This document discusses various classifications and conservative surgical treatments for pelvic organ prolapse. It begins by describing the normal anatomical supports that prevent prolapse, including the bony scaffolding, endopelvic fascia, and pelvic musculature. It then covers several classification systems for prolapse, including the Baden-Walker and POP-Q systems. Conservative surgeries discussed include abdominal sling operations, various sling procedures, anterior and posterior colporrhaphies, paravaginal defect repairs, and perineorrhaphies. Newer procedures like vaginal sacrospinous cervico-colpopexy and posterior intravaginal slingplasty are also mentioned. The document emphasizes that hyster
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
Hysterectomy vs levonorgestrel inter-uterine device
Hysterectomy was the most cost-effective treatment
Progesterone receptor modulators for the treatment of uterine fibroids
Progesterone receptor modulators (ulipristal acetate or mifepristone) were also identified as a potential new treatment by members of the Guideline Development group (GDG)
Pre-surgical medical treatment of uterine fibroids (progesterone receptor modulaters and gonadotrophin releasing hormone analogues)
The new evidence may favour ulipristal acetate over gonadotrophin releasing hormone analogue for some, but not all outcomes as a pre-treatment for uterine fibroids before myomectomy
Early Prediction, Proper Planning can lead to Prevention of Disastrous Progre...Indraneel Jadhav
Uterine Leiomyosarcoma (LMS), the rare, aggressive tumours carrying poor prognosis are mostly diagnosed incidentally at time of myomectomy/hysterectomy done for a presumed benign condition.
The incidence of LMS is1 in 10,000 general population. The incidence of leiomyosarcoma in uterine leiomyomas is between 0.13 to 0.29%
LMS generally arise from a solitary lesion and are a result of genetic instability (errors in p16, p53, Ki67) with aggressive biology and chemotherapy resistance.
LMS is characterized by early dissemination with an overall survival of less than 50% at 2 years.
The modern diagnosis of LMS is based on the work of Bell et al and includes a combination of features including
Diffuse moderate to severe cellular atypia
Mitotic count >10 mitotic figures/10 HPF
Coagulative tumor necrosis
INFERTILITY: Failure to conceive within one or more years of regular unprotected coitus.
PRIMARY INFERTILITY: Patients who have never conceived
SECONDARY INFERTILITY : Previous pregnancies but failure to conceive subsequently
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
Vitamin D regulates estrogen biosynthesis through VDR’s
Direct regulation of the expression of the aromatase gene
Maintaining extracellular calcium homoeostasis
Vitamin D increases progesterone secretion by
Granulosa cell leutinisation – HOXA10 expression
Increased 3 β- HSD mRNA levels
Vitamin D increases placental sex steriod production
Regulates human chorionic expression
Secretion from human syncitiotrophoblasts (promoter- CYP19 )
Prediction of Gestational Diabetes Mellitus and Hypertensive Disorders in Pre...Indraneel Jadhav
Globally the burden of GDM and hypertension in pregnancy is increasing, and in India too it is 5-15%.
Although insulin resistance is a physiological phenomenon in normal pregnancy, in predisposed individuals this could lead to hyperinsulinemia with development of GDM, hypertensive disorders of pregnancy or both
Early recognition is the key to prevent feto-maternal complications in these medical disorders
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Indications and incidence of primary caesarean delivery in a multigravidaIndraneel Jadhav
Caesarean delivery - most commonly performed operations today
Worldwide increase in caesarean delivery rates
Primary caesarean delivery in multigravida means first caesarean done in patients who had delivered vaginally once or more
Previous normal delivery – a false sense of security
A genetic condition where affected people have male chromosomes and male gonads with complete or partial feminization of the external genitals
An inherited X-linked recessive disease with a mutation in the Androgen Receptor (AR) gene resulting in:
Functioning Y sex chromosome
Abnormality on X sex chromosome
Post Operative status in patients undergoing Total Laparoscopic HysterectomyIndraneel Jadhav
To determine the indications and complications of Total Laparoscopic Hysterectomy
Post procedure Hemoglobin fall, pain scoring and total hospital stay
Time interval for regain to work and associated delayed complications
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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 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
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
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.
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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.
6. POP - Q Classification of prolapse
Aa Ba C
gh pb tvl
Ap Bp D
7. Stages of pelvic organ prolapse
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
8. Abdominal Sling operations
Indicated in nullipara & young women.
Preserves reproductive function.
