetrating types depending upon whether an intraoperative entry into the anterior chamber occurs.
Goniotomy and trabeculotomy are similar simple and directed techniques of microsurgical dissection with mechanical disruption of the trabecular meshwork.
Canaloplasty is a nonpenetrating procedure utilizing microcatheter technology. To perform a canaloplasty, an incision is made into the eye to gain access to Schlemm's canal in a similar fashion to a viscocanalostomy.

Glaucoma Surgery 3D Animation

Saturday, May 12, 2012


An automated external defibrillator is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient,and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.
AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome.
Uncorrected, these cardiac conditions (ventricular tachycardia, ventricular fibrillation, asystole) rapidly lead to irreversible brain damage and death. After approximately three to five minutes,irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 7 percent per minute in the first 3 minutes, and decreases by 10 percent per minute as time advances beyond ~3 minutes.
The first commercially available AEDs were all of a monophasic type, which gave a high-energy shock, up to 360 to 400 joules depending on the model. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites. Newer AEDs have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 - 200 joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time.

Automated External Defibrillator

Friday, May 4, 2012


A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma. Cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine, and is associated with fewer complications.However, while cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established.
In a typical cricothyrotomy procedure, a scalpel is used to create a 1 cm vertical incision through the skin and the cricothyroid membrane, and the resulting hole is opened by either inserting the scalpel handle into the wound and rotating 90 degrees or by using a clamp. A tracheostomy tube or endotracheal tube with a 6 or 7 mm internal diameter is then inserted, the cuff is inflated, and the tube is secured. A bag-valve device with the highest available concentration of oxygen is used to provide ventilation, the success of which is assessed by bilateral ausculation and observation of the rise and fall of the chest.

How to perform Surgical Cricothyrotomy

Saturday, April 21, 2012


Although arthroplasty is a well-established procedure for many joints, its use in the wrist is less common, and the indications are less well defined. The standard procedure for the painful arthritic wrist remains radiocarpal arthrodesis. However, as technology and surgical procedures improve, wrist arthroplasty is being used more frequently. The authors provide a brief history of total wrist arthroplasty and review the arthroplasties most commonly used in the United States.

Total Wrist Arthroplasty Procedure

Friday, April 13, 2012


Postpartum hemorrhage, is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section. It is the most common cause of perinatal maternal death in the developed world and is a major cause of maternal morbidity worldwide.

Uterine atony after delivery accounts for 75-90% of all PPHs.This rate may vary depending on the studied region of the world.Severe PPH hemorrhages are frequently associated with disseminated intravascular coagulopathy (DIC) and high mortality risk. Various approaches have been proposed for the management of PPH due to atony yet a significant number of cases end in hysterectomy, procedure not exempt of risks and or complications. Women who survive a PPH are bound to have severe anemia and infections and are more prone to die in the year following PPH episode.

The International Federation of Gynecology and Obstetrics (FIGO) and other international organizations have given different recommendations to prevent and treat PPH. A very successful session during the South African FIGO congress was that devoted to the management of PPH. The B-Lynch technique comprises a compressive suture of the uterine fundus placed after hysterotomy and fetal extraction.The brace suture is easy to be applied and provides the possibility of preserving female fertility. Moreover the procedure is easier to perform than hysterectomy or a hypogastric artery ligature, most convenient for developing countries with low resources and high obstetrical output.

Technique B-Lynch suture for postpartum hemorrhage

Thursday, April 12, 2012



Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis.It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long standing osteoarthritis, the surgery may be more complicated and carry higher risk.
The surgery involves exposure of the front of the knee, with detachment of part of the quadriceps muscle (vastus medialis) from the patella. The patella is displaced to one side of the joint allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The cartilages and the anterior cruciate ligament are removed; the posterior cruciate ligament may also be removed but the tibial and fibular collateral ligaments are preserved. Metal components are then impacted onto the bone or fixed using polymethylmethacrylate cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve osseointegration, including porous metal prostheses.
Risks and complications in knee replacement are similar to those associated with all joint replacements. The most serious complication is infection of the joint, which occurs in <1% of patients. Deep vein thrombosis occurs in up to 15% of patients, and is symptomatic in 2-3%. Nerve injuries occur in 1-2% of patients. Persistent pain or stiffness occurs in 8-23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.

