Amputation is the complete removal of an injured or deformed body part. It is indicated for conditions like peripheral vascular disease, infection, trauma, tumors and diabetes. The goals of amputation are to remove diseased tissue, reduce morbidity/mortality, and allow for maximum independent function with prosthetics. Determining the appropriate amputation level considers factors like circulation, soft tissues, bone/joint condition and infection control. Techniques aim to debride nonviable tissue, close wounds primarily or with flaps/grafts, smooth bone edges and allow for rapid rehabilitation. Complications include non-healing, infection, phantom pain/sensation and contractures.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
the slide describes femoral fracture with case presentations as well as rediological diagnosis ,when opened and closed .the management from emergency period and through to stabilization
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Instructions for Submissions thorugh G- Classroom.pptx
Amputation notes
1. Amputation
Amputation is the complete removal of an injured or deformed body part
A.Indications for Amputation
1. Peripheral vascular disease
2. Peripheral Arterial occlusive disease
3. Acute occlusion due to embolism
4. Aneurysm
5. Diabetic limb disease
6. Necrotising fasciitis
7. Trauma (severe tissue damage) - traumatic amputation
8. Infection (chronic disabling infection, Gas Gangrene)
9. Tumours (Malignant)
10. Nerve injury (trophic ulceration – insensitive limb)
11. Congenital anomalies (eg. extra digits/ Gross deformity dysmelia)
12. Diabetes
o Damage to micro-vessels
o Peripheral neuropathy, no sensation
o Ulcers develop due to trauma, infection often ensues
o Arterial blood supply is reduced
o Ulcer becomes chronic with bouts of acute infection leading to loss of digits/foot/limb
13. Other Factors
o Malignancy: squamous cell carcinoma
o Cardiac disease: AF, CCF, MI,
o Trauma: RTA, crushing injury, gunshot, bomb blast, industrial machinery and burns.
B.Aims
1. Return Patient to maximum level of independent function
2. Ablation of diseased tissue (tumor or infection)
3. Reduce morbidity & mortality (tumor or infection)
4. Considered first part of a Reconstruction to produce a physiological end organ .
C.Determination of level
1. Zone of Injury (trauma)
2. Adequate margins (tumor)
3. Adequate circulation (vascular disease)
4. Soft tissue envelope
5. Bone and joint condition
6. Control of infection
7. Nutritional status
2. D.Techniques
1. Debridement of all Nonviable tissue and foreign material
2. Several debridements may be required
3. Primary wound closure often contraindicated
4. High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle
may be present while superficial muscles can remain viable
5. Nerve
Prevent neuroma formation
Draw nerve distally, section it, allow it to retract proximally
6. Skin
Opportunistic flaps
Rotation flaps
Tension free
Skin grafts
7. Bone:
Choose appropriate level
Smooth edges of bone
Narrow metaphyseal flare for some disarticulations
8. Goals of Postoperative Management
Prompt, uncomplicated wound healing
Control of edema
Control of Postoperative pain
Prevention of joint contractures
Rapid rehabilitation
9. Post operative:
a. Rigid dressing : decreses edema, decreases post operative pain, protect limb from trauma, early
mobilsation. Good bandaging to mold the stump into Conical shape to accept the prosthesis.
b. In postoperative prosthesis : early training with an IPOP is believed to increase the long term
acceptance and use of prosthesis
c. Epidural analgesia
d. Cast to be appied at the end of the procedure, changed on the post op day 5 + IPOP
e. Cast changed weekly
f. Early prosthetic fitting . New prosthesis around 18 months
g. Avoid proximal compression of the limb.
h. Prevent contracture (by splinting and / or muscle exercises)
3. E.Complication
1. Failure of wound to heal : gap if wider than 1cm needs revision
2. Infection : open – flaps retract / edematous
results in shortening the bone
3. Phantom sensation : diminishes over time, telescoping
4. Pain and phantom pain : massage , cold packs, exercise and neuromuscular stimulation
TENS ( trans cutaneous electric nerve stimulation) : incorporated in a prosthesis
-carbamazipine,Phenytoin,gabapentin,Amitriptylin &Mexiletine
-Preioperative analgesia can prevent or decrease the later incidence of phantom pain
.(Epiduralperineural)
5. Edema- mistakes :- 1) Too tightly applied cast 2) Soft spica cast
6. Haematoma
10. Infection
11. Necrosis of stump end.
12. Contractures (due to muscle imbalance)
13. Neuroma at the cut nerve ending
14. Phantom pain
15. Terminal overgrowth (children)
Pain
in the postoperative period- 3 sources, wound pain, back pain and phantom pain. Wound pain can be
controlled with opiates in the immediate phase and, if needed, NSAID’s used.
between normal postoperative (ie, surgical) pain and phantom limb pain.
