The document summarizes the contents of the vertebral canal, including the spinal cord, meninges (dura mater, arachnoid mater, pia mater), blood supply, and applied anatomy of epidural anesthesia and lumbar puncture. Key structures mentioned include the spinal cord terminating at L1-L3, the cauda equina formed by nerve roots, the subarachnoid space containing cerebrospinal fluid, and the valveless vertebral venous system that allows blood flow in either direction.
Lateral ventricle of Brain. By Dr.N.Mugunthan.M.Smgmcri1234
Lateral ventricle of brain. Lecture by Dr.N.Mugunthan.
Associate Professor,
Mahatma Gandhi Medical College & Research Institute,
Sri Balaji Vidyapeeth, Pondicherry.
Atlanto occipital and atlanto axial jointShubham Singh
Anatomy:
>Atlas is the topmost vertebra and chief peculiarity of atlas is that it has no body, it is ring like and consist of anterior and posterior arch and two lateral masses.
>Axis, the 2nd cervical vertebra has a concave under side and convex from side to side. The most distinctive characteristic of this bone is strong odontoid process, the dens.
TheJoint:
>Atlanto-occipital joint (articulation between the atlas and the occipital bone) consists of a pair of condyloid joints.
>The atlanto-occipital joints are synovial socket-type joints
Ligaments:
> Posterior atlanto-occipital membrane: extend from anterior arch of atlas to posterior margin of foramen magnum.
>Anterior atlanto-occipital membrane: extend from anterior arch of atlas to anterior margin of foramen magnum.
>The ligamentam flavam join laminae of adjacent vertebral arches.
>The interspinous ligaments expand to form the ligamentum nuchae which inserts along the posterior foramen magnum and external occipital condyle.
> The following four ligaments stabilize these joints:
1.Apical ligament: Connects the dens to the foramen magnum of the occipital bone.
2.Alar ligaments: Connect the dens to the lateral margins of the foramen magnum.
3.Cruciate ligament: Attaches the dens to the anterior arch of the atlas and the body of the axis to the foramen magnum of the occipital bone.
4.Tectorial membrane: Starts at the skull and becomes the posterior longitudinal ligament.
>Atlanto-axial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis.
Muscles:
>Flexion is produced mainly by the action of longis capitis, rectus capitis anterior and sternocleidomastoid (anterior fibres)
>Extension by the rectus capitis posterior major and minor, the obliquus capitis superior, the semispinalis capitis, splenius capitis, longissimus capitis, sternocleidomastoid and upper fibres of the trapezius
>The recti lateralis are concerned in the lateral movement, assisted by the trapezius, splenius capitis, semispinalis capitis, and the sternocleidomastoid of the same side, all acting together.
Movements:
>Flexion and extension in the Sagittal axis, which give rise to the ordinary forward and backward nodding of the head.
>Lateral flexion to one or other side in the Frontal axis(titling of head
>Lateral AAJ Movement: It is a synovial joint which allows only gliding
>Medial AAJ Movement: This joint allows the rotation of the atlas the axis i.e round the dens.
Clinical anatomy:
> Headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs.
>Excessive flexion could rupture the supraspinous ligament.
>Posterior atlanto-occipital membrane ossification cause migraine headaches due to compression of artery.
features and characteristics of the typical and the A typical cervical vertebrae, typical and A typical cervical vertebrae, attachments of cervical vetebrae, atlas and axis features
Lateral ventricle of Brain. By Dr.N.Mugunthan.M.Smgmcri1234
Lateral ventricle of brain. Lecture by Dr.N.Mugunthan.
Associate Professor,
Mahatma Gandhi Medical College & Research Institute,
Sri Balaji Vidyapeeth, Pondicherry.
Atlanto occipital and atlanto axial jointShubham Singh
Anatomy:
>Atlas is the topmost vertebra and chief peculiarity of atlas is that it has no body, it is ring like and consist of anterior and posterior arch and two lateral masses.
>Axis, the 2nd cervical vertebra has a concave under side and convex from side to side. The most distinctive characteristic of this bone is strong odontoid process, the dens.
TheJoint:
>Atlanto-occipital joint (articulation between the atlas and the occipital bone) consists of a pair of condyloid joints.
>The atlanto-occipital joints are synovial socket-type joints
Ligaments:
> Posterior atlanto-occipital membrane: extend from anterior arch of atlas to posterior margin of foramen magnum.
>Anterior atlanto-occipital membrane: extend from anterior arch of atlas to anterior margin of foramen magnum.
>The ligamentam flavam join laminae of adjacent vertebral arches.
>The interspinous ligaments expand to form the ligamentum nuchae which inserts along the posterior foramen magnum and external occipital condyle.
> The following four ligaments stabilize these joints:
1.Apical ligament: Connects the dens to the foramen magnum of the occipital bone.
2.Alar ligaments: Connect the dens to the lateral margins of the foramen magnum.
