Journal Club - Extra axial Endoscopic Third Ventriculostomy.pptxDr. Rahul Jain
journal club including 2 journals from same authors on topic of extra axial subfrontal endoscopic thord ventricuostomy, its techniques, advantages, limitations, principles
This presentation of mine is a brief overview of surgical management of root canal treatment failure . The non surgical approach is already explained in other presentation.
Journal Club - Extra axial Endoscopic Third Ventriculostomy.pptxDr. Rahul Jain
journal club including 2 journals from same authors on topic of extra axial subfrontal endoscopic thord ventricuostomy, its techniques, advantages, limitations, principles
This presentation of mine is a brief overview of surgical management of root canal treatment failure . The non surgical approach is already explained in other presentation.
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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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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- 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
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
3. Why Subtemporal Approach
The subtemporal approach provides a wide operative corridor to the floor
of the middle fossa and upper petroclival territories and their associated
cisterns. More specifically, this corridor reaches the anterior upper
brainstem through the anterior petrosectomy.
4. Site of skull base easily approachable through this route-
1. Middle fossa floor
2. Anterior basal cisterns
3. Upper clivus
5. Indications
1. Resection of mid to posterior intraparenchymal tumour
2. Resection of convexity temporal lobe tumors
3. Access to mid hippocampal lesions
4. Access to lateral thalamic tumors
5. Access to basal cisterns through the transcortical,
transventricular, transchoroidal pathway.
6. Lesions readily reached via this route
1. Middle fossa meningiomas
2. Small acoustic tumors
3. Trigeminal schwannomas
4. Low-lying basilar caput/upper basilar artery aneurysms
5. Upper petroclival meningiomas
7. The subtemporal approach can be used in combination with the
extended pterional route for access to-
1. Complex vascular abnormalities of the interpeduncular cisterns
2. Fibrous multicompartment menigniomas filling the medial incisural
and parachiasmatic space.
8. Preoperative Considerations
• The location of the vein of Labbe and its drainage site into the transverse sinus should be
estimated preoperatively.
• The displacement of other arterial and venous structures along the medial tentorium
should be defined.
• The potential need for a combined approach to tumors with both supratentorial and
infratentorial extensions should be planned preoperatively.
• Mannitol (1g/Kg) should be administered during skin incision if a “tight” brain is
expected.
• A lumbar drain for most patients, regardless of their tumor size, in order to minimize the
risk of temporal lobe retraction injury during intradural or extradural elevation of the
lobe.
9. Venous anatomy of Sylvian and posterior temporal regions. The vein of Labbe runs a variable course toward
the transverse sinus, but must always be preserved, especially during combined approaches to the posterior
temporal region. Locating this vessel is critical for preventing its injury and temporal lobe venous infarction.
Middle temporal vein should not be confused with the vein of Labbe (Image courtesy of AL Rhoton, Jr).
10. Subtemporal Craniotomy
Appropriate head position is paramount for surgery on deep skull base lesions.
The patient’s head position should direct the surgeon to the region of interest
through a path that allows
1. Adequate exposure of the lesion
2. Minimizes brain retraction
3. Affords flexible working angles
Furthermore, the patient’s head position should enable a comfortable
ergonomic body posture for the surgeon during the operation.
11. Patient Position
• The patient is frequently placed in the supine position (if the patient’s
neck is supple)
• In the lateral position-
1. If the neck is relatively rigid.
2. Older and heavy-set patients
3. If the patient has a history of significant cervical spondylosis, this
dictates the need for a lateral position. The head is then tilted ~20
degrees toward the floor for gravity retraction to mobilize the
temporal lobe away from the middle fossa.
13. Skin Incision
• The exact location and size of the lesion will determine the corresponding
skin incision.
• In general, smaller lesions that are within the superior or middle temporal
gyri are amenable to linear incisions.
• Whereas large subtemporal lesions benefit from a horseshoe-shaped
incision.
• For lesions that require access to the anterior temporal pole, a small
reverse question mark incision would be appropriate.
16. Craniotomy
• Placing a generous single burr hole just above the root of the zygoma.
• Penfield dissector to mobilize the dura away from the inner table of
the calvarium in preparation for the craniotomy.
• If an extradural approach to the middle fossa is planned, it is essential
to avoid early injury to the dura in order to protect the lobe during
extradural subtemporal dissection and petrosectomy.
17. • If the dura is adherent to the inner skull bone, then place numerous
burr holes.
