The correct answer is e. Hemodialysis is not associated with high-flow priapism. The other answer choices are all known causes or associations of high-flow priapism.
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
This is a slide prepared by urology resident.
It's an approach and management principles of priapism and peyronie's disease.
I hope it is useful for who reads it.
Leave me a comment
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Agenda
1. Definition
2. Historical BACKGROUND
3. PHISILIOGY OF ERECTION
4. Types of priapism and comparison between different types
5. Management of each type
6. Take home massage
7. Questions
4. Physiology of erection
Cavernosal
artery smooth
muscle
Relaxation
Dunder parasympathetic
nerve by release of NO
increase penile
blood flow asnd
corporal expantion
Increase intracaversosal pressure
Compression of subtunical veins
Full Rigidity and tumesent
5. Physiology of erection
Detumescent
begin by smooth
muscle contraction
under sympathetic
control by
norepinephrine at alpha
receptor
Vasocontrection and
Decrease arterial inflow
and blood is drained by
the veins
Detumescent
6. • Priapism is a pathological condition representing a true
disorder of penile erection that persists for more than four
hours and is beyond or unrelated to sexual interest or
stimulation (failure of detumesent).
• Erections lasting up to four hours are defined by consensus
as ‘prolonged’.
• Priapism may occur at all ages.
Definition
8. •Ischemic priapism (low-flow) is a persistent erection marked by
rigidity of the corpora cavernosa, with little or no cavernous arterial
inflow.
•Nonischemic priapism (arterial, high-flow) is a persistent erection
caused by unregulated increase in cavernous arterial inflow. The
corpora are tumescent but not rigid, and the erection is not painful.
•Stuttering priapism describes a pattern of recurrence. It described
recurrent prolonged and painful erections in men with SCD.
Definition
9. Ischemic (Low-Flow or Veno-Occlusive) Priapism
• IT is most common and seious type accounting for more than 95% of all cases.
• IT is identified as idiopathic in the vast majority of patients,
• while sickle cell anaemia is the most common cause in childhood.
• Ischaemic priapism occurs relatively often (about 5%) after intracavernous injections of
papaverinem based combinations, while it is rare (< 1%) after prostaglandin E1
monotherapy.
• Priapism is rare in men who have taken PDE5Is with only sporadic cases reported
10. Ischemic (Low-Flow or Veno-Occlusive) Priapism
Pathophysiology
First decrease in
venous outflow
(LOW OUTFLOW)
Increase of
intracavernousal
pressure
Decrease in arterial inflow
(low inflow)
Stasis of blood causes
hypoxia and acidosis
PAINFULL FULLY RIGID ERECTION
14. Ischemic (Low-Flow or Veno-Occlusive) Priapism
prognosis
• Ischemic priapism is an emergency.
• The longer the duration of priapism the higher the rate of ED
• Interventions beyond 48 to 72 hours of onset may help relieve erection
and pain but have little benefit in preserving potency(100% ED).
• When left untreated, resolution may take days and erectile dysfunction
(ED) invariably results (dissolution of thrombus can be found in the
sinusoidal spaces)
15. Non Ischemic (High flow) Priapism
Pathophysiology
First arterial inflow as
cavernosal artery to corporal
tissue fistula (high inflow)
No decrease in venous
outflow (high outflow)
Non PAINFULL partially RIGID ERECTION without hypoxia or acidosis
16. Non Ischemic (High flow) Priapism
Etiology manily attributed to trama
• Staddle injury
• Kick of the perineum
• Pelvic fracture
• Iatrogenic as during visual cold knife urethrotomy
Prognosis
• Can occurs immediately or few weeks after trama
• Spontenous resolution in 62 % without intrtvention
17. Stuttering (recurrent or intermittent) priapism
• It is recurrent ischemic priapism
• a distinct condition that is characterized by repetitive and painful episodes of
prolonged erections.
• Sickle cell disease is the most common cause
• Due to obstruction of venous outflow by sickled erythrocytes leads to
stagnation of blood within the sinusoids during erection
• Each episode should managed as usual
25. Start management of ischaemic priapism as early as possible (within four to six hours) and follow
a stepwise approach.
Inial conservave measures
• Local anaesthesia of the penis
• Insert wide bore butterfly (16-18 G) through the glans into the corpora cavernosa
• Aspirate cavernosal blood un•til bright red arterial blood is obtained
Management of ischemic priapism
27. phenylephrinecan be concentrated as 200 ug/mL in saline and
administered intermittently as 0.5 mL to 1.0 mL, every 5 to 10 minutes to a
maximum dosage of 1 mg.
• This will permit up to 10 separate injections of 0.5 mL (100 ug each) or 5
separate injections of 1 mL (200 ug each).
• Aspirate the penis between successive injections until distal shaft is
empty.
