1. The document discusses fears about an increased risk of gastric cancer after a Billroth II procedure or mini-gastric bypass. However, many studies have shown no association between these procedures and gastric cancer.
2. Some older studies did report a small increased risk but these were likely confounded because the Billroth II was used to treat ulcers caused by H. pylori, which is a risk factor for gastric cancer.
3. The predicted increased lifetime risk of gastric cancer from the worst case Billroth II studies is small, around 0.25%, which is lower than the risk from one or two CT scans.
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-JejunostomyDr. Robert Rutledge
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-Jejunostomy
** Why is it that GENERAL Surgeons Can Figure this Out;
** While Bariatric Surgeons are Still Confused and in the Dark?
Example:
Publication Title: To Roux or not to Roux…Gastric Cancer. 2015 Sep 23
To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.
World LEADING Gastric Cancer Centers from around the USA!!
** No Fear of Using Billroth II in Gastric Cancer Patients!!
Bariatric Surgeons Fear and Confusion Related to Billroth II for 20 years!!!
General/Trauma and CANCER SURGEONS No Fear of Billroth II
Our study of Bariatric surgeons showed …
The less knowledge of general and cancer surgery =
the greater the fear and criticism of the Billroth II
Irrational Fears of Cancer Bariatric Surgeons FEAR the Billroth II; General S...Dr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Irrational Fears of Cancer in the MGB by Bariatric SurgeonsDr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
Fear & Confusion about the Risk of Cancer after Bariatric SurgeryDr. Robert Rutledge
Esophageal Cancer from
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
Sleeve & Band vs Risk of Gastric Cancer after Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery, www.CLOS.net www.MiniBypass.net Email: DrR@clos.net
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-JejunostomyDr. Robert Rutledge
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-Jejunostomy
** Why is it that GENERAL Surgeons Can Figure this Out;
** While Bariatric Surgeons are Still Confused and in the Dark?
Example:
Publication Title: To Roux or not to Roux…Gastric Cancer. 2015 Sep 23
To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.
World LEADING Gastric Cancer Centers from around the USA!!
** No Fear of Using Billroth II in Gastric Cancer Patients!!
Bariatric Surgeons Fear and Confusion Related to Billroth II for 20 years!!!
General/Trauma and CANCER SURGEONS No Fear of Billroth II
Our study of Bariatric surgeons showed …
The less knowledge of general and cancer surgery =
the greater the fear and criticism of the Billroth II
Irrational Fears of Cancer Bariatric Surgeons FEAR the Billroth II; General S...Dr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Irrational Fears of Cancer in the MGB by Bariatric SurgeonsDr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
Fear & Confusion about the Risk of Cancer after Bariatric SurgeryDr. Robert Rutledge
Esophageal Cancer from
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
Sleeve & Band vs Risk of Gastric Cancer after Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery, www.CLOS.net www.MiniBypass.net Email: DrR@clos.net
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
5th Annual Early Age Onset Colorectal Cancer - Session VI: Palliative Care: Why Early is Best Including Guidance, Support and Resources to Patients and Caregivers During Their Treatment Journey/Continuum of Care. Epigenetics and its Future Role in the Diagnosis and Treatment of Individuals More Specifically and Accurately.
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Evidence-based guidelines for the nutritional management of adult oncology pa...milfamln
Webinar Objectives
1. The participant will be able to discuss the validity of malnutrition screening and nutrition assessment tools and their utilization in clinical oncology settings
2. The participant will be able to better utilize the Nutrition Care Process to provide appropriate and high-quality nutrition care to oncology patients
3. The participant will be able to describe the evidencebased relationships between nutritional status and morbidity and mortality outcomes in oncology
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
Fear of Gastric Cancer after MGB
Surgeons who repport Fear of Gastric Cancer after MGB
Show evidence of limited knowledge of
Gastric Cancer, General Surgery and Bariatric Surgery
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
5th Annual Early Age Onset Colorectal Cancer - Session VI: Palliative Care: Why Early is Best Including Guidance, Support and Resources to Patients and Caregivers During Their Treatment Journey/Continuum of Care. Epigenetics and its Future Role in the Diagnosis and Treatment of Individuals More Specifically and Accurately.
