Micturating Cystourethrography (MCU) and Retrograde Urethrography (RGU) are imaging techniques used to evaluate the lower urinary tract. MCU involves filling the bladder with contrast and imaging the bladder and urethra during voiding. RGU involves retrograde injection of contrast through the urethra. Both techniques can detect abnormalities of the bladder, urethra, and identify vesicoureteral reflux. Precise technique and imaging in multiple planes are required to fully evaluate the lower urinary tract. Potential complications include infection, contrast reaction, and trauma.
HELLO GUYS, THIS PRESENTATION IS ABOUT CONVENTIONAL CONTRAST STUDY USED IN RADIOGRAPHY FOR EXAMINING LOWER URINARY TRACT AND TO CHECK VARIOUS PATHOLOGIES OR VESICO URETRO REFLUX. CONTRAST MEDIA IS USED TO VISUALIZE THE TRACT. M.C.U. is also known as Voiding Cystourography.
HELLO GUYS, THIS PRESENTATION IS ABOUT CONVENTIONAL CONTRAST STUDY USED IN RADIOGRAPHY FOR EXAMINING LOWER URINARY TRACT AND TO CHECK VARIOUS PATHOLOGIES OR VESICO URETRO REFLUX. CONTRAST MEDIA IS USED TO VISUALIZE THE TRACT. M.C.U. is also known as Voiding Cystourography.
A presentation about Imaging the urinary tract using contrast.
contains 45 slides, and covers the following methods :
1 - Antegrade urography
2 - Retrograde urography
3 - Retrograde cystography
4 - Voiding cystography
5 - Retrograde Urethrography
Intravenous urography is covered in a separate presentation, that you can read and download from here :
http://www.slideshare.net/abdallamutwakil/intravenous-urography-ivu-35107052
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
evaluation of fetal anatomy in 1st trimester.pptxdypradio
EVALUATION OF FETAL ANATOMY IN FIRST TRIMESTER .
FETAL DEVELOPMENT IN FIRST YAER.
NORMAL ULTRASOUND FINDINGS IN THE FIRST TRIMESTER.Evaluation of fetal anatomy, including a detailed fetal cardiac examination, is possible in the late first trimester.
Many anatomic abnormalities can be detected in the first trimester, giving families time to make important decisions regarding pregnancy management and the opportunity for early termination of pregnancy to reduce maternal morbidity risks.Week 6: By the 6th week, the limb buds begin to differentiate into upper and lower limbs with large hand plates, which develop primordial digits. The lower extremities lag behind the upper limbs by approximately 4 to 5 days. The primordial ear develops and the eyes become obvious as the retina becomes pigmented. The fetal liver occupies the majority of the abdominal cavity at the 6th week. As the rapid growth of the intestines exceeds the growth of the abdominal cavity the physiologic herniation of the intestines into the umbilical cord occurs. Spontaneous twitching movements and reflex responses to touch begin to take place.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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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.
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
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
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2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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
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
2. ANATOMY OF URETHRA
• MALE URETHRA IS 18-20 cms LONG
• EXTENDS FROM BLADDER NECK TILL THE MEATAL OPENING AT PENIS
• It has four named regions:
Prostatic urethra:
• Is approximately 3 cm in length.
• Passes through the prostate gland.
Membranous urethra:
• Is approximately 1 cm in length.
• Passes through the urogenital diaphragm.
3. Bulbar urethra
From inferior aspect of urogenital diaphragm to
penoscrotal junction.
Spongy (penile) urethra:
Passes through the length of the penis.
4. PARTS OF URETHRA
ANTERIOR URETHRA
-PENILE URETHRA
-BULBAR URETHRA
POSTERIOR URETHRA
- MEMBRANOUS URETHRA
- PROSTATIC URETHRA
5. SPHINCTERS OF URETHRA
INTERNAL URETHRAL SPHINCTER -
• involuntary in nature
• Supplied by sympathetic nerves
• It controls the neck of the bladder & prostatic
urethra above the opening of ejaculatory ducts
EXTERNAL URETHRAL SPHINCTER-
• voluntary in nature
• Supplied by perineal branch of the pudendal nerve (s2-s4)
• Controls the membranous urethra & is responsible for voluntary holding of urine
6. Female urethra :-
• Widest at bladder neck.
• 4-5cms in length
• Narrowest & least distensible at meatus.
