HoLEP is at least as effective as other surgical therapies, including TURP, OP and other laser modalities, with fewer complications, shorter hospital stays, and decreased catheter time. These benefits make HoLEP the procedure of choice for men seeking surgical relief for BPH related LUTS and the gold standard for the 21st Century.
Retrograde Intrarenal Ureteroscopic Surgery (RIRS)Urovideo.org
Gerhard J. Fuchs, M.D., Dr. med., F.A.C.S.
Professor of Urology, UCLA School of Medicine
Vice Chair, Cedars Sinai Department of Surgery
Medallion Chair in Minimally Invasive Urology
Cedars-Sinai Medical Center
Los Angeles, USA
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Retrograde Intrarenal Ureteroscopic Surgery (RIRS)Urovideo.org
Gerhard J. Fuchs, M.D., Dr. med., F.A.C.S.
Professor of Urology, UCLA School of Medicine
Vice Chair, Cedars Sinai Department of Surgery
Medallion Chair in Minimally Invasive Urology
Cedars-Sinai Medical Center
Los Angeles, USA
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Sephaneous vein graft for anterior urethral stricutreDr. Manjul Maurya
El-Morsi et al. [10] first used a saphenous vein graft (SVG) in 1972 in 10 patients with promising results and suggested it as an alternative to Johanson staged urethroplasty, which was widely used at that time
Laparoscopy in gynaecology presented by drs igbodike emeka philip and dr rotimiigbodikeobgyn
This slide will be helpful if the presentation revolves around laparoscopy in gynaecological practice. Kindly like , clip and share the slide. it is free!
Comparison of Laparoscopic Appendectomy with open appendectomy in Treating Ch...jhon freddy hoyos verdugo
To analyze feasibility and curative effect of laparoscopic appendectomy in the treatment of pediatric appendicitis and compare it with open appendectomy
Laparoscopic Urologic surgery, is a part of the curriculum of Minimal Access Surgery, and requires lot of skills and patience. All new surgeons carrying out Basic Laparoscopic surgery should aim at also doing Lap. Urological surgeries, which has a steep learning curve, but with with excellent outcomes.
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.
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.
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.
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.
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
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
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
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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. Introduction
• TURP is the historical gold standard to which all surgical modalities for BPH
are compared.
• Other interventions, such as OP, PVP, and various laser therapies have
demonstrated efficacy in relieving BPH related LUTS.
• HoLEP is poised to replace all of these modalities as the new standard,
based on nearly two decades of data that consistently demonstrate its
superior outcomes and lower morbidity.
3. • This review article summarizes the available literature comparing HoLEP and
traditional therapies for BPH that are widely used and have long-term
efficacy.
• Patients undergoing HoLEP have greater improvements in
1. post-operative Q-max
2. post-operative subjective symptom scores,
3. lower rates of repeat endoscopic procedures
4. significantly shortened catheterization times
5. decreased length of hospital stay.
4. • Various RCTs have demonstrated that HoLEP can enucleate adenomas
greater than 100 grams with similar efficacy as open prostatectomy, but
with radically decreased hospitalization stay, catheterization times, blood
loss, and transfusion rates.
5. HoLEP vs TURP
• There is an abundance of level 1 data directly comparing outcomes and
complications for HoLEP andTURP.
6.
7. • Based on these studies, it was suggested that HoLEP was the only procedure
that did not require re-operation for adenoma regrowth within 5 years.
• An argument against HoLEP is that operative times are significantly longer
than withTURP.
• However, Ahyai also found that the mean tissue resection rate (g/ min) for
HoLEP and TURP was statistically similar (0.52 g/min vs 0.57 g/min), making
them equally time-efficient procedures.
• Post-ope-rative complications tend to be lower for HoLEP compared to TURP,
and post-HoLEP TUR syndrome has never been reported-even for adenomas
hundreds of grams in size.
8. HoLEP vs Open prostectomy
• Contrary to TURP, HoLEP is a size-independent procedure and the
consequence of this is that HoLEP will eventually make OP all but a
historical operation for even the largest of prostates.
• HoLEP has been used to successfully enucleate adenomas as large as 800 g .
9.
10. • HoLEP and OP outcomes have been directly compared in multiple,
well-designed, RCTs.
• These studies found almost equivocal functional outcomes but a
lower transfusion rate , decreased catheterization time, and shorter
hospital Length of stay in patients who underwent HoLEP as
compared to Open prostectomy.
11. • In addition to HoLEP and TURP, numerous other minimally invasive therapies
exist for the treatment of symptomatic BPH, including ….
1. Greenlight PVP
2. PKRP
3. ThuLEP
• Greenlight PVP is the most well established laser alternative to traditional
TURP that allows for quick and efficient vaporization of prostatic
adenoma.Recent advances in the PVP laser have allowed for the treatment of
larger adenomas .
• PKRP is similar to bipolar TURP. Chen, et al compared HoLEP and PKRP in a
RCT and found HoLEP procedures had significantly more tissue resected and
shorter hospital LOS and catheter time.
