This document discusses breast reconstruction using DIEP flaps, which involves using blood vessels and tissue from the lower abdomen. The goals of breast reconstruction are to provide a natural breast contour and shape, avoid the need for external prosthetics, and help patients regain confidence. The document discusses the history of breast reconstruction and why abdominal tissue became popular. It provides details on different types of flaps and considerations for medial versus lateral perforator flaps. Key points discussed are the importance of vessel diameter, central positioning of perforators, and vascular branching patterns. The document also addresses techniques like subfascial dissection and skin-sparing approaches to breast reconstruction.
Breast Reduction Surgery (mammaplasty) in Kolkata | Dr Jayanta Kumar SahaCosmetic-Therapy Clinic
Reduction mammaplasty is the surgical procedure which is performed to reduce, reshape and tighten the size of excessively large female breast. Patients opt for reduction mammaplasty or breast reduction surgery in order to overcome the physical, sexual and social embarrassment attached with the problem. Dr. Jayanta Kumar Saha of Cosmetic Therapy Clinic, Kolkata is an expert cosmetic plastic surgeon who performs this procedure with great perfection and expertise. Consult him over phone or email him to seek advice on female breast reduction surgery and any other cosmetic surgery performed in his cosmetic therapy clinic in Kolkata. Chek here for more details: http://www.cosmetic-therapy.com/cosmetic-surgeries/surgeries-for-female/breast-reduction-surgery/
Breast Reduction Surgery (mammaplasty) in Kolkata | Dr Jayanta Kumar SahaCosmetic-Therapy Clinic
Reduction mammaplasty is the surgical procedure which is performed to reduce, reshape and tighten the size of excessively large female breast. Patients opt for reduction mammaplasty or breast reduction surgery in order to overcome the physical, sexual and social embarrassment attached with the problem. Dr. Jayanta Kumar Saha of Cosmetic Therapy Clinic, Kolkata is an expert cosmetic plastic surgeon who performs this procedure with great perfection and expertise. Consult him over phone or email him to seek advice on female breast reduction surgery and any other cosmetic surgery performed in his cosmetic therapy clinic in Kolkata. Chek here for more details: http://www.cosmetic-therapy.com/cosmetic-surgeries/surgeries-for-female/breast-reduction-surgery/
Breast Reconstruction at Perimeter Plastic SurgeryDr. Mark Deutsch
After breast cancer survivors have endured a mastectomy, many choose to pursue breast reconstruction surgery to help enhance their natural beauty. Dr. Deutsch at Perimeter Plastic Surgery is one of the most accomplished breast reconstruction surgeons in the Southeast. In this presentation, Perimeter Plastic Surgery explains what Breast Reconstruction is and the different options patients have for their procedure.
this slide contain detail about chest wall tumor, its classification, presentation and management. This also contain chest wall reconstruction and way of reconstruction.
Colonic incarceration in an adult umbilical hernia: case report and review of...KETAN VAGHOLKAR
Umbilical hernia is one of the commonest ventral hernias constituting ten percent of all hernias. It affects obese individuals and has a high recurrence rate if repaired by suture techniques. Incarceration of the colon in an umbilical hernia is quite rare. A case of colonic incarceration in an umbilical hernia is presented to highlight the diagnostic and technical challenges in managing such a hernia. Contrast enhanced computerized tomography is essential to ascertain the contents. Open surgery is the main stay of treatment especially in such rare cases. A combined tissue and mesh repair provides excellent results.
Almost all groin hernias should be surgically repaired. When the potential complications as incarceration and strangulation are weighed against the minimal risks of hernia repair (particularly when local anesthesia is used), the early repair of groin hernias is clearly justified. This is especially true in the case of femoral hernias, since the rigid borders of the femoral canal increase the risk of incarceration
The esophageal hiatus is an elliptical opening in the diaphragmatic muscular portion. The crura of diaphragm originate from the anterior surface of the first four lumbar vertebrae on the right and L2–L3 on the left to insert anteriorly into the transverse ligament of the central portion of diaphragm.
