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Download Endoscopy of Carcinoma of the Ampulla of Vater download mp4 3gp mp3

Periampullary tumors are neoplasms that arise in the vicinity of the ampulla of Vater Neoplasms that arise in this site can originate from the pancreas, duodenum, distal common bile duct (CBD), or the structures of the ampullary complex The ampulla of Vater is formed by the duodenal aspect of the sphincter of Oddi muscle, which surrounds the confluence of the distal CBD and main pancreatic duct as well as the papilla of Vater, a mucosal papillary mound at the distal insertion of these ducts on the medial wall of the duodenum Ampullary carcinomas are defined as those that arise within the ampullary complex, distal to the confluence of the distal common bile duct and the pancreatic duct It can be difficult to distinguish a primary ampullary carcinoma from other periampullary tumors preoperatively However, true ampullary cancers have a better prognosis than periampullary malignancies of pancreatic or bile duct origin Resectability rates are higher, and five-year survival rates are approximately 30 to 50 percent in patients with limited lymph node involvement In contrast, fewer than 10 percent of patients with completely resected node-positive pancreatic cancer are alive at two years Thus, an aggressive approach to diagnosis and treatment of periampullary tumors is needed to ensure that patients with these comparatively favorable cancers are treated optimally Presentation of ampullary cancer Ampullary cancer is a cancer that arises from the Ampulla Vater The Ampulla Vater is a nipple like projection into the duodenum (the first portion of the intestine) into which the pancreatic and bile ducts open All of the pancreatic and biliary secretion enter the duodenum through the Ampulla Vater Blockage of the Ampulla Vater by the tumor leads to obstruction of drainage of the pancreatic and biliary secretions into the intestine Blockage of drainage of bile into the duodenum leads to the development of jaundice; since the bile cannot drain into the intestine it accumulates into the bloodstream causing yellowness of the skin Patients with ampullary cancer typically present with obstructive jaundice Frequently the patient will undergo an endoscopy or an ERCP at which time an ulcerating tumor will be identified at the ampulla Premalignant lesions that may give rise to an ampullary cancer In patients with an ampullary cancer, a pre-existing benign adenoma (growth of the ampulla Vater) is often found The incidence of this adenoma is higher in patients who have inflammatory bowel disease This adenoma, often called a villous adenoma, should be completely excised to prevent future cancerous change in this tumor A villous adenoma may be excised by surgical or endoscopic techniques Small villous adenomas can be snared during endoscopy It is important though that the gastroenterologist is able to completely excised to tumor If remnants of the tumor are left behind then these may undergo malignant change in the future Surgical resection of the adenoma is required if the tumor is not amenable to removal by endoscopic techni



Here is something you don t see too often An 80 year old lady was admitted 4 weeks ago with a fall and was treated for a chest infection She was noted to have mildly abnormal liver chemistry (Bilirubin 8 umol l, ALT 30, Alk Phosp 280 (NR less than 130), GGT 215) An ultrasound showed dilated bile ducts and CT scan showed an ampullary mass with dilatation of both the bile ducts and the pancreatic duct An EUS performed 2 weeks ago confirmed a 3 5cm ampullary mass and FNA showed signet-ring cell carcinoma of the ampulla Over the past week she has rapidly developed deep jaundice (Bilirubin 300 umol L, ALT 310, Alk Phosp 2100) Hence an ERCP was performed (see video) Most tumours of the ampulla of Vater are well-differentiated adenocarcinomas Signet-ring cell carcinoma (SRCC) is a very rare histological variant found at this site SRCC are characterized by signet-ring cells with intracytoplasmic mucin occupying more than 50% of the tumour Including the original report in Japanese by Sekoguchi et al in 1979, about 30 cases of ampullary SRCC have been mentioned in medical literature According to one report, the median age at diagnosis is 61 years and the median tumour diameter is 20 mm (range, 10–95 mm) The origin of SRCCs remains controversial One theory is that these tumours originate from heterotopic gastric mucosa Another theory suggests that they arise from areas of gastric-type plastic epithelia, which are considered to be a protective response to elevated acidity and are observable in the duodenal bulb of patients with peptic ulcer Signet ring cells may originate from periampullary duodenal heterotopia and expand to the ampulla of Vater Immunohistochemical staining patterns of cytokeratin and mucin allow classification of SRCC to intestinal, pancreatobiliary, gastric, and mixed type Patients with intestinal type have a favourable prognosis whilst and those with mixed type have poor prognosis The majority of patients in previously reported cases of ampullary SRCC underwent pancreatoduodenectomy (PD), occasionally with extended lymphadenectomy and or partial gastrectomy This radical approach facilitates lymph node dissection in advanced disease states, but a pylorus-preserving pancreatoduodenectomy (PPPD) may be more applicable in early disease The overall 5-year survival rate in patients with papillary carcinoma (all types) after radical resection is 30–68% In most cases, the prognosis is better than with biliary and pancreatic carcinomas Owing to their anatomical location, ampullary tumors become clinically apparent earlier because of biliary or pancreatic duct occlusion Chemoradiotherapy based on 5-fluorouracil has been used as an adjunctive treatment modality following curative resection of ampullary adenocarcinomas However, there is debate as to whether this actually affords a significant survival benefit, since many patients develop static disease Presently, no established adjuvant chemotherapeutic regimen exists specifically for ampullary SRCC REFERENCES 1 Sekoguchi T, Mizumoto R Clinicopathological study of papilla of Vater Geka Chiryo 1979;41 1–5 (In Japanese) 2 Masaki Wakasugi et al, Int J Surg Case Rep 2015; 12 108–111 Signet ring cell carcinoma of the ampulla of vater Report of a case and a review of the literature s www ncbi nlm nih gov pmc articles PMC4486405 3 Acharya MN et al JOP 2013 Mar 10;14(2) 190-4 Poorly-differentiated signet-ring cell carcinoma of the ampulla of Vater report of a rare malignancy www serena unina it index p… … article view 1267


