The document discusses laser lithotripsy for treating urinary stones. It notes that the holmium:yttrium-aluminum-garnet (Ho:YAG) laser has become the standard for urinary stone treatment. The Ho:YAG laser uses photothermal energy absorption to break stones into fine fragments. Laser lithotripsy provides versatility and can be used in various areas of the genitourinary tract. Studies show laser lithotripsy has higher stone-free rates and lower re-treatment rates compared to extracorporeal shock wave lithotripsy. Laser lithotripsy also plays an important role in minimally invasive procedures like ureteroscopy, percutaneous neph
he ability of the laser to ablate prostatic tissue with minimal hemorrhage has concentrated most of the interest in urologically applied lasers to benign prostatic hyperplasia (BPH) [Anson et al. 1994]. Despite tremendous advances in the surgical and minimally invasive treatment of BPH, transurethral resection of the prostate (TURP) is still considered the ‘gold standard’. The risks of TURP are always mentioned when discussing the reasons for seeking alternative treatment modalities for BPH. Bleeding certainly remains a concern, especially in patients on some form of anticoagulation (heparin, coumarin related compounds, antiplatelet agents) or those with prostates in excess of 60–80 g. On the other hand, with the availability of transurethral resection in saline (TURiS), the TURP syndrome is nowadays considered by many to be a relatively rare complication
he ability of the laser to ablate prostatic tissue with minimal hemorrhage has concentrated most of the interest in urologically applied lasers to benign prostatic hyperplasia (BPH) [Anson et al. 1994]. Despite tremendous advances in the surgical and minimally invasive treatment of BPH, transurethral resection of the prostate (TURP) is still considered the ‘gold standard’. The risks of TURP are always mentioned when discussing the reasons for seeking alternative treatment modalities for BPH. Bleeding certainly remains a concern, especially in patients on some form of anticoagulation (heparin, coumarin related compounds, antiplatelet agents) or those with prostates in excess of 60–80 g. On the other hand, with the availability of transurethral resection in saline (TURiS), the TURP syndrome is nowadays considered by many to be a relatively rare complication
Background.
Treatment Algorithm.
Pre-Op preparation.
Surgical Techniques and Technology in stone removal:
Intracorporeal Lithotripters.
Extracorporeal Shock wave Lithotripsy.
Percutaneous Nephrolithotomy.
Ureteroscopic Management of Stones.
Laparoscopic and Open stone Surgery.
Urinary stones During Pregnancy.
AUA and EAU guidelines.
Questions.
Peizosurgery: A boon in modern periodonticsAnushri Gupta
Piezoelectricity is the electricity resulting from pressure. It is effective in precise bone cutting. It spares soft tissue and hence less blood loss is seen.
This lecture reviews the role of laser therapy in dentistry in particular for Periodontal treatment. Dr. Smith reviews many of his own cases with the audience.
Please contact Dr. Smith with questions.
drsmith@cpident.com
Lasers in orthodontics /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Lasers in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
Background.
Treatment Algorithm.
Pre-Op preparation.
Surgical Techniques and Technology in stone removal:
Intracorporeal Lithotripters.
Extracorporeal Shock wave Lithotripsy.
Percutaneous Nephrolithotomy.
Ureteroscopic Management of Stones.
Laparoscopic and Open stone Surgery.
Urinary stones During Pregnancy.
AUA and EAU guidelines.
Questions.
Peizosurgery: A boon in modern periodonticsAnushri Gupta
Piezoelectricity is the electricity resulting from pressure. It is effective in precise bone cutting. It spares soft tissue and hence less blood loss is seen.
This lecture reviews the role of laser therapy in dentistry in particular for Periodontal treatment. Dr. Smith reviews many of his own cases with the audience.
Please contact Dr. Smith with questions.
drsmith@cpident.com
Lasers in orthodontics /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Lasers in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
Similar to Laser based treatment in urolithiasis.pptx (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Introduction
• A laser is a device that emits light through
the process of optical amplification by the
stimulated emission of electromagnetic
radiation.
• The word laser is derived from an acronym
for “light amplification by stimulated
emission of electromagnetic radiation.”
3. • Laser light has specific properties. It is
monochromatic and of a single wavelength.
• The light is coherent with a uniform spatial
relationship between all portions of the
electromagnetic wave.
