CBDSs are one of the medical conditions leading to surgical intervention. They may occur in 3%–14.7% of all patients for whom cholecystectomies are preformed. When patients present with CBD, the one important question that should be answered: what is the best modality of treatment under the giving conditions? There are competing technologies and approaches for diagnosing CBDS with regard to diagnostic performance characteristics, technical success, safety, and cost effectiveness. Management of CBDS usually requires two separate teams: the gastroenterologist and the surgical team. One of the main factors in the management is initially the detection of CBDS, before, during, or after cholecystectomy. The main options for treatment are pre- or postoperative ERCP with endoscopic biliary sphincterotomy (EST), laparoscopic or open surgical bile duct clearance. There are other options for the treat- ment of CBDS such as electrohydraulic lithotripsy (EHL), extracorporeal shockwave lithotripsy (ESWL), dissolving solutions, and laser lithotripsy. It is unlikely that one option
will be appropriate for all clinical circumstances in all centers. Variables such as disease status, patient demographics, availability of endoscopic, radiological and surgical expertise, and healthcare economics will all have significant influence on practice
A kidney biopsy is a medical procedure in which a kidney tissue is extracted for the laboratory analysis. A kidney biopsy is also known as renal biopsy.
CBDSs are one of the medical conditions leading to surgical intervention. They may occur in 3%–14.7% of all patients for whom cholecystectomies are preformed. When patients present with CBD, the one important question that should be answered: what is the best modality of treatment under the giving conditions? There are competing technologies and approaches for diagnosing CBDS with regard to diagnostic performance characteristics, technical success, safety, and cost effectiveness. Management of CBDS usually requires two separate teams: the gastroenterologist and the surgical team. One of the main factors in the management is initially the detection of CBDS, before, during, or after cholecystectomy. The main options for treatment are pre- or postoperative ERCP with endoscopic biliary sphincterotomy (EST), laparoscopic or open surgical bile duct clearance. There are other options for the treat- ment of CBDS such as electrohydraulic lithotripsy (EHL), extracorporeal shockwave lithotripsy (ESWL), dissolving solutions, and laser lithotripsy. It is unlikely that one option
will be appropriate for all clinical circumstances in all centers. Variables such as disease status, patient demographics, availability of endoscopic, radiological and surgical expertise, and healthcare economics will all have significant influence on practice
A kidney biopsy is a medical procedure in which a kidney tissue is extracted for the laboratory analysis. A kidney biopsy is also known as renal biopsy.
The presence of haematuria may be the sole symptom of an underlying disease, either benign or malignant. It is one of the most common presentations of patients with urinary tract diseases and of patients referred for urinary imaging. Painless visible haematuria (VH) is the commonest presentation of bladder cancer.
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
Laparoscopic cholecystectomy is the current gold standard for surgical removal of the Gall bladder, particularly in benign pathologies. Hence, it is necessary to highlight some steps to accomplish this procedure successfully while avoiding pitfalls.
Post cholecystectomy pancreatitis: a misleading entity KETAN VAGHOLKAR
Cholecystectomy is one of the commonest hepatobiliary procedures performed in general surgical practice. Both laparoscopic as well as open cholecystectomies have their place in modern-day surgical practice. Post cholecystectomy syndrome is a known entity affecting approximately 20% of patients who have undergone cholecystectomy. Post cholecystectomy pancreatitis is an uncommon and rare complication. A case of acute early post cholecystectomy pancreatitis is presented to create an awareness of this rare but misleading and morbid complication.
The diagnosis and management of common bile duct stones has evolved considerably in recent years. New endoscopic, radiologic and surgical techniques now provide doctors with a range of options. We present an evidence based approach which incorporates the latest technology and techniques to optimize outcomes for patients.
