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Patient with severe CBD stricture caused by panc head mass. Failed ERCP. Proceeded with EUS cholecystoduodenostomy. Stent placed successfully but only clear fluid could be seen coming through the stent? What is going on here? @EHolzwanger Tyler Berzin MD, FASGE Prabhleen Chahal MD,MASGE,FACG

Sultan Mahmood MD FASGE

7,182 subscribers

16,791 Aufrufe • vor 3 Jahren •via X (Twitter)

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10 Kommentare

Profilbild von Tyler Berzin MD, FASGE

Tyler Berzin MD, FASGEvor 3 Jahren

@EHolzwanger @ChahalPrabhleen What’s going on here is a super smooth, freehand LAMS placement by a highly skilled interventional fellow… 👏👏👏

Profilbild von Sultan Mahmood MD

Sultan Mahmood MDvor 3 Jahren

@EHolzwanger @ChahalPrabhleen

Profilbild von Tarun Rustagi

Tarun Rustagivor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen Nicely done 👍👌👏 Here's another one👇

Profilbild von Sultan Mahmood MD

Sultan Mahmood MDvor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen You beat me to it . I was gonna share your tweet as a response 🙏

Profilbild von ZiaRahman_Endo

ZiaRahman_Endovor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen Nice case!! Clear bile is a bad prognostic marker and may be seen in chronic biliary blockages.

Profilbild von Samuel Igbinedion MD

Samuel Igbinedion MDvor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen Beautiful work 👏🏾

Profilbild von Erik Holzwanger, MD, ABOM-D

Erik Holzwanger, MD, ABOM-Dvor 3 Jahren

@tberzin @ChahalPrabhleen Great case! Very well done!

Profilbild von Prabhleen Chahal MD,FASGE,FACG

Prabhleen Chahal MD,FASGE,FACGvor 3 Jahren

@EHolzwanger @tberzin Nicely done @SultanMahmoodMD !

Profilbild von Omkolsoum

Omkolsoumvor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen White bile !!!

Profilbild von Muhammad Tahir

Muhammad Tahirvor 3 Jahren

@EHolzwanger @tberzin @ChahalPrabhleen White bile? 🥸

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Jolyon Palmer answers the question 'Why didn't Leclerc get a penalty for not giving the position back to Lewis?' "It's a good question and I don't have the answer. So let's have a look with this reverse angle because I think it becomes more clear cut here that Hamilton should have that place, second position, because of the way here that Charles gives Hamilton the space, Verstappen is then going to have a squeeze. At the moment, Max is looking like he's going to have a clear launch down the outside. Remember, he's on a medium tyre, so it's a particularly decent start. But in the end, we get four wide. You've got the two Ferraris neck and neck. You've got Verstappen so ambitious out wide onto the kerb. It's the first race he's not led out of the out of the first corner since 2019 here. He's got astonishing form and as a result, a lot of confidence to go and attack this first corner. You can actually see Hamilton is marginally ahead of Charles Leclerc before the braking zone. So it's just a nose in front. But I would say the Ferrari on the left is ahead of the Ferrari on the right." "We come through the corner. So if we ignore Verstappen now, he's never going to make it stop from that outside line. We come through the corner and now Charles is in a real squeeze here. We've had contact in the past before with Perez, Leclerc and Verstappen. This time it's Hamilton, Leclerc and Verstappen. And they managed to get through. Max doesn't turn in. He can't turn in." "So now Lewis has definitely got the second place. He's ahead of Charles, who is coming through. He's got space to stay on the track should he wish to stay on the track. But he's also chosen to go wide at this point, realises that you can just cut through. He's done it before at the first corner and gets away with it. Behind, you've got Antonelli going to do the same thing from side by side with Russell. Piastri actually is going to go deep as well, but try his best to stay on the track, whereas others won't. And Leclerc, from behind Hamilton, chooses to go off the road." "He's not forced off by Lewis. You can see the space that Lewis leaves on the exit, goes straight across. The safest thing to do at this point is to absolutely floor it, rejoin in the lead and choose who you're going to let pass. Basically, be your own judge at this point." "And as we play it through, Charles lets Lando go through, but does not let Lewis go through. It should be a penalty. It should be a slam dunk." "I can only assume the stewards saw five cars go through. Absolute melee. You've even got Franco Colapinto at the back of the field having a spin. You've got contact. You've got debris on the circuit. Marshall's needed to retrieve it, which was another sketchy condition that we had early on in the race. And I can only assume the stewards just thought Ferrari side by side, they emerged second and third." "But the reality is here, Charles Leclerc overtook Lewis Hamilton off the track and he should have had a penalty for it." - F1 2025 Mexico -

