This patient's shock was reluctant to resuscitation by I/V fluids, blood transfusion and all sorts of effort. I opened his abdomen with taking double bond consent. So he was saved. Thanks God.
Two cases of accidental bronchopleural fistula during video-assisted endoscopic esophagectomy are reported. In both cases, a sharp increase in end-tidal carbon dioxide was the first indication that a bronchial injury had occurred during lymph node dissection. Once notified, surgeons found and repaired iatrogenic injuries to the left mainstem bronchus in each case. Vigilant monitoring of end-tidal carbon dioxide allowed for early detection and treatment of this serious complication.
This document discusses emergency thoracotomy for traumatic injuries. It outlines indications for the procedure including hemodynamic instability from penetrating chest injuries or cardiac tamponade. Steps of the procedure are described including a clamshell incision and interventions like controlling hemorrhage, cardiac massage, and aortic clamping. Contraindications include prolonged downtime or signs of unsurvivable injuries. Studies show improved survival in penetrating injuries with signs of life when thoracotomy is performed in the ED. Proper training and equipment are needed to perform this critical lifesaving procedure.
This presentation discusses chest trauma. It begins with an introduction noting that the chest contains vital organs and thoracic trauma is a common cause of death. [It then provides details on the anatomy of the chest and classifications of blunt vs penetrating trauma.] It identifies the "Deadly Dozen" as the most life-threatening chest injuries requiring immediate treatment, including tension pneumothorax, massive hemothorax, and flail chest. [It also discusses several potentially life-threatening injuries requiring secondary survey, such as tracheobronchial disruptions.] Throughout, it emphasizes the importance of strict adherence to ATLS protocols to identify and treat deadly chest injuries.
A 28-year-old Egyptian male presented to the emergency room after sustaining a laceration to his chest wall from a stone cutting saw. Examination revealed a 2cm laceration on his lower sternum with no active bleeding. A CT scan showed a fractured sternum with foreign body inside, minimal pneumothorax and pneumomediastinum, and contusions on parts of both lungs. The wound was cleaned and closed, and the patient was admitted for observation where he remained stable with good pain management.
A nephrectomy is a surgical procedure to remove one or part of a kidney. The first successful nephrectomy was performed in 1869 in Germany. Laparoscopic nephrectomy, involving smaller incisions, was first performed in 1990. A nephrectomy removes the kidney through small incisions or one larger incision in the abdomen. It is used to treat severe kidney damage or diseases like cancer, infections, or cysts, and to donate a healthy kidney for transplantation. Risks include infection, bleeding, and kidney failure of the remaining kidney. Patients may experience pain and discomfort after surgery and should avoid strenuous activity during recovery.
- 16-year-old male patient presented with recurrent right-sided pneumothorax. He has a history of left-sided pneumothorax and bullectomy.
- His sister also has a history of recurrent bilateral pneumothorax requiring bilateral chest tubes.
- HRCT showed multiple thin-walled cystic air spaces and mosaic attenuation pattern. Lung biopsy showed findings suggestive of hypersensitivity pneumonitis.
An appendicectomy is a surgical procedure to remove the vermiform appendix, usually performed as an emergency operation to treat acute appendicitis. The patient is placed under general or regional anesthesia and their abdomen is cleaned with iodine and alcohol. The surgeon makes an incision, such as McBurney's grid-iron incision, to access the appendix which will appear inflamed and possibly contain pus or a faecolith. The appendix is then removed and the patient is given postoperative care including IV fluids, antibiotics, and monitoring for complications like infection, abscess or fistula.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
Two cases of accidental bronchopleural fistula during video-assisted endoscopic esophagectomy are reported. In both cases, a sharp increase in end-tidal carbon dioxide was the first indication that a bronchial injury had occurred during lymph node dissection. Once notified, surgeons found and repaired iatrogenic injuries to the left mainstem bronchus in each case. Vigilant monitoring of end-tidal carbon dioxide allowed for early detection and treatment of this serious complication.
This document discusses emergency thoracotomy for traumatic injuries. It outlines indications for the procedure including hemodynamic instability from penetrating chest injuries or cardiac tamponade. Steps of the procedure are described including a clamshell incision and interventions like controlling hemorrhage, cardiac massage, and aortic clamping. Contraindications include prolonged downtime or signs of unsurvivable injuries. Studies show improved survival in penetrating injuries with signs of life when thoracotomy is performed in the ED. Proper training and equipment are needed to perform this critical lifesaving procedure.
This presentation discusses chest trauma. It begins with an introduction noting that the chest contains vital organs and thoracic trauma is a common cause of death. [It then provides details on the anatomy of the chest and classifications of blunt vs penetrating trauma.] It identifies the "Deadly Dozen" as the most life-threatening chest injuries requiring immediate treatment, including tension pneumothorax, massive hemothorax, and flail chest. [It also discusses several potentially life-threatening injuries requiring secondary survey, such as tracheobronchial disruptions.] Throughout, it emphasizes the importance of strict adherence to ATLS protocols to identify and treat deadly chest injuries.