Objective
• Buttress the weakened support Mackenrodts
and uterosacral ligaments
9. Selection criteria
First or second degree Uterine prolapse
Uterocervical length less than 5 inches
No infravaginal elongation of cervix
Cystocele or rectocele if present should be repaired
before the surgery
10. Purandare’s cervicopexy
Rectus sheath is anchored
to Anterior part of isthmus
through ASIS and the
leaves of broad ligament
Purandare and Mhatre ‘s
modification
•Tape is fixed posteriorly to
isthmus below uterosacrals
11. Shirodkar’s sling
Principle
Tape is fixed to the posterior
aspect of isthmus & sacral
promontory
Anatomically most correct
but difficult to perform
In cases of
Defective rectus sheath
Poor abdominal muscle tone
Failed purandare’s
cervicopexy
12. Shirodkar’s sling operation
Right side
Shirodkars needle is passed through
retroperitoneal space and tape is attached
posteriorly to isthmus
Left side
Peritoneum over psoas muscle exposed
Psoas loop made
Knot is placed lateral
Shirodkars needle is passed through
retroperitoneal space and tape is attached
posteriorly to isthmus
13. Khanna’s sling
Support is from bony point
Tape is fixed to the posterior
aspect of the isthmus to the
anterior superior iliac spine
14. Virkud’s composite sling operation
End of mersilene tape - sacral
promontory to posterior surface
of isthmus - sutured to rectus
sheath
Plication of left side uterosacral
ligament to correct
dextrorotation
15. Virkud’s composite sling operation
Advantages
Easy to perform
Double support- bony + dynamic
Tape is posterior-no risk during
LSCS
No enterocele
No injury to sigmoid colon
16. Joshi’s sling
Anterior surface of the
uterus at the level of the
internal os is suspended to
the pectineal ligament on
both side with merciline
tape
18. Fothergill operation / Manchester operation
Principle steps
Anterior colporrhaphy
Plication of Mackenrodts ligaments in front of the
cervix using fothergills stitch
Partial amputation of the cervix
Amputated cervix covered with vaginal flap using
sturmdorff suture
Posterior colpoperineorrhaphy
21. Shirodkar’s modification
of Fothergill’s operation
Amputation of cervix is not done
Plication of uterosacral ligaments
Nadkarni’s sleeve
operation
• Modification of Fothergill’s
operation
• Supravaginal portion is
excised
• Fertility is not affected
22. LeFort’s Operation/ Partial colpocleisis
Old age and unfit for surgery
Uterine pathology to be ruled out
Pap smear to be done
25. Tension-free vaginal mesh (TVM) systems
Prolift,
Apogee/Perigee
Avaulta
all of which vary in
terms of mesh size,
shape and surgical
technique
26. This system has four main characteristics:
Mesh -replacement for defective visceral pelvic
fascia
Bridge between the left and right arcus tendineus
fascia pelvis (white line, or ATFP)
Large-size mesh is held in place by passing
cannulas through the obturator fascia (anterior wall)
or the sacrospinous ligament (SSL) to attach the
arms of the mesh graft
Bladder neck is preserved
Mesh repair-principles
27. Laparoscopic
surgery
Vaginal length must be
maintained
Ureters must be
identified and dissected
Requires great skill and
expertise
Newer conservative
surgeries
• Vaginal sacrospinous cervico-
colpopexy/sacrospinous
hysteropexy
• Posterior intravaginal slingplasty
• Abdominal /laparoscopic
sacrocolpopexy
• Posterior mesh repair
28. Hysterectomy should not be the prime treatment and fixing of the cervix to
strong ligament such as sacrospinous ligament could give a more
successful result and conservation of the uterus in young women
29. Anterior colporrhaphy
• To correct cystocele and urethrocele
• The underlying principles are to excise a portion of the
relaxed anterior vaginal wall
• To mobilize the bladder and push it upwards after cutting
the vesicocervical ligament
• The bladder is then permanently supported by plicating
the endopelvic fascia and the pubocervical fascia
under the bladder neck in the midline
31. Paravaginal defect repair
Abdominal method
Entering the retropubic space
To correct detachment between vagina and arcus
tendinus
Repair is done by fixing (reattaching) the
endopelvic fascia to the arcus tendineus fascia
(white line) of the pelvis.
Done retropubically through the space of Retzius
or vaginally.
34. Abdominal sacrohysteropexy is a safe, efficient surgical technique for the
treatment of uterine prolapse in women who desire to preserve the uterus
Khunda A, et al., New procedures for uterine prolapse, Best Practice &
Research Clinical Obstetrics and Gynaecology (2013),
http://dx.doi.org/10.1016/j.bpobgyn.2012.12.004
35. Laparoscopic uterine suspension techniques seem
promising. Advantages are improved visualisation of pelvic
anatomy, shorter hospitalisation, less postoperative pain, and
a quicker return to normal activities
36. References
Rock, John A.; Jones, Howard W.Te Linde's Operative Gynecology, 10th
Edition:Lippincott Williams & Wilkins 2008 section VII chapter 36A
Schorge et al -Williams gynaecology 1st edition 2008 Section III Chapter 24 ,Page
no- 1023-53
Khunda A, et al., New procedures for uterine prolapse, Best Practice &
Research Clinical Obstetrics and Gynaecology (2013)
Jonathan S Berek , Emil Novak :Berek and Novak’s Gynecology 15th edition
Lippincott Williams & Wilkins, 2007:Page no-1211-29
Practical Obstetrics and gynecology , Virkud, 3rd Edition,Chapter 18 : Page no-
323-47
Anteflexion of 170 degrees and anteversion of 90 degrees. Retroversion is the 1st step in POP
When the levator muscles contract forcibly, the genital hiatus narrows as it is pulled posteriorly towards sacrum, this mechanism works when the pressure forces on the uterus are transmitted onto the levator muscle
Michigan, identifies specific structural goals for each of the 3 levels of support of the vagina, defines a set of goals for the pelvic reconstructive surgeon
