This document discusses pilonidal sinus disease and summarizes the use of the Limberg flap surgical procedure in 180 patients over 10 years. Some key points:
- Pilonidal sinus disease commonly affects the hair follicles in the natal cleft, presenting as cysts, sinuses or abscesses. It is more common in males and associated with obesity, sweating and sedentary lifestyles.
- The study evaluated 180 patients who underwent rhomboid excision and Limberg flap reconstruction surgery. This procedure aims to thoroughly excise infected tissue and close the wound with minimal complications and recurrence.
- Results found a low recurrence rate of 3.3% and minor complications in a small
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Tríptico Olimpíadas de Matemática 2017. Resultados de Olimpíada de Matemática 2016 y programación (fechas) de Olimpíada de Matemáticas 2017.
Canguro Matemático.
Bachillerato
The video for this presentation is available on our Youtube channel:
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Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
Splenic Abscess: Etiology, clinical spectrum and Therapyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The Mastoid Compartment of Middle Ear Cleft-A Clinic Pathological Study in Patients with Chronic Otitis Media-Mucosal Type by George MV in Experiments in Rhinology & Otolaryngology
https://crimsonpublishers.com/ero/fulltext/ERO.000525.php
Pilonidal sinus is disease commonly affecting young hairy individuals. The disease causes recurring infection and has a high recurrence rate. Understanding the pathophysiology is essential for developing a treatment plan. A variety of techniques have been developed for treating pilonidal sinus. These range from minimally invasive to excisional techniques. However no single procedure can be considered as the gold standard of care. Proper preparation of the area followed by optimum choice of the procedure can help in reducing both local wound complications as well as recurrences.
A Case of Postmenopausal Pyometra Caused By Endometrial Tuberculosisiosrjce
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.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Ectoparasites on genitalia in this Era - a study at tertiary care center in T...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.
Pilonidal sinus disease is characterized by a granulomatous reaction to a hair shaft penetrating epidermis from the cutaneous surface. Commonly seen in sacro-coccygeal region, however it can be encountered in the umbilical area. Umbilical pilonidal sinus is a rare entity. Even though there is no general consensus on the treatment of this disease, a balance between conservative and surgical treatment should be maintained. Various surgical approaches has been described ranging from debridement of the sinus, to sinus resection with umbilical reconstruction up till reaching umbilectomy
— The microbiological content of Lettuce (a vegetable), commonly vended in the Benin metropolis of Edo state were evaluated. Five vending locations were chosen for the study. Whole and soft rot samples were purchased and analysed for microbiological composition. Results showed high counts in soft rot samples in lettuce. Nutrient agar plated lettuce samples had bacterial counts in the range of 2.0x 103 to 4.7x10 7. Pseudomonas species was the dominant species found in lettuce samples. Bacillus species was isolated from one location in the lettuce samples. Mac Conkey agar plated lettuce plated had bacterial counts in the range of 2.3 x 10 3 to 5.7x 10 7. Enterobacter species, E. coli, and Klebsiella species were the dominant species isolated. Though, Proteus species was isolated from lettuce samples obtained from location five only. The study observes that consuming soft rot samples could pose a risk of introducing pathogens to the consumer due to their high microbial counts and could be detrimental to the health of the consumer.