• This forms the Spinning top configuration of urethra
on normal MCU.
7. Urethrography is of 2 types:
1. Ascending/Retrograde urethrography - Contrast is retrogradely injected
in the ureter with the urethral orifice occluded to prevent reflux of contrast.
2. Descending /MCU- Bladder is filled with contrast via suprapubic or
retrograde catheterization and the urethra is assessed during voiding.
8. • Voiding cystourethrogram/ Micturating cystourethrogram demonstrates the lower
urinary tract
• Helps in detection of:
vesico-ureteral reflux
bladder pathology
congenital or acquired anomalies of bladder outflow tract.
Micturating Cystourethrogram (MCU)
9. INDICATIONS
Children:
1. UTI
2. Voiding difficulties like dysuria, thin stream, dribbling, frequency, urgency.
3. Vesico ureteric reflux.
4. Other congenital anomalies : Meningomyelocele, Sacral agenesis,Rectal anomalies.
5. For post operative evaluation of ureteric abnormalities.
6. Pelvic Trauma.
7. In renal failure to exclude reflux.
8. Boys with hematuria-MCU can demonstrate posterior uretheral valve or polyp.
11. CONTRAST MEDIA
• Water soluble constrast media like Urograffin 60% are used which is diluted with
normal saline in 1 :3 ratio.
• The estimated volume of contrast medium to be given:
Less than one year
Weight (kg) x 7 = capacity (ml)
Less than two years
(2 x age in years + 2) × 30 = capacity (ml)
More than two years
(Age in years/2 + 6) × 30 = capacity (ml)
12. Procedure
• Using a sterile technique, a catheter is introduced into the bladder.
• A 5f feeding tube with side holes are used for children and in older children or
adults 8f or 10 f catheters are used.
• In girls after initial inspection of perineum to identify any local genitilia
abnormalities (cystoceles or labial fusion ) the catheter is introduced.
• When it enters the bladder a varying amount of urine will flow through it .if no
flow a catheter is introduced till urine is obtained.
13. • Suprapubic pressure Is sometimes helpful.
• In males, foreskin is retracted and catheter is introduced.
• The catheter should be lubricated with anaesthetic jelly and inserted slowly and
gently into the urthera holding the penis is vertical position.
• The normal bladder capacity in children is estimated to be 1 ounce i.e 29 cc.
• For newborns -30 to 35 cc can be instilled.
• For upto 3 yrs - 200 to 250 cc
• Adequate capacity is reached when the child becomes uncomfortable and begins
voiding around the catheter.
14. Filming
In children
• In children up to the age of 2 yrs bladder is filled by hand injection.
For older children contrast medium is instilled from a bottle elevated one metre above examination table.
• During filling, fluoroscopic screening is performed at short intervals to see if vesicoureteral reflux, diverticuli
or other abnormalities are present. The child is turned oblique on both sides to ensure that minimal reflux
is not overlooked.
• If reflux appears, films are taken in the appropriate oblique projection. If the bladder appears normal, one
film is taken in the frontal projection at the end of filling.
• Voiding starts in infants the moment the catheter is removed.
• At the end of voiding, a frontal film is made of the entire abdomen including the kidney region in order to
prevent overlooking the vesicoureteral reflux which is apparent only on termination of voiding and may
reach the upper collecting system.
15. In adult male :
• Bladder is filled in the usual way as in older child and voiding filming is done in both oblique
projection views.
• The voiding study in male adults can be modified by getting the patient to void against resistance
i.e. by compression of distal part of penis or using penile clamp thus enhancing the visualization
of urethra by artificial distention.This is known as CHOKE CYSTOURETHROGRAPHY
In adult female:
• The procedure is essentially the same
• In addition to the standard exposures, a double exposed film taken at rest and during straining
demonstrates the degree of bladder descent if any.
16. Filming Technique:
Scout film:
• The first image that is taken while performing the MCU and VCUG is the image of KUB that
is called scout film. We evaluate the spine, pelvis, and soft tissues on the scout film.
• After several seconds of the contrast media begins to flow, the image of minimally filled
bladder is taken in Antero-posterior (AP) projection.
• During early filling a ureterocele or tumor can be detected
and it may obscure as more contrast material enters
into the bladder.
17. Voiding phase
• The image taken during voiding may demonstrate the urethral strictures or obstructions.