Impact of dead space closure and lymph vessel ligation during MRM on Post-ope...Dr./ Ihab Samy
Hany F. Habashy MD.a , Ihab S. Fayek MD b , Mohamed I.Abd el aziz MD a
a:Department of Surgery-Fayoum University Hospital-El Fayoum , Egypt.
b:Department of Surgical Oncology –National Cancer Institute – Cairo University ,Egypt.
Kasr el-aini journal of surgery Volume 14, No.2, May 2013
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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
DIEP Flap - For Breast Reconstruction
1. BREAST RECONSTRUCTION WITH DIEP
FLAP-SPECIAL CONSIDERATIONS
Stamatis Sapountzis M.D
Division of Plastic Surgery
China Medical University Hospital
2. Goals of Breast Reconstruction
Provide permanent breast contour
Make the breasts look balanced
Avoid the need for external prosthesis
Re-establish normalcy and confidence
5. History
Vincenz Czerny
Oncology, gynecology
In 1895 he published the first account of a
breast implant which he had carried out, by
transferring a benign lipoma to "avoid
asymmetry" after removing a tumor in a
patient's breast.
1879 performed the first total hysterectomy
via the vagina
8. Free DIEP > Free TRAM
(Plast. Reconstr. Surg. 124: 752, 2009
Donor Site Morbidity
DIEP patients has one-half the risk
of abdominal bulge or hernia
9.
10.
11. Plast. Reconstr. Surg. 125: 772, 2010.)
Each perforators was
injected with contrast and
the flaps were subjected to
dynamic computed
tomography scanning.
Three-dimensional and four-dimensional computed tomographic
angiography was utilized to reappraise the zones of vascularity.
13. Three-dimensional computed tomography
angiogram
Perfusion tends to stay in one hemi- The injected medial perforator was connected
abdomen. to the contralateral medial row perforator
through indirect linking vessels via the
subdermal plexus.
14. (Above) Lateral row perforator is injected. At least two sets of linking vessels need
to be crossed to reach the midline
(Below) Medial row perforator is injected. Fewer linking vessels are required to cross
the midline,thus contrast flows into zone II more easily, hence a more centralized
perfusion..
15.
16. Illustration of a medial perforator DIEP
flap, in which perfusion is more
centralized and has a bigger vascular
territory.
These are useful for large breast
reconstructions.
Medial perforator DIEP flaps follow
Hartrampf zones of perfusion. Zone II is
on the contralateral hemi-abdomen.
17. Illustration of a lateral perforator DIEP
flap, in which perfusion is more
lateralized. These are useful for small to
moderate sized and bilateral breast
reconstructions.
Lateral perforator DIEP flaps follow Holm’s
zones of perfusion.
Zone II is on the ipsilateral hemi-abdomen.
20. (Plast. Reconstr. Surg. 128: 581e, 2011
There were 228 patients, with 120 medial (52.6
percent) and 108 lateral (47.4 percent) branch flaps
21.
22. Regardless of whether the dominant perforator is laterally
or medially located, as long as it is included, a safe flap can be
harvested and the perfusion related complications can be reduced to
an absolute minimum.
23. 3 Key Points
1. Vessel diameter is important and
Poiseuille’s law is determining.
The flow through a tube is related to the
fourth power of the radius of a vessel
The flow in a vessel with a 2-mm
diameter is approximately 16 times
higher than in a vessel with a diameter of
1 mm
24. 3 Key Points
1. Vessel diameter is important and Poiseuille’s law is determining
2. The central positioning of the perforator in the flap is essential
3. The number and three-dimensional structure of the branches of the
perforator, once it has pierced the deep fascia, will determine which
areas of the flap will be vascularized
25. Computed tomographic scan of a perforator originating from the lateral
branch of the right deep inferior epigastric artery with a perforator that
bends off laterally and vascularizes only the most lateral and ipsilateral
part of the flap.
