Intraoperative bone graft perfusion scintigraphy can assess vascularized bone graft viability during mandible reconstruction surgery. In a pilot study of 3 patients, scintigraphy using the Sentinella and declipseSPECT gamma cameras successfully visualized iliac crest bone graft perfusion before and after harvesting and mandibular transplantation. Before harvesting, scintigraphy clearly delineated the well-perfused iliac crest graft area. After transplantation and vessel reanastomosis, scintigraphy still showed adequate graft perfusion through the arterial connection in all patients. Intraoperative scintigraphy is a potential new tool for ensuring bone graft viability during complex mandible reconstruction surgeries.
This study compared information obtained from standard computed tomographic angiography (s-CTA) scans and modified CTA (m-CTA) scans of the deep circumflex iliac artery (DCIA) flap to cadaver dissections. The m-CTA scans showed longer visible DCIA lengths, better visualization of branching patterns, and more detail on vessel course compared to s-CTA scans. However, s-CTA scans allowed bilateral evaluation while m-CTA only showed the injected side. Both CTA methods provided more information than cadaver dissections for preoperative planning of DCIA flaps.
This document summarizes a study that evaluated a method of assessing skeletal asymmetry using submental-vertical (S-V) radiographs. The study assessed landmark reproducibility on S-V radiographs and developed a cephalometric analysis system using cranial base, maxillary, and mandibular landmarks. Ten patients with a 2+ mm apical base discrepancy were selected. Landmark identification error was found to be less than 1 mm. The analysis system uses reference lines and planes constructed from cranial base, maxillary, and mandibular landmarks to assess asymmetry within and between craniofacial structures. Examples are provided to demonstrate how the analysis can be used to evaluate skeletal asymmetry and incorporate it into treatment planning for patients with as
This document summarizes a study of 110 patients who underwent distal femur resection and endoprosthetic reconstruction between 1980-1998. The majority had malignant bone tumors. Reconstruction was performed with modular, custom-made, or expandable prostheses. At minimum 2-year follow up, function was good or excellent in 85% of patients. Complications included deep infection in 5%, aseptic loosening in 5%, and prosthetic failure in 5%. The limb salvage rate was 96%. Distal femur endoprosthetic reconstruction provided good function and local tumor control in most patients.
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
1) A study compared the clinical results of using hollow screws versus plates for treating spiral fractures of the lower third of the tibia combined with posterior malleolar fractures.
2) 61 patients were treated with tibia plate fixation and either hollow screw fixation (34 patients) or plate fixation (27 patients) of the posterior malleolar fracture.
3) At 6-36 months follow up, all fractures healed well with no differences in healing time or infection rates between the two groups. Functional outcomes assessed using the Baird-Jackson scoring system also did not significantly differ between groups.
This document reports a case study of a 29-year-old schizophrenic patient who attempted genital auto-mutilation for the second time. The first attempt resulted in shallow wounds, but the second attempt was more severe, resulting in complete amputation of the penis. The patient was brought to the emergency department in hemorrhagic shock and required resuscitation. Surgeons were able to control bleeding and perform a urethrostomy. Given the severity of injury and time delay, reattachment was not possible. The patient received postoperative care and will be followed by psychiatrists to monitor for risk of recurrence. Genital auto-mutilation is a psychiatric emergency that requires multidisciplinary treatment from surgeons,
This document describes a study evaluating the efficacy of using a dynamic hip screw (DHS) drill under image intensifier guidance to ablate osteoid osteoma of the lower extremities in children and adolescents. Eighteen patients between ages 4-16 were treated with this minimally invasive technique, with 16 achieving initial success from one drilling. Complications included one tibial fracture and two skin abrasions. At follow-up, all patients were classified as having a good clinical response. The combination of intraoperative localization using image intensifier guidance and ablation with a DHS drill provided an efficient, safe, and curative procedure with minimal bone loss for treating osteoid osteoma.
This document discusses principles of limb salvage surgery for bone and soft tissue tumors. Key points include defining limb salvage as resection of tumor with acceptable oncological, functional and cosmetic results while preserving the limb. Patient selection, historical background, surgical principles for different tumor stages and sites are covered. Reconstruction options including allografts, prostheses and arthrodesis are summarized for different skeletal defects involving joints, the diaphysis and epiphysis.
