This document summarizes evidence on surgical treatments for posterior compartment prolapse. It finds that posterior fascial duplication has better objective outcomes than site-specific repair. There is no evidence of benefit from using mesh or biological grafts. While symptoms improve in most patients, elevatormuscle suturing can increase dyspareunia. The transvaginal approach is superior to the transanal approach. Overall, the literature provides no evidence that mesh or biological patches provide any added benefit over traditional non-mesh surgery for posterior compartment prolapse repair.
- Minimally invasive technique
- Feasible & reproducible
- Single approach to a complete correction of the 3 compartments of the pelvic floor
- Excellent functional & anatomical results
- Limited risk of complications and good long-term results in the treatment of all types of POP.
- Shorter learning curve than conventional laparoscopy
Results of incisional hernia repair are poor. Centralized hernia surgery is a prerequisite for improvement of clinical outcomes. Center for a hernia and abdominal wall reconstruction should be an essential component of a university hospital. A hernia and abdominal wall reconstructive surgery is a practical and academic sub-specialization.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
- Minimally invasive technique
- Feasible & reproducible
- Single approach to a complete correction of the 3 compartments of the pelvic floor
- Excellent functional & anatomical results
- Limited risk of complications and good long-term results in the treatment of all types of POP.
- Shorter learning curve than conventional laparoscopy
Results of incisional hernia repair are poor. Centralized hernia surgery is a prerequisite for improvement of clinical outcomes. Center for a hernia and abdominal wall reconstruction should be an essential component of a university hospital. A hernia and abdominal wall reconstructive surgery is a practical and academic sub-specialization.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Similar to Chirurgia protesica e compartimento posteriore: un connubio possibile? (20)
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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!
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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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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
2. DIMENSIONE DEL PROBLEMA
• Lifetime risk di intervento chirurgico per
prolasso: 11.1%
• Negli USA circa 200.000 interventi di correzione
chirurgica di prolasso in 1 anno, di cui 22.6%
colporrafia anteriore e posteriore e 10.5% solo
colporrafia posteriore
• Riportato tasso di reintervento dopo chirurgia
per prolasso del 30%
Smith 2010
Shah 2008
Olsen 1997
3. DIMENSIONE DEL PROBLEMA
• Ricorrenza di prolasso anteriore dopo
colporrafia anteriore > 40%
• Nel 2001 la FDA approva l’utilizzo delle
mesh per via vaginale, mutuando
l’esperienza della chirurgia dell’ernia
• (… e anche della TVT…)
Sand 2001
Weber 2001
4.
5. MEMENTO…
• Scarsa conoscenza dei fattori di rischio di fallimento
della chirurgia (giovane età, elevato BMI, prolassi III-IV
grado)
• Swift dimostra che il 98% delle donne risulta
asintomatica se la parete vaginale prolassata si presenta
entro il margine imenale
Whiteside 2004
Diez-Itza 2007
Salvatore 2009
Swift 2005
IL SUCCESSO IN CHIRURGIA E’ CONSEGUENTE A QUESTO CONCETTO:
LA MAGGIOR PARTE DEGLI ARTICOLI UTILIZZA LO STADIO I O II, MA IL
CRITERIO FONDAMENTALE DOVREBBE ESSERE L’ASSENZA DI SINTOMI
SENSO DI PESO E/O CORPO ESTRANEO VAGINALE ASSOCIATO A
DISFUNZIONI URINARIE, DEFECATORIE O SESSUALI
6. LA CHIRURGIA DEL
COMPARTIMENTO POSTERIORE
• Approccio transvaginale
- Colporrafia posteriore (duplicatura fasciale
mediana) associata o meno a miorrafia
degli elevatori
- Riparazione sito-specifica del difetto
- Reti protesiche
• Approccio transanale
• Approccio addominale (LPT, LPS, robot)
12. OUTCOMES DELLA CHIRURGIA FASCIALE
• Colporrafia posteriore con duplicatura fasciale
mediana: tasso di successo oggettivo 87% a 12 mesi e
79% a 24 mesi considerando prolasso residuo ≤ stadio
I; tasso di successo oggettivo 97% a 12 mesi e 89% a
24 mesi e 87% sulla defecazione ostruita (Maher 2004)
• Colporrafia posteriore vs riparazione sito-specifica: 4%
vs 11% a 12 mesi con stadio > II grado (Abramov
2005)
• Tasso globale di risoluzione anatomica con almeno 12
mesi di follow up 80-96% per colporrafia posteriore
(Mellgren 1995, Kahn 1997)
• Tasso globale di risoluzione anatomica con almeno 12
mesi di follow up 82-92% per riparazione sito-specifica
(Cundiff 1998, Kenton 1999, Singh 2003)
13. OUTCOMES DELLA CHIRURGIA PROTESICA
• MESH BIOLOGICHE: tasso di fallimento anatomico
del 20% (prolasso ≥ II grado) a 12 mesi con mesh
derma porcino (Altman 2006) e del 12% con
sottomucosa intestinale porcina (Sung 2012)
• MESH SINTETICHE: tasso di successo 84-92%
(Lim 2005, de Tayrac 2006, Milani 2005)
• KITS: tasso di successo 82-89% (Elmer 2009,
Simon 2011)
14.
15.