Download 2 Minute Neuroscience Vestibular System download mp4 3gp mp3

The vestibular system is a sensory system that is essential to normal movement and equilibrium In this video, I discuss the vestibular labyrinth---the primary structure of the vestibular system, which consists of the semicircular canals, ampullae, and otolith organs All of these are essential to the vestibular system s ability to provide the brain with information about things like motion, head position, and spatial orientation TRANSCRIPT Welcome to 2 minute neuroscience, where I simplistically explain neuroscience topics in 2 minutes or less In this installment I will discuss the vestibular system The vestibular system is a sensory system responsible for providing our brain with information about motion, head position, and spatial orientation; it also is involved with motor functions that allow us to keep our balance, stabilize our head and body during movement, and maintain posture The main components of the vestibular system are found in the inner ear in a system of compartments called the vestibular labyrinth, which is continuous with the cochlea The vestibular labyrinth contains the semicircular canals which are three tubes that are each situated in a plane in which the head can rotate Each of the canals can detect one of the following head movements nodding up and down, shaking side to side, or tilting left and right The semicircular canals are filled with a fluid called endolymph When the head is rotated, it causes the movement of endolymph through the canal that corresponds to the plane of the movement The endolymph flows into an expansion of the canal called the ampulla, within which there are hair cells, the sensory receptors of the vestibular system At the top of each hair cell is a collection of small "hairs" called stereocilia The movement of the endolymph causes movement of these stereocilia, which leads to the the release of neurotransmitters to send information about the plane of movement to the brain The vestibular system uses two other organs, known as the otolith organs, to detect forward and backward movements and gravitational forces There are two otolith organs in the vestibular labyrinth the utricle, which detects movement in the horizontal plane, and the saccule, which detects movement in the vertical plane Within the utricle and saccule, hair cells detect movement when crystals of calcium carbonate called otoconia shift in response to it, leading to movement in the layers below the otoconia and displacement of hair c


Download Sphincterotome Stricturoplasty for Ampullary Stenoses and Biliary Strictures download mp4 3gp mp3

Abstract Endoscopic sphincterotomy (ES) is performed frequently during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) 1 On cholangiogram, long ampullary stenoses and fibrotic distal biliary strictures are not encountered infrequently and they are defined as a significant narrowing of the common bile duct (CBD) from the level of duodenal wall into CBD after initial ES 2 The upstream CBD is dilated Despite adequate ES, the contrast drainage is poor due to the downstream stricture Instead of balloon stricturoplasty and stenting,3 and 4 these strictures can be managed with sphincterotome stricturoplasty (SS) during the initial ERCP 2 The SS is performed using the same sphincterotome in a slightly bowed position under endoscopic and fluoroscopic guidance The cutting wire is placed parallel to the superior border within the stricture and incising the stenosis In cases of relatively long strictures, during initial SS, the majority of the cutting wire is inside the biliary opening This differs from ES where about one-third to one-half of the length of cutting wire is outside the ampulla Compared with balloon stricturoplasty ± biliary stenting, SS is a simple and cost-effective alternative option in managing long ampullary stenosis and or distal fibrotic biliary stricture during the initial ERCP This article is part of an expert video encyclopedia READ THE FULL ARTICLE ON OUR OPEN ACCESS VIDEO JOURNAL & ENCYCLOPEDIA HERE www sciencedirect com science article pii S2212097113702334 #Endoscopic #sphincterotomy #endoscopy #ERCP #Elsevier #openaccess #journal #V


