We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions.
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions.
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
Explore the breadth of new robotic devices being developed for surgical assistance. See the LinkedIn Robot-of-the-Day (#ROTD) series for an ongoing discussion of this exciting technology.
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
Explore the breadth of new robotic devices being developed for surgical assistance. See the LinkedIn Robot-of-the-Day (#ROTD) series for an ongoing discussion of this exciting technology.
Significant improvements in the surgical approaches and management of diseases have been made in the last century since the advent of antibiotics and aseptic surgical techniques. A major revolution has happened in the last 25 years, as the focus has shifted to minimally invasive surgery and subsequently to robotic assisted surgery. The da Vinci system is by far the most successful surgical robot in use today.
This brief presentation highlights the major applications of surgical robots in addition to the most used models. It also briefs the current benefits and limitations of this technology.
Robot-assisted laparoscopic surgery: Just another toy?Apollo Hospitals
One of the most significant developments in medical technology in the past decade is the advent of Robot-assisted laparoscopic surgery. Laparoscopic surgery has distinct advantages over conventional open surgery, and most gynecological procedures can now be performed by the laparoscopic route. However, the popularity and acceptance of laparoscopic surgery is far from universal, mainly due to the technical difficulties in the procedure. Laparoscopic surgery requires training and skill, and has a long learning curve. Robot-assisted surgery may help overcome some of these problems.
On July 11, 2000, the Food and Drug Administration (FDA) approved the first completely robotic surgery device, the da Vinci surgical system from Intuitive Surgical (Mountain View, CA).
The DA VINCI robotic surgery is one of the greatest inventions of human race.
It has been used to carry out major operations with precisions and higher success rate.
This is mostly used for gynaecological surgeries and repairing the cardiac valves.
The use of a robotic surgical system can provide added dexterity for delicate intraocular manipulations.
By Jean Pierre Hubschman, MD; Angelo Tsirbas, MD; and Steven D. Schwartz MD
To Restore Your Gut Bacteria and Health rememder the saying of Messenger of Allah Muhammad pbuh ; "No man fills a container worse than his stomach. A few morsels that keep his back upright are sufficient for him. If he has to, then he should keep one-third for food, one-third for drink and one-third for his breathing.“ [At-Tirmidhi] . Also remember the saying of Hippocrates 460 BC - 370 BC : "Let thy food be thy medicine and thy medicine be thy food". And this saying by Moses Maimonides, the great 12th century physician : "No illness which can be treated by diet should be treated by any other means”.
Aging is the progressive accumulation of damage to an organism over time leading to disease and death. Aging research has been very intensive in the last years aiming at characterizing the Pathophysiology of aging and finding possibilities to fight age-related diseases. Various theories of aging have been proposed. In the last years advanced glycation end products (AGEs) have received particular attention in this context. AGEs are formed in high amounts in diabetes but also in the physiological organism during aging. Higher levels of diabetic complications are due to poor glycemic control. The incidence and prevalence of diabetes mellitus is rising. About 50% of people with diabetes mellitus are unaware of their condition. Pharmacotherapy and Therapeutic lifestyle change (Diet, Regular exercises, Sunshine, Vitamin D and Calcium normal levels) should be the cornerstone of diabetes management.
Epigenetics, the microbiome and the environmentfathi neana
An epigenome consists of a record of the chemical changes to the DNA and histone proteins of an organism. These changes can be passed down to an organism's offspring via transgenerational epigenetic inheritance. Epigenetics, Gut microbiome and the Environment interplay like a vicious triad.
1- The epigenome is highly sensitive to external environment
2- The epigenome is highly sensitive to internal environment (Microbiome)
3- The microbiome (internal environment) is affected by the external environment
Care of the microbiome seems to be a personal issue but as it is affected by the external environment the issue must be global and a worldwide campaign have to be started.
Covid -19 informations you have to knowfathi neana
With Corona worldwide pandemic the people who exposed to the virus show different reactions some did not catch the virus and among those who catch the virus most of them did not show any symptoms or mild unnoticeable symptoms but some of them show sever manifestations and are killed by this virulent virus. Luckily enough this last group are the minority. The question is not why some people is affected by the virus but th question should be why most of the people are not affected or even those who are affected can defeat the virus and escape its fatal outcome?. To answer this question we have to know some basic facts.
A vitamin is an organic molecule (or related set of molecules) that is anessential micronutrient which an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrients cannot besynthesized in the organism, either at all or not in sufficient quantities, and therefore must be obtained through the diet.
Vitamins are classified as either water-soluble or fat-soluble. In humans there are 13 vitamins: 4 fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. Because they are not as readily stored, more consistent intake is important. Fat-soluble vitamins are absorbed through the intestinal tractwith the help of lipids (fats). Vitamins A and D can accumulate in the body, which can result in dangerous hypervitaminosis. Fat-soluble vitamin deficiency due to malabsorption is of particular significance in cystic fibrosis.
