Anatomy of urinary bladder. surfaces, border of urinary bladder its relation , ligament support, peritoneal relation in male and females, pouches, blood supply of bladder, nerve supply of bladder, true and false ligament of urinary bladder,
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
Anatomy of urinary bladder. surfaces, border of urinary bladder its relation , ligament support, peritoneal relation in male and females, pouches, blood supply of bladder, nerve supply of bladder, true and false ligament of urinary bladder,
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
Urinary system
a) Anatomy and physiology of urinary system
b) Formation of urine
c) Renin Angiotensin system – Juxtaglomerular apparatus - acid base Balance
d) Clearance tests and micturition
The azygos vein connects the inferior vena cava and the superior vena cava
The thoracic duct is the largest lymph vessel that ultimately drains lymph from all parts of the body into the blood circulation
We shall look at them one at a time
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.
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
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.
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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.
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.
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.
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!
5. RENAL VASCULAR ANATOMY
• The renal pedicle classically consists of a single artery and a single
vein that enter the kidney via the renal hilum .
• The renal arteries arise from the aorta at the level of the
intervertebral disk between the L1 and L2 vertebrae where the longer
right renal artery passes posterior to the inferior vena cava (IVC).
• Renal arteries give branches to the adrenal glands, renal pelves, and
proximal ureters.
6. • Blood supply of the kidney. A
and B, Segmental branches of
the right renal artery
demonstrated by renal
angiogram. C, Segmental
circulation of the right kidney
shown diagrammatically. Note
that the posterior segmental
artery is usually the first branch
of the main renal artery and it
extends behind the renal pelvis.
a, artery
7. • Figure 91.12 Segmental arterial
anatomy of the right kidney. (By
permission from Walsh PC, Retik
AB, Vaughan ED et al (eds) 2002
Campbell's Urology, 8th edn.
Philadelphia: Saunders.)
8. • After entering the hilum, each artery divides into five segmental end
arteries that do not anastomose significantly with other segmental
arteries.
• Therefore occlusion or injury to a segmental branch will cause
segmental renal infarction.
• Nevertheless, the area supplied by each segmental artery could be
independently surgically resected.
• The renal artery usually divides to form anterior and posterior
divisions.
9. • The anterior division supplies roughly the anterior two thirds of the
kidney, and the posterior division supplies the posterior one third of
the kidney.
• Typically, the anterior division divides into four anterior segmental
branches:
• apical
• upper
• middle and
• lower
10. • The posterior segmental artery represents the first and most constant
branch, which separates from the renal artery before it enters the
renal hilum.
• A small apical segmental branch might originate from this posterior
branch, but it arises most commonly from the anterior division.
• The posterior segmental artery from the posterior division passes
posterior to the renal pelvis while the others pass anterior to the
renal pelvis.
11. • If the posterior segmental branch passes anterior to the ureter,
UPJO may occur.
• In 25% to 40% of kidneys, anatomic variations in the renal vasculature
have been reported.
• Supernumerary renal arteries are the most common variation, with
reports of up to five arteries, especially on the left side.
• The main renal artery may manifest early branching after originating
from the abdominal aorta and before entering the renal hilum.
12. • These perhilar arterial branches should be detected in patients
undergoing evaluation for donor nephrectomy.
• An accessory renal artery may arise from the aorta, between T11 and
L4, and terminate in the kidney.
• Rarely, it may also originate from the iliac arteries or superior
mesenteric artery.
13. ACCESSORY RENAL ARTERIES
• Accessory renal arteries are seen in 25% to 28% of patients and are
considered the sole arterial supply to a specific portion of the renal
parenchyma, commonly the lower and occasionally the upper pole of
the kidney.
• These accessory renal arteries may contraindicate laparoscopic donor
nephrectomy and result in severe bleeding if they are injured during
endopyelotomy for UPJO.
• Multiple renal arteries that arise from the aorta or iliac arteries are
frequently seen in horseshoe and pelvic kidneys. In approximately 5%
of patients, the main and accessory right renal arteries pass anterior
to the IVC.
14. AVASCULAR PLANE OF BRODEL
• There is a longitudinal avascular plane (line of Brodel) between the
posterior and anterior segmental arteries just posterior to the lateral
aspect of the kidney through which incision results in significantly less
blood loss.
• However, this plane may have various locations that necessitate its
delineation before incision either by preoperative angiography or
intraoperative segmental arterial injection of methylene blue.
• This has important surgical implications. For example, during percutaneous
access into the kidney, posterior calyces along the line of Brodel are
preferred.
• Furthermore, during anatrophic nephrolithotomy (Boyce procedure), an
incision is made through this avascular plane.
