This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:
Diagnosis of levator avulsion injury: a comparison of three methods
H.P Dietz, F. Moegni, K.L. Shek
Volume 40, Issue 6, Date: December 2012, pages 693-698
It can be accessed here: http://onlinelibrary.wiley.com/doi/10.1002/uog.11190/abstract
2011 Debate on Chromoendoscopy for IBD colitis surveillanceRupert Leong
Chromoendoscopy and other advanced endoscopic imaging techniques are becoming the standard of care in the surveillance of dysplasia. At the 2011 Australian Gastroenterology Week, the use of advanced imaging techniques was compared against four quadrant random biopsies at a breakfast debate.
2011 Debate on Chromoendoscopy for IBD colitis surveillanceRupert Leong
Chromoendoscopy and other advanced endoscopic imaging techniques are becoming the standard of care in the surveillance of dysplasia. At the 2011 Australian Gastroenterology Week, the use of advanced imaging techniques was compared against four quadrant random biopsies at a breakfast debate.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Indications to CTC are increasing
CTC is recommended in all cases of unfeasibility of colonoscopy
CTC is not ready for mass screening but is ideal for screening on an individual basis.
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
The UOG Journal Club for June 2013 features two papers on the detection of obliteration of the pouch of Douglas and rectal involvement in DIE using a ‘uterine sliding sign’ on TVS:
Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign
S. Reid, C. Lu, I. Casikar, G. Reid, J. Abbott, G. Cario, D. Chou, D. Kowalski, M. Cooper, and G. Condous
Volume 41, Issue 6, Date: June 2013, pages 685–691
http://onlinelibrary.wiley.com/doi/10.1002/uog.12305/abstract
Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum
G. Hudelist, N. Fritzer, S. Staettner, A. Tammaa, A. Tinelli, R. Sparic, and J. Keckstein
Volume 41, Issue 6, Date: June 2013, pages 692–695
http://onlinelibrary.wiley.com/doi/10.1002/uog.12431/abstract
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
Indications to CTC are increasing
CTC is recommended in all cases of unfeasibility of colonoscopy
CTC is not ready for mass screening but is ideal for screening on an individual basis.
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
The UOG Journal Club for June 2013 features two papers on the detection of obliteration of the pouch of Douglas and rectal involvement in DIE using a ‘uterine sliding sign’ on TVS:
Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign
S. Reid, C. Lu, I. Casikar, G. Reid, J. Abbott, G. Cario, D. Chou, D. Kowalski, M. Cooper, and G. Condous
Volume 41, Issue 6, Date: June 2013, pages 685–691
http://onlinelibrary.wiley.com/doi/10.1002/uog.12305/abstract
Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum
G. Hudelist, N. Fritzer, S. Staettner, A. Tammaa, A. Tinelli, R. Sparic, and J. Keckstein
Volume 41, Issue 6, Date: June 2013, pages 692–695
http://onlinelibrary.wiley.com/doi/10.1002/uog.12431/abstract
Interobserver agreement in describing adnexal masses using the International Ovarian Tumor Analysis simple rules in a real-time setting and using three-dimensional ultrasound volumes and digital clips
B. RUIZ DE GAUNA, P. SANCHEZ, L. PINEDA, J. UTRILLA-LAYNA, L. JUEZ, J. L. ALCÁZAR
Volume 44, Issue 1, Date: July 2014, pages 95-99
http://onlinelibrary.wiley.com/doi/10.1002/uog.13254/abstract
Intra- and interobserver agreement with regard to describing adnexal masses using International Ovarian Tumor Analysis terminology: reproducibility study involving seven observers
L. ZANNONI, L. SAVELLI, L. JOKUBKIENE, A. DI LEGGE, G. CONDOUS, A. C. TESTA,
P. SLADKEVICIUS, L. VALENTIN
Volume 44, Issue 1, Date: July 2014, pages 100-108
http://onlinelibrary.wiley.com/doi/10.1002/uog.13273/abstract
Clínica Rementería | http://www.cirugiaocular.com
COMPARATIVE STUDY OF CORNEAL THICKNESS MEASURES BY ULTRASOUND PACHYMETRY, CORNEAL TOPOGRAPHY AND ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY
Trabajo presentado en la pasada edición del OPTOM Meeting Malaga 2013 por Sara Fernandez Cuenca.
