To study the outcome of Birmingham mid-head resection (BMHR) arthroplasty of the hip in young and active patients with avascular necrosis of femoral head with gross defects.
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.
This article of mine which came out in the Journal of Orthopaedic Case Reports has been converted into a small book entitled `Modified Posterior Approach to the Hip Joint' which should be available world wide and also listed on Flipart, Amazon,infibeam.
e-Book - Rockstand, Scribid, Kobo, Kindle, Google Play store.
Dr.K.Mohan Iyer,Bangalore,India
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.
This article of mine which came out in the Journal of Orthopaedic Case Reports has been converted into a small book entitled `Modified Posterior Approach to the Hip Joint' which should be available world wide and also listed on Flipart, Amazon,infibeam.
e-Book - Rockstand, Scribid, Kobo, Kindle, Google Play store.
Dr.K.Mohan Iyer,Bangalore,India
A spinal fusion surgery is a procedure that is used to join two or more vertebrae together. Spinal Fusion Surgery India has a high success rate and you can be one of the many people who recover from a serious illness and live a long and happy life.
Spine Arthroplasty or Artificial Disc Replacement is a new term which is used more and more in international scientific meetings and publications starts to dominate the scenery. The last three decades have been the most revolutionary in the history of spine treatment. The 80’s were dominated by the development of modern implants for internal segmental fixation such as pedicle screw systems and others. In the 90’s „Mini-open“ as well as „closed“ endoscopic techniques replaced the majority of conventional surgical approaches . Progress in biological and biochemical research seems to open new perspectives in fusion technology. We must not forget that bony fusion of a functional spinal unit is non physiological and it is associated with a variety of proven and (yet) unproven undesired effects and sequelae. At the beginning of this century, the progress in implant technology open a new dimension for spinal reconstructive non-fusion surgery. A variety of new implants are used today for: nucleus pulposus, total disc replacement, dynamic posterior reconstruction systems, posterior shock absorbers and injectable intradiscal materials. Cervical Disc Replacement is a Motion preserving surgery, Treat painful / pathologic process while restoring/maintaining motion, Decreased stress in adjacent levels, May prevent problems of adjacent segment disease, secondary surgery, pseudoarthrosis.
Comparing arthroplasty (ACDR) vs fusion (ACDF) most of the studies are in favour of (ACDR) because of, Higher neurologic success, Earlier return to work, Degrees of maintained motion, Adjacent Segment Degeneration 5 yrs, Statistically significant better scores (NDI, Arm pain, VAS, and SF-36 scores), lower revision rate (Reoperation rate for ACDF – 11.3% vs 2.9% ACDR)
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Medial Patellofemoral Ligament Reconstruction in ChildrenDavid Sadigursky
Review related to de MPFL Reconstruction combined with the Medial Patellotibial Ligament in open fises patients.
Artigo de revisão relacionado à reconstrução do Ligamento Patelofemoral Medial associado ao Ligamento Patelotibial Medial em pacientes com esqueleto imaturo.
Background: Posterior lumbar interbody fusion is acknowledged as the technique designed to take an advantage of making
circumferential fusion by a single approach while avoiding the injury to anterior vascular structures. However, due to the increasing usage of the interbody techniques, there are emerging case reports and series of the vascular injury followed by the interbody fusion in addition to ALIF.
Crimson Publishers-Comparison of Minimal Invasive Subvastal Approach with Sta...crimsonpublishersOOIJ
Comparison of Minimal Invasive Subvastal Approach with Standard Medial Parapatellar Approach in Total Knee Replacement by Mohamed Nabil in Orthoplastic Surgery & Orthopedic Care International Journal
Total hip arthroplasty has been an important surgical operation in orthopaedics in the 20th century. After many trails, major advancement in Total Hip Arthroplasty was made by Sir John Charnley in 1962, who introduced low friction arthroplasty. This consists of a polyethylene cup and 22.2 mm head, both components being fixed with methacrylate cement. In the following years there were many changes to this basic principle (model) of total hip arthroplasty. Patient education has become an important factor in improvement of function following total hip replacement.