sim 🇧🇷🇲🇽🇸🇳🇫🇷🇭🇹

273,432 Aufrufe • vor 9 Monaten

Islam is incompatible with Western civilization. The U.K. Rape Gang Inquiry makes that clear. But we should not be surprised by this. Sex-slavery and rape of non-Islamic women is commonplace in the Muslim world. It’s permissible under their religious teachings. The Quran permits sexual use of female slaves (4:24, 23:5-6, 33:50). Historical Islamic conquests involved enslaving and raping non-Muslim women as war spoils because they are seen as less than human. If you mass import people from Muslim countries expect to get Islamic practices like rape gangs, cousin marriage, honor culture, segregation, higher inbreeding/impulse control and racial supremacist preaching in mosques. Anyone who is for mass immigration from the Muslim world is “for” these things. It’s not “racist” to say this. It’s well documented cultural data. We need to start calling mass migration what it is: A direct attack by our leaders on Christianity and our way of life. It is the greatest desecration of your ancestors and mine who fought and died in the Great Wars under the assumption they were stopping barbarity from forcibly entering our homes... only for it to be imported through the front door. This civilizational suicide must stop now. Please understand what time it is…

Islam is incompatible with Western civilization. The U.K. Rape Gang Inquiry makes that clear. But we should not be surprised by this. Sex-slavery and rape of non-Islamic women is commonplace in the Muslim world. It’s permissible under their religious teachings. The Quran permits sexual use of female slaves (4:24, 23:5-6, 33:50). Historical Islamic conquests involved enslaving and raping non-Muslim women as war spoils because they are seen as less than human. If you mass import people from Muslim countries expect to get Islamic practices like rape gangs, cousin marriage, honor culture, segregation, higher inbreeding/impulse control and racial supremacist preaching in mosques. Anyone who is for mass immigration from the Muslim world is “for” these things. It’s not “racist” to say this. It’s well documented cultural data. We need to start calling mass migration what it is: A direct attack by our leaders on Christianity and our way of life. It is the greatest desecration of your ancestors and mine who fought and died in the Great Wars under the assumption they were stopping barbarity from forcibly entering our homes... only for it to be imported through the front door. This civilizational suicide must stop now. Please understand what time it is…

Benny Johnson

133,803 Aufrufe • vor 2 Monaten

this reel absolutely gutted me tonight. hits different with two kids the same age. charlie was a fantastic debater and public speaker. he let people talk and had rational conversations with them. i will never be a charlie. but i do have a voice, and it’s time i start using it. having gone from a nobody to a moderate audience within the last year, i’ve struggled with what to do with my X account. how do i make the best use of the resources i’ve been given? well now it’s clear. my platform here is going to be about family. it will be carrying on charlie’s message to young men that having a family is the biggest blessing in life. it will be about raising good kids. eating healthy. spending quality time with them. and how there’s no greater achievement in a man’s life than that. a lunatic might have killed charlie, but it’s only starting a movement that will be bigger than anything charlie could have done on his own. the events of today will backfire massively. charlie’s assassination will not be in vain, and i’ll do my part to make damn well sure of it.

this reel absolutely gutted me tonight. hits different with two kids the same age. charlie was a fantastic debater and public speaker. he let people talk and had rational conversations with them. i will never be a charlie. but i do have a voice, and it’s time i start using it. having gone from a nobody to a moderate audience within the last year, i’ve struggled with what to do with my X account. how do i make the best use of the resources i’ve been given? well now it’s clear. my platform here is going to be about family. it will be carrying on charlie’s message to young men that having a family is the biggest blessing in life. it will be about raising good kids. eating healthy. spending quality time with them. and how there’s no greater achievement in a man’s life than that. a lunatic might have killed charlie, but it’s only starting a movement that will be bigger than anything charlie could have done on his own. the events of today will backfire massively. charlie’s assassination will not be in vain, and i’ll do my part to make damn well sure of it.

Cory Watilo

37,793 Aufrufe • vor 11 Monaten

🚨 If Erika Kirk ever cared about Charlie Kirk, she would be publicly sounding the alarm. Last night, Candace Owens released unedited footage that is substantially better quality than the footage provided by authorities in the case against Tyler Robinson. This exclusive, high-quality footage, obtained from an anonymous government source, should have vindicated the official narrative against Tyler Robinson. However, it failed to do so. The person in the footage bears no resemblance to Tyler Robinson. Baron Coleman and many others are more convinced than ever that Tyler Robinson is being framed for the assassination of Charlie Kirk. The man in the footage is not skinny; he appears far more muscular and robust than Tyler Robinson. The man by all metrics appears to be left-handed. He even put an earpiece in his left ear. This isn't 2005; who wears an earpiece in public?! You can clearly see that the man is wearing white leggings or thigh-high white socks under his shorts. Authorities never mentioned leggings or thigh-high socks. Furthermore, it’s quite possible that a ponytail could be hiding underneath his hat, considering the way he’s wearing it. Why is this of interest? Lance Twiggs, Tyler’s roommate whose less degraded DNA was found on every piece of evidence against Tyler Robinson, has a ponytail. Why didn’t our government release this high-quality footage, which is obviously available? Why does it seem that authorities deliberately degraded the footage presented in court? Why is this evidence coming from not only a podcaster but also a pregnant mother of four who works out of her basement in Nashville, Tennessee? Why are TPUSA and Erika Kirk completely silent?! Why aren't Erika Kirk, Andrew Kolvet, and Tyler Bowyer on Fox News asking what the hell is going on here?! Everyone should be demanding answers for who actually killed Charlie Kirk, but Erika Kirk and every individual at TPUSA should be at the forefront of demanding answers for this blatant and evident failure of our law enforcement institutions.