A 28-year-old Egyptian male presented to the emergency room after sustaining a laceration to his chest wall from a stone cutting saw. Examination revealed a 2cm laceration on his lower sternum with no active bleeding. A CT scan showed a fractured sternum with foreign body inside, minimal pneumothorax and pneumomediastinum, and contusions on parts of both lungs. The wound was cleaned and closed, and the patient was admitted for observation where he remained stable with good pain management.
A nephrectomy is a surgical procedure to remove one or part of a kidney. The first successful nephrectomy was performed in 1869 in Germany. Laparoscopic nephrectomy, involving smaller incisions, was first performed in 1990. A nephrectomy removes the kidney through small incisions or one larger incision in the abdomen. It is used to treat severe kidney damage or diseases like cancer, infections, or cysts, and to donate a healthy kidney for transplantation. Risks include infection, bleeding, and kidney failure of the remaining kidney. Patients may experience pain and discomfort after surgery and should avoid strenuous activity during recovery.
- 16-year-old male patient presented with recurrent right-sided pneumothorax. He has a history of left-sided pneumothorax and bullectomy.
- His sister also has a history of recurrent bilateral pneumothorax requiring bilateral chest tubes.
- HRCT showed multiple thin-walled cystic air spaces and mosaic attenuation pattern. Lung biopsy showed findings suggestive of hypersensitivity pneumonitis.
An appendicectomy is a surgical procedure to remove the vermiform appendix, usually performed as an emergency operation to treat acute appendicitis. The patient is placed under general or regional anesthesia and their abdomen is cleaned with iodine and alcohol. The surgeon makes an incision, such as McBurney's grid-iron incision, to access the appendix which will appear inflamed and possibly contain pus or a faecolith. The appendix is then removed and the patient is given postoperative care including IV fluids, antibiotics, and monitoring for complications like infection, abscess or fistula.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
The document provides information on emergency conditions for abdominal surgery. It discusses common etiologies for abdominal surgical emergencies such as appendicitis, pancreatitis, hernias, intestinal obstruction, peptic ulcers, esophageal varices, and more. For each condition, it describes characteristics, causes, diagnostic methods, and treatment approaches whether through conservative management or surgery. The document serves as a reference for various acute abdominal conditions that may require emergency surgical intervention.
This document provides an overview of inguinal hernias. It defines a hernia as the protrusion of an organ through a weakness in the muscle wall. It then discusses the epidemiology, types, anatomy, etiology, pathogenesis, signs and symptoms, diagnosis, treatment and complications of inguinal hernias. The treatment options covered are herniotomy, herniorrhaphy, and laparoscopic repair techniques like the Lichtenstein method. The prognosis is typically good, though there is a small risk of recurrence.
This document provides information on common abdominal surgeries including gastrectomy, cholecystectomy, appendectomy, herniotomy, nephrectomy and spleenectomy. For each surgery, it describes the procedure, types of incisions used, postoperative care and exercises. It also outlines principles of physiotherapy for abdominal surgery including pre-operative assessment and training, post-operative assessment, and a recommended rehabilitation plan focusing on breathing, mobility and strengthening exercises to aid recovery.
This document discusses hernias, including definitions, causes, types of abdominal wall hernias, and details on inguinal and femoral hernias. It defines a hernia as a protrusion of an organ or tissue through an abnormal opening. The main types of abdominal wall hernias are inguinal, femoral, obturator, sciatic, and lumbar. Inguinal hernias are further classified as direct or indirect. Femoral hernias have a high risk of strangulation due to their narrow neck. Both inguinal and femoral hernias require surgical repair to prevent complications like obstruction, incarceration, and strangulation.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing mesh to cover the defect, and post-operative care. The laparoscopic approach has advantages over open surgery such as smaller incisions, less tissue disruption, and less post-operative pain, though it requires practice to learn.
Chest injuries account for 25% of severe injuries and are usually caused by road traffic accidents. The primary survey focuses on the airway, breathing, circulation, disability and exposure to identify and treat immediate life threats like tension pneumothorax. Secondary survey involves a full history, examination and investigations like CXR and CT scan to evaluate injuries. Most chest injuries are managed conservatively but conditions like massive hemothorax or cardiac tamponade may require chest tube insertion or thoracotomy.
Abdominal trauma is a frequent cause of preventable death due to inadequate evaluation, diagnosis, resuscitation, and delayed surgery. Initial assessment of trauma patients focuses on the ABCDEs with no abdominal injury taking precedence over initial assessment. Diagnostic tests like ultrasound, CT scans, and diagnostic peritoneal lavage can help detect abdominal injuries but management is generally the same regardless of the specific organ involved and includes resuscitation, monitoring for changes, and consideration of laparotomy for signs of peritonitis.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
1) Mr. AZ, a 21-year-old man, was brought to the ED after a motorbike accident with open fractures of his left forearm bones and bilateral lung contusions.
