Over the last two decades, laparoscopic cholecystectomy
has replaced open cholecystectomy as the standard surgical procedure for majority of patients of gall stone disease. Till 1999, laparoscopic Cholecystectomy was being performed using multiple ports usually 3 or 4 ports.
Intensive desire of surgeon to reduce the number of ports led invention of two port cholecystectomy and then finally
single incision laparoscopic cholecystectomy (SILC) .
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
Robotic, Multi-Articulated Endoscopic Surgical Tools for Natural Orifice Tran...Devin Berg
Presented at the Doctoral Consortium for Medical Simulation and Robotics held on March 11, 2010 in Chicago, IL in conjunction with the Americal College of Surgeons Accredited Education Institutes Consortium.
Cite: http://dx.doi.org/10.6084/m9.figshare.785746
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
Robotic, Multi-Articulated Endoscopic Surgical Tools for Natural Orifice Tran...Devin Berg
Presented at the Doctoral Consortium for Medical Simulation and Robotics held on March 11, 2010 in Chicago, IL in conjunction with the Americal College of Surgeons Accredited Education Institutes Consortium.
Cite: http://dx.doi.org/10.6084/m9.figshare.785746
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI SurgeryDr Pradeep Jain Reviews
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery. Dr. Pradeep Jain Fortis Hospital has over 20 years of experience in the Laparoscopic GI and GI Oncology Surgery.
Χαμηλή Πρόσθια Εκτομή : «Η Λαπαροσκοπική Προσπέλαση Πλεονεκτεί για τον Ασθενή...Dimitris P. Korkolis
Potential Advantages of Lap TME
- Less blood loss
- Faster recovery
- Earlier return of gut function
- Lower morbidity and mortality
- Magnified view allows precise dissection (pelvic autonomics)
- Earlier hospital discharge
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Clinical value of the laparoscopic transabdominal preperitoneal techniqueMohamedTag14
Current guidelines recommend that surgical treatment of recurrent inguinal hernia should avoid the anatomical difficulties caused by the primary surgery, and that the recurrence repair should be done via a different surgical approach to that used during the primary repair.
Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
A retrospective study of outcome of intraoperative gallbladder perforation du...Kundan Singh
Abstract:
Background: During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently while gallbladder is being dissected from liver bed or while extracting it through the port site. In this retrospective study we have studied the case files of the patients who underwent laproscopic cholecystectomy and had intraoperative gallbladder perforation and had studied its effect on outcome of the surgery.
Material & method: This is a retrospective done at patna medical college and hospital in January 2016 in which the patients records of 310 patients of laproscopic cholecystectomy from January 2015 to December 2015 were studied. The incidence of perforation, duration of operation and the post-operative complications were noted and the data obtained was analysed
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI SurgeryDr Pradeep Jain Reviews
Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery. Dr. Pradeep Jain Fortis Hospital has over 20 years of experience in the Laparoscopic GI and GI Oncology Surgery.
Χαμηλή Πρόσθια Εκτομή : «Η Λαπαροσκοπική Προσπέλαση Πλεονεκτεί για τον Ασθενή...Dimitris P. Korkolis
Potential Advantages of Lap TME
- Less blood loss
- Faster recovery
- Earlier return of gut function
- Lower morbidity and mortality
- Magnified view allows precise dissection (pelvic autonomics)
- Earlier hospital discharge
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Clinical value of the laparoscopic transabdominal preperitoneal techniqueMohamedTag14
Current guidelines recommend that surgical treatment of recurrent inguinal hernia should avoid the anatomical difficulties caused by the primary surgery, and that the recurrence repair should be done via a different surgical approach to that used during the primary repair.
Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
A retrospective study of outcome of intraoperative gallbladder perforation du...Kundan Singh
Abstract:
Background: During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently while gallbladder is being dissected from liver bed or while extracting it through the port site. In this retrospective study we have studied the case files of the patients who underwent laproscopic cholecystectomy and had intraoperative gallbladder perforation and had studied its effect on outcome of the surgery.
Material & method: This is a retrospective done at patna medical college and hospital in January 2016 in which the patients records of 310 patients of laproscopic cholecystectomy from January 2015 to December 2015 were studied. The incidence of perforation, duration of operation and the post-operative complications were noted and the data obtained was analysed
30 Simple Systems Packs
If you need start planning to manage your business growth.
If you need to organize every aspect of your business, to work efficiently and effectively.
If your Startup is taking the first steps.
The 30 Simple Systems program is all you need!
