The rectum receives its blood supply from three arteries. Rectal trauma is usually caused by penetrating injuries like gunshot or stab wounds, though blunt trauma from pelvic fractures can also cause injury. Diagnosis involves a digital rectal exam, proctosigmoidoscopy, and CT scan. Intraperitoneal injuries are managed like colon injuries with primary repair. Management of extraperitoneal injuries has evolved from routinely using colostomy, presacral drainage, and rectal washout, though new evidence questions the value of routine presacral drainage and rectal washout. Current treatment involves fecal diversion or primary repair depending on the injury, with presacral drainage only used for posterior injuries repaired via laparotomy
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
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
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
2 cases of colorectal trauma - one due to blunt trauma abdomen and one due to penetrating trauma to rectum are discussed in the light of colorectal trauma
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
2 cases of colorectal trauma - one due to blunt trauma abdomen and one due to penetrating trauma to rectum are discussed in the light of colorectal trauma
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
PPT with MCQs on the Diaphragm. This is part 1 and contains short cases on the anatomy and pathology of the diaphragm. Every slide has an image followed by a question. More MCQs are available on youtube- search sbmedex. You will ace any exam if you can do these questions.
A lecture about the management approaches for abdominal vascular injuries. Injury to the major arteries and veins in the abdomen are technical challenge to the surgeon and are often fatal. All vessels are susceptible to injury with penetrating trauma. Vascular injuries in blunt trauma are far less common and usually involve the renal arteries and veins, though all other vessels, including the aorta, can be injured. Blunt trauma results from deceleration, AP compression or pelvic fractures.
ABDOMINAL INCISIONS AND LAPAROTOMY-1.pptxAbhijitAzeez
The theoretical advantage of a paramedian over a midline incision is
a diminished risk of wound dehiscence and incisional hernia
In practice, when these incisions are reopened, the medial edge of the rectus muscle is frequently adherent to the anterior or posterior sheath incision and does not effectively buttress the wound.
A “lateral paramedian incision” refers to a vertical incision created several centimeters lateral to the location of the traditional paramedian incision.
In the patient who has had prior abdominal surgery, the cosmetic advantages of reentering the abdomen through a preexisting scar must be balanced against the challenges associated with dissection in a reoperative field. Close proximity of a new incision to an old one should be avoided in order to minimize the risk of ischemic necrosis of intervening skin and fascial bridges.
Mass closure of the abdominal wall is usually advocated, using large bites and short steps in the closure technique and either non-absorbable (e.g. nylon or polypropylene) or very slowly absorbable suture material (e.g. polydioxanone suture (PDS)). It has been estimated that, for abdominal wall closure, the length of the suture material should be at least four times the length of the wound to be closed to minimise the risk of abdominal dehiscence or later incisional hernia.
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
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Rectal injury
1. Rectal Trauma
Dr. Khaled MESTAREEHY
General & colorectal surgery MD.JB
Colorectal Unit- Jordanian Royal Medical Services
1
2. Anatomy
• The rectum is about 15 cm long and is only
partially intraperitoneal.
• The rectum receives its blood supply from the
superior rectal artery off the inferior
mesenteric artery, the middle rectal artery off
the internal iliac artery, and the inferior rectal
artery off the internal pudendal artery.
2
4. Only the upper two thirds anteriorly and the upper one third
laterally are covered by peritoneum.
The lower third of the rectum is completely extraperitoneal and
makes exposure and repair of any injuries difficult.
Anatomy
4
5. The majority of rectal injuries are due to penetrating
trauma, usually firearms.
• Gunshot wounds account for about 85% .
• stab wounds for about 5% of rectal injuries.
Other causes of penetrating trauma:
- Iatrogenic injuries from urologic and endoscopic procedures.
- Sexual misadventure.
- Anorectal foreign bodies.
Epidemiology
5
6. Blunt trauma accounts for only 5–10%
of injuries.
Usually the result of pelvic fractures or
impalement.
Epidemiology
6
7. Rectal Organ Injury Scale
The American Association for the Surgery of Trauma (AAST)
7
8. The clinical signs and diagnosis of intraperitoneal rectal
injuries are the same as for colonic injuries.
