New Developments in Breast Reconstruction Surgerybkling
Deborah Axelrod, MD, of NYU Langone Perlmutter Cancer Center, and Rachel Bluebond-Langner, MD, of NYU Langone Medical Center discuss the latest research in autologous breast reconstruction, fat injection, pre-pectoral implants, and oncoplastic surgery.
Disclaimer: Graphic medical imagery.
While many women desire round, lifted, and proportionate breasts, pregnancy, weight loss or gain, heredity, and age, can affect these goals. Breast augmentation, also known as breast enhancement or breast enlargement, allows a woman to increase the size of her breasts. Implants filled with silicone or saline can provide balance to their figure, while feeling surprisingly natural.
Breast Reduction Surgery (mammaplasty) in Kolkata | Dr Jayanta Kumar SahaCosmetic-Therapy Clinic
Reduction mammaplasty is the surgical procedure which is performed to reduce, reshape and tighten the size of excessively large female breast. Patients opt for reduction mammaplasty or breast reduction surgery in order to overcome the physical, sexual and social embarrassment attached with the problem. Dr. Jayanta Kumar Saha of Cosmetic Therapy Clinic, Kolkata is an expert cosmetic plastic surgeon who performs this procedure with great perfection and expertise. Consult him over phone or email him to seek advice on female breast reduction surgery and any other cosmetic surgery performed in his cosmetic therapy clinic in Kolkata. Chek here for more details: http://www.cosmetic-therapy.com/cosmetic-surgeries/surgeries-for-female/breast-reduction-surgery/
This is a powerpoint presentaiton given by W. Thomas McClellan, MD FACS, a Board Certified Plastic Surgeon who specializes in breast augmentation. This presentation is unique and critical because it gives patients detailed information about what is important regarding breast augmentation. For example: How to choose a surgeon, what is important in the operating room, postoperative care, how to pick a size, type of breast implant.
New Developments in Breast Reconstruction Surgerybkling
Deborah Axelrod, MD, of NYU Langone Perlmutter Cancer Center, and Rachel Bluebond-Langner, MD, of NYU Langone Medical Center discuss the latest research in autologous breast reconstruction, fat injection, pre-pectoral implants, and oncoplastic surgery.
Disclaimer: Graphic medical imagery.
While many women desire round, lifted, and proportionate breasts, pregnancy, weight loss or gain, heredity, and age, can affect these goals. Breast augmentation, also known as breast enhancement or breast enlargement, allows a woman to increase the size of her breasts. Implants filled with silicone or saline can provide balance to their figure, while feeling surprisingly natural.
Breast Reduction Surgery (mammaplasty) in Kolkata | Dr Jayanta Kumar SahaCosmetic-Therapy Clinic
Reduction mammaplasty is the surgical procedure which is performed to reduce, reshape and tighten the size of excessively large female breast. Patients opt for reduction mammaplasty or breast reduction surgery in order to overcome the physical, sexual and social embarrassment attached with the problem. Dr. Jayanta Kumar Saha of Cosmetic Therapy Clinic, Kolkata is an expert cosmetic plastic surgeon who performs this procedure with great perfection and expertise. Consult him over phone or email him to seek advice on female breast reduction surgery and any other cosmetic surgery performed in his cosmetic therapy clinic in Kolkata. Chek here for more details: http://www.cosmetic-therapy.com/cosmetic-surgeries/surgeries-for-female/breast-reduction-surgery/
This is a powerpoint presentaiton given by W. Thomas McClellan, MD FACS, a Board Certified Plastic Surgeon who specializes in breast augmentation. This presentation is unique and critical because it gives patients detailed information about what is important regarding breast augmentation. For example: How to choose a surgeon, what is important in the operating room, postoperative care, how to pick a size, type of breast implant.
MASTECTOMY:
EPIDEMOLOGY
INCIDENCE
INDICATIONS
ANATOMY OF BREAST
TYPES OF MASTECTOMY
TYPES OF INCISIONS IN MASTECTOMY
MANAGEMENT
POST SURGICAL MANAGEMENT
EARLY COMPLICATIONS
LATE COMPLICATIONS
BREAST RECONSTRUCTIVE SURGERY
Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
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
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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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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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.
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
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2. ROLE OF THE GENERAL SURGEON IN BREAST
RECONSTRUCTION
•“What will it look like when you are done?”
• “Will I have to live without a breast?”
3. History
• Volkmann, Czerny, and Billroth local recurrence rates 52% to 85%.
• William Halsted 6% recurrence rate.
• Halsted concept “To attempt to close the breast by any plastic method is
hazardous, and in my opinion, to be vigorously discounted.”
• The first attempt by Vincent Czerny in 1895 transplanted a large lipoma .
• Tansini (1896) latissimus dorsi myocutaneous flap
• In 1942, Sir Harold Gillies of England started using a tubed pedicle technique of
breast reconstruction.
• Olivari, McCraw, and Muhlbauer in 1970 reintroduced myocutaneous flap .
• In 1963, the silicone breast implant .
9. PREREQISITS
• Type of mastectomy (ie.. skin-sparing technique vs. the standard modified
radical mastectomy)
• Body habitus (thin women or fat women).
• Contralateral breast size and shape.