Learn how to easily develop an Operations Manual that:
• maps out exactly how things should get done in your business;
• build a clear and well-designed business organization structure saving you time and reducing business stress;
• helps businesses reach their maximum potential in all 5 business areas.
Choose the solution that best suits your business needs.
Trikle Trade is Socially Responsible Company that provide Random acts of kindness. Kindness is contagious and as part of Personal Socially Responsibility everyone carrying out random acts of kindness on a daily basis.
Laparoscopic colon resections are being performed with increasing frequency all over the world. However, the use of minimal access surgery in colorectal surgery has lagged behind its application in other surgical fields.
Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease. The operation is routinely performed using four or three ports of entry into the abdomen. At laparoscopy hospital, we frequently perform cholecystectomy by two-port method using modified extracorporeal knot.
Peritoneal adhesions are a common cause of bowel obstruction, pelvic pain, and infertility. More often than not, these adhesions need to be released surgically for the management of these complications.
Laparoscopic surgery has undergone rapid development in recent years. Laparoscopic cholecystectomy was first performed in 1985. Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery.
LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)KETAN VAGHOLKAR
Background: Appendicectomy is one of the common procedures performed by a general surgeon. However,
the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore
there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The
study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and
postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised
into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised
25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative
findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced
need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed
in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure
for appendicectomy.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
Follow us on: Pinterest
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
2. Original Article
SINGLE PORT ACCESS CHOLECYSTECTOMY: THE INITIAL LEARNING CURVE*
Radha Govind Khandelwal, Kirubha Shankar and Prasanna Kumar Reddy
Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals, 21Greens Lane,
Off. Greams Road, Chennai 600 006, India.
Correspondence to: Dr Prasanna Kumar Reddy, Head of Department of Surgical Gastroenterology, Apollo Hospitals, 21
Greams Lane, Off Greems Road, Chennai 600 006, India.
e-mail: drpkreddy@hotmail.com
Objective: Single port surgery is a rapidly advancing technique with a lot of enthusiasm among minimal
access surgeons. Single port access cholecystectomy (SPAC) is one of the most commonly performed single
port access surgery all over the world. To establish this technique as standard of care for management of
benign biliary diseases, it needs strong comparison with traditional laparoscopic cholecystectomy. Initial
learning curve, cost effectiveness, post operative pain, post operative recovery and complications rate is yet to
be established. Methods: SPAC was performed on 19 selected patients for symptomatic gall stone disease by
a single surgeon at our institute. The SILSTM port was placed in the umbilicus and combination of articulating
and straight instruments were used. Patient characteristics and outcome were reviewed. Results: The main
selection criteria for SPAC were based on clinical history, body mass index, and ultrasonographic findings. The
SPAC had a mean time of 50 minutes. The first single port cholecystectomy took 120 minutes with sequential
improvement in operating time for further cases. The average patient body mass index was 23. No major
complications or conversion to traditional technique occurred. Conclusion: One of the largest series to date of
SPAC for benign biliary diseases in India, performed by a single surgeon in a single institute is presented. We
conclude that it is a safe and reproducible technique with short learning curve for appropriately trained minimal
access surgeons with a higher cosmetic satisfaction for patients.
Key words: Single port access cholecystectomy (SPAC), SILSTM port, Reproducible, Learning curve.
INTRODUCTION
METHODS
Over the last two decades, laparoscopic cholecystectomy has replaced open cholecystectomy as the
standard surgical procedure for majority of patients of gall
stone disease. Till 1999, laparoscopic Cholecystectomy was
being performed using multiple ports usually 3or 4 ports.
Intensive desire of surgeon to reduce the number of ports led
invention of two port cholecystectomy and then finally
single incision laparoscopic cholecystectomy (SILC) .
Until the beginning of July 2009, traditional multiport
laparoscopic cholecystectomy was the standard of care
for the majority of benign biliary diseases. Before that we
tried SILC occasionally for selected cases but we found it
to be difficult to perform. With the availability of SILSTM
port in india, we started to perform single port access
chole-cystectomy using multichannel SILSTM port in
properly selected cases. We retrospectively reviewed the
effect of this transition on operative times and surgical
complications.
Single incision laparoscopic surgery utilizes three
fascial ports through the single skin incision at umbilicus
[1]. With the introduction of single port with multiple
sleeves, now single port access has become a vital option
for cholecystectomies and other commonly performed
laparo-scopic procedures. Single port access surgery is
being considered as no scar surgery, because the single
port is placed within the umbilical ring that is not visible at
all. We conducted a prospective study to assess learning
curve, reproducibility and advantages of this new
technique at our centre, before offering it to all types of
patients of benign biliary diseases.