Surgical pain usually responds well to opioids.
Phantom limb pain usually is like a burning, stinging, electric pain, and it can be increased with anxiety
and stress.
phantom pain is quite common initially,
if it is still present at 6 months postsurgery, the prognosis is unfavorable.
Phantom limb sensation also must be differentiated from phantom limb pain.
Phantom limb sensation is the sensation that the amputated limb is still present.
4. Patients usually report that the absent hand/arm/limb is itching, tickling, or moving through space.
Phantom sensation is perceived as a "funny" or "different" feeling but usually is not perceived as painful.
Phantom limb pain theories
Three theories as to why patients experience phantom limb pain and sensation exist.
One theory is that the remaining nerves continue to generate impulses.
A second theory is that the spinal cord nerves begin excessive spontaneous firing in the absence of
expected sensory input from the limb.
The third theory is that there is altered signal transmission and modulation within the somatosensory
cortex.
Telescoping
Another common phenomenon is telescoping.
Telescoping is the sensation that the distal part of the amputated extremity has moved proximally up
the arm.
A patient might report that it feels like the entire extremity has shrunk so that the hand is now up at the
elbow.
This is a normal part of the nerve healing process and usually fades with time.
F. What do the following terms mean?
Residual limb - The preferred term for the remaining portion of the amputated limb (Stump, while still
used, is politically incorrect.)
Terminal device - Most distal part of the prosthesis used to do work (eg, hand)
Myodesis - Direct suturing of muscle or tendon to bone
Myoplasty - Suturing muscles to periosteum
Prehensile - Grasp
Forequarter Amputation
is the removal of the upper limb with the scapula
Mainly for malignancy
Krukenberg procedure
5. Separate radial and ulna rays distally
forming radial and ulna pincers capable of strong prehension and excellent manipulative ability
SYME'S AMPUTATION: The Syme's amputation provides an end-bearing stump that in many
circumstances allows ambulation without a prosthesis over short distances. It is an excellent amputation
for children, in whom it preserves the physes at the distal end of the tibia and fibula (26).
BOYD AMPUTATION
The Boyd procedure provides a broad weight-bearing surface of the heel by creating an arthrodesis
between the distal tibia and the tuber of the calcaneus
Compared to a Syme's amputation, it provides more length and better preserves the weight-
bearing function of the heel pad. Its increased complexity and morbidity have made it less used
now than the Syme's amputation.
6. Chopart's amputation amputation of the foot by a midtarsal disarticulation.
closed amputation one in which flaps are made from the skin and subcutaneous tissue and sutured
over the end of the bone.
amputation in contiguity amputation at a joint.
amputation in continuity amputation of a limb elsewhere than at a joint.
double-flap amputation one in which two flaps are formed.
Dupuytren's amputation amputation of the arm at the shoulder joint.
elliptic amputation one in which the cut has an elliptical outline.
Gritti-Stokes amputation amputation of the leg through the knee, using an oval anterior flap.
guillotine amputation one performed rapidly by a circular sweep of the knife and a cut of the saw, the
entire cross-section being left open for dressing.
Hey's amputation amputation of the foot between the tarsus and metatarsus.
interpelviabdominal amputation amputation of the thigh with excision of the lateral half of the pelvis.
interscapulothoracic amputation amputation of the arm with excision of the lateral portion of the
shoulder girdle.
Larrey's amputation amputation at the shoulder joint.
Lisfranc's amputation
1. Dupuytren's a.
2. amputation of the foot between the metatarsus and tarsus.
oval amputation one in which the incision consists of two reversed spirals.
Pirogoff's amputation amputation of the foot at the ankle, part of the calcaneus being left in the
stump.
racket amputation one in which there is a single longitudinal incision continuous below with a spiral
incision on either side of the limb.
root amputation removal of one or more roots from a multirooted tooth, leaving at least one root to
support the crown; when only the apex of a root is involved, it is called apicoectomy.
spontaneous amputation loss of a part without surgical intervention, as in diabetes mellitus.
subperiosteal amputation one in which the cut end of the bone is covered by periosteal flaps.
7. Syme's amputation disarticulation of the foot with removal of both malleoli.
Teale's amputation amputation with short and long rectangular flaps.