A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
Robert P. Edwards, MD, Chair of OB/GYN/RS, Co-Director of Women's Cancer Program at University of Pittsburgh, offers information about the current state of immunotherapy for recurrent ovarian cancer patients.
This phase IV clinical trial (ClinicalTrials.gov NCT01525550) was
conducted as post-approval commitments to the FDA and other
regulatory agencies to confirm the efficacy and safety of sunitinib in advanced and/or metastatic, well-differentiated, unresectable pNETs.
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
Robert P. Edwards, MD, Chair of OB/GYN/RS, Co-Director of Women's Cancer Program at University of Pittsburgh, offers information about the current state of immunotherapy for recurrent ovarian cancer patients.
This phase IV clinical trial (ClinicalTrials.gov NCT01525550) was
conducted as post-approval commitments to the FDA and other
regulatory agencies to confirm the efficacy and safety of sunitinib in advanced and/or metastatic, well-differentiated, unresectable pNETs.
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
Transanal Endoscopic Microsurgery in Young Patients: A Retrospective Studysemualkaira
Local excision of rectal lesions is considered an acceptable choice for elderly and high-risk patients, yet data is scarce regarding its application in young adults
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...JohnJulie1
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...daranisaha
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...semualkaira
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...semualkaira
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...semualkaira
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline
tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous
group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant
treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...semualkaira
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...NainaAnon
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...semualkaira
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline
tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous
group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant
treatment in this particular group.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
- 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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain Diagnosis
1. 75
Nigerian Journal of Surgery Jul‑Dec 2014 | Volume 20 | Issue 2
Address for correspondence:
Dr. Ashvind Bawa,
Bawa Hospital, Near Old Dandi Swami Mandir,
Civil Lines, Ludhiana, Punjab, India.
E‑mail: drbawa@gmail.com
Introduction
Since the days of Hippocrates, medical science is constantly
thriving to peep into dark places of the body and to achieve
such techniques that would bring perfection to diagnosis.
Laparoscopy, one such achievement developed in the twentieth
century, offers a simple, rapid, and safe method to evaluate and
diagnose intra‑abdominal diseases.[1]
The success of laparoscopy in making definite and reliable
diagnosis of abdominal disorders over the past two decades, has
firmly established it in the armamentarium of a general surgeon
to perform this procedure safely. Despite this fact, general
surgeons are still reluctant to use this method of diagnosis as
often as they can.
Diagnostic and therapeutic laparoscopy has its most important
and ultimate application in the developing world. Less than
20% of the population in the developing world has access to
imaging devices like ultrasound, CT scan, magnetic resonance
imaging (MRI) or Doppler. By a happy paradox, vast areas of
the developing world have access to a laparoscope, thanks largely
to its use in widespread government‑sponsored family planning
campaigns in almost every developing country throughout the
world.[1]
Laparoscopy can be proved to be an important tool in the
minimally invasive exploration of selected patients with chronic
abdominal disorders, whose diagnosis remains uncertain, despite
exploring the requisite laboratory and imaging investigations
like ultrasonography, CT scan, and the like. Chronic abdominal
conditions are associated with poor quality of life[2]
and significant
levels of depressive symptoms.[3]
Much is known about the
prevalence, social burden, and suffering associated with chronic
abdominal conditions.[4]
As noninvasive technology in diagnosis has reached such
sophistication, Laparoscopy, it must be stressed, is still an invasive
procedure. It has to prove its value both in terms of positive
diagnosis and also in terms of safety. It must always follow
careful clinical examination and its greatest value is in addition
to other diagnostic aids.
To evaluate these potential benefits of diagnostic laparoscopy
in cases of chronic abdominal conditions with uncertain
diagnosis, this study was conducted on 120 subjects, expecting
that in the coming future, it might obviate the need for
imaging techniques in establishing the final diagnosis of these
conditions.
Role of Diagnostic Laparoscopy in Chronic
Abdominal Conditions with Uncertain Diagnosis
Amandeep S Nar, Ashvind Bawa, Atul Mishra, Amit Mittal1
Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, 1
Department of Neurosurgery,
Govind Ballabh Pant Hospital, New Delhi, India
Abstract
Introduction: Laparoscopy has proved to be an important
tool in the minimally invasive exploration of selected patients
with chronic abdominal disorders, whose diagnosis remains
uncertain,despiteexploringtherequisitelaboratoryandimaging
investigations like ultrasonography, computed tomography
(CT) scan, and the like. Materials and Methods: Diagnostic
Laparoscopy was conducted on 120 patients, admitted to the
Departments of Surgery and Gynecology, Dayanand Medical
College and Hospital, Ludhiana, with an uncertain diagnosis
after four weeks of onset of symptoms. Conclusion: With
laparoscopy providing tissue diagnosis, and helping to achieve
the final diagnosis without any significant complication
and less operative time, it can be safely concluded that
diagnostic laparoscopy is a safe, quick, and effective adjunct
to non‑surgical diagnostic modalities, for establishing a
conclusive diagnosis, but whether it will replace imaging
studies as a primary modality for diagnosis needs more
evidence.
