The document discusses various gynecological instruments including speculums, dilators, forceps and cannulas. It explains their uses in obstetrics and gynecology for examining patients, performing procedures like dilation and curettage, and managing conditions like postpartum hemorrhage. Key instruments mentioned are Sims speculum, Simpson sound, Matthew Duncan dilator, Mayo scissors, sponge holding forceps, and Green Armytage forceps. Conditions where only dilation is needed and contraindications for procedures are also summarized.
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
Recurrent bacteriuria in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria, acute cystitis and pyelonephritis.
Recurrent bacteriuria in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria, acute cystitis and pyelonephritis.
SLOFT (Submucosal Ligation Of Fistula Tract) is new minimally invasive method to treat fistula in ano. It is closure of internal opening, It is modification of LIFT with more simplicity, reproducibility and no limitations of those of LIFT
A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina. Cervical biopsies can be done in several ways.
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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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
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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
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.
7. USES - BOTH
OBSTETRIC USES
• 1) To confirm diagnosis of PROM.
• 2) During cervical encirclage procedure.
GYNEC USES
• 1) to take Pap smear
• 2) during vaginal hysterectomy.
• 3) To exam the anterior vaginal wall for diagnosis
of vesico-vaginal fistula.
• 4) To diagnose pelvic organ prolapse.
8. ADVANTAGES & DISADVANTAGES –
OVER SIMS SPECULUM
• Self retaining instrument – needs no
assistant
• Cannot be used for procedures involving
the anterior and posterior vaginal wall.
12. USES – uterine sound / Matthew Duncan
UTERINE SOUND
• measure uterocervical length.
• Know AV/ RV uterus.
•
MATTHEW DUNCAN
• For dilatation and curettage.
• Only 1 size per instrument
• For Anteversion of uterus during lap cases.
17. Mayo artery forceps
Uses……
• This is a hemostat.
• For clamping bleeding vessels.
• For grasping tissue at the time of
operation. (Opening and closing
peritoneum) .
• To hold stay sutures.
• 2 types- straight and curved.
19. USES
SPONGE HOLDING FORCEPS
• Preparation of parts with antiseptic solution
• To hold a sponge to mop from a distance
• For blunt dissection with a gauze
• To hold cervix in pregnancy during – cerclage,
diagnosis & repair of cervical tear, D&E
OVUM FORCEPS
1. To remove products of conception
2. To remove uterine polyp
3. To remove foreign body in vagina .
21. USES
ALLIS TISSUE HOLDING FORCEPS
– Hold edges of vaginal wall during
• Colporrhaphy
• TAH
• Vaginal wall cyst excision
– Myomectomy
– Hold the rectus sheath
– Hold the uterine edges in ceaserean
section
BABCOCK’S
• To hold soft tissues during surgery
• Fallopian tubes
• Bladder
• Bowel
• appendix
25. • This forceps is used as a hemostatic instrument in caesarean operation. As the tips are
broad wide area can be compressed.
• In LSCS the cut uterine edges bleed . This forceps is applied to the two angles and lower and
upper edge of the incision.
uses
28. • USE – TAH
• Serrations are oblique – risk of tissues slipping is less
• No tooth at the tip – risk of tissue trauma is less
Advantages over kochers
30. KARMAN’S SUCTION CANNULA
# UTERINE PERFORATION IS LESS
# BLOOD LOSS IS MINIMAL
# INCOMPLETE EVACUATION IS LESS LIKELY
ADVANTAGE OVER metal CURETTAGE ?
32. HYSTERO SALPINGO GRAPHY
Which day of cycle ?
6 to 8th day
What DYE ?
Uro graffin / 60% Sodium Iotalamate or
(60%methylglucaminediatrizoate(water soluble)
Alternatives to HSG ?
Laparoscopic chromotubation
Advantage over lap chromotubation
Site of block
36. • Ayre’s Spatula – for taking the smear from cervix,
posterior vaginal wall, upper 1/3 of lateral vaginal wall
• Cyto Brush – used to take smear from the cervical canal
• Solution used is 95% ethanol
• Indications of Pap smear
• CIN/Ca Cx
• Follow up after Wertheim’s hysterectomy
• Hormonal cytology from upper 1/3 of lateral vaginal wall
• Buccal smear for Barr bodies
• Liquid based cytology
• suspension of cells from the sample and this is used to
produce a thin layer of cells on a slide.
