This document discusses recurrent diaphragmatic hernias after initial repair in infants born with congenital diaphragmatic hernias. It notes that recurrence rates can be as high as 42% and the need for reoperation is often predictable. The most common indications for reoperation are recurrence of the hernia and feeding problems like gastroesophageal reflux. Recurrence usually presents within the first 2 years of life. Symptoms may include pulmonary or gastrointestinal issues. Diagnosis involves imaging studies like chest x-rays, UGI, or CT scan. Repair can be done via open or minimally invasive approaches depending on factors like hernia size and location. The goal is to ascertain the mode of initial repair failure and
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
This product discuss Hirschsprung’s disease in pediatrics included [pathology, presentation, diagnostic tools, surgical procedures complications and management. Also discuss the recent concepts of management of post operative complications.
Colon cancer is one of the most common reasons for colonic obstruction. This presentation focusing on benign as well as malignant diseases with its management.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Since the advent of laparoscopic surgery in the 1980s, laparoscopic surgery has been popularized by surgeons throughout the world. However, routine laparoscopic surgery has been slow to catch the pregnant patient.
CMC Pediatric X-Ray Mastery: February CaseSean M. Fox
Drs. Kaley El-Arab and Neha Ray are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Acute chest syndrome (review)
• Traumatic diaphragmatic hernia
• Cervical distraction injury
• Traumatic pneumothorax
• Pelvic fractures from GSW
• Lung whiteout from mucous plug
• Scapula fracture and subclavian artery injury from GSW
• Pulmonary contusions
• Pneumomediastinum
• Post-op pneumothorax
• Pulmonary contusions, femur fracture, and pelvic fractures
• Lines and tubes practice
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
This product discuss Hirschsprung’s disease in pediatrics included [pathology, presentation, diagnostic tools, surgical procedures complications and management. Also discuss the recent concepts of management of post operative complications.
Colon cancer is one of the most common reasons for colonic obstruction. This presentation focusing on benign as well as malignant diseases with its management.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Since the advent of laparoscopic surgery in the 1980s, laparoscopic surgery has been popularized by surgeons throughout the world. However, routine laparoscopic surgery has been slow to catch the pregnant patient.
CMC Pediatric X-Ray Mastery: February CaseSean M. Fox
Drs. Kaley El-Arab and Neha Ray are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Acute chest syndrome (review)
• Traumatic diaphragmatic hernia
• Cervical distraction injury
• Traumatic pneumothorax
• Pelvic fractures from GSW
• Lung whiteout from mucous plug
• Scapula fracture and subclavian artery injury from GSW
• Pulmonary contusions
• Pneumomediastinum
• Post-op pneumothorax
• Pulmonary contusions, femur fracture, and pelvic fractures
• Lines and tubes practice
Diagnostic laparoscopy is a minimally invasive surgical
procedure that allows the visual examination of intraabdominal organs in order to detect any pathology. This
procedure allows the direct visual examination of intraabdominal organs including large surface areas of the
liver, gallbladder, spleen, peritoneum, pelvic organs, and
retroperitoneum. Biopsies, aspiration, and cultures can be
obtained, and laparoscopic ultrasound (US) may be used.
Diagnostic laparoscopy is safe and well tolerated and
can be performed in an outpatient or inpatient setting
under general anesthesia (Fig. 1A). There may also be
unique circumstances where office based diagnostic
laparoscopy may be considered under local anesthesia.
These circumstances should include only procedures where
complications and the need for therapeutic procedures
through the same access are extremely unlikely. Manipulation
and biopsy of the viscera is possible through additional ports.
Diagnostic laparoscopy is the most commonly performed
gynecological procedure today. Its greatest advantage is that
it has replaced exploratory laparotomy.
Diagnostic laparoscopy was first introduced in 1901,
when Kelling, performed a peritoneoscopy in a dog and was
called ‘‘celioscopy’’. A Swedish internist named Jacobaeus is
credited with performing the first diagnostic laparoscopy on
human in 1910. He described its application in patients with
ascites and for the early diagnosis of malignant lesions.