2) Secondary surveys found additional injuries including possible skull fracture and closed fractures of his right wrist bone.
3) The patient was resuscitated for hypovolemic shock and underwent wound care, imaging, and splinting while awaiting stabilization for orthopedic surgery.
1) Abdominal trauma is commonly encountered in the emergency department and can be challenging to diagnose due to subtle or delayed presentations of serious intra-abdominal injuries.
2) A thorough primary and secondary survey including vital signs monitoring, focused assessment with ultrasound, and diagnostic tests like CT scan are used to identify injuries.
3) Uncontrolled hemorrhage and sepsis are major causes of mortality, so prompt diagnosis and management of injuries is important to prevent complications.
Chest trauma can represent a major burden and lead to significant morbidity and mortality. Chest injuries require prompt evaluation and management to address life-threatening injuries like tension pneumothorax, hemothorax, and cardiac injuries. The chest is divided into the thoracic cavity containing the lungs, heart, and great vessels which are vulnerable to injury from blunt or penetrating trauma. Common injuries include rib fractures, flail chest, pulmonary contusions, and pneumothorax. Immediate airway control and treatment of life-threatening injuries is essential, followed by management of potential injuries and complications to optimize outcomes.
This document describes the procedure of pneumonectomy and the role of physiotherapy both before and after the surgery. Pneumonectomy involves complete removal of a lung, usually done to treat lung cancer, infections, or other lung diseases. Physiotherapy before surgery focuses on teaching exercises and breathing techniques to prepare the patient. After surgery, physiotherapy aims to clear secretions, expand the remaining lung, prevent complications, and restore movement and exercise tolerance through a gradual recovery program over 2-3 weeks before discharge.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
This document describes the peri-operative management of a Jehovah's Witness patient requiring an emergency exploratory laparotomy who refused blood transfusion. It presents a case report of a 65-year-old male who underwent surgery under general anesthesia. Special consent was obtained for no blood transfusion. Intraoperatively, blood loss was replaced with crystalloids and the colloid Tetrastarch (Voluven) to maintain cardiovascular stability given the patient's anemia. The patient had an uneventful recovery without blood transfusion, demonstrating that surgery can be safely performed in Jehovah's Witness patients refusing transfusion through careful pre-operative optimization and use of alternatives to blood loss replacement like collo
TYPES OF MANAGEMENT IN HERNIA (CONSERVATIVE AND OPERATIVE)
TYPES OF SURGERY
(IN CHILDREN/ADULTS ,OPEN/LAPAROSCOPIC)
HERNIOTOMY ,TYPES OF HERNIORRAPHY ,HERNIOPLASTY (INCLUDING MESH)
"LAPAROSCOPIC ANATOMY"
LAPAROSCOPIC REPAIRS (TEP,TAPP)
EMERGENCY AND ELECTIVE TREATMENT IN INGUINAL FEMORAL AND OTHER TYPES OF HERNIAS
COMPLICATIONS
1. The document discusses the surgical management and techniques for repairing giant inguino-scrotal hernias using laparoscopic total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approaches.
2. Key steps for both TEP and TAPP are identified, including dissection to access the preperitoneal space, division of vessels and fascia to improve visibility and access, manual reduction of the hernia sac, and closure with mesh placement.
3. Outcomes data is presented showing low morbidity, reoperation and recurrence rates for both TEP and TAPP approaches for giant hernia repair. TAPP may be preferable for giant hernias due to easier
1. The document discusses different types of chest injuries including open chest injuries which break the skin and closed chest injuries usually from blunt trauma.
2. Closed chest injuries can include pulmonary contusions which are treated with supplemental oxygen, checking for flail chest, and applying soft pressure.
3. Pericardial tamponade and tension pneumothorax are also discussed, including signs, symptoms, and treatments such as rapid transport, oxygen, and chest decompression.
4. Open chest wounds addressed include not removing impaled objects and treating sucking chest wounds with a three-sided dressing.
Postoperative complications can range from minor issues like fatigue to life-threatening problems like blood clots. The highest risk period is 1-3 days after surgery. Complications can be general, like fever or infection, or specific to the type of procedure. Common general issues include wound infections, blood clots, collapsed lungs, and kidney problems. Without treatment, some complications can lead to serious problems or even death. Close monitoring in the first few days after surgery can help address potential complications early.
Mrs. Sunita Kumari, a 24-year-old female, presented with severe abdominal pain and was found to have signs of shock. Her history revealed missed menses for 1.5 months and pregnancy tests were positive. Exploratory surgery found a ruptured ectopic pregnancy with significant blood loss of approximately 1.5 liters. She received aggressive fluid resuscitation, blood transfusions, and vasopressor support intraoperatively. Post-operatively, she was monitored closely in the ICU and gradually recovered with continued supportive care.
