1) This document summarizes 17 case studies of patients with lumbar disc extrusions who were treated non-operatively.
2) Across all 17 case studies, the disc extrusions showed complete absorption or regression without requiring surgery.
3) The authors presented these case studies to demonstrate that lumbar disc extrusions often improve with non-surgical treatments alone and do not necessarily require immediate surgery.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
T12 fracture with spinal cord compression spinal cord injury treated with posterior spinal fusion and T12 decompression using costotransversectomy approach
http://www.drsandeepagrawal.com/spine.php
There are many different types of conditions that cause back pain. Like most medical conditions, back pain is treatable through several methodologies. Determining what condition you have is the key to determining the right treatment option for you. Back pain comes in many forms, lower back pain, middle back pain, and upper back pain are just a few of the symptoms associated with spinalconditions. You may also have pain or tingling in your extremities that may be indications of spinal conditions. Feel free to browse through our articles about conditions. Contact your doctor to set up an appointment to start your road to recovery.
Every person is different, so symptoms of conditions may present
differently for different people. Symptoms also vary depending on the
condition, its severity, location, and other factors.
T12 fracture with spinal cord compression spinal cord injury treated with posterior spinal fusion and T12 decompression using costotransversectomy approach
http://www.drsandeepagrawal.com/spine.php
There are many different types of conditions that cause back pain. Like most medical conditions, back pain is treatable through several methodologies. Determining what condition you have is the key to determining the right treatment option for you. Back pain comes in many forms, lower back pain, middle back pain, and upper back pain are just a few of the symptoms associated with spinalconditions. You may also have pain or tingling in your extremities that may be indications of spinal conditions. Feel free to browse through our articles about conditions. Contact your doctor to set up an appointment to start your road to recovery.
Every person is different, so symptoms of conditions may present
differently for different people. Symptoms also vary depending on the
condition, its severity, location, and other factors.
Conservative management of Lumbar disc prolapse.pptxvinod naneria
conservative management, non-surgical treatment of lumbar PID,
current concepts on Lumbar disc management, MRI correlation with neurological deficit in PID
Rehabilitation of dominant upper limb amputationJoe Antony
Hand dominance is the preferential use of one hand over the other for motor tasks.
90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less dexterous, non-dominant hand.
When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer
There are innate differences in dexterity influenced by hand dominance.
Although most activities are accomplished bimanually, the dominant hand acts as the more dexterous, main executor while the non-dominant hand acts as supporter.
In the context of rehabilitation, permanent loss of dexterity in dominant hand is more devastating because dexterity skill previously endowed to dominant hand must be transferred to non-dominant hand
Persons with unilateral dexterity loss of the dominant limb have two challenges
they are forced to complete two handed tasks with one hand.
the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb.
Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries.
Persons with unilateral dexterity loss of the dominant limb have two challenges
they are forced to complete two handed tasks with one hand.
the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb.
Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries.
Persons with unilateral dexterity loss of the dominant limb have two challenges
they are forced to complete two handed tasks with one hand.
the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb.
Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries.
Leading cause of upper limb amputations is trauma occurring in males ages 15-25 years,
Most of traumatic amputation happen on dominant limb
vascular complications of diseases.
No limb prefernces
cancer/tumors (common cause of more proximal amputations such as a shoulder disarticulation or forequarter amputation)
In this presentation I summarize research on Endobutton-assisted repair of the distal biceps tendon. Find out more about hand and arm problems at http://www.noelhenley.com
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Similar to Lumbar disc extrusion –complete absorption (20)
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxvinod naneria
Autoimmune chronic multifocal recurrent osteomyelitis , case report, Auto-inflammatory osteomyelitis in children, non-pyogenic osteomyelitis in both Tibia,
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Lumbar disc extrusion –complete absorption
1. Lumbar disc Extrusion –
an observational study Part 1
Vinod Naneria
Complete Absorption Girish Yeotikar
Arjun Wadhwani
Choithram Hospital & Research centre, Indore,
2.
3.
4.
5.
6.
7.
8. Cochrane review
• Prolapsed lumbar discs – < 5% of all low-back
problems.
• Ninety percent of acute attacks of sciatica
settle with non-surgical management.
• Surgical options are usually considered for
more rapid relief in the minority of patients
whose recovery is unacceptably slow.
The effects of surgical treatments for individuals
with 'slipped' lumbar discs
Gibson JA, Waddell G
9.
10.
11.
12. Saal JA, Saal JS, Herzog RJ: The natural history of lumbar
intervertebral disc extrusions treated non-operatively. Spine 15:
683–686, 1990
• Patients with large compressive lesions are
also generally believed to be more ideally
suited to surgical intervention. These same
patients, however, are those most likely to
experience spontaneous regression of their
lesions and they have a high rate of clinical
improvement with noninvasive treatments.