Individually Optimized Contrast-Enhanced 4D-CT for Radiotherapy Simulation in...Wookjin Choi
Purpose/Objectives: To develop an individually optimized contrast-enhanced (CE) 4D-CT for radiotherapy simulation in pancreatic adenocarcinoma (PDA).
Materials/Methods: Ten PDA patients were enrolled and underwent three CT scans: a 4D-CT immediately following a CE 3D-CT, and an individually optimized CE 4D-CT using a test injection to estimate the peak contrast enhancement time and to optimize the delay time. Three physicians contoured the tumor and pancreatic tissues. We compared image quality scores, tumor volume, motion, image noise, tumor-to-pancreas contrast, and contrast-to- noise ratio (CNR) in the three CTs. We also evaluated inter-observer variations in contouring the tumor using simultaneous truth and performance level estimation (STAPLE).
Results: The average image quality scores for CE 3D-CT and CE 4D-CT were comparable (4.0 and 3.8, p=0.47), and both were significantly better than that for 4D-CT (2.6, p<0.001). The tumor-to- pancreas contrast in CE 3D-CT and CE 4D-CT were comparable (15.5 and 16.7 HU, p=0.71), and the later was significantly higher than that in 4D-CT (9.2 HU, p=0.03). Image noise in CE 3D-CT (12.5 HU) was significantly lower than that in CE 4D-CT (22.1 HU, p<0.001) and 4D-CT (19.4 HU, p=0.005). The CNR in CE 3D-CT and CE 4D-CT were comparable (1.4 and 0.8, p=0.23), and the former was significantly better than that in 4D-CT (0.6, p=0.04). The average tumor volume was smaller in CE 3D-CT (29.8 cm 3 ) and CE 4D-CT (22.8 cm 3 ) than in 4D-CT (42.0 cm 3 ), though the differences were not statistically significant. The tumor motion was comparable in 4D-CT and CE 4D-CT (7.2 and 6.2 mm, p=0.23). The inter-observer variations were comparable in CE 3D-CT and CE 4D-CT (Jaccard index 66.0% and 61.9%), and the former was significantly smaller than that of 4D-CT (55.6%, p=0.047).
Conclusions: The CE 4D-CT demonstrated largely comparable characteristics to the CE 3D-CT. It has high potential for simultaneously delineating the tumor and quantifying the tumor motion with a single scan.
Volumetric-Based Analysis of In-Vivo and Ex-Vivo Quantita-tive MR Diffusion P...JohnJulie1
Imaging biomarkers are needed to assess modifications in pancreatic adenocarcinoma (PA) induced by stroma-targeted therapies. The study investigates correlations between quantitative diffusion parameters obtained in vivo and ex vivo with a tumour volumetric approach and quantitative pathologic findings including fibrosis, vascular and total nuclear densities in PA
Volumetric-Based Analysis of In-Vivo and Ex-Vivo Quantita-tive MR Diffusion P...JapaneseJournalofGas
Imaging biomarkers are needed to assess modifications in pancreatic adenocarcinoma (PA) induced by stroma-targeted therapies. The study investigates correlations between quantitative diffusion parameters obtained in vivo and ex vivo with a tumour volumetric approach and quantitative pathologic findings including fibrosis, vascular and total nuclear densities in PA
Individually Optimized Contrast-Enhanced 4D-CT for Radiotherapy Simulation in...Wookjin Choi
To develop an individually optimized contrast-enhanced (CE) 4D-CT for radiotherapy simulation in pancreatic ductal adenocarcinomas (PDA).
http://scitation.aip.org/content/aapm/journal/medphys/43/6/10.1118/1.4958261
RCT on Base tie in laparoscopic appendecomy (Journal Club).pptxadnanhabib31
This is ppt made on a study based on Randomised controlled trial on the tie of appendix base in laparoscopic appendectomy by hem-o-lok,endoloop or stapler.This study showed that hem-o-lok clips are better and cheaper as compared to others.
This is the lecture on transabdominal ultrasound technique for students seeking help on gynaecological ultrasound approaches. In this lecture the approaches of ultrasound and types of ultrasound are explained.
Similar to UOG Journal Club: Diagnosis of levator avulsion injury: a comparison of three methods (20)
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.
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
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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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
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10. Define the mean QRS vector
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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
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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)
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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.