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Review Article
Pilonidal sinus disease with especial reference to
Limberg flap
Ajay K. Khanna a,
*, Satyendra K. Tiwary b
a
Professor, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi,
Uttar Pradesh 221005, India
b
Assistant Professor, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University,
Varanasi, India
1. Background
First historical description of pilonidal disease dates back to
1833 by Herbert Mayo as a hair containing sinus1
but the term
'Pilonidal' was coined by Hodge in 1880.2
The disease is a very
common problem affecting middle-aged working population,
and it most often arises in the hair follicles of the natal cleft of
the sacrococcygeal area. Incidence of pilonidal sinus is about
26 cases per 100,000, affecting males thrice as much as
females. Men are thought to be at higher risk because of their
hirsute nature. Pilonidal sinus is also associated with obesity
(37%), sedentary occupation (44%), and local irritation or
trauma (34%).3
It may manifest as pilonidal cyst, sinus, or
abscess, and inflammation may lead to rapid progression of
the disease. During the Second World War, pilonidal disease
very commonly appeared in jeep drivers, so called as ‘‘jeep
disease’’.4
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x
a r t i c l e i n f o
Article history:
Received 30 June 2015
Accepted 28 July 2015
Available online xxx
Keywords:
Pilonidal sinus
Jeep disease
Limberg flap
Epidemiology
Bacterial contamination
a b s t r a c t
This article lays an emphasis on ‘‘Pilonidal Sinus disease’’ along with the historical back-
ground, materials, and methods used. The term 'Pilonidal' was coined by Hodge in 1880. The
disease commonly affects middle-aged working population and most often arises in the hair
follicles of the natal cleft of the sacrococcygeal area. This disease affects males thrice as
much as females because of their hirsute nature. Pilonidal sinus is associated with obesity,
sedentary occupation, and local irritation or trauma. The management of pilonidal disease is
complex and a big burden on hospital and community resource because of the recurrent
nature of the disease. Various surgical methods have been practiced to treat sacrococcygeal
pilonidal sinus disease. Each method is associated with different postoperative complica-
tions, morbidity, and recurrence rates for each of the procedures.
The most simple approach for pilonidal disease is simple incision. It is effective for
simple, superficial, small, and mostly midline tracts. Excision is a simple technique used for
chronic and recurrent pilonidal sinuses. Rhomboid Limberg flap reconstruction plastic
surgery procedure was done after proper preoperative assessment and preparation in all
cases.
# 2015 Published by Elsevier B.V. on behalf of Indraprastha Medical Corporation Ltd.
* Corresponding author. Tel.: +91 9415201954.
E-mail address: akhannabhu@gmail.com (A.K. Khanna).
APME-309; No. of Pages 7
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Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
http://dx.doi.org/10.1016/j.apme.2015.07.013
0976-0016/# 2015 Published by Elsevier B.V. on behalf of Indraprastha Medical Corporation Ltd.
3. Pilonidal disease can appear as an acute abscess along
with sinus tract formation. There have been a lot of debate on
whether pilonidal disease is congenital or acquired, but now it
is beyond doubt that it is an acquired condition.5,6
A more
complex manifestation usually after episode of inflammation
can be characterized by chronic or recurrent abscesses with
extensive branching sinus tracts. The commonest presenta-
tion for which a patient seeks medical advice is in the form of
an acute abscess characterized by the existence of a midline
pit in the natal cleft typically identified 4–8 cm from the anus.
A deep natal cleft serves favorable atmosphere for bacterial
colonization due to anaerobic environment, sweating, hair in
growth, close proximity to bacteria leading to contamination.
This primary tract leads into a subcutaneous cavity, which
contains granulation tissue and usually a nest of hairs that are
present in two thirds of cases in men and in one third of those
in women and may be seen projecting from the skin opening.
Many patients have secondary lateral openings 2–5 cm above
the midline pit. The skin opening and the superficial portion
of the tract are lined with squamous cell epithelium, but the
deep cavity and its extensions are not. Maximum number of
cases of pilonidal sinus are present in postsacral area, but it
may be seen in other regions such as interdigital, axillary,
umbilical, peri-anal, para-anal, intra-anal, and cervical
region.7,8
The management of pilonidal disease is complex and a big
burden on hospital and community resource because of the
recurrent nature of the disease.9,10
Treatment and prevention
are successful, if causative factors such as deep natal cleft and
presence of hair are taken care or minimized to prevent
sweating, maceration, bacterial contamination, and penetra-
tion of hairs.11,12
Proper decision making is based on the type
of presentation and treatment modality that range from
antibiotics, shaving, simple incision and drainage, phenol
application, cryosurgery, excision with primary closure,
excision with open packing, and excision with marsupializa-
tion to a wide excision with reconstructive surgical proce-
dures.13–16
There is no clinical consensus on the optimal management
of the pilonidal sinus but low recurrence, low morbidity,
acceptable cosmesis, insignificant tissue loss, and minimal
economic loss should be the goal in management. Our
experiences are mostly with reconstructive procedure of
Limberg flap in 180 patients of pilonidal disease from year
2004 to 2014.