The majority of patients have signs of peritonitis and the diagnosis
is almost always made intraoperatively.
The diagnosis of extraperitoneal rectal injuries is more challenging
because of the lack of peritoneal signs.
The diagnosis is based on a high index of suspicion in the
appropriate cases, a digital rectal examination, rigid
proctosigmoidoscopy, and CT scan.
■ Diagnosis
8
9. The diagnostic accuracy of the digital rectal exam and rigid
proctosigmoidoscopy ranges from 80% to 95%.
CT scan with or without rectal contrast or a gastrografin enema
study should be considered in selected cases with penetrating
injuries to the buttocks.
9
10. ■ Operative Management
Historical Perspective
The history of the management of rectal trauma parallels that
of colon trauma with many of the therapeutic principles evolving
from lessons learned from wartime experiences.
Mortality from rectal gunshot wounds was as high as more than 60% in
the early part of World War II, until the Army Surgeon General mandated colostomy for
all colon and rectal injuries.
Presacral drainage was added in 1943, and appeared to further improve mortality.
Shortly after World War II, distal rectal washout became part of the routine
management.
The triad of colostomy, presacral drainage, and rectal washout remained
the standard of care of these injuries over the next several decades, despite
the lack of any solid scientific evidence.
The validity of these principles however was challenged in the 1990s with new
studies suggesting that routine colostomy may not be necessary,
presacral drain may have little or no value, and rectal washout may be harmful.
10
11. Intraperitoneal rectal injuries are managed like
colon injuries, the vast majority amendable to
primary repair.
Intraperitoneal Injuries
11
12. Extraperitoneal Injuries
The cornerstone of extraperitoneal rectal injuries was based
on a triad consisting of fecal diversion, presacral drainage, and
distal rectal washout. This practice was challenged in the 1990s.
12
13. Fecal Diversion or Primary Repair.
Loop colostomy
loop ileostomy
Hartmann’s procedure should be reserved for patients withextensive destruction of the
rectum
Primary repair without proximal fecal diversion in selected cases with small
perforations.
Proximal diverting colostomy alone, without suturing of the perforation (For some
extraperitoneal injuries which difficult to repair because they are too low for
transabdominal repair and too high for transanal Repair).
13
14. Presacral Drainage.
Introduced in the management of extraperitoneal rectal injuries in World
War II
Numerous studies, including a prospective randomized one, showed no
benefit of routine presacral drainage.
Transabdominal presacral drainage may be useful in cases with posterior
rectal injuries that have been repaired through a laparotomy.
14
16. Distal Rectal Washout.
Distal rectal irrigation was added to the management of rectal injuries during the
Vietnam War.
There is no evidence that it is of any value in reducing morbidity.
It has been suggested that washout may liquefy the rectal contents and facilitate
fecal spillage into the surrounding extrarectal soft tissues
16
17. Technical Tips
Patient should be placed on the operatingtable in the lithotomy position for
rigid sigmoidoscopy evaluation.
In the hemodynamically unstable patients, due to associated intra-
abdominal injuries, an exploratory laparotomy for bleeding control precedes
the sigmoidoscopy
Low rectal injuries may be repaired transanally and high rectal injuries can
be accessed transperitoneally after dissection of the peritoneum.
17
18. In mid-rectal injuries, the exposure may be difficult, especially in males with a
narrow pelvic inlet. In these cases a proximal diverting sigmoid loop colostomy should
be considered without repairing the rectal perforation.
18
19. Hartmann’s procedure vs loop colostomy (for fecal diversion)
Repair the rectal and any genitourinary injuries and separate the repairs with well-
vascularized tissue such as omentum in order to reduce the risk of vascular graft
infection or the formation of rectovesical fistula, which can occur in up to 24% of
patients with combined bladder and rectal injuries
19
20. Complex anorectal injuries after open pelvic fractures should be managed with
hemostasis, wound packing, and a sigmoid colostomy .
In rare cases with devastating anorectal injuries an early abdominoperineal
resection may be the only option to control massive bleeding and prevent
severe postoperative sepsis.
Anorectal reconstruction is usually attempted electively or semielectively by
an experienced colorectal surgeon.
20