This study compared information obtained from standard computed tomographic angiography (s-CTA) scans and modified CTA (m-CTA) scans of the deep circumflex iliac artery (DCIA) flap to cadaver dissections. The m-CTA scans showed longer visible DCIA lengths, better visualization of branching patterns, and more detail on vessel course compared to s-CTA scans. However, s-CTA scans allowed bilateral evaluation while m-CTA only showed the injected side. Both CTA methods provided more information than cadaver dissections for preoperative planning of DCIA flaps.
This document summarizes a study that evaluated a method of assessing skeletal asymmetry using submental-vertical (S-V) radiographs. The study assessed landmark reproducibility on S-V radiographs and developed a cephalometric analysis system using cranial base, maxillary, and mandibular landmarks. Ten patients with a 2+ mm apical base discrepancy were selected. Landmark identification error was found to be less than 1 mm. The analysis system uses reference lines and planes constructed from cranial base, maxillary, and mandibular landmarks to assess asymmetry within and between craniofacial structures. Examples are provided to demonstrate how the analysis can be used to evaluate skeletal asymmetry and incorporate it into treatment planning for patients with as
This document summarizes a study of 110 patients who underwent distal femur resection and endoprosthetic reconstruction between 1980-1998. The majority had malignant bone tumors. Reconstruction was performed with modular, custom-made, or expandable prostheses. At minimum 2-year follow up, function was good or excellent in 85% of patients. Complications included deep infection in 5%, aseptic loosening in 5%, and prosthetic failure in 5%. The limb salvage rate was 96%. Distal femur endoprosthetic reconstruction provided good function and local tumor control in most patients.
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
1) A study compared the clinical results of using hollow screws versus plates for treating spiral fractures of the lower third of the tibia combined with posterior malleolar fractures.
2) 61 patients were treated with tibia plate fixation and either hollow screw fixation (34 patients) or plate fixation (27 patients) of the posterior malleolar fracture.
3) At 6-36 months follow up, all fractures healed well with no differences in healing time or infection rates between the two groups. Functional outcomes assessed using the Baird-Jackson scoring system also did not significantly differ between groups.
This document reports a case study of a 29-year-old schizophrenic patient who attempted genital auto-mutilation for the second time. The first attempt resulted in shallow wounds, but the second attempt was more severe, resulting in complete amputation of the penis. The patient was brought to the emergency department in hemorrhagic shock and required resuscitation. Surgeons were able to control bleeding and perform a urethrostomy. Given the severity of injury and time delay, reattachment was not possible. The patient received postoperative care and will be followed by psychiatrists to monitor for risk of recurrence. Genital auto-mutilation is a psychiatric emergency that requires multidisciplinary treatment from surgeons,
This document describes a study evaluating the efficacy of using a dynamic hip screw (DHS) drill under image intensifier guidance to ablate osteoid osteoma of the lower extremities in children and adolescents. Eighteen patients between ages 4-16 were treated with this minimally invasive technique, with 16 achieving initial success from one drilling. Complications included one tibial fracture and two skin abrasions. At follow-up, all patients were classified as having a good clinical response. The combination of intraoperative localization using image intensifier guidance and ablation with a DHS drill provided an efficient, safe, and curative procedure with minimal bone loss for treating osteoid osteoma.
This document discusses principles of limb salvage surgery for bone and soft tissue tumors. Key points include defining limb salvage as resection of tumor with acceptable oncological, functional and cosmetic results while preserving the limb. Patient selection, historical background, surgical principles for different tumor stages and sites are covered. Reconstruction options including allografts, prostheses and arthrodesis are summarized for different skeletal defects involving joints, the diaphysis and epiphysis.
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
This document discusses the differences between incision, excision, and resection procedures in ICD-9-CM and ICD-10-PCS coding. It defines each term and provides examples. Incision refers to a cut made during surgery, while excision means cutting out a portion of a body part and resection is cutting out or removing all of a body part. In ICD-10-PCS, procedures are classified by their root operation rather than using the term "incision." The document emphasizes that accurate differentiation between these terms is important for correct medical coding and reimbursement.
This case report describes an unusual complication during a robot-assisted pyeloplasty procedure where the distal coil of a double-J stent migrated into the contralateral ureter. Specifically:
- A 25-year old male underwent a right robot-assisted pyeloplasty with placement of a double-J stent.
- Post-operatively, the patient reported left flank pain and hematuria. Imaging revealed the distal coil of the stent was located in the left ureter, causing hydronephrosis.