Free radicals are electron missing atoms or molecules. It is very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction like snowball.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell. The rule of antioxidants is to give electrons to free radicals and neutralize its destructive effects especially on the DNA.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin. In contrast to normal cells, which derive most of their usable energy from oxidative phosphorylation, most cancer cells become heavily dependent on substrate level phosphorylation to meet energy demands. Evidence is reviewed supporting a general hypothesis that genomic instability and essentially all hallmarks of cancer, including anaerobic glycolysis (Warburg effect), can be linked to impaired mitochondrial function and energy metabolism. A view of cancer as primarily a metabolic disease and how autophagy process is activated will impact approaches to cancer management and prevention.
Lastly the question is Why some people have no cancer ? the answer is it is the life style and the diet rich in Healthy fat, Antioxidants, Vitamin C, Salvestrols and many natural remedies.
Free radicals are very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell.
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
Small intestinal bacterial overgrowth (SIBO)fathi neana
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO).
The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency.
The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states.Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, Rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Microbiota, Vitamin D Receptor and Autoimmuityfathi neana
1. Vitamins are substances which usually cannot be made by the body itself.
2. The body synthesizes vitamin D from 7-dehydro-cholesterol. Vitamin D is not a vitamin, it is a Gene-Transcriptional-Activator, a paracrine steroid hormone. It is the primary ligand which activate VDR
3. Deactivated VDR causes down regulation of the innate immunity. The burden on adaptive immunity increases creating a state of chronic inflammation with possible maladaptation and autoimmunity
4. What causes VDR deactivation is mostly a state of chronic inflammation caused by the pathogens associated with dysbiosis or leaky gut
5. VDR deactivation lead to Increased 1,25-dihydroxy vitamin-D (calcitriol) as there is no consumption and no breakdown
6. Sunshine, dietry and Ingested Vitamin D are preparing the precursors of 1,25-dihydroxy vitamin-D (calcitriol)in the presence of good liver and kidney function
7. 1,25-dihydroxy vitamin-D (calcitriol) is the active form which act as the primary ligand for VDR
8. Olmesartan, a VDR agonist, restores innate immune activity, allows (slow) recovery from advanced disease.
9. Treatment on the long term should be directed to reactivation of VDR by the Natural Ways that Increase Calcitrol and Vitamin D Receptor Gene Expression
10. restoring a balanced Microbiota and overcoming the leaky gut play a major rule in VDR reactivation
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
Microbiota, vitamin D receptor VDR and autoimmuityfathi neana
The big question is what is behind sickness during our life ?. How the pathogens can prevail and what happen to our immune system and microbiota. How the pathogens in a clever way shut down the innate immunity causing persistent chronic illness, chronic inflammation, maladaptive autoimmunity and other chronic diseases. What is the rule of vitamin D and its receptor VDR . What about the current debate regarding the best choice for managing vitamin D deficient function. Hope we can find the answer in this presentation.
DIC is not a disease entity but an event that can accompany various disease processes. It is an “Acquired” Pathological process. Widespread activation of the clotting cascade lead to formation of blood clots in small blood vessels throughout the body causing a compromise of tissue blood flow leading to multiple organ damage MOD. The coagulation process consumes clotting factors and platelets,normal clotting is disrupted and severe bleeding can occur from various sites. Patients with DIC should be treated at hospitals with appropriate critical care units (ICU) with available Subspecialty expertise, such as hematology, blood bank, or surgery. Patients who present to hospitals without those capabilities and who are stable enough for transfer should be referred expeditiously to a hospital that has those resources. Treatment of DIC includes the underlying disorder, supportive treatment and hemostatic Therapy.
Deep vein thrombosis (DVT) & pulmonary embolism (PE). Life-threatening complications following trauma. Incidence of 5 to 63%. Risk factors: Pelvic and lower extremity fractures,Head injury and Prolonged immobilization. DVT prophylaxis is essential in the management of trauma patients.
Sepsis is the systemic inflammatory response syndrome (SIRS) due to severe infection. Sepsis simply is a Race to death between the host immune system and the pathogens. Micro-organisms grow out of control => hyperinflammatory response, With this insidious pathology the body attacks itself (auto immunity) leading to life threatening risk of organ dysfunction, septic shock and death. Micro-organisms can invade the body through wounds, IV lines, catheters etc. Sepsis kills more than 210,000 people in the US /year. It kills about 1,400 people worldwide every day. Significant decrease in Mortality due to increased Recognition and early Treatment.
