Llenging portion of the gi tract for endoscopic or laparoscopic surgery alone. viagra online without prescription 1. Introduction even with recent advantage of endoscopic and laparoscopic technology, duodenum is still a challenging organ for minimal invasive surgery due to its anatomical properties. Recently there have been various reports concerning “combined laparo-endoscopic surgery,” which consist of both endoscopic surgery from inside the gastrointestinal tract and laparoscopic surgery from the outside. generic viagra without prescription Here, we report a case of duodenal smt applied this novel surgical procedure. 2. viagra online jersey Case report a male patient in his 60s visited our hospital because he was diagnosed with a submucosal tumor (smt) of the duodenum that had progressed in size during 3-month follow up. Esophagogastroduodenoscopy revealed a 20-mm diameter smt located in the third portion of the duodenum (figure 1(a)). Ct scan revealed hypervascular tumor existing in the third portion of duodenum (figure 1(b)). An 18 f-fluorodeoxyglucose-positron emission tomography-computed tomography (fdg-pet-ct) scan showed a homogenous submucosal lesion without lymph node swelling nor distant metastasis. viagra online jersey The initial surgical consultation indicated segmental duodenal resection with roux-en y reconstruction, or in a worst case scenario, pancreaticoduodenectomy. The lesion, however, was considered as a low-risk gist according to the recent nccn sarcoma guidelines [1]. The surgical team, therefore, offered the endoscopic resection under laparoscopic assistance as less invasive alternative to segmental duodenectomy and pancreaticoduodenectomy. Figure 1: (a) endoscopic appearance revealed a 20-mm diameter submucosal tumor with a smooth surface in the third portion of the duodenum. viagra online cheap canada (b) preoperative endoscopic ultrasonography (12 mhz miniature probe). Arrowheads indicate that muscle layer was preserved beneath the tumor without an extramural component. viagra cost The procedure was performed at our surgical unit under general anesthesia. lilly viagra daily After establishment of standard greenhouse emission pneumoperitoneum, three surgical ports were placed at the umbilicus, right, and left midabdomen, respectively. The peritoneal cavity was explored laparoscopically, and the proximal jejunum was gently clamped (figure 2(a)). viagra pillen bestellen online A flexible endoscope (gif-h260z, olympus medical systems co. Ltd, tokyo, japan) was inserted perorally with a greenhouse gas feeding system (ucr, olympus medical systems co. Ltd, tokyo, japan). overnight generic viagra The endoscope was then advanced into duodenum, and we confirmed the lesion located at the third portion of duodenum with transmitted light from flexible endoscopy (figures 2(b) and 2(c)). Subsequently, we confirmed that the. is generic viagra safe viagra samples

Welcome to Jubing Kristianto's official website.
If you love classical/fingerstyle guitar music, this site is for you.

You can download Jubing's solo guitar arrangements/compositions and listen Jubing's playing.

 


"He created magic with his guitar"
(The Jakarta Post Daily, March 14.  2016)

"With his hand, a piece of guitar could became a mini-orchestra"
(Tempo Magazine, July 15.  2007)

"Is hard to believe that a single guitar could produces many sounds and nuances of silence at the same time." (Rolling Stone Indonesia, December 2007)

"In Jubing's hand, this six string music instrument could produce thousand kinds of  sounds" 
(Kompas Daily, June 30, 2007)

 

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