This document discusses the management of multi-ligament knee injuries (MLKI). It notes that MLKI have a low incidence but can cause life-threatening neurovascular complications. While the literature lacks large comparative studies, it generally supports early surgical treatment and rehabilitation. There is debate around issues like timing of surgery, repair vs reconstruction, graft choices, and postoperative rehabilitation. Proper assessment of neurovascular injury is important in the acute setting. Surgical management aims to anatomically reconstruct the injured structures using validated techniques to improve outcomes.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Avascular necrosis of Hip - treatment modalities and current concepts.pptxVivek Jadawala
Slide 1 - Treatment modalities of Avascular Necrosis of Hip
JOURNAL CLUB PRESENTATION
Dr. Vivek Jadawala
PGY-3, Dept. of Orthopaedics,
JNMC, DMIHER
Slide 2 - image
slide 3 - image
slide 4 - Osteonecrosis of Hip - Osteonecrosis is death of living elements of involved bone (cells including marrow) with progressive destruction and alteration of bone architecture as a result of compromised vascularity.
Usually aseptic but may be incited by loss of vascularity from infection.
Slide 5 - Epidemiology - Male > Female
Average age group – 35 to 50 years
Bilateral Hip joints – 80 % of the cases
Most common site – Antero-lateral aspect of femoral head
Slide 6 - Blood supply of femoral head
Slide 7 - Classification of AVN: Ficat and Arlet -STAGE 0 :
X-ray : normal
MRI: normal
clinical symptoms: nil
STAGE I :
X-ray : normal or minor osteopenia
MRI: edema
bone scan: increased uptake
clinical symptoms: pain typically in the groin
Slide 8 - Stage I
Slide 9 - Stage II -
X-ray: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign)
MRI: geographic defect
Bone scan: increased uptake
clinical symptoms: pain and stiffness
Slide 10 - Stage III - X-ray: Crescent sign and eventual cortical collapse
MRI: same as plain radiograph
clinical symptoms: pain and stiffness +/- radiation to knee and limp
Slide 11 - Stage IV - X-ray: end-stage with evidence of secondary degenerative change
MRI: same as plain radiograph
clinical symptoms: pain and limp
Slide 12 - Stage IV
Slide 13 - image
Slide 14 - Steinberg staging of AVN
Slide 15 - Steinberg staging - STAGE 0:
- normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often contralateral hip involved, or patient has risk factors and hip pain)
STAGE I:
normal radiograph, abnormal bone scan and/or MRI
STAGE II:
- cystic and sclerotic radiographic changes
STAGE I AND II
A, mild: <15% head involvement as seen on radiograph or MRI
B, moderate: 15% to 30%
C, severe: >30%
Slide 16 - STAGE III:
- subchondral lucency or crescent sign
A, mild: subchondral collapse (crescent) beneath <15% of articular surface
B, moderate: crescent beneath 15% to 30%
C, severe: crescent beneath >30%
STAGE IV:
flattening of femoral head, with depression graded into
A, mild: <15% of surface has collapsed and depression is <2 mm
B, moderate: 15% to 30% collapsed or 2-4 mm depression
C, severe: >30% collapsed or >4 mm depression
Slide 17 - STAGE V:
- joint space narrowing with or without acetabular involvement
STAGE VI:
- advanced degenerative changes
Slide 18 - Association Research Circulation Osseous classification
Slide 19 - image
Slide 20 - Kerboul angle - Original classification was proposed on radiographs where he divided the necrotic region into small, medium and large regions:
Small - less than or equal to 160°
Medium - 161 to 199°
Large - 200 or more degrees.
Slide 21 - Modified Kerboul angle - based on MRI has much higher values as the MRI overestimates the necrotic region
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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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.
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.
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
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
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.
1. Management in
Multi- ligamentous knee injury
(MLKI)
Dr. Jose Austine
Resident, Dept. of Orthopaedic surgery,
Kasturba Medical College, Mangalore
Moderators
Dr. Atmananda Hegde
Dr. Sunil Murthy
2.