In last 10 years, laparoscopy has made a great difference
to the diagnosis of abdominal acute and chronic pain. It
has evolved as an informative and important method of
diagnosing a wide spectrum of both benign and malignant
diseases. Exploratory laparoscopy also allows tissue
biopsy, culture acquisition, and a variety of therapeutic
interventions. Elective diagnostic laparoscopy refers to the
use of the procedure in chronic intra-abdominal disorders.
Emergency diagnostic laparoscopy is performed in patients
presenting with acute abdomen
Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination of intraabdominal organs in order to detect any pathology.
When widespread use of laparoscopy and thoracoscopy in adult patients occurred in the first part of the 1990s, it did not transfer into widespread application in the pediatric population for a number of reasons.
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
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.
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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
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.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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. “Good judgment comes from experience, and
often experience comes from poor judgment.”
3. OVERVIEW
The complexity of patients born with CDH
creates a challenge to every surgeon who
must bring these infants to the operating
theater for the initial repair.
In this instance, the operation is relatively
straight forward,
but the physiology is treacherous.
4. Cont,
Conversely, when situations arise requiring a
subsequent procedure, the physiology is often,
but not always, more settled, but the
procedure is usually much more difficult.
With increased survival has come increased
morbidity and, not surprisingly, subsequent
operations have become fairly common.
5. Cont,
In one report, 42% of CDH survivors required
at least one additional operation. The need for
reoperation is often predictable, as are the
common indications.
First and foremost is a recurrence of the
hernia.
Second feeding problem(gastro esophageal
reflux (GER),
Then variable other causes as un descended
testes, inguinal hernia, other.
6. Incidence of Reherniation
Re herniation after a CDH repair has varied from
2–22%.
But has been reported to be as high as 80% in a
select group:
large defect,
absent posterior portion of the diaphragm,
Sever lung hypo- plasia that require ECMO ,long
mechanical ventilation.
Patch graft repair,
Neuorogenic defect associated with CDH as
phrenic nerve affection.
7. CONT,
Also the method of initial reconstruction.
Most important is the length of follow-up:
Van Meurs et al., 40% of CDH survivors with a
patch repair eventually had a recurrence.
Moss et al; reported that within 3 years of initial
repair, nearly 50% of patients who underwent a
patch repair had developed a re-herniation.
Moss also noted that the majority of re-herniations
were owing to the patch pulling away from the
posterior thoracic wall
8. Presentation
The majority present within the first 24 months
of life.
Moss and colleagues found a bimodal peak
incidence of recurrence.
The first being between 1 and 3 months of age
and the second between 10 and 36 months.
Saltzman et al. reported that the age at time of
recurrence ranged from 2 to 48 months, with
the average being approximately 14 months
9. CONT,
In fact, reherniation is often only discovered on
routine chest radiographs.
For this recommend regular surveillance chest
radiographs is important as:
Monthly for the first 6 months.
3months until the age of 24 months.
Then at 30 and 36 months.
Every 2–3 years until age 10.
10. Cont,
in may experience the incidence of recurrence
drops precipitously after 6 months, so I do not
obtain annual chest x-rays (CXR) for
surveillance purposes alone unless there is
clinical need after that time.
11. symptoms related to a
reherniation
Generally fall into two categories:
1. pulmonary symptoms.
2. gastrointestinal symptoms.
12. pulmonary symptoms
I. Pulmonary symptoms are rare beyond the
neonatal period.
II. Tachypnea,
III. Persistent cough,
IV. Development of aspiration pneumonia,
and/or recurrent
V. Wheezing requiring increased use of
bronchodilators
13. Cont,
Respiratory distress in an older child is an
ominous sign as tachypnea is usually a
physiologic response to metabolic acidosis
rather than pulmonary compromise.
Development of any of these symptoms should
trigger a search for an occult reoccurrence.
14. The gastrointestinal symptoms
Progressive oral aversion.
New or increased feeding intolerance.
Increased vomiting or worsening GER.
Abdominal distension, or abdominal pain.
Although these symptoms are not unique to
reherniation,so I have differentiate between
rehernation, adhesive intestinal obstruction,
GER.