2. Materials and methods
Retrospective data analysis of 180 patients during 2004–2014
was done. Detailed demographics, epidemiology, and clinical
presentations were analyzed. Only cases with surgical inter-
ventions were considered for study. Conservative manage-
ment by antibiotics and drainage of pus was carried out in
abscess, and these patients were later subjected to rhomboid
excision Limberg flap reconstruction.
Age, sex, duration, co-morbidity, presentation, number of
openings, number of surgical interventions in past, treatment,
duration of hospital stay, complications, and follow-up were
recorded and analyzed (Table 1).
3. Results
In 180 patients, males were 126 (70%), and females were 54
(30%). Mean age of presentation was 24.2 years (15–65 years)
with mean BMI of 22.3 kg/m2
(17.1–30.5). Co-morbidity was
present in 42 patients (23.3%) in the form diabetes, renal
failure, and immunocompromised patient. Recurrent disease
with history of past surgical intervention was noticed in 36
patients (20%). Most significant finding was history of
previous infection or abscess in 171 patients (95%). Single
tract was in 153 patients (85%) and multiple tract in 27 (15%).
All patients underwent surgical intervention by Limberg flap
reconstruction. Mean hospital stay was 3.2 days (1–9 days)
and mean follow-up of 38.4 months (6–60 months). Recur-
rence was noticed in only 6 cases (3.3%). Outcome and follow-
up in pilonidal disease treated by Limberg Flap is shown in
Table 2.
Surgical excision and rhomboid Limberg flap reconstruc-
tion plastic surgery procedure (Figs. 1–4) were done after
proper preoperative assessment and preparation in all cases.
First and foremost measure was control of inflammation and
infection in all cases with antibiotics and drainage with
incision and debridement. Anatomical mapping with fistulo-
gram preoperatively in all cases was done to plan reconstruc-
tive procedures. Fistulogram delineated the number of tract,
depth of cavity and lateral extension leading to proper
planning of extent of rhomboid flap excision for curative
intent. Hairs over the region were shaved preoperatively in all
cases. Spinal anesthesia was used in 171 cases (95%) and local
anesthesia in 9 cases (5%). Position was jackknife prone in all
Table 1 – Demographics of pilonidal disease (n = 180).
Total, n, % 180 (100%)
Male, n, % 126 (70%)
Female, n, % 54 (54%)
Age, years Mean 24.2 (15–65)
BMI Mean 22.3 (17.1–30.5)
Comorbidity (Diabetes,
Immuno compromised,
Renal failure), n, %
42 (23.3%)
Recurrent disease, n, % 36 (20%)
Previous infection or abscess, n, % 171 (95%)
Single tract, n, % 153 (85%)
Multiple tracts, n, % 27 (15%)
Hospital stay Mean, 3.2 days (1–9 days)
Follow-up Mean 38.4 months
(6 months to 60 months)
Recurrence, n, % 6 (3.3%)
Table 2 – Outcome and follow up in pilonidal disease
(n = 180).
Seroma 2 (1.1%)
Hematoma 6 (3.3%)
Wound dehiscence 8 (4.4%)
Flap necrosis 1 (0.5%)
Wound infection 4 (2.2%)
Residual pain and heaviness 9 (5%)
Recurrence 6 (3.3%)
Hypoasthesia 8 (4.4%)
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2
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4. cases. After prepping and draping, lesion was marked and
included in rhomboid area to be excised. Limberg flap was
raised as per the dimensions to cover the defect. The flap was
raised along with the fascia over the gluteus maximus. Two-
layered closure was done with vicryl 2-0 for adipofacial
approximation and prolene 3-0 for skin closure. Minivac
suction drain was placed after hemostasis in 160 cases (88.1%).