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Evidence-based guidelines for the nutritional management of adult oncology pa...milfamln
Webinar Objectives
1. The participant will be able to discuss the validity of malnutrition screening and nutrition assessment tools and their utilization in clinical oncology settings
2. The participant will be able to better utilize the Nutrition Care Process to provide appropriate and high-quality nutrition care to oncology patients
3. The participant will be able to describe the evidencebased relationships between nutritional status and morbidity and mortality outcomes in oncology
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
Fear of Gastric Cancer after MGB
Surgeons who repport Fear of Gastric Cancer after MGB
Show evidence of limited knowledge of
Gastric Cancer, General Surgery and Bariatric Surgery
Gastric Cancer declining rapidly, primarily related to environmental factors; easily modified.
Risk of GCA after B2 related to Ulcer & H. Pylori, if present at all.
Endoscopic screening is not recommended.
While some bariatric surgeons have expressed fears of the B2 causing cancer; General and Oncologic Surgeons continue to routinely use the B2.
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Rational Data Analysis vs.Irrational FEAR Gastric Cancer
1. Gastric Cancer Declining Rapidly
2. GC Environmental Causes; Easily Prevented
3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori
4. Many large studies: NO increased risk
5. Endoscopic Screening: Not Recommended
6. General, Trauma & Oncologic Surgeons Use Billroth II
Presentation; Discussion of Herd Behaviour is Erroneous Human Decision Making; PROACT Decision Making Tool; 30 Point Multi-Dimensional assessment tool; Selection of the Best Bariatric Surgey; Discussion of the Lack of Risk of Gastric Cancer and the Billroth II
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
Prediction of Weight Loss Following The Mini-Gastric Bypass: Multivariate Regression Modeling
Robert Rutledge, K Kular, N. Manchanda CLOS Center For Laparoscopic Obesity Surgery, MGB Review Corp
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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!
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.
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.
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.
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
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Gastric cancer & Billroth II & the MGB
1. Irrational Fear of Gastric Cancer:
CHOOSING THE BEST WEIGHT LOSS
SURGERY
R Rutledge MD,
www.CLOS.net
Email: DrR@clos.net
2. Irrational Fears of Cancer
General Surgeons Use the Billroth II
Bariatric Surgeons FEAR the Billroth II
(Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
3. Dr Rutledge: Training &
Background
• Undergrad/Medical School; Teacher
Dr. Lester Dragstedt Pioneer / Inventor of the
Highly Controversial Vagotomy and Pyloroplasty
• 2 Years Cardiac Surgery National Institutes of
Health National Heart Lung Blood Institute
• 20 years University of NC; Professor of Surgery,
Associate Chief of Staff, Director of Section Medical
Informatics, Director North Carolina Trauma
Registry
• Author of 100 papers and articles
4. Dr Rutledge: Training &
Background
• Specialty: Trauma, Critical Care, Medical Informatics
and Bariatric Surgery (1978-1998 20 years University
NC)
• Experience: Trauma Surgery, Director NC Trauma
Registry
• Peptic Ulcer Surgery; Vagotomy & Pyloroplasty;
Antrectomy & Billroth II
• Bariatric Surgery 33 years:
Open RNY & Vertical Banded Gastroplasty
• 1997 one first surgeons laparoscopic RNY
• Mini-Gastric Bypass; 14 years, over 6,000 cases
5. Dr. Rutledge
USA 001-702-714-0011 DrR@clos.net
CONSIDERING THE MGB?
MGB IS A SUPERB SURGERY
BUT…
WARNING:
“THERE ARE “TRICKS AND
TRAPS”
6. OFFER A SAFE & SUCCESSFUL
MGB PROGRAM
• Call / Email: Anytime question or advice on any clinical,
technical or patient MGB question
• USA 001-702-714-0011 DrR@clos.net
• Personal Visit: Dr. Rutledge Visiting Professor: France,
Turkey, Austria & India, Upcoming visits Greece,
Istanbul, United Kingdom, Czech Republic, Italy,
Germany
• Please Use the Knowledge of Others Before You Start;
Experience; over 14 years, over 6,000 patients
• USA 001-702-714-0011 DrR@clos.net
7. MGB Results
• In Short
• By every measure
• In every study
• By Every Author
• MGB Equal to or Better Than
any other form of Bariatric
Surgery
8. Fear of Mini-Bypass
• Numerous studies now confirm
that the Mini-Gastric Bypass (MGB)
is
• Short, simple, highly effective, very
safe, very durable and easily
revised surgery
• In almost every way the MGB out
performs the Sleeve, Band and
RNY
9. Lack of Knowledge and Patient
Outcomes
• Studies Show Correlation Between
Surgeon's knowledge in there areas of
expertise and patient outcomes
• Survey Data Showed :
• Surgeons who FEAR GCa after MGB
were much less knowledgeable about
GCa and Billroth II and General Surgery
than other Bariatric Surgeons
10. Fear of Gastric Caner after Mini-Bypass
Purpose: Education
1 Gastric Cancer (GCa)
2 Declining Risk
3 Causes Prevention GCa
4 H Pylori GCa
5 Billroth II and GCa
6 General/Oncolotrauma
Surgeons Routine Use BII
7 Incidence/Frequency of GCa
8 Many Studies show NO
Increased Risk of GCa Post
BII
9 Some Studies DO show
Increased Risk of GCa after
BII...BUT BII Rx for ULCERS!