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Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
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Taste buds on the tongue
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Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
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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
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
UOG Journal Club: Diagnosis of levator avulsion injury: a comparison of three methods
1. UOG Journal Club: December 2012
Diagnosis of levator avulsion injury:
a comparison of three methods
HP Dietz, F Moegni, KL Shek
Volume 40, Issue 6, Date: December 2012, pages 693–698
Journal Club slides prepared by Dr Tommaso
Bignardi
(UOG Editor for Trainees)
2. Background
• Levator avulsion is common after vaginal delivery and is strongly
associated with prolapse and prolapse recurrence after
reconstructive surgery
• Levator avulsion can be diagnosed by vaginal palpation, 3D/4D
translabial ultrasound or magnetic resonance imaging (MRI)
• With the 3D ultrasound technique, data can be analysed as rendered
volumes or else tomographic multislice imaging
3. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
The aim of this study was to compare assessment by
digital palpation and two ultrasound methods, one using
rendered volumes and the other multislice imaging, for
the diagnosis of levator avulsion
4. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Patients and Methods
• 266 women seen at a tertiary urogynecological unit
• Each woman underwent an interview, vaginal examination and 3D/ 4D translabial ultrasound
retrospective offline analysis of ultrasound volumes,
blinded against clinical data, using two techniques
rendered volumes tomographic ultrasound imaging (TUI)
Agreement was evaluated between the ultrasound techniques and findings on digital palpation
The results were finally related to symptoms and signs of pelvic organ prolapse
5. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Vaginal palpation
The index finger is placed parallel to the urethra,
with fingertip at the bladder neck.
The fingertip is turned towards the inferior pubic
ramus, whilst the patient is asked to contract the
pelvic floor.
The gap between urethra and muscle should be
about one fingerbreadth.
If no contractile tissue is palpated there will be
room for two or more fingers between urethra and
pelvic sidewall, and a diagnosis of avulsion is
made.
6. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Rendered volumes
• Obtained on maximal pelvic floor contraction
• Slice thickness of between 1.5 and 2.5 cm
• Plane of minimal hiatal dimensions included in the ‘region of interest’
7. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Tomographic ultrasound imaging (TUI)
• Obtained during maximum pelvic floor contraction
• Set of 8 slices in the axial plane at intervals of 2.5mm
• Taken from 5mm caudad to 2.5mm cephalad of the plane of minimal hiatal dimensions
8. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Results: Agreement between methods
Methods compared Agreement Cohen’s kappa
(%) (95% CI)
Palpation versus 86 0.43 (0.32–0.53)
rendered volume
Rendered volume 80 0.35 (0.26–0.44)
versus TUI
Palpation 87 0.56 (0.48–0.62)
versus TUI
TUI, tomographic ultrasound imaging.
CI, confidence interval
9. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Results: Association with symptoms and signs of prolapse
Method Symptoms Significant Maximum Maximum
of prolapse bladder hiatal area
prolapse (POPQ stage 2+) descent on on Valsalva
ultrasound
Palpation χ2 = 39.8 χ2 = 91.1 t = 4.22 t = -6.92
P< 0.001† P< 0.001† P< 0.001 P< 0.001*
Rendered χ2 = 25.8 χ2 = 64.3 t = 2.73 t = -3.46
volume P< 0.001* P< 0.001* P= 0.007* P< 0.001**
Tomographic χ2 = 13.8 χ2 = 58.3 t = 3.78 t = -7.04
ultrasound P< 0.001 P< 0.001 P< 0.001 P< 0.001*
n=266 except for *n=259 and **n=252. All findings were blinded against each other,
except for those marked with †.
10. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Key findings
• Vaginal palpation, rendered ultrasound volumes and
multislice imaging all seem to be moderately repeatable
and they correlate moderately well with each other
• Findings for all three methods are significantly associated
with symptoms, signs and ultrasound findings of female
pelvic organ prolapse
11. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Limitations
• Retrospective analysis
• Women with previous pelvic surgery not excluded
• Palpation data obtained by senior author not consistently
blinded to history and other clinical findings
• These three methods need validation in other populations
12. Diagnosis of levator avulsion injury: a comparison of three methods
Dietz et al., UOG 2012
Discussion points
• Should the study of levator avulsion form part of routine investigations for
women presenting with symptoms and/or signs of pelvic prolapse?
• What are the clinical implications of diagnosing avulsion, especially prior
to prolapse surgery?
• Do the data presented in the study demonstrate the superiority of
ultrasound techniques over digital palpation for diagnosing levator
avulsion?
• How do the techniques investigated compare against MRI assessment?
• How can we identify and counsel women at higher risk of recurrence after
pelvic reconstructive surgery?