- Cystoscopy confirmed the diagnosis and the distal coil was extracted from the left ureter. The patient recovered uneventfully and the stent was later removed without issue.
1. Reconstructive surgeries aim to restore skeletal continuity and function after tumor resection through techniques like arthrodesis, bone grafts, and endoprosthetic replacements.
2. Limb salvage surgery is now possible in 90% of cases due to improved chemotherapy, diagnostics, and surgical techniques. The goal is a painless, functional tumor-free limb.
3. Evaluation includes biopsy, imaging to determine tumor extent and involvement of surrounding structures, staging, and psychosocial/functional assessment. Wide local excision with clear margins while preserving neurovascular structures is key.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
The study analyzed 76 MRI scans to identify vascular safe zones in hip arthroscopy. It found:
1) The medial femoral circumflex artery passes through the middle third of the area between the lesser trochanter and inferior femoral head/acetabular junction, providing a safe zone for psoas tendon release.
2) The medial femoral circumflex artery inserts on the posterior femoral neck between 10:30-12 o'clock and gives off an average of 4 retinacular vessels that pass along the posterior neck.
3) The femoral neck osteoplasty safe zone is the anterior half of the femoral neck to avoid damaging the retinacular vessels, which were found posterior to the 12 o'
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
The implementation of MDCT in urological imaging has solved much of the diagnostic dilemma. Thanks to its multiplanar capabilities and post processing techniques.
The treatment for sarcoma cancer is done only through the surgical methods in which the bone and soft-tissue of limb of the patient is saved from extremity tumour cases.
Use and safety has been validated with large-scale randomized prospective studies comparing TFA and TRA
Romangnoli et al (JACC 2012), Mehta et al (JACC 2012), and Valgimigli et al (Lancet 2015)
The document discusses limb salvage surgery for both trauma and tumor cases. For traumatic injuries, it discusses the decision making process around whether to attempt limb salvage or perform amputation. It presents several scoring systems used to evaluate the likelihood of successful salvage. For tumors, it discusses options for reconstruction after limb salvaging resections, including allografts, endoprostheses, and allograft-prosthetic composites. It also outlines techniques for resections and reconstructions of various parts of the upper and lower extremities.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
This document summarizes a study on the outcomes of occlusion treatment for amblyopia in children under 12 years old with strabismus. The study reviewed medical records of 38 Qatari children treated with occlusion therapy for strabismic amblyopia from 1992-2002. Good outcomes, defined as final visual acuity of 6/9 or better, were found in 73% of patients. Poor outcomes with visual acuity less than 6/9 occurred in 26% of patients. Factors like age at presentation, type of strabismus, presence of anisometropia and compliance did not significantly affect treatment outcomes.
The authors describe a novel "footprint" technique for ACL reconstruction that aims to reliably achieve anatomic tunnel positioning while avoiding the risks of double-bundle reconstruction or conventional transtibial techniques. Key steps include:
1) Precise portal placement, centered on the tibial and femoral ACL footprints.
2) Detaching and defining the tibial and femoral footprint margins using radiofrequency.
3) Reaming the femoral tunnel independently through the anteromedial portal using a flexible guidewire, aiming for the center of the femoral footprint.
4) Preparing the tibial tunnel centered in the tibial footprint without relying on secondary landmarks.
This technique is reported to restore native ACL anatomy with
Patella in total knee arthroplasty to resurface or not is the questionBipulBorthakur
This document discusses different perspectives and techniques regarding patellar resurfacing during primary total knee arthroplasty. It notes that while resurfacing was routinely performed in North America, Asian surgeons often do not due to patient characteristics. Three main approaches are described: always resurfacing, never resurfacing, and selective resurfacing based on factors like cartilage quality and arthritis. Complications of both resurfacing and non-resurfacing are presented. Multiple studies are reviewed that compare outcomes between the two techniques, with many finding reduced reoperation rates but similar pain levels with resurfacing. The conclusion is that the best approach remains controversial, though resurfacing is often recommended for inflammatory arthritis or severe patellar deformity.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
1) The document describes a study comparing computer-assisted mandibular reconstruction using vascularized iliac crest bone grafts to conventional reconstruction techniques.
2) With computer-assisted planning, a surgical guide was designed based on CT scans and used to precisely shape and position the bone graft. This method aimed to reduce operating time and bone removal compared to conventional techniques.