Total Knee Replacement Surgery Animation

Sunday, April 8, 2012


Assisted vaginal birth is to help deliver the baby during the last part of labour when the cervix is fully dilated.
There are many reasons for needing an assisted birth.They are:
    the baby is not moving out of the birth canal
    the baby is in distress during the birth
    you are unable to, or have been advised not to, push during birth.
To do this, an obstetrician or midwife uses vacuum extractor or forceps to help the baby to be born.

A ventouse (vacuum extractor) is an instrument that uses suction to attach a soft or hard plastic or metal cup on to the baby’s head. The cup is attached by tubing to a suction device. The machine is switched on and the suction cup becomes firmly applied to the baby’s head by the vacuum. With a contraction and a woman’s pushing, the obstetrician or midwife gently pulls to help deliver the baby.
Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around the baby’s head. The forceps are carefully positioned around the baby’s head and joined together at the handles. With a contraction and a woman’s pushing, an obstetrician gently pulls to help deliver the baby.
A ventouse is less likely to cause vaginal tearing. However, it is not suitable if the baby is less than 34 weeks because the baby’s head is softer.

Assisted Birth Delivery HD

Tuesday, April 3, 2012


The knee joint joins the thigh with the leg and consists of two articulations: one between the femur and tibia, and one between the femur and patella.It is the largest joint in the human body and is very complicated.The knee is a mobile a pivotal hinge joint,which permits flexion and extension as well as a slight medial and lateral rotation.
The knee is a hinge type synovial joint, which is composed of three functional compartments: the femoropatellar articulation consists of the patella, or "kneecap", and the patellar groove on the front of the femur through which it slides; and the medial and lateral femorotibial articulations linking the femur, or thigh bone, with the tibia, the main bone of the lower leg.The joint is bathed in synovial fluid which is contained inside the synovial membrane called the joint capsule. The posterolateral corner of the knee is an area that has recently been the subject of renewed scrutiny and research.
The articular bodies of the femur are its lateral and medial condyles. These diverge slightly distally and posteriorly, with the lateral condyle being wider in front than at the back while the medial condyle is of more constant width.
The articular capsule has a synovial and a fibrous membrane separated by fatty deposits. Anteriorly, the synovial membrane is attached on the margin of the cartilage both on the femur and the tibia, but on the femur, the suprapatellar bursa or recess extends the joint space proximally.The suprapatellar bursa is prevented from being pinched during extension by the articularis genu muscle.Behind, the synovial membrane is attached to the margins of the two femoral condyles which produces two extensions similar to the anterior recess. Between these two extensions, the synovial membrane passes in front of the two cruciate ligaments at the center of the joint, thus forming a pocket direct inward.
The articular disks of the knee-joint are called menisci because they only partly divide the joint space.These two disks, the medial meniscus and the lateral meniscus, consist of connective tissue with extensive collagen fibers containing cartilage-like cells. Strong fibers run along the menisci from one attachment to the other, while weaker radial fibers are interlaced with the former. The menisci are flattened at the center of the knee joint, fused with the synovial membrane laterally, and can move over the tibial surface.

Knee Anatomy

Sunday, April 1, 2012

A prostatic stentis used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms.Prostatic obstructionis a common condition with a variety of etiologies. Benign prostatic hyperplasia (BPH) is the most common cause.There are two types of prostatic stent: temporary and permanent.
Although a permanent prostatic stent is not a medical treatment, it falls under the classification of a surgical procedure.Placement of a permanent prostatic stent is carried out as an outpatient treatment under local, topical or spinal anesthesia and usually takes about 15–30 minutes.
A temporary prostatic stent can be inserted in a similar manner to a Foley catheter, requiring only topical anesthesia.