*Paper presented in IAGES – 2010 held at Delhi on 21 February 2010.
Apollo Medicine, Vol. 7, No. 2, June 2010
132
All patients of symptomatic benign biliary
diseases were evaluated thoroughly, only those
patients who had history of biliary colic, BMI less
than 23 and normal looking gall bladder with no
evidence of acute or chronic cholecystitis and
choledocholithiasis on ultra sonography were
included in the study. Patients characteristics are
demonstrated in (Table 1).16 patients of symptomatic gall
stone disease and 3 patients of adenomyomatosis of gall
bladder were selected for single port access
cholecystectomy (Fig.1).
3. Original Article
area for retraction because of obstruction of calot’s
triangle by liver.
Table 1. Demonstrating the patient characteristics
Patient characteristics
Number
Male
Female
15
Mean age
32
Mean BMI
28
Coronary artery disease
Nil
Diabetes mellitus
RESULT
4
nil
In first two cases both of symptomatic biliary colic that
were attempted for single port access cholecystectomy, we
required an additional ethilon suture for retracting the
Hartman to expose the calot’s triangle. In initial five cases,
we took long operative time due to poor coordination
between assistant holding the Hartman with articulating
grasper and surgeon doing dissection using straight
instrument. In further cases both surgeon and assistant
were tuned up, so operating time was reduced. In two
cases the liver was enlarged and obstructing the calot’s
triangle. To overcome this problem with exposure, an
ethilon suture was passed around the falciform ligament
from the left subcostal area to pull the liver up.
Instead of anterior and posterior dissection of standard
multiport laparoscopic cholecystectomy, right and left
dissection in calot’s triangle performed to expose the
cystic duct and cystic artery. Meticulous dissection was
done to expose the critical window, as in standard LC.
Fig.1.Preoperative indications for Single port cholcecystectomy
Patients were placed in modified lithotomy position. A
20 mm incision was given entirely within the umbilical
ring and single port deployed. Following access and
placement of port, the surgeon stood in between the legs of
patient with the assistant and camera person on left side of
patient. 5 mm 30 degree scope was used in all cases. The
single port access cholecystectomy was commenced by
passing a straight needle with ethilon suture via right
subcostal region for retraction of gall bladder fundus
cephalad. Articulating grasper was used for lateral
retraction of hartmann’s pouch for exposure of calot’s
triangle. The surgeon held the single operating instrument
for dissection, assisted retracted the Hartman pouch with
articulating grasper. Single handed dissection carried out
in calot triangle by surgeon using Maryland grasper or
harmonic scalpel. After skeletoni-zation of cystic duct and
cystic artery and creation of adequate posterior window,
cystic artery and duct clipped using 5 mm clip applicator
and divided. Harmonic scalpel was then used to remove
the gall bladder from liver bed, and the specimen was
removed along with the port.
Additional traction suture was used for Hartman
retraction in 2 cases. In 2 cases, a second ethilon suture
was passed around the falciform from the left subcostal
Therefore, 19 selected patients underwent SPAC
without the need of additional ports or open conversion.
No gross gallstones or spillage of bile noted with ethillon
sutures. Operative time was reduced from 100-140
minutes (initial 4 cases) to 45-65 minutes (last 4 cases).
None of the cases required placement of drain.
All patients were discharged on the next day of
surgery. The operative time of all successful 19 cases of
single port cholecystectomy is shown in (Fig.2).Mean
operative time for our first four cases was 122.5 minutes
while mean operative time for last 4 cases was 62.5
minutes, that is almost similar to standard laparoscopic
cholecystectomy at our centre.
DISCUSSION
Since 1990’s laparoscopic cholecystectomy using
multiple ports around the abdomen is gold standard
procedure for benign biliary diseases. The constant effort of
surgeons to reduce the number of ports to reduce pain and
higher cosmetic demand from patient led to introduction of
Single port surgery in the field of minimal access surgery. In
single port access cholecystectomy, the incision is placed in
the umbilical ring (not around it). This permits a scar less
operation, because the operative scar is hidden in natural
scar i.e. umbilicus. Any port incision is associated with
some potential complications, although the rate of
incidence varies with the port size and type. Port
complications may include hernias, abdominal wall
133
Apollo Medicine, Vol. 7, No. 2, June 2010
4. Original Article
Like prior published series [4,5], we also
included selected cases in our series to start this
technique at our centre. In our series we found that
this technique is associated with higher cosmetic
satisfaction among patients. Furthermore the learning
curve described is specific to the primary surgeon, a
highly experienced laparoscopic surgeon, and may vary
with the comfort level and technical skills of other
surgeons. However, in our personal experience that after
performing the 10 cases of single port access
cholecystectomy, surgeon reaches an adequate level to
perform single port cholecystectomy independently and
effectively.
