This document describes a modified posterior approach to the hip joint developed by the author in 1981. The modification involves osteotomizing the posterior overhanging part of the greater trochanter to improve exposure and decrease dislocations. Cadaver tests found the modified approach provided greater stability than conventional posterior approaches. The author then used the approach clinically with no dislocations reported. Several other surgeons found similar success rates with the modified approach. The approach preserves soft tissue attachments and muscle insertions for improved stability and less risk of nerve damage compared to other posterior approaches.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Dr. Goradia with G2 Orthopedics and Sports Medicine in Glen Allen, VA reviews advances in knee replacement surgery that are helping more patients live pain free.
Since 60 percent of patients ungergoing a knee replacement are women, it makes sense to have a specially designed implant for the female anatomy. The Gender specific knee implant is an unique prosthesis designed for women's anatomy. Women with bilateral knee replacements one with a tradiitonal knee and the other with a gender knee state that they are more comfortable with the gender knee.
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
Reversing the Trend- Newer Types of Shoulder Replacementcoreinstitute
Recently, there has been much discussion about a relatively new type of shoulder replacement, which offers patients the prospects of pain relief and better shoulder function. View this presentation to learn more about this shoulder replacement surgery.
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
This article of mine which came out in the Journal of Orthopaedic Case Reports has been converted into a small book entitled `Modified Posterior Approach to the Hip Joint' which should be available world wide and also listed on Flipart, Amazon,infibeam.
e-Book - Rockstand, Scribid, Kobo, Kindle, Google Play store.
Dr.K.Mohan Iyer,Bangalore,India
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Dr. Goradia with G2 Orthopedics and Sports Medicine in Glen Allen, VA reviews advances in knee replacement surgery that are helping more patients live pain free.
Since 60 percent of patients ungergoing a knee replacement are women, it makes sense to have a specially designed implant for the female anatomy. The Gender specific knee implant is an unique prosthesis designed for women's anatomy. Women with bilateral knee replacements one with a tradiitonal knee and the other with a gender knee state that they are more comfortable with the gender knee.
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
Reversing the Trend- Newer Types of Shoulder Replacementcoreinstitute
Recently, there has been much discussion about a relatively new type of shoulder replacement, which offers patients the prospects of pain relief and better shoulder function. View this presentation to learn more about this shoulder replacement surgery.
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
This article of mine which came out in the Journal of Orthopaedic Case Reports has been converted into a small book entitled `Modified Posterior Approach to the Hip Joint' which should be available world wide and also listed on Flipart, Amazon,infibeam.
e-Book - Rockstand, Scribid, Kobo, Kindle, Google Play store.
Dr.K.Mohan Iyer,Bangalore,India
comminuted fracture of left patellar with displacement case presentationJOEL RAJAN U
A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments. It typically results from a hard blow to the front of the knee or falling on the knee.
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
Computer Navigated Medial Opening Wedge High Tibial Osteotomy- Review of Lite...CrimsonPublishersOPROJ
Computer Navigated Medial Opening Wedge High Tibial Osteotomy- Review of Literature by Kunal Dhurve* in Crimson Publishers: Orthopedic Research and Reviews Journal
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
1.The best way for the anterior approach to the hip on a standard operating table using a leg holder with a combined spinal anaesthetic and general anaesthetic, as written by John O’Donnell, Melbourne, Australia, in 2018.
2.The chapter on total hip replacement as a day case, which is an evolution in total hip replacement, has been written by authors from Frankfurt, Germany, mentioning their schedule in detail in 2018.
3.The principles of anterior approach for total hip arthroplasty have been discussed in detail by authors from Italy in 2018. Their technique involves choice of patients; superficial and deep dissection, exhibiting each step through excellent figures; and dedicated surgical instruments along with the use of intra-operative imaging.
4. Chapter from formerly Hip Preservation Fellow, Research Fellow at Warwick Medical School, UK now based in Sri Lanka discussing how the Direct Anterior approach to the Hip in 2018 can be done on the plain table with supporting explaining figures which is useful in countries in Asia like India without the use of special operating tables and dedicated surgical instruments for the same.
