The document discusses the Loop Electrosurgical Excision Procedure (LEEP). It begins by outlining eligibility criteria and contraindications. It then explains that LEEP uses electrosurgical current to cut or coagulate cervical tissue. The procedure involves local anesthesia, applying iodine to outline lesions, and using a loop electrode at varying power settings to remove lesions. Follow up advice is given, including expected discharge and restrictions. Complications are less than 2% but can include bleeding. A follow up after 9-12 months is needed to check for persistent lesions.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Cervical Cancer Symptoms, Causes, TreatmentsMedWorld India
Cervical cancer is the malignancy that starts in the cervix. Cervical cancer instigate from the cells located on the surface of the cervix. Cervical cancer occurs in several forms. The most common is squamous cell carcinoma, which accounts for 85 to 90 percent of cervical cancers.
In operating room the most hazardous devise used in a daily basis is diathermy.
A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.
Dissection is defined as the separation of tissues with hemostasis. It consists of a sensory visual and tactile component, an access component involving tissue manipulation, and instrument maneuverability.
laparoscopy and minimal invasive surgery is modern gyn surgical tool tool it is wise to know some basics about electro- cauterization … and how to avoid its dangers.
Surgical Diathermy the For Way in Modern Open SurgeryBatubo Nimi
The surgical diathermy is one of the most important surgical tool in the operating theatre. It is use to cut tissues, controlling bleeding by coagulation haemostasis and destruction of unwanted cells.
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
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.
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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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3. CAUTION
First, it must be confirmed that the woman
meets the eligibility criteria.
If there is evidence of pelvic inflammatory
disease (PID), cervicitis, vaginal trichomoniasis,
bacterial vaginosis or anogenital ulcer, it is
advisable to delay LEEP until that condition has
been treated and resolved.
If there is marked atrophy due to estrogen
deficiency in an older woman and staining of the
outer margin of a lesion is indistinct, it is
advisable to delay LEEP until after a course of
topical estrogen treatment.
4. PRINCIPLE
Electrosurgery is the use of radiofrequency
electric current to cut tissue or achieve
haemostasis.
A LEEP operator needs to keep in mind that
electricity flows to ground along the path of the
least electrical resistance.
The electrical energy used in electrosurgery is
transformed into heat and light energy.
5. The heat from a high-voltage electrical arc
between the operating electrode and tissue allows
the practitioner to cut by vaporizing tissue (at
100 ⁰C) or to coagulate by dehydrating tissue
(above 100⁰C).
The cutting electrodes are loops of very fine (0.2
mm) stainless steel or tungsten wire to achieve
different widths, depths, and configurations of
cut.
6.
7. The higher temperatures involved in coagulation
produce thermal effects greater than in electro-
surgical cutting.
This is important in electrosurgery, since an
adequate pathological examination requires that
the coagulation effect be minimal in the excised
surgical specimen.
On the other hand, some coagulation effect is
desirable, even while cutting, in order to
minimize bleeding in the surgical field.
8. Manufacturers offer electrosurgical cutting
settings that lead to some coagulation by
blending electrical currents, one with a cutting
waveform and another with a coagulation
waveform.
This combination is called a blended cutting
waveform.
9. When the coagulation setting is selected on the
electrosurgical generator, the coagulation
waveform has a higher peak-to-peak voltage
(producing higher temperatures) than that used
for a pure cutting waveform, and is meant only to
heat the tissue above 100°C to achieve
dehydration.
10. There are three types of coagulation:
desiccation, in which the active electrode touches
the tissue;
fulguration, in which the active electrode does
not touch the tissue but ‘sprays’ multiple sparks
between itself and the tissue;
puncture coagulation, in which an electrode,
usually a needle, is inserted into the centre of a
lesion.
11. Coagulation using the fulguration setting and a
3- to 5-mm ball electrode is the type of
coagulation is normally used.
One exception is be the use of a needle electrode
to fulgurate a stubborn area of bleeding.
The fulguration setting uses a higher peak-to-
peak voltage waveform than the other
coagulation settings, coagulating tissue with less
current and, therefore, less potential harm to
adjacent tissue.
12. PROCEDURE
Local anaesthesia is achieved 30 seconds after
multiple injections of a total of 5ml or less of 1%
xylocaine into the stromal tissue of the
ectocervix.