3. • Knee dislocation and
MLKI
• <0.02% incidence
• Life and limb
threatening(neuro-
vascular) complications
• Large-scale data for
comparative analysis
and defining a standard
treatment protocol are
not available.
4. • Conservative vs operative
• Timing of surgery
• Repair vs reconstruction
• Allograft vs autograft
• Partial vs total repair
• Immediate vs delayed mobilization
Management Controversies
All ‘supported’ by at best Level 3 evidence.
10. Acute MLKI- Emergency Mx
• Prompt reduction of dislocation in the ER
• Re-evaluate the neurovascular status
• Splint the limb
11.
12. Ankle brachial index (ABI)
ABI = Doppler systolic blood pressure in the injured limb(A)
Systolic blood pressure in the uninjured upper limb(B)
ABI <0.8 or <0.9 then angiogram
18. Surgical vs Non-surgical Mx
• Dedmond et al (Meta analysis 2001)
• Richter et al (Meta analysis 2002)
• Levy et al (Meta analysis 2009)
üLiterature supports surgical treatment and
postoperative functional rehabilitation of multi-
ligament knee injuries.
üRare occasions such as advanced age, immobility and
comorbidities that nonsurgical treatment can be
considered.
19. Repair vs reconstruction
• Patients with repair of cruciate ligaments had higher rates of flexion deficit >6°, higher rates of posterior
instability and lower rates of return to preinjury activity levels. (Mariani et al)
• High reoperation rates have been reported in patients with posterolateral injuries treated with repair.
ü Anatomic reconstruction of the injured structures using biomechanically validated techniques
yield improved outcomes.
ü In the setting of multi-ligament injuries, reconstruction of the torn ligaments is recommended.
ü Repair of the collaterals is usually reserved for bony avulsion injuries.
21. Timing of surgery
• Early surgery (<3 week) has shown higher incidences of postoperative
stiffness and a fixed flexion deformity with higher rates of manipulation
under general anesthesia as compared to delayed repair.
• Delayed repair has higher chances of scarring of soft tissue with more
difficulty in identification and navigation in the joint leading to higher
chances of vascular complications.
• No conclusive evidence is suggestive of an advantage offered by a single
or a staged procedure.
22. Timing of surgery
• Acute- generally favoured in literature
- 3 weeks( before scarring or necrosis occurs)
(Engebretsen et al , Mariani et al , Fanelli et al, Harner et al)
- 6 weeks regarded as acute by Levy et al, Laprade et al
• Chronic – Not recommended unless forced delay
(eg- vascular injury)
23. Choice of graft- Auto vs Allo
Auto-grafts Allo-grafts
• Tensor fascia lata
• Bone patella tendon
bone
• Hamstring
• Quadriceps
• Peroneus longus
• Tibialis posterior/ anterior
• Tendoachilles
• Patellar tendon
• Hamstrings
27. Avoiding tunnel convergence
• Tunnel convergence increases the risk of
reconstruction graft failure.
• Potential damage to reconstruction grafts and
fixation devices.
• Not having sufficient bone stock between the grafts
for fixation and graft incorporation.
28.
29.
30.
31. Tensioning sequence
Moatshe G, Laprade et al
• AL bundle of PCL at 90°(restore normal tibial step off)
• PM bundle of PCL in extension
• FCL at 20°−30° knee flexion and slight valgus.
• Other PLC structures at 60°of flexion and neutral rotation.
• ACL near full extension
• Finally, Posteromedial corner.
32.
33.
34. Major Pitfalls
Ø Patient positioning
Ø Graft preparation- Prevent oversizing, ensure availability
Ø Tunnel convergence
Ø Meniscal root injuries- Malposition of PCL and ACL tunnel
Ø Neurovascular complications- when creating tibial tunnels
Ø Fixation
35.
36. Summary
Ø Complex problem
Ø Assessment of vascular and neurological injury paramount.
Ø Data lacking for definitive management protocols.
Ø Any intervention needs to be individualized by the presence of any life- or limb-threatening
complication
Ø Early operative treatment yields improved functional and clinical outcomes compared with non-
operativemanagement or delayed surgery.
