Megacolon, also known as Hirschsprung's disease, is a congenital condition where part of the colon lacks nerve cells (ganglia), preventing normal contractions. This leads to dilation of the colon above the affected area. It is caused by failed migration of nerve cells during fetal development. The main symptoms are constipation and abdominal distension in infants. Diagnosis involves barium enema, rectal biopsy, and manometry to detect the absence of ganglia and abnormal contractions. The definitive treatment is surgical removal of the aganglionic segment and reconnection of the bowel.
Dr Bipin Ghanghurde, hand surgeon, Mumbai, +917738729068,
Bipinghanghurde@gmail.com
Syndactyly is a common hereditary digit malformation where
adjacent fingers are webbed due to a failure to separate during limb development. Surgical release is indicated in almost every case except for a mild, incomplete syndactyly without functional impairment.
References
Braun TL, Trost JG, Pederson WC: Syndactyly Release. SeminPlastSurg 30:162-70, 2016.
2. Cronin TD. Syndactylism: results of zig-zag incision to prevent postoperative contracture. PlastReconstrSurg (1946) 1956;18(6): 460–468.
3. Dao KD, Shin AY, Billings A, Oberg KC, Wood VE: Surgical treatment of congenital syndactyly of the hand. J Am AcadOrthopSurg 12:39-48, 2004.
4. Malik S: Syndactyly: phenotypes, genetics and current classification. Eur J Hum Genet 20:817-24, 2012.
5. Tonkin MA: Failure of differentiation part I: Syndactyly. Hand Clin 25:171-93, 2009.
6. Withey SJ, Kangesu T, Carver N, Sommerlad BC. The open finger technique for the release of syndactyly. J Hand Surg [Br] 2001; 26(1):4–7.
Types, Investigation, complication and treatment of Incisional herniaimraxid
It is herniation through a weak abdominal scar (scar of previous surgery).
It is common in old age and obese individuals.
Predisposing Factors:
..> Vertical scar, midline scar, lower abdominal scar— may injure the nerves of the abdominal muscles.
...> Scar of major surgeries (biliary, pancreatic).
...> Scar of emergency surgeries (peritonitis, acute abdomen).
For Health Tips: http://MedicoPk.com/
Dr Bipin Ghanghurde, hand surgeon, Mumbai, +917738729068,
Bipinghanghurde@gmail.com
Syndactyly is a common hereditary digit malformation where
adjacent fingers are webbed due to a failure to separate during limb development. Surgical release is indicated in almost every case except for a mild, incomplete syndactyly without functional impairment.
References
Braun TL, Trost JG, Pederson WC: Syndactyly Release. SeminPlastSurg 30:162-70, 2016.
2. Cronin TD. Syndactylism: results of zig-zag incision to prevent postoperative contracture. PlastReconstrSurg (1946) 1956;18(6): 460–468.
3. Dao KD, Shin AY, Billings A, Oberg KC, Wood VE: Surgical treatment of congenital syndactyly of the hand. J Am AcadOrthopSurg 12:39-48, 2004.
4. Malik S: Syndactyly: phenotypes, genetics and current classification. Eur J Hum Genet 20:817-24, 2012.
5. Tonkin MA: Failure of differentiation part I: Syndactyly. Hand Clin 25:171-93, 2009.
6. Withey SJ, Kangesu T, Carver N, Sommerlad BC. The open finger technique for the release of syndactyly. J Hand Surg [Br] 2001; 26(1):4–7.
Types, Investigation, complication and treatment of Incisional herniaimraxid
It is herniation through a weak abdominal scar (scar of previous surgery).
It is common in old age and obese individuals.
Predisposing Factors:
..> Vertical scar, midline scar, lower abdominal scar— may injure the nerves of the abdominal muscles.
...> Scar of major surgeries (biliary, pancreatic).
...> Scar of emergency surgeries (peritonitis, acute abdomen).