• Blood pressure monitoring is recommended if repeated
sympathomimetic dosing is given. In patients with significant cardiovascular
risks, electrocardiogram monitoring is recommended.
28. • The objective of shunt surgery is reoxygenation of the cavernous smooth
muscle.
• The principle of shunt procedures is to reestablish corporal inflow by
relieving venous outflow obstruction; this requires creation of a fistula
between the corpora cavernosa (CC) and glans penis, CC and corpus
sponsigosum, or CC and dorsal/ saphenous veins.
• Shunt procedures are subdivided on the basis of anatomic
location on the penis.
1) Percutaneous distal shunts—Ebbehoj (1974), Winter (1976), or T-shunt (Brant, 2009)
2) Open distal shunt—Al-Ghorab (Hanafy, 1976; Borrelli, 1983) or Corporal Snake (Burnett, 2009)
3)Open proximal shunt—Quackles (1964) or Sacher (1972) l Saphenous vein—Grayhack (1964)
4)Deep dorsal vein shunt—Barry (1976)
Management of ischemic priapism
shunt surgery
29. A.Distal Shunts(corporal- glandular shunt)
Aim: to create fistula between corpus cavernosa and glans
Management of ischemic priapism
1. Winter shunt.
• A distal
cavernoglanular shunt
transglanular
placement of a tru- cut
needle in the distal
glans and excise
multiple core of corpus
cavernosum.
30. 2. T shunt
• The blade is inserted into
the corpus cavernosum
from the gland and turn 90
degree laterally then pulled
out.
• First on one side If not
resolved do it in the other
side
Management of ischemic priapism
31. 3.Open Al-ghorab shunt
• 2cm transverse incision in the glans
• then through this incision distal part of tunica albuginea of corpus
cavernousum is excised from each side
Management of ischemic priapism
33. 1.Corporo spongiosum shunt
• Through apernial incision or penile the corpus sponisum and corpus cavernousum are incised and
anastomosed on one side
• The more proximal the less urethral fistula as spongiusm thick more proximally.
Management of ischemic priapism
34. 2.Copro saphenous shunt
The Grayhack shunt mobilizes the
saphenous vein below the junction of the femoral vein and
anastamoses the vein end to side into the corpus
cavernosum.
Management of ischemic priapism
35. • Complete flaccidity
• Visualization of bright red blood
• In cases where the examination may be equivocal (penile rigidity rather than
complete flaccidity) ,color Doppler ultrasonography or cavernous blood gas is
recommended to demonstrate patency of shunt and restoration of cavernous
inflows
Management of ischemic priapism
Assessing shunt patency
36. Surgical Management of Ischemic Priapism with Immediate Penile
prosthesis
Consider penile prosthesis if:
1. The patient has failed aspiration and sympathomimetic intracavernous injection.
2. The patient has failed distal and proximal shunting.
3. Ischemia has been present for longer than 36 hours.
The advantages of early penile implantation
• preservation of penile length (before fibrosis)
• easier insertion.
Disadvantages
There are higher rates of revision surgery and complications
due to infection, urethral injury, device migration, and device erosion.
Management of ischemic priapism
37. Management Non-ischaemic (high-flow or arterial) priapism
• IT is not an emergency because the corpus cavernosum does not contain ischaemic blood.
• About 62% resolve spontenouslly without intervention
38. Surgical management of non ishemic priapism
• Surgery is technically challenging and may pose significant risks, mainly ED due to accidental
of the cavernous artery instead of the fistula.
• It is rarely performed and should only be considered when there are contraindications for selective
embolisation, no availability of the technique or embolisation failure
Management Non-ischaemic (high-flow or arterial) priapism
42. • Start management of ischaemic priapism as early as possible (within four to six hours) and follow a stepwise
approach.
• Interventions 48 hours beyond the onset of ischemic priapism may relieve pain but will have little benefit in
preserving potency.
• Priapism following a PDE5 inhibitor usually occurs in men with other risk factors.
• Spontaneous resolution of high-flow arterial priapism generally occurs in two thirds of patients.
• Aspiration has no role in high-flow priapism other than for diagnosis; it plays no role in treatment.
Take home massage
43. 1. Ischemic priapism is a persistent erection
marked by each of the following clinical and
pathophysiologic characteristics EXCEPT:
a. rigidity of the corpora cavernosa.
b. bright red corporal blood.
c. hypoxic and acidotic corporal environment.
d. painful rigidity.
e. thrombus within the sinusoidal spaces.
Questions
44. Questions
2. The associations and pathophysiology of high-
flow priapism include each of
the following EXCEPT:
a. straddle injury.
b. coital trauma.
c. birth canal injury to the newborn male.
d. cold-knife urethrotomy.
e. hemodialysis.