This case presentation describes an 11-year-old boy who presented with multiple shrapnel wounds after an explosive injury. On examination, he was hemodynamically stable but unable to move his left leg. Imaging showed shrapnel in his abdomen, left shoulder, and left knee. His abdomen was initially soft on examination. However, a follow up CT scan revealed two shrapnel fragments in his abdominal cavity requiring an exploratory laparotomy. The surgery revealed two perforations in his descending colon that were closed primarily. His postoperative recovery was uncomplicated. This case illustrates that penetrating abdominal trauma should be surgically explored even with a normal abdominal exam initially due to the risk of delayed presentation of intra-abdominal
Case History of Dedifferentiated LiposarcomaVictor Effiom
This document summarizes the case history of a 24-year-old male who presented with abdominal distension, difficulty breathing, and weight loss. Imaging and exploratory surgery revealed a giant intra-abdominal mass weighing 20kg, which was removed. Histopathology determined the mass was a dedifferentiated liposarcoma. The patient required multiple blood transfusions post-operatively to manage anemia, but was eventually discharged and doing well on follow up.
The document provides information on emergency conditions for abdominal surgery. It discusses common etiologies for abdominal surgical emergencies such as appendicitis, pancreatitis, hernias, intestinal obstruction, peptic ulcers, esophageal varices, and more. For each condition, it describes characteristics, causes, diagnostic methods, and treatment approaches whether through conservative management or surgery. The document serves as a reference for various acute abdominal conditions that may require emergency surgical intervention.
This document provides an overview of inguinal hernias. It defines a hernia as the protrusion of an organ through a weakness in the muscle wall. It then discusses the epidemiology, types, anatomy, etiology, pathogenesis, signs and symptoms, diagnosis, treatment and complications of inguinal hernias. The treatment options covered are herniotomy, herniorrhaphy, and laparoscopic repair techniques like the Lichtenstein method. The prognosis is typically good, though there is a small risk of recurrence.
This document provides information on common abdominal surgeries including gastrectomy, cholecystectomy, appendectomy, herniotomy, nephrectomy and spleenectomy. For each surgery, it describes the procedure, types of incisions used, postoperative care and exercises. It also outlines principles of physiotherapy for abdominal surgery including pre-operative assessment and training, post-operative assessment, and a recommended rehabilitation plan focusing on breathing, mobility and strengthening exercises to aid recovery.
This document discusses hernias, including definitions, causes, types of abdominal wall hernias, and details on inguinal and femoral hernias. It defines a hernia as a protrusion of an organ or tissue through an abnormal opening. The main types of abdominal wall hernias are inguinal, femoral, obturator, sciatic, and lumbar. Inguinal hernias are further classified as direct or indirect. Femoral hernias have a high risk of strangulation due to their narrow neck. Both inguinal and femoral hernias require surgical repair to prevent complications like obstruction, incarceration, and strangulation.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing mesh to cover the defect, and post-operative care. The laparoscopic approach has advantages over open surgery such as smaller incisions, less tissue disruption, and less post-operative pain, though it requires practice to learn.
Chest injuries account for 25% of severe injuries and are usually caused by road traffic accidents. The primary survey focuses on the airway, breathing, circulation, disability and exposure to identify and treat immediate life threats like tension pneumothorax. Secondary survey involves a full history, examination and investigations like CXR and CT scan to evaluate injuries. Most chest injuries are managed conservatively but conditions like massive hemothorax or cardiac tamponade may require chest tube insertion or thoracotomy.
Abdominal trauma is a frequent cause of preventable death due to inadequate evaluation, diagnosis, resuscitation, and delayed surgery. Initial assessment of trauma patients focuses on the ABCDEs with no abdominal injury taking precedence over initial assessment. Diagnostic tests like ultrasound, CT scans, and diagnostic peritoneal lavage can help detect abdominal injuries but management is generally the same regardless of the specific organ involved and includes resuscitation, monitoring for changes, and consideration of laparotomy for signs of peritonitis.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
1) Mr. AZ, a 21-year-old man, was brought to the ED after a motorbike accident with open fractures of his left forearm bones and bilateral lung contusions.
2) Secondary surveys found additional injuries including possible skull fracture and closed fractures of his right wrist bone.
3) The patient was resuscitated for hypovolemic shock and underwent wound care, imaging, and splinting while awaiting stabilization for orthopedic surgery.
1) Abdominal trauma is commonly encountered in the emergency department and can be challenging to diagnose due to subtle or delayed presentations of serious intra-abdominal injuries.
2) A thorough primary and secondary survey including vital signs monitoring, focused assessment with ultrasound, and diagnostic tests like CT scan are used to identify injuries.
3) Uncontrolled hemorrhage and sepsis are major causes of mortality, so prompt diagnosis and management of injuries is important to prevent complications.