The injections are given in a ring pattern 1 -2
mm deep (at 3, 6, 9 and 12 o’clock positions) at
the periphery of the lesion and transformation
zone using a 5ml syringe and 25- to 27-gauge
needle.
13. It is common practice to reduce the amount of
bleeding during the procedure by mixing a
vasoconstrictor agent such as vasopressin (no
more than one pressor unit) with the injected
local anaesthetic agent.
The use of xylocaine with 2% adrenaline instead
of pitressin also is adequate for local anaesthesia,
but may cause palpitations and leg tremors
before surgery.
14. The application of Lugol’s iodine solution is
helpful to outline lesion margins before the start
of treatment.
An insulated vaginal speculum with an
electrically insulating coating or a speculum
covered with a latex condom should be used to
avoid an electrical shock to the woman in the
event that the activated electrode inadvertently
touches the speculum.
15.
16. The aim of the LEEP procedure is to remove the
lesions and the transformation zone in their
entirety and send the affected tissue to the
histopathological laboratory for examination.
The least amount of power that will effectively
perform the electrosurgery should be used, so as
to minimize the risk to the patient’s normal
tissues and ensure that the excised specimen has
minimum of thermal artifact for pathological
assessment.
17. The power setting used depends on the size of the
tissue electrode being used for cutting and
whether fulguration is being performed.
The commonly used power settings for the
different loop electrodes are as follows:
1.0 x1.0 cm 30 watts;
1.5 x 0.5 cm 35 watts;
2.0 x 0.8 cm 40 watts;
2.0 x 1.2 cm 50 watts.
18.
19.
20. FOLLOW UP ADVICE
Women should be advised that they will have a
brown or black discharge lasting between a few
days and two weeks.
They should be advised to promptly report back if
the discharge persists for more than two weeks, if
discharge becomes malodorous and/or is
associated with lower abdominal pain or if
profuse bleeding develops.
Women should be advised not to use a vaginal
douche or tampons, or to have sexual intercourse
for one month.
21. COMPLICATIONS
Severe perioperative bleeding occurs after 2% or less
of LEEP procedures.
Few women complain of post-operative pain. If post-
operative pain occurs, it usually is similar to cramps;
women should be instructed to use oral analgesics, if
necessary.
A blood-tinged, dark brown mucus discharge usually
lasts for one or two weeks after treatment.
Severe and moderate post-operative bleeding occurs
in a few women, who should be seen promptly.
Healing after LEEP usually takes place within a
month.
22. When post-operative bleeding occurs, it usually
appears 4-6 days after treatment and often from the
posterior lip of cervix.
This bleeding can usually be controlled by
fulguration, using a silver nitrate applicator stick.
Rarely, placement of a suture at the bleeding site is
necessary. If a woman presents post-operatively with
a malodorous discharge, it should be cultured.
In developing countries, it may be preferable to
institute routine presumptive treatment with
antibiotics after LEEP (doxycycline 100 mg orally,
two times a day, for seven days and metronidazole
400 mg orally, three times a day, for seven days).
23. PERSISTENT LESION AT FOLLOW UP
All women, regardless of whether or not the pathology
report states that the excisional margins are clear,
should be followed up at 9 - 12 months from
treatment to evaluate regression or persistence of
lesions and complications.
Treatment failures (persistent lesion(s) at follow-up)
are detected in less than 10% of women when they are
checked at the follow-up appointment.
It is advisable to biopsy all persistent lesions to rule
out the presence of unsuspected invasive carcinoma.
Persistent lesions should be re-treated with
cryotherapy or LEEP or cold- knife conization, as
appropriate.
24. TAKE HOME MESSAGE
Electrosurgical current applied to tissues can
have one of three effects on the tissue,
depending on the power setting and the
waveform of the current used: desiccation,
cutting, and fulguration.
The key advantage of LEEP over cryotherapy is
that it removes rather than destroying the
affected epithelium, allowing histological
examination of the excised tissue.
A loop wider than the lesion(s) and the
transformation zone to be removed should be
used; otherwise, the lesion should be removed
with multiple passes.
25. Women will have a brown or black
discharge for up to two weeks after LEEP.
Women should be advised not to use a
vaginal douche, tampon, or have sexual
intercourse for one month after LEEP.
Moderate to severe post-operative bleeding
occurs in less than 2% of treated women
and they should be seen promptly.
The failure rate with LEEP in women
treated for the first time is around 10%.