A spinal fusion surgery is a procedure that is used to join two or more vertebrae together. Spinal Fusion Surgery India has a high success rate and you can be one of the many people who recover from a serious illness and live a long and happy life.
Spine Arthroplasty or Artificial Disc Replacement is a new term which is used more and more in international scientific meetings and publications starts to dominate the scenery. The last three decades have been the most revolutionary in the history of spine treatment. The 80’s were dominated by the development of modern implants for internal segmental fixation such as pedicle screw systems and others. In the 90’s „Mini-open“ as well as „closed“ endoscopic techniques replaced the majority of conventional surgical approaches . Progress in biological and biochemical research seems to open new perspectives in fusion technology. We must not forget that bony fusion of a functional spinal unit is non physiological and it is associated with a variety of proven and (yet) unproven undesired effects and sequelae. At the beginning of this century, the progress in implant technology open a new dimension for spinal reconstructive non-fusion surgery. A variety of new implants are used today for: nucleus pulposus, total disc replacement, dynamic posterior reconstruction systems, posterior shock absorbers and injectable intradiscal materials. Cervical Disc Replacement is a Motion preserving surgery, Treat painful / pathologic process while restoring/maintaining motion, Decreased stress in adjacent levels, May prevent problems of adjacent segment disease, secondary surgery, pseudoarthrosis.
Comparing arthroplasty (ACDR) vs fusion (ACDF) most of the studies are in favour of (ACDR) because of, Higher neurologic success, Earlier return to work, Degrees of maintained motion, Adjacent Segment Degeneration 5 yrs, Statistically significant better scores (NDI, Arm pain, VAS, and SF-36 scores), lower revision rate (Reoperation rate for ACDF – 11.3% vs 2.9% ACDR)
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Medial Patellofemoral Ligament Reconstruction in ChildrenDavid Sadigursky
Review related to de MPFL Reconstruction combined with the Medial Patellotibial Ligament in open fises patients.
Artigo de revisão relacionado à reconstrução do Ligamento Patelofemoral Medial associado ao Ligamento Patelotibial Medial em pacientes com esqueleto imaturo.
Background: Posterior lumbar interbody fusion is acknowledged as the technique designed to take an advantage of making
circumferential fusion by a single approach while avoiding the injury to anterior vascular structures. However, due to the increasing usage of the interbody techniques, there are emerging case reports and series of the vascular injury followed by the interbody fusion in addition to ALIF.
Crimson Publishers-Comparison of Minimal Invasive Subvastal Approach with Sta...crimsonpublishersOOIJ
Comparison of Minimal Invasive Subvastal Approach with Standard Medial Parapatellar Approach in Total Knee Replacement by Mohamed Nabil in Orthoplastic Surgery & Orthopedic Care International Journal
Total hip arthroplasty has been an important surgical operation in orthopaedics in the 20th century. After many trails, major advancement in Total Hip Arthroplasty was made by Sir John Charnley in 1962, who introduced low friction arthroplasty. This consists of a polyethylene cup and 22.2 mm head, both components being fixed with methacrylate cement. In the following years there were many changes to this basic principle (model) of total hip arthroplasty. Patient education has become an important factor in improvement of function following total hip replacement.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Femoroacetabular impingement in young adults
Dr.sandeep agrawal agrasen hospital,gondia maharashtra
A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head
Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty
Pelvic osteotomy ,outerbridge classification
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
3. BMHR arthroplasty for early stage AVN of the femoral
head. We offered mid-head resection arthroplasty to all
the patients who attended our clinic with MRI diagnosis
of AVN of the femoral head with large cysts or to those
who had collapsed femoral heads (Stage 4 modified Ficat
& Arlet staging).4
Among the 23 hips, four hips that were
posted for resurfacing arthroplasty of the femoral head,
we switched to perform mid-head resection arthroplasty
on the table due to the small size of the femoral heads
(<46 mm).5
In two other hips, we found large sub-chondral
cysts with sclerotic non-viable bone. Patients who were old
(>60 years) with sedentary lifestyles, and patients with
a history of renal failure or renal compromise5
were
excluded from the study. All patients in whom the femoral
head was in the early pre-collapse stage were managed
conservatively, but the subset of these patients who were
severely symptomatic with pain and stiffness underwent
either core decompression or BMHR arthroplasty.
