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29

Surgery: Third year rotations

I’m student Dr. Thompson, I’m a third year medical student and In this video I will explain what my surgery rotation was like and at the end give you the Mus...  
YouTube
almost 5 years ago
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56

Dissection: The Mediastinum and Heart

The anatomical landmarks of the mediastinum and the heart using a human cadaver. Orig. air date: JUN 28 74 This is part of the Open.Michigan collection at: h...  
YouTube
almost 5 years ago
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A Modest Man

The registrar's face was taking on a testy look. So enduring was the silence our furtive glances had developed a nystagmic quality. “Galactosaemia” came her peremptory reply. Right on queue the disjointed chorus of ahs and head nods did little to hide our mental whiteboard of differentials being wiped clean. At the time conjugated bilirubinaemia in children only meant one thing: biliary atresia. A fair assumption; we were sitting in one of three specialist centres in the country equipped to treat these patients. Ironically the condition has become the unwieldy yardstick I now measure the incidence of paediatric disease. Biliary atresia is the most common surgical cause of neonatal jaundice with a reported incidence of 1 in 14-16ooo live births in the West. It is described as a progressive inflammatory obliteration of the extrahapatic bile duct. And Dr Charles West, the founder of Great Ormond Street Hospital, offers an eloquent description of the presenting triad of prolonged jaundice, pale acholic stools and dark yellow urine: ‘Case 18...It was born at full term, though small, apparently healthy. At 3 days however, it began to get yellow and at the end of 3 weeks was very yellow. Her motions at no time after the second day appeared natural on examination, but were white, like cream, and her urine was very high coloured.’ 1855 was the year of Dr West's hospital note. An almost universally fatal diagnosis and it would remain so for the next 100 years. The time's primordial classification of biliary atresia afforded children with the 'noncorrectable' type, a complete absence of patent extrahepatic bile duct, an unfortunate label; they were beyond saving. Having discovered the extent of disease at laparatomy, the surgeons would normally close the wound. The venerable Harvardian surgeon, Robert E. Gross saved an enigmatic observation: “In most instances death followed a downhill course…” K-A-S-A-I read the ward’s board. It was scrawled under half the children's names. I dismissed it as just another devilishly hard acronym to forget. The thought of an eponymous procedure had escaped me and in biliary atresia circles, it's the name everyone should know: Dr Morio Kasai. Originating from Aomori prefecture, Honshu, Japan, Dr Kasai graduated from the National Tohoku University School of Medicine in 1947. His ascension was rapid, having joined the 2nd department of Surgery as a general surgeon, he would assume the role of Assistant Professor in 1953. The department, under the tenure of Professor Shigetsugu Katsura, shared a healthy interest in research. 1955 was the landmark year. Katsura and Kasai operated on their first case: a 72 day old infant. Due to bleeding at the incised porta hepatis, Katsura is said to have 'placed' the duodenum over the site in order to staunch the flow. She made a spectacular postoperative recovery, the jaundice had faded and there was bile pigment in her stool. During the second case, Katsura elected to join the unopened duodenum to the porta hepatis. Sadly the patient's jaundice did not recover, but the post-mortem conducted by Kasai confirmed the development of a spontaneous internal biliary fistula connecting the internal hepatic ducts to the duodenum. Histological inspection of removed extrahepatic duct showed the existence of microscopic biliary channels, hundreds of microns in diameter. Kasai made a pivotal assertion: the transection of the fibrous cord of the obliterated duct must contain these channels before anastomosis with the jejunal limb Roux-en-Y loop. This would ensure communication between the porta hepatis and the intrahepatic biliary system. The operation, entitled hepatic portoenterostomy, was first performed as a planned procedure for the third case at Tohoku. Bile flow was restored and Kasai published the details of the new technique in the Japanese journal Shujutsu in 1959. However, news of this development did not dawn on the West until 1968 in the Journal of Pediatric Surgery. The success of the operation and its refined iterations were eventually recognized and adopted in the 1970s. The operation was and is not without its dangers. Cholangitis, portal hypertension, malnutrition and hepatopulmonary syndrome are the cardinal complications. While diagnosing and operating early (<8 weeks) are essential to the outcome, antibiotic prophylaxis and nutritional support are invaluable prognostic factors. Post operatively, the early clearance of jaundice (within 3 months) and absence of liver cirrhosis on biopsy, are promising signs. At UK centres the survival after a successful procedure is 80%. The concurrent development of liver transplantation boosts this percentage to 90%. Among children, biliary atresia is the commonest indication for transplantation; by five years post-Kasai, 45% will have undergone the procedure. On the 6th December 2008, Dr Kasai passed away. He was 86 years old and had been battling the complications of a stroke he suffered in 1999. His contemporaries and disciples paint a humble and colourful character. A keen skier and mountaineer, Dr Kasai lead the Tohoku University mountain-climbing team to the top of the Nyainquntanglha Mountains, the highest peaks of the Tibetan highlands. It was the first successful expedition of its kind in the world. He carried through this pioneering spirit into his professional life. Paediatric surgery was not a recognized specialty in Japan. By founding and chairing multiple associations including the Japanese Society of Pediatric Surgeons, Dr Kasai gave his specialty and biliary atresia, the attention it deserved. Despite numerous accolades of international acclaim for his contributions to paediatric surgery, Dr Kasai insisted his department refer to his operation as the hepatic portoenterostomy; the rest of the world paid its originator the respect of calling it the ‘Kasia’. Upon completion of their training, he would give each of his surgeons a hand-written form of the word ‘Soshin’ [simple mind], as he believed a modest surgeon was a good one. At 5 foot 2, Kasai cut a more diminutive figure one might expect for an Emeritus Professor and Hospital Director of a university hospital. During the course of his lifetime he had developed the procedure and lived to see its fruition. The Kasia remains the gold standard treatment for biliary atresia; it has been the shinning light for what Willis J. Potts called the darkest chapter in paediatric surgery. It earned Dr Kasai an affectionate but apt name among his peers, the small giant. References Miyano T. Morio Kasai, MD, 1922–2008. Pediatr Surg Int. 2009;25(4):307–308. Garcia A V, Cowles RA, Kato T, Hardy MA. Morio Kasai: a remarkable impact beyond the Kasai procedure. J Pediatr Surg. 2012;47(5):1023–1027. Mowat AP. Biliary atresia into the 21st century: A historical perspective. Hepatology. 1996;23(6):1693–1695. Ohi R. A history of the Kasai operation: Hepatic portoenterostomy for biliary atresia. World J Surg. 1988;12(6):871–874. Ohi R. Morio Kasai, MD 1922-2008. J Pediatr Surg. 2009;44(3):481–482. Lewis N, Millar A. Biliary atresia. Surg. 2007;25(7):291–294. This blog post is a reproduction of an article published in the Medical Student Newspaper, April 2014 issue.  
James Wong
over 5 years ago
141bd7ffe3b3ed512898cdd22d08791ee5e879ed4060425668804899
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Radical Neck Dissection: (RND) Classification, Indication and Techniques