• The ThinPrep method requires an instrument and
special polycarbonate filters.
• After the instrument immerses the filter into the
vial, the filter is rotated to homogenize the sample.
Cells are collected on the surface of the filter when
a vacuum is applied.
• The filter is then pressed against a slide to
transfer the cells into a 20 mm diameter circle.
37. Urinary catheters
• Metal catheter
• Intermittent bladder drainage
• Uses
• Prior to any vaginal procedures
• Foleys catheter
• Size – 16 F
• Uses –
• Gynec –
• Continous bladder drainage – major surgical
procedures.
• Obs –
• Control haemorrhage (balloon Tamponade)
• Induction of labour.
38. • Bakri balloon tamponade
• Mechanical method of management of PPH.
• Maximum instilled water – 350 ml
• 24 F catheter.
39. • Cryo probe
• Treatment of LSIL or CIN 1
• Freeze thaw freeze technique. -70 C
• Cryotherapy – mechanism of action
• Side effects – profuse vaginal discharge
post procedure
• Loop electro excision procedure (LEEP)
• Conisation – surgical technique wherein
cone shaped cervix removed with the help
of the cautery.
• 8 – 10 mm cervical tissue
51. A drop of saline is placed on
hub of the needle sucked in to
peritoneal cavity
Saline can be injected in
to needle freely and cannot
be reaspirated
CONFIRM ENTRY INTO
PERITONEAL CAVITY
VEREES NEEDLE
52. TROCAR & CANULA
• Trocar is put into the canula – then entered into abdominal cavity.
• Size – 10 mm – camera
• 7 mm – band applicator instrument
• 5 mm – working port
• Trumphet – prevent gas leak
• Opening to connect the gas
59. 1. Identify
• Ca. endometrium
2. Corpus cancer syndrome ?
3. Familial hereditary syndrome
associated with Ca
endometrium.
4. How will you diagnose?
Fractional curettage
63. IDENTIFY
TUBAL Ectopic pregnancy
.What is SAM?
Surgically Administered Medical therapy
.Pre-requisites for methotrexate?
beta HCG < 1500 IU
Tubal mass <3.5cms
FH ABSENT
MOA – methotrexate
Side effects
Multi dose regimine
64. Department of Obstetrics and Gynaecology, SRMC&RI
IDENTIFY
Hydatiform mole
Karyotype of partial mole – Triploid
Treatment - S & E
How will you follow up this patient?
Weekly till normal for three weeks
Monthly for six months.
66. • A 27 year nulliparous lady (marital life 5 yrs) had come for infertility treatment
• Her usg shows this picture
• Comment on this
• Any other tests for the same..?
68. PCOS Criteria
ROTTERDAM
ESHRE/ASRM
• 24 Years unmarried girl with
irregular cycles
• USG picture as given, comment
• Criteria for diagnosing this
condition
• Clinical implications and treatment
69. 30 yrs , primary infertility for 3yrs , undergone ovulation induction and now has come with pain
abdomen and vomiting and her USG showed this picture
Diagnosis
Classification
Management and prevention
71. • Gonen and casper in 1990.
• Type a: entirely homogeneous, hyperechogenic pattern, without a central echogenic line
• Type b: intermediate iso-echogenic pattern, with the same reflectivity as the surrounding myometrium and a non-
myometrium and a non-prominent or absent central echogenic line
• Type c: multilayered ‘triple-line’ endometrium consisting of a prominent outer and central hyperechogenic line and inner
hyperechogenic line and inner hypo-echogenic or black region
72. • APPLEBAUM SCORING
• The endometrial and periendometrial areas are divided into the following four zones
• Zone 1: A 2-mm thick area surrounding the hyperechoic outer layer of the endometrium.
• Zone 2: The hyperechoic outer layer of the endometrium.
• Zone 3: The hypoechoic inner layer of the endometrium.
• Zone 4: The endometrial cavity.
75. • 44 yr old multiparous lady came with heavy menstrual bleeding and pain abdomen.