15.
16. • At the renal sinus, each segmental artery branches into lobar
arteries, which further subdivide in the renal parenchyma to form
interlobar arteries.
• These interlobar arteries progress peripherally within the cortical
columns of Bertin to give the arcuate arteries at the base of the renal
pyramids at the corticomedullary junction.
17.
18. • Note the close relationship of the interlobar arteries to the infundibuli
of minor calyces. Interlobular arteries branch off the arcuate arteries
and move radially, where they eventually divide to form the afferent
arterioles to the glomeruli.
• Each afferent arteriole supplies a glomerulus, one of approximately 2
million glomeruli, where urinary filtrate leaves the arterial system and
is collected in the glomerular (Bowman) capsule.
• Blood returns from the glomerulus via the efferent arteriole and
continues as either secondary capillary networks around the urinary
tubules in the cortex or descends into the renal medulla as the vasa
recta.
19. VEINOUS DRAINAGE
• The renal venous drainage correlates closely with the arterial supply
• The exception that unlike the arterial supply, has extensive collateral
communication through the venous collars around minor calyceal
infundibula.
• Furthermore, the interlobular veins that drain the post-glomerular
capillaries also communicate freely with perinephric veins through
the subcapsular venous plexus of stellate veins.
• The interlobular veins progress through the arcuate, inter-lobar,
lobar, and segmental veins paralleling their corresponding arteries.
20. • Three to five segmental renal veins eventually unite to form the renal
vein. Because the venous drainage communicates freely forming
extensive collateral venous drainage of the kidney, occlusion of a
segmental venous branch has little effect on venous outflow.
• The right and left renal veins lie anterior to the right and left renal
arteries and drain into the IVC.
• Whereas the right renal vein is 2 to 4 cm long, the left renal vein is 6
to 10 cm. The longer left renal vein receives the left suprarenal
(adrenal) vein and the left gonadal (testicular or ovarian) vein.
21. • The left renal vein also may receive a lumbar vein, which could be
easily avulsed during surgical manipulation of the left renal vein.
• The left renal vein traverses the acute angle between the superior
mesenteric artery anteriorly and the aorta posteriorly.
• In thin adolescents, the left renal vein may get compressed between
the superior mesenteric artery and aorta, causing nutcracker
syndrome.
• In approximately 15% of the patients, supernumerary renal veins are
seen and often are retroaortic when present on the left.
22. • Accessory renal veins are more common on the right side, and the
most common anomaly of the left renal venous system is the
circumaortic renal vein, reported in 2% to 16% of patients.
• The retroaortic renal vein is less commonly seen than the
circumaortic vein, in which the left renal vein bifurcates into ventral
and dorsal limbs, which encircle the abdominal aorta.
• In retroaortic renal vein, the single left renal vein courses posterior to
the aorta and drains into the lower lumbar segment of the IVC.
23.
24.
25. IMAGING FOR RENAL VASCULAR ANATOMY:
• Doppler ultrasonography clearly identifies renal arteries at their origin
from the abdominal aorta .
• However, the main renal artery is often difficult to identify at baseline
ultrasonography.
• (CTA) is currently considered the gold standard to assess renal
arteries, with 100% sensitivity for identification of renal arteries and
veins.
• The 3D volume-rendered CTA has emerged as a fast, reliable, and
noninvasive modality that can reliably and accurately depict
• the number, size, course, and relationship of the renal vasculature.
26. • Arterial branches down to the segmental branches could be
identified, but vessels smaller than 2 mm could be missed.
• Magnetic resonance arteriography uses no ionizing radiation, does
not require arterial access, and includes different imaging techniques
to visualize renal vasculature.
• Contrast material can give faster, better resolution and more accurate
images without artifacts, inferior mesenteric artery and diaphragm),
with occasional additional drainage into the retrocrural nodes or
directly into the thoracic duct above the diaphragm.
27. • Right renal lymphatic drainage primarily goes into the right
interaortocaval and right paracaval lymph nodes (between common
iliac vessels and diaphragm), with occasional additional drainage from
the right kidney into the retrocrural nodes or the left lateral para-
aortic lymph nodes.
28. Vascular Complications
• Preoperative patient preparation
• history and physical exam to elicit any signs or symptoms of bleeding
dyscrasias
• work-up as needed by hematology should be performed as an uncorrected
coagulopathy is the only absolute contraindication for percutaneous renal
surgery
• Preoperative labs
• should include a prothrombin time/partial thromboplastin time
(PT/PTT),international normalized ratio (INR), complete blood count, and
serum electrolytes; and cross-matched blood should be available,
depending on the type of case.