5.An additional chapter on DAA ,written by Dr Kirubakaran Pattabiraman, assistant professor, Department of Orthopedics, JIPMER, Puducherry, India, has been added in the book because his contribution is the most unique as it provides extensive details on DAA.
6.The main aim of this book is for the upcoming postgraduates in orthopedics anywhere in the world to be well versed in the direst anterior approach (DAA) to the hip joint.
K.MohanIyer[15/8/2023]
Piriformis Syndrome:
Table of contents
1.Introduction.
2.Epidemiology of Piriformis Syndrome.
3.Predisposing Factors.
4.Aetiology of Piriformis Syndrome.
5.Specific tests for the Piriformis Syndrome.
6.Pathophysiology
7.Differential Diagnosis
8.Imaging
9.Electro-diagnostic studies
10.Intrapelvic Causes of Sciatica in Piriformis Syndrome
11.Pyomyositis of the Piriformis Muscle
12.Bipartitite Piriformis giving rise to sciatic nerve entrapment
13.Hydrodissection of Piriformis Syndrome
14.Composite Anatomical Variations between the Sciatic
Nerve and the Piriformis Muscle
15.Epidemiology.Clinical Diagnosis of Piriformis Syndrome
16. Peroneal Neuropathy in Piriformis Syndrome
17. Physiotherapy for Piriformis syndrome
18.Treatment of Piriformis Syndrome
19.Complications with Prognosis.
The foreword has been given by Mr Dipen K Menon,MS(Orth), FRCS (Eng Et Glasg), MCh(Orth), FRCS(Tr Et Orth) Consultant Orthopaedic Surgeon, Kettering General Hospital,NHS Foundation Trust (Affiliated to University of Leicester), United Kingdom.
"Piriformis Syndrome" is currently planned to be published by 29.10.2023.
K.Mohan Iyer[1/8/2023]
Modified Posterior Approach to the Hip Joint.pdfnew.pdfKrishnamohan Iyer
Modified Posterior Approach to the Hip Joint[2nd edition]
Table of contents
This is more complex as the entire manuscript is based on my original research that I had done in 1981,which I have been following since then till today with my references.
Chapter no.1: Introduction Posterior Approach(PA) by
Ahmed Zaghloul, Assistant Lecturer,
Orthopaedic department, Faculty of
Medicine, Mansoura University, Egypt.
Chapter no.2: Additional version of PA by Kemal Şibar and
Alper Öztürk,Ankara,Turkey.
Chapter no.3: Direct Anterior Approach to the Hip by Prof.
John O'Donnell,Melbourne,Australia.
Chapter no.4:Principles of Direct Anterior Approach to the
Hip by Alessandro Geraci,Orthopaedic
Department, CaFoncello Hospital,Treviso, Italy
Chapter no.5:Anterior Minimally Invasive Surgery (AMIS) by
Hiran Amarasekera,Consultant Orthopaedic
Surgeon, Neville Fernando Teaching Hospital,
Malabe, Sri Lanka
Chapter no.6: DAA by Kirubakaran Pattabiraman,
Department of Orthopedics,JIPMER,
Puducherry,INDIA and Prof Thomas
Mullner,Austria.
Chapter no.7:DAA[Direct Anterior Approach to the Hip Joint]
by Calllum McBryde et al [Consultant Young
Adult Hip Surgeon, Department of Trauma &
Orthopaedics, Royal Orthopaedic Hospital NHS
Trust, Birmingham, UK]
Chapter no.8:Direct Anterior Approach for Total Hip
Arthroplasty by Rajesh Malhotra and Deepak
Gautam
"Modified Posterior Approach to the Hip Joint 2nd ed." is tentatively planned to be published by 24.09.2023.
K.Mohan Iyer[1/8/2023]
Revised final table of contents:
1.Introduction.
2.Epidemiology of Piriformis Syndrome.
3.Predisposing Factors.
4.Aetiology of Piriformis Syndrome.
