This document discusses hypopharyngeal pouch (also known as Zenker's diverticulum) and stylalgia (Eagle's syndrome). It defines these conditions, describes their etiology, clinical features, investigations, staging, treatment options including both surgical and non-surgical, and potential complications. It provides diagrams to illustrate the normal anatomy, stages of Zenker's diverticulum, surgical procedures like cricopharyngeal myotomy and endoscopic diverticulotomy, and an elongated styloid process.
ENT Nasal septal perforation..... for best rhinoplasty and nose reshape surgery contact
Dr Junaid Ahmad (MBBS FCPS) is the best plastic surgeon in Lahore. He is a well known, trained and expert in his field. He is MBBS and FCPS in Plastic and Recosntructive Surgery. He is a post graduate of the College of Physicians and Surgeons Pakistan which is oldest and best institute for post graduation in this area of the world. He is doing his practice in Lahore, Pakistan. He is always kind to the patients and listens them carefully as it is part of modern clinical skill and training. He is expert in both cosmetic as well as reconstructive surgery. He is also skin cancer and burn expert. A few of Dr Junaid Ahmad expertise are listed here..... call 03104037071
ENT Nasal septal perforation..... for best rhinoplasty and nose reshape surgery contact
Dr Junaid Ahmad (MBBS FCPS) is the best plastic surgeon in Lahore. He is a well known, trained and expert in his field. He is MBBS and FCPS in Plastic and Recosntructive Surgery. He is a post graduate of the College of Physicians and Surgeons Pakistan which is oldest and best institute for post graduation in this area of the world. He is doing his practice in Lahore, Pakistan. He is always kind to the patients and listens them carefully as it is part of modern clinical skill and training. He is expert in both cosmetic as well as reconstructive surgery. He is also skin cancer and burn expert. A few of Dr Junaid Ahmad expertise are listed here..... call 03104037071
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Allergic rhinitis is a very much prevalent condition in the community. This presentation hopes to spread a ray of hope in treating allergic and intrinsic rhinitis.
CSOM may lead to different complications. Although less common in developed countries, CSOM is common in developing and underdeveloped countries.
This presentation explains the complications of CSOM in details.
Facial nerve is the nerve of facial expression. Facial nerve disorders can lead to ugly face. This presentation explains the facial nerve disorders in details.
CSOM AA might present with both intracranial and extracranial complications. Extracranial complications might again be divided into Intratemporal and extratemporal extracranial.
This presentation explains you about different complications of CSOM in details.
Multiple choice Questions in Otorhinolaryngology with explanations module 2 ...Dr Krishna Koirala
In our part of world, final university examination in otorhinolaryngology carries 80 marks in theory. Out of that there shall be 30 MCQ questions each carrying 1 mark.
So I request you all to go through this presentation.
Audiometry for Undergraduate and postgraduate ENT students Dr Krishna Koirala
Audiometry is one of the essential topic in MBBS.
This presentation helps students to learn about basic audiometry for MBBS level and shall equally be useful for postgraduate ENT students, too.
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. Definition
• Acquired pulsion diverticulum caused by
posterior protrusion of mucosa through pre-
existing weakness between thyropharyngeus
and cricopharyngeus component of inferior
constrictor muscle
6. • Tonic spasm of cricopharyngeal sphincter (Negus)
• Lack of inhibition to cricopharyngeus (Dohlmann)
• Neuromuscular in-coordination between thyropharyn
geus and cricopharyngeus (Korkis)
• Second swallow against closed cricopharynx( Wilson)
Increased intraluminal pressure in hypopharynx and
mucosa bulges out through the weak areas
9. • Sensation of food sticking in throat and dysphagia:
entrapment of food in pouch
• Foul taste, bad odor, nocturnal coughing, choking :
regurgitation of entrapped food
• Hoarseness : spillage laryngitis or sac pressure on
RLN
• Weight loss due to malnutrition
• Compressible neck swelling on left side that reduces
with a gurgling sound (Boyce sign)
10. Complications
• Aspiration of sac contents into lungs
• Bleeding from sac mucosa
• Absolute esophageal obstruction
• Fistula formation into trachea or major blood
vessels
• Squamous cell carcinoma within Zenker's
diverticulum (rare)
11. Investigations
• Chest X-ray: may show sac and air - fluid
level
• Barium swallow
• Barium swallow with video-fluoroscopy
• Rigid Esophagoscopy
• Flexible Endoscopic Evaluation of Swallowing
15. Staging ( Lahey system)
• Stage I:
– Small mucosal protrusion
• Stage II:
– Definite sac present, but hypo-pharynx and
esophagus are in line
• Stage III:
– Hypopharynx is in line with pouch and esophagus
pushed anteriorly
19. External Endoscopic
Longer procedure Short procedure and anaesthetic time
Longer hospital stay (typically 5–7
days) with nasogastric feeds for 5 days
Short hospital stay (1–2 days) with oral
intake within 24 hours
Higher complication rate Lower complication rate
Specimen available for histological
assessment to exclude carcinoma
No histological assessment of pouch
Proved long term satisfactory results
Long term results of stapling awaited,
although good results reported with
laser
Revision surgery can be difficult Revision surgery straightforward
Advantages/disadvantages of endoscopic vs.
