This document discusses puerperal genital haematomas, which are collections of blood outside blood vessels in the genital tract following childbirth. It covers the types (infralevator below levator ani muscle, supralevator above), causes (injury during birth, coagulopathies), risk factors (episiotomy, instruments), symptoms (pain, bleeding), investigations (blood tests, imaging), and management (conservative for small, surgery or embolization for large). Prompt diagnosis is key as excessive perineal pain should prompt examination, and treatment may require resuscitation, antibiotics, and monitoring for recurrence of bleeding.
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
Urinary Tract Fistulas -(VVF) Etiology, Diagnosis, ManagementVikas V
Urinary Tract Fistulas - Etiology, Diagnosis, Management
Surgical and Relevant Anatomy, Classification, eitiology, VVF in Detail, Examination and Diagnosis, Management of VVF - Both Conservative And Surgical Management - Steps of Surgical Management, Post operative Management.
This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
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.
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
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Follow us on: Pinterest
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
3. Introduction
Relatively uncommon
± serious morbidity & even maternal death.
± difficult to diagnose
{symptoms non-specific and
bleeding is often concealed}.
Haematoma:
localized collection of blood outside of blood vessels
> 2.5 cm
4. Incidence
1:300 to 1:1000 deliveries
(Thakar and Sultan 2009)
>4 cm: 1/1000 deliveries.
Supralevator < infralevator
Surgical intervention:
1/1000 deliveries
5. Types
I. Infralevator:
below the levator ani muscle
usually around vulva, perineum& lower vagina
1. Vulval:
limited to the vulval tissues superficial to the
anterior urogenital diaphragm.
Haematoma: evident on the vulva.
9. 3. Paravaginal
confined to the paravaginal tissues
in the space bounded
inferiorly by the pelvic diaphragm and
superiorly by the cardinal ligament.
not obvious externally but can be diagnosed by
vaginal examination.
often occludes the vaginal canal
extends into the ischiorectal fossa.
10. II. Supralevator: Supravaginal= Subperitoneal
Spread
Upwards&outwards beneath the broad lig. or
Downwards to bulge into the wall of the upper
vagina, or
Backwards into the retroperitoneal space.
13. Aetiology
Injury
Direct: episiotomy, forceps or
Indirect: stretching of the birth canal as the fetus
passes through.
80 %: failure to achieve haemostasis
e.g. at the apex of an episiotomy or tear.
20 %: concealed ruptured vessel with an
apparently intact perineum
50 %: spontaneous delivery.
15. I. Infralevator
Usually associated with vaginal birth
1.Vuval or vulvovagial
injury to the branches of the pudendal artery:
posterior rectal
transverse perineal
posterior labial arteries
2. Paravaginal
Injury to descending branch of the uterine artery.
17. II. Supralevator
Injury to uterine artery branches in the broad lig.
May occur after spontaneous birth
More commonly
operative vaginal birth
difficult CS
Due to an extension of a tear of the cervix, vaginal
fornix or uterus
19. Presentation and differential diagnosis
Onset
usually within a few hours of delivery.
Speed of diagnosis depend on
extent of the bleeding
associated consequences
level of awareness of medical staff.
20. Classical symptoms
Pain:
Excessive perineal pain is a hallmark symptom
Should prompt pelvic examination.
Over a few days in a small haematoma in an
episiotomy
Restlessness
Rectal tenesmus
Constant need to empty bowels within a few
hours after birth
21. Collapse:
within a few hours of delivery in large haematoma
Bleeding
Continued vaginal: if haematoma ruptures into the
vagina
DD: other causes of PPH: e.g. atonic uterus.
Rare symptoms
Retention of urine
unexplained pyrexia.
22. Vulval and vulvovaginal haematomas
Typical symptoms:
pain and swelling in the perineum.
DD:
abscesses.
pain of an episiotomy
tear or
haemorrhoids: Examination
23. Paravaginal haematomas
Typical symptoms:
Rectal pain
lower abdominal pain (often vague)
symptoms of hypovolaemia: often out of
proportion to revealed blood loss.
These non-specific symptoms can readily be
attributed to other causes: delay the correct
diagnosis.
24. Supravaginal haematoma
Symptoms:
Abdominal pain
no vaginal symptoms.
Signs
hypovolaemia: collapse.
shock: elevated pulse, decreased BP, pale,
sweaty, clammy, dizzy
Abdominal examination:
uterus is deviated upward and laterally, to the
opposite side from the broad ligament
haematoma.
DD:
pelvic mass: abscess
intra-abdominal bleeding.
25. Investigations
Blood tests
CBC
Coagulation screen
mandatory {determine baseline values}
should be repeated as necessary.
Cross matching
according to the clinical picture.
{Transfusion more likely with paravaginal and
subperitoneal than with vulval haematomas}.
26. Imaging
US, CT and MRI
diagnosing haematomas above pelvic
diaphragm
assess any extension into the pelvis
MRI
location, size and extent of a haematoma
monitoring progress or resolution.