16. NB: non viene analizzato il compartimento posteriore separatamente
17. NB: outcomes specifici per il compartimento posteriore sono stati analizzati e la
recidiva posteriore si è manifestata nel 21.9% delle donne sottoposte a
chirurgia protesica vs 18.2% delle donne sottoposte a chirurgia fasciale
18. TROCAR-GUIDED MESH COMPARED WITH CONVENTIONAL VAGINAL REPAIR IN RECURRENT
PROLAPSE: A RANDOMIZED CONTROLLED TRIAL
Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME.
Obstet Gynecol. 2011 Feb;117(2 Pt 1):242-50
OBJECTIVE:
To compare efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal
prolapse repair in patients with recurrent pelvic organ prolapse.
METHODS:
Patients with recurrent pelvic organ prolapse stage II or higher were randomly assigned to either conventional
vaginal prolapse surgery or polypropylene mesh insertion. Primary outcome was anatomic failure (pelvic
organ prolapse stage II or higher) in the treated vaginal compartments. Secondary outcomes were subjective
improvement, effects on bother, quality of life, and adverse events. (…)
RESULTS:
Ninety-seven women underwent conventional repair and 93 mesh repair. The follow-up rate after 12 months
was 186 of 190 patients (98%). Twelve months postsurgery, anatomic failure in the treated compartment was
observed in 38 of 84 patients (45.2%) in the conventional group and in eight of 83 patients (9.6%) in the
mesh group (P<.001; odds ratio, 7.7; 95% confidence interval, 3.3-18). Patients in either group reported less
bulge and overactive bladder symptoms. Subjective improvement was reported by 64 of 80 patients (80%) in
the conventional group compared with 63 of 78 patients (81%) in the mesh group. Mesh exposure was
detected in 14 of 83 patients (16.9%).
CONCLUSION:
At 12 months, the number of anatomic failures observed after tension-free vaginal mesh insertion was less
than after conventional vaginal prolapse repair. Symptom decrease and improvement of quality of life were
equal in both groups.
NB: recidiva posteriore 4.2% nelle mesh vs 24.5% nella chirurgia fasciale
19. Int Urogynecol J. 2015 Aug;26(8):1161-70
VAGINAL MESH FOR PROLAPSE: A LONG-TERM PROSPECTIVE STUDY OF 218 MESH KITS FROM A
SINGLE CENTRE
Karmakar D, Hayward L, Smalldridge J, Lin S.
INTRODUCTION AND HYPOTHESIS:
The aim was to assess the long-term surgical outcomes and complications in patients undergoing mesh-
augmented vaginal repair of pelvic organ prolapse.
METHODS:
This is a report of a prospective long-term follow-up experience from the Urogynaecological Service, Counties
Manukau District Health Board, Auckland, New Zealand. The subjects were 158 symptomatic women
undergoing mesh-augmented prolapse repair (218 kits, Feb 2005 to July 2013) using the Apogee and/or Perigee
kits.
RESULTS:
The median follow-up times were 138 and 105 weeks for the Apogee and Perigee kits, respectively; 56.6% and
48.8% of these kits, respectively, were inserted for recurrent prolapse. Cure rates for prolapse using mesh kits in
patients with a history of native tissue POP repair in the same compartment were 90.91% for the anterior
compartment (60 of 66) and 95.74% for the posterior compartment (45 of 47). The cumulative mesh
extrusion/exposure rate was 15.8% of patients (11.5% of mesh kits) and was significantly higher with the
Apogee kit than with the Perigee kit (P=0.03). There was a significantly higher rate of extrusion/exposure with
the Perigee kit in women with previous anterior compartment native tissue repair than with the Apogee kit in
women with previous posterior compartment native tissue repair (21.2% versus 6.4%; P=0.03). Only 8% of
extrusions/exposures needed revision of the mesh.. Overall success rates were 81.4% (110/135) for the Perigee
kit and 74.7% (62/83) for the Apogee kit.
CONCLUSIONS:
This is one of the longest prospective mesh follow-up studies to date from a single centre and highlights the
need for continuing surveillance despite high overall success rates.
20.
21.
22.
23.
24.
25.
26.
27.
28. In particular, the literature review revealed that:
- Mesh used in transvaginal POP repair introduces risks not present in traditional non-
mesh surgery for POP repair.
-Mesh placed abdominally for POP repair appears to result in lower rates of mesh
complications compared to transvaginal POP surgery with mesh.
-There is no evidence that transvaginal repair to support the top of the vagina (apical
repair) or the back wall of the vagina (posterior repair) with mesh provides any added
benefit compared to traditional surgery without mesh.
- While transvaginal surgical repair to correct weakened tissue between the bladder and
vagina (anterior repair) with mesh augmentation may provide an anatomic benefit
compared to traditional POP repair without mesh, this anatomic benefit may not result in
U.S. Food and Drug Administration
Protecting and Promoting Your Health
UPDATE on Serious Complications Associated with Transvaginal
Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA Safety Communication
Date Issued: July 13, 2011
29.
30. TAKE HOME MESSAGES
• Duplicazione fasciale posteriore > riparazione
sito-specifica in termini di outcome oggettivi
(grado B)
• Miorrafia elevatori aumenta la dispareunia
(grado C)
• Approccio transvaginale superiore a transanale
(grado A)
• Nessuna evidenza di qualsiasi beneficio da uso
di mesh o di patches biologici (grado B)
• La sintomatologia migliora nella maggior parte
delle pazienti (grado B)