The approval of local ethical committee was obtained
and clinical and radiological data, along with outcome
scores were collected.
OPERATIVE TECHNIQUE
In the lateral position and general anesthesia the hip was
exposed through the posterior approach. Gluteus maximus
tendon was released routinely. Ascending branch of medial
circumflex was sacrificed and short external rotators were
incised without disturbing the joint capsule. Capsule was
then incised close to acetabulum from 12’ O clock to 6’
O clock position to preserve retinacular vessels. Lower
limb was internally rotated up to 90
to visualize the
anterior capsule. Anterior capsule was then incised close
to the labrum. Circumferentially the hip joint capsule was
incised away from the femoral neck preserving the soft
tissue cover over the femoral neck. This neck capsule
approach has been described previously.2
After opening
the hip by neck capsule preserving approach, initial step
would be to determine the minimum size of femoral
component the femur would accommodate (Fig. 4).
Accordingly the acetabulum size also determined. But
reaming of acetabulum will be done independent of femoral
preparation. McMinn jig was positioned to pin placed in
lateral cortex and head preparation was carried out. There
should be intact head neck junction (HNJ) for resurfacing
devices. In case the proportion of defects in head is more
than intact head, BMHR will be the procedure of choice.
Since instrumentation is same for both, decision of switch-
ing to BMHR from BHR can be carried out on the table.
Fig. 1 Method used for calculation of stem shaft angle and
cup inclination.
Fig. 2 Ratio of base of stem diameter and neck diameter.
Fig. 3 Conical reaming using conical reamer.
298 Apollo Medicine 2012 December; Vol. 9, No. 4 Sharath and Bose
4. Napkin ring is placed at HNJ after chamfering of head
was done (Fig. 5) and apple core reamer was used to
ream the head and decision of implanting BMHR was
taken. Proper positioning of ring is very important for leg
length equality. Uppermost part of head was removed
over the ring. Trial implantation was done at this stage
for leg length assessment.
Cone reamer for stem was used to ream the neck (Figs. 3
and 7). Conical uncemented BMHR stem was then placed
over reamed neck. Modular head with 12/14 taper was
then placed over stem (Fig. 6) matching to the size of
implanted acetabular cup.
Procedure is similar to the one described by McMinn.6
Meticulous capsule-to-capsule closure was performed
with No-2 ethibond sutures. Post-operatively drain was
not used routinely.
All patients received three doses of prophylactic antibi-
otic (1 g Cefazolin) perioperatively. Thromboprophylaxis
was in the form of Enoxaparin after 8 h of surgery until
discharge. Thromboembolus deterrent (TED) stockings
and 75 mg aspirin once daily for a duration of 4 weeks
was prescribed at the time of discharge.7
All the patients
were mobilized full weight bearing on the first post-opera-
tive day. Supervised physiotherapy was commenced and
continued throughout the inpatient period. No restrictions
were imposed otherwise except for the use of abduction
pillow when in lateral position for 4 weeks.
Post-operatively, the patients were followed up at 6
weeks, 6 months, 1-year, and then at 2-year intervals. For
the purposes of this study pre-operative functional hip
scores (UCLA hip score) were collected and repeated at
the latest follow up. The antero-posterior (AP) view of
the pelvis was obtained at each follow up.8
For pre and
post-operative hip scores and activity scores, descriptive
statistics were calculated and statistical significance
analyzed using an unpaired Students t-test.
Fig. 5 Napkin ring.
Fig. 6 Implanted BMHR.
Fig. 7 Conical reamer and stem.
Fig. 4 Measuring head size.