Download 1 7 Step 7 Ampulla and features of the cochlea download mp4 3gp mp3

These videos have been excerpted from Netter’s Video Dissection Modules on Student Consult   bit ly 2oEt9CO Step 7 In this right temporal bone preparation, the anterior semicircular canal and the lateral semicircular canal can be identified At one end of the anterior semicircular canal is a dilated region called the ampulla Within the ampulla lies the portion of the membranous labyrinth containing the receptors for the semicircular duct The cochlea can best be located by trimming away the bone on the medial anterior slope of the petrous ridge near the apex of the ridge The obvious structures will be the partitions between individual spirals and the osseous spiral lamina Seen here at the tip of the pointer, It contains the spiral ganglion Also obvious are large spaces on either side of the osseous spiral lamina that contain perilymph The one anteromedial to the osseous spiral lamina is the scala vestibuli and the one posterolateral is the scala tympani Key Terms • Anterior semicircular canal the most anterior and superior of the three semicircular canals N95 It is a hollow arch with a thin, dense wall of bone The canal houses the anterior semicircular duct N95 and protrudes upward to form the arcuate eminence on the petrous ridge It lies in the same plane as the contralateral posterior semicircular canal N97 Its anterior end is dilated to accommodate the ampulla, and its posterior end joins the posterior canal to form a common bony limb • Lateral semicircular canal the bony canal that houses the lateral semicircular duct It is also called the horizontal canal, which indicates its orientation The outer surface of the canal protrudes into the middle ear cavity where it forms the prominence of the lateral semicircular canal; here it lies just dorsal to the bony prominence of the facial canal N94 In terms of the oval window (and footplate of the stapes) it is useful to remember that the ventral to dorsal sequence is oval window facial canal lateral semicircular canal It is the ampulla of the canal that lies above the oval window N95 • Semicircular ducts the three endolymphatic fluid-filled ducts that are components of the membranous labyrinth N95 They have the same anterior, posterior and lateral designations as the canals they occupy One end of each duct has a dilated region (ampulla) where the receptor cells are located These cells are normally stimulated by motion of the receptors relative to that of the more static endolymphatic fluid The signals sent to the vestibular nerve are essential to balance and equilibrium The ducts lie in three different planes and the plane of the anterior canal aligns with the posterior canal of the opposite side The two lateral canals are in the same horizontal plane • Ampulla (bony) dilation at one end of each of the bony semicircular canals, which is approximately twice the diameter of the canal N95 They each open into the bony vestibule • Ampulla (membranous) dilatations at one end of each of the membranous semicircular ducts N95 N96 The ampulla of each of the three bony canals encloses the membranous ampulla The ampulla contains the cupula, a cluster of sensitive hair cells embedded in a gelatinous tissue containing embedded calcareous granules called otoliths As the head moves in the plane of a given canal, motions of the fluid deflect the cupula to produce nerve impulses • Bony (osseous) labyrinth the network of passages with bony walls lined with periosteum that surrounds the membranous labyrinth N95 It includes the semicircular canals, the cochlea, and the centrally located vestibule which connects to the other parts It is lined with periosteum and contains perilymph, which lies between the walls of the bony labyrinth and the membranous labyrinth It is named by analogy with the mythical maze that imprisoned the Minotaur ABOUT The project was made possible by several very dedicated faculty and staff at University of North Carolina, Chapel Hill--especially O W Henson and Noelle A Granger--and partner schools, and by a grant from the Fund for the Improvement of Post-Secondary Education of the US Department of Education This channel includes over 400 short videos highlighting the steps in a full-body human dissection in the gross anatomy lab Each step is narrated and key structures lab


Download 17 148GS Laparoscopic Partial Sleeve Duodenectomy for Non Ampullary Duodenal Adenoma download mp4 3gp mp3