For Health Tips: http://MedicoPk.com/
Adhesion are defined as abnormal attachments between tissues and organs. Intra-abdominal adhesions classified as congenital or acquired. Acquired adhesions result from the inflammatory response of the peritoneum that arises after intra-abdominal inflammatory processes for example acute appendicitis, pelvic inflammatory disease, exposure to intestinal contents, radiation and surgical trauma.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
A miscarriage is the loss of pregnancy from natural causes before the 20th week of pregnancy. Most miscarriages occur very early in the pregnancy, often before a woman even knows she is pregnant. There are many different causes for a miscarriage. In most cases, there is nothing you can do to prevent a miscarriage.
This clinical topic presentation which was done by me, on topic gynecomastia, a common problem medicine and endocrine specialists face on their day to day practice. It gives a brief idea about definition, clinical presentation, pathophysiology and management and prognosis of gynecomastia.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Adhesion are defined as abnormal attachments between tissues and organs. Intra-abdominal adhesions classified as congenital or acquired. Acquired adhesions result from the inflammatory response of the peritoneum that arises after intra-abdominal inflammatory processes for example acute appendicitis, pelvic inflammatory disease, exposure to intestinal contents, radiation and surgical trauma.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
A miscarriage is the loss of pregnancy from natural causes before the 20th week of pregnancy. Most miscarriages occur very early in the pregnancy, often before a woman even knows she is pregnant. There are many different causes for a miscarriage. In most cases, there is nothing you can do to prevent a miscarriage.
This clinical topic presentation which was done by me, on topic gynecomastia, a common problem medicine and endocrine specialists face on their day to day practice. It gives a brief idea about definition, clinical presentation, pathophysiology and management and prognosis of gynecomastia.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
HIRSCHSPRUNG DISEASE of neonate wrr.pptxShambelNegese
disease is a condition that affects the large intestine (colon) and causes problems with passing stool. The condition is present at birth (congenital) as a result of missing nerve cells in the muscles of the baby's colon.
Hirschsprung's diseasedelayed pssage of meconium ,abdominal distension , repe...FarsanaM
Hirschsprungs disease, I n newborn ; delayed pssage of meconium ,abdominal distension , repeated vomiting,constipation or gas, diarrhoea,in older children chronic constipation, abdominal distension, failure to thrive, also called as Aganglionic megacolon occures due to absence of ganglion cells in myeneteric and submucosal lpexus.Results in failure in relaxation of the internal anus sphincture and affected bowel
Hirchsprung’s disease by Dr Afuye Olubunmi OlusolaAlade Olubunmi
In Hirchsprung's disease, Absence of ganglion cells in the myenteric and submucosal plexus
Upstream bowel becomes dilated secondary to functional obstruction.
Hirschsprung disease is a developmental disorder of the enteric nervous system that is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the distal intestine.
Because these cells are responsible for normal peristalsis, patients with Hirschsprung disease present with functional intestinal obstruction at the level of aganglionosis.
Some patients present later in childhood, or even during adulthood, with chronic constipation.
This is most common among breast-fed infants, who typically develop constipation around the time of weaning.
Although most children who present after the neonatal period have short-segment disease, this history may also be found in those with longer segment or even total colonic involvement, particularly if the child has been exclusively breast-fed.
The etiology of HAEC is controversial.
The most common theory is that stasis caused by functional obstruction due to the aganglionic bowel permits bacterial overgrowth with secondary infection.
Infectious agents such as Clostridium difficile or Rotavirus have been postulated as being causative, but there are few data to support a specific pathogen.
Can occur in either pre or post operative period (sometimes both)
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
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.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
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
5. Aetiology and Pathogenesis
• It is caused by absence of ganglionic cells of the
pelvic parasympathetic system in both
Auerbach’s plexus between the circular and
longitudinal muscle layers of the colon and
Meissner's plexus in the submucosa.
• It is believed to be the result of failure of
migration of neuroblasts into the gut from nerve
trunks.
• It usually occurs at the end of the first trimestar
of foetal life.
6. Aetiology and Pathogenesis
• Aganglionosis may result if there cessation of
migration of neuroblasts, which migrate from
the primitive node along the alimentary track
distalwise.
• The internal anal sphincter is aganglionic in
every case of Hirschsprung’s disease.
• This aganglionosis extends proximaliy to
variable distance according to the failure of
descent of the neuroblasts.
7. Aetiology and Pathogenesis
• Approximately 80% of cases involve the
rectosigmoid junction and 15% have aganglionic
segment extending as far proximaliy as the
hepatic flexure.