BMHR arthroplasty of hip for avascular necrosis of femoral head Original Article 299
5. Radiographic analysis was performed independently by
two observers (VCB and SKR). Points noted were lucent
lines, osteolysis, spot welding, component loosening, and
migration. The inter teardrop line was used as the reference
for cup inclination (Fig. 1). The distance between the
ischial tuberosity and a fixed point on the lesser trochanter
was used to measure leg length and compared to the contra-
lateral side. Angle between lines joining mid-diaphyseal
line and mid-line of implant stem was compared post-oper-
atively and at latest follow up.
RESULTS
The mean follow up was 23.57 months. Twenty patients
were diagnosed to have idiopathic avascular necrosis, of
which 2 were steroid induced and one post-traumatic.
Mean age of patients was 38.7 years with youngest patient
being 19 years and oldest 56 years (Table 1). All patients
were under the care of a senior orthopedic surgeon
(VCB) who performed all the procedures.
Ten patients had bilateral avascular necrosis. Out of
these ten, three of them underwent bilateral BMHR, another
three underwent BHR on one side and BMHR on the oppo-
site side, two of them underwent THR on one side and
BMHR on the opposite side, and the remaining two patients
underwent BMHR on one side and conservative treatment
on the opposite hip. There were no major post-operative
complications like DVT or infection, either superficial or
deep. Two patients required blood transfusion and one
patient had transient urinary symptoms that settled with
antibiotics for a period of 1 week. There was significant
improvement in UCLA scores post-operatively (Table 2).
The mean inclination of the acetabular component was
46.2
as measured on the latest AP pelvis radiograph and
the mean stem shaft angle was 132.8
(Table 3). There
were no radiolucencies or evidence of osteolysis around
the acetabular or the femoral components. Femoral compo-
nent-femoral shaft angle was valgus in seventeen patients,
neutral in six patients compared to original.9
None of the
components were in varus position. Out of 23 hips,
2 hips had V1 stem and the rest got VST stems. Mean
combined abductionevalgus angle (we proposed in our
previous paper) was 184.53
.
DISCUSSION
Birmingham mid-head resection technique is relatively new
and promising for those hips where resurfacing is not
possible yet conservative arthroplasty is desirable. Unce-
mented HA coated proximal stem with porous coated, grit
blasted fluted distal stem helps in good osteo-integration
and rules out the possibility of cement related loosening
and augurs well with recent trends of uncemented arthro-
plasty. Birmingham mid-head resection is more versatile
in equalizing the limb lengths10
and valgus or neutral orien-
tation of femoral components.
Although neck narrowing has been observed in 2 cases
it is unlikely to be an indicator of neck fracture. Neck
fracture is a phenomenon of short term failure and that
which is not seen for first 2 years is highly unlikely to
occur later as explained by Takamura et al.11
There is
association of neck narrowing with valgus orientation of
native neck shaft angle (although not statistically signifi-
cant). Position of femoral stem with respect to neck is
key to survival of prosthesis. Tip of stem should never
touch any of the cortices in both AP and lateral plane
radiographs. We have measured implant tip to lateral
cortex width in post-operative and immediate follow up
X-rays. There is no significant movement of stem either
due to subsidence or varus collapse. For neck thinning
we measured width of implant (femoral component
base) and width of neck (at implant neck) and ratio of
the values were calculated (Fig. 2). Measurement of ratios
helps us to avoid issues of magnification, that are common
with digital X-rays.
Ratios at immediate post-operative and latest follow up
have not changed with respect to statistically significant
values. There was no narrowing or any evidence of stress
shielding of the femoral neck.
In our study no patients had any issues with regard to
metallosis or adverse local tissue reaction (ALTR). No
patient had any local fluid or solid mass or allergic reac-
tion.12
Mean acetabular cup inclination was 43.18
. One
patient had acetabular cup inclination of 55.85
. At the
Table 1 Clinical details of 20 patients (23 hips).
Age (in years) 38.78 (19e57)
Height (in cm) 164 (158e183)
Weight (in kg) 79.7 (57e99)
Male:female 22:1
BMI 27.79 (21.71e36.58)
Table 2 Details of University of California, Los Angeles score
(UCLA).