13. Asraf Beg – case -summary
Case summary 1
• 40 yr, M, short statured, obese
• DM + HT
• Acute PID L4 – L5 rt<1wk
• Nil neurology at admission
• MRI – Nov 2010 extruded disc
• Tx - Conservative
• Develop ankle jerk loss and EHL gr2 in one wk
• Follow up MRI – Feb 2011
• Last follow up – Sept 2012
Total absorption
86. Disclaimer
• All photographs were taken with the consent of the all
patients.
• Clinical photos were also put with due verbal
permission.
• This presentation strictly for students of orthopedics
with the sole idea of propogating knowledge.
• Any objection as for photographs or x-rays, please
inform naneria@yahoo.com for prompt deletion.
• Material collected from C.H.& R.C., Indore and from
private clinics of the authors.
87. DISCLAIMER
Information contained and transmitted by this presentation is
based on personal experience and collection of cases at
Choithram Hospital & Research centre, Indore, India, during
last 25 years. It is intended for use only by the students of
orthopaedic surgery. Views and opinion expressed in this
presentation are personal opinion. Depending upon the x-
rays and clinical presentations viewers can make their own
opinion. For any confusion please contact the sole author for
clarification. Every body is allowed to copy or download and
use the material best suited to him. I am not responsible for
any controversies arise out of this presentation. For any
correction or suggestion please contact naneria@yahoo.com
Editor's Notes
Presence of free fragments of extruded disc material is usually considered as a severe form of PID and it is considered as a strong indication for surgery. How ever when patient is not willing for surgery, a phobia is created into the mind of the patient regarding possible paraplagia (cuada-equina syndrome).
There are three special situations. One : migration intra-dural. This is always associated with cauda-equina syndrome. Only 60 cases have been reported in the world literature.Second: Migration posterior to the dural sac. It cannot be diagnosed even on MRI and usually it gives a picture of Spinal tumour.A third situation is also commonly seen – Roof disc. It is central extrusion but still contained by the posterior longitudinal ligament. Here symptoms are different and there may not be much root pain but with profound neurological deficit.
Inui, Yoshihiro et al in Spine. 29(21):2365-2369, November 1, 2004.Fas-Ligand Expression on Nucleus Pulposus Begins in Developing Embryo. Expressed there views as - The present results demonstrated that Fasligand expression is not detected in the notochord, but at the time of intervertebral disc formation, Fasligand expression develops in the nucleus pulposus. These results indicate that the immune privilege of the intervertebral disc may begin in the very early stages of disc formation. Moreover, Fasligand may play an important role in the formation of the intervertebral disc. There are three proposed hypothesis for absorption. The first proposed hypothesis is the retraction back into the intervertebral space. If there is bulging or herniation into the annulus fibrosis, this situation can be encountered theoretically. Second hypothesis is based on the concept of dehydration ( shrinkage with the loss of the water content of the herniated disc material), slowly The recent studies asserted that the spontaneous regression, to be a result of enzymatic degradation and phagocytosis against the extruded disc tissue in the epidural space with inflammatory reaction and neovacularization . There are some pathological and experimental studies supporting this situation. There is also possibility that all 3 of these mechanisms take part in the spontaneous regression and disappearing of the disc material altogether. In journal of Neurological Sciences Volume 23, Number 4, Page(s) 339-343, 2006, Mehmet ŞENOĞLU, KasımZafer YÜKSEL, and Mürvet YÜKSEL reported two cases of spontaneous absorption.It has been made clear in the world literature that the radicular pain from the compressed nerve root is primarily due to sensitization of the nerve root as a result of inflammation induced by antigen – antibody reaction. This is the reason for a quick response to cortisone therapy in acute prolapse. This is the reason why fragments mainly composed of nucleolus pulposus get absorbed early. The annulus is absorbed by granulation formation.Lumbar Disk Herniation:Correlation of Histologic Findings with Marrow Signal Intensity Changes in Vertebral GebhardSchmid, MDEndplates at MR Imaging- GebhardSchmid et al published in “Radiology Vol 231 No.2 - Findings in the current study show that avulsion-type disk herniation with hyaline cartilage material occurs frequently (in nearly 50% of patients). The amount of cartilage may be as much as 50% of the extruded material, and bone fragments were observed in five patients. Our results confirm that there is cartilaginous material in a high proportion of extruded disk herniations. The amount of cartilage in the herniation material is usually less than 10%, but it can be as much as 50%. The association of the amount of cartilaginous material with endplate abnormalities supports the theory that avulsion of the vertebral endplate is one source of disk herniation. The good correlation of marrow signal intensity changes in the middle third of the endplate with cartilaginous material in the disk herniation further supports the histopathologic findings by Tanaka et al (22) that most avulsions occur in the inner or transitional zone of the annulus end plate interface. Carreon LY, Ito T, Yamada M, Uchiyama S, Takahashi HE. Neovascularization induced by annulus and its inhibition by cartilage endplate: its role in disc absorption.Spine 1997; 22:1429–1434.