FNAC of breast - definition, history, purpose, preparations, basic equipment, procedure, smear preparation, fixatives, staining solutions, rapid stains - toluidine blue, difference between air dried and wet fixed slides, complications and contraindications, advantages, general criteris for malignancy, nuclear size and pleomorphism, nuclear membrane, irregularity and extranuclear chromatin, nuclear fragility and mitotic figures, types of breast carcinoma.
The presence of haematuria may be the sole symptom of an underlying disease, either benign or malignant. It is one of the most common presentations of patients with urinary tract diseases and of patients referred for urinary imaging. Painless visible haematuria (VH) is the commonest presentation of bladder cancer.
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
Laparoscopic cholecystectomy is the current gold standard for surgical removal of the Gall bladder, particularly in benign pathologies. Hence, it is necessary to highlight some steps to accomplish this procedure successfully while avoiding pitfalls.
Post cholecystectomy pancreatitis: a misleading entity KETAN VAGHOLKAR
Cholecystectomy is one of the commonest hepatobiliary procedures performed in general surgical practice. Both laparoscopic as well as open cholecystectomies have their place in modern-day surgical practice. Post cholecystectomy syndrome is a known entity affecting approximately 20% of patients who have undergone cholecystectomy. Post cholecystectomy pancreatitis is an uncommon and rare complication. A case of acute early post cholecystectomy pancreatitis is presented to create an awareness of this rare but misleading and morbid complication.
The diagnosis and management of common bile duct stones has evolved considerably in recent years. New endoscopic, radiologic and surgical techniques now provide doctors with a range of options. We present an evidence based approach which incorporates the latest technology and techniques to optimize outcomes for patients.
FNAC of breast - definition, history, purpose, preparations, basic equipment, procedure, smear preparation, fixatives, staining solutions, rapid stains - toluidine blue, difference between air dried and wet fixed slides, complications and contraindications, advantages, general criteris for malignancy, nuclear size and pleomorphism, nuclear membrane, irregularity and extranuclear chromatin, nuclear fragility and mitotic figures, types of breast carcinoma.
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.
Appendectomy is one of the commonest abdominal operation performed all over the world. Stump appendicitis is one of the uncommon complications of appendectomy. The diagnosis of stump appendicitis is delayed due to low index of suspicion by virtue of the fact that an appendectomy has already been done. The clinical presentation exactly simulates acute appendicitis. Contrast enhanced computed tomography is diagnostic. Completion appendectomy either open or laparoscopic is the mainstay of treatment. Awareness regarding the possible aetiology, diagnosis and management is essential for avoiding delay in the diagnosis.
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.
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
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.
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
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
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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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.
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.
2. Introduction : BE
A premalignant condition of the distal oesophagus predisposing to EAC.
Given the potential for malignant progression & the poor prognosis of
EAC when diagnosed at a symptomatic stage, patients with known BE
undergo regular endoscopic surveillance to detect neoplastic progression at
an early& preferably endoscopically, treatable stage.
Endoscopic management of early BE neoplasia consists of endoscopic
imaging, endoscopic resection& endoscopic ablation. Below we discuss a
number of mistakes that are frequently made when managing BE
neoplasia and how to avoid them.
Much of this discussion draws on existing guidelines&practically driven
recommendations based on common sense &experience.
3. 1:Clean&inspect well
With inadequate cleaning& immediately ‘jumping’ to obtain the inevitable
random biopsy samples you will not detect the more subtle Barrett lesions.
Use the waterjet of to clean the Barrett segment;takes 1–2 minutes.
Switch to optical chromoscopy: if the oesophagus looks impeccably clean
on narrow-band imaging (NBI), then cleaning is optimal.
Spend 3–5 minutes inspecting the segment using white light endoscopy.
Switching back-forth with optical chromoscopy, help to see more.
Retroflex the endoscope to inspect the ‘danger zone’—the area where the
Barrett segment transits into the hiatal hernia,area has the highest risk of
neoplasia &highest risk of neoplasia being missed endoscopically.
Look longer, biopsy less! After taking first biopsy sample most of imaging
opportunities are lost.
