Mpfl tech - MPFL Reconstruction for Patellar InstabilityDelhiArthroscopy
MPFL Rec onstruction for Patellar Instability - By Dr Shekhar Srivastav .
Surgical Technique
- Diagnostic Arthroscopy
- Look for any Osteochondral fragment
(Loose body)
- Look for any Chondral damage
- Patellar tracking though Supero-lateral portal
Post-op Protocol
Ambulation with stick and Knee Brace- 3 wks
ROM exer – Next day upto 300 and progress
Review every 2 wks,6 wks,3 mnths,6 mnths and
yearly thereafter
Post-op assessment (Crosby-Insall criteria)
Excellent- No pain,normal activity
Good- Occasional pain,discomfort
Fair/Poor- Pain,loss of flexion,recurrent
dislocation/subluxation
Worse- Pain increased,displacement more
frequent
Caution
Must avoid overtightening-
Medial instability
Medial patellar arthritis
Patellar fractures
Preexisting Chondromalacia
Details @ http://www.delhiarthroscopy.com/
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Mpfl tech - MPFL Reconstruction for Patellar InstabilityDelhiArthroscopy
MPFL Rec onstruction for Patellar Instability - By Dr Shekhar Srivastav .
Surgical Technique
- Diagnostic Arthroscopy
- Look for any Osteochondral fragment
(Loose body)
- Look for any Chondral damage
- Patellar tracking though Supero-lateral portal
Post-op Protocol
Ambulation with stick and Knee Brace- 3 wks
ROM exer – Next day upto 300 and progress
Review every 2 wks,6 wks,3 mnths,6 mnths and
yearly thereafter
Post-op assessment (Crosby-Insall criteria)
Excellent- No pain,normal activity
Good- Occasional pain,discomfort
Fair/Poor- Pain,loss of flexion,recurrent
dislocation/subluxation
Worse- Pain increased,displacement more
frequent
Caution
Must avoid overtightening-
Medial instability
Medial patellar arthritis
Patellar fractures
Preexisting Chondromalacia
Details @ http://www.delhiarthroscopy.com/
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Nuclear medicine in orthopaedic conditionsGokul Kafle
This presentation helps to develop a basic concept in Nuclear Medicine, It also helps to outline the use of Nuclear Medicine in Orthopaedic diagnostics and Orthopaedic therapeutics.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Presentation by Dr. Cinthia Drachenberg summarizing the pancreas sessions from 2011 Eleventh Banff Conference on Allograft Pathology, June -10, 2011 in Paris, France.
Nuclear medicine in orthopaedic conditionsGokul Kafle
This presentation helps to develop a basic concept in Nuclear Medicine, It also helps to outline the use of Nuclear Medicine in Orthopaedic diagnostics and Orthopaedic therapeutics.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Presentation by Dr. Cinthia Drachenberg summarizing the pancreas sessions from 2011 Eleventh Banff Conference on Allograft Pathology, June -10, 2011 in Paris, France.
different causes of low back pain,how to diagnose low back pain ,interventional management for low back pain ,evidence based interventions ,color real photos for different interventions
FIBROUS-DYSPLASIA-
CASE-PRESENTATION-At-Shaheed-Suhrawardy-Medical-College-Hospital-Dhaka-Bangladesh (1).pptx is queued for conversion. Meanwhile you can add details and save.
BEDSORE (SOFT TISSUE CHRONIC WOUND) HEALING- By
Low Level Laser Therapy:
LED ( Ga-Al-As, 660) on Soft Tissue Healing: Review, Mechanism and A case report (Research Paper) -
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.
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
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
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
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
22. Diagnosis of Nonunion-
History
• Painless abnormal movement at fracture
site
• Pain present at fracture site, but in
established non union it is pain free.
• Symptoms of infection
• In ability to bear weight.