• They will also give the details of the presence or absence of vesicoureteral reflux.
• Voiding film necessary because gives the determination of reflux because reflux may
only happen with the pressure generated by voiding.
18. Post-voiding film
• A post-voiding film may demonstrate the reflux or extravasation of
urine from the bladder or urethra.
• A normal post-void film has no reflux and no residual urine.
19.
20. COMPLICATIONS
• Contrast reaction.
• Contrast induced cystitis.
• UTI.
• Catheter trauma.
• Bladder perforation - overfilling.
• Retention of a foley catheter.
• Catheterisation of vagina / ectopic ureter.
• Radiation exposure
• Autonomic dysreflexia- in paraplegic patients due to spinal cord injury at or above t6
level, forceful injection of contrast causes severe headache ,sweating,hypertension
with bradycardia due to forceful opening of bladder neck
21. ALTERNATE TECHNIQUES
1) SUPRAPUBIC BLADDER PUNCTURE.
Sometimes in PUV & pelvic trauma - not possible to catheterize.
2) EXCRETION MCU (MCU followed by IVU)
• This method makes use of contrast media accumulated in the urinary bladdder during ivp
Advantages : avoidance of physical and psychological trauma of catherization
• Avoidance of infection
Disadvatanges : visualization is not usually adequate Takes longer time
• Vu reflux visualised poorly.
.
29. CONTRAST MEDIUM :-
• Iopamidol (LOCM)
EQUIPMENT :-
Tilting radiography table.
• Fluoroscopy/spot film device.
• Foley's catheter, Syringe, Gloves
PREPARATION :-
• Patient is asked to micturate prior to the procedure
30. TECHINIQUE :-
Preliminary film - coned supine PA view of bladder base and urethra
• Patient is made to lie in supine position and slightly tilted
with legs position as shown in the image.
• Using aseptic conditions, the tip of the Foley's catheter is
inserted in the urethra after applying lignocaine jelly
for 2 to 4 cm length.
• Pressure is applied over the glans penis to avoid expulsion of the catheter and also to
straighten the penis over the ipsilateral leg and prevent urethral overlap.
• Contrast medium is injected slowly under fluoroscopic control.
31. IMAGING:-
• Supine PA before injecting contrast medium.
• 30º left anterior oblique
• 30º right anterior oblique
32. AFTER CARE:-
1. Observation.
2. Prophylatic antibiotics may be used
COMPLICATIONS :-
• Contrast reaction (due to absorption through bladder mucosa)
• UTI
• Urethral trauma.
• Extravasation of contrast - due to use of excessive pressure in
stricture.
33. Advantages of MR - MCU and RGU
1. These studies are most valuable to detect congenital anomalies, posterior urethral
injuries, and with urethral and periurethral tumours.
2. It is a better imaging modality for assessing the post traumatic pelvic anatomy &
non-invasive method for measuring stricture length.
3. It clearly shows the extent of scar tissue as well as prostatic displacement.
4. MR uretherography is more accurate in estimating the length of obliterative
urethral stricture than RGU combined with Voiding cystouretherography
34. Limitations of conventional RGU combined with voiding
cystouretherography:
1. It does not provide accurate length of the defect because of poor prostatic
urethral filling.
2. It does not provide information regarding extent of fibrosis of corpora spongiosa
or prostatic displacement.
3. The stricture length is overestimated if bladder neck does not relax.
35. Advantages of CT urethrography
1. C.T. voiding uretherography is more comfortable to the patient
because it requires adaptation only in one position.
2. Less time consuming; takes only few seconds
3. Comparison of lurninal size & stricture length for follow up is possible.
4. Extralurninal pathology can be detected
5. Good patient compliance
6. Ability to survey whole urinary tract from kidney to urethra
36.
37.
38.
39. RGU/ASU vs VCUG/MCU
• RGU/ASU is carried out to visualise anterior urethral abnormalities
• VCUG/MCU for posterior urethral abnormalities.
• Additionally, although the bladder is not generally the main target of the exam, as with a
cystogram, a VCUG/MCU may be useful in detection of bladder abnormalities and vesico-
ureteric reflux (VUR).
• In a trauma situation, an RGU/ASU should be performed first. A VCUG/MCU should not be
performed first because blindly trying to introduce a Foley catheter into the bladder in a
trauma setting may lead to creating additional urethral damage with the catheter