At the present time, there is one temporary prostatic stent that has received U.S. Food and Drug Administration (FDA) approval.The Spanner temporary prostatic stent maintains urine flow and allows natural voluntary urination. The prostatic stent is a completely internal device and can be inserted and removed as easily as a Foley catheter.It permits normal bladder and sphincter functioning and can be worn comfortably by patients.The temporary prostatic stent is typically used to help patients maintain urine flow after procedures that cause prostatic swelling, such as brachytherapy, cryotherapy, TUMT, TURP. It has also become an effective differential diagnostic tool for identifying poor bladder function separate from prostatic obstruction.


Insertion of Spanner Prostatic Stent

Thursday, March 29, 2012


Liver transplantation  is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Liver transplantation is potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Uncontrolled metastatic cancer outside liver, active drug or alcohol abuse and active septic infections are absolute contraindications. While infection with HIV was once considered an absolute contraindication, this has been changing recently. Advanced age and serious heart, pulmonary or other disease may also prevent transplantation . Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis of the liver. Some centers use the Milan criteria to select patients with liver cancers for liver transplantation.
Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated hepatitis C infection, long-term untreated hepatitis B infection. The concept of LDLT is based on  the remarkable regenerative capacities of the human liver and the widespread shortage of cadaveric livers for patients awaiting transplant. In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient’s diseased liver has been entirely removed.

In a typical adult recipient LDLT, 55 to 70% of the liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate approaching 100% function within 4–6 weeks, and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor.

Living donors are faced with risks and/or complications after the surgery. Blood clots and biliary problems have the possibility of arising in the donor post-op, but these issues are remedied fairly easily. Although death is a risk that a living donor must be willing to accept prior to the surgery, the mortality rate of living donors in the United States is low. The LDLT donor's immune system does diminish as a result of the liver regenerating, so certain foods which would normally cause an upset stomach could cause serious illness.

Living donor surgery is done at a major center. Very few individuals require any blood transfusions during or after surgery. Even though the procedure is very safe, all potential donors should know there is a 0.5 to 1.0 percent chance of death. Other risks of donating a liver include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery.The vast majority of donors enjoy complete and full recovery within 2–3 months.

Living Donor Liver Transplantation

Friday, March 23, 2012


A pacemaker is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart.The primary purpose of a pacemaker is to maintain an adequate heart rate, either because of the heart's native pacemaker is not fast enough, or there is a block in the heart's electrical conduction system. Modern pacemakers are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Some combine a pacemaker and defibrillator in a single implantable device. Others have multiple electrodes stimulating differing positions within the heart to improve synchronisation of the lower chambers of the heart.
Permanent pacing with an implantable pacemaker involves transvenous placement of one or more pacing electrodes within a chamber, or chambers, of the heart. The procedure is performed by incision of a suitable vein into which the electrode lead is inserted and passed along the vein, through the valve of the heart, until positioned in the chamber. The procedure is facilitated by fluoroscopy which enables the physician or cardiologist to view the passage of the electrode lead. After satisfactory lodgement of the electrode is confirmed, the opposite end of the electrode lead is connected to the pacemaker generator.
There are three basic types of permanent pacemakers, classified according to the number of chambers involved and their basic operating mechanism:
    Single-chamber pacemaker. In this type, only one pacing lead is placed into a chamber of the heart, either the atrium or the ventricle.
    Dual-chamber pacemaker. Here, wires are placed in two chambers of the heart. One lead paces the atrium and one paces the ventricle. This type more closely resembles the natural pacing of the heart by assisting the heart in coordinating the function between the atria and ventricles.
    Rate-responsive pacemaker. This pacemaker has sensors that detect changes in the patient's physical activity and automatically adjust the pacing rate to fulfill the body's metabolic needs.
The pacemaker generator is a hermetically sealed device containing a power source, usually a lithium battery, a sensing amplifier which processes the electrical manifestation of naturally occurring heart beats as sensed by the heart electrodes, the computer logic for the pacemaker and the output circuitry which delivers the pacing impulse to the electrodes.
Most commonly, the generator is placed below the subcutaneous fat of the chest wall, above the muscles and bones of the chest. However, the placement may vary on a case by case basis.

