- Most asymptomatic gallstones (ASGS) rarely have clinical significance and do not require treatment. However, certain subgroups are at higher risk of developing complications from ASGS.
- These higher risk subgroups include those under 55, smokers, females, obese individuals, those with multiple or large stones, and those with a life expectancy over 20 years. Prophylactic cholecystectomy may be advised for these patients.
- Other special subgroups that may benefit from early cholecystectomy include those with chronic hemolytic anemias, transplant recipients, patients with perioperative discovery of ASGS, and those with common bile duct stones. Expectant management is generally recommended for ASGS patients with diabetes or cirrhosis
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
Bile duct injuries represent a complex clinical scenario seen with increased frequency owing to
aberrant anatomy
more lap cholecystectomies being performed
Incidence :
0.1-0.2 % in open cholecystectomy
0.4-0.6 % in lap cholecystectomy
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
Bile duct injuries represent a complex clinical scenario seen with increased frequency owing to
aberrant anatomy
more lap cholecystectomies being performed
Incidence :
0.1-0.2 % in open cholecystectomy
0.4-0.6 % in lap cholecystectomy
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
Cholesterolosis of the gall bladder: a surgical dilemmaKETAN VAGHOLKAR
Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.
Benign Biliary Stricture is a common condition which we encounter during gastro practice. Here we discuss in detail about its diagnosis and management.
CARCINOMA ESOPHAGUS - DR ZAHID IQBAL MIR
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
He is an enthusiastic, enigmatic and dedicated teacher as well. He is not just a resolute learner, but also an awe inspiring guiding light for his juniors, which makes him the most loveable and respected senior.
Currently he is running “LOVE FOR SCALPEL” for PGMEE aspirants on most of the social platforms, which is gaining immense popularity among residents, medical graduates and undergraduates.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Eminence v/s Evidence
• ‘There is no innocent gallstone’
(William J Mayo, MD, 1904)
• More than a century after the above
statement, there is now enough
evidence that most incidentally
discovered, clinically silent GS rarely
have clinical significance.
5. GS that cause no GS-related symptoms
or complications and are diagnosed
during routine ultrasound for other
abdominal conditions are called
asymptomatic GS.
Asymptomatic Gall Stones
6. Symptomatic Gallstones
Pain in right upper abdomen /
epigastrium.
Symptom complexes of acute
cholecystitis, obstructive
jaundice and gallstone
pancreatitis.
Bloating, belching, flatulence,
dyspepsia and abdominal
discomfort.
7. Gallstones are the red herrings of surgical
practice.
Role of panendoscopy.
8. Burden of disease
According to European studies, at the age of
65, about 30% of women have GS, and by the
age of 80 years, 60% of both males and
females have GS. The large majority of these
(70–85%) are asymptomatic.
In India, Khuroo et al. reported a 6.1% (men
3.1% and women 9.6%) prevalence of GS in
subjects above 15 years of age from Kashmir
in northern India; 94% of these were
asymptomatic at the time of diagnosis.
9. Why treat
Known complications like acute
cholecystitis, gall stone
pancreatitis and obstructive
jaundice.
Gallstones and cancer.
10. Facts
A longitudinal follow-up study of AsGS showed that
over a 20-year period
Only 18% people developed biliary pain, and the mean
yearly probability of development of biliary pain was 2%
for the first 5 years, 1% during the second 5 years and
0.5% and 0.1% during the third and fourth 5 years,
respectively. None of these individuals died of GS
disease.
According to the National Institute of Health
consensus conference report, 10% of patients develop
symptoms during the first 5 years and 20% by
20 years.
11. Factors that have been reported to confer a higher
risk of progression from asymptomatic to
symptomatic disease and/or complications include
Age <55 years
Smoking
Female sex
Obesity
Presence of three or more GS
Presence of floating stones
Life expectancy >20 years,
Calculi >2 cm in diameter,
Calculi <3 mm and patent cystic duct
Non-functioning GB
Perioperative detection of incidental stones
12. Gallstones and Cancer
No proof of a causal relationship,
but there is a significant
association which in high incidence
areas like North India hangs like the
sword of Damocles.
13. The risk of gallbladder cancer in these groups has been reported to be
substantially higher than the 1 per 1,000 patients per year risk in other
patients with gallstones.