22
25. Investigations-
Radiologic Evaluation
Diagnosis of
Nonunion-
• Standard radiographs are often diagnostic
Investigations: Specific-
• 45 degree oblique films can increase
diagnostic accuracy
• Despite additional projections, the
potential for false-positive results for
fracture healing remains
25
26. X-Ray and Imaging
Diagnosis of • Usually a plain X-Rays is adequate for
Nonunion-
Investigations: Specific-
diagnosis of Non Union.
• But rarely stress X-ray, CT scans and MRI
is required.
26
27. Valgus
Diagnosis of
Nonunion- Varus
Investigations: Specific-
Clinical diagnosis can be confirmed and
information about stability obtained with
stress radiographs.
27
28. Radionuclide Scanning
• Technetium - 99 diphosphonate
• Detects repairable process in bone ( not
Diagnosis of specific)
Nonunion-
Investigations: • Gallium - 67 citrate
Specific-
• Accumulate at site of inflammation (not
specific)
• Sequential technetium or gallium
scintigraphy
• Only 50-60% accuracy in subclinical
ostoemyelitis
28
33. Non-operative-
BMP (Bone morphogenic protein
Treatment injection)
Bone marrow injection
Ultrasound
Electric stimulation
Low Level Laser Therapy.
But in established non union, non operative
method rarely helpful. 33
34. Surgical Treatment-
A. Hypertrophied non inions unite with
Treatment good adequate fixation (intramedulary
nails, Locking plates or DCP and
different types of wiring), may not
require bone graft.
B. Atrophied non union always needs bone
graft with adequate fixation.
C. Gap non union needs vascularised fibula
graft or bone transportation /
lengthening.
D. Infected nonunion needs special
combined effort. 34
35. Infected Non-unions
• Contaminated implants and devitalized
implants must be removed
Treatment • Infection treated:
Infected • Temporary stabilization (external
nonunion
fixation)
• Culture specific antibiotics
• +/- local antibiotic delivery (antibiotic
beads)
• Secondary stabilization with augmentation
of osteogenesis (cancellous grafting)
35
36. Bone Grafting-
Treatment
Atrophied • Osteoinductive - contain proteins or
non union chemotactic factors that attract
vascular ingrowths and healing
i.e.. dematerialized bone matrix
&BMP’s
• Osteoconductive - contains a
scaffolding for which new bone
growth can occur
i.e. allograft bone, calcium hydroxyapatite
36
37. Treatment Bone Grafting-
Atrophied
non union
• Used to stimulate biologic
response of healing in
nonunion (usually atrophic
nonunion)
• Also used to fill defects in
fracture zone
i.e. up to 6 cm intercalary defects of
long bones)
Bosse, MJ e.t.al. JBJS 1989 37
38. Autogenous Cancellous Bone
• Sites
Posterior Iliac Crest (20 cc)
Anterior Iliac Crest (10cc)
Treatment
Atrophied Proximal Tibia (7cc)
non union Distal Radius, Calcaneus, Olecronon (?).
• All series suggest some incidence of donor
morbidity dependent upon harvest site and
volume required.
• Still considered by many to be the most osteogenic
graft material.
38
39. Treatment
Hypertrophied Locking Plate
non inions
Technology
• Will give better fixation in
pathologic bone
• Most likely will prevent early
failure
(Occasionally seen with traditional
compression plating techniques )39
40. Treatment
Hypertrophied
non inions
Traumatic Bone Loss-
• Reconstructive planning and
intervention should begin prior to
meeting the time requirements for
nonunion
• Options
Distraction osteogenesis
Vascularized bone graft
with Iliac crest bone grafting
40
41. Intra-medullary Nailing-
• Mechanically stabilizes long bone nonunion as a load
sharing implant
• Corrects mal-alignment
Treatment
• Reaming is initially detrimental to intra-medullary
Hypertrophied
blood supply, but it does recover and is believed to
non inions
stimulate biologic healing at fracture
• Allow patient to mobilize surrounding joints and
dynamize fracture environment.
41
42. Intra-medullary Nailing
Treatment
Hypertrophied
• Can be performed without direct
non inions exposure or dissection of the
fracture soft tissue envelope
• Non-applicable in articular
fractures.
42