This document discusses posterior urethral valves (PUV), including their etiology, classification, pathophysiology, clinical presentation, diagnosis, and management. PUV are congenital obstructions of the posterior urethra that commonly cause urinary outflow obstruction in boys. Type I valves are the most common. Initial management involves bladder drainage and antibiotics. Surgical valve ablation is usually curative, but long-term sequelae like renal disease are significant due to the primitive tissue injury caused by the obstruction.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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.
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.
2. Introduction
• A congenital obstruction of the posterior
urethra ascribed to valvelike leaflets
– 1769 by Morgagni
– Langenbeck in 1802
– Hugh Hampton Young coined “posterior urethral
valve”(1919)
– Randall carried out the first endoscopic resection
of valves in 1920
3. Incidence
• The most common structural cause of urinary
outflow obstruction in pediatric practice
• The most common type of obstructive uropathy
leading to childhood renal failure
• 1 of every 5000 to 8000 male births
• 10% of prenatally diagnosed hydronephrosis
• 1 PUV in 1250 fetal ultrasound
5. PUV Defined
• Type I
– Obstructing membrane that extends distally from each
side of the verumontanum towards the membranous
urethra where they fuse anteriorly
• Type II
– Described as folds extending cephalad from the
verumontanum to the bladder neck
• Type III
– Represent a diaphragm or ring-like membrane with a
central aperture just distal to the verumontanum
– Thought to represent incomplete dissolution of the
urogenital membrane
11. Renal Dysplasia
• Defined as a congenital defect of tissue
development without premalignant potential
• Histological diagnosis
• Cause ?
1- high pelvic pressure during
nephrogenesis
2- primary embryologic abnormality
from abnormal position of uteteric bud
12. Renal Function
• Children with PUV may demonstrate gradual
loss of renal function over time
• Cause:
1- Renal parenchymal dysplasia
2- Incomplete relief of obstruction
3-parenchymal injury from :
* UTI
*HTN
*Progressive glomerulosclerosis
from hyperfiltration
* Obstruction
13. • ESRD
-Occurs in 25% - 40%
-1/3 soon after birth
-2/3 during late teenager
14. Renal Tubular Function
• 50% of patients with PUV have impairment
concentration ability
• Persistently high urinary flow rate
regardless of fluid intake or state of
hydration
• severe dehydration and electrolyte
imbalance
• ureteral dilatation and high resting vesical
pressure
15. Hydronephrosis
• Significant urethral obstruction variable
degree of ureteral dilatation
• After relief of obstruction : gradual but
substantial reduction of hydronephrosis
• If not reduced we have to role out:
1- High intravesical pressure
2- ureteral muscle weakness
3- UVJ obstruction
16. Vesicoureteral Reflux
• Present in 33 - 50%
• Usually Secondary
– High intravesical pressures
• 33% resolve spontaneously when obstruction
treated
• 33% do well on prophylactic antibiotics
17. BLADDER DYSFUNCTION
• Commonly presented in patient with PUV
• Usually primary, secondary to irreversible
change in organization and function of the
smooth muscle from outlet obstruction
• Present as urinary incontinence (20%)
• Bladder dysfunction persist in 75 % after valve
ablation
18. • May cause deterioration of renal function
• Three groups of dysfunction were described
- Detrusor –hyperreflexia (29%)
- Hypertonic and poor compliant bladder
(31%)
- Myogenic failure and overflow
incontinence (40%)
20. • Factors responsible for devolution of a bladder
into a valve bladder
(1) polyuria.
(2) poor bladder compliance with high-pressure
voiding and elevated wall tension bladder, and
(3) residual urine volume.
21. Clinical Presentation
• Varies by degree of obstruction
– Symptoms vary by age of presentation
• Antenatal
– Bilateral hydronephrosis
– Distended and thickened bladder
– Dilated prostatic urethra
– Oligohydramnios - accounts for co-presentation of
pulmonary hypoplasia.
