The document describes the anatomy of the gluteal region. It discusses the skin and fascia, muscles including the gluteus maximus, tensor fascia latae, gluteus medius and minimus. It details the bony landmarks, ligaments, vessels, nerves and related structures like the sciatic nerve, superior and inferior gluteal nerves. Key arterial anastomoses around the hip including the trochanteric and cruciate anastomoses are outlined.
Anatomy of brachial plexus explained in detail along with nerve supply of all the muscles of upper limb and various paralysis caused by brachial plexus injury
The sciatic nerve is the longest and largest nerve in the human body. It runs from the lower back through the back of the leg, and down to the toes. Any type of pain and/or neurological symptoms that are felt along the sciatic nerve is referred to as sciatica.
Anatomy of brachial plexus explained in detail along with nerve supply of all the muscles of upper limb and various paralysis caused by brachial plexus injury
The sciatic nerve is the longest and largest nerve in the human body. It runs from the lower back through the back of the leg, and down to the toes. Any type of pain and/or neurological symptoms that are felt along the sciatic nerve is referred to as sciatica.
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
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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.
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
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
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- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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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
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.
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.
3. L1
L2
L3
S1
S2
S3
Branches from
posterior cutaneous
nerve of the thigh
Lateral cutaneous branch of iliohypogastric nerve
Lateral cutaneous nerve of the subcostal nerve T12
Branches from lateral
cutaneous nerves of the
thigh
1-The upper medial quadrant
Supplied by
2-The upper lateral quadrant
Supplied by
Anterior primary rami of
4-The lower lateral
quadrant
Supplied by
Anterior primary rami of
3-The lower medial quadrant
Supplied by
Anterior primary rami of
Cutaneous Innervation of the gluteal region
A) Skin of the Buttock (Gluteal region)
4. 1- Superficial fascia; is thick especially in women .
It contributes to the prominence of the buttock.
2- Deep fascia; contentious with the deep
fascia of the thigh (fascia lata).
B) Fascia of the Buttock (Gluteal region)
Is a strong fibrous sheet that surrounds the whole
of the thigh like a tight trousers.
Thin on its medial side while it is getting thicker
on its lateral side to form the iliotibial tract.
Iliotibial tract
Is a strong wide band (thickening of the deep
fascia (fascia lata)) on the lateral side of the
thigh) attached above to the tubercle of ilium
and below to the lateral condyle of tibia.
Receives the insertion of tensor fascia latae
and GM muscles.
Fascia lata
6. • Gluteus maximus
Origin:
1- Ilium ( area behind the posterior
gluteal line)
2- Back of sacrum and coccyx
3- Back of sacrotuberous ligament
Insertion
1- The superficial
three –fourths
are inserted into
the iliotibial
tract
2- The lower deep
part is inserted
into the gluteal
tuberosity of
femur
7. Actions
1- Extends thigh, some lateral rotation (main
extensor of the hip joint)
2-Plays an important role in climbing
upstairs and cycling
3- Supports the Extended knee joint through
Iliotibial tract
Innervation - Inferior gluteal nerve,
L5;S1,2
8. STRUCTURES UNDER THE COVER OF GLUTEUS MAXIMUS MUSCLE
A- Bony structures
1-Greater trochanter and bursa
2-Gluteal tuberosity
3-Ischial tuberosity and bursa
1- Sacrotuberous ligament
2- Scrospinous ligament
B- Ligaments
C- Muscles
1- Gluteus medius and minimus
2-Short Lateral rotator muscles (6)
3- origin of the hamstring muscles
D- Vessels
1- Superior gluteal vessels
2- inferior gluteal vessels
3- Internal pudendal vessels
E- Nerves
1- Superior and inferior gluteal nerve
2- Sciatic nerve
3- Pudendal nerve
4- Posterior cutaneous nerve of the thigh
5- Nerve to obturator internus
6- Nerve to quadratus femoris
9. Bursae Related to Gluteus Maximus
Gluteofemoral Bursa:
lies between gluteus
maximus tendon and
vastus lateralis
Trochanteric Bursa:
lies between gluteus
maximus tendon and
greater trochanter
Ischial Bursa: lies
between gluteus
maximus & ischial
tuberosity
10. T e n s o r f a s c i a e l a t a e
Origin
Iliac crest
Insertion
Iliotibial tract
Action
Assist gluteus maximus in extending the
knee joint
Nerve supply
Superior gluteal nerve L4,5
11. • Gluteus medius
• Gluteus minimus
Origin
Ilium ?
Insertion
Greater trochanter of femur
Actions
1-Abduction (main abductor
of the hip joint)
2-Medial rotation (anterior
fibers)
3-Both muscle contract
reflexly on each side
alternatively during
walking to prevent
tilting of the pelvis to
the unsupported side
Innervation
Superior gluteal nerve
13. Read these muscles from this slide which can be found on page (566) Snell 8th edition
Muscle Origin Insertion Nerve supply
Short lateral rotator muscles of the hip joint
They have common function; lateral rotation of the thigh at hip joint.
Make sure that you know where to find it on the femur
14. A) Structures passing through the greater sciatic
foramen:
1- Piriformis: fills the foramen almost completely
leaving some structures to pass either above or below it.
Structures passing above Piriformis muscle:
1- Superior gluteal nerve and vessels
Structures passing below Piriformis muscle:
1-inferior gluteal nerve
2-inferior gluteal vessels
3-sciatic nerve
4-posterior cutaneous nerve of the thigh
5-nerve to quadratus femoris
6-pudendal nerve
7-internal pudendal vessels
9-nerve to obturator internus
B) Structures passing through the lesser sciatic foramen:
1- tendon of obturator internus
2-pudendal nerve
3-internal pudendal vessels
4-nerve to obturator internus
15. Bursae Related to Gluteus Maximus
Gluteofemoral Bursa:
lies between gluteus
maximus tendon and
vastus lateralis
Trochanteric Bursa:
lies between gluteus
maximus tendon and
greater trochanter
Ischial Bursa: lies
between gluteus
maximus & ischial
tuberosity
16. Superior Gluteal Nerve (L4, 5 and S1)
a branch of the sacral plexus
leaves the pelvis through the greater
sciatic foramen above the piriformis
It divides into superior and inferior
branches
The superior branch supplies the
gluteus medius muscle
The inferior branch supplies the
gluteus medius, minimus muscles and
ends by supplying the tensor fasciae
latae muscle.
Inferior Gluteal Nerve (L5, S1, S2)
a branch of the sacral plexus, leaves
the pelvis through the greater sciatic
foramen below the piriformis
It supplies the gluteus maximus
muscle
17. NERVES
1. Sciatic nerve.
2. Posterior cutaneous
nerve of thigh.
3. Superior and Inferior
Gluteal nerves.
4. Nerve to Quadratus
Femoris.
5. Nerve to Obturator
Internus.
6. Pudendal nerve.
18. SCIATIC NERVE
It is the largest
nerve in the body.
It is the larger of
the two terminal
branches of the
sacral plexus.
It is flat and broad
near its origin and
becomes rounded
downwards.
19. SCIATIC NERVE
It is composed of two
components :
(a) Tibial nerve :
It arises from the ventral
divisions of all components
of the sacral plexus.
(b) Common peroneal
verve :
It arises from the dorsal
divisions of all components
of the sacral plexus.
20. COURSE
It leaves the pelvis
through the lower part of
the GSF below the
piriformis.
As it descends it lies on:
1.Root of ischial spine.
2.Gemelli.
3.Obturator internus.
4.Quadratus femoris.
5.Adductor magnus.
21. COURSE
It is related posteriorly to :
1.Posterior cutaneous nerve
of the thigh.
2.Gluteus maximus.
It enters the back of the
thigh by passing deep to the
long head of biceps femoris.
Branches :
Usually it has No branches in
the gluteal region.
23. POSTERIOR CUTANEOUS N. OF
THE THIGH
ORIGIN :
Sacral plexus.
COURSE :
It leaves the pelvis through
the lower part of the GSF
below piriformis.
It descends on the posterior
surface of the sciatic nerve
till the popliteal fossa.
24. POSTERIOR CUTANEOUS N. OF
THE THIGH
BRANCHES :
1. Gluteal : to the lower
medial quadrant of the
buttock.
2. Perineal : to the skin
of the back of scrotum (or
labia majora).
3. Cutaneous : to the
back of the thigh and
upper leg.
25. SUPERIOR GLUTEAL NERVE
ORIGIN :
From the sacral
plexus (L4,5 & S1).
COURSE :
It leaves the pelvis
through the upper
part of the greater
sciatic foramen above
piriformis.
It passes between
gluteus medius and
minimus.
27. INFERIOR GLUTEAL NERVE
Origin:
Sacral plexus (L5, S1 &S2).
Course :
It leaves the pelvis through
the lower part of the (GSF)
below piriformis.
Branches:
It gives motor supply to :
Gluteus maximus.
28. NERVE TO QUADRATUS
FEMORISN
It arises from the sacral
plexus.
It leaves the pelvis
through the lower part of
the GSF below piriformis.
It supplies :
(1) Quadratus femoris.
(2) Inferior gemillus.
29. PUDENDAL N. & N. TO
OBTURATOR INTERNUS
Both arise from the
sacral plexus.
They Leave the pelvis
through the lower part of
GSF below piriformis.
They reenter the pelvis
through the LSF with the
pudendal vessels by
crossing the ischial spine.
30. PUDENDAL N. & N. TO
OBTURATOR INTERNUS
Nerve to obturator
internus
Supplies :
1. Obturator internus.
2. Superior gemellus.
Pudendal Neve
Supplies the structures
in the perineum.
31. SUPERIOR & INFERIOR
GLUTEAL ARTERIES
They arise from the internal
iliac artery.
They leave the pelvis through
the GSF above and below the
piriformis muscle respectively
in company with the
corresponding nerves.
They distribute into many
branches and share in the
anastomoses in the gluteal
region and back of the thigh.
32. TROCHANTERIC ANASTOMOSIS
Position :
Near the trochanteric fossa.
Arteries sharing :
(1) Superior gluteal.
(2) Inferior gluteal.
(3) Medial circumflex femoral.
(4) Lateral circumflex femoral.
Function :
It is the main source of
arterial supply of the head
of the femur.
33. Trochanteric Anastomosis
Is the main supply to the head &
neck of femur
Provides a connection between
internal iliac and femoral arteries
Lies near the trochanteric fossa,
branches run along the femoral
neck beneath the reticular fibers of
the capsule
Formed by:
Descending branches of
superior and inferior gluteal
arteries &
Ascending branches of lateral
and medial circumflex arteries
34. Posterior view
Arterial supply to Femoral
head
•
Medial & lateral femoral
circumflex arteries
•
Superior and inferior
gluteal arteries
•
Post. obdurator artery
via artery of femoral
ligament
TROCHANTERIC
ANASTOMOSIS
35. CRUCIATE ANASTOMOSIS
Position :
On the upper part of the back
of the thigh.
Arteries sharing :
(1) Inferior gluteal.
(2) Medial circumflex femoral.
(3) Lateral circumflex femoral.
(4) First perforating.
Function :
It provides connection between
internal iliac and femoral
arteries.
36. Cruciate Anastomosis
Lies at the level of lesser
trochanter
Provides a connection between
internal iliac and femoral
arteries
Formed by:
Descending branch of
inferior gluteal artery
Transverse branches of
medial and lateral circumflex
arteries &
Ascending branch of first
perforating artery
37. 1-Superior Gluteal Artery
is a branch from the internal iliac artery
enters the gluteal region through the
greater sciatic foramen above the piriformis
It divides into superficial and deep
branches.
The superficial branch supplies the
gluteus maximus muscle
The deep branch supplies the glutei
medius and minimus.
2-Inferior Gluteal Artery
is a branch of the internal iliac artery
enters the gluteal region through the greater
sciatic foramen, below the piriformis
It divides into numerous branches that are
distributed throughout the gluteal region.
Arteries of the Gluteal Region
38. The Cruciate Anastomosis
The cruciate anastomosis is situated at the level of
the lesser trochanter of the femur and, together
with the trochanteric anastomosis, provides a
connection between the internal iliac and the
femoral arteries
Branches from the internal iliac artery (superior and inferior gluteal arteries) anastomosis
With branches from the femoral artery to form
1-The Trochanteric Anastomosis 2-The Cruciate Anastomosis
The trochanteric anastomosis :
provides the main blood supply to
THE HEAD OF THE
FEMUR
The nutrient arteries pass
along the femoral neck
beneath the capsule
The following arteries take part in the
anastomosis:
A) The superior gluteal artery, the
inferior gluteal artery and the
obturator artery (from the internal
iliac artery)
B) The medial femoral circumflex
artery, and the lateral femoral
circumflex artery (from the femoral
artery)
39. The muscles of the gluteal region are acting on the hip joint
as different functional groups
Gluteus maximus
Acts as the main extensor of the hip joint
Gluteus medius and minimus
They act as the main abductors of the hip joint while
their anterior fibers act as medial rotators on the hip joint
Short Lateral rotator muscles
They act as lateral rotators on the hip joint
The muscles of the gluteal region, therefore, extend, abduct and rotate the hip joint
medially and laterally
Leaving adduction and flexion to other groups of muscles, which ? Why?
40. When standing on
one leg, the abductors of the hip on this side (gluteus medius and minimus
and tensor fasciae latae) maintain fixation at the hip joint
If, however, there is any defect in these muscles or lever mechanism
of the hip joint, the weight of the body in these circumstances forces
the pelvis to tilt downwards on the opposite side.
Trendelenburg’s test
The stability of the hip in the standing position depends on
two factors:
1- The strength of the surrounding muscles
2-The integrity of the lever system of
the femoral neck and head within the intact hip joint
The positive Trendelenburg test is seen if:
A- The hip abductors are paralysed (e.g. poliomyelitis) nerve injury
B-Congenital dislocation of the hip
C-The head of the femur has been destroyed by disease or
removed operatively (pseudarthrosis),
D-There is an un-united fracture of the femoral neck
E-There is a very severe degree of coxa vara
41. Trendelenburg Test
To assesses whether the hip abductors (particularly
gluteus medius) are functioning normally
Observe patient from
behind, ask him/her to
stand on one foot and
then the other
Negative test:
Pelvis ‘tilts up’ on
contralateral side
Positive test: Pelvis
‘sags’ on
contralateral side
42. Problems that could lead to a positive
Trendelenburg test:
Fracture neck of femur
Dislocation of hip joint
Coxa Vara
Nonfunctioning gluteus medius and minimus
due to:
Neurological damage (L4 – 5 disc herniation)
Any disease affecting muscles (myopathy)
43. Safe Area for Intramuscular Injection
Intramuscular injection enables a large amount of a drug
to be introduced at once but absorbed gradually.
The injection site must be carefully selected to avoid
injury to the underlying large vessels and nerves.
Outer upper quadrant of the
buttock is the safe area for
intramuscular injection to
avoid injury to the
underlying sciatic nerve
44. Positive Trendelenburg's sign
If right gluteus
medius and
minimus muscles
are paralyzed, the
unsupported left
side of the pelvis
falls (sags)
instead of rising;
normally, the
pelvis rises.
45. Injury to the superior gluteal nerve
On one side causes Lurching gait
Both sides Waddling gait
Positive Trendelenburg’s test
Clinical Notes
Gluteus Medius and Minimus and Poliomyelitis
The gluteus medius and minimus muscles may be paralyzed when
poliomyelitis involves the lower lumbar and sacral segments of the
spinal cord.
They are supplied by the superior gluteal nerve (L4 and 5 and S1)
Paralysis of these muscles seriously interferes with the ability of the
patient to tilt the pelvis when walking.
The test indicates
‘a defect in
the osseo-muscular
stability
of the hip joint’
46. Clinical Notes
The great thickness of
gluteus maximus muscle
makes it ideal for
intramuscular injections.
To avoid injury to the
underlying sciatic nerve,
the injection should be
given well forward on
the upper outer quadrant
of the buttock.
47. However, the upper lateral quadrant,
most likely to be made by the
Gluteus medius muscle rather than the
gluteus maximus muscle .
The gluteus maximus covers the
posterior part only of the
Gluteus medius while the anterior part
(which makes the upper lateral
quadrant)
is covered by skin and fascia only
Therefore, the intramuscular injection
will be injected into the gluteus medius
muscle rather than gluteus maximus
muscle