Pre-operative Post-operative p-Value
UCLA (n ¼ 20)a
4.2 7.9 0.0000012
UCLA (n ¼ 10)b
3.8 7.5 0.000023
a
There were total 20 patients who were administered UCLA score.
b
Ten patients had bilateral involvement and other side hip was operated
in 8 patients (3 BHR, 2 THR, 3 BMHR), 2 patients had conservative
treatment.
UCLA after exclusion of those 10 patients.
300 Apollo Medicine 2012 December; Vol. 9, No. 4 Sharath and Bose
6. latest follow up, the patient is asymptomatic and there are
no radiological evidence to suggest anything amiss with
the implants.
ROM was improved significantly in all patients, but
improvement was more in patients with more pre-operative
range. There were no radiological signs of repetitive
impingement of neck. None of the patients had a post-oper-
ative dislocation at the latest follow up. Gait was normal for
all but one patient, who had had clinical shortening of 1 cm
post-operatively. He was advised shoe modification. No
other patients had any leg length discrepancy. One patient
complained of groin pain anteriorly which was aggravated
by activity. It was treated with short term analgesics. Pain
intensity reduced but was not relieved completely. The
average UCLA score was 7.9 post-operatively when
compared to a pre-operative average score of 4.2, and this
was highly significant (Table 2). This satisfaction is most
likely as a result of high post-operative activity, good
abductor strength and good pain relief.
Migration of well fixed femoral component in resurfaced
patients with osteonecrosis is a known phenomenon due to
continued process of head destruction and enlargement of
existing small cysts in sub-chondral area. In the BMHR
procedure, we remove all the necrotic head while
preserving the vascularity of the retained neck by the use
of modified neck capsule preserving approach.13
As a result
of both of above said reasons, we can expect good osteo-
integration of femoral component.
The present study had some limitations. We used revi-
sion of the prosthesis as end point, but it is possible that
there were some cases in which hip was symptomatic and
was failing but had not yet reached revision. This is
a common limitation of studies that use revision as end
point.14
But since we are considering a small number of
patients with short term study we could get to their symp-
toms or other problems individually during their follow
up. We have not considered metal ion studies either pre-
operatively or post-operatively to screen our patients,
and post-operative MRI/ultrasonography to detect any
asymptomatic fluid collection or pseudotumor formation.
We could not perform these screening procedures as there
are no standard guidelines15e17
available for the same and
cost was a limiting factor in most of our patients.
Overall the results suggest that reliable and durable short
term outcomes may be expected with use of uncemented
COeCr monoblock acetabular cup with uncemented
femoral mid-head resection component. However proper
patient selection and following proper surgical techniques
are sine qua non for the initial behavior of metal compo-
nents. Further long term studies will be useful in ascertain-
ing the eventuality of mid-head resection arthroplasty, in
comparison to conventional total hip arthroplasty for usage
in young and active individuals with gross destruction of
femoral head.
CONFLICTS OF INTEREST
All authors have none to declare.
ACKNOWLEDGMENTS
Mr Jahir Abbas helped us with data collection and Dr Bis-
wajit Dutta Baruah assisted with data assimilation and
statistical analysis.
REFERENCES
1. Adili A, Trousdale RT. Femoral head resurfacing for the treat-
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Table 3 Details of radiological parameters (mean, range).
Pre-operative Post-operative p-Value
Neck shaft angle 137.48 (129.2e145.3) 145.69 (134.2e156) 0.00032
Acetabular inclination 45.23 (39.01e52.45) 43.18 (37.9e50.85) 0.19
Immediate post-operative Latest follow up p-Value
Acetabular inclination 43.18 (37.9e55.85) 43.05 (37.3e55.85) 0.75
Neck shaft angle 145.69 (134.2e156) 144.98 (134.8e155.87) 0.678
Neck width ratio 0.248 (0.20e0.36) 0.244 (0.20e0.34) 0.777
Tip to lateral cortex 32.01 (12.0e61.0) 32.23 (12.8e60.46) 0.29
BMHR arthroplasty of hip for avascular necrosis of femoral head Original Article 301
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302 Apollo Medicine 2012 December; Vol. 9, No. 4 Sharath and Bose