3) Results found that with computer-assisted planning, the bone graft fit perfectly into the mandibular defect with less adjustment needed. Operating time and bone removed were also reduced compared to conventional techniques. Patients reported higher satisfaction with their appearance.
Value of Contrast Enhanced CT in Detecting Active Haemorrhage in Patients wit...ijtsrd
This document discusses a study that evaluated the use of contrast enhanced CT scans to detect active hemorrhaging in patients with blunt abdominal or pelvic trauma. The study found that contrast enhanced CT was able to precisely locate sites of active hemorrhaging in the spleen, pelvis, retroperitoneum, kidneys, liver, and adrenal gland. The CT attenuation values of active hemorrhaging ranged from 75-350 HU, which was significantly higher than the 45-65 HU range for clotted blood. Contrast enhanced CT can thus effectively distinguish between active hemorrhaging and clotted blood, aiding clinical decisions about surgical or angiographic intervention for trauma patients.
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
This document discusses the differences between incision, excision, and resection procedures in ICD-9-CM and ICD-10-PCS coding. It defines each term and provides examples. Incision refers to a cut made during surgery, while excision means cutting out a portion of a body part and resection is cutting out or removing all of a body part. In ICD-10-PCS, procedures are classified by their root operation rather than using the term "incision." The document emphasizes that accurate differentiation between these terms is important for correct medical coding and reimbursement.
This case report describes an unusual complication during a robot-assisted pyeloplasty procedure where the distal coil of a double-J stent migrated into the contralateral ureter. Specifically:
- A 25-year old male underwent a right robot-assisted pyeloplasty with placement of a double-J stent.
- Post-operatively, the patient reported left flank pain and hematuria. Imaging revealed the distal coil of the stent was located in the left ureter, causing hydronephrosis.
- Cystoscopy confirmed the diagnosis and the distal coil was extracted from the left ureter. The patient recovered uneventfully and the stent was later removed without issue.
1. Reconstructive surgeries aim to restore skeletal continuity and function after tumor resection through techniques like arthrodesis, bone grafts, and endoprosthetic replacements.
2. Limb salvage surgery is now possible in 90% of cases due to improved chemotherapy, diagnostics, and surgical techniques. The goal is a painless, functional tumor-free limb.
3. Evaluation includes biopsy, imaging to determine tumor extent and involvement of surrounding structures, staging, and psychosocial/functional assessment. Wide local excision with clear margins while preserving neurovascular structures is key.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
The study analyzed 76 MRI scans to identify vascular safe zones in hip arthroscopy. It found:
1) The medial femoral circumflex artery passes through the middle third of the area between the lesser trochanter and inferior femoral head/acetabular junction, providing a safe zone for psoas tendon release.
2) The medial femoral circumflex artery inserts on the posterior femoral neck between 10:30-12 o'clock and gives off an average of 4 retinacular vessels that pass along the posterior neck.
3) The femoral neck osteoplasty safe zone is the anterior half of the femoral neck to avoid damaging the retinacular vessels, which were found posterior to the 12 o'
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
The implementation of MDCT in urological imaging has solved much of the diagnostic dilemma. Thanks to its multiplanar capabilities and post processing techniques.
The treatment for sarcoma cancer is done only through the surgical methods in which the bone and soft-tissue of limb of the patient is saved from extremity tumour cases.
Use and safety has been validated with large-scale randomized prospective studies comparing TFA and TRA
Romangnoli et al (JACC 2012), Mehta et al (JACC 2012), and Valgimigli et al (Lancet 2015)
The document discusses limb salvage surgery for both trauma and tumor cases. For traumatic injuries, it discusses the decision making process around whether to attempt limb salvage or perform amputation. It presents several scoring systems used to evaluate the likelihood of successful salvage. For tumors, it discusses options for reconstruction after limb salvaging resections, including allografts, endoprostheses, and allograft-prosthetic composites. It also outlines techniques for resections and reconstructions of various parts of the upper and lower extremities.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
This document summarizes a study on the outcomes of occlusion treatment for amblyopia in children under 12 years old with strabismus. The study reviewed medical records of 38 Qatari children treated with occlusion therapy for strabismic amblyopia from 1992-2002. Good outcomes, defined as final visual acuity of 6/9 or better, were found in 73% of patients. Poor outcomes with visual acuity less than 6/9 occurred in 26% of patients. Factors like age at presentation, type of strabismus, presence of anisometropia and compliance did not significantly affect treatment outcomes.
