Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Fear & Confusion about the Risk of Cancer after Bariatric SurgeryDr. Robert Rutledge
Esophageal Cancer from
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
Sleeve & Band vs Risk of Gastric Cancer after Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery, www.CLOS.net www.MiniBypass.net Email: DrR@clos.net
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Fear & Confusion about the Risk of Cancer after Bariatric SurgeryDr. Robert Rutledge
Esophageal Cancer from
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
Sleeve & Band vs Risk of Gastric Cancer after Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery, www.CLOS.net www.MiniBypass.net Email: DrR@clos.net
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
Presentation; Discussion of Herd Behaviour is Erroneous Human Decision Making; PROACT Decision Making Tool; 30 Point Multi-Dimensional assessment tool; Selection of the Best Bariatric Surgey; Discussion of the Lack of Risk of Gastric Cancer and the Billroth II
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Rational Data Analysis vs.Irrational FEAR Gastric Cancer
1. Gastric Cancer Declining Rapidly
2. GC Environmental Causes; Easily Prevented
3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori
4. Many large studies: NO increased risk
5. Endoscopic Screening: Not Recommended
6. General, Trauma & Oncologic Surgeons Use Billroth II
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April CasesSean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
- Large Bowel Obstruction
- Blunt Aortic Injury
- Abdominal Aortic Aneurysm with Rupture
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: December...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
- Bladder Rupture
- Small Bowel Diverticula
- Type B Aortic Dissection
Oesophageal surgery- Is there light at the end of the tunnel? Professor Neil ...SMACC Conference
The 105 years since the first successful thoracic oesophagectomy was performed saw initially slow progress in terms of operative mortality, morbidity and oncological outcomes. Even until the late 1990’s, operative mortality figures of 15-20% were commonplace and long term survival was poor, as low as 12%1. The last 20 years has seen a major change in these outcomes both within Australia and overseas. These improvements have been based on the bed rocks of improved surgical techniques, improved peri operative care, changes in the distribution of the pathophysiology of the disease, improved patient selection through better staging, Development of endoscopic techniques for early tumours, development of effective neo adjuvant regimes and the development of “high” volume centres have all contributed to the current figures of 4% preoperative mortality and overall 5 year survivals in the post surgical patient of 40%. Better understanding of the nutritional issues involved has led to an emphasis on better quality of life issues in both the curative and palliative settings. This talk outlines the forces that have brought about the changes including outlining the modern treatment algorithm and discussing the volume effects of surgery in the Australian context
1. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;67: 381-90
Drs. Rossi and Shreve’s CMC Abdominal Imaging Mastery Project: December CasesSean M. Fox
Dr. Brian Shreve is an Emergency Medicine Resident and Dr. Isolina Rossi is a Surgery Resident at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
▪ Traumatic diaphragmatic hernia
▪ Internal hernia after Roux-en-y
▪ Inguinal hernia
Marginal Ulcer after Gastric Bypass; RNY & MGB
Marginal ulcers RNY ranging from 0.6 to 16%
True incidence is very likely much higher
Csendes prospective study routine postoperative endoscopic evaluation
28% of marginal ulcers were asymptomatic
Gastric Bypass (RNY & MGB)HIGH incidence of Marginal Ulcer
BILE MAKES NO DIFFERENCE!!!
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
Prediction of Weight Loss Following The Mini-Gastric Bypass: Multivariate Regression Modeling
Robert Rutledge, K Kular, N. Manchanda CLOS Center For Laparoscopic Obesity Surgery, MGB Review Corp
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
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
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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
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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.
4. 2 Years Cardiac Surgery National Institutes of Health National Heart Lung Blood Institute
5. 20 years University of NC; Professor of Surgery, Associate Chief of Staff, Director of Section Medical Informatics, Director North Carolina Trauma Registry
14. Personal Visit: Dr. Rutledge Visiting Professor: France, Turkey, Austria & India, Upcoming visits Greece, Istanbul, United KingdomCzech Republic, Italy, Germany, UAE, Pakistan,
15. Please Use the Knowledge of Others Before You Start;Experience; over 14 years, over 6,000 patients
16.