Detecting early neoplasia is all about recognizing how early
neoplasia actually looks.
Excellent training modules are available at [www.best-academia.eu].
4.
5.
6.
7. 2:Think twice of biopsy results.
When BE segment biopsy is diagnosed as non-dysplastic or inflammatory,
this situation requires either endoscopic resection of the abnormality for
optimal diagnosis or repeat endoscopy to document its regression, because
a lesion that clearly looks neoplastic on endoscopy generally is neoplastic.
The biopsy samples not to be misplaced&the histological assessment might
not close to the squamocolumnar junction in the presence of a grade A or B
reflux oesophagitis&provide this information as well.
8. 3:perform intervention after optimal evaluation.
We prefer to use a diagnostic endoscope for most therapeutic work in
patients with Barrett oesophagus.
Optimal imaging makes the right decision regarding resection versus
ablation& allows optimal delineation of lesions. A waterjet is essential to
ensure adequate cleaning.
During endoscopic resection, deal with bleeding before proceeding with
ESD or piecemeal resection.
For piecemeal resections, any bleeding from prior resections must be
adequately treated& the surface cleaned of blood/ mucous&emptied the
stomach of fluids / blood before you embark on your next resection.
9. 4:resect visible resectable lesions before ablation.
The above is the most common reason for neoplastic progression under
ablation.
The endoscopist performing ablation in BE should be able to switch gears
to endoscopic resection&ablation shouldn’t be used as an excuse for not
having to do an endoscopic resection.
Endoscopist should have skills in managing both; ablation& resection of
visible resettable BE.
10. 5:Don’t ablate inflamed or swollen BE.
Ablation sessions are generally scheduled at 3-month intervals & the 2nd
session should not be done if there inflammation&swelling because:
Ablation will not be effective, given the thickness of the epithelium,
The likely inadequate acid suppression.
Not be able to adequately inspect the segment for neoplastic progression.
Not allow to detect neoplastic progression, especially when you have
overlooked a visible lesion at the initial ablation.
11.
12. 6:Start resection with marking.
The outer margins of your neoplastic target area may not be sufficiently
visible once the multiband mucosectomy (MBM) kit has been assembled&
resections/ bleeding may hamper visualisation during
piecemeal procedures.
Given the importance of marking, generally use a diagnostic endoscope
with a small distant attachment cap for this purpose to allows stabilize the
endoscope tip onto the mucosa during the marking.
The use of optical chromoscopy& a near-focus mode (with Olympus
endoscopes) or zoom function (with Fujifilm or Pentax endoscopes) enables
both the detection of the demarcation line& the controlled positioning of
the electrocoagulation markers with the tip of the snare (for MBM
procedures) or the ESD knife .
13. 7:carefully choose the ideal resection technique.
Most of the early neoplastic lesions can be effectively removed by
MBM,but a subgroup of lesions should not be resected by MBM because of
the likelihood that there is deep submucosal invasion&/or a large
intraluminal extent of the lesion.
This will compromises any subsequent endoscopic resection being
performed by more experienced endoscopists.
14.
15.
16. 8:Should be trained well with good case load.
All guidelines state that adequate training& a yearly case volume of at
least 10 new patients with HGD or early cancer are needed,soneeds to be
centralized.
17. 9:Be prepared to manage significant bleeding.
Most ESD bleeds can be managed by directing therapy to the vessel that
has been accidentally cut7coagulation forceps will do the job here.
After MBM procedures, where the resection is ‘blind’& less controlled
than in ESD, the bleeding source may be more difficult to determine.
Do not remove the MBM cap unless it is absolutely necessary, because
most bleeds can be treated by touching the bleeding site with the tip of the
snare& apply very gentle pressure with the tip of the snare.
A careful snare tip coagulation generally suffices, but if the bleeding
continues despite two or three applications you need to switch gears to
coagulation forceps,which will require to release the remaining rubber
bands in the stomach to allow passage of the forceps.