This document discusses ovarian cortical strips transplantation as a method for fertility preservation. It describes how ovarian cortical tissue can be removed, prepared into thin strips, and transplanted to various locations in the body. Locations mentioned include remaining ovaries, pelvic walls, abdominal muscles, and under the skin of the forearm or abdomen. The goals are to maintain hormone levels and potentially allow for future natural conception. Success is determined by restoration of hormone levels and follicular development visible on ultrasound over subsequent months.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
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
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
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
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Automotive Systems course (Module 03) - Fuel Systems in Spark Ignition Intern...Mário Alves
This presentation provides an overview of the fuel systems in Spark Ignition (SI) Internal Combustion Engines, browsing its technological evolution along the years. Spark Ignition engines are the one that need an artificial spark (provided by spark plugs) to ignite (inflame) the air-fuel mixture, such as the ones based on gasoline, alcohol or Liquefied Petroleum Gas (LPG). Diesel engines belong to another class of engines, called "Compression Ignition" (CI) engines.
Automotive Systems course (Module 10) - Active and Passive Safety Systems for...Mário Alves
This presentation browses the most relevant safety systems for road vehicles. It is organized according to the traditional classification of safety systems: active safety and passive safety. Active safety systems help preventing accidents, so they they control the dynamics of the vehicle. Passive safety systems help mitigating the consequences of accidents, thus they protect occupants and pedestrians upon a crash.
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
This presentation consist MR procedure of pelvis and hip joint , anatomy and MR planning is shown by picture with positioning block and parameters are included ,it includes basic sequence of both procedures
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
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. The Ovaries
• The ovaries are two nodular bodies, situated one
on either side of the uterus in relation to the lateral
wall of the pelvis, and attached to the back of the
broad ligament of the uterus, behind and below the
uterine tubes
• Ovaries are of a grayish-pink color, and present
either a smooth or a puckered uneven surface.
• They are each about 4 cm. in length, 2 cm. in
width, and about 1 cm in thickness,
3. Why? !
• Ovarian tissue transplantation is an option for women who want to
protect their fertility and hormones while they undergo treatment
for cancer, including chemotherapy and radiotherapy
• For women undergoing oophorectomy (in severe or recurrent
ovarian disease such as cysts, benign tumours or endometriomas
or ovarian pain ), accidental bilateral salpingo-oophorectomy for
huge uterine fibroids and dense pelvic adhesion--- not only to
maintain endocrine functions but also for fertility preservation
• Ovarian dysgenesis with missing normal ovarian complement and
premature ovarian failure has come in the forefront.
• Women in their 20s or 30s could theoretically have an ovary
removed and frozen, and then have it reimplanted years later when
they are ready to have children as “We are in the middle of an
infertility epidemic
4. Types
• Fresh or Frozen-thawed
• Whole ovary (with vascular anastomosis) immediate restoration
of vascular supply and ovarian hormonal functions is possible.
or ovarian cortical strips (without vascular anastomosis )
• xenografting (human to animal ) to avoid recurrence of cancer
• Orthotopic (near the infundibulopelvic ligament or on an present
ovary) lead to natural conception or Heterotopic (the tissue is
grafted subcutaneously to the forearm or suprapubic area) does
not require general anesthesia or abdominal surgery. It is also easy to
monitor follicle development and to remove the transplanted tissue from the
subcutaneous site when necessary
• allotransplantation ( human to human ) or Autotransplantation
( Human to herself or to monozygotic twin) without
immunosuppressant treatments
5. Xenograft
• The growth of ovarian tissue from one species within
another species
• This technique has shown early promise, and even
patients with ovarian cancers may be able to use this
technique to recover normal eggs without the risk the
restoration of any associated cancer cells.
• Furthermore this technique allows the more efficient
maturation and retrieval of eggs for IVF.
• Moreover the limited quantity of ovarian tissue allows
strips to be unfrozen gradually over time to allow
additional attempts to produce offspring.
• Even small biopsies of tissue, if proven adequate for
IVF, may be taken to create an egg bank for later use
6. Orthotopic Whole Fresh
Ovary Microsurgical
Transplantation
• (A) Depiction of donor
oophorectomy.
• (B) Microsurgical isolation
of donor ovary blood supply.
• (C) End-to-end anastomosis
of ovarian blood vessel.
• (D) Completed anastomosis
of ovarian artery and veins.
7. Heterotopic Whole Fresh Ovary
Microsurgical Transplantation
• the patients' own ovaries
were transplanted to their
upper limb to avoid the
effect of pelvic radiation
as a treatment of
Hodgkin lymphoma in
one patient and uterine
cervical cancer in the
other
8. How To Prepare Ovarian
Cortical Strips
• Under general anesthesia
• One ovary was removed laparoscopically or minilaparotomy,
• The whole ovary was transferred to a Petri dish
• Under Microscope . dissection with a scalpel and toothed
forceps.
• It was felt important to prepare a cortical tissue slice no thicker
than ~1.0 mm to facilitate rapid revascularization
• While keeping the tissue constantly irrigated with ice-cold
medium
• Its cortex was prepared in 8 strips of 50x 5 x 1 to 2 mm
• DEPENDING ON PATIENT SIZE : from 5 to 15 pieces
• The cortex of each ovary was cut into pieces 10 × 10 × 1 mm.
---- 2 or 3 pieces for woman
or The cortex of each ovary was cut into pieces 15 × 5 × 1 mm.