Laparoscopic Partial Sleeve Duodenectomy for Non-Ampullary Duodenal Adenoma John A Stauffer, MD; Samantha Permenter, BS; Levan Tsamalaidze; Lucio Pereira; Horacio Asbun Mayo Clinic FL Objective Adenomas of the duodenum are a rare but challenging disease They may either harbor malignancy at diagnosis or may undergo future malignant degeneration into duodenal adenocarcinoma If endoscopic removal is not possible, these lesions should be surgically resected Previously, many large duodenal lesions would require pancreaticoduodenectomy for complete removal We report a case of a patient with a large but non-invasive non-ampullary duodenal adenoma treated with a partial duodenal resection using a minimally invasive approach Methods & Procedures The patient was a 77 year old male found to have a duodenal mass Preoperative workup revealed a non-invasive, non-ampullary tubulovillous adenoma of the second portion of the duodenum Due to the non-ampullary location and non-invasive nature, he was offered a partial sleeve duodenectomy Results The video shows a laparoscopic partial sleeve duodenectomy using a 4-trocar technique The duodenum is mobilized and freed from under the root of the mesentery The fourth, third, and distal second portion of the duodenum are carefully freed from the uncinate process and head of the pancreas up to the level of the ampulla A cholangiogram is performed to assure that there is no obstruction to biliary flow and the duodenum is divided just below the ampulla Frozen section analysis is performed Reconstruction is performed by a stapled side to side duodenojejunostomy Conclusions Laparoscopic partial sleeve duodenectomy is an excellent treatment of non-invasive, non-ampullary duodenal lesions Separation of the duodenum from the pancreas can be performed under direct magnified visualiza


Download 9217GS Laparoscopic Transduodenal Sphincteroplasty download mp4 3gp mp3

TITLE Laparoscopic Transduodenal Sphincteroplasty Introduction This video illustrates the key aspects of laparoscopic transduodenal sphincteroplasty for distal common bile duct (CBD) stricture We present the case of a 67-year-old man who was referred to us after failure of endoscopic treatment (ERCP) of CBD stenosis The patient had a history of CBD stones, CBD dilatation, and elevation of liver enzymes He developed stenosis of the distal CBD that was treated unsuccessfully with multiple ERCP and stent placements over the last 14 years A preoperative magnetic resonance cholangiopancreatography revealed a dilated CBD tapering in the lower CBD without evidence of tumor Methods A laparoscopic transduodenal sphincteroplasty was performed with the patient in the split-leg position After the CBD was exposed just above the duodenum, a cholangiogram was performed directly in the CBD, showing no evidence of any CBD stones and a short stenotic area at the ampulla Then, through a 10-cm longitudinal duodenotomy, a sphincterotomy using the Harmonic scalpel was performed after a transcystic catheter was pushed down through the ampulla A sphincteroplasty was then performed followed by a 2-layered closure of the duodenum Results The patient tolerated the procedure well On the first postoperative day, an upper gastrointestinal study showed no evidence of leak So, diet was resumed safely and the patient was discharged home uneventfully on the third postoperative day Conclusion We conclude that laparoscopic transduodenal sphincteroplasty for CBD stenosis is a safe and feasible alternative to choledochoduodenostomy Abs# 9217GS Authors Trelles Nelson, MD, Palermo Mariano, MD, Gagner Miche


Download Introduction to Embryology Fertilisation to Gastrulation (Easy to Understand) download mp4 3gp mp3

If you find embryology difficult to understand, then this should be the first video you watch This video covers the basic concepts from ovulation to the formation of the trilaminar germ disc (which will turn into YOU!) Post any questions you have about the video below, I read all the comments ***PLEASE SUPPORT ME*** GoFundMe s www gofundme com f minass Facebook s www facebook com M1NA55 Instagram @m1 nass @mi nass Email me m inass@outlook com SUMMARY OF VIDEO First week of development Ovulation to Implantation 1 After ovulation the oocyte is transported through the uterine tube 2 Fertilisation (fusion of a sperm with the oocyte) occurs in the ampulla of the oviduct For fertilisation to occur, both capacitation and acrosome reaction occur (not explained in video but important to know) 3 Cleavage and blastocyst formation occur 4 Implantation into the uterine wall Second week of development Bilaminar Germ Disc 1 Trophoblast differentiates into the cytotrophoblast and the syncytiotrophoblast 2 Epiblast and hypoblast layers develop 3 Small cavities form the amniotic cavity and yolk sac 4 Blastocyst completely embedded in the uterus, but it produces a slight protrusion into the lumen of the uterus 5 Syncytiotrophoblast penetrates deeper and erode the endothelial lining of the maternal capillaries These capillaries are congested and dilated (sinusoids) 6 Uteroplacental circulation is established Third week of development Trilaminar Germ Disc 1 Gastrulation occurs, beginning with the appearance of the primitive streak 2 Epiblast cells move inward (invaginate) to form new cell layers, the endoderm and the mesoderm 3 Cells that do not migrate through the streak but remain in the epiblast form ectoderm Note the epiblast gives rise to all three germ layers, and these layers form all of the tissues and organs MORE EMBRYOLOGY Embryology of the Heart s www youtube com watch?v FgTk57vE3A4 Embryology of the CNS s www youtube com watch?v 4Swn8_Jnlss Embryology of the Kidney s www youtube com watch?v 81yCpy