• A preoperative urine culture should be negative.
29. • increased risk of hemorrhage are those with cardiac stents who are
unable to discontinue their antiplatelet medication prior to surgery
• The recommendations are as follows:
• antiplatelet agents, such as acetylsalicylic acid and clopidogrel, should be
stopped 10 days prior,
• warfarin 5 days prior, intravenous heparin 6 h prior, and low molecular weight
heparin 24 h prior to surgery.
30. Risk of hemorrhage with
renal procedures
Percutaneous renal biopsy
• A recent series reports the incidence of postbiopsy hemorrhage
(subcapsular and perinephric) to be lower (38.4%, 28 of 73) when
18G core needle biopsies are performed
• All hemorrhagic complications were managed conservatively; no
embolization or blood products were required in this series.
31. Percutaneous cryotherapy/radiofrequency ablation
• tumor size directly correlated with incidence of bleeding. Tumors with
a
• median size of 4.2 cm were associated with increased rates of
postablation hemorrhage when compared to tumors with a median
size of 2.6 cm (P > .05)
• When only a single probe is used, the rate of bleeding decreases to
0%.
• The use of multiple probes increases the degree of renal trauma and,
hence, the incidence of bleeding complications
32. Percutaneous nephrolithotomy
• that balloon dilators could decrease the risk of hemorrhage
associated with PCNL.
• factors associated with blood transfusions post PCNL and reported an
association with
• multiple punctures,
• renal pelvic perforation, inexperience,
• preoperative anemia and
• total blood loss
• Complications decrease with experience.
33. Management
• Venous haemorrhage
• Usually conservative
• AMPLATZ Sheath
• Nephrostomy tube 24 Fr .
• Kaye tamponade balloon catheter
• Perinephric hematoma
• triphasic abdominal CT scan to distinguish it from urinary leak
• transfusion of crystalloids and blood products
• conservative measures fail, then renal angiography and superselective
embolization should be performed in an attempt to identify and embolize the
bleeding arterial branches
• a return to the operating room for open exploration could be warranted
35. Laparoscopic partial nephrectomy
• The majority of the literature regarding the complications of renal surgery
focuses on the comparison of open to laparoscopic techniques.
• When evaluating the hemorrhage associated with laparoscopic renal
surgery, it is important to keep it in perspective, because authors define
the term “hemorrhage” in multiple ways.
• For example, a hemorrhage that requires a blood transfusion differs
significantly from a hemorrhage that requires reoperative management or
embolization.
• Patients with immediate hemorrhaging postoperatively were managed
conservatively 2% (4 of 200), and delayed hemorrhaging occurred in 4% (8
of 200) of the patient.
37. • Arterial haemorrhage
• stabilization with crystalloids and blood products, patients should undergo
renal angiography and super-selective embolization
• The most common findings on angiography are
• arteriovenous fistulas,
• pseudoaneurysms, and
• lacerated renal segmental arteries (vessel cut-off)
• Grade V renal trauma still requires surgical exploration.
38. Vascular anatomy of the ureteropelvic
junction: importance for endopyelotomy
• Today, endopyelotomy is a common procedure for both primary and
secondary UPJO.
• The risk of injuring a large vessel during endopyelotomy can be
greatly reduced or even eliminated if the endourologist understands
and keeps in mind the 3D vascular relationships to the UPJ [44, 45,
51]. This section describes the vascular anatomy of the UPJ and this
should be used to perform endopyelotomy safely and efficiently.
39. Figure 6.41
(A) Anterior view of a right kidney
endocast (pelviocalyceal system
together with the intrarenal arteries)
shows a close relationship between
the inferior segmental artery and the
anterior surface of the ureteropelvic
junction (UPJ; arrow). u, ureter. (B)
Anterior view of a right kidney
endocast (pelviocalyceal system
together with the intrarenal veins)
shows a close relationship between a
vein draining the lower pole and the
UPJ (arrow). RV, renal vein; u, ureter
(reproduced from Sampaio and
Favorito [44], with permission).
40. • Anterior vascular ureteropelvic junction relationshiAps
• 65% of the endocasts there was a prominent artery, vein, or both vessels in
close relationship with theventral surface of the UPJ (Figures 6.41 and 6.42).
• Among these endocasts, the relationship was with the inferiorsegmental
artery in 45%
41. • To protect the arteries
from lesion, it has
been recommended
to examine via
intrarenal endoscopy
the area to be incised
for any arterial
pulsation and, if
detected, to avoid
incising that site.
42. • the exact role of crossing vessels
in obstruction and the success of
endopyelotomy are yet to be
determined.