This document provides information about hysteroscopy, including:
- A hysteroscope is an endoscope used to visualize the uterine cavity and perform procedures.
- It describes the historical development of hysteroscopy from the 19th century to modern techniques.
- The types of hysteroscopes and instrumentation used are outlined, including distention media, electrodes, sheaths, and cameras.
- The document discusses the procedures, indications, contraindications and complications of diagnostic and operative hysteroscopy.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Hysteroscopy is a procedure of diagnostic and treat causes of abnormal bleeding.
Hysteroscopy procedure is done by Hysteroscpe and Hysteroscopic Instruments. Hysteroscop is connected with Light Source and Camera system.
Hysteroscopy products includes Hysteroscope, Hysteroscope Sheath, Hysteroscopy Forcep, Bugbee Electrodes.
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!
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.
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.
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.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
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
- 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
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
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Hysteroscope is an
endoluminal endoscope
that can be used as an
aid to visualize uterine
cavity or to direct the
performance of variety
of intrauterine
procedures.
3. Historical aspect
• 1869: Pantaleon visualize polypoidal tumour in uterus.
• 1925: Rubin used cystourethroscope to visualize
uterus; he used water to distend uterus and to wash
lens. Later he used C02
• 1960-70 – low viscosity fluids like saline or ringer
lactate with pressure 50-100mmhg; popularly used in
diagnostic hysteroscopy. Cheap and easily available.
• 1971 – Hyson
- used by Menken
- 30% dextran in 10% glucose
( K Y jelly is been used in India as distending media for
diagnostic hysteroscope)
4. Instruments
• Hysterocsope:
-Telescope : eyepiece, barrel & objective lens.
- Angle options : 0,12 ,15, 25, 30 & 70 degree.
- 0 degree provides a panoramic view.
- angled one improve the view of ostia in an
abnormally shaped uterine cavity.
5. • Rigid hysteroscope
- in-patient and complex operating room
procedures.
- 3-5mm in diameter
- more durable and provide superior image.
6. • Flexible hysteroscope
- most commonly used for office hysteroscopy
- flexibility; tip deflection of 120-160 degree.
- irregularly shaped uterus & navigation around
intrauterine lesions.
7. Light source.
-halogen and xenon; xenon
generator provides white
light, which gives a
superior color and
intensity.
9. Diagnostic sheaths
-to deliver the distention media
-fit by means of a watertight seal lock
- 4 to 5 mm in diameter, with a 1 mm
clearance between the inner wall and the
telescope, through which the distention
media is transmitted.
10. • Operative sheaths
- larger diameter - 7 to 10
- allows space for instillation of medium, for
the telescope, and for the insertion of
operating devices.
11. • Resectoscope
-three basic electrodes: a ball,
barrel, and a cutting loop.
• Accessory instruments
- alligator grasping forceps,
biopsy forceps, and scissors,
morcellator
-monopolar and bipolar
electrodes
-A new bipolar system named
VersaPoint™
(saline may be used as
distention media)
12. • DISTENTION MEDIA
-muscle of uterine walls requires a minimum
pressure of 40 mm Hg to distend the cavity.
-types of distention media
- gaseous
-liquid - high-viscosity and low-viscosity fluids
13. • Carbon dioxide
- colorless gas
-ideal for office hysteroscopy.
- given through insufflator
- it allows entry evaluation of the
endocervical canal.
- disadvantages – gas embolism, no
effective way to remove blood and debris.
14. • High viscosity fluids
- Dextran 70 (Hyscon )
• Low viscosity fluids with electrolytes
-normal saline and lactated ringer’s solution
-easy availability and low cost
- miscibility with blood hence obscuring the
vision
- pulmonary and cerebral edema
15. • Low viscosity fluids without electrolytes
-1.5 % glycine is the most commonly used medium.
-Other non-electrolyte media - 5% glucose and
sorbitol/mannitol.
16. Procedure
Preparation of the patient:
– Detailed history and complete physical
examination
– In proliferative phase of menstrual cycle
– Informed consent
– bimanual examination
17. Therapeutic Hysteroscopy Anesthesia
• Local - Paracervical block plus fentanyl 100 mcg IV
or ibuprofen 600 mg with diazepam 5mg po 1hr
before
• Spinal – allows monitoring of sensorium with
respect to hyponatremia
• General anesthesia with paracervical block
18. Vasopressin in Paracervical Block
• Less force (about ½) needed for dilation
• Less fluid absorbed (about 1/3)
• Ed’s solution= 5U (1/4 ml) vasopressin in 30ml 1%
chloroprocaine or lidocaine (+3ml NaCO3). Inject 6-
10ml each side.