Associated gall bladder polyps (> 1 cm)
Calcified (Porcelain) Gall bladder (25%)
Areas where there is a strong association between stones and
cancer due to genetic predisposition,
Individuals with anomalous pancreatic-biliary ductal junctions
Individuals with gallstones greater than 3 cm in diameter or
occupying significant volume of the gall bladder
The incidence of GBC is also reported to be higher in patients with
xanthogranulomatous cholecystitis and Mirizzi’s syndrome – both
associated with long-standing GS disease.
14. There MAY be a case for suggesting
preventive (for GBC) cholecystectomy in a
young (20s or 30s) patient with a large GS in
northern India but, as of today, there is no data
or evidence to support it.
16. Chronic haemolytic Syndromes
Onset of GS is at a younger age and,
therefore, there is an increased life-time risk
of developing complications; 50% develop
complications in 3 –5 years after diagnosis.
Biliary complications of GS and veno-
occlusive crises may present with similar
manifestations (pain, fever, leucocytosis and
jaundice, thus confounding diagnosis.
Elective, prophylactic cholecystectomy is
thus recommended on diagnosis of GS
before development of symptoms or
complications.
17. Transplant Recipients
Treatment of AsGS in patients
undergoing transplantation
assumes importance because
of the need for postoperative
immunosuppression. Some of
the immunosuppressive drugs
such as cyclosporine and
tacrolimus are prolithogenic.
The aim of prophylactic
cholecystectomy is to remove a
possible septic focus that may
cause severe complications in
an immunosuppressed patient.
18. Perioperative Discovery
In patients with AsGS who undergo unrelated
abdominal surgery, a high (up to 70%)
incidence of biliary symptoms and/or
complications following surgery has been
reported.
It has been observed that cholecystectomy is
required in up to 40% of these patients within
one year of the initial operation.
A prophylactic cholecystectomy at the time of
the initial operation is usually advised.
19. Diabetes Mellitus
Prophylactic cholecystectomy offers no clear benefit
and should not be routinely recommended for diabetics
with AsGS.
It is now believed that asymptomatic patients with DM
do not benefit from screening for GS and that
cholecystectomy should only be performed in cases of
symptomatic cholelithiasis, as is the case of the
general population.
Early surgery, however, is highly recommended in
diabetics with symptomatic GS and acute cholecystitis.
20. Cirrhosis of Liver
Liver cirrhosis is a well-documented
risk factor for the formation of GS.
However, in most of these patients,
the GS are asymptomatic and surgery
is rarely required.
The risk of development of
complications is low, but the mortality
associated with acute episodes of
cholecystitis is high.
Incidental cholecystectomy is not
justified in cirrhotic patients with
AsGS, but close follow-up with early
elective operation when symptoms
supervene should be recommended.
21. Common Bile Duct Stones
The subgroup of patients with AsGS who have
associated common bile duct stones is
reported to be at a higher risk (up to 50%) of
developing potentially severe complications,
and thus recommended for a prophylactic
cholecystectomy .
22. Gall Bladder Polyps
Any gallbladder polyp that is felt to be symptomatic should be removed.
Cholecystectomy should only be undertaken in cases where there are
clinical signs of gallbladder polyps, polyps with diameters greater than 10
mm, fast-growing polyps, sessile polyps or wide-based polyps, polyps with
long pedicles, patient aged over 50, concurrent gallstones, polyps of the
gallbladder infundibulum or abnormal gallbladder wall ultrasound.
The surgery of choice is laparoscopic cholecystectomy. A gallbladder
polyp greater than 18 mm in size has a high likelihood of being an
advanced cancer; it should be removed with open cholecystectomy, partial
liver resection, and possible lymph node dissection.
Gallbladder polyps that are not resected should be followed-up with serial
ultrasound examinations. Clear guidelines on a screening interval are so
far not available, even though a screening interval of every 6–12 months
has been documented.
23. Advantages Disadvantages
Expectant Management
Avoids overtreatment Potential for development of a serious
complication while waiting
Avoids anaesthesia/surgery-related
morbidity/mortality
Need to operate on an older patient (with co-
morbidities) or in an emergent setting may
increase morbidity and mortalityAvoids unnecessary cost/workload for the
health care system
Routine Cholecystectomy
Definitive cure Overtreatment of a large number of patients
Potential morbidity/mortality of
anaesthesia/surgery
Generally a safe procedure with low morbidity
and mortality, especially when performed in
absence of complications
Increased cost/workload for the health care
system
Selective Cholecystectomy
Theoretically ideal – only subgroups at higher
risk for development of symptoms or
complications would be treated
Practically difficult – clear identification of high-
risk subgroups still far from easy
Pros and cons of management strategies