🚨 If Erika Kirk ever cared about Charlie Kirk, she would be publicly sounding the alarm. Last night, Candace Owens released unedited footage that is substantially better quality than the footage provided by authorities in the case against Tyler Robinson. This exclusive, high-quality footage, obtained from an anonymous government source, should have vindicated the official narrative against Tyler Robinson. However, it failed to do so. The person in the footage bears no resemblance to Tyler Robinson. Baron Coleman and many others are more convinced than ever that Tyler Robinson is being framed for the assassination of Charlie Kirk. The man in the footage is not skinny; he appears far more muscular and robust than Tyler Robinson. The man by all metrics appears to be left-handed. He even put an earpiece in his left ear. This isn't 2005; who wears an earpiece in public?! You can clearly see that the man is wearing white leggings or thigh-high white socks under his shorts. Authorities never mentioned leggings or thigh-high socks. Furthermore, it’s quite possible that a ponytail could be hiding underneath his hat, considering the way he’s wearing it. Why is this of interest? Lance Twiggs, Tyler’s roommate whose less degraded DNA was found on every piece of evidence against Tyler Robinson, has a ponytail. Why didn’t our government release this high-quality footage, which is obviously available? Why does it seem that authorities deliberately degraded the footage presented in court? Why is this evidence coming from not only a podcaster but also a pregnant mother of four who works out of her basement in Nashville, Tennessee? Why are TPUSA and Erika Kirk completely silent?! Why aren't Erika Kirk, Andrew Kolvet, and Tyler Bowyer on Fox News asking what the hell is going on here?! Everyone should be demanding answers for who actually killed Charlie Kirk, but Erika Kirk and every individual at TPUSA should be at the forefront of demanding answers for this blatant and evident failure of our law enforcement institutions.

Travis

104,134 Aufrufe • vor 6 Tagen

🚨 Charlie Kirk: FAILED Mass Shooting Event & 3 BRAND NEW Evidence Points More 2-Shot Theory Evidence To Consider: - The 2-man camera crew in the tunnel DELIBERATELY filmed the rear-right shot to Charlie Kirk's head. Why wasn't this evidence at court? Where is this video? - Dan Flood gave hand signals to start the operation. Dan Flood had no idea that an infrared beam wasn't just on the back of Charlie Kirk's head, but the beam was also on him during his hand signal. - Phil Lyman was directly in the LINE OF FIRE with an infrared beam on the back of his head too, but absolutely didn't know it. If Phil didn't miss Charlie Kirk being assassinated, we would VERY LIKELY be looking at a mass shooting event involving a Presidentially pardoned political candidate. This addition to Charlie's death would have caused a civil war overnight. I'm giving away so much tea before I release Charlie Kirk: Operation 322 PART VI... And I have a lot more to give! Charlie Kirk was shot TWICE at the same time; once by Bird of Prey drone platform, once with a pinfire pistol. I discovered this and released everything you need in my Charlie Kirk: Operation 322 series on YouTube. It's 8 hours long, but you can just check out PARTS IV & V if you're pressed for time. You can also read my "Charlie's CLOSURE" article right here on X... The second video in the article has a 10 minute frame-by-frame analysis that details both shots. CKO322 PART VI will show you ALL of the details on how this MASS SHOOTING operation actually failed... Stay Tuned...

WeAreNotGoingToMars

117,315 Aufrufe • vor 22 Tagen

It has been almost A WEEK since California’s primary “ended." The votes are still rolling in and guess what? They're heavily favoring the Democrats! Who could have seen that coming? And California officials actually had the gall to ask us to be patient because this is "normal" for their elections. No, California, NOTHING about how you handle your elections is NORMAL. You don’t need to be a conspiracy theorist to smell the rot here. At the least, this is the appearance of corruption. And when it comes to our elections, appearance is EVERYTHING. Voting is built on trust: Trust that the dead aren’t suddenly voting. Trust that a van with thousands of ballots doesn’t show up overnight and swing the election one way. Trust that non-citizens aren’t casting votes that are being counted. Trump was right to demand transparency. But BOTH sides should be just as furious.