4. • Although various wavelengths of lasers are
employed to treat soft-tissue conditions such
as stricture disease, benign prostatic
hyperplasia (BPH), urothelial cell cancer, and
genital skin lesions,
• the holmium:yttrium-aluminum-garnet
(Ho:YAG) laser has become the accepted gold
standard for the treatment of urinary calculi at
this time
5. Holmium:YAG
• The Ho:YAG laser is a 2140-nm pulsed laser
that is used for soft-tissue and lithotripsy
applications in urology.
• The 2140-nm wavelength is strongly
absorbed in water, traveling only about 0.5
mm in the fluid medium, making it ideal for
the urologic environment.
6. • In the prostate, the absorption depth is about
0.4 mm resulting in a high-energy density
that leads to the rapid vaporization of tissue.
Heat is also generated during this process
and allows for coagulation of small blood
vessels up to a depth of approximately 2 mm.
7. • Preceding technologies, such as the Nd:YAG
lasers, used photoacoustic or
photomechanical processes, where light
energy created shockwaves that fragmented
stones.
• In contrast, photothermal stone breakage
during holmium laser use was hypothesized
based on early observations of “glowing hot
stones.”
8. • Photothermal processes involve direct light
energy absorption (“photo”) by stone
surfaces causing rapid temperature
(“thermal”) increases, before significant heat
diffusion can occur.
9. • Ho:YAG lasers produce fine fragments in large
part owing to photothermal energy
absorption by urolithiasis; this results in the
breakdown and disintegration of the heated
area, causing craters and fragmentation
10. So,
• Laser lithotripsy has brought versatility to intracorporeal
lithotripsy by allowing safe fragmentation in virtually all
areas of the genitourinary tract.
• Ho:YAG laser fragmentation is predominantly due to
photothermal decomposition and possibly photoacoustic
propulsion of fragments.
• Laser output can be adjusted based on rate (Hz), energy (J),
pulse duration (μsec), and fiber size (μm).
• Maximal deflection is achieved with 200-μm fibers during
flexible ureteroscopy; however, maximal efficiency is seen
with 360-μm fibers.
11. • Proper laser fiber handling can help reduce
scope damage and prolong the life of reusable
fibers.
• Techniques used during stone fragmentation
include painting and “popcorning,” which create
fine stone dust (precluding removal), or crude
fragmentation for basket extraction.
• Laser lithotripsy can produce the smallest
fragments and is efficacious in all stone
compositions.
12. In Ureteroscopy
• By reducing the diameter of ureteroscopes,
slender intracorporeal lithotripters must pass
easily through a working channel smaller than 4
Fr, while allowing room for irrigation.
• These instruments also must be durable
enough to be advanced and retracted
repeatedly through a scope without breaking,
even when deflected 270 degrees.
13. • Ho:YAG laser lithotripsy fulfills these
requirements because hydroxy silica fibers
are thin, flexible, and durable and possess
transmission efficiencies allowing for
effective photothermal stone fragmentation.
14. • Flexible ureteroscopy typically uses 200-μm
laser fibers, which have a minimal impact on
scope deflection.
• For semirigid ureteroscopy, 365-μm fibers are
more suitable, although they can be used with
flexible nephroscopy if minimal deflection is
required.
• These are considered workhorse fibers because
they have been shown to display maximal
efficiency and durability while being typically
cheaper (than 200-μm fibers)
15. • Ureteroscopic laser fragmentation can be
performed by several Techniques:
• Dust-sized fragments are produced by painting
the fiber across the surface of a stone. Avoiding
the creation of large fragments that are difficult
to pass makes basket extraction unnecessary.
• By using lower energy levels of 0.2 J and higher
pulse rates (i.e., 40 Hz), small debris and
minimal retropulsion are encountered, while
trading off a reduction in total fragmentation.
16. • Controlling for total energy, increasing pulse
energy levels were found to result in larger
fragments, with faster fragmentation times.
Alternatively, as laser fragmentation
becomes more time-consuming as fragments
become smaller, one can create large pieces
and remove them using an endoscopic
basket.
17. Comparing with ESWL
• With improving endoscopic technology,
ureteroscopy and intracorporeal lithotripsy
have replaced ESWL for treatment of many
ureteric stones.
