This document discusses anterior recurrent shoulder dislocation. It begins with an introduction stating that the shoulder is one of the most unstable joints and anterior dislocation is the most common type, affecting around 2% of the population. It then covers the anatomy and stabilizing structures of the shoulder joint. It describes the mechanism of injury as anterior dislocation occurring during abduction and external rotation. Classification, risk factors, pathoanatomy, clinical features, investigations, and various surgical and non-surgical treatment options are discussed. Common procedures mentioned include Bankart repair, Laterjet procedure, and remplissage.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
With the pandemic overclouding the whole world it has effected every strato of people including the Orthopaedic groups. This is to highlight the impact of COVID 19 on the orthopaedic in general.
Conservative management in 3 and 4 part proximal humerus fractureBipulBorthakur
Proximal humerus fracture is common in both young as well as elderly people with most of the elderly patients unable to undergo operative management. This study is to see the aspect of conservative management in proximal humerus fracture.
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.
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.
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.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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.
2. Introduction
• most unstable and frequently dislocated joints
in the body
• 50% of all dislocations
• 2% incidence in the general population
3. Anatomy
• Comprises of glenoid cavity of scapula and
humoral head
• Factors providing stability of joint –
– Static stabilisers
• Glenoid cavity
• Glenoid labrum- increases the depth of glenoid cavity
by 50%
• Negative intra-articular pressure
• Glenohumeral ligament complex
4. • Dynamic stabilisers
– rotator cuff-
a) Supraspinatus
b) infraspinatus
c) teres minor
d) subscapularis
– Muscles around the shoulders
5.
6. Mechanism of injury
• Anterior dislocation- abduction and external
rotation of arm
– E.g- throwing of ball
7. Classification
• Based on direction of force-
– Anterior dislocation –
• most common (95%)
• humeral head dislocated anteriorly
• according to position of humeral head it is subdivided
into
– Subcoracoid
– Subglenoid
– Subclavicular
– intrathoracic
9. Risk factor
• Factors that influence the probability of
recurrent dislocations are-
• Age- youngr the age more the chance of
recurrence,
• Return to contact or collision sports.
• hyperlaxity,
• a significant bony defect in the glenoid or
humeral head.
10. Pathoanatomy
• No essential lesion for every dislocation.
• There are pathological changes in stabilizing
components.
• Hyperlaxity of the capsule- due to collagen
vascular disease or microtrauma.
• Tears of the capsulolebral complex.
• Bony defect of the glenoid or humerol head.
11. • Ligament injury or laxity.
• There are secondary changes wth repeated
dislocation. Like Erosion of the anterior
glenoid rim, stretching of the anterior
capsule
subscapularis tendon, and fraying and
degeneration of the glenoid
12. Bankert lesion
• humeral head is forced anteriorly out of the glenoid
cavity
• Tears the fibrocartilaginous labrum from almost
the entire anterior half of the rim of the glenoid cavity
• and the capsule and periosteum from the anterior
surface of the neck of the scapula.
• This traumatic detachment of the glenoid labrum has
been called the Bankart lesion.
• Single most imp factor in ant recurrent dislocation
13. Classification
• Based on duration-
– Acute dislocation- less than 6 weeks duration
– Chronic dislocation- more than 6 weeks
– Recurrent dislocation
14. History
• The history important in recurrent instability
of the shoulder joint
• The amount of initial trauma, if any, should be
determined.
• High-energy traumatic collision sports and
motor vehicle accidents are associated with
increased risk of glenoid or humeral bone
defects. Recurrence with minimal
15. • history of repeated microtrauma.
• Position at which dislocation occurs.
16. Clinical feature
• Pain may be absent.
• Swelling
• Attitude of the shoulder- shoulder abducted and
external rotation ( anterior dislocation)
• Prominent acromion
• Loss of contour
• Loss of range of motion .
17. Physical examination
• Both shoulders should be thoroughly
examined, with the normal shoulder used as
reference.
• Asymmatry or atrophy of shoulder,
• Tenderness over ant and post. Capsule and
rotator cuff and AC joint.
• Examination of rotator cuff and muscles
• Neurovascular examination.
18. Clinical tests
• Duga’s test – difficulty to touch the opposite
shoulder
• Callaway’s test – increase circumference of
the axilla compared to opposite side
• Hamilton ruler test – normally ruler placed
over the lateral aspect of arm will not touched
acromion & lateral epicondyle simultaneously
but here it can
20. Shift and load test
• one hand placed along the edge of the scapula
to stabilize it and grasping the humeral head
with the other hand and applying a
slight compressive.
• Anterior and posterior translation is
measured.
21. Sulcus test
• Done in 0 and 45 degree abduction.
• Done by pulling distally and observing for
sulcus.
23. Other tests
• Anterior drawer test- done in various degree
od abduction and external rotation.
• Jobes relocation test.
• Beighton hyperlaxity scale .
24. investigations
• X-rays shoulder–
– AP
– AXILLARY
– SCAPULAR Y VIEW
• Special views
– West point view – to see the Bankart’s lesion
– Stryker notch view – to see the Hill Sach’s lesion
– AP in internal rotation- bankert lesion.
29. CT scan
• CT with three dimensional view most
sensitive test for detecting and measuring
bone deficiency or retroversion of the glenoid
or humerus.
• also indicated for evaluating recurrences that
occur with trivial trauma, low angle instability,
and failed surgical procedures .
30. • MRI- imp. For shoft tissue pathology.
• Arthrgraphy- xray or CT arthrography can
show capsular laxity, tear, soft tissue
abnormality and bony abnormality.
• Examination under anaesthesia sometime
help in clinical diagnosis.
31. treatment
• Mostly surgical
• Non operative treatment done in case-
1. Old low demanding patient
2. Hyperlaxity due to collagen vascular disease
• Muscle strengthening and avoiding vulnarbale
position
35. Surgical Treatment
• Lots of operative procedure have been
described
• But no single best procedure
• Choice of procedure depends on-(
– has a low recurrence rate
– has a low complication rate
– has a low reoperation rate,
36. 4) does no harm (arthritis)
5) maintains motion
6) is applicable in most cases
7) allows observation of the joint
8) corrects the pathological condition
9) is not too difficult.
37. • Can be done open or arthroscopy
• Repairable defects – arthroscopic procedures
– Bankart and capsular plication preferred
• Open procedure Jobe capsulolabral
reconstruction or NEER capsular shift
preferred.
• For glenoid bony defect – Laterjet procedure
38. • Humeral head defect-
– Moderately sized treated with arthroscopic
remplissage procedure and bankart repair
– Larger defect(35-45%)- Laterjet procedure
39. Bankart operation
• Subscapularis and shoulder capsule open
vertically
• Lateral leaf of capsule reattach to anterior
glenoid rim
• Medial leaf of capsule imbricated
40. Laterjet procedure
• Coracoid process is devided at the junction of
horizontal and vertical portion
• Vertical part is transferred to antero-inferior part
of glenoid rim
• Additional iliac graft can be done for bony defect
• Post OP care
– immobilization in a sling for 2 weeks
– Forward flexion is begun thereafter
– External rotation started at 6 weeks
41. Laterjet procedure
• Post OP care
– immobilization in a sling for 2 weeks
– Forward flexion is begun thereafter
– External rotation started at 6 weeks
– Strengthening exercise at 8 weeks