Preparation of surgeon's hands

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KETAN VAGHOLKAR

Preparation of the surgeon's hands is an integral part of preoperative preparation. Adequate disinfection of the hand that is operating is a very important aspect of the aseptic ritual. It is equally important to decide which is the best disinfectant to use.

Health & Medicine Education

Preparation of the surgeon’s
hands
By

Dr. Ketan Vagholkar
MS, DNB, MRCS, FACS
Consultant General Surgeon
&
Professor of Surgery

Preparation of surgeon's hands

Preparation of surgeon's hands

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Background: The development of a pseudocyst after mesh repair of an incisional hernia is a rare complication. Both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct though rare entity. Case report: A pseudocyst formation following an onlay mesh repair of an incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well-formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast-enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

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Background: Traumatic lumbar hernia is due to shearing of bony insertions of the muscle in the lumbar region. In recurrent cases, there is more attenuation of muscles. This makes fixation of the mesh extremely difficult. Hence, the need to develop a new technique. Case report: A 27-year-old male presented with a recurrent post-traumatic right- sided lumbar hernia. He had a severe two wheeler accident. Following the accident he had undergone various surgical interventions for a fractured pelvis with a deglowing injury involving the right gluteal region and upper thigh. He had also developed a post-traumatic lumbar hernia for which he had undergone open mesh repair. Subsequently he developed recurrence of the post traumatic right-sided lumbar hernia. After complete investigation he underwent open mesh repair for the recurrent post traumatic lumbar hernia. The defect was wide and was devoid of healthy surrounding muscles. The mesh was fixed to the ileal bone with bone anchors and to the twelfth rib with trans-osseous fiber sutures passed through holes drilled in the twelfth rib. Flaps were created from the remnant surrounding attenuated muscles. They were double-breasted to cover the mesh. Postoperative outcome was excellent with no recurrence for the last six months. Discussion: The various anatomical and technical considerations of bone fixation of the mesh for hernia repair are discussed. Conclusion: Bone fixation of the mesh with bone anchors is a viable option especially in cases where there is severe attenuation of adjacent muscles for mesh fixation.

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Giant lipoma over the back

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Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical intervention for complications is the mainstay of treatment.

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KETAN VAGHOLKAR

Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

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Background: Skin approximation is a very important step in a surgical operation. The quality of skin approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications. Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation). The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation) had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction. Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

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Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively. Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60 years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B. The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic requirement, early commencement of oral feeds, and shorter duration of hospitalization

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In this comprehensive lecture, Dr. Faiza delves deep into the physiologic anatomy of the heart and the intricate properties of cardiac muscles. Beginning with a thorough exploration of the circulatory system, she meticulously elucidates the physiological arrangement of the right and left hearts, providing a detailed overview of systemic circulation's parallel arrangement. Through meticulous explanation, she traces the intricate path of blood flow, providing insightful comparisons of pressures across various components of the heart and circulatory tree, offering a holistic understanding of cardiovascular dynamics. Transitioning seamlessly, Dr. Faiza meticulously dissects the functional anatomy and mechanics of the atrioventricular and semilunar valves, essential components for maintaining the precise unidirectional flow of blood within the heart. By delving into their structure and function, she illuminates their pivotal role in cardiac physiology, elucidating their mechanisms to prevent backflow and ensure efficient circulation. Furthermore, Dr. Faiza embarks on a detailed exploration of the properties of cardiac muscles, providing a comprehensive understanding of their histological composition, syncytial arrangement, and action potential characteristics. Through detailed analysis, she sheds light on the factors influencing contractility, including sympathetic stimulation, hormonal regulation, and alterations in extracellular and intracellular ion concentrations. Throughout the lecture, Dr. Faiza employs illustrative diagrams and engaging explanations to facilitate understanding, ensuring students grasp the intricate nuances of cardiac physiology. By elucidating the fundamental concepts underlying heart anatomy and cardiac muscle properties, she equips learners with the foundational knowledge necessary for a comprehensive understanding of cardiovascular function and pathology.

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MedicoseAcademics

ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

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Dr. A Sumathi - LINEARITY CONCEPT OF SIGNIFICANCE.pdf

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Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.

Difference Between Skeletal Smooth and Cardiac Muscles

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MedicoseAcademics

We’re going to talk about journaling! Turns out it’s not just for teenage girls! Journaling is actually very therapeutic and has immense benefits for not only our mental health and well-being, but it also helps improve our lives overall. I’m going to explain some cool stuff about the subconscious and writing that I learned in my days as a hypnotherapist. Handwriting is an amazing tool to help re-program the unconscious mind!

The Clean Living Project Episode 23 - Journaling

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The Clean Living Project

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Lifecare Centre

Rhesus (Rh) incompatibility is a crucial topic in the realm of pregnancy and childbirth. This condition arises when a pregnant woman, who is Rh-negative, carries a fetus with Rh-positive blood, causing a potential mismatch that can lead to serious complications. Understanding the mechanisms and implications of Rh incompatibility is paramount for healthcare providers and expecting parents alike. Let's delve into this intricate interplay between blood types, antibodies, and pregnancy, to grasp the significance of Rh incompatibility and its management.