5.Specific tests for the PS
6.Pathophysiology
7.Differential Diagnosis
8.Imaging
9.Electro-diagnostic studies
10.Intrapelvic Causes of Sciatica in Piriformis Syndrome
11.Pyomyositis of the Piriformis Muscle
12.Bipartitite Piriformis giving rise to
sciatic nerve entrapment
13.Hydrodissection of Piriformis Syndrome
14.Composite Anatomical Variations between the Sciatic
Nerve and the Piriformis Muscle
15.Epidemiology.Clinical Diagnosis of Piriformis Syndrome
16. Peroneal Neuropathy in Piriformis Syndrome
17. Physiotherapy for Piriformis syndrome
18.Treatment of Piriformis Syndrome
19.Complications with Prognosis.
20. References
21.References for further reading[9 chapters]
K.Mohan Iyer[6/7/2023]
Modified Posterior Approach to the Hip Joint,2nd Edition,
The Surgery for the Hip Joint has evolved considerably in different parts of the world.This evolution dates back to as early as 1883 and is still occuring in many parts of the world.Dr,K.Mohan Iyer started with his research in 1981 and is seen in many textbooks of repute.It has reached a new dimension to include
1. Posterior Approach to Hip Joint.
2. Southern Posterior Approach of the Hip
3. Direct Anterior Approach to the Hip Joint
4. Principles of the Anterior Approach for Total Hip
Arthroplasty
5. Anterior Minimally Invasive Surgery
6. The Direct Anterior Approach
7. Direct Anterior Approach to the Hip Joint
8. Direct Anterior Approach for Total Hip Arthroplasty.
The best part of his research is its feasibility in third world countries when it can be done in an indegenious way as shown in detail in chapter 8 of this book.
This book is being published by Springer Nature[Switzerland] and should be released in 2023.
K.Mohan Iyer[10/6/2023]
My ebook titled Posterior Approaches to the Hip Joint should be available by ...Krishnamohan Iyer
Citations in textbooks of repute
Original Research work done: A New Posterior Approach to the Hip Joint – K. Mohan Iyer, Injury, 13, 76-80, 1981.
1 Campbell’s Textbook of Operative Orthopaedics,12th Edition,by S.Terry Canale and James H.Beaty,Page No.331.
2. The Year Book of Orthopaedics 1982-Mark B.Coventry, Pages:371-373.
3.The Hip: ISBN 10:0812113020/ISBN 13:9780812113020
My original work has been quoted on page no.90.
4. Surgery of the Hip, Elsevier, Mosby/Saunders, Volume 2, by Daniel J.Berry and Jay R.Lieberman, Page No.269.
5. The Adult Hip by John J Callaghan MD, Aaron G Rosenberg MD, Harry E Rubash. Volume 1, Callaghan, Rosenberg and Rubash, ISBN:078175092X, Pages:700-701,718.
6. Surgery of the Hip Edited by Raymond G. Tronzo; Ref.no.187:(Page no.333):Fractures of the Hip in Adults: My original research on the Hip Joint has been quoted.
7. Minially Invasive Total Joint Arthroplasty by William J Hozak,Martin Kirsmer,Michael Hogler,Peter M Bonutti,Franz Rachbauer,Jonathan L Scaffer,William J Donnelly(Editors).
My original work(1981) is also referred to in this book Total
Hip Arthroplasty Arch Orthop Trauma Surg 102:225-229 at reference no.24[pages 115 -229]
This is my book review that came out on 24th Sunday 2017 in the EJOST(European Journal of Orthopaedic Surgery and Traumatology),which I have sent as an attachment.
K.Mohan Iyer(25/9/2017)
This is my next book after which I will be publishing my book “Hip Joint in Adults: Advances and Developments” following my book THE HIP JOINT.by PanStanford,Singapore.(17/7/2017)
Detailed programme of the Global Ortho Congress at Philadelphia,USA where my presentation is on 8/11/2016 at 3.15 to 3.35 pm as seen in this attachment.
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
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.
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
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.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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.
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
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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
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International Journal of Orthopaedics Sciences
Fig 3: Internal rotation torque being applied when the hip joint was
standardized to a fixed angle of flexion and adduction (Courtesy:
Photograph reproduced with the kind permission of Injury/Elsevier)
The stability of the Hip Joint was tested as seen above by
applying trorque with the Hip Joint standardized to fixed angle
of flexion and adduction, to mainly see whether the
trochanteric fixation disrupted or the Hip Joint dislocated.in all
the 3 cadavers tested, the Hip Joint never disrupted indicating
greater stability and hence this devised Modified Posterior
Approach was used in patients.