The authors describe a novel "footprint" technique for ACL reconstruction that aims to reliably achieve anatomic tunnel positioning while avoiding the risks of double-bundle reconstruction or conventional transtibial techniques. Key steps include:
1) Precise portal placement, centered on the tibial and femoral ACL footprints.
2) Detaching and defining the tibial and femoral footprint margins using radiofrequency.
3) Reaming the femoral tunnel independently through the anteromedial portal using a flexible guidewire, aiming for the center of the femoral footprint.
4) Preparing the tibial tunnel centered in the tibial footprint without relying on secondary landmarks.
This technique is reported to restore native ACL anatomy with
Patella in total knee arthroplasty to resurface or not is the questionBipulBorthakur
This document discusses different perspectives and techniques regarding patellar resurfacing during primary total knee arthroplasty. It notes that while resurfacing was routinely performed in North America, Asian surgeons often do not due to patient characteristics. Three main approaches are described: always resurfacing, never resurfacing, and selective resurfacing based on factors like cartilage quality and arthritis. Complications of both resurfacing and non-resurfacing are presented. Multiple studies are reviewed that compare outcomes between the two techniques, with many finding reduced reoperation rates but similar pain levels with resurfacing. The conclusion is that the best approach remains controversial, though resurfacing is often recommended for inflammatory arthritis or severe patellar deformity.
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
1) The document describes a study comparing computer-assisted mandibular reconstruction using vascularized iliac crest bone grafts to conventional reconstruction techniques.
2) With computer-assisted planning, a surgical guide was designed based on CT scans and used to precisely shape and position the bone graft. This method aimed to reduce operating time and bone removal compared to conventional techniques.
3) Results found that with computer-assisted planning, the bone graft fit perfectly into the mandibular defect with less adjustment needed. Operating time and bone removed were also reduced compared to conventional techniques. Patients reported higher satisfaction with their appearance.
Value of Contrast Enhanced CT in Detecting Active Haemorrhage in Patients wit...ijtsrd
This document discusses a study that evaluated the use of contrast enhanced CT scans to detect active hemorrhaging in patients with blunt abdominal or pelvic trauma. The study found that contrast enhanced CT was able to precisely locate sites of active hemorrhaging in the spleen, pelvis, retroperitoneum, kidneys, liver, and adrenal gland. The CT attenuation values of active hemorrhaging ranged from 75-350 HU, which was significantly higher than the 45-65 HU range for clotted blood. Contrast enhanced CT can thus effectively distinguish between active hemorrhaging and clotted blood, aiding clinical decisions about surgical or angiographic intervention for trauma patients.
Ann Vasc Surg 2012; 26: 141-148-Selected technique- Funnel Technique for EVAR: ‘‘A Way Out’’ for Abdominal Aortic Aneurisms With Ectatic Proximal Necks
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
This document discusses the use of surgical navigation in craniomaxillofacial surgery and classifies different indications for its use. It analyzes cases where surgical navigation was used or considered at a clinic from 2003-2009. Four typical clinical situations are presented: 1) difficult secondary reconstruction of a zygomatic bone fracture where navigation provided high accuracy, 2) acute orbital floor fractures where navigation aided in identifying bony edges, 3) removal of lingual displaced root fragments where navigation helped locate structures near bony areas, and 4) bilateral midface fractures where navigation was not deemed necessary. The document concludes by classifying indications for surgical navigation as Class I (clear), Class II (limited), or Class III (no indication).
This study reviewed the long-term outcomes of total knee arthroplasty (TKA) in patients with severe valgus knee deformity (variant-III). 32 patients (37 knees) underwent TKA with an average follow up of 10 years. The mean preoperative valgus alignment of 33 degrees was corrected to nearly neutral alignment postoperatively. Clinical and functional outcomes significantly improved based on HSS knee scores and range of motion. No revisions were required. Complications included 3 transient peroneal nerve palsies and 2 DVTs, but no infections or loosening. TKA can successfully treat severe valgus deformity with proper soft tissue balancing and implant selection.