• A review of 82 patients undergoing either
ESWL or ureteroscopy for impacted proximal
stones showed no difference in 3-month stone-
free rates (80% vs. 68%) or complications,
although patients undergoing ESWL required
more secondary procedures (Khalil, 2013).
18. • Similar results were achieved in a prospective
randomized trial comparing 180 patients
undergoing ESWL or semirigid ureteroscopy
and laser lithotripsy for stones less than 2
cm. No significant differences were found
between the two modalities in terms of 3-
month stone-free rates, although re-
treatment rates were higher for ESWL (6.1%
vs. 1.1%, P < .001)
19. • a multicenter randomized trial of distal and
midureteric stones (n = 156) treated with ESWL or
ureteroscopy and laser lithotripsy showed an
advantage for ureteroscopy. The 3-month stone-
free rate was 91% for ureteroscopy (vs. 51% for
ESWL), and re-treatment rates were significantly
lower (9% vs. 45% in ESWL) (Hendrikx et al, 1999).
• Several authors found cost savings associated with
ureteroscopy and laser use compared with ESWL
because of higher success rates and lower re-
treatment rates
20. Comparing other intracorporeal
lithotripsy modalities,
• A retrospective review of 394 patients with proximal
ureteral stones treated with laser or pneumatic
lithotripsy via semirigid ureteroscopy was performed
showing 86% were treated successfully with
pneumatic lithotripsy; 14% required secondary ESWL
for residual fragments (identified on radiograph).
Laser lithotripsy produced a 97% stonefree rate, and
only 2% required secondary procedures. Ureteral
perforations were uncommon and not significantly
different between groups (Bapat et al, 2007).
21. • In larger distal and mid-ureteric stones (mean
diameter 13 mm), a prospective randomized
trial showed a delayed stone-free rate of 95%
with laser lithotripsy versus 85% with
pneumatic lithotripsy on noncontrast
computed tomography. Laser use was
associated with less stone migration, although
complication rates were for both arms
(Kassem et al, 2012).
22. In Percutaneous Nephrolithotomy
• Although laser lithotripsy is not the favored modality
for use in large renal stone burdens treated
percutaneously, it plays an important role in flexible
instrumentation.
• Anterograde nephroscopy using flexible scopes can
access calyces that rigid nephroscopes cannot reach,
reducing the need for multiple accesses.
• For patients with large impacted ureteric stones,
reimplanted ureters, and reconstructed bladders,
anterograde flexible ureteroscopy and laser lithotripsy
can allow straightforward access to the stone.
23. • Coarse fragmentation and basket extraction
simplify the procedure because the ureteric
portion proximal to the obstruction is often
dilated, allowing for active retrieval of larger
stones.
24. • Laser fragmentation is central to percutaneous
nephrolithotomy performed with reduced-
diameter sheaths (i.e., minipercutaneous, ultra-
minipercutaneous, micro percutaneous).
• Developed initially for pediatrics, the procedure is
now used in adults with sheath diameters ranging
from 24 Fr (8 mm) to 16 gauge (1.3 mm). When
using extremely narrow sheaths, techniques
require special miniaturized imaging technologies
and laser lithotripsy.
• Because stone extraction is impossible with
extremely narrow sheaths, 200-μm laser fibers
are used to dust stones, and debris is cleared by
pressurized irrigation or passive urine flow.
25. In Bladder Stones
• An advantage of laser cystolithotripsy is its use
in flexible cystoscopy, allowing for treatment
in reconstructed bladders and challenging
genitourinary anatomy that precludes use of
rigid instruments.
• Flexible laser lithotripsy has been used under
local anesthetic in healthy men with stones
greater than 3 cm, with minimal pain and
improvements in lower urinary tract
symptoms, without significant complications
26. • In pediatric urolithiasis, instrument diameter
plays a key role in management options.
Bladder stones have been successfully treated
using 8-Fr ureteroscopes with 550-μm laser
fibers for stones less than 4 cm .
• No laser-related complications were
encountered perioperatively, and no children
showed recurrences or urethral stricture
formation in longterm follow-up (mean 48
months).
27. • In children with complicated genitourinary
reconstructions, augmentations, and
continence procedures, percutaneous laser
cystolithotripsy through a previous suprapubic
catheter site allowed for maximal stone
fragmentation, while minimizing the risk to
intraperitoneal structures and/or vascular
supply to bowel segments used for
augmentation