The patient is placed on the sound side. The skin incision
extends from just distal and lateral to the posterior superior
iliac spine towards the lateral edge of the greater trochanter,
with a curve in the direction of the fibres of gluteus maximus,
and extends down the shaft of the femur for about 10 cm. The
gluteal fascia and the ilio-tibial tract are exposed; the deep
fascia incised vertically in the lower part of the incision and
the incision is curved upwards through the middle of the fibres
of gluteus maximus.
The greater trochanter is osteotomised (Fig.4) through so that
the detached part includes the insertion of the following
structures. From below upwards these are quatratus femoris,
obturator internus with the inferior and superior gaemelli,
piriformis and the posterior third of the fibres of the gluteus
medius. The osteotomy extends from the junction of the
posterior third and anterior two-thirds of the lateral border of
the greater trochanter obliquely downwards and posteriorly to
the shaft of the femur just distal to the quadrate tubercle.
Line Diagram 4 Line Diagram 5 Line Diagram 6
Fig 4: Line Diagram showing the osteotomy of the posterior
overhanging part of the greater trochanter:(Courtesy: Line Diagram
reproduced with the kind permission of Injury/Elsevier): A, Gluteus
maximus; B, Gluteus medius; C, piriformis; D, triradiate tendon; E,
quadratus femoris; F, sciatic nerve; G, greater trochanter, H, osteotome
Fig 5: Line Diagram showing the osteotomy completed and the flap
retracted. (Courtesy: Line Diagram reproduced with the kind
permission of Injury/Elsevier); A, Gluteus maximus; B, gluteus
medius; C, piriformis; D, triradiate tendon; E, quadratus femoris; G,
greater trochanter
Fig 6: Line Diagram to show that the Osteotomy is completed and the
flap retracted, after incising the capsule to expose the Hip Joint,
(Courtesy: reproduced with the kind permission of Injury/Elsevier)
Line diagram showing the following structures: A, gluteus maximus,
B, gluteus medius; C, piriformis; D, triradiate tendon; E, quadratus
femoris; G, greater trochanter; I, acetabulum; J, femoral head
The posterior triangular flap containing the overhanging
posterosuperior part of the greater trochanter at its apex is then
dissected free and turned down to expose the capsule of the hip joint
(Fig.5). The capsule is then incised to expose the joint(Fig.No.6 &
7)After completing the work on the Hip Joint, the Greater Trochanter
is reconstituted by wiring(Fig.No8) with 2 Stainless steel wires,
gauge 18 and thereafter the Hip Joint is closed routinely(Fig 9)
Fig 7: Hip Joint opened; Fig.No.8: Wiring of the trachanteric fragment; Fig.No.9: Closure of the Hip Joint (Figs 7,8 &9: Courtesy: reproduced
with the kind permission of Injury/Elsevier)
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International Journal of Orthopaedics Sciences
Check X-rays are routinely done after the operation
(Fig.No.10)
Fig 10: Radiograpgh of Total Hip Prosthesis. (Courtesy: reproduced
with the kind permission of Injury/Elsevier)
The Modified Posterior Approach follows the anatomical
intermuscular plan and permits full exposure of both the
proximal femur and the acetabulum. (Refs.No.1,2,3 &4) Iyer,
Shatwell and Elloy reported on early results in 44 patients who
had a hemiarthroplasty done with no dislocation in this series.
(Ref.No.5)
Compared to the literature, preserving the piriformis tendon
seems to be superior to repairing it as is done in the Southern
Approach in terms of dislocation of the Endoprosthesis or
THR. (Refs No. 6 & 7)
Mark Coventry did concur with the concept of this approach in
imparting more stability posteriorly postoperatively, as
compared to all other posterior approaches to the hip joint
described since 1874, which either divide the short external
rotators or pass between them which thereby increase the risk
of postoperative dislocation of the hip. (Ref.No. 8)
After I described this Approach, it was quite encouraging that
my respected teacher (Mr.F.H.Beddow) in Liverpool, UK did
a series of 220 Primary Total Hip Replacements by my
technique and noted only 2 dislocations throughout his series.