DD between other causes of a pelvic mass:
abscess or endometrioma.
28. Assessment: high index of suspicion is required.
Prompt examination of vulva, perineum, vagina:
Identify site of haematoma
Whether it is still expanding
Estimate blood loss
often underestimated
Monitor ongoing blood loss:
29. 1. Resuscitative measures
First line of treatment.
Fluid replacement:
crystalloids/colloids: Hartmann’s, sodium
chloride 0.9 %, Gelafusine
Assessment of coagulation status:
essential if
heavy bleeding or
signs of hypovolaemia.
Blood should be available for transfusion.
Urinary catheter
monitor fluid balance
avoid possible urinary retention resulting from
pain, oedema or the pressure of a vaginal pack.
30. 2. Conservative management
Indication
Small (5 cm), static haematomas
Not for
Larger haematomas:
{longer stays in hospital
An increased need for antibiotic, blood
transfusion & operative intervention}.
Expanding haematoma
{unlikely to settle with conservative measures}.
31. Steps
Broad spectrum antibiotics
Ice packs
Analgesia:
1. Regular paracetamol
2. NSAID:
diclofenac [Voltaren®] 50 mg tds),
contraindications: pp hge, PET, renal
disease, concurrent use of other NSAIDs,
aspirin, digoxin
3. intramuscular opioid
4. Avoid rectal administration of analgesics
Regular review
{ensure that bleeding has settled and haematoma
has resolved}.
32. 3. Surgical
Indication
Large (5 cm) vulval haematomas
Steps:
Adequate anaesthesia
Evacuation:
Incisions should be placed to minimise
scarring (this is often medially).
Clot should be evacuated
Any apparent bleeding points ligated.
33. Primary closure
The exact origin of the bleeding is rarely identified
The space should be closed with deep mattress
sutures
Overlying skin reapproximated without tension.
Avoid damage to contiguous structures:
ureters, bowel and bladder
Compression
The vagina should be packed tightly for 12–24 h.
34. Drains:
usually brought through a separate site distant
from the repair.
useful to highlight ongoing or recurrent bleeding.
defeat the object of packing, which is to
tamponade bleeding vessels.
What is optimal management ?
primary repair (with or without drains)
primary repair with packing, and
packing alone have all been advocated.
35. Subperitoneal haematomas
1. Small, stable: conservative.
2. Larger:
Surgical abdominal approach:
identification and ligation of bleeding vessels.
Arterial embolisation
under radiological control is now an alternative
Broad spectrum antibiotic
Regular review
{ensure bleeding has settled and haematoma has
resolved}.
36. Persistent bleeding
{Haematomas can recur after surgical management}:
Continued monitoring for signs of blood loss: essential.
If first line management fails:
further surgical intervention
The haematoma cavity should be explored again.
Ligation of the internal iliac artery, or even
hysterectomy, may be necessary. or
occlusion of the internal iliac artery/ies by balloon
catheter or embolisation
37. 4. Pelvic arteriography and arterial embolisation
Success rate: over 90%.
Steps:
Pelvic circulation is accessed via the femoral a
Angiography is used to identify bleeding vessels
before selective embolisation.
Embolic agents
temporary: absorbable, gelatin-impregnated
permanent: metal coils.
Performed under light sedation
take 1–2 h
38. Complications
Uncommon: 9%
low grade fever
pelvic infection
ischaemic buttock pain
temporary foot drop
groin haematoma
Vessel perforation.
Use of temporary embolic agents:
reduces the risk of ischaemic problems.
39. Advantages:
preserve fertility (despite exposure of the ovaries to ionising radiation)
most women continue to menstruate.
avoid the risks of laparotomy, although the option
of surgery is retained.
limitation
experience
equipment.
Indication
first line treatment for persistent bleeding
40. (a) Digital subtraction angiography (DSA) image of left
internal iliac artery runs showing contrast
extravasation (arrows) from the inferior vesicle
branch (arrowheads) indicating an active bleed.
(b) An oblique view showing more extravascular contrast
accumulation in the delayed phase (arrows).
41. Post embolisation image showed blockage of the
inferior vesicle artery and the bleeding was
successfully arrested.
42. Prevention
Good surgical technique, with attention to
haemostasis in the repair of lacerations and
episiotomies
However, haematomas are not unavoidable.
43. Conclusion
Genital tract haematomas are uncommon and can
cause diagnostic confusion.
Clinicians must be alert to haematomas as a dd of
postpartum pain and bleeding.
44. Key elements of management of puerperal genital
haematoma
The most important factor in correct diagnosis is
clinical awareness
Excessive perineal pain is a hallmark symptom: its
presence should prompt examination
Aggressive fluid resuscitation/blood transfusion
may be required
45. Coagulation status should be monitored
Treatment should be carried out in an operating theatre
A urinary catheter should be used to prevent urinary
retention and monitor fluid balance
The threshold for using antibiotics should be low
There is no evidence to support best management,
which can be primary repair or packing, with or
without insertion of a drain
Awareness should be maintained after primary
repair/packing, as recurrence is common