This document discusses the rehabilitation of the atrophic posterior maxilla using pterygoid implants. It provides background on the challenges of posterior maxillary rehabilitation and outlines treatment options like sinus lifts, short implants and tilted implants. It then focuses on the anatomy of the pterygoid region and classifications for pterygoid implants. The document details the surgical protocol for placing pterygoid implants using guides, angled abutments, impressions and final prosthesis placement. It concludes that pterygoid implants provide an alternative to maxillary reconstruction and avoid cantilevers while allowing for immediate loading.
1. The document describes three cases of patients with giant aneurysmal bone cysts (ABCs) that were treated with en bloc resection and reconstruction with non-vascularized fibular bone grafts.
2. All patients achieved bony union following the procedure and had no recurrence of the cysts or limitations in range of motion.
3. Non-vascularized fibular grafts provided an effective reconstruction method for large bone defects left after resection of giant ABCs.
FUNNEL TECHNIQUE, J ENDOVASC THER 2006;13:775–778- Case Report-Funnel Techniq...Salvatore Ronsivalle
FUNNEL TECHNIQUE: A WAY OUT IN ABDOMINAL AORTIC ANEURYSM WITH ECTATIC PROXIMAL NECK.
TECNICA FUNNEL: UNA SOLUZIONE ALTERNATIVA IN ANEURISMA DELL'AORTA ABDOMINALE CON COLLETTO PROSSIMALE ECTASICO.
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
CBCT imaging allows for more accurate implant planning compared to traditional 2D radiographs. It provides 3D views of the bone that are crucial for determining implant placement and potential augmentation procedures. For a patient with severe maxillary resorption, CBCT revealed thin bone in the premaxilla requiring grafting and sufficient bone in the molar region but requiring sinus lifts. Implants were successfully placed following the CBCT-based treatment plan with grafts and have sufficient bone support and integration.
Bone scanning & nasal bone graft viabilityLawrence Ho
This study examined the use of radionuclide bone scanning in the early assessment of free autologous cancellous bone grafts used in augmentation rhinoplasty. Twenty patients underwent bone scanning between 2-15 weeks after rhinoplasty surgery. Bone scans predicted graft failure in 2 of 20 patients, where graft uptake was less than or equal to soft tissue. These failures were confirmed by clinical assessment and X-ray evidence of bone resorption 3 months later. Both failures involved grafts from the calvaria. However, failure rates between calvaria and iliac grafts were not significantly different. Bone scanning appears useful for early detection of nasal bone graft failure.
1. The study examines the reduction in size of keratocystic odontogenic tumors (KCOTs) in the mandible via marsupialization and 3D CT scans over time.
2. Fifteen patients with KCOTs underwent marsupialization surgery, and their 42 serial CT scans were analyzed to measure tumor diameter and volume changes.
3. The results show that KCOTs reduced equally towards the marsupialization window and that volume reduction per day followed the formula Vr = -0.0029 × V, indicating volume is reduced by half over 239 days of marsupialization. This allows prediction of tumor size changes over time.
Crestal approach for maxillary sinus augmentation in patients with less than ...droliv
This study evaluated the success of a crestal approach sinus lift procedure combined with immediate implant placement in patients with varying amounts of residual alveolar bone (RAB). 102 patients received 109 implants across three clinical sites. Patients were divided into two groups based on RAB height: group 1 had 24 mm RAB and group 2 had >4 mm RAB. The success rate was 100% for group 1 and 98.5% for group 2 after 6-100 months. Both groups experienced minimal crestal bone loss on average (0.55 mm for group 1 and 0.07 mm for group 2) with no significant difference between groups. The study concludes the crestal approach is a viable technique for patients with as little as
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...pateldrona
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess, aiming to stress out the immense contribution...
Intravenous&EndocavitaryContrastEnhancedUltrasound(CEUS) in Multiseptated Pyo...komalicarol
This case report describes the use of intravenous and endocavitary contrast-enhanced ultrasound (CEUS) to guide drainage of a complex multiseptated pyogenic liver abscess in an 84-year-old woman. CEUS with Sonovue contrast agent allowed visualization of abscess cavities, septations, and surrounding structures to safely place drainage catheters. Endocavitary CEUS through the catheters confirmed correct positioning. CEUS provided real-time imaging guidance without radiation, avoiding surrounding vessels and confirming drainage between cavities. The successful drainage with CEUS guidance improved the patient's condition.
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...AnonIshanvi
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess, aiming to stress out the immense contribution...