Keywords: Chronic abdominal conditions, diagnostic
laparoscopy, uncertain diagnosis
Original Article
Access this article online
Quick Response Code:
Website: www.nigerianjsurg.com
DOI:
*****
2. Nar, et al.: Diagnostic laparoscopy in uncertain chronic abdominal conditions
76
Nigerian Journal of SurgeryJul‑Dec 2014 | Volume 20 | Issue 2
Materials and Methods
This study was done in 120 patients, admitted to the Departments
of Surgery and Gynecology, at the Dayanand Medical College
and Hospital, Ludhiana, with an uncertain diagnosis, after four
weeks of onset of symptoms.
Exclusion criteria
1. Severe/decompensated cardiopulmonary failure
2. Acute myocardial infarction
3. Bacterial peritonitis
4. Abdominal wall infection
5. Severe coagulopathy
6. Large ventral hernia
7. Diaphragmatic hernia
8. Patient unfit for general anesthesia.
In any chronic abdominal condition in which the cause was
unknown, Laparoscopy was performed after completion of all
the necessary hematological, biochemical, radiological, and ascitic
fluid analysis, gastrointestinal endoscopic and imaging techniques,
and Mantoux test (when indicated). Therapeutic intervention was
performed depending on the underlying pathology with open
laparotomy or laparoscopic techniques.
For the purpose of this study, a positive diagnostic benefit
was defined as a definite diagnosis made on the basis of
laparoscopic findings. In the case of turnovers, diagnostic benefit
also implied staging and assessment of inoperability, either
because of metastatic deposits or significant local invasion. The
complications during the procedure were also recorded. The
findings of laparoscopy were compared with those of imaging
techniques. The data was presented by descriptive statistics. For
statistical purposes, the Chi‑square test, t‑test, and Levene’s test
were applied.
Results
One hundred and twenty patients were selected for the study,
in which the diagnosis remained uncertain despite requisite
investigations. The majority of the patients were in the age
group of 55 ± 5 years with no gender preference. Pain was
associated with other complaints like fever [15 (12.5%)],
weakness [13 (10.8%)], constipation [12 (10%)], loss of weight
and appetite [11 (9.16%)], and vomiting [4 (3.33%)] [Figure 1].
Forty (33.33%) patients had a history of previous abdominal
surgery, twelve (10%) had received anti‑tuberculosis treatment,
and eight (6.66%) subjects had peripheral lymphadenopathy,
with inconclusive cytology and biopsy. Twenty‑eight (23.3%)
patients had a palpable lump, the erythrocyte sedimentation rate
was raised in nine (7.5%) subjects, while the Mantoux test was
positive in fifteen (12.5%) subjects.
All subjects underwent computerized tomographic scanning
(CT scan), out of which, sixty - three (52.5%) patients had a change
in findings when compared with the findings on ultrasonography.
The CT scan was better able to suggest dilatation of gut loops
and retroperitoneal/mesenteric lymphadenopathy [Figure 2].
Outcome of diagnostic laparoscopy
Thirty‑three subjects out of 120 cases (27.5%) had altogether
new findings, while 87 (72.5%) cases had findings similar to
the radiological means. Thirty‑five out of these 87 had new
findings along with the previous findings. Therefore, 68 out
of the 120 subjects had new findings, irrespective of the
previous findings, in the form of nodules (peritoneal, omental
or liver) (35), small bowel tumor (4), cirrhosis of liver (8),
and adhesions (21). Inflamed appendix, creeping fat necrosis,
abdominal wall abscess etc., were the other significant findings.
After diagnostic laparoscopy, tissue diagnosis was achieved in
102 of the 120 subjects (85%), out of which 56.6% were benign
and 43.3% were malignant.
The final diagnosis was reached in 112 of the 120 cases, namely,
disseminated carcinomatosis (28), tuberculosis (23) [Figure 3],
lymphoma (17), benign liver cyst (9), cirrhosis liver (8) [Figure 4],
benign ovarian cyst (5), postoperative adhesions/band (7), chronic
appendicitis (3), Crohn’s disease (3), chronic pancreatitis (3),
gastrointestinal stromal tumor (4), and angiosarcoma (2) [Figure 5].
Discussion
Chronic abdominal conditions have been a challenge. Prior to the
era of diagnostic laparoscopy, these patients used to undergo a
battery of expensive investigations, while remaining dissatisfied.
The search for pathology in these patients usually entailed a series
of laboratory and invasive tests.
Surgeons are consulted when the pathology is unclear or
tissue diagnosis is required.[5,6]
Diagnostic laparoscopy
provides an intermediate option avoiding full exploratory
laparotomy and minimizing the surgical trauma in chronically
ill patients.