• The former condition is called ‘short segment
aganglionosis’ and the latter condition is called
‘long segment aganglionosis’.
• There are some cases where aganglionosis occurs
in skip areas, these are known as ‘segmental
aganglionosis’.
8. Aetiology and Pathogenesis
• There is absence of peristalsis in the
aganglionic segments thus producing
adynamic intestinal obstruction.
• Lack of peristalsis in the aganglionic segment
and failure of relaxation of the internal anal
sphincter produce varying degrees of
intestinal obstruction found in this disease.
9. PATHOLOGY
• The bowel proximal to the aganglionic
segment becomes gradually dilated and
hypertrophied for a variable length as the
peristaltic waves try to propel stools through
the obstructing aganglionic segment
10. PATHOLOGY
• There is a visible transition zone, usually 1 to 5
cm in length between the dilated bowel which
contains ganglionic cells on the proximal side
and normal sized aganglionic segment of
bowel on the distal side.
• All layers of the dilated intestine show gross
pathological changes.
• The mucous lining is chronically inflamed and
frequently ulcerated.
11. PATHOLOGY
• The pelvic mesocolon is elongated and
thickened and its blood vessels are large and
prominent.
• As in majority of cases the aganglionic
segment stops proximaliy at sigmoid colon,
the grossly dilated portion mostly involves the
upper sigmoid colon and lower descending
colon.
12. Clinical features
• This condition is more common in males and
it shows familial tendency.
• The symptoms appear within 3 days of birth
and the presenting features are as follows :
(i) Constipation
(ii) Abdominal distension
13. Clinical features
(i) Constipation
• The new born child fails to pass meconium
within first 2 or 3 days.
• If the little finger is introduced into the rectum
meconium is passed in inadequate amount
and toothpaste like.
14. Clinical features
(ii) Abdominal distension
This becomes obvious by the 3rd day.
Gradually the distension progressesand the colon
is involved in distension.
Visible peristalsis may be seen with loud
borborygmi.
15. Clinical features
• In some babies the symptoms may suggest
mild gastroenteritis or a feeding problem
associated with mild constipation.
• As the condition becomes more chronic the
baby fails to gain weight, becomes
hypoproteinaemic and suffers from
intermittent episodes of severe constipation
and diarrhoea.
16. Clinical features
• Eventually enterocolitis may develop, a lethal
complication of Hirschsprung’s disease.
• The clinical picture includes fever, vomiting,
watery or bloody diarrhoea, septic shock and
finally death.
• Enterocolitis develops due to invasion of
bacteria from the dilated colon through
erosion and ulceration in the mucosa into the
wall of the colon.
• Immediate vigorous management is indicated
18. Special Investigations
• 1. BARIUM ENEMA EXAMINATION
This should be done in unprepared bowel as
wash-outs may minimise the dilatation of the
gut above the obstruction.
Barium enema should be prepared with
normal saline and not with water, as
magacolon absorbs water much more rapidly
than normal bowel and may result in water
intoxication.
20. • This examination will demonstrate dilated colon
followed by narrow aganglionic segment.
• The diagnosis becomes difficult if the child has a
very short segment involved or if the entire colon
is aganglionic.
• In infants the proximal non-affected colon may
not become very much dilated, but in these cases
the retention of barium after 24 hours is quite
diagnostic.
• It is always essential that both anteroposterior
and lateral views should be taken as narrow short
segments may be overlapped by dilated proximal
colon in one of the views.
22. 2. RECTAL BIOPSY
• Will demonstrate absence of ganglionic cells in
the intramural and submucous plexuses.
• Biopsy should be taken at least 2 cm above
the dentate line.
• An attempt should be made to take full
thickness wall for biopsy, as superficial biopsy
cannot confirm presence or absence of
ganglion cells in the intramural plexus.
23. 3. MANOMETRIC STUDIES
• Can be done easily in the older children and
absence of relaxation of the internal anal
sphincter will confirm the diagnosis.
24. Treatment
The main curative treatment of this disease is
excision of the entire aganglionic segment
(the cause of functional obstruction) and
continuity is restored with normal sphincteric
control of the anus.
COLOSTOMY