3.Cruciate ligament: Attaches the dens to the anterior arch of the atlas and the body of the axis to the foramen magnum of the occipital bone.
4.Tectorial membrane: Starts at the skull and becomes the posterior longitudinal ligament.
>Atlanto-axial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis.
Muscles:
>Flexion is produced mainly by the action of longis capitis, rectus capitis anterior and sternocleidomastoid (anterior fibres)
>Extension by the rectus capitis posterior major and minor, the obliquus capitis superior, the semispinalis capitis, splenius capitis, longissimus capitis, sternocleidomastoid and upper fibres of the trapezius
>The recti lateralis are concerned in the lateral movement, assisted by the trapezius, splenius capitis, semispinalis capitis, and the sternocleidomastoid of the same side, all acting together.
Movements:
>Flexion and extension in the Sagittal axis, which give rise to the ordinary forward and backward nodding of the head.
>Lateral flexion to one or other side in the Frontal axis(titling of head
>Lateral AAJ Movement: It is a synovial joint which allows only gliding
>Medial AAJ Movement: This joint allows the rotation of the atlas the axis i.e round the dens.
Clinical anatomy:
> Headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs.
>Excessive flexion could rupture the supraspinous ligament.
>Posterior atlanto-occipital membrane ossification cause migraine headaches due to compression of artery.
features and characteristics of the typical and the A typical cervical vertebrae, typical and A typical cervical vertebrae, attachments of cervical vetebrae, atlas and axis features
venous drainage of the upper limb, median vein of forearm, deep veins, basilic vein, cephalic vein, median cubital vein, superficial vein, dorsal venous arch,
venous drainage of the upper limb, median vein of forearm, deep veins, basilic vein, cephalic vein, median cubital vein, superficial vein, dorsal venous arch,
External ear,tympanic membrane and auditory tube Dr.N.Mugunthan.M.S.,mgmcri1234
External ear,tympanic membrane and auditory tube - Lecture by Dr.N.Mugunthan.M.S.,Associate Professor, Mahatma Gandhi Medical College & Research Institute, Pondicherry,
Sri Balaji Vidyapeeth University.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
8. Vertebral Column
Central bony pillar of the body.
Supports the skull, pectoral girdle, upper
limbs and the thoracic cage.
Within its cavity lie the spinal cord, the roots
of the spinal nerves, the covering-meninges.
Composed of 33 vertebrae: 7 cervical, 12
thoracic, 5 lumbar, 5 sacral, 4 coccygeal.
It is a flexible structure made up of
fibrocartilage called intervertebral discs.
8
9. VERTEBRAL CANAL
The vertebral
canal is formed by
placing the
vertebra in a
sequence, that
their vertebral
foraminae are lie
one below the
other forming
continuous canal
9
10. The vertebral canal
The vertebral canal is bounded
anteriorly by the vertebral bodies and
the intervertebral discs, each
covered by the posterior longitudinal
ligament, which is continuous from
the back of the body of the axis to
the sacrum.
10
11. The vertebral canal
Posteriorly it is bounded
by the laminae,
ligamenta flava and the
arch of the vertebra.
The vertebral canal is
usually larger in the
cervical and lumbar
regions.
11
12. CONTENTS OF VERTEBRAL CANAL
The contents –from outwards;
1.epidural or extra dural space
2.thick dura mater or pachymenix
3.subdural capillary space
4.delicate arachnoid mater
5.wide subarachnoid space containing CSF
6.firm pia mater .The Arachnoid and Piamater together-leptomeninges
7.spinal cord and the cauda equina
8.Blood supply [arteries and lodges, valveless, dangerous venous plexus
[Batsons].. 12
14. CONTENTS OF THE VERTEBRAL CANAL
Spinal cord
is a cylindrical, grayish-
white structure, 42-45 cm
in length that begins above
the foramen magnum,
where it is continuous with
the medulla oblongata of
the brain.
It terminates below in the
adult at the level of the
lower border of the first
lumbar vertebra.
In the young child it is
relatively longer and ends
at the upper border of the
third lumbar vertebra.
14
15. BLOOD SUPPLY OF THE SPINAL CORD
The spinal cord receives its
arterial supply from three
small, longitudinally running
arteries-the two posterior
spinal arteries branches of
posterior inferior cerebellar
arteries and the one anterior
spinal artery branch of
Vertebral artery,
15
16. The veins of the spinal
cord drain into the
internal vertebral
venous plexus
16
17. Meninges of the spinal cord
1. Dura mater
the most external membrane
and is a dense, strong, fibrous
sheet that encloses the spinal
cord and cauda equina.
Continuous above through
the foramen magnum with
the meningeal layer of dura
covering the brain.
Inferiorly, it ends on the filum
terminale at the level of the
lower border of the second
sacral vertebra.
Epidural space- contains
loose areolar tissue and the
internal vertebral venous
plexus.
17
18. 2. Arachnoid mater
a delicate impermeable
membrane covering the
spinal cord and lying
between the pia mater
internally and the dura
mater externally.