• Alternatively misoprostol (200-400 microgram) can
be use 12-24 hrs prior.
23. Second
generation
Hydrothermal
Uterine thermal
balloon
ablator
Microwave
endometrial
ablation
Nova sure
Her
option(cryosurgery)
24.
25. – Correct uterine malformation like septate uterus by
resection of the septum. (bicorneate uterus is corrected
by laparotomy using metroplasty)
– Polypectomy.
– Intrauterine adhesions
– Myomectomy
26. Used as a therapeutic tool
- Removal of foreign bodies and IUCD.
- CANNULATION OF FALLOPIAN TUBE
- to canalize the tube:interstitial
obstruction secondary to cellular debris and
tubal spasm.
- to place intra tubal device for
sterilization.
27. • treatment of hemangiomas and arteriovenous
malformations
37. • Myomas treated hysteroscopically
- All submucosal myomas:
( two step procedure are considered)
- Single Intramural fibroid <5 cm that lie close
to endometrium
38.
39.
40.
41. Contraindications
• Pregnancy.
• Current or recent pelvic infection.
• Current vaginitis, cervicitis and
endometritis.
• Recent uterine perforation.
• Active Bleeding.
42. Complications
• Intra-operative bleeding
- increase the pressure of distention media above
the mean arterial pressure, this compresses the wall
of the uterus sufficiently to stop bleeding.
-bleeding vessel can be coagulated with a 3 mm
ball electrode.
43. • Bleeding can be controlled by inserting a Foleys
balloon and inflating it to 3 to 5 ml. The balloon can
be kept in situ for 6 to 12 hours
• rare cases when the bleeding is arterial- uterine
artery embolization or even hysterectomy may be
needed.
44. • Delayed postoperative bleeding - associated
with endometrial slough, chronic endometritis or
spontaneous expulsion of intramural portion of
previously resected submucous myoma
• Uterine perforation
45. - Complications related to distention media:
due to CO2 insufflation:
-Cardiac arrhythmia due to excessive
absorption.
-Gas embolism.
due to fluid:
- Anaphylactic reaction
- Pulmonary edema
- Adult RDS
46. • Acute hyponatremic state- fluid deficit equal or
greater than 500 ml should alert a surgeon to a
likelihood of hyponatremia and hypoosmolality,
which can furthur lead to cerebral edema an CNS
abnormality. Close monitoring of inflow and outflow
and thereby the deficit can avoid these
complications.
47. Complications
- Late onset:
- Infections, PID
- Vaginal discharge: common after ablative
procedures and it is self limiting.
- Adhesion formation
50. ACOG Committee Opinion
Number 444 – November 2009
• “Evidence demonstrates that, in general, vaginal
hysterectomy is associated with better outcomes and
fewer complications than laparoscopic and
abdominal hysterectomy. When it is not feasible to
perform a vaginal hysterectomy, the surgeon must
choose between laparoscopic hysterectomy, robot-assisted
hysterectomy or abdominal hysterectomy.”
52. • Gynecologic Conditions
• da Vinci® Surgical System
• da Vinci Gynecologic Surgery
da Vinci Hysterectomy for Early Stage Gynecologic Cancer
da Vinci Hysterectomy for Benign Conditions
da Vinci Myomectomy
da Vinci Sacrocolpopexy
53. Drawbacks with Conventional
Laparoscopic Surgery
• Surgeon operates from a 2D image
• Straight, rigid instruments (limited
range of motion)
• Instrument tips controlled at a distance
• Reduced dexterity, precision and
control
• Unsteady camera controlled by
assistant
• Dependent on assistant for surgical
support through an accessory port
• Greater surgeon fatigue
• Makes complex operations more
difficult
54. How to overcome these drawbacks?
Improve visualization
Improve instrument
control
Enhance dexterity for
technically challenging
aspects of the procedure
Use superior ergonomics
55. da Vinci Hysterectomy
Dexterity for complex
dissections (e.g
endometriosis)
Vaginal cuff suture
closure with ease
Improved visualization
and access around the
cervix for a colpotomy
56. da Vinci Sacrocolpopexy
Easier, quicker and more
precise suturing
Complete control of the
camera and all three
operative arms
A reproducible approach