10 H Pylori => Ulcers => GCa
11 Gastroenterologists DO NOT
recommend endo F/U for BII
patients; Why? BECAUSE
RISK IS TOO LOW
12 Irrational Fears: Hot Dogs,
CAT-Scans and Cognitive
Biases in Humans and
Bariatric Surgeons
11. Human Decision Making
• Numerous Studies show that
Human Decision Making is far from
the ideal logical and rational skill
that many of us imagine
• Cognitive Biases
• Foundation of Good Decision
Making is a Clear understanding of
the data
12. Survey 102 Bariatric Surgeons
• Experience with over 39,000 cases
• Surgeons who
Fear of GCa after MGB
• Significantly LESS Knowledgeable
about GCa, General Surgery,
outcomes of BII and MGB
14. Gastric Cancer (GCa)
• Studies Show just the Word
"Cancer" engenders an inordinate
amount of fear in study
participants
• Example what's more deadly
cancer or bowel obstruction
• To judge the right response to a
risk we need to look at the actual
data...
15. Gastric Cancer (GCa)
Declining Risk
• There has been a long-term decline
in incidence of stomach cancer in
virtually all countries worldwide
• This is linked to falling rates of
infection with H. pylori, and the use
of refrigeration instead of salting to
preserve foods,
16. Gastric cancer is declining in
Japan and all over the world
• The incidence of gastric cancer is declining
in Japan and all over the world.
• In a study conducted in Osaka prefecture,
• the age-adjusted mortality rate for gastric
cancer decreased from 84 (1963–65) to 41
(1987–89) for males and from
• 41 to 18 for females during the same period
17. Gastric Cancer (GCa)
Declining Risk
• Researchers at Harvard School of
Public Health CGA declined 60%
between 1978 and 2008
• H. pylori infection and smoking
accounted for 47%
• Predicted 2008-2040, U.S. CGA rates
will fall an additional 47%, and
• H. pylori and smoking will contribute to
more than 80% of the decline.
18. Gastric Cancer (GCa)
Declining Risk
• What to KNOW
1. Worldwide Massive Decline of GCa
2. Why?
= Decline in Smoking
= Refrigeration => Decrease in Nitrate
in Preserved Foods/More Fresh Fruit
and Veges AND
= Decline in H.Pylori
3. NOT Billroth II
19. Causes/Prevention GCa
• H. pylori can cause peptic ulcers.
cause of stomach cancer
• Smoking: Heavy smokers are most at
risk.
• Diet: Smoked, Salted, Or Pickled
increased risk
• Diet high in fresh fruits & vegetables
lower risk
• Sedentary and Obesity Increase Risk
20. Fear Gastric Cancer?
Prevention is Simple!
• Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled foods
• * DO Eat * fresh fruits & vegetables
• Be Active and Rx Obesity
21. H Pylori GCa
• H. pylori infection is the major
cause of gastric (stomach) cancer
• "Helicobacter pylori causes gastric
cancer in human and in
experimental animals. "