CONCLUSION
Fig. 2. Operative times ( x-axis - Patient, y-axis - Operative
Time in minutes).
bleeding , bowel injury and wound infection . Reducing the
port incisions from 3 or 4 to one definitely reduces the
incidence of these morbidities. Furthermore Bresadola,
et al showed that in single incision transumbilical
laparoscopic cholecystectomy, using only the periumbilical
port incision reduces the level of pain engendered by
traditional multiport laparoscopic surgery [2].
Kravetz AJ, et al performed single port access
cholecystectomy on all types of biliary disease, including
acute cholecystitis with inflammation and found that this
form of surgery can be performed in all types of biliary
disease with a short learning curve of approximately five
cases, with an obvious cosmetic benefit [3].
Although initial 4 cases took long operative times, the
last 4 cases were performed with operative times comparable to those with multiport cholecystectomy. Because we
eliminated the additional time in putting the additional
ports and the time in retrieving the gall bladder, we
anticipate that our operative time will continue to diminish
to a level below that of multiport cholecystectomy.
One of the largest series to date of single port
cholecystectomy for benign biliary diseases in India,
performed by a single surgeon in a single institute is
presented. We conclude that this technique can be applied
effectively in selected group of patients with benign
biliary diseases in comparable operative time to traditional
laparoscopic cholecystectomy in a safe manner. It is a
reproducible technique with short learning curve for
appropriately trained minimal access surgeons with a
higher cosmetic satisfaction for patients. The loss of basic
laparo-scopic concept of triangulation, instrumental
cluttering and unfamiliar ergonomics are pitfalls of this
technique. With improvement in articulating instruments,
laparoscope and advance training it may stand the test of
time to become a standard technique for all patients with
benign biliary diseases.
REFERENCES
The learning curve for single port cholecystectomy
primarily reflects the difficulties experienced in understanding the spatial restriction due to instruments cluttering
and the camera. As the traditional concept of laparoscopic
triangulation, anterior and posterior dissection (to some
extent), is lost in single port access surgery, so adoption of
right and left dissection in calot’s triangle and acceptance of
some instrumental cluttering by primary surgeon is crucial
for performance of single port surgery. The use of articulating instrument may aid to manage the spatial conflict
of instruments; however it does not eliminate the technical
challenges associated with single port surgery.
Apollo Medicine, Vol. 7, No. 2, June 2010
134
1. Piskun G, Rajpal S. Transumbilical laparoscopic
cholecystectomy utilizes no incisions outside the
umbilicus. J Laparoendosc Adv Surg Tech. 1999; 9:
361-364.
2. Bresadola F, Pasqualucci A, Donini A, et al. Elective
transumbilical compared with standard laparoscopic
cholecystectomy. Eur J Surg. 1999;165(1) :29-34.
3. Kravetz AJ, Iddings D, Basson MD, Kia MA. The learning
curve with single port cholecystectomy. Journal of
society of laparoendoscopic surgeons 2009;13 (3): 332336.
4. Hong TH, You YK, Lee KH. Transumbilical single-port
laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc. 2009;23(6):1393-1397.
5. Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK, Kim DG.
Single-port
transumbilical
laparoscopic
cholecystectomy: a preliminary study in 37 patients with
gallbladder disease. J Laparoendosc Adv Surg Tech A.
2009; 19(4):495-499.
5. A o oh s i l ht:w wa o o o p a . m/
p l o p a : t / w .p l h s i lc
l
ts p /
l
ts o
T ie: t s / ie. m/o p a A o o
wt rht :t t r o H s i l p l
t
p /w t c
ts
l
Y uu e ht:w wy uu ec m/p l h s i ln i
o tb : t / w . tb . a o o o p a i a
p/
o
o
l
ts d
F c b o : t :w wfc b o . m/h A o o o p a
a e o k ht / w . e o k o T e p l H s i l
p/
a
c
l
ts
Si s ae ht:w wsd s aen t p l _ o p a
l e h r: t / w .i h r.e/ o o H s i l
d
p/
le
A l
ts
L k d : t :w wl k d . m/ mp n /p l -o p a
i e i ht / w . e i c c a y o oh s i l
n n p/
i
n no o
a l
ts
Bo : t :w wl s l e l . /
l ht / w . t a h a hi
g p/
e tk t n