Intravenous & Endocavitary Contrast Enhanced Ultrasound (CEUS) in Multiseptat...AnnalsofClinicalandM
Pyogenic liver abscess is a potentially life-threatening pathology, while image-guided drainage is highly indicative as first-line treatment approach. We report the case of an 84-year-old woman, diagnosed with large multiseptated pyogenic liver abscess,
An 83-year-old female patient was admitted to the hospital with breathing difficulties and weight loss. An autopsy revealed adenocarcinoma of the lung and colon in the late stages. Molecular testing found that both cancers had a BRAF V600E mutation, which is rare for two separate cancers to share. The autopsy also uncovered several other previously unknown medical conditions, demonstrating the importance of autopsies for quality control and teaching.
Kongressplakat pathologie dworak grading system prof. hansen_din a0Klinikum Lippe GmbH
This study evaluated the Dworak tumor regression grading (TRG) system as a prognostic indicator for 159 rectal cancer patients treated with neoadjuvant chemoradiotherapy. Patients were observed for a mean of 42.5 months. A univariate Kaplan-Meier analysis found that patients with Dworak TRG grades 3+4 had a mean progression-free survival of 121 months, significantly higher than the 53.6 months for patients with grades 1+2. A multivariate analysis identified Dworak TRG grade and postoperative nodal stage as independent risk factors. The study concludes that Dworak TRG is an important prognostic indicator of progression-free survival and that subclassifying into grades 1+2 and 3
This study developed and tested a non-language specific speech test using made-up syllables to evaluate speech in cleft patients from different cultural and language backgrounds. The test was administered to 41 cleft patients and 39 non-cleft individuals from Germany, Iran, and India. Two speech pathologists independently rated audio recordings of the tests and found significant differences in hypernasality, nasal emissions, and consonant errors between cleft patients and non-cleft controls from the same language group. While inter-rater agreement was poor, the test was able to distinguish speech characteristics between cleft and non-cleft individuals across different languages and cultures.
This study evaluated the use of vascularised fatty tissue flaps to replace excised parotid tissue and prevent Frey's syndrome in 37 patients who underwent parotidectomy between 2008-2017. The fatty flaps took an average of 17 minutes to dissect and were stable for up to 9 years of follow up. None of the patients reported symptoms of Frey's syndrome such as flushing or sweating when eating. The flaps were an easy technique that avoided donor site morbidity compared to other options and successfully prevented Frey's syndrome in all patients.
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
This document describes a new minimally invasive technique for harvesting a deep circumflex iliac artery (DCIA) flap for jaw reconstruction using virtual surgical planning and 3D printed surgical guides. Virtual planning based on CT scans allows for precise preoperative design of the bone flap and surgical guide. The guide enables a medial approach to the pelvis to harvest the flap, preserving important anatomical structures and muscles to reduce donor site morbidity. Initial results found the new technique allowed for shorter recovery times and less complaints about walking or hip profile changes compared to standard approaches.
This study analyzed the three-dimensional morphology of ears in 240 Caucasian volunteers aged 21-65. 3D scans were taken and distances, angles, and proportions between landmarks on the ears were measured. The results showed that the distance between the subaurale and superaurale, as well as the width of the ear, significantly increased with age. The lower quadrant of the ear extended the most with increasing age. The ear continues changing shape in adulthood even after body growth stops. These measurements can help surgeons plan operations to achieve aesthetic outcomes for patients of different ages.
This study assessed parental risk factors for cleft lip and palate (CL/P) in 187 children with CL/P and 190 non-cleft children. The study found that family history of clefts, lack of folic acid consumption during pregnancy, and consanguineous marriage were strongly associated with increased risk of a child being born with CL/P. Children with CL/P also had significantly higher rates of other congenital abnormalities and physical problems compared to non-cleft children. The findings suggest expecting mothers with a family history of CL/P or who engage in consanguineous marriages should take extra precautions to prevent CL/P in their children.
2016 wahl-immunotherapy with imiquimod and interferon alfa for metastasized m...Klinikum Lippe GmbH
1) The document describes the case of a 90-year-old woman with metastatic Merkel cell carcinoma (MCC) that was treated with a combination of local and systemic immunotherapy.
2) Treatment included weekly intralesional injections of interferon alfa-2a along with topical imiquimod cream 3 times per week, as well as subcutaneous injections of pegylated interferon alfa-2b.