• Many surgeons who fear GCa in
MGB did not seem to be clear on
this simple fact
22. Fear Gastric Cancer?
•Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled foods
• * DO Eat * fresh fruits & vegetables
• Be Active and Rx Obesity
23. Billroth II and GCa
Many Surgeons who fear the
GCa Association with MGB not
clear on the research on this
topic
24. Billroth II and GCa
Studies showing NO Increased Risk of GCa
Post BII
• Many Surgeons who fear the GCa
Association with MGB do not know that
• Many Studies of BII and GCa Show
• NO ASSOCIATION
• Studies showing NO Increased Risk of
GCa Post BII
25. BARIATRIC SURGEONS FEAR BILLROTH II
Many Studies Show NO Association
• Mayo Clinic Study (Example)
• 338 Billroth II patients
• Followed 25-years
• 5,635 person-years
• Only 2 Cancers in 5,000+ pt years of
Follow Up
• Schafer et al, Risk of gastric carcinoma after treatment for benign
ulcer disease. N Engl J Med. 1983 Nov 17;309
26. BARIATRIC SURGEONS FEAR BILLROTH II
MAGNITUDE OF THE PROBLEM
• Population based study, 338 Billroth II
pts
• Followed 25-years
• 5,635 person-years
• Only 2 Cancers Found in 5,000 years
• Predicted 2.6 cancers (relative risk
0.8)
Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J
Med. 1983 Nov 17;309
27. BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• 338 Billroth II pts, Followed 25-yrs
• 5,635 person-years
• Only 2 Cancers in 5,000 pt yrs follow
up
• Lifetime Risk GCa after BII 0.04%
• RATE of Gastric Cancer is Declining
• 24 - 50% Expected Decrease from
1983
• Future risk <<1 patient / 5,000 pt years
28. BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• Only 2 Cancers in 5,000 pt yrs follow up
• Lifetime Risk GCa after BII 0.04%
• Remember!
• RATE of Gastric Cancer is Declining
• This was Published in 1983!
• 24 - 50% Expected Decrease from 1983
• Future risk GCa: ~1 pt / 5,000 pt yrs
• Lifetime Risk of GCa after 5,000 pt yrs FU
0.02% Less than the risk for the rest of the
population!
29. BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• Remember!
• RATE of Gastric Cancer is Declining
• This was Published in 1983!
• 24 - 50% Expected Decrease from 1983
• Future risk GCa: ~1 pt / 5,000 pt yrs
• Lifetime Risk of GCa after 5,000 pt yrs FU
0.02%
• Less than the risk for the rest of the
population!
30. Billroth II and GCa
• Many Surgeons who fear the GCa
Association with MGB do not know that
• Many Studies of BII and GCa Show
• NO ASSOCIATION
31. Remember
If You Fear Gastric Cancer?
• Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled foods
• * DO Eat * fresh fruits & vegetables
• Be Active and Rx Obesity
32. Some Studies DO show
Increased Risk of GCa after
BII...BUT in these studies
BII Done for ULCERS!
Meta-analysis:
7 studies show Small increased risk
5 studies No Increased Risk
33. Some Studies DO Show
Association Billroth II and GCa
• Ulcers associated with increased
risk of GCa
• Why?
• Because H.Pylori Infection
• AND
• H. Pylori causes GCa (RR = 1.53)
34. Some Studies DO Show
Association Billroth II and GCa
• Meta-analysis:
7 studies show Small increased risk
5 studies No Increased Risk
• Some Studies DO Show
Association Billroth II and GCa
• (RR = 1.5) similar to ulcers
• BUT...
36. Some Studies DO Show
Association Billroth II and GCa
• 7 studies show Small increased risk
BUT...
• Studies increased Risk; Flawed
• Why Billroth II? Rx Ulcers
• Ulcers = H. Pylori Infection
• H. Pylori Infection => GCa
37. Some Studies DO Show
Association Billroth II and GCa
• Increased Risk of BII vs Population;
Flawed
• Billroth II performed to Rx Ulcers
• Ulcers = H. Pylori Infection
• H. Pylori Infection => GCa
• Increased GCa from H Pylori
NOT BII
38. BII and GCa
• Many Studies Show No Association
between BII and GCa
• Some studies DO show an association
• But
• In the studies that do show an
association the BII was done for Ulcers
• Ulcers = H. Pylori
• H. Pylori causes GCa
• Billroth II probably has little or nothing
to do with RR of GCa
39. General Surgeons Routine Use of BII
Bariatric Surgeons Fear Billroth II;
General Surgeons Choose Billroth II
Trauma Surgeons Choose Billroth II
Oncologic Surgeons Choose Billroth II
40. BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
• 1,490 articles on performance of the Billroth
II
• General/Trauma/Oncologic surgeons
commonly use the Billroth II
• Over 16,000 Billroth II operation
performed in USA 2007
• While Bariatric Surgeons Fear the Billroth II
General Surgeons use the Billroth II routinely
41. BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
• Studies from Oncologic Surgeons
from Korea and China
• Location of some of the highest
rates of GCa in the world
• Routinely report the use of Billroth II
reconstructions in GCa patients
43. Incidence/Frequency of
GCa
• From Cancer.org
• USA Lifetime Risk of stomach
Cancer * 0.5% *
• MD India * 0.51% *
• Declining Rates of Stomach
Cancer
44. Cancer from CAT Scans
Additional Cancer Risk(%)
Abd/Pelvis CT
Additional Cancer Risk(%) ++0.14%
2 Abd/Pel CtScan + Contrast 40mSv
Additional Cancer Risk(%) ++0.28%
45. Lifetime Risk of Gastric Cancer &
Predicted Increased Risk from
WORST Billroth II Studies (RR1.5)
Baseline Lifetime Risk of GCa 0.50%
Using Worst Billroth II studies
Predicted Additional Cancer Risk(%)
++0.25%
46. Lifetime Risk of Gastric Cancer &
Predicted Increased Risk from
WORST Billroth II Studies (RR1.5)
Baseline Lifetime Risk of GCa 0.50%
Using Worst Billroth II studies
Predicted Additional Cancer Risk(%)
++0.25%
47. Declining Rates of Stomach
Cancer
• Stomach cancer incidence rates have
decreased since the mid-1970s
• For males, European AS incidence
rates decreased by *59%* between
1975-1977 and 2008-2010.