Separated from the dura
by the subdural space
that contains a thin film
of tissue fluid.
Separated from the pia
mater by a wide space,
the subarachnoid space,
which is filled with
cerebrospinal fluid.
Inferiorly , it ends on the
filum terminale.
18
19. 3. Pia mater
A vascular membrane
that closely covers the
spinal cord.
Below it fuses with the
filum terminale
The pia mater is
thickened on either side
between the nerve roots
to form the ligamentum
denticulum, which
passes laterally to be
attached to the dura.
19
20. LIGAMENTUM DENTICULATUM
These are the ribbon like
thickened bands of pia
mater,extending
laterally,piercing the arachnoid
and attached to the inner
surface of the duramater
The first teeth of denticulatum
lies at the level of foramen
magnum
The last betweenT12andL1
The lowest tooth is forked and
the posterior root of the L1 lie
at the outer prong of the fork
Serve as a guide in cardotomy
20
22. CONUS MEDULLARIS and CAUDA
EQUINA
The roots of the nerves
lumbar, sacral and
coccygeal leave through
appropriate numbered
intervertebral foramen
They together look like
a horse tail-cauda
equina
The terminal end of the
spinal cord-conus
medullaris.
22
25. EPIDURAL SPACE
Lies between the spinal
duramater and the
periosteum and
ligaments lining the
vertebral canal
1.loose areolar
connective tissue
2.semiliquid fat
3.spinal arteries
4.the internal vertebral
venous plexus.
25
26. Applied anatomy
Lumbar epidural
anaesthesia
Between L3 and L4
spine n eedle course
through, skin, fat,
supraspinous and
interspinous ligaments,
ligamentum flava,
epidural space.
This space is confirmed
by the fact that it is a
space with negative
pressure
26
27. CAUDAL EPIDURAL ANAESTHESIA
The needle is passed
through sacral hiatus
which lies equidistant
from the right and left
posterior superior iliac
spines and enters the
sacral canal
This space lies below
S2
27
28. SUBDURAL SPACE
Is a potential space
between the duramater
and the arachnoid,
containing thin film of
serous fluid.
Permits movements of
dura over the arachnoid
Continued for a short
distance on to the spinal
nerve
Free comunication with
the lymph spaces
around the nerves
28
30. SUB ARACHNOID SPACE
IS a wide space
between the pia and
the arachnoid filled
with CSF
Spinal sub arachnoid
space is wider then the
space around the brain
Widest below where it
encloses the caudae
30
31. Applied aspects
LUMBAR PUNCTURE:
Done through the
Intervertabral disc
between L3 and L4 for
threuptic and diagnostic
purpose.
In children-vertabrel
level-L1.
31
34. VERTESBRAL SYSTEM OF VEINS
The vertebral venous
system –
valveless,complicated
network ,with
longitudinal pattren
Runs parallel to SVC
andIVC and
anastomoses with
them
34
36. This network has three
intercommunicatiing
sub divisions
1,the epiduralplexus lies
in the vertebral canal
outside the durameter
Consists of 1. postcentral
2.pre laminar portion
This plexus drains the
structures in the
vertebral canal
Itself drained at regular
intervals by
Segmental veins-
vertebral,posterior
intercostal,lumbar and
lateral sacral .
36
37. Plexus within the
veretebral bodies-
drains backwards into
the epidural plexus
Anterolaterally-into
the external vertebral
plexus
37
38. 3. External vertebral venous
plexus-
It consists of anterior vessels
lying in front of the vertebral
bodies
Posterior vessels on the back
of the vertebral arches and on
adjacent muscles- drained by
segmental veins
The sub occipital plexus of
veins lying in the sub occipital
triangle is a part of external
venous plexus
It receives the occipital veins
of the scalp – connected with
the transverse sinus by
emissary veins and drains into
the subclavian veins
38
39. BATSON’S PLEXUS
39
The azygos system also
communicates with a valveless
venous network known as
BATSON’S PLEXUS. When the
vena cava is partially or totally
occluded, Batson’s plexus
provides an alternate route for
blood return to the heart.
The vessels of Batson’s
plexus may be referred to as
epidural veins
Batson’s
plexus
40. Communications- valveless vertebral system of
veins communicates
1. Above with intracranial venous sinuses
2. Below with the pelvic veins, portal vein and caval
system of veins
The veins are valveless and so the blood can flow
in either direction
An increase in intra thoracic or intra abdominal
pressure due to coughing and straining may cause
blood to flow either upwards or downwards away
from heart
Such periodic changes in venous pressure are
clinically important
40
41. There may possible spread of tumours or
infection-eg: cells from pelvic, abdominal
thoracic and breast tumours-venous system-
lodge in the vertebra, spinal cord, skull or the
brain
Primary sites of tumours causing secondaries in
vertebra are breast, prostate and kidney
Vertebral caries – tuberculous infection with in
the veretebrae
41