(Ref.No.9)
Beddow and Tulloch reported on their experience using this
approach in 220 cases of primary total hip replacement in
which there were only 2 cases of dislocation. James Shaw
mentioned the usefulness of this approach (Ref.No.10) in
complex primary cases and revision hip surgery stressing on
the excellent exposure of the acetabulum and femoral shaft,
while eliminating many of the problems associated with other
techniques. He described his own experience by reattaching
the trochantric fragment with 2 lag screws. He did stress this
approach gives an excellent exposure of both the acetabulum
and femur without dissection through scarred anterior or
posterior soft tissue planes or forceful retraction on adjacent
tissues and that the potential for damage to the sciatic or
femoral nerves or femoral vessels is considerably less. He also
noted the obvious advantages to postoperative function as the
muscle insertions of the short lateral rotators are undisturbed,
thereby restoring hip stability and leaving an intact and
considerably uncompromised envelope of soft tissues on the
prosthetic joint.
Terry Canale (Campbell’s Operative Orthopaedics,9th Edition,
1992) does make a reference to this approach in their chapters
on Surgical Approaches and Complications after Total Hip
Arthroplasty with respect to dislocations.(Refr.No:11)
Callaghan, Rosenberg and Rubash (The Adult Hip, 1998) [12]
mention the advantages of preserving the original soft tissue
attachments of the posterior aspect of the hip joint, as obtained
with this approach. They also stress on the excellent exposure
of both the acetabulum and femoral shaft achieved with this
approach in being applicable to both revision arthroplasty and
complex primary arthroplasty. (Refr.No:12)
Thomas Stahelin et al (2002) [13]
have stated that the failure
rate of reinserted short lateral rotators was extremely high at
70% with majority of failures occurring within the first
postoperative day. They also concluded that bone to bone
reattachment as done in this approach is more secure, as
proved by the cadaveric study.(Refr.No:13)
Deepa Iyer (2006) [14]
was fascinated by this Orthopaedic
Dilemma in the elderly that she studied this fracture in detail
and noted its importance for the junior doctors in training,
thereby decreasing morbidity by early diagnosis and treatment.
(Refr.No:14)
Robert H. Cofield (2010) [15]
of Mayo Clinic in Rochester,
Minnesota, USA has been using this approach for the last 25
years with no regrets. He is extremely happy using this
approach since I presented it during the Scientific Congress of
the Asean Orthopaedic Association in Singapore in 1984.
(Refr.No:15)
Mayo Clinic conducted a study of 68 consecutive cases by the
Modified Posterior Approach to the Hip Joint. There were no
cases of late instability. Posterior approach to the hip joint
through a posterior trochanteric osteotomy is associated with
high union rates and a low rate of late instability after hip
replacement. (Refr.No:16)
I am also in regular touch with Daniel J Berry of the Mayo
Clinic, Minnesota, USA who states that he currently uses the
posterior approach to the hip for most primary hip
arthroplasties, while for revision arthroplasties, he frequently
uses the extensile approaches including extended greater
trochanteric osteotomy (Ref.17)
They concluded one disadvantage of the posterior trochanteric
osteotomy is the potential for injury to the superior gluteal
nerve if the gluteus medius muscle split is extended
proximally more than 5 cm from the tip of the trochanter.
In the Modified Posterior Approach to the Hip Joint, bleeding
is minimal, because the plane of cleavage through the gluteus
maximus is through its middle thus leaving intact the branches
of the superior gluteal artery in the proximal half and branches
of the inferior gluteal artery in the distal half, and hence there
is no need to worry about the amount of blood lost. Bleeding is
further reduced as the leash of vessels which lies at the inferior
border of the short lateral rotators is neither cut nor handled.
The most important advantage is that the sciatic nerve is not
isolated at any step in this approach, as corresponding to the
level of the greater trochanter, it lies well medially. Above all,
it is firmly held between the piriformis tendon and the
triradiate tendon, when the greater trochanter is turned
posteriorly, thereby preventing any movement of the nerve.
With this modified posterior approach to the Hip Joint, the
gluteus medius is neither cut at its origin nor insertion, thereby
leaving the abductor mechanism intact.
