This document discusses renal stones and obstructive uropathy. It covers the etiology and pathogenesis of renal stones, including idiopathic calcium urolithiasis, hypercalcemic disorders, renal tubular syndromes, uric acid lithiasis, and enzyme disorders. It also discusses clinical features, complications, stone management approaches like ESWL, ureteroscopy, and PCNL, and medical treatment options. Regarding obstructive uropathy, it defines key terms, discusses classifications like congenital and acquired causes, clinical features, imaging approaches, and treatment indications and options like nephrectomy, pyeloplasty, and endoscopic procedures.
Background.
Treatment Algorithm.
Pre-Op preparation.
Surgical Techniques and Technology in stone removal:
Intracorporeal Lithotripters.
Extracorporeal Shock wave Lithotripsy.
Percutaneous Nephrolithotomy.
Ureteroscopic Management of Stones.
Laparoscopic and Open stone Surgery.
Urinary stones During Pregnancy.
AUA and EAU guidelines.
Questions.
Background.
Treatment Algorithm.
Pre-Op preparation.
Surgical Techniques and Technology in stone removal:
Intracorporeal Lithotripters.
Extracorporeal Shock wave Lithotripsy.
Percutaneous Nephrolithotomy.
Ureteroscopic Management of Stones.
Laparoscopic and Open stone Surgery.
Urinary stones During Pregnancy.
AUA and EAU guidelines.
Questions.
Retrograde Intrarenal Ureteroscopic Surgery (RIRS)Urovideo.org
Gerhard J. Fuchs, M.D., Dr. med., F.A.C.S.
Professor of Urology, UCLA School of Medicine
Vice Chair, Cedars Sinai Department of Surgery
Medallion Chair in Minimally Invasive Urology
Cedars-Sinai Medical Center
Los Angeles, USA
The diagnosis and management of common bile duct stones has evolved considerably in recent years. New endoscopic, radiologic and surgical techniques now provide doctors with a range of options. We present an evidence based approach which incorporates the latest technology and techniques to optimize outcomes for patients.
this presentation deals with various types of endourology, upper urinary tract endoscopy, rigid and flexible endoscopy, lower urinary tract endoscopy, ureteroscopy, care and sterilization of instruments and endoscops. use as therapeutic and diagnostic modalities.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
Retrograde Intrarenal Ureteroscopic Surgery (RIRS)Urovideo.org
Gerhard J. Fuchs, M.D., Dr. med., F.A.C.S.
Professor of Urology, UCLA School of Medicine
Vice Chair, Cedars Sinai Department of Surgery
Medallion Chair in Minimally Invasive Urology
Cedars-Sinai Medical Center
Los Angeles, USA
The diagnosis and management of common bile duct stones has evolved considerably in recent years. New endoscopic, radiologic and surgical techniques now provide doctors with a range of options. We present an evidence based approach which incorporates the latest technology and techniques to optimize outcomes for patients.
this presentation deals with various types of endourology, upper urinary tract endoscopy, rigid and flexible endoscopy, lower urinary tract endoscopy, ureteroscopy, care and sterilization of instruments and endoscops. use as therapeutic and diagnostic modalities.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
Nephrolithiasis, commonly known as kidney stones, refers to the formation of hard mineral and salt deposits within the kidneys or urinary tract. These stones can vary in size, ranging from tiny grains to larger, more substantial formations. Nephrolithiasis is a relatively common condition and can affect people of all ages, although it is more prevalent in adults.
Common disorder with an annual incidence of 0.1% to 0.5%.
The peak age at onset is 20 to 30 years
Men > Women ( until 50s )
Wide geographic variations exist, due to differences in diet and water composition, as well as ambient and sunlight exposure. 5-9% in Europe 20% in Saudi Arabia
VAC therapy also known as negative pressure wound therapy (NPWT) is a method of delayed wound closure, where in primary closure is not possible. this PPT details the make & model of the device, its modifications, principle , mechanism , advantages and disadvantages
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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.
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
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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.