The patient was nursed in prone position or lateral position for
initial 24 h. The dressing was changed after 48 h and the drain
was removed if contents were less than 10–15 ml.
Fig. 1 – Planning of Rhomboid or Limberg Flap
Fig. 2 – Marking, incision and excision
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 3
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5. 4. Discussion
Various surgical methods have been practiced to treat
sacrococcygeal pilonidal sinus disease; each is associated
with different postoperative complications, morbidity, and
recurrence rates for each of the procedures. Excision of the
infected tissue and sinuses is not considered a major technical
problem but healing is cumbersome and expensive for both
the patient and physician due to its long duration and the
Fig. 3 – Incision and mobilization of Limberg Flap
Fig. 4 – Closure in Limberg Flap
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x4
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6. requirement for daily wound dressings using the open-
packing technique.17
Although the primary closure method
results in rapid recovery and quick resumption of daily
activities, high complication and recurrence rates have been
reported.18,19
Pilonidal disease affects men20,21
between 16 and 25 years
of age. Usually it is associated with obesity22,23
and hirsute
individuals, who experience profuse sweating and have a
sedentary lifestyle.24,25
High morbidity and chronicity of the
disease leads to significant economic burden. In acute phases
of inflammation, an antibiotic and conservative approach is
the choice. There is almost always history of inflammation or
abscess formation. Definitive and curative approach always
includes some type of surgical intervention. The treatment of
pilonidal disease is mostly surgical. The most commonly used
procedures today are simple incision, excision, marsupializa-
tion, fistulotomy, and various plastic surgery techniques.
Most simple approach for pilonidal disease is simple
incision. It is basically a limited intervention in acute
inflammatory stage and is most important for relieving pain
and rapid recovery for subsequent definitive excision and flap
reconstruction surgery. A midline incision through the
mouths of the pits carried out and is effective in those cases
of so-called raphe cannulization where infection spreads from
pit to pit.26,27
It is effective for simple, superficial, small, and
mostly midline tracts. After unroofing the tract, it is debrided,
cleaned, and drained.28,29
Recurrence is frequent, and defini-
tive plastic reconstructive procedure is planned for final cure.
Excision is a simple technique used for chronic and
recurrent pilonidal sinuses. Excision of all involved skin and
subcutaneous tissue is must for definitive treatment. Wounds
may be left open with healing by secondary intention, allowing
the wound to granulate, or is closed by primary intention with
immediate suturing.30,31
Various types of silastic dressing and
negative pressure therapy are used to fasten the healing of
wound. Laying the sinus open permits adequate drainage of
secretions, pus, or debris. The healing by secondary intention
requires more time, but has lower recurrence rate.32
In healing
by primary intention, the pilonidal sinus is excised and the
wound sutured by using deep tension sutures tied over a gauze
dressing. The advantages are quicker healing, less hospital
stay, and an early return to work, albeit with higher recurrence
when compared to the open technique.33,34
Plastic surgery techniques that include these procedures do
not only cover the wound but also, in theory, flatten the natal
cleft, as well as reduce hair accumulation, mechanical
irritation and risk of recurrence.20,35
Various kinds of flaps
have been used: 1–2 skin flaps, fasciocutaneous flaps like the
V-Y flap (for recurrent and complicated sinus disease) and
rhomboid excision and the Limberg flap.6
The Karydakis flap36
achieves asymmetric closure of the pilonidal wounds by
avoiding to place the wound in the midline at the depth of the
natal cleft and also flattens the cleft, reducing hair accumula-
tion and mechanical irritation36,37
resulting in decreased
recurrence.