---- 3 or 4 pieces for woman
10. An Ovarian Cortical-
Tissue Grafting
• Under general anesthesia, one ovary was
removed from donors using laparoscopy or
minilaparotomy.
• prepare a cortical tissue slice no thicker than
~1.0 mm to facilitate rapid revascularization
• The pared cortex was divided into three or four
pieces of approximately equal size for grafting,
one piece to each recipient ovary.
• The tissue graft was trimmed to the dimensions
of the exposed surface of the recipient organ
and attached using 9–0 interrupted sutures
under an operating microscope
• The medullary bed was sutured to the under
surface of the cortical graft with 9–0 sutures to
maintain tight tissue approximation.
11. Transplantation of fresh
ovarian cortical pieces
under the tunica
albuginea
• Three pairs of 5-mm transverse incisions were
made in the left ovary through the tunica albuginea
• With blunt dissection, cavities were formed
beneath the cortex for each of the three strips.
• Each piece of thawed ovarian tissue (1.5 by 0.5 cm
in area and 0.1 to 0.2 cm in thickness) was gently
placed in a cavity, and the incisions were closed
with 4/0 Vicryl sutures.
12. Transplantation of fresh ovarian cortical
pieces between monozygotic twins
• Ovarian cortical pieces
measuring 4–5 mm to 1 cm in
size were grafted onto the
remaining ovary after the
cortex of this ovary had been
removed.
• (a) Cortex of the remaining
ovary was removed.
• (b) Cortical pieces were
sutured with 7-0 stitches.
13. Transplantation Of Fresh
Ovarian Cortex Strips In
Lateral Wall Of The Pelvis
• Ovarian strips strung with a 6.0 delayed
absorbable suture and 3 strings of pieces
were attached to an cellulose membrane
• The grafts were sutured to a peritoneal
pocket created in the left pelvic ovarian
fossa and to ovarian fossa caudal to the first
by pulling on the suture , thus The graft is
flattened against the vascular pelvic wall
• The placement of 2 grafts side by side
• Closure of peritonium with interrupted
sutures
14. Ovarian Cortical Strips
Transplantation into a muscle pocket
in the rectus muscle of abdomen
• Cortical ovarian tissue was minced into 40–45
fragments 2–3 mm3 and then placed into a muscle
pocket in the rectus muscle of abdomen according
to the technique principles used for the heterotopic
parathyroid autotransplantation in the
sternocleidomastoid muscle
• The muscle pocket and fascia were closed with
stiches of vicryl
15. Ovarian Cortical
transplantation under the skin
of the forearm• after oophorectomy, ovarian cortical strips are prepared
• if the tissue will be cryopreserved 1x 0.5 cm strips 1-3 mm in
thickness are prepared
• if transplantation will be performed with the fresh tissue , the strips
can be cut longer 5 x 0.5 cm strips 1-3 mm in thicknesss will
facilitate the transplantation procedure
• a 1 cm transeverse incision is made over brachioradialis muscle , 5
cm below the antecubital fossa
• using blunt dissection , a pocket is created between the fascia and
subcutaneous tissue
• this area is relatively vascular , so attention must be focused on
preventing major bleeding , because the ovarian tissue will acquire
its blood supply from these vessels , it is not desirable to perform
extensive cauterization
• then each piece is ragged with 4.0 vicryl by passing the needle
between stroma and cortex under an operating microscope
16. • once the dissection is completed , the free end of the
suture is threaded onto a reusable needle specially half
circle cutting needle with chord length 25 to 38 mm
• this needle is inserted into the subcutsneous pocket as
far as possible
• the needle is then is passed through the skin and the
cortical piece is wedged into subcutaneous pocket by
pulling on the suture
• pieces are always inserted with the cortical side facing
up
• the needle is then removed
• and free end of the suture is held with a mosquito clamp
• the purpose of this suture pull-through technique is to
guide the tissue placement
• depnding on the patient size, 5 – 15 cortical pieces can
be fanned out between the forearm skin
• once satisfied with the tissue placement , the sutures are
cut
17. • after the skin is closed subcuticalarly , a nonpressure
dressing is applied
• pressure be avoided to prevent reducing the blood flow to
the area
• starting on the afternoon of the surgery , 75 IU/ dav of FSH
in injected directly in the graft for 7 days
• in addition , 80 mg of aspirin is admistered for 7 days
• the patient,s forearm is splinted for 72 hours to prevent
dislodgment due to muscle movement
• hormone replacement therapy is started within 48 hours of
transplantation and discontinued with the first sign of graft
function
• the return of ovarian function may take 2-3 months as
heralded by development of ovarian follicles beneath the
skin
18. Ovarian Cortical Strips Transplantation
to the anterior abdominal wall at incision
site of Pfannenstiel
• Under local anaesthesia, implant 5- 15
ovarian cortical pieces according the size
of the patient
• with sizes ranging from 5 x 5x 1 mm to 15
x 5x 1 mm—beneath the skin of the
patient’s lower abdominal wall with a
suture pull-through technique, similar to
technique applied in forearm
transplantaion
19. How To Diagnose Success?!
• Follicular development evident after few
months by ultrasound examination
• Restoration of serum FSH and LH levels to
nonmenopausal range
• Disappearance of menopausal symptoms
• And last for few years
20. In The Future
• Women in their 20s or 30s could theoretically
have an ovary removed and frozen, and then
have it reimplanted years later when they are
ready to have children as
“We are in the middle of an infertility epidemic