In this Modified Posterior Approach, Union of the trochanteric
fragment should normally occur, as it is through cancellous
bone and in close proximity to the anastomosis in the
trochanteric fossa.
The concept of trochanteric osteotomy was mainly used in
difficult exposures and soft tissue tensioning. Contemporary
THA accentuates a streamlined approach to surgery and
recovery while maximizing long-term success.
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International Journal of Orthopaedics Sciences
The standard osteotomy may be oblique or posterior. The
standard TO was originally popularized for use in hip
arthroplasty by Charnley (Refr. No: 18).
Complications of trochanteric osteotomy can be divided into
two broad categories: those related to osteotomy healing and
those related to the mode of fixation. Nonunion or a fibrous
union of the trochanter is not necessarily a complication with
clinical significance.[If the trochanter does not heal by bony
bridging, however, associated issues of pain, hardware
breakage, or abductor dysfunction may manifest as impaired
gait, Trendelenburg lurch, subluxation, or dislocation of the
hip replacement. Even when union of the trochanter occurs,
the patient may still have problems. Trochanteric pain and
bursitis may be related to a prominent trochanter or to
irritating hardware. Fraying and breakage of hardware can lead
not only to pain, but also to wear and the need for early
revision.
Though Surgeons may adopt any approach to the hip joint in
which they are familiar or trained, this modification may be
helpful when the greater trochanter is intact in cases when
treating a dislocated hip joint, when the blame for the
dislocation may be avoided on the posterior approach to the
hip joint.
2. References
1. Iyer KM. Technical note on Modified Posterior Approach
to the Hip Joint. Journal of Orthopaedic Case Reports.
2015; 5(1):69-72.
2. Iyer KM. Guest Editorial for the Journal of Medical
Thesis. 2015; 3(1):3-3.
3. Modified Posterior Approach to the Hip Joint. Notion
Press (Chennai, India), 2015.
4. A New Posterior Approach to the Hip Joint – K. Mohan
Iyer, Injury, 1981; 13:76-80.
5. Experience with Thompson’s prosthesis using the New
Posterior Approach – K. Mohan Iyer, M.A. Shatwell and
M.A. Elloy, Injury, 1982; 14:243-244.
6. Incidence Of Piriformis Tendon Preservation On The
Dislocation Rate Of Total Hip Replacement Following
The Posterior Approach, by Charbel D. Moussallem, Fadi
A. HOYEK and Jean-Claude F. LAHOUD in the
Lebanese Medical Journal. 2012; 60(1):19.
7. HIP JOINT (Under Publication by Pan Stanford
Publishing)
8. Mark B. Coventry, the Year Book of Orthopaedics, 1982,
371-373.
9. Rheumatoid Arthritis Surgical Society-Clinical
Experience with the Iyer modification of the Posterior
Approach to the Hip: F.H. Beddow and C.Tulloch, J.Bone
Joint Surg (BR) 1990; 73B(II):164-165.
10. Experience with modified Posterior Approach to the Hip
Joint. A Technical note: Shaw J.A: J Arthroplasty. 1991;
6(1):11-18.
11. Campbell’s Operative Orthopaedics, S. Terry Canale
Ninth Edition, 1992; 1(140):387-466.
12. Callaghan, Rosenberg, Rubash. The Adult Hip
(Lippincott-Raven), 1998; 1:700-701, 718.
13. Failure of Reinserted Short External Rotator Muscles after
Total Hip Arthroplasty-Thomas Stahelin, P. Vienne and
O. Hershe The Journal of Arthroplasty. 2002; 17(5):604-
607.
14. Deepa Iyer. The Orthopaedic Enigma: A Simplified
Classification. The Internet Journal of Orthopaedic
Surgery. 2006, 3(2).
15. Cofield Robert H. Personal Communication, 2010.
16. Primary hip arthroplasty through a limited posterior
trochnteric osteotomy-JaoquinSanchez- Sotelo, John
Gipple, Daniel Berry, Charles Rowland, Robert Cofield
Acta Orthop Belg., 2005; 71:548-554.
17. Daniel Berry J. Personal Communication, 2015.
18. Charnley J. The long-term results of low-friction
arthroplasty of the hip performed as a primary
intervention. J Bone Joint Surg Br. 1972; 54:61.