external surgery
20. Surgical Treatment
• Cricopharyngeal myotomy and combinations
• Diverticulum invagination (Keyart)
• Diverticulopexy: Sippy-Bevan
• External or open Diverticulectomy: Wheeler
• Rigid Endoscopic Diverticulotomy : Cautery
(Dohlman), Laser , Stapler
• Microendoscopic diverticulotomy ( Van Overbeek)
• Flexible Endoscopic Diverticulotomy with Laser
21. Treatment Protocol
• Small sac (< 2cm)
– Cricopharyngeal (CP) myotomy + invagination
• Large sac (2-6 cm)
– Open Diverticulectomy with CP myotomy
– Endoscopic Diverticulotomy with CP myotomy
• Very large sac (> 6 cm)
– Open Diverticulectomy with CP myotomy
– Diverticulopexy with CP myotomy
29. Diverticulopexy
• Sac mobilized & its fundus fixed to sternocleido-
mastoid muscle in a superior, non-dependent position
• CP myotomy is also performed
32. Introduction
• Normal length of styloid process is 20–25 mm
• Length >30 mm in radiography is considered an
elongated styloid process
• 5-10% pts with elongated styloid process have pain
• Increased angulation of styloid process both
anteriorly and medially, can also cause pain
• Commonly seen in females over 40 years
• Watt Weems Eagle (1937 )
33. Types
• Classical
– Occurs several years after tonsillectomy
– Presents as pharyngeal foreign body sensation ,
dysphagia ,dull pharyngeal pain on swallowing,
rotation of neck or protrusion of tongue ,referred
otalgia
– Due to scar tissue in tonsillar fossa engulfing
branches of glossopharyngeal nerve
34. • Carotid Artery Syndrome
– Sequale of head or neck trauma
– Carotid artery compression by styloid process
•Leads to carotidynia, headache & dizziness
– External carotid artery involvement
•Neck pain that radiates to eye, ear, mandible, palate &
nose
– Internal carotid artery involvement
•Parietal headache, pain along ophthalmic artery
37. Theories for ossification
• Reactive hyperplasia
– Trauma ossification of fibrocartilaginous
remnants in stylohyoid ligament
• Reactive metaplasia
– Abnormal post-traumatic healing calcification of
stylohyoid ligament
• Loss of elasticity of stylohyoid ligament due to ageing
• Normal anatomical variation
38. Theories for pain
• Irritation of glossopharyngeal nerve
• Irritation of sympathetic nerve plexus around
internal carotid artery
• Inflammation of stylohyoid ligament
• Stretching of overlying pharyngeal mucosa
39. Diagnosis
• Digital palpation of styloid process in tonsillar fossa
elicits similar pain
• Relief of pain with injection of 2% Xylocaine solution
into tonsillar fossa
• X-ray neck lateral view
• Ortho-pan-tomogram (O.P.G.)
• Coronal C.T. scan skull
• 3-D reconstruction of C.T. scan skull
44. Medical Treatment
• Oral analgesics
• Injection of steroid + 2% Lignocaine into tonsillar
fossa
• Carbamazepine: 100 – 200 mg T.I.D.
• Operative intervention reserved for
– Failed medical management for 3 months
– Severe & rapidly progressive complaints
45. Styloid Process Excision
• Intra-oral route
– Via tonsillar fossa
– No external scarring
– Poor visibility due to difficult access
– High risk of damage to internal carotid artery
– Iatrogenic glossopharyngeal nerve injury
– High risk of deep neck space infection
48. • Tonsillectomy done and styloid process palpated
• Incision made in tonsillar fossa just over the tip
• Styloid attachments elevated till its base with
periosteal elevator
• Styloid process broken near its base with bone
nibbler, avoiding injury to glossopharyngeal nerve
• Tonsillar fossa incision closed
49. Extra- oral route
• Incision extends from
mastoid process along the
sternocleidomastoid to the
level of hyoid then across
neck up to midline of chin
– External scar present
– Better exposure
– Less morbidity