3) This combination led to the regression of all cutaneous metastases and lymph node metastases within 4 months, and the patient remained alive 30 months after starting immunotherapy, suggesting locally metastasized MCC can be controlled with local and systemic immunotherapy.
1) The study examined the effect of using acellular dermal grafts in combination with Z-plasty technique for secondary cleft lip deformities.
2) 18 patients underwent scar revision, submucosal tunneling, Z-plasty, and placement of an acellular dermal graft.
3) Quantitative measurements before and after surgery found significant improvements in symmetry, defect height, and lip thickness, indicating acellular dermal grafts with Z-plasty can effectively treat secondary cleft lip deformities.
This document describes a technique for reconstructing full-thickness defects of the lower third of the nose using a three-layer approach. A reversed nasolabial flap is used to reconstruct the nasal lining, an auricular cartilage graft provides structural support, and a forehead flap provides skin coverage. The technique was used in 21 patients and resulted in satisfactory aesthetic and functional outcomes in most cases. Combined flaps from local and distant sites incorporating cartilage can effectively reconstruct large nasal defects while restoring the three anatomical layers.
2016 heinz-two-step reconstruction of non-marginal auricular defectsKlinikum Lippe GmbH
This document describes a two-step surgical technique for reconstructing non-marginal full-thickness defects of the auricle. In the first step, tissue from the preauricular and retroauricular regions is used to reconstruct the anterior and posterior surfaces of the auricle defect. In the second step, performed two weeks later, the tissue pedicles are separated and adjusted. Thirteen patients underwent this procedure with excellent esthetic outcomes, low morbidity, and patient satisfaction. Vertical and horizontal dimensions of the reconstructed auricles changed minimally. The two-step technique provides an improved method for reconstructing central auricle defects.
This study retrospectively evaluated 34 patients with class III dentofacial deformities who underwent either maxillary advancement or mandibular setback surgery. Pre- and post-operative lateral cephalograms were analyzed to compare changes in 14 soft tissue parameters between the two surgical approaches. Statistically significant differences were found for cervical length, which increased after maxillary advancement but decreased after mandibular setback. Some other aesthetic parameters were found to be superior after maxillary advancement compared to mandibular setback. The study aims to help determine the best surgical approach for correcting class III deformities while optimizing aesthetic outcomes.
This study compared the clinically usable bone regions of the ilium and fibula for mandible reconstruction. Measurements were taken of 241 ilia, 91 mandibles, and 60 fibulas. The ilium offered a similar total usable bone length to the fibula but maintained a more constant bone thickness throughout, whereas the fibula's dimensions varied significantly. In some fibulas, only a small portion of the total bone length could actually be used. The study suggests the ilium may be a better donor site than the fibula, especially for women requiring occlusal rehabilitation after mandible reconstruction.
This study compared outcomes of 86 patients who underwent reconstruction of facial soft tissue defects following tumor excision using various surgical techniques, including non-vascularised skin grafts, local flaps, a modified face-lift technique, and microvascular free flaps. The face-lift technique resulted in shorter hospital stays and lower rates of ectropion than other methods for defects under 60 cm2. It provided the best aesthetic outcomes but was limited to smaller defects. Microvascular free flaps were necessary for the largest defects over 60 cm2 due to the amount of tissue needed.
2015 heinz-repairing a non-marginal full-thickness auricular defect using a r...Klinikum Lippe GmbH
This document describes a surgical technique using an anterior pedicled retroauricular flap (APRF) to reconstruct full-thickness defects of the central non-marginal area of the ear. The APRF is harvested from the postauricular skin in two stages and used to reconstruct both the posterior and anterior surfaces of the defect. The procedure was performed successfully in 11 patients to repair conchal defects, with good aesthetic outcomes, minimal donor site morbidity, and high patient satisfaction. The APRF provides an effective method to reconstruct central ear defects while maintaining ear size and shape with minimal stress on the flap.
This document discusses the use of techniques from aesthetic rhinoplasty in reconstructive nasal surgery after tumor resection. The authors used osteotomy and tip shaping techniques in 17 patients to reshape the nasal framework after removing underlying bone or cartilage. This increased the margin of safety and reduced the size of the defect, allowing tension-free primary closure with local tissue flaps. Patients were satisfied with the aesthetic and functional outcomes. The techniques require knowledge of procedures from aesthetic rhinoplasty but can improve reconstruction results.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics