This document discusses the initial management of urethral injuries. It describes the anatomy of the male and female urethra and types of urethral injuries. For anterior urethral injuries, the classic triad of symptoms is outlined and initial investigations and management with suprapubic cystostomy or immediate repair are summarized. Posterior urethral injuries are often associated with pelvic fractures and initial management focuses on hemodynamic stability and associated injuries before addressing the urethra. The document recommends suprapubic cystostomy with possible delayed endoscopic realignment as the standard approach.
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
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.
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.
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
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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.
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
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept Of Urology, KMC and GRH,
Chennai
2
3. ANATOMY OF MALE URETHRA:
• Anterior urethra-
penile and bulbar
urethra
• Posterior urethra-
membranous and
prostate.
Dept Of Urology, KMC and GRH,
Chennai
3
8. Clinical features:-
Classic TRIAD:
1. Blood at urethral meatus
2. Distended bladder
3. Perineal haematoma.
Extravasation limited by Bucks or Colles Facia
- Bucks fasia limitation- upto base of penis
- Colles fasia limitation- involvement of penis,
scrotum,abdominal wall upto thigh and clavicle.
Dept Of Urology, KMC and GRH,
Chennai
8
9. INVESTIGATIONS:
• Retrograde Urethrogram
- 10 – 20 ml of water soluble contrast
- flouroscopic guidance ideal.
- extravasation seen at the site of injury.
• Diagnostic catheterization
- should not be attempted
- may convert partial into complete tear.
- infect perineal haematoma
- increase prostatic bleeding.
Dept Of Urology, KMC and GRH,
Chennai
9
10. MANAGEMENT:
• Partial urethral injury
- suprapubic
cystostomy
- if extravasation
occurs- drainage and anti
biotics
Dept Of Urology, KMC and GRH,
Chennai
10
11. • Complete Urethral Transection
Management options:
a . Immediate urethral repair:
Indication - Concomitant penile fracture.
- Penetrating injuries in stable patient
- Associated rectal injuries.
Surgical technique
-Midline perineal Incision
-Drainage perineal hematoma..
-Debridement of urethral margins.
-Mobilisation of urethra.
-Tension free spatulated anastomosis.
with 16 F silicone catheter.
Dept Of Urology, KMC and GRH,
Chennai
11
12. b.SPC and delayed repair:
- Most advised method of management
- Delayed repair afterwards.
Dept Of Urology, KMC and GRH,
Chennai
12
13. POSTERIOR URETHRAL
INJURIES
90 % Posterior urethral injuries usually due to
pelvic fractures.
But only 10% of pelvic fractures are associated
with urethral injuries.
Prostato-membranous junctional injuries-
common.
Dept Of Urology, KMC and GRH,
Chennai
13
15. CLINICAL FEATURES
CLASSIC TRIAD:
-BLOOD AT URETHRAL MEATUS
-DISTENDED BLADDER
-PERINEAL HEMATOMA
High riding prostate.
Boggy mass in the pelvis.
Dept Of Urology, KMC and GRH,
Chennai
15
16. DIAGNOSIS
• Retrograde urethrogram - Extravasation of contrast
• IVU-To evaluate upper tracts & bladder, since10% association with
bladder injuries.
• Urethral injuries are classified according to retrograde urethrogram.
Type1 - Urethra stretched, but intact.
TypeII - Disruption proximal to UG Diaphragm.
TypeIII - Combined disruption proximal and distal to
UG diaphragm
Type IV - Bladder neck injury with extention in to urethra..
Dept Of Urology, KMC and GRH,
Chennai
16
18. MANAGEMENT;
• INITIAL MANAGEMENT:
Hemodynamic stability
Associated injuries
In multiple injuries the order of priorities are :
1.Airway
2.Treatement of shock.
3.Treatment of associated injuries like
a.Cerebral
b.Thoracic
c.Abdominal organs including kidney.
d.Orthopaedic
e.Urologic
In acute phase just above all other injuries take precedence over the
urethra but the patient survives the urethral injury can cause him the
greatest disability. Dept Of Urology, KMC and GRH,
Chennai
18
19. MANAGEMENT (contd)
• Primary re-alignment:
Indications- Associated bladder neck injuries
-Vascular injuries
- Rectal injuries
Surgical technique:
Urethral re-alignment with catheters
- midline incision
- bladder opened
- 16 F foleys catheter passed via urethra and retrieved
through retropubic space.
- Catheter passed from internal meatus and retrieved
through retropubic space.
- Both catheters tied and rail roaded. SPC catheter kept.
Dept Of Urology, KMC and GRH,
Chennai
19
20. Railroad by interlocking sounds
are given up because of
associated injuries to the
surrounding tissues.
Dept Of Urology, KMC and GRH,
Chennai
20
21. DIRECT (OPEN primary re-alignment):
Open repair by removing pelvic haematoma,
dissecting and tissue suturing the severed urethra
under vision.
Not followed nowadays because of complications
a. Impotence
b. Incontinence
c. Stricture formation
d. Operative blood loss
Dept Of Urology, KMC and GRH,
Chennai
21
22. INDIRECT (Endoscopic primary re-
alignment) :
- Present definiton.
- Urethral gap bridged by urethral catheter to
promote urethral healing.
Advantages:
Less complications.
Shortens the length of the stricture
Eases subsequent urethroplasty
- Impotence
- Anejacualtion
- Incontinence are not worsened.
Dept Of Urology, KMC and GRH,
Chennai
22
23. TECHNIQUE
• Midline incision
• Open cystotomy
• Direct urethral catheterisation
• Ante-grade flexible cystoscopy and guide wire passed to
urethral meatus.
• Retrograde urethral catheterisation with 16 Fr foley
catheter.
• SPC for 6 weeks.
Dept Of Urology, KMC and GRH,
Chennai
23
24. DELAYED REPAIR
• SPC followed by delayed or secondary repair after
3 – 6 months.
- At present most accepted procedure.
- Less blood loss and infection
- Reduced post-op stricture.
- Less impotence and incontinence.
Dept Of Urology, KMC and GRH,
Chennai
24
25. MANAGEMENT
• SPC alone-
96% develops urethral stricture, which require posterior urethroplasty.
• SPC + Initial Primary Re-alignment
Heals without stricture
Heals with mild stricture [Dilatation + O.I.U]
Eases Subsequent urethroplasty.
• SPC followed by delayed or secondary repair after 3 – 6 months.
Dept Of Urology, KMC and GRH,
Chennai
25
26. Female Urethral Injuries
• Rare
• Accompanied by bony
pelvic disruption
• Injury to bladder neck
& vagina
• Common in young
girls
Dept Of Urology, KMC and GRH,
Chennai
26
27. MANAGEMENT
• Immediate reconstruction of bladder neck
• Repair of all vaginal lacerations
• Retropubic repair with urethral catheter
stenting & SPC
• Urethrovaginal fistula – secondary closure
Dept Of Urology, KMC and GRH,
Chennai
27
28. • AUG
• No diagnostic Catheterisation
• SPC diversion & Delayed endoscopic repair
Dept Of Urology, KMC and GRH,
Chennai
28