Crile in 1906 introduced RND and is followed by Martin as a the classical procedure for the management of cervical lymph node metastasis  
Souradeep Dutta
over 4 years ago
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Thrombectomy plus thrombolysis for acute stroke: A word of caution

Introduction: Problem of the premature standard of care 0 This issue has previously been discussed with regards to heparin and thrombolysis for submissive  
pulmcrit.org
over 4 years ago
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Pediatric Brain Tumors

In this episode, neurosurgeon Dr. Vivek Mehta discusses pediatric brain tumors.  
surgery101.org
over 4 years ago
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Informed consent? How do primary care professionals prepare women for cervical smears: A qualitative study

Cervical screening is a procedure that is mainly carried out in primary care, predominantly by general practitioners (GPs) and practice nurses (PNs). Much has been published about the effects on women of receiving an abnormal smear result but little has been done to investigate the preparation of women by primary care professionals for this.  
sciencedirect.com
over 4 years ago
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How to perform an episiotomy | RCM

The RCM website is published by The Royal College of Midwives. Midwives magazine, Evidence Based Midwifery and Midwives Jobs are published by Redactive Publishing Ltd on behalf of The Royal College of Midwives.  
rcm.org.uk
over 4 years ago
Www.bmj
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Routine appendectomy could be abandoned for uncomplicated appendicitis, study finds

An appendectomy may not be needed in patients with uncomplicated acute appendicitis, researchers have reported in JAMA.1  
feeds.bmj.com
over 4 years ago
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Nano-dissection identifies genes involved in kidney disease

A new method developed by researchers called "in silico nano-dissection" uses computers rather than scalpels to separate and identify genes from specific cell types, enabling the systematic study of genes involved in diseases.  
sciencedaily.com
over 4 years ago
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Valtech Cardio's Cardioband for Minimally Invasive Mitral Valve Annuloplasties Approved in Europe |

Valtech Cardio, a company out of Or Yehuda, Israel, won European CE Mark approval to introduce its Cardioband annuloplasty system. The Cardioband allows fo  
medgadget.com
about 4 years ago
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Colonoscopy in a CRC Screening Program With FOBT

What types of policies should be put in place to ensure quality of colonoscopy in organized colorectal cancer screening programs?  
medscape.com
about 4 years ago
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The Adult Neck Mass - American Family Physician

Family physicians frequently encounter neck masses in adult patients. A careful medical history should be obtained, and a thorough physical examination should be performed. The patient's age and the location, size, and duration of the mass are important pieces of information. Inflammatory and infectious causes of neck masses, such as cervical adenitis and cat-scratch disease, are common in young adults. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis. Neoplasms (benign and malignant) are more likely to be present in older adults. Fine-needle aspiration and biopsy and contrast-enhanced computed tomographic scanning are the best techniques for evaluating these masses. An otolaryngology consultation for endoscopy and possible excisional biopsy should be obtained when a neck mass persists beyond four to six weeks after a single course of a broad-spectrum antibiotic.  
aafp.org
about 4 years ago
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Extracellular Vesicles as a Fluid Biopsy for Prostate Cancer

A new review explores the potential of prostate cancer cell fragments as a diagnostic biomarker for prostate cancer.  
medscape.com
about 4 years ago
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43

Breast Cancer

The folks at OnlineMedEd made Breast Cancer easy for me, check it out!  
onlinemeded.org
about 4 years ago
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10

How to tie off a knot

 
youtube.com
about 4 years ago
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knot no 1

Descript  
youtube.com
about 4 years ago
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37

continuous suturing

 
youtube.com
about 4 years ago