Fat Embolism Syndrome (FES) is a Syndrome characterized by: Hypoxia, Confusion and Petechiae. Presenting soon after long bone fracture and soft tissue injury. Diagnosed by exclusion of other causes 0f (Hypoxia & Confusion). It occurs in 0.9 – 8.5% of all fracture patients. Up to 35% of the multiply injured. Mortality 2.5 – 15 - 20%. Rare in upper limb injury and children.
Treatment includes prompt stabilization of long bone fractures and supportive measures which includes: 1- Oxygen Therapy to maintain PaO2. 2- Mechanical Ventilation. 3- Adequate Hydration.
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
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.
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.
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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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. We live in an age of
a new unpreceded
wonders
The wonders of the world are not
seven any more
The inanimate talk to us
We are flying in the air
More than 65,000-Ton can float
over the water in an iron vessel
The Robotic Doctor is already a
reality
6. When we talk about robots doing
the tasks of humans, we often talk
about the future.
But robotic surgery is already a
reality.
The surgeon views the patient via
a terminal and manipulates
robotic surgical instruments via a
control panel.
7. The surgeon views the patient via a terminal and manipulates
robotic surgical instruments via a control panel.
8. The difference between Endoscopic
surgery (as laparoscopic surgery)
and Robotic surgery is that
The instruments are controlled by
the Robotic system in stead of the
direct hold by the human (surgeon)
hands
9. Robotics does not replace
Human intelligence
Skill
Experience
RobotSurgeon
12. Pedicle screw instrumentation :
1- Free hand (FH) conventional pedicle screw
instrumentation
15.3% error rate for 544 screws from T5 to S1
7 patients necessitated reoperation
4 patients sustained long-term neurological sequelae
2- Computer assisted navigation (CAN) and surgical
robotics
5.4% error rate for the 294 screws
No patients required reoperation in the CAN group
None experienced postoperative neurological deficits.
Navigation and Robotics in Spinal Surgery: Where Are We Now?
Neurosurgery 80:S86–S99, 2017
VOLUME 80 | NUMBER 3 | MARCH 2017 Supplement www.
Samuel C. Overley, MD∗, Samuel K. Cho, MD∗, Ankit I. Mehta, MD‡, Paul M. Arnold, MD§
∗The Mount Sinai Hospital, Icahn School of Medicine, New York, New York; ‡University of Illinois, Hospital
and Health Sciences Center, Chicago, Illinois; §The University of Kansas Hospital, Kansas City, Kansas
13. These systems have the potential to
improve the safety and effectiveness
of surgeries.
Three major advances aided by
surgical robots:
Remote surgery,
Minimally invasive surgery, and
Unmanned surgery.
32. The surgeon instead of directly moving the instruments, He uses one of two
methods to control the instruments;
1- Direct telemanipulator
. A remote manipulator that allows the surgeon to perform the normal movements
associated with the surgery (on simulator) whilst the robotic arms carry out those
movements using end-effectors and manipulators to perform the actual surgery on the
patient.
2- Computer control systems
The surgeon uses a computer to control the robotic arms and its end-effectors, (these
systems can also still use telemanipulators for their input).
One advantage of using the computerized method is that the surgeon does not
have to be present, but can be anywhere in the world, leading to the possibility
for remote surgery.
Robotically-assisted minimally-invasive surgery
and Remote surgery (Telesurgery)
33.
34. Robotic surgery
Robotic surgery is a type of
minimally invasive surgery.
“Minimally invasive” instead
of operating on patients
through large incisions,
we use miniaturized surgical
instruments that fit through a
series of quarter-inch
incisions.
35. Robotic surgery
The main object of such smart
instruments is to reduce or
eliminate the tissue trauma
traditionally associated with
open surgery without
requiring more than a few
minutes' training on the part
of surgeons.
36. Why Robotic Surgery
A robot is not just a machine
It is an information system with
arms
The robots are actually more
accurate than Human beings
(Robotic Pedicular screws error 5% vs. 11% human experts vs.
40% human learning curve)
37. Total Integration of Surgical Care
Courtesy of Joel Jensen,
SRI International, Menlo Park, CA
Minimally Invasive
& Open Surgery
Pre-operative planning
Surgical Rehearsal
Intra-operative navigation
Remote Surgery
Simulation & Training
Pre-operative Warm-up
38. APPLICATIONS
• Cardiac surgery
• Gastrointestinal
surgery
• Gynecology
• Neurosurgery
• Orthopedics
• Pediatrics
• Radio surgery
• Urology
Different procedures, including:
Coronary artery bypass
Cutting away cancer tissue from sensitive
parts of the body such as blood vessels,
nerves, or important body organs
Gallbladder removal
Hip replacement
Hysterectomy
Kidney removal
Kidney transplant
Mitral valve repair
Pyeloplasty (surgery to correct ureteropelvic
junction obstruction)
Pyloroplasty
Radical prostatectomy
Radical cystectomy
Tubal ligation
39. Da Vinci Surgical System
ZEUS Robotic Surgical
System
AESOP Robotic System
There are three surgical robots that have
been recently developed
40. Surgical Robot - “Da vinci”
4 arms
• Da vinci’s miniaturized instruments are mounted on
three separate robotic arms, allowing the surgeon
maximum range of motion and precision. The da Vinci’s
fourth arm contains a magnified high-definition 3-D
camera that guides the surgeon during the procedure.
