This document discusses minimal access and endoscopic approaches to spinal surgery. It notes the advantages of these approaches over conventional open surgeries, including less tissue damage, blood loss, post-operative pain and recovery time. Specific techniques discussed include video-assisted thoracoscopic surgery (VATS) for thoracic procedures and endoscopic retroperitoneal approaches for lumbar surgery. Indications, equipment, positioning and technical considerations for performing VATS and spinal endoscopy are outlined. Case examples of using these techniques for thoracic tuberculosis and discitis are also presented.
Establishing the need for a surgical intervention
Confirmation of relevant physical findings and review of the clinical history and laboratory investigations that support the need of surgical intervention
Type of approach- Benefits & Risks of surgical procedure
The incision site- ease of surgery as well as cosmetic considerations
Type of anesthesia
Establishing the need for a surgical intervention
Confirmation of relevant physical findings and review of the clinical history and laboratory investigations that support the need of surgical intervention
Type of approach- Benefits & Risks of surgical procedure
The incision site- ease of surgery as well as cosmetic considerations
Type of anesthesia
FUNDAMENTALS OF LAPAROSCOPIC AND ROBOTIC UROLOGIC SURGERY.pptxvaidyamk89
In past 30 years- minimally invasive urology has become predominant. Laparoscopic and robotic procedures have shown equivalent efficacy and acceptable efficiency as well as the distinct advantages of
decreased postoperative pain,
improved cosmesis,
expedited recovery, a shorter hospital stay,
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal
Emergency sonography in Pediatrics has evolved to become one of the most versatile
modalities for diagnosing and guiding
treatment of critically ill patients.
Basics of laproscopic surgery..
by dr navdeep s kamboj presented at sgrdumsar amritsar.
topics covered--
1 basics of laparoscopy
2 lap cholecystectomy
3 lap appendixcectomy
pneumoperitonem
merits and demerits of laproscopy
ligasure
endoscopy,
laparoscopic instruments
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
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!
3. Conventional Surgical Approach to spine
•
•
•
•
•
Conventional thoracotomy require large approach.
More morbidity
Rib resection cause post operative costal pain.
More blood loss
Post operative pleural adhesion and loss of lung
compliance.
• Postoperative shoulder stiffness.
• Late recovery, late rehabilitation, longer hospital
stay and higher cost of treatment.
5. Conventional Surgical Approach to spine
• Conventional retroperitoneal and
laparotomy again need large exploration.
• More morbid cause of large dissection
trough abdominal musculature.
• Requires mobilization of big vessels.
• Complication like incisional hernia is
possible.
• Peritoneal adhesion causes post
operative pain.
• Infection and instrumentation failure is
common
• Late recovery, longer rehabilitation and
training is required.
8. Video assisted Minimal access
surgery
• Video assisted minimal access surgeries
is done through small incision with
special retractor system.
• Enhanced visualization with help of
telescope placed from same portal or
different portal.
• Promising result with faster recovery.
• Less morbid approach.
• All possible spinal procedure can be
done.
11. SPINAL ENDOSCOPY
• Minimum-access techniques have
been
introduced
throughout
surgery, including Orthopaedics and
traumatology, where, since the early
80s, arthroscopy has revolutionized
the treatment of joint disorders.
12. SPINAL ENDOSCOPY
• The first Thoraco-scopy was performed by H.C.
Jacbaeus in Stockholm in 1910 using cystoscope
for the division of tuberculous adhesions.
• Till early 1980’s laparoscopy was used extensively
to perform general surgical work.
• In early 1990’s VATS was used to treat various
pulmonary conditions like recurrent pleural
effusion, recurrent pneumothoraces, for lung
biopsy and evaluation of mediastinal adenopathy.
13. SPINAL ENDOSCOPY
• Obenchain performed a laparoscopic L5-S1
discectomy, followed, in 1992, by Thomas
Zdeblick’s L5-S1 fusion by laparoscopic placement
of an interbody cage.
• In 1994, Rosenthal et al reported the first excision
of a herniated thoracic disc by thoracoscopic
surgery.
• In 1994, Le Huec and Husson performed the first
endoscopic retroperitoneal approach to the lumbar
spine.
Together, these three techniques provide access to
the thoracic and lumbar spine in its entirety.
14. Advantages over conventional
approach
• Minimal access to thorasic,
retroperitoneal, and abdominal cavity.
• Faster recovery
• Less post operative pain
• Less morbidity
• Less blood loss
• Less hospital stay
• Quick return to work
Requires higher skills and long learning
curve.
15. • VATS on the spine should be performed in a
standard operating room. Some modifications
from routine spinal procedures are needed.
• Double-lumen Endotracheal tube placement for
one lung anesthesia.
• Position: in the lateral decubitus position and
secured. The lower extremities are gently flexed
away.
• The operating table should be capable of
Trendelenburg or reverse Trendelenburg
positions in order to allow the deflated lung to
fall away from the spine to increase visualization
and decrease inadvertent injury during the
procedure.
16.
17. • Both the Spine surgeon and Thoracic
surgeons stand on the same side of the
patient, the abdominal side, across from
the video monitor.
• The third assistant, if necessary, stands
on the back side of the patient and faces
an opposing second monitor.
• The thoracic surgeon usually obtains and
holds the exposure, the orthopaedic
surgeon controls the orthopaedic
instruments with both hands, and the
third assistant may hold the camera
and/or retract the lung.
19. Thoracoscopy-Telescope
• Usually 30 degree, 10mm DM
scope is used for all spinal
procedure.
• Rigid scope had flexible claw
camera attachment at rear end
and light source on side.
20. Trocar system
• Trocar system are the portals to enter the
Thorasic, Retroperitoneal or Abdominal
cavity.
• They come in size from 5 mm to 12 mm
sleeve size.
• The Trocar it self is of different variety
like blunt tip, blade tip and dilating tip
according to the tissue to be approached.
• The cannula size also comes from 60
mm to 110 mm length.
23. • The first trocar inserted for
thoracoscopy is at the usual site in
5th or 6th intercostal space. According
to marker over spine.
• Usually blunt tip trocar to avoid
damage to lung.
• Other ports are taken in direct vision
to allow optimum placement for the
intended procedure.
32. Indication
• Release of anterior scoliosis and other
deformities.
• Herniated disc disease
• Vertebral fractures, decompression and
reconstruction of spinal column with or
with out anterior Instrumentation
• Abscess drainage and debridement in
tuberculous spine with reconstruction.
• Tumor biopsy and resection.
33. Thorasic Infection
• Use of large approach for drainage of
spinal abscesses seems to be
unrealistic in modern era
• Small portal surgery or conventional
endoscopy can perform same work
with less morbidity
• Thoraco-scopy is reliable method
used for removal of adhesion of
lungs in pleurisy and fibrolysis so can
be used with adherent lung.