• Examination revealed bulky and tender uterus, bilateral fornices free
• Her USG showed this pic
• Diagnosis
• Management
76. • USG criteria for ADENOMYOSIS
• Diffuse uterine enlargement
• Diffusely heterogenous myometrium
• Asymmetrical thickening of myometrium
• Poor defining of endometrial –myometrial borders
• Inhomogenous hypoechoic areas
• Focal probe tenderness
77. • Identify this picture
• What modality of investigation is better for the diagnosis
• Specific complaints
• Management
79. • 47 yrs, multiparous women with heavy menstrual bleeding
• Imaging shows this picture
• Diagnosis
• Treatment
• Role of medical management
• Prerequisites for myomectomy
80. • Comment on this picture
• Indications and contraindications
• Procedure
83. • Uterine anomalies
• Classification
• AFS(1988)- lacked specific diagnostic criteria
• ESHRE (2013) - based primarily on uterine anatomy with cervical vaginal anomalies.
Classes: U0–U6 , C0–C4, V0–V4. 3D-based diagnostic criteria for septate and bicornuate
uterus
• ASRM(2021)- Nine classes: Mullerian agenesis, cervical agenesis, unicornuate, uterus
didelphys, bicornuate, septate, longitudinal vaginal septum, transverse vaginal septum,
complex anomalies.
84.
85. • Screening tests
• Diagnostic tests - 3D TVS and MRI
• The diagnostic accuracy of 3D - 97.6%
• Sensitivity- 98.3% and specificity -99.4%
86. • Angle of divergence: <75
• External contour normal or
mild indentation
• Angle of divergence >105
• Indentation>10mm
• Intervening cleft >1cm
• Intercornual distance >5cm
Bicornuate uterus
Septate uterus
Limitation
• External uterine contour cannot be evaluated
• In cases of non-communicating rudimentary uterine horn may be missed.
87. 1- interostial line
2- Parallel line over the fundus
3-uterine thickness
4-septal indentation
Troiano and mccarthy formula
A line joining both the horns
• If it cosses the fundus or
<5mm- bicornuate
• >5mm- septate
88. Tvs pelvis
•
Uterine
morphology
Internal contour External contour
Normal Straight or convex Uniformly convex or with
indentation < 10 mm
Arcuate Concave fundal indentation with
central point of indentation at
obtuse angle (>90◦ )
Uniformly convex or with
indentation < 10 mm
Subseptate Presence of septum, which does
not extend to cervix, with central
point of septum at an acute angle
(<90)
Uniformly convex or with
indentation < 10 mm
Septate Presence of uterine septum that
completely divides cavity from
fundus to cervix
Uniformly convex or with
indentation < 10 mm
Unicornuate Single well-formed uterine cavity
with a single interstitial portion
of fallopian tube and concave
fundal contour
Indentation >10mm if
rudimentary horn is present
Bicornuate Two well-formed uterine cornua Indentation>10mm dividing
2 cornu
T shaped T-shaped uterine cavity
89.
90. CLINICAL IMPLICATIONS OF SEPTATE UTERUS
• Infertility
• Frequency of ectopic 27.34% as compared to 13.3% otherwise
• Abortions
• First trimester – 28-45%
• Second trimester-5%
• Preterm deliveries
92. HSG findings in Genital TB
FALLOPIAN TUBES
Specific findings
• Beaded tube
• Golf club appearance
• Pipestem app
• Floral app
• Leopard skin app
Non specific findings
• Hydrosalphinx
• Mucosal thickening
• Peritubal adhesions(tobacco pouch app, loculated spill, cockscrew app
93.
94.
95.
96.
97. PARARECTAL SPACE
• Medial- rectum
• Lateral- internal iliac artery
• Anterior- uterine artery
• Roof- posterior leaf of broad ligament
• Floor- levator ani
• The ureter further divides the pararectal
space into the medial and lateral pararectal
spaces
• Medial pararectal space- OKABAYASHI
SPACE
• Lateral pararectal - LATZKO SPACE
• Clinical implications : (superior hypogastric
plexus)nerve-sparing radical hysterectomy,
as well for nerve-sparing fertility preserving
procedures (endometriosis)
PARAVESICAL SPACE
• Medially- bladder,
• Laterally- pelvic walls
• Inferiorly -uterine artery
• The paravesical space is divided into
medial and lateral paravesical spaces by
the obliterated hypogastric artery or the
lateral umbilical ligament
• medial paravesical space dissection -
optimum oncological clearance
• lateral paravesical space - obturator and
pelvic lymph nodes(pelvic
lymphadenectomy)
98.
99. • Criteria for conservative management, medical management
• SAM
• RUBINS CRITERIA
• STUDDFORD CRITERIA
• SPIEGELBERG CRITERIA