ABO Blood grouping in-compatibility in pregnancy

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A cancer diagnosis is stressful. Feelings of worry, fear, self-doubt, sadness, and loneliness are normal but can feel exhausting and consuming at times. Cultivating a habit of thought-watching and learning to recognize thought traps that might be contributing to our discomfort can help us respond and care for ourselves in helpful ways. Learn more about the connection between what we think and how we feel and what you can do about it that might impact how you feel today. Let’s talk about it.

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Anticipatory grief is the emotional experience when there is an impending loss that will occur. Often, people associate loss and grief with death, this is just one area in which grief and loss can occur. Anticipatory grief is often a slower grieving process marked by intermittent, small or large losses. In the world of cancer, anticipatory grief may show up in a variety of ways, such as before a major surgery, losing hair from chemotherapy treatment or caring for a loved one with advanced cancer. Learn about anticipatory grief and ways to cope with it. We will also explore methods to heal from this challenging experience.

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Creeping Stroke - Venous thrombosis presenting with pc-stroke.pptx

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Obat Aborsi Ampuh No.1 Usia Kandungan 1 2 3 4 5 6 7 Bulan Dan Cara Penggunaan Obat Aborsi Cytotec Penggugur Kandungan Jika anda berminat dan membutuhkan segera pesan dan konsultasi langsung melalui nomer kami. Bisa melalui Whatsap Tlp Maupun sms Online 24 jam. Hubungi untuk pemesanan ⇛⇛⇛ WhatsApp 081901 222272 Obat Aborsi Asli Apotik kami hanya menjual produk asli pfizer bukan produk palsu. Obat aborsi murah yang kami jual sudah tidak diragukan lagi keampuhannya dalam hitungan jam akan gugur bersih dan tuntas. Hebatnya lagi, obat penggugur yang kami jual tidak memberikan resiko tinggi terhadap wanita yang ingin menggugurkan kandungan, bisa dibilang minim efek samping. Keunggulan melakukan dengan menggunakan obat aborsi : Efektif tingkat keberhasilan mencapai 98%. Minim efek samping. Proses cepat. Tidak perlu melalukan tindakan berat yang menguras tenaga. Dan masih banyak lagi keunggulan aborsi dengan menggunakan obat. Obat Penggugur Kandungan yang kami jual terbilang paling ampuh dan menjadi no.1 di Dunia. Telah sejak lama digunakan oleh wanita di seluruh belahan negara. Dapatkan Obat Aborsi yang aman dan efektif hanya di sini. Kami menyediakan Obat Cytotec Misoprostol 400 mg Asli Pfizer, yang merupakan salah satu obat penggugur kandungan paling ampuh dan aman di apotik. Obat pelancar haid ini tidak dijual secara umum, sehingga Anda dapat memastikan keamanan dan kualitasnya. Dengan menggunakan obat telat datang bulan ini, Anda dapat menggugurkan kandungan dengan cepat dan alami dalam hitungan jam, mulai dari janin muda hingga tua, dari usia 1 bulan hingga 7 bulan. Tidak perlu khawatir, cara menggugurkan kandungan ini telah terbukti 100% ampuh dan berhasil. Jangan ragu untuk menghubungi kami sekarang untuk mendapatkan solusi yang tepat untuk menggugurkan kehamilan Anda. Obat Aborsi Cytotec: Amankah Menggugurkan Kandungan Yang Masih Gumpalan Darah Mereka yang mengalami kehamilan yang tak diinginkan, khususnya bagi pasangan yang belum menikah, umumnya akan mencari cara untuk menggugurkan kandungannya. Hal ini terbukti dengan tingginya angka pencarian pada Google tentang cara menggugurkan kandungan yang masih gumpalan darah. Format Pemesanan Seperti Di Bawah ini : nama lengkap : ------- alamat lengkap : ------- no. hp aktif : ------- pesanan barang : ------- transfer Bank : ------- Contoh Format Pemesanan nama lengkap : puput dwi rosmala alamat lengkap : Jl. Hasan Nuddin No.102 rt 17 rw 07 desa jakarta kec malang kab bandung jawa barat no. hp aktif : 08123456xxx pesanan barang : paket obat aborsi 4 bulan, Rp xxxxxx transfer bank : via bank BRI Melayani Pengiriman Seluruh Indonesia Dan Luar Negeri

Obat Aborsi Ampuh Usia 1,2,3,4,5,6,7 Bulan 081901222272 Obat Penggugur Kandu...

Obat Aborsi Ampuh Usia 1,2,3,4,5,6,7 Bulan 081901222272 Obat Penggugur Kandu...

Obat Aborsi Ampuh Usia 1,2,3,4,5,6,7 Bulan 081901222272 Obat Penggugur Kandu...

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Cara Menggugurkan Kandungan 087776558899

In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

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MedicoseAcademics

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Dr. A Sumathi - LINEARITY CONCEPT OF SIGNIFICANCE.pdf

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The Clean Living Project Episode 23 - Journaling

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Preparation of surgeon's hands

1. Preparation of the surgeon’s hands By Dr. Ketan Vagholkar MS, DNB, MRCS, FACS Consultant General Surgeon & Professor of Surgery