Chest trauma can represent a major burden and lead to significant morbidity and mortality. Chest injuries require prompt evaluation and management to address life-threatening injuries like tension pneumothorax, hemothorax, and cardiac injuries. The chest is divided into the thoracic cavity containing the lungs, heart, and great vessels which are vulnerable to injury from blunt or penetrating trauma. Common injuries include rib fractures, flail chest, pulmonary contusions, and pneumothorax. Immediate airway control and treatment of life-threatening injuries is essential, followed by management of potential injuries and complications to optimize outcomes.
This document describes the procedure of pneumonectomy and the role of physiotherapy both before and after the surgery. Pneumonectomy involves complete removal of a lung, usually done to treat lung cancer, infections, or other lung diseases. Physiotherapy before surgery focuses on teaching exercises and breathing techniques to prepare the patient. After surgery, physiotherapy aims to clear secretions, expand the remaining lung, prevent complications, and restore movement and exercise tolerance through a gradual recovery program over 2-3 weeks before discharge.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
This document describes the peri-operative management of a Jehovah's Witness patient requiring an emergency exploratory laparotomy who refused blood transfusion. It presents a case report of a 65-year-old male who underwent surgery under general anesthesia. Special consent was obtained for no blood transfusion. Intraoperatively, blood loss was replaced with crystalloids and the colloid Tetrastarch (Voluven) to maintain cardiovascular stability given the patient's anemia. The patient had an uneventful recovery without blood transfusion, demonstrating that surgery can be safely performed in Jehovah's Witness patients refusing transfusion through careful pre-operative optimization and use of alternatives to blood loss replacement like collo
TYPES OF MANAGEMENT IN HERNIA (CONSERVATIVE AND OPERATIVE)
TYPES OF SURGERY
(IN CHILDREN/ADULTS ,OPEN/LAPAROSCOPIC)
HERNIOTOMY ,TYPES OF HERNIORRAPHY ,HERNIOPLASTY (INCLUDING MESH)
"LAPAROSCOPIC ANATOMY"
LAPAROSCOPIC REPAIRS (TEP,TAPP)
EMERGENCY AND ELECTIVE TREATMENT IN INGUINAL FEMORAL AND OTHER TYPES OF HERNIAS
COMPLICATIONS
1. The document discusses the surgical management and techniques for repairing giant inguino-scrotal hernias using laparoscopic total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approaches.
2. Key steps for both TEP and TAPP are identified, including dissection to access the preperitoneal space, division of vessels and fascia to improve visibility and access, manual reduction of the hernia sac, and closure with mesh placement.
3. Outcomes data is presented showing low morbidity, reoperation and recurrence rates for both TEP and TAPP approaches for giant hernia repair. TAPP may be preferable for giant hernias due to easier
1. The document discusses different types of chest injuries including open chest injuries which break the skin and closed chest injuries usually from blunt trauma.
2. Closed chest injuries can include pulmonary contusions which are treated with supplemental oxygen, checking for flail chest, and applying soft pressure.
3. Pericardial tamponade and tension pneumothorax are also discussed, including signs, symptoms, and treatments such as rapid transport, oxygen, and chest decompression.
4. Open chest wounds addressed include not removing impaled objects and treating sucking chest wounds with a three-sided dressing.
Postoperative complications can range from minor issues like fatigue to life-threatening problems like blood clots. The highest risk period is 1-3 days after surgery. Complications can be general, like fever or infection, or specific to the type of procedure. Common general issues include wound infections, blood clots, collapsed lungs, and kidney problems. Without treatment, some complications can lead to serious problems or even death. Close monitoring in the first few days after surgery can help address potential complications early.
Mrs. Sunita Kumari, a 24-year-old female, presented with severe abdominal pain and was found to have signs of shock. Her history revealed missed menses for 1.5 months and pregnancy tests were positive. Exploratory surgery found a ruptured ectopic pregnancy with significant blood loss of approximately 1.5 liters. She received aggressive fluid resuscitation, blood transfusions, and vasopressor support intraoperatively. Post-operatively, she was monitored closely in the ICU and gradually recovered with continued supportive care.
This case presentation describes an 11-year-old boy who presented with multiple shrapnel wounds after an explosive injury. On examination, he was hemodynamically stable but unable to move his left leg. Imaging showed shrapnel in his abdomen, left shoulder, and left knee. His abdomen was initially soft on examination. However, a follow up CT scan revealed two shrapnel fragments in his abdominal cavity requiring an exploratory laparotomy. The surgery revealed two perforations in his descending colon that were closed primarily. His postoperative recovery was uncomplicated. This case illustrates that penetrating abdominal trauma should be surgically explored even with a normal abdominal exam initially due to the risk of delayed presentation of intra-abdominal
Case History of Dedifferentiated LiposarcomaVictor Effiom
This document summarizes the case history of a 24-year-old male who presented with abdominal distension, difficulty breathing, and weight loss. Imaging and exploratory surgery revealed a giant intra-abdominal mass weighing 20kg, which was removed. Histopathology determined the mass was a dedifferentiated liposarcoma. The patient required multiple blood transfusions post-operatively to manage anemia, but was eventually discharged and doing well on follow up.