It has been almost A WEEK since California’s primary “ended." The votes are still rolling in and guess what? They're heavily favoring the Democrats! Who could have seen that coming? And California officials actually had the gall to ask us to be patient because this is "normal" for their elections. No, California, NOTHING about how you handle your elections is NORMAL. You don’t need to be a conspiracy theorist to smell the rot here. At the least, this is the appearance of corruption. And when it comes to our elections, appearance is EVERYTHING. Voting is built on trust: Trust that the dead aren’t suddenly voting. Trust that a van with thousands of ballots doesn’t show up overnight and swing the election one way. Trust that non-citizens aren’t casting votes that are being counted. Trump was right to demand transparency. But BOTH sides should be just as furious.

Glenn Beck

72,344 Aufrufe • vor 2 Monaten

🧵An interview w/ prominent Attorney Blake Horwitz by Clayton J Baker MD on the Geoengineering legal front: "It cannot be that they are playing God, if you don't believe in God, it cannot be that they are playing Mother Nature -The poisons in the atmosphere are very detrimental to agriculture, plant life and the flora & Fauna of the Earth -That is why I chose to take this project on - There is no way that I can put my head down at night and say to myself I am OK with this going on, if I have something to do with changing the course of events, I will." "We are going to sue the individuals polluting the environment - We are going make known to the World know what is taking place." "They cannot put nanoparticles into our body without our consent, our bodies are being exposed to it through breathing and absorption through the skin and the food we are eating." Sulfur Dioxide atmospheric dispersion -"Some business are getting millions of dollars in support and investment for doing this" "Nature has historically worked out Earths issues, for mankind to inject himself into this equation of weather modification is really an absurd concept- Lets let Mother Nature run its course and not play God." ~Ending with: "Legal cases can force transparency" Tom Renz Nicole C. Pearson, Esq.

🧵An interview w/ prominent Attorney Blake Horwitz by Clayton J Baker MD on the Geoengineering legal front: "It cannot be that they are playing God, if you don't believe in God, it cannot be that they are playing Mother Nature -The poisons in the atmosphere are very detrimental to agriculture, plant life and the flora & Fauna of the Earth -That is why I chose to take this project on - There is no way that I can put my head down at night and say to myself I am OK with this going on, if I have something to do with changing the course of events, I will." "We are going to sue the individuals polluting the environment - We are going make known to the World know what is taking place." "They cannot put nanoparticles into our body without our consent, our bodies are being exposed to it through breathing and absorption through the skin and the food we are eating." Sulfur Dioxide atmospheric dispersion -"Some business are getting millions of dollars in support and investment for doing this" "Nature has historically worked out Earths issues, for mankind to inject himself into this equation of weather modification is really an absurd concept- Lets let Mother Nature run its course and not play God." ~Ending with: "Legal cases can force transparency" Tom Renz Nicole C. Pearson, Esq.

Babooschka

113,991 Aufrufe • vor 7 Monaten

Tucker Carlson on Iran: Everybody knows the only reason we're having this war is because Israel wants it. This is their last chance. This presidency is the last presidency where they're going to have unequivocal bipartisan support. Period. You can't primary every Thomas Massie, and there's a whole army of them coming at some point because everyone can see what's going on. And you can shut down X, and you can just shut down the internet. You can be like Great Britain and arrest people who protest Israel, but attitudes are not going to revert to what they were five years ago. Sorry. And they know this. So this is their last chance. What's so amazing is that Israel, which at least is acting in what it perceives to be its own national interest, is joined by its shills in the United States, of course. But really, its only other ally in this is the American news media, whose job it is to tell you the truth and inform you as to what's happening — to tell you, hey, wake up, the world could be changing and it's going to affect you and your family. That's their job. And instead, they've been lulling you to sleep with the same variety of transparent lies and propaganda.

Tucker Carlson on Iran: Everybody knows the only reason we're having this war is because Israel wants it. This is their last chance. This presidency is the last presidency where they're going to have unequivocal bipartisan support. Period. You can't primary every Thomas Massie, and there's a whole army of them coming at some point because everyone can see what's going on. And you can shut down X, and you can just shut down the internet. You can be like Great Britain and arrest people who protest Israel, but attitudes are not going to revert to what they were five years ago. Sorry. And they know this. So this is their last chance. What's so amazing is that Israel, which at least is acting in what it perceives to be its own national interest, is joined by its shills in the United States, of course. But really, its only other ally in this is the American news media, whose job it is to tell you the truth and inform you as to what's happening — to tell you, hey, wake up, the world could be changing and it's going to affect you and your family. That's their job. And instead, they've been lulling you to sleep with the same variety of transparent lies and propaganda.

Clash Report

285,035 Aufrufe • vor 5 Monaten