• The lumbar drain is used to remove ~30 to 40cc of CSF gradually (in
10–20cc aliquots) to relax the brain. This drainage facilitates
dissection of the dura from the calvarium and reduces the risk of a
dural tear.
• A craniotome is then used to complete the craniotomy.
18. In the case of a subtemporal operative corridor, the craniotomy should be created as close to the middle fossa
floor as possible. This task may be accomplished by identifying one important landmark: the upper edge of the
root of zygoma marks the level of the middle fossa floor. It is also important to remember that the floor of the
middle fossa is oblique and slopes slightly superiorly from the anterior to posterior direction. Therefore, the
inferior edge of the craniotomy should be only slightly above the level of the zygoma.
19. The craniotomy in relation to the root of zygoma (*) is evident (top). Most often, the inferior edge of
the craniotomy leaves a strip of overhanging bone, obscuring a clear operative path toward the
middle fossa floor. Subsequently, a Leksell rongeur may be used to remove this overhanging bone
until the edge of the craniotomy is at the level of the floor (bottom). A handheld drill further assists
with this task.
20. Removal of the overhanging bone over the inferior craniotomy will allow an unobstructed view of the
middle fossa floor, minimizing the need for temporal lobe retraction. The location of the root zygoma (*) is
marked. The temporal bone and mastoid air cells are thoroughly waxed to prevent development of a
postoperative CSF fistula (arrows). Dural Tack up sutures are placed.
21. The dura may now be incised, as illustrated, for resection of intraparenchymal lesions.
22. Caution during Dural Dissection
Alternatively, an extradural dissection along the middle fossa may be
resumed for skull base lesions.
Importantly, the location of the vein of Labbe should be estimated
preoperatively.
The dural opening and extradural temporal lobe elevation should be
adjusted for protection of this vital venous structure.
Additional CSF may be released through the lumbar drain to further
relax the lobe.
23. Extended Subtemporal Transtentorial Approach To The
Ventrolateral Upper Brainstem
This expansion of the subtemporal approach towards the ventrolateral brainstem is
especially worthwhile and should be employed when necessary to replace more radical
skull base approaches such as an anterior petrosectomy. The following two key steps allow
anterolateral reflection of the medial tentorial flap:
• Dissection of the trochlear nerve from its dural canal up to its entrance in the cavernous
sinus and
• Extension of the tentorial incision up to the Meckel's cave.
24. This above modified technique of tentorial incision and reflection maximizes the subtemporal
transtentorial exposure and operative maneuverability by increasing the rostrocaudal and
anterolateral exposure without permanent postoperative trochlear nerve deficit.
25. Closure
• A watertight dural closure primarily or secondarily using a piece of dural allograft.
• Adipose tissue with its globular texture is one of the best barriers against CSF leakage. Before
placement of the adipose grafts, all air cells must be meticulously waxed.
• In the case of subtemporal skull base exposures that require removal of the tumor-infiltrated
dura and bone, strips of adipose tissue are placed across the dural opening to seal the dural
defect.
• Alternatively, a vascularized muscle flap prepared from the posterior aspect of the temporalis
muscle may be rotated to fill the defect within the bone or dura. This latter method is used
during repeat operations for patients who have previously undergone radiation treatment.
• Any additional mastoid and temporal air cell are rewaxed. Finally, the bone flap is replaced and
the scalp is closed in anatomic layers.
26. Postoperative Considerations
• Postoperatively, the patient is admitted to the ICU for neurologic and blood
pressure monitoring and pain control.
• Frequent and careful neurologic exams are paramount because temporal lobe
hematomas can occur due to lobar retraction injury or venous drainage
compromise, leading to rapid brainstem compression.
• The patient is usually transferred to the regular ward on the first or second
postoperative day. Lumbar drainage may be continued if there is a high suspicion
of CSF leakage.
• Due to manipulation of the temporal lobe, the use of prophylactic antiepileptic
medications for at least one week after surgery is highly recommended.
27. Pearls and Pitfalls
• During positioning, tilting the patient’s head toward the floor is a key maneuver to
maximize the use of gravity retraction and obtain appropriate subtemporal
exposure.
• The upper edge of the zygoma is a good landmark for locating the level of the
middle fossa floor.
• Removal of the overhanging inferior edge of the craniotomy is important for
preparing an obstructed operative trajectory toward the middle fossa floor.
• The location of the vein of Labbe should be estimated preoperatively. Dural
opening and extradural temporal lobe elevation should be adjusted for protection
of this vital venous structure.