• The decline is slightly bigger for
women, with rates decreasing by
*64%* between 1975-1977 and 2008-
2010.
48. Comparison of Risk of Worst
Predicted Outcomes of BII
Compared to 1 or 2 CT Scans
• 1 or 2 CT Scans vs BII
(as predicted by the worst BII risk
studies, published in the 60's-80's)
• CT Scan 0.78% vs BII 0.75%
• Lifetime risk cancer
49. Fear CTScans?
• Many studies show no increased
risk of GCa after BII
• Of the old studies that do show an
increased risk the magnitude of the
risk is about the risk see with one
or two CT Scans
• Fear CT Scans?
53. • Answer Hot Dog
• Do you Fear Hot
Dog or a CAT
Scan?
• Remember Many
Studies of Billroth II
Show No increased
Risk of GCa
CANCER QUIZ: MORE DEADLY
Hot Dog or Mini-Gastric Bypass
54. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 1. Gastric Cancer Declining Rapidly, > 50%
• 2. Gastric Cancer Cause:
Environmental Factors / Easily Prevented
Diet, Lifestyle changes and Rx of H. Pylori
(Avoid Etoh, smoking, processed & salted
meats and foods, seek high intake of fruits and
vegetables)
55. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 3. Some studies Slight Increased Risk of
gastric cancer after 20 – 30 years (RR 1.5):
But: BII to Rx Ulcer =>
Ulcer => Increased Risk
• (Worried? Rx H Pylori, Eat healthy etc.)
• 4. Many Large Studies: No Increased Risk
Thousands of patients followed for Decades
56. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 5. Endoscopic screening of Billroth II patients
is Not Recommended. Why? Low Risk!
• 6. General, Trauma and Oncologic surgeons
routinely use the Billroth II (Thousands of
publications)
• 7. 2007 ~16,000 BII procedures were
performed in the USA
57. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 8. Billroth II and the Mini-Gastric Bypass
Excellent, Safe and Effective
• 9. FEAR Gastric Cancer?
Avoid ETOH, Tobacco, Processed &
Preserved Meats,
Rx H. Pylori,
Eat Fruits and Veggies, Yogurt and Drink
Green Tea
• A Billroth II probably makes NO difference
58. • Rational Review of the Data vs.
Fear Gastric Cancer / Bile Reflux
• Rational Thinking vs. Reptilian
Brain
59. Rational Data Analysis vs.
Irrational FEAR Gastric Cancer
• 1. Gastric Cancer Declining Rapidly
• 2. GC Environmental Causes; Easily
Prevented
• 3. Some studies show Small Increased Risk
Probably from Ulcers / H. Pylori
• 4. Many large studies: NO increased risk
• 5. Endoscopic Screening: Not Recommended
• 6. General, Trauma & Oncologic Surgeons Use
Billroth II
60. FEAR OF GASTRIC CANCER
• FEAR gastric cancer?
• Avoid: Alcohol, Tobacco, Processed
& Preserved Meats
Rx: H. Pylori,
Eat Fruits & Veggies, Yogurt
• Billroth II Probably Makes NO
Difference
61. FEAR OF GASTRIC CANCER
A Billroth II Probably
Makes No
Difference