Before embarking on an approach, the surgeon should be familiar with both the ventricular anatomy and the options for optimally Accessing lesions in third ventricle is a surgical challenge because of its difficult corridor as well as deeper location, need of neural incision, preservation of vascular, thalamus and hypothalamus and likely risk of fornix injury.
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
Before embarking on an approach, the surgeon should be familiar with both the ventricular anatomy and the options for optimally Accessing lesions in third ventricle is a surgical challenge because of its difficult corridor as well as deeper location, need of neural incision, preservation of vascular, thalamus and hypothalamus and likely risk of fornix injury.
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies coined after Liliequist (1956). It has surgical importance in Endoscopic third ventriculostomy and cisternostomy.
Vascular Access Part 1: Reducing risk and increasing catheter longevityCoda Change
The aim of having a structured decision matrix in the approach to vascular access is to reduce catheter-associated complications and to increase device longevity. There are over 15,000 central venous catheters placed in Australia annually. The actual insertion process for placing a central line only accounts for a small part of the 'life span' of that line (approximately 1%), but the choices made at the time of insertion have a huge impact on the longevity of the device and the associated complications. In this introductory talk Evan Alexandrou outlines the top ten tips for reducing complications associated with vascular access devices:
1. Always use ultrasound: Never do a blind puncture
2. Ensure with the site chosen for the catheter that it exits the skin on a flat surface.
3. Consider the Axillary vein in preference for the subclavian vein
4. Use micro-puncture techniques
5. Avoid using a scalpel if possible
6. Avoid catheters being inserted all the way to the hub
7. Use impregnated dressings when possible
8. Use sutureless securing techniques
9. Secure the dressing on a flat surface (refer rule 2)
10. Ensure optimal positioning of the catheter tip by utilising ultrasound or intracavitary ECG
Tips and tricks to site and maintain nerve cathetersAmit Pawa
This lecture was given on Friday 13th September 2019 at the annual congress of the European Society of Regional Anaesthesia in Bilbao and Spain. The talk was also contributed to by the Twitter Community. Strategies and techniques to site, secure and maintain perineural nerve catheters is discussed
Peripheral Nerve Catheters - an introductionAmit Pawa
In November 2019 Dr Pawa Delivered a Lecture to the South Thames Acute Pain Group, in Cobham, Just outside London, on Peripheral Nerve Catheters. This was meant to serve as an introduction to the subject and to outline some of the challenges and difficulties he had instituting these at his own trust.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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!
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
1. Craniometrics and Ventricular Access:
A Review of Kocher’s, Kaufman’s, Paine’s,
Menovksy’s, Tubbs’, Keen’s, Frazier’s,
Dandy’s, and Sanchez’s Points
By Dr. Shahnawaz Alam
Mch-Neurosurgery
2. • The ventricular system is routinely accessed for a variety of emergency and elective
neurosurgical procedures.
• Depending upon the indications, different locations within the ventricles may need to be
accessed.
• Thus, a multitude of ventricular access points have been described over the past century.
• Each entry point requires an operative technique with different surface landmarks for
burr hole placement, trajectories for catheter passage, and ending locations within the
ventricles.
• Although ventricular access is one of the most common procedures performed, there is
a paucity of literature illustrating the operative techniques for the most common
ventricular access points.
• Additionally, the operative techniques depicted within the current literature are poor
quality and difficult to interpret.
3. • Because it is important that all neurosurgeons be versed in the craniometrics
associated with these techniques, there is a need for high-quality images with clear
measurements depicting the details of each access point, which remains unmet.
• In this historical review, they describe the indications and operative techniques for 9
ventricular access points. They separate them into anterior and posterior categories
based upon their starting location relative to the external auditory canal.
• Anterior access sites include Kocher’s, Kaufman’s, Paine’s, Menovksy’s, and Tubbs’
points; posterior access sites include Keen’s, Frazier’s, Dandy’s, and Sanchez’s points.
• Additionally, they include detailed, Multiview illustrations that provide the reader with
a novel understanding of the craniometrics associated with each point.
4. Ventricular access via Kocher's point
• MC Location for EVD
• May be used for ETV,
endoscopic removal colloid
cyst or VP-shunting
• Failure rate 4-40% (Abdoh
MG et al)
5. Ventricular access via Paine’s, Hyun’s, and Park's points
• In pt. undergoing FT-
craniotomy when there is
concern for severe brain
edema; lessens the need of
brain retraction
• Theoretical risk of
damaging Brocas’s area,
head of caudate nucleus,
thalamus; But no clinical
series to demonstrate its
efficacy & safety
• In series, Hyun’s point
more accurate trajectory
with 100% success rate
• Park’s point- 94% success
rate with 2.5% chance of
injury compared with 90%
with paine’s point
6. Ventricular access via Kaufman’spoint
• Rapid access to ventricular
system for emergent
drainage of CSF
• Rarely used d/t cosmetic
appearance
• 90% success rate
7. Ventricular access via Menovsky’s point
• Used while performing
supraorbital craniotomy
through eyebrow incision
• 87% success rate
8. Ventricular access via Tubbs’ point.
• Emergent ventricular
decompression via
transorbital route; spinal
needle
• No burr; time efficient;
Risk of globe injury; No
clinical series
9. Ventricular access via Keen’s point
• Used for elective
placement of proximal VP-
shunt catheter
• Emergent CSF diversion
during posterior fossa sx
• No clinical series
10. Ventricular access via Dandy’s point
• Initially used for
ventriculography
• In a case series 100%
success rate ( Lee,s et al)
11. Ventricular access via Frazier’s point
• In a case series 100%
success rate ( Lee,s et al)
12. Ventricular access via Sanchez’s point
• For catherization of
temporal horn in setting of
trapped ventricle or to
endoscopically access
mesial temporal structures
• 100% success rate (sanchez
et al)
13. CONCLUSION
• The ventricles are accessed for numerous emergent and elective neurosurgical
procedures, and all neurosurgeons should feel comfortable using craniometrics
to help cannulate the ventricles when neuronavigation is unavailable.
• This review provides detailed descriptions and illustrations of the most
common anterior and posterior ventricular access points and should serve as
an important reference for both neurosurgical trainees and experienced
neurosurgeons.
14. REFERENCES
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discussion 1051.
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22. Rehman T, Rehman A, Ali R, et al. A radiographic analysis of ventricular trajectories. World Neurosurg. 2013;80(1-2):173-178.
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discussion 1200-1191.
24. Madrazo Navarro I, Garcia Renteria JA, Rosas Peralta VH, Dei Castilli MA. Transorbital ventricular puncture for emergency ventricular decompression. J Neurosurg. 1981;54(2):273-
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discussion 277-278.