Download ASMR unboxing Light of Tree by AMPULLA download mp4 3gp mp3

US www amazon com dp B07CKVVJKJ CA s www amazon ca dp B07CKVVJKJ UK s www amazon co uk dp B074NXT8LY AU www amazon com au dp B07CKVVJKJ use coupon code LIGHTOFTREE for 20% off until Jan 1st, 2019 This is a sponsored video Hello my dear darlings, here s yet another unboxing video, which is one of my personal favorites to record and also watch ) Hope you like unboxings too XoXo Follow me on Instagram @terradiasmr www instagram com terradiasmr Twitter @TerraDiASMR s twitter com terradiasmr Snapchat @realterradiasmr Special thanks to my Patrons Crystal C John Henry Kelly Correct Rachel Victor Felipe S Lupe G Johny L Matt K Jari Eduadro M Mathew P Equipment I use Camera s goo gl iEha92 Zoom Recorder s goo gl MMKrLe Microphones Blue Spark s goo gl Sh1wuv 3Dio s 3diosound com Senheisser s goo gl t2UMUo Monoprice s goo gl Qbbm9s Blue Yeti s goo gl nFHSwq Movo lavalier s goo gl 8ENeM8 XLR cables s goo gl MFpoRv Soft box light s goo gl sH9P2Q Ring Light s www dvestore com prismatic-le P S If you want to donate and support s www patreon com terradiasmr s www gofundme com asmr-youtube s www PayPal Me TerraDiASMR In case you don t know what is ASMR, well ASMR (Autonomous Sensory Meridian Response) is a physical sensation characterized by a pleasurable tingling that typically begins in the head and scalp, and often moves down the spine and through the limbs Many people are unaware that such a phenomenon exists Others experience the sensation regularly, but have no idea it possesses a defined title *some are affiliate links #terrad


Download Bile Pathway and Pancreas (+Spleen) Accessory Organs Part 2 download mp4 3gp mp3

This video is Part 2 of the anatomy of the Accessory Organs anatomy of Bile Pathway Liver produces bile - Ductus Hepaticus Dexter and Ductus Hepaticus Sinister - Ductus Heptaticus Communis - Ductus Choledoctus (Bile duct, or common bile duct) - Ductus Cysticus Gall Bladder (Vesicae Bilaris) Lies in fossa vesicae bilaris - Fundus Vesicae Bilaris, Corpus Vesicae Bilaris, Collum Vesicae Bilaris, Ductus Cysticus Walls of bile duct Tunica mucosa - Plicae Tunicae Mucosae, Plica Spirales, Glandulae Mucosae Tunica Muscularis of bile duct and gall bladder - One layer of muscle called Stratum Circulare Tunica Adventitia - Connective tissue covering on fossa of gall bladder Tunica Serosa - Serous layer formed by peritoneum through Ligamentum Hepatoduodenale Bile Duct - joins with pancreatic duct (ductus pancreaticus) - Form ampulla hepatopancreatica (hepatopancreatic ampulla) - Goes into Duodenum through papilla duodeni major - Limited by Sphincter ampullae hepatopancreatica Anatomy of the Pancreas Exocrine function - Secretes pancreatic juice (succus pancreaticus) Endocrine Function - Blood sugar regulation (insulin and glucagon) Pancreas lies in the epigastric region and the right hypochondriac region Three parts of pancreas - Caput pancreatis - Corpus Pancreatis - Cauda Pancreatis Pancreas has accessory duct called ductus pancreaticus accessorius (accessory pancreatic duct) goes in duodenum through papilla duodeni minor Anatomy of the Spleen - lies in left hypochondriac region - has a Diaphragmatic surface and visceral surface - Hilium Splenicum - Covered by Capsula Fi

Video 2 "Step by Step" D1 D1 Duodenectomy pancreas sparing ampulla preserving technique As .MP4 3GP FLV-

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