A tendency toward using flap reconstruction techniques to
treat pilonidal sinus has been established, as they provide the
desired results, such as flattening of the natal cleft, providing
tissue healing without tension, short duration of healing
and return to work, acceptable cosmetic results, and low
recurrence rates.38
The problem, related to a continuing deep
natal cleft after surgery, leads surgeons to find techniques in
order to minimize or flatten natal cleft. Infection starts in hair
follicles due to open orifices leading to sinus as hypothesized
by Bascom and excision of midline pits with lateral open
drainage of any associated abscess essential for cure. Natal
cleft effect, wound tension, and complete excision are three
key factors that prompted various plastic reconstructive
procedures such as Z plasty, W plasty, V-Y plasty, and various
flap techniques. Various techniques have been described that
attempt to eliminate factors that cause negative primary
closure results such as a midline incision scar and tissue
tension resulting in lower recurrence rates.12,20,39–42
One of
the most commonly used techniques is Limberg flap
reconstruction.
The flap necrosis after Limberg flap is rare, and it varies from
0 to 3.3% of cases in literature.43
In our study, only one patient
out of 180 had partial flap necrosis, which is acceptable and
comparable to various studies in past. The rate of development
of seroma after Limberg flap is 0–14.5% of cases in various
studies. Mentes et al. reported a seroma rate of 2.2% without
placing a drain and a mean duration of hospitalization of 4.51
Æ 2.85 days in their series of 353 patients.44
Kirkil et al. reported
the rates of seroma development in groups with and without
drains to be 10.7 and 18.5%, respectively (total, 14.5%), in their
series of 55 patients who were randomized for drain placement
with a mean 3.2 days of hospitalization.45
They reported that all
such patients were treated by repeated aspiration of seroma.
Okuş et al. reported a mean duration of hospitalization of 1.85
days and that no seroma developed in any patient treated with
Limberg flap in their prospective study of 49 patients in an
Limberg flap group in which drains were placed in all patients.46
Therefore, these studies suggest no relationship between
development of a seroma and duration of hospitalization. We
discharged our patients 24–48 h after surgery with a mean of 3.2
days (1–9 days). The rates of hematoma and wound dehiscence
after Limberg flap are 0–4% and 0–10.4%, respectively, and in our
patients, such were 3.3 and 4.4%. Although hematomas have
been treated with repeated aspiration in some studies, but good
hemostasis is the key to prevent hematoma.45
The rate of wound infection after the Limberg flap
procedure varies from 0–8% of cases.43
Different rates of
infection in studies with similar numbers of patients and
duration of hospitalization have been reported, suggesting
that there is no direct relationship between the duration of
hospitalization and the development of infection. The rate of
infection was 2.2% (4 patients) in our series of 180 patients.
The most commonly reported result in long-term studies is
the recurrence rate. The reported rates of recurrence following
Limberg flap vary between 0 and 9%.43
Two other long-term
problems with Limberg flap are hypoesthesia at the operative
site and cosmetic dissatisfaction. Mentes et al. reported a
recurrence rate of 2.2%.44
The rates of recurrence and
hypoesthesia in our study agree with those in the literature
(3.3 and 4.4%, respectively).
Short- and long-term postoperative results are in agree-
ment with the literature data in patients treated with the
Limberg flap procedure in our study. The duration of
hospitalization varies from 1.7 to 5.9 days43,44
in studies in
which Limberg flap was performed.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 5
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7. 5. Conclusion
Pilonidal sinus is a benign disorder but two serious issues are
associated with it; those are significant economic loss and
significant morbidity. It affects the working middle-aged
population and individuals receiving their education or those
in early phases of their job. The time spent in the hospital
continues to result in significant economic issues. The Limberg
flap procedure has minimal postoperative complications and
very low recurrence in long-term follow-up with minimal time
to be spent in hospital. Though it requires a good geometric
calculation for raising the flap, the flap never fails with an
advantage of flattening natal cleft so to have the low
recurrence of the disease.
Conflicts of interest
The authors have none to declare.
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a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 7
APME-309; No. of Pages 7
Please cite this article in press as: Khanna AK, Tiwary SK. Pilonidal sinus disease with especial reference to Limberg flap, Apollo Med.
(2015), http://dx.doi.org/10.1016/j.apme.2015.07.013