The Perfusion of the conventionally designed flap will be extremely poor
26. Multi-detector CT angiography scan
Info on perforator location, diameter (>0.3mm, >1mm
included), intramuscular course, high spatial resolution
allows multi-planar evaluation (3D view), less habitus
dependent, predictive value on outcome (DIEP Vs MS
free TRAM), can evaluate SIEA system
Reduced operative time. Sensitivity 99.6% (Rozen et al.)
Op time reduction average 100min (Casey et al, Smit et al, Masia et al)
Expensive
Radiation dose
Contrast
30. Dissection of the lower abdomen skin Longitudinal incision to the anterior rectus
and fat flap from the underlying sheath approximately 0.5 cm medial to the
aponeurosis terminates when the lateral border
lateral border of anterior rectus sheath
is reached
31. The semilunar incision line (dotted line) through the
anterior rectus sheath that is lateral to the lateral row
of perforators
32. Identification of the lateral row of Transverse incision of the aponeurosis
perforators of the deep inferior toward the perforator
epigastric artery (DIEA) in the
subaponeurotic layer.
33. Subaponeurotic blunt dissection of the The anterior rectus sheath has been
deep inferior epigastric artery perforators incised and raised exposing the
is performed perforators piercing the posterior surface
of the fascia
34.
35. Advantages
Save time: easy plane between fascia and
muscle
Safe dissection: blunt dissection
Easy to define the largest perforator
36.
37. Raising a flap with a skin paddle with less vertical height reduces the donor
site morbidity, especially in terms of reducing the risk of wound dehiscence,
as tight abdominal closure is avoided (e.g in thin patients)
The technique we describe offers the patient a naturally shaped breast that
can be achieved without the need to raise a very large abdominal flap
38. Projection the mastectomy scar onto the contralateral breast and measurement of
the dimensions of skin in the area of the breast inferior to this imaginary scar line
39. An inverted V-shaped flap is designed on the inferior mastectomy skin flap and a
template of this also made
This triangular template is then superimposed on the inferior aspect of the template
and excised because this part of the skin in the new breast will be created by the
mastectomy skin flap
40. When the breast template is opened and flattened the shape of the required
flap is almost rectangular.
The V shaped scar is on the underside of the breast occupying a natural
aesthetic subunit of the breast, thus making it inconspicuous.
A fatty layer is also included from the upper abdominoplasty flap to
partially fill the upper poles of the new breast.
43. Two-esthetic unit breast reconstruction. (A) Single-esthetic unit breast reconstruction.
The mastectomy scar is excised. (B) The DIEAP (A) The skin in between the mastectomy scar
flap is inset in the center of the breast mound and the new inframammary fold is de-
creating a breast consisting of two-esthetic epithelialized. (B) The DIEAP flap extends to
units: the native skin and the flap’s skin paddle. the inframammary fold, reconstructing the
entire breast
44.
45. A skin envelope is created with tissue expander and then the expander is
replaced with a de-epithelialised flap, leaves a breast with the original
mastectomy scar and no skin island
46.
47. Can we perform abdominal
flaps after liposuction or
with the existence of
vertical laparotomy scars?
48. 8 cases (7 autologous breast reconstruction, 1
thigh reconstruction.
All patients had a vertical abdominal midline
scar as a result of a previous surgical
intervention.
49. •In the past was contraindication
•Preoperative colour duplex or CT angiography is mandatory
•The dissection of the perforator flaps was sometimes more
difficult due to increased fibrosis and scar formation of the
subcutaneous tissue.
50. (Ann Plast Surg 2011;67: 251–254)
11 DIEPS contained a midline scar
In flaps with a midline scar approximately 70%
of the entire flap volume appeared to be well
vascularized (pink area) after harvest