Professor Abdulsalam Y Taha presents several cases of extremity vascular injuries managed at his medical unit to emphasize principles for proper care of such patients. Limb salvage rates of 70-95% are reported in major centers for patients with limb arterial trauma when prompt diagnosis, resuscitation, hemorrhage control, and revascularization are achieved. However, primary amputation may be necessary for limbs that are too severely damaged or when prolonged ischemia time makes salvage unlikely to succeed. The goal of vascular trauma management is to save both the patient's life and limb through early recognition, exploration, and appropriate repair or reconstruction of injured blood vessels.
1) A 46-year-old woman presented with abdominal pain and was found to have an appendiceal abscess based on CT scan and clinical examination.
2) She underwent pigtail drainage which provided some relief but her condition deteriorated, so she had an exploratory laparotomy where her appendix was found to be gangrenous and two iatrogenic bowel perforations were repaired.
3) She required a second surgery for bleeding from the incision but has since recovered well under observation.
The document discusses the management of abdominal trauma and damage control surgery, outlining the diagnostic modalities, surgical procedures, and complications. It emphasizes the importance of early resuscitation, high clinical suspicion for intra-abdominal injuries, and the staged approach of damage control surgery to improve outcomes in severe trauma patients. The challenges facing trauma management in Pakistan are also summarized.
Mr. N, a 52-year-old motorcyclist, was brought to the emergency department after a motor vehicle accident. He had deformities and lacerations to both upper limbs. In the emergency department, his condition deteriorated and he became restless. Imaging found free fluid and he was intubated. However, he went into cardiac arrest and efforts to resuscitate him failed. At autopsy, he was found to have rib fractures on both sides, a sternal fracture, and puncture wounds to his left lung and heart along with a ruptured abdominal aorta, leading to the cause of death being severe hemorrhage from his multiple traumatic injuries.
This document presents two case reports on the impact of Sujok acupuncture in treating acute pancreatitis.
Case 1 describes a 64-year-old man who presented with severe abdominal pain and was diagnosed with acute pancreatitis. Sujok acupuncture provided immediate pain relief and prevented the need for further analgesia. Various Sujok techniques were used to treat complications including acute renal failure, infection, pseudocyst, diabetes, neuropathy, and bedsores.
Case 2 describes a 41-year-old man who had recurrent attacks of acute pancreatitis despite surgery and stenting of the pancreatic duct. Sujok acupuncture was able to effectively treat both cases of acute pancreatitis and prevent further attacks and complications
Is there a role for internal iliac artery ligation in post cesarean uterine a...Apollo Hospitals
A pseudoaneurysm is a blood-filled cavity communicating with the arterial lumen owing to deficiency in one or more layers of the arterial wall. Development of pseudoaneurysms is a complication of vascular injury resulting from inflammation, trauma, or iatrogenic causes such as surgical procedures, percutaneous biopsy, or drainage. Pseudoaneurysm of the uterine artery is a rare but serious complication of gynecologic surgery that may be unnoticed in the early post-operative period. Without precise ultrasonographic and radiologic diagnosis before the manifestation of symptoms associated with hemorrhage, these pseudoaneurysms are prone to unpredictable rupture, resulting in exsanguination with high morbidity and mortality rates.
A 16-year-old male presented with abdominal pain, vomiting, and constipation for 3 days. Imaging showed a left diaphragmatic rupture with herniation of abdominal organs into the left hemithorax, likely resulting from a previous stab wound injury 2 months prior that was repaired but resulted in a diaphragmatic defect. The patient underwent surgery to repair the diaphragmatic rupture and his recovery was uneventful.
An 11-year-old boy presented with abdominal pain and vomiting, followed by sudden right scrotal pain. Examination found right iliac fossa tenderness and a swollen, tender right testis. Imaging showed appendicitis and absent blood flow to the right testis. Surgery revealed concurrent acute appendicitis and right testicular torsion requiring appendicectomy and orchidopexy. This rare case report presents the first known occurrence of simultaneous acute appendicitis and testicular torsion in a pediatric patient.
A 40- Year-Old Male with Teta Injury Casualty DMCHCasualtyBlock01
A 40-year-old male presented with multiple penetrating injuries from a teta (spiked agricultural tool) incident. On examination, he had wounds to his left flank, both thighs, and genitals. Imaging found no other injuries. He underwent surgery to remove foreign bodies and repair wounds. During the procedure, injuries to the femoral vessels in his left thigh requiring repair were discovered. His postoperative care involved antibiotics, wound management, and monitoring of the repaired vessels.
1. Patient A, age 65, presented with constipation and neutropenia post chemotherapy. CT scan showed bowel obstruction. Treatment plan included laxatives and changing chemotherapy drug.