As the purpose of this study was to evaluate the role of
laparoscopy as a major diagnostic tool in patients presenting
with a chronic abdominal condition, with uncertain diagnosis, it
has been clearly observed that laparoscopy has a diagnostic rate
of 93.3% in these patients.
In a study, Salky[7]
was able to identify pathology in 69 of
70 patients with either appendicitis or gynecological pathology
being the main finding. Al‑akeely MH[8]
in his study reported
tuberculosis to be the common final diagnosis (45.71%) followed
by carcinomatosis peritonei (28.5%) and lymphoma (8.57%).
In comparison, disseminated carcinomatosis (23.3%) was
the common final diagnosis in our study followed by
tuberculosis (19.1%) and lymphoma (14.1%).
The reason behind the low percentage of tuberculosis in our
study could be due to the tendency of a therapeutic trial of
3. Nar, et al.: Diagnostic laparoscopy in uncertain chronic abdominal conditions
77
Nigerian Journal of Surgery Jul‑Dec 2014 | Volume 20 | Issue 2
anti‑tubercular treatment being given in our society to patients
with a strong suspicion of tuberculosis, without any diagnostic
proof. We would recommend having a definite diagnosis to rule
out malignancy, prior to anti‑tubercular treatment.
Clinically, small, metastatic foci in the peritoneum or
liver cannot be accurately diagnosed using the traditional
ultrasound, CT or MRI, in some cases.[9]
In the current study,
23.3% of the cases were diagnosed as having disseminated
carcinomatosis on diagnostic laparoscopy with 57.1% of these
having peritoneal/omental nodules. The other associated
findings included liver nodules (42.8%), ascites (39.2%), and
lymphadenopathy (17.8%), whereas, only four out of 120 patients
had findings of peritoneal deposits on radiological investigations.
In this aspect, diagnostic laparoscopy clearly scores above the
imaging studies.
Negative laparoscopic exploration in patients suspected to have
malignancy is considered a useful outcome, as this provides
reassurance to the patient and physician, thus avoiding the
implementation of further expensive diagnostic tests.[5]
The success of diagnostic laparoscopy in the diagnosis and
staging of gastrointestinal malignancies suggested that it could
be used for intra‑abdominal lymphomas as well. Mann et al.,[10]
reported that laparoscopy helped in obtaining tissue samples in
suspected cases of lymphoma. In our study, tissue biopsy taken
during laparoscopy, confirmed the diagnosis of lymphoma in
14.16% of the cases.
Figure 2: Distribution of subjects according to imaging studies
Figure 4: Liver cirrhosis on diagnostic laparoscopy
Figure 1: Percentage of patients according to complaint reported
(Some patients had more than one complaint)
Figure 3: Abdominal tuberculosis on diagnostic laparoscopy
Figure 5: Distribution of subjects according to final diagnosis
4. Nar, et al.: Diagnostic laparoscopy in uncertain chronic abdominal conditions
78
Nigerian Journal of SurgeryJul‑Dec 2014 | Volume 20 | Issue 2
Diagnostic laparoscopy has a great deal to offer in the early
diagnosis of abdominal tuberculosis.[11]
Udwadia TE suggests that
the common findings in abdominal tuberculosis are peritoneal
or visceral tubercles, varying in size from 2 mm to 1 cm.[12]
Small bowel adhesions and strictures can also be seen. In the
present study, 23 cases had been finally diagnosed as having
abdominal tuberculosis, without any evidence of Pulmonary
Koch’s; 52.2% of these cases had intra‑abdominal adhesions as
the operative findings.
Diagnostic laparoscopy has also widened the horizon in the field
of Hepatology.[13]
In the current study, nine out of 120 patients
were diagnosed as having benign liver cysts, with 6.6% of the
cases having cirrhosis as an incidental finding. Therefore, 14.2%
of the patients had liver pathology, whereas, imaging studies
suggested liver pathology in only 6.7% of the cases. Herrera et al.,
also reported the detection rate of liver lesions and a diagnostic
yield up to 95% with laparoscopy.[14]
Diagnostic laparoscopy, when performed by general surgeons
has an additional advantage of providing a definite treatment
at the same time. As seen in our study, therapeutic intervention
was done in cases of benign liver cysts (9), chronic appendicitis
(3), gastrointestinal stromal tumor (GIST) (4), postoperative
bands (7), and cholelithiasis with cirrhosis (4).
Only one of the patients in the present study had postoperative
wound complications, from which the patient recovered within
a week. Easter et al.,[2]
also reported no major procedure‑related
complications.
Conclusion
Laparoscopy is able to achieve the final diagnosis and provide
tissue diagnosis without any significant complication and
less operative time. It can be safely concluded that diagnostic
laparoscopy is a safe, quick, and effective adjunct to diagnostic
modalities, for establishing a conclusive diagnosis, but, whether, it
will replace imaging studies as the primary modality for diagnosis,
needs more evidence.
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Source of Support: Nil, Conflicts of Interest: None declared.