Pacemaker Implantation 3D Animation

Tuesday, March 20, 2012


The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next.Each beat of the heart involves five major stages. The first two stages, often considered together as the "ventricular filling" stage, involve the movement of blood from atria into ventricles. The next three stages involve the movement of blood from the ventricles to the pulmonary arteryand the aorta .

The first, "early diastole", is when the semilunar valves close, the atrioventricular (AV) valves are open, and the whole heart is relaxed. The second, "atrial systole", is when the atrium contracts, the AV valves open, and blood flows from atrium to the ventricle. The third, "isovolumic ventricular contraction", is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth, "ventricular ejection", is when the ventricles are empty and contracting, and the semilunar valves are open. During the fifth stage, "Isovolumic ventricular relaxation", pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.

Throughout the cardiac cycle, blood pressure increases and decreases. The cardiac cycle is coordinated by a series of electrical impulses that are produced by specialized heart cells found within the sinoatrial node and the atrioventricular node. The cardiac muscle is composed of myocytes which initiate their own contraction without help of external nerves (with the exception of modifying the heart rate due to metabolic demand). Under normal circumstances, each cycle takes approximately one second.

The Cardiac Cycle

Monday, March 19, 2012

Abdominal sacral colpopexy is one of the most successful operations for vaginal vault prolapse with excellent results. It involves suturing a synthetic mesh that connects and supports the vagina to the sacrum.Now Laparoscopic Sacral Colpopexy has been developed to mitigate the morbidity associated with the abdominal approach.One of the primary goals of laparoscopic reconstruction is to reproduce proven abdominal techniques, but in a minimally invasive fashion and without compromising safety or efficacy.
Surgical Technique for Laparoscopic Sacral Colpopexy
After placing the four small incision sites noted above and then placing the access ports , the bowel is mobilized out of the deep pelvis and the sacrum is identified.The peritoneum over the sacrum is elevated and then incised.
A sponge stick is placed into the vagina to elevate the apex or vaginal vault into the surgical field
The peritoneum covering the apex of the vagina is incised and the bladder is dissected away from the top of the vagina anteriorally and the rectum dissected away posteriorly.
A piece of mesh which is shaped like a Y is then attached both to the anterior aspect of the vagina apex and to the posterior vaginal apex
The long arm of the Y-mesh is then pulled up to the sacrum and subsequently attached.The placement of sutures into the sacrum, which will then be attached to the mesh. By attaching this suture to the mesh, the vagina is supported to the sacrum via a bridge of mesh between the vagina and sacrum.The mesh is attached distally to the vagina (anterior & posterior) and proximally to the sacrum.
The peritoneum, which was originally incised and opened at the beginning of the operation, is now closed over the mesh. This part of the surgery does not add support to the surgery but is thought to decrease potential complications, like bowel obstruction and adhesions.


Laparoscopic Uterosacral Colpoplexy HD

Thursday, March 15, 2012

Ectopia cordis results from a failure of proper maturation of midlinemesoderm and ventral body wall formation during embryonic development.The exact etiology remains unknown, but abnormalities in the lateral body wall folds are believed to be involved. Normally, the lateral body walls are responsible for fusion at the midline to form the ventral wall. Corruption of this process may underlie ectopia cordis.
Defective ventral body wall formation yields a heart unprotected by the pericardium, sternum, or skin. Other organs may also have formed outside the skin, as well. Many cases of ectopia cordis have associated,in which the heart itself has failed to properly form.
Defects more commonly associated with ectopia cordis include:
Intracardiac defects-ASD,VSD,TOF,Tricuspid atresia,Double outlet right ventricle
Non-cardiac malformations-Pentalogy of Cantrell,Omphalocele,Anterior diaphragmatic hernia,Cleft palate



Newborn with Bulging Heart outside Thorax(Ectopia cord