2. Patient B, age 39, presented with nausea, vomiting, weight loss and pain in upper right abdomen increasing with eating. Exam showed tenderness and ultrasound was ordered to check for gallstones. Treatment included pain medication until results.
3. Patient C, age 16, was in a motor vehicle accident and presented with facial injuries and a fractured clavicle. Treatment included immobilization, CT scan, pain medication and sling if scans were clear.
Colopericardial fistula following colonic interposition can primary repair be...Georges Khalifeh
This case report describes a rare complication in a 24-year-old male who underwent colonic interposition for esophageal atresia as an infant. He presented with chest pain and pneumonia, and was found to have a colopericardial fistula. The fistula tract was divided, the colonic defect was primarily repaired, and a pericardial window was created. The patient recovered well with no complications at 3-month follow up. Colopericardial fistula is a life-threatening complication after colonic interposition that requires prompt surgical treatment to control infection and allow nutritional support.
A 15-year-old boy presented with abdominal pain localized to the right lower quadrant. A provisional diagnosis of acute appendicitis was made based on his fever, leukocytosis, and tenderness on examination. Acute appendicitis is defined as inflammation of the appendix caused by obstruction. It presents with abdominal pain shifting to the right lower quadrant, nausea, anorexia, and vomiting. Imaging and lab work can help in diagnosis. Treatment involves antibiotics, IV fluids, and an appendectomy to remove the inflamed appendix. Complications can include wound infections, abscesses, and bowel obstructions.
A 23-year-old male presented with a traumatic tracheoesophageal fistula (TTEF) following a road traffic accident that caused chest and arm injuries. Diagnostic tests revealed a fistula between the trachea and esophagus. Initial treatment involved nil by mouth and ryles tube feeding. When symptoms did not improve, an esophageal stent was placed endoscopically. However, the stent migrated on two occasions requiring repositioning. TTEF is a rare complication of blunt chest trauma, with high mortality if not treated surgically or with stents. Proper suspicion and early diagnosis are important for successful management of this condition.
Thigh Abscess Secondary to Continuous Popliteal Nerve Catheter: A Rare Compli...Jennifer Gerres, DPM
This case report describes a rare complication of a continuous popliteal nerve catheter (CPNC), where a 53-year-old woman developed a posterior thigh abscess secondary to the CPNC placed after surgery for a trimalleolar fracture. Despite removal of the catheter, her symptoms worsened with fever and increasing thigh pain. Imaging revealed a large abscess, requiring radical debridement of two-thirds of her posterior thigh compartment. Cultures grew methicillin-resistant Staphylococcus aureus. She required months of IV antibiotics and extensive physical therapy for recovery. The report reviews typical CPNC complications but highlights serious infection as rare, discussing this case and two similar reports where abscess developed secondary to MRSA from an ind
A 32-year-old male presented to the emergency department with swelling, pain and redness in his right big toe. He was initially diagnosed with gout but his symptoms worsened. It was later discovered that 17 years prior he had stepped on a nail which punctured his toe. For years after, the joint would periodically flare up with symptoms. Cultures from the joint grew Pseudomonas aeruginosa, indicating latent osteomyelitis from the prior puncture wound injury. He underwent surgical debridement and continued IV antibiotics for treatment.
The patient presented with a Tscherne type 2 tibial shaft fracture and developed skin blistering within an hour. In the operating room, compartment pressures were measured in all four compartments of the leg. The anterior compartment pressure was found to be 74 mmHg, which was more than 30 mmHg higher than the patient's diastolic blood pressure of 74 mmHg, indicating an anterior compartment syndrome. Fasciotomies were performed on the anterior and lateral compartments and the fracture was treated with an intramedullary nail. The posterior compartments did not develop compartment syndromes.
Diabetes in surgery (evidence based management protocol)Hriday Ranjan Roy
25% diabetic patient need surgery. He or she may have surgical disease along with diabetes or diabetes may complicate to surgical conditions. So it is critical to manage diabetes during surgical events.
Post Operative (Gastro-Jejunostomy) Efferent Loop Obstruction due to Recurren...Hriday Ranjan Roy
A gastric operation (no documentation) was done in 1982 by an inexpert surgeon. This patient developed severe vomiting. Here the description to evaluate the case and its management.
I was fallen into a severe RTA (Road Traffic Accident) in 2005 between two buses. Everybody had given up hope of my survival. By the grace of almighty God, I was saved and thus I'm here in front of you and enjoying with you thereby. Here are details of my injury and events.....
The document provides information about intensive care units (ICUs) including what they are, the types of patients treated, equipment used, and processes involved. It defines ICUs as sections of hospitals that care for patients with life-threatening conditions requiring close monitoring. Patients often need help breathing and with organ functions. The summary describes the various machines, treatments, and staff involved in ICU care like ventilators, IVs, nurses, and monitoring of vital signs. It also outlines some common complications and the goal of weaning patients off equipment back to independent breathing.