17. Hands On Surgery (with approval) Scrub in on cases Assist and Participate in MGB Surgery
22. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY 1. Low Risk 2. Major Weight Loss 3. Easily performed 4. Short operative times 5. Outpatient or short hospital stay 6. Minimal Blood Loss 7. No Need for ICU Stay 8. Minimal Pain 9. Very High Patient Satisfaction 10. A Good "Exit Strategy"
23. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY 11. Change Behavior & Preferences; Marked Decrease in Hunger and Increased Satiety 12. Minimal Retching and Vomiting 13. Few adhesions or hernias 14. Minimal impact on Heart and Lung Function 15. Low Failure Rate 16. Low Cost 17. Short Recovery Time 18. Rapid Return to Work 19. Low Risk of Pulmonary Embolus 20. Durable weight loss
24. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY 21. Low Risk of Marginal Ulcer 22. Fat Malabsorption; low cholesterol & CV risk 23. No Plastic Foreign Body 24. Easily Verifiable Results; > 10 years of Results 25. Low Risk of Bowel Obstruction 26. Based upon sound surgical principles 27. Independent confirmation of results 28. Healthy life after surgery 29. Supported by LEVEL I Evidence; RCT (Controlled Prospective Randomized Trial) 30. Block “Sweet Eater” Failures
32. Epidemiology: What do we know about Marginal Ulcers? Marginal ulcers represent one of the most problematic postoperative complications following Roux-en-Y A marginal ulcer, or stomal ulceration, refers to the development of mucosal erosion at the gastrojejunal anastomosis, typically on the jejunal side. incidence of marginal ulcers is 0.6 to 16 % The true incidence is very likely much higher
33. Marginal Ulcer has been known since the beginning GI Surgery MARGINAL, GASTROJEJUNAL OR PEPTIC ULCER SUBSEQUENT TO GASTROENTEROSTOMY. Erdmann JF. Ann Surg. 1921Apr;73(4):434-40.
34. Marginal Ulcer has been known since the beginning GI Surgery THE ROENTGEN DIAGNOSIS AND LOCALIZATION OF MARGINAL PEPTIC ULCER. Carman RD. Cal State J Med. 1920 Nov;18(11):377-82
35. Marginal Ulcer has been known since the beginning GI Surgery Re-evaluation of the role of the pyloric antrum in marginal peptic ulcers. SCHILLING JA, PEARSE HE. SurgGynecol Obstet. 1948 Aug;87(2):225-34
36. Marginal Ulcer has been known since the beginning GI Surgery Vagotomy as a treatment for marginal ulcer. CRILE G Jr, BROWN GM Jr. Gastroenterology. 1951 Jan;17(1):14-9
37. Marginal Ulcer has been known since the beginning GI Surgery Review Article: The present status of the management of marginal ulcer. BYRD BF Jr. J Tn State Med Assoc. 1953 Feb;46(2):56-8.
38. Marginal Ulcer has been known since the beginning GI Surgery 2,282 RYGB 122 (5%)Marginal ulcers 39 (32%) Surgery SurgObesRelat Dis. 2009 May-Jun;5(3):317-22. Revisionaloperations for marginal ulcer after Roux-en-Y gastric bypass. Patel RA, Brolin RE, Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08536
39. Marginal Ulcer Very High After RNY Gastric Bypass 441 RYGB 10 (12%)of RNY gastric bypass presented an "early" marginal ulcer Asymptomatic (28%) ObesSurg. 2009 Feb;19(2):135 Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Csendes Aet al Department of Surgery, University Hospital, University of Chile, Santiago, Chile.
40. Marginal Ulcer Very High After RNY Gastric BypassAssociated with H. Pylori 260 RYGB 7%of RNY gastric bypass marginal ulcer H. pylori infection, (treated), was twice as common marginal ulceration (32%) as among those who did not (12%) SurgEndosc. 2007 Jul;21(7):1090-4. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Rasmussen JJ, Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Sacramento, CA 95817, USA
41. Marginal Ulcer after Gastric Bypass; Both RNY & MGB Marginal Ulcers after Roux-en-Y Gastric Bypass: Pain for the Patient…Pain for the Surgeon by Camellia Racu, January 2010 Bariatric Times. 2010;7(1):23–25
43. Marginal Ulcer after Gastric Bypass; RNY & MGB Marginal ulcers RNYranging from 0.6 to 16% True incidence is very likely much higher Csendesprospective study routine postoperative endoscopic evaluation 28% of marginal ulcers were asymptomatic Gastric Bypass (RNY & MGB)HIGH incidence of Marginal Ulcer BILE MAKES NO DIFFERENCE!!!
44. Incidence of perforated gastrojejunal anastomotic ulcers after RNY April 2002 to April 2010, 1213 patients underwent laparoscopic RYGB Operative mortality was .15% 10 perforated GJA ulcers (.82%) at a mean of 13.5 (6-19) months Morbidity and mortality rate was 30% and 10% Perforated GJA ulcers can develop in 1 of 120 Roux en Y Gastric Bypasses & DEADLY
45. Marginal Ulcers: Achilles Heel of Gastric Bypass Management 1. Warn Patients & Surgeon “Be Vigilant” 2. Aggressive anti-H. Pylori Rx 3. Aggressive use of Antacids 4. Strict Avoidance of Ulcerogenic Agents(NSAIDS, Etoh, Smoking, Coffee, Soda, Nitrates) 5. Encourage: Probiotics, Yogurt, Fruits Vegetables BILE MAKES NO DIFFERENCE!!!
52. 100,000’s of people already have and are living with and are getting the Billroth II every day
53.
54. Why haven’t concerned bariatric surgeons stepped forward to start a fund to help suffering Billroth II patients get needed conversions of their surgery to Roux-en-Y?
55.
56. Why haven’t concerned bariatric surgeons stepped forward to national funding for lifetime endoscopic screening of Billroth II patients to find dreaded gastric cancers?