• Donor site evaluation
• Course of overall health
10. THE IDEAL TOTAL MASTECTOMY
• Preserve pectoralis major muscle
• 2cm excess margin
• Incision
• Best is oblique
• Worst is transverse patey incision.
12. IMPLANTS
• Silicone gel implants represented an historic medical breakthrough.
• Biologically inert
• Fibrous encapsulation
• Better results with under muscle placement
• Low grade infection
13. TISSUE EXPANSION
• Stretch the retained breast skin
• Decreasing the encapsulation seen with the permanent silicone
implant
• Best suited for a well built patient
• Avoid placing under tight. Thin. Or irradiated skin.
14. Technique
• The pectoralis muscle for superomedial aspect of the implant.
• Serratus anterior and some of the fascia of the rectus muscle inferiorly.
• Light compressive dressing& applied to the superior pole of the breast
to prevent migration for 4-6 weeks .
• Major drawback is distortion of shape over time and repeated
corrections , not suited for large defects
17. MYOCUTANEOUS FLAPS
• LATISSIMUS DORSI BREAST RECONSTRUCTION
• Revolutionized the reconstruction of the radical mastectomy defect
1. Replacement of the pectoralis muscle
2. Muscle coverage of the implant
3. Replacement of missing skin
18. Techinique
• Flap marked before the breast surgery in standing position
• Paraspinous origins of the muscle divided while preserving the
thoracodorsal neurovascular bundle.
• The flap is carefully rotated on its humeral insertion toward the
anterior chest wall
• Cornerstone is protecting thoracodorsal artery and vein during axillary
dissection
19. • 2-cm. layer of fat on the surface of the latissimus dorsi
muscle can provide 500 g of fat.
• Immediate reconstruction is possible and with single
stage
• Functional loss is unnoticed .
20. • In irradiated patients it brings a robust blood supply into a deficient
region.
• Irradiated skin is best excised
• If an implant is used. it must be covered in its entirety with muscle.
• latissimus dorsi myocutaneous flap is refractory to radiation-induced
loss due to its rich blood supply.
25. AUTOGENOUS MYOCUTANEOUS FLAPS
• Hartrampf in 1982 used the TRAM flap.
• It was the first breast reconstruction using only vascularized
autologous tissue
• In the late 1980s, the autologous extended latissimus flap was
developed
• 1990s, microvasular transfer of the TRAM to ·high-risk" patients
(smoking , diabetics , obesity) .
26. TRAM FLAP
• Gold standard of breast reconstruction.
• Used mainly for difficult reconstructions (extensive skin
removal)
• Management of the donor site is needed
• If B/L flap taken closed with a onlay mesh
27. TECHNIQUE
• 'TRAM flap differs from every other myocutaneous flap in that its
vascular supply is more tenuous requiring delicate handling.
• These flaps are supplied by musculcutaneous perforating branches from
the deep superior epigastric artery and vein.
• One or two pedicled flaps
• Excellent for B/L mastectomy reconstruction
38. FREE TISSUE TRANSFER
Advantages
1. Deep inferior epigastric
artery and vein
2. Better blood supply
3. Lower incidence of fat
necrosis
4. Decreases donor site
morbidity.
5. Does not require tunneling
6. No epigastric bulge
Disadvantages
• Longer operative time
• Needs monitoring
• Needs specialised training
42. DELAYED RECONSTRUCTION
• Reasons that patient expresses for delayed reconstruction
1. Fear of additional prodedure
2. Relif from negative feelings
3. Symmetry
4. Lasting results
5. Emotional recovery
43. Immediate reconstruction
• Differentiation should stop between the treatment and
reconstruction
• Immediate reconstruction does not interfer with surgical
treatment
• Favoured procedure for stage I and IIa and for advanced stages
if patient choices immediate can be opted
• RECURRENCES NEVER OCCUR ON THE FLAPS
44. CHEMOTHERAPY IMPACT
• Chemotherapy can be started while there is still a surface wound that
has not yet epithelialized
• Avoided if frank tissue necrosis, seroma, or infection.
• In anticipated bad wounds flaps are better than implants
45. Mastectomy and radiation effects
• Scarring between skin and pectoralis major muscle
• Shrinkage of both skin and muscle
• Causes persistent perivascular inflammation.
46. OPPOSITE BREAST CONSIDERATIONS
• Reduction mammaplasty involves the removal of breast tissue as well as
excess skin.
• Mastopexy in contrast corrects breast ptosis by elevating the breast
mound (preserves breast volume )
• Augmentation mammoplasty
48. NIPPLE RECONSTRUCTION
• Can be done immediate or delayed(preffered)
• The nipple is formed by local bilobed or trilobed flaps.
• The arms of these flaps are wrapped around themselves to form a
standing cone.
• Nipple and Areola are provided by imbedding pigments
using a tattooing machine.
Choosing the vohune of the implant can
be diflicult. In such cases. the use of a postoperatively
adjustable implant can simplify
this task.
Lats muscle covering the implant protects it for a max of 5 yrs
This method is falling out for the fact that shape and softness of the implant associated
and the skin
paddle can carry an additlonal300 to 500 g
of fat. '1his total of 800 to 1000 g is, in most
cases, enough to replace the entire volume of
breast tissue.
who were considered unacceptable
candidates for pedicled TRAM flap reconstructions.