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
This document summarizes a case report of a large right atrial myxoma in a 45-year old man that presented with syncopal attacks, dyspnea, fever and headache. Echocardiography revealed a 9cm x 7cm myxoma attached to the right atrium. The patient underwent open-heart surgery using cardiopulmonary bypass to remove the tumor. Severe tricuspid regurgitation was also found and repaired with annuloplasty. The patient recovered well after surgery with disappearance of symptoms. Right atrial myxomas are uncommon but can cause diverse symptoms and need urgent surgery for removal and symptom relief.
Miss Sathi was treated by many anti-hypertensive drugs. But her hypertension was not being controlled. Latter it was diagnosed as a case of Coarctation of Aorta. It was then operated on. Post op events were uneventful. Now she is fine and no more anti-hypertensive drugs needed.
Blunt chest trauma with surgical emphysema - A case reportHriday Ranjan Roy
This patient was presented to us with severe life threatening conditions. We treated him at ICU, Rangpur Medical College Hospital and he was completely cured. Later a case presentation was done at Seminar Room of the same institute.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
2. Penetrating abdominal
assault causing IVC injury- A
case report.
Organized by- Department of
Surgery, Rangpur Medical
College Hospital.
Presenter- Dr. Hriday Ranjan roy,
Asst. Professor (Surgery)
6. Mr Hafizur Rahman, aged 28 years
hailing from Gangachara, Rangpur
was admitted into this hospital on 5
January 2010 having history of stab
injury on right upper abdomen.
Assault on him was occurred at 10
am and he reached hospital at 1.30
pm on the same day.
7. On admissionHe was restlessness and his cloths
were stained with profuse blood.
Continuous oozing of blood through
the wound.
Omentum came out through it.
8. Examination findings on
admission wereAppearance- restlessness, anemic.
Urine output- scanty
Pulse- rapid, thready and feeble.
B.P- non recordable
9. Rapid resuscitation was tried by I/V
fluid and blood transfusion. But the
result of resuscitation was failed.
There was continuous oozing of fresh
blood through the stab wound. So,
the patient was submitted for urgent
laparotomy with double risk bond
consent.
10. At 7.30 pm, abdomen was opened by
a generous right paramedian
incision. The whole peritoneal cavity
was full of clotted and fresh blood. It
was sucked out and mopped out
rapidly ( about 2/3 liters ). But
continuous severe exsanguinations of
blood made the field so difficult to
identify the injury.
11. An injury on stomach at its antral part
and blood stained lesser sac - which
was full of blood draw the attention.
So, lesser sac was accessed rapidly
by opening the gastrocolic ligament.
12. There was terrible bleeding like a
igneous of volcano through an injury
at the site of body and head of the
pancreas medial to duodenal C-cap.
Pressure by mop failed to control the
bleeding. So, manual finger pressure
(introducing finger to the injury) was
applied and it was controlled.
13. Keeping it controlled by an assistant,
duodenum was kocherized from
laterally and the IVC was explored.
The injury was found extended up to
vertebral column injuring both
anterior and posterior wall of IVC.
14. Meticulous dissection of IVC was done
and control taken by rubber catheter
both above and below of the injury.
There was about 1 inch linear
longitudinal injury in both anterior
and posterior aspect of IVC in its
suprarenal part.
19. Both were repaired by 5/0 prolene.
Control was removed. During these
procedure, only carotid pulse was
recorded by anesthesiologist.
After removal of control, pulse, B.P
and urine output began to reappear.
Oozing from pre-vertebral area was
controlled by cauterization. The renal
and gonadal veins were found to be
intact.
20. There was also associated injury to the
stomach injuring both anterior and
posterior wall near its antral part.
Both were repaired by double layered
suture.
24. Nothing was done for the associated
pancreatic injury.
Two drain, one in pelvis and another in
lesser sac (through foramen of
Winslow) were inserted. Closure of
incision wound and stab wound was
done accordingly. Recovery from
anesthesia was uneventful.
25. 4 units of fresh blood were given
per-operatively. Injection calcium
gluconate and sodi bi carb was also
given.
Postoperative period was uneventful.
26. At 5th post operative day, a cystic
swelling began to appear in left
hypochondriac region which was
gradually enlarging occupying the
left hypochondriac, epigastria,
umbilical and left lumber region.
An ultrasonogram was done ( 13/
01/2010 ) and report reveals huge
encysted thick (infected) collection in
upper abdomen.
27. Patient also had respiratory distress.
Aspiration was done by wide bore
needle by which the patient felt
comfort. The aspirate was clear
pancreatic fluid. Later on a folley
catheter was inserted into the cyst
by local anesthesia. Initially, about 1
to 11/2 liter of collection per 24 hours
was there. But it was not responding
to any conservative measure.
29. After 5/6 monthsA 2nd operation was done for pseudopancreatic cyst by posterior cystogastrostomy.
Improvement was excellent.
We could do this operation at 1st
setting, but his general condition was
so grave to cope further lengthening
of anesthesia periods.