12. • The thulium:YAG laser (ThuLEP) works at a wavelength of 2013 nm
in continuous wave mode, and boasts excellent vaporization and
hemostatic capabilities with outcomes and complication rates similar
to that of HoLEP. However, as a pulsed laser, HoLEP offers greater
versatility to the urologic surgeon .
13. HoLEP and sexual function`
• Regarding sexual function, HoLEP appears to offer no distinct advantage
overTURP .
• Retrograde ejaculation was equally common after HoLEP (50-96%) and
TURP (50-86%).
• Various studies suggested that HoLEP did not significantly affect libido,
erections, or sexual satisfaction.
14. Cost effectiveness
• Regarding cost-effectiveness, it seems obvious that HoLEP patients
would generate decreased hospital bills, based purely on shorter
average LOS.
• Several studies have attempted to compare the cost-effectiveness of
HoLEP withTURP.
• When comparing HoLEP to OP, Salonia, et al found that average
costs were $2,919 vs. $3,556, respectively .
15. Current surgical techniques of
enucleation in HoLEP
• Historically, urologists in New Zealand have made significant contributions to
BPH surgeries using a holmium laser.
• The first attempt to use a holmium laser for transurethral prostatectomy was
made by Gilling et al , who combined the use of a holmium laser with an
Nd:YAG laser to perform a so-called combined endoscopic laser ablation of
the prostate or CELAP.
• In 1996, Gilling et al developed a new surgical procedure, HoLRP, which
involved excising the prostate with a holmium laser.
• HoLRP was later applied to BPH surgery, which became the precursor
16. • HoLRP was later applied to BPH surgery, which became the
precursor surgery of HoLEP.
• Following the development of the morcellator, large prostatic
fragments could be pulled out of the bladder.
• HoLRP was no longer extended, and soon it was replaced with
HoLEP.
• This enucleation method has become a powerful method for treating
enlarged prostates of any size.
17. (1) CLASSIC GILLING’S THREE-LOBE
TECHNIQUE
• Gilling’s method is based on the enucleation of three lobes, where the
median and both lateral lobes are enucleated independently in
retrograde fashion by making three longitudinal incisions from the apex
to the bladder neck.
• After the morcellator became available, this HoLRP surgical technique
evolved into HoLEP.
• Similar to HoLRP, the bladder neck at the 5 o’clock position and 7
o’clock position is incised vertically to the verumontanum; a further
deep incision is made until a surgical capsule is reached.
18. (1) CLASSIC GILLING’S THREE-LOBE
TECHNIQUE
• If there is no discernable median lobe, only one longitudinal incision may be
made at the 6 o’clock position.
• Once the two incisions are complete, they are connected just above the
verumontanum to allow enucleation of the median lobe.
• The median lobe is completely separated from the bladder neck before being
placed into the bladder for later morcellation.
• Next, both lateral lobes are enucleated.
• the medial edges of both lateral lobes, formed by the previous step for
removing the median lobe, are extended to the apex to more clearly define
the apical anatomy.
19. (1) CLASSIC GILLING’S THREE-LOBE
TECHNIQUE
• The enucleation of the left lateral lobe is proceeded by sweeping
circumferentially until the 2 o’clock position is reached.
• longitudinal incision should be made at the 12 o’clock position of the
bladder neck, extended in the distal direction; the incision should be
deepened until the underlying capsular plane is reached.
• The space between the adenoma and the capsule is developed
laterally and circumferentially with a sweeping motion.
• The enucleation from the upper and lower parts is connected to each
other at the 2 o’clock position of the apex.
20. (1) CLASSIC GILLING’S THREE-LOBE
TECHNIQUE
• After further enucleating the left lateral lobe, it is placed into the
bladder, and the right lateral lobe is enucleated similarly to the left
lateral lobe.
• Kuo et al. [33] described a few additional technical details. They
explained that enucleation of the right lateral lobe should precede the
left lobe.
• They also suggested that a lower power setting (2 J, 40 Hz) during
apical dissection is needed to reduce thermal injury to the sphincter.
• They emphasized that the dissection should begin at a point slightly
proximal to the apex to preserve the apical fat pad, so as to protect
21. (2) ANTERO-POSTERIOR DISSECTION BY THE TOKYO
GROUP
• In 2008, Endo et al modified Gilling’s three lobe technique to further
reduce the possibility of sphincter damage.
• The enucleation method on the middle lobe remained the same, but the
method of enucleating the lateral lobes was modified.
• This new procedure is performed similarly to the previous procedure in
that the bottom edge of the lateral lobe was enucleated from the surgical
capsule throughout the apex and the bladder neck.
• However, this procedure did not extend further upward, and instead
stopped just after forming the edge.
22. (2) ANTERO-POSTERIOR DISSECTION BY THE
TOKYO GROUP
• A longitudinal incision was made over the 12 o’clock direction from the
bladder neck to the sphincter level.
• In detail, the urethral mucosa at the 12 o’clock point opposite the
verumontanum was first vaporized to reach the surgical capsule, which
was extended to the bladder neck in a retrograde fashion.
• The adenoma was then released from the surgical capsule in either side
around the 12 o’clock position while pressing downward at the mid-
portion of each lateral lobe.