22. Clinical Presentation
• Newborn
– Palpable abdominal mass
• Distended bladder, hydronephrotic kidney
• Bladder may feel like a small walnut in the suprapubic area
– Ascites
• 40% of time due to obstructive uropathy
– History of Oligohydramnios
– Respiratory distress from pulmonary hypoplasia
• Severity often does not correlate with degree obstruction
• Primary cause of death in newborns
23. Clinical Presentation
• Early Infancy
– Dribbling / poor urinary stream
– Urosepsis
– Dehydration
– Electrolyte abnormalities
– Uremia
– Failure to thrive; due to renal insufficiency
• Toddlers
– Better renal function (less obstruction)
– Febrile UTI
– Voiding dysfunction – incontinence
– Daytime incontinence may be the only symptom in boys with
less severe obstruction
24. Diagnosis
Ultrasonography
• 1 in 1250 ultrasound screenings
• pathognomonic u/s findings:
– thickened, dilated bladder along with bilateral
hydroureter and pelvocaliectasis
– Oligohydramnios
– dilated posterior urethra
28. • VUR in 50% of patients with PUV
• Normal MCUG exclude PUV
29. Functional assessment
• Radionuclide Renal Scan
– quantification of differential renal function, and
cortical deficits
– DTPA OR MAG-3
– with urethral catheter in place
Exclude obstruction and assess split renal
function
30. • Serum Creatinine
– After 48 hours the infant's baseline laboratory
values may be monitored.
– nadir creatinine value at 1 year of age is
considered an important diagnostic tool
31. Initial Management
• Bladder Drainage
– A 5 or 8 Fr pediatric feeding tube is ideal
– A Foley catheter should not be used, due to the tendency
of the balloon to occlude the ureteral orifice and cause a
bladder spasm.
• Secondary obstruction
– Broad spectrum antibiotic coverage
– Metabolic panel
• Assess renal function and metabolic abnormalities
• Acidosis, hyperkalemia common problems
33. • Transurethral Valve Ablation
– Incise at 5, 7 & 12 o’clock positions via Pediatric
resectoscope
• Avoid urethral sphincter
• Catheter drainage for 1-2 days
• VCUG at 2 months to ensure destruction of valves
• Regular U/S to evaluate resolution of hydronephrosis
34. • Transurethral Valve Ablation
– Alternatively, 8F cystoscope with a Bugbee
electrode adjacent
– Insulated crochet hook (“Whitaker hook”)
• When urethra too small to accommodate
cystoscope/Bugbee
35. Antegrade valve ablation
• Zaontz and Firlit
• advantage of avoidance
of instrumentation to
the small male distal
urethra
36. Vesicostomy
• reserved for
– the very lowbirth-weight infant
– continued impaired renal function,
– high bladder urine volumes,
– and upper tract deterioration after valve ablation
or urethral catheterization.
37.
38.
39.
40. •key operative step in creation of the vesicostomy is to
ensure that the posterior wall of the bladder is taut
•accomplished by bringing the dome of the bladder to the
skin
43. Circumcision
• Risk of UTI in children with PUV is 50% to
60%
• UTI can quickly progress to pyelonephritis and
sepsis
• Circumcision reduces that risk of UTI by 83%
to 92%,
• Strongly recommended as a prophylactic
measure for any boy diagnosed with posterior
urethral valves
44. Antenatal m/m
• Intervention when antenatal sonography detects
evidence of
– oligohydramnios,
– a dilated bladder, and
– severe hydroureteronephrosis—without renal cortical
cystic lesions—in a fetus with a normal karyotype
• Vesicoamniotic shunting to treat
oligohydramnios offers potential ameliorative
effects on pulmonary function
45. PROGNOSTIC FACTOR
• Good Factors
• Nadir creatinine < 0.8 mg/dl
• S. creatinine < 1 mg/dl
• Pop-off mechanism
• - massive unilateral reflux
• -Urinary Ascitis (urinoma)
• - Large bladder diverticulum
46.
47.
48.
49. Bad Factors
• Age
• Delayed correction
• GFR < 50 % of normal in infancy
• VUR
- Bil -----> 57 % mortality
- Uni. -----> 17 %
- Non -----> 9 %
• Loss of cortico medullary junction
• delayed incontinence beyond 5 years
50. Transplantation in PUV Patients
• The prevalence of end-stage renal disease in
PUV- up to 50%
• Obstructive uropathy as the second most
common cause for transplantation
• Mixed outcome after transplantation
• Transplantation into a valve-affected bladder may
carry a higher risk of ureteral obstruction
• However, there is no increased risk of graft loss
compared to controls
51. Quality of Life with PUV
• have lifetime repercussions
• long-term risk factors
– valve bladder
– erectile dysfunction and infertility
– Risk of urinary tract infections
– associated comorbidities of renal transplantation
• counseling, preparing, and treating valve
patients as they reach adulthood
52. Conclusions:
Posterior Urethral Valves
• Two PUV types, Type I the most common, Type III
with a worse prognosis
• Prognosis improved with improved symptoms
within 1 month of therapy or the presence of a
“Pop-off” valve
• Drainage, antibiotics and correction of metabolic
disturbances key to initial care
• VCUG, U/S and renal nuclear scan to evaluate
• Majority managed by valve ablation
• Long-term sequelae significant, primarily renal
disease