15. Diagnostic Tools
The diagnosis of recurrent CDH should be
suspected based on history and physical exam,
and can often be confirmed with a single chest
radiograph.
Adjunctive radiological studies will be necessary
to help better understand the anatomy as
regards the location of reherniation and the
amount of abdominal contents involved.
16. The studies of value
upper gastrointestinal (UGI) with small bowel
follow through.
contrast enema.
With the advent of faster CT scans which have
eliminated the need for sedation, CT has
become our preferred diagnostic tool.
In cases where reherniation is suspected on
clinical grounds, but the chest film is equivocal
20. The Surgical Approach
patients can be divided into symptomatic and
asymptomatic groups.
Symptomatic-------- urgent repair.
Asymptomatic------- treated expectantly for
several months, or in some cases years, as
long as they are carefully monitored.
I believe that all recurrences will eventually
necessitate repair.
21. The justification for delaying repair
in asymptomatic patients
includes allowing time for improvement in:
Pulmonary
nutritional parameters
Tissue to be viable and tolerate repair
Avoid bleeding and subsequent non required morbid
procedures.
From a practical standpoint, repairing or replacing
a patch simply resets the clock until the next
recurrence. So allowing the asymptomatic child to
grow might allow for a more secure repair later
and fewer repairs in total.
22. The choice of approach
Theoretically, the repair can be performed
either via open or minimally invasive
technique, but as a practical matter, the latter
is probably only appropriate for the most
minimal of defects.
The choice of approach may be influenced by
other circumstances such as:
Fundoplication
Gastrostomy tube will also be performed at the time of
the repair,
An incisional hernia is present
23. The trans thoracic approach
Favored by some
It is more likely to provide a virgin operative field
in patients who initially underwent a trans
abdominal repair.
Well not be reasonable in :
child has evidence of pulmonary hypertension
inadequate lung reserve
Practically you cant repair the postero medial herniation
through it, also the retro peritoneal weakness cant be
managed through.
If the patient need for other procedure as gastrostomy
,fundoplication, adhesolysis,
24. Trans abdominal approach
which is often a bit more challenging and time
consuming.
Allows us better visualization of the defect itself,
and the organs and structures that must be
preserved.
It also provides ready access to perform a
fundoplication and/or gastrostomy tube should
one be needed.
25. The thoraco-scope
It can be diagnostic
Repair small postero lateral defect.
Large rehernation is associated with adhesion
exposing the procedure to failure or end with
morbidity.
So theoretically it is helpful ,practically it is too
risk.
26. Repair Techniques
plan the most appropriate repair technique.
the mode of failure of the initial repair must be
ascertained.
The location of failure is important, as it will dictate
subtle but important differences in timing and
technique.
there are four primary modes of failure:
failure of a primary repair
failure of the medial aspect of the repair
recurrence at the posterior-lateral margin
Development of a paraesophageal hernia
which is not recurrence in all most the
literature.
27. Anterior and lateral
failures are rare
probably because the anterior lip of diaphragm
seems to be the thickest muscle.
The liver act as a support foe the repair.
The heart also from above.
There is no real negative force at this site as
the maximum force loud come at the center of
the diaphragm and posterolateral.
28. the cause of recurrence
In the case of a failed primary repair, the cause of
recurrence is often a high-tension initial repair in
which the sutures simply could not hold the tissue
together.
In these cases, another primary repair is usually
impossible and a new prosthetic patch should be
placed.
A novel dome technique was described by Loff
and coworkers in 2005.
A variety of novel approaches to repairing a
recurrent hernia both with prosthetic patches and
with muscle flaps have been described.
29. Holy Grail
The “Holy Grail” of CDH repair is a patch that can
grow and remodel with the child. Recent large
animal data suggest that CDH repair with
autologous, engineered tendon patches is
possible.
These grafts can be made available at birth, as
they can be engineered in parallel to gestation,
from cells normally present in, and harvested
from, the amniotic fluid.
A proposed protocol for the first clinical trial of this
novel therapeutic concept is currently under
review by the Food and Drug Administration
(FDA)
30. What we do?
However, until pre-engineered bio prosthetic
patches
become a clinical reality, we will continue to
rely on the synthetic devices currently
available.