4. 1. Idiopathic calcium urolithiasis
• 70% of patients with urinary tract stones
• Unexplained ↑ Calciuria
• Normal serum Calcium
• Often coexists with
• Hyperoxaluria, hyperuricosuria, inhibitor deficiency & incomplete renal
tubular acidosis
5. 2. Hypercalcaemic disorders
a. Primary hyperparathyroidism
• <5% patients with radio-opaque stones
b. Prolonged immobilization
• Bone resorption
c. Milk-Alkali Syndrome
• Nephrocalcinosis also
d. Sarcoidosis
e. Disseminated malignancy
f. Cushing’s Disease
g. Hyperthyroidism
6. 3. Renal tubular syndromes
a. Renal tubular acidosis
• Type I- hypercalciuria, low urinary citrate excretion
• Pure calcium phosphate stones mainly, Nephrocalcinosis
b. Cystinuria
• Autosomal recessive defect of A.A. transport – COLA
• Stones: multiple, very hard & radio-opaque
7. 4. Uric acid lithiasis
• 5-10%
• Cause: excess excretion in urine, excessively acidic urine, low urine
volume or idiopathic
• Stones: multiple, hard, smooth, multifaceted
• Pure- translucent, but mostly radio-opaque due to calcium
9. 6. Secondary urolithiasis
a. Secondary hyperoxaluria
b. Dietary excess
c. Infection
d. Obstruction and stasis
e. Medullary sponge kidney
f. Urinary diversion
g. Drugs
10. 7. Others
• Geography
• Climatic & seasonal factors
• Water intake
• Diet
• Occupation: sedentary jobs in hot climate
11. Clinical features
• Acute ureteric colic
• 30-50 years, slightly male preponderance
• +/- Renal pain
• Dipstick hematuria
• Confirmation by at earliest NCCT
• Supplementary plain X Ray
• Significance: 5 recognised narrowings ureter
• Complications
• Obstructive uropathy
• Infection
12. Stone management
1. Emergency setting
2. Elective setting
• ESWL (Extracorporeal Shockwave Lithotripsy)
• Ureteroscopy
• PCNL (Percutaneous Nephrolithotomy)
• Open stone surgery
3. Medical management
13. 1. Emergency setting
• CT to confirm
• <5mm stones pass spontaneously
• Frequent pain, obstruction, infection or significant decline eGFR- early
intervention
• Urgent pain management:
• In situ ESWL, Cystoscopy + ureteric stenting, primary ureteroscopic stone retrieval or
laser tripsy
• Obstructing calculus causing sepsis:
• PCN placement, Cystoscopy + ureteric stenting
14. 2. Elective setting: ESWL
• Commonest non invasive technique
• Shockwaves used
• Generated outside body
• Focused on stones- USG/ fluoroscopy
• Indication- <= 1.5cm stone
• Limitations- impacted stone, infection, hard stones
• Risk of hematuria, parenchymal hemorrhage,
perirenal hematoma
• Contraindications: obese, pregnant, anti coagulants
• *several sessions may be required
15. 2. Elective setting: Uretero-reno scopy
• Scope: rigid, semi- rigid or flexible
• Entire urinary tract is accessible: diagnostic + therapeutic
• Stone management
• Wire retrieval basket- <6mm & distal ureter
• Lithotripsy using USG, laser, electrokinetic energy sources
• Mechanical disintegration by lithoclast
• Complications:
• Ureteric mucosal/ wall injury, perforation, extravasation, avulsion,
stricture
16. 2. Elective setting: PCNL
• Treat larger stones in renal pelvis, calyces, or sometimes proximal
ureter
• Technique:
• Localization
• Establishment of tract, dilatation
• Working sheath placement- visualisation & stone management
• Nephrostomy tube left
• Indications:
• Obstruction, obesity, lower calyx stones, composition
• Complications:
• Injury- kidney & vasculature, surrounding organs; sepsis; extravasation, retained stones
17. 2. Elective setting: Open Surgery
• Total nephrectomy
• Pyelo/ uretero/ nephro-lithotomy seldom done
• Difficult post PCNL, infection, XGP
18. 3. Medical treatment: General
• Goal:
• prevent further stone formation OR growth of existing stones
• Thus may have to be life long
• Therapy for stone expulsion is controvertial
• High fluid intake- aiming minimum 2.5L/d urine output
• Elimination of dietary excess
22. Terminologies
• Obstructive uropathy
structural or functional changes in the urinary tract that impede normal urine
flow.
• Obstructive nephropathy
renal disease caused by impaired flow of urine or tubular fluid.
• Hydronephrosis (HDN)
aseptic dilatation of the urinary tract.
23. Classification
Congenital
• Can affect either upper or lower
urinary tract
• Males
• PUV (Postrerior Urethral Valve) or PUJO
(Pelvi-ureteric junction obstruction)
• Early gestation: dysplastic kidney
• Later, low grade or unilateral:
hydronephrosis with nephron
loss
Acquired
• Can affect either upper or lower
urinary tract
• Based on causes
• Cause:
• extrinsic
• Intrinsic: intra or extra luminal
24.
25. Clinical features
Unilateral hydronephrosis
• MC- Women, right sided
• Mild dull aching pain loin, often a
dragging heaviness worsened by
excessive fluid intake
• Kidney may be palpable
• Intermittent hydronephrosis (Dietl’s
crisis)
• USG- antenatal detection
• Usually benign, but postnatal
investigation is required to detect those
with significant PUJ obstruction
Bilateral hydronephrosis
• Due to lower urinary obstruction
• Bladder outlet obstruction symptoms
predominant
• Due to bilateral upper urinary tract
obstruction
• Idiopathic retroperitoneal fibrosis
• Idiopathic PUJO
• HDN of pregnancy: upto 20wks
26. Imaging
• USG
• IVU
• helps only if there is significant function in obstructed kidney
• Dilatation of extra renal pelvis, minor calyces- clubbed
• RGU/P
• Confirms site of obstruction
• Isotope renography
• Best test to confirm obstructive dilatation
• DTPA or MAG-3
27.
28. Treatment
• Indications
• Bouts of renal pain, increasing HDN, parenchymal damage & infection
• Mild cases- to be followed serial USG & operated if dilation increases
1. Nephrectomy: <10% split function
2. Pyeloplasty
3. Endoscopic pyelolysis
• Retrograde balloon dilatation
• PUJ incision by hot wire over balloon
• Laser incision
• Percutaneous pyelolysis