Da vinci is the one of the most
advanced Surgical bot in the
world.
43. Da Vinci robot consists
• A surgical console
• Patient- side cart
• Instruments and imaging processing equipment
44. The surgeon views the patient via a terminal and manipulates robotic surgical
instruments via a control panel.
45. Da Vinci Components
Surgeon’s Console
• Optimal hand-eye
alignment
• Immersive 3D stereo
viewer
• Comfortable seat
posture – ergonomic
• Motion scaling &
tremor reduction
Master controller controls the motion of the end effector wrist
46. Da vinci Cart
•Endowrist instruments
•3-4 robotic arms
•Interchangeable end
effectors
Da Vinci Components
47. Da Vinci System
• Multiple robotic arms
– For camera control and end
effector control
Stereo endoscope
Tools at arms of bot
48. The Endoscope
• Fiber optic instrument
• Inserted through a small
incision
• Has a very tiny video camera
• Shows the surgeon a 3-
dimensional, magnified view
• Projects to a television screen
49. Speciality of Da vinci
The surgeon controls these instruments and the camera from
a console located in the operating room. Placing his fingers
into the master controls, he is able to operate all four arms of
the da Vinci simultaneously while looking through a
stereoscopic high-definition monitor that literally places him
inside the patient, giving him a better, more detailed 3-D view
of the operating site than the human eye can provide
50.
51. Robotic and Remote surgery (Telesurgery)
Robotic surgery is a type of rapidly
advancing minimally invasive
surgery.
A robot is not just a machine
It is an information system with
arms
The robots are actually more
accurate than Human beings
52. • Surgeons have enhanced view
• Easier to attach nerve endings
• Surgeons tire less easily
• Fewer doctors required in operating
rooms
• In turn, cheaper for hospitals.
• Smaller risk of infection
• Less anesthesia required
• Less loss of blood
Benefits of Robotic Surgery (Operative)
53. Benefits of Robotic Surgery (Post operative)
• Operations through small tiny
incisions less scarring
• Faster recovery time
• Reduce loss of healthy tissue
• Less pain, shorter hospital stay
• Reduced cost
• Patient returns to work sooner
• Greater surgical precision
• Less blood loss and transfusion.
54. • Time lag between surgeons commands and
action of robot could harm the patient
(fiber optic)
• Loss of power in an electrical failure
• Robotics does not replace human
intelligence, skill and experience
• Surgericals Robots are much
costlier - Da vinci's cost is 2.5 million euro.
Legal/Ethical issue in Robotic surgery
55. • The rate of discovery of new technology is
outpacing the ability of business, society,
and healthcare to integrate and apply
• Robotic surgery is but one example of such
technology that may reduce operative
morbidity, hospital stay, and recovery, while
potentially improving clinical outcomes
• But at what point do the benefits justify the
increased expense?
Legal/Ethical issue in Robotic surgery
56. Figure 1. Annual Numbers of Adverse Event Reports and Rates of Events per Procedure
The left Y-axis corresponds to the bars showing the absolute numbers of adverse events (based on the year that
reports were received by the FDA). The right Y-axis corresponds to the trend lines showing (in logarithmic scale)
the annual number of adverse events per 100,000 procedures (based on the year the events occurred). Numbers on
the bars indicate number of deaths reported per year. Error bars represent 95% confidence intervals for the
proportion estimates. Because of the small number of injury and death events reported for 2004 and 2005, a
combined rate was calculated for 2004–2006. Note that of all the events, 40 were reported as part of the articles or
the legal disputes received by the manufacturing company.
DISADVANTAG
ES
The Question
of
Safety & Cost
57. During the study period
1- 144 deaths (1.4% of the 10,624
reports)
2- 1,391 patient injuries (13.1%)
3- 8,061 device malfunctions
(75.9%) were reported
14 year period of 2000–2013
Adverse Events in Robotic Surgery:
A Retrospective Study of 14 Years of FDA Data
specialties, for which robots
are extensively used, such as
gynecology and urology, had
lower number of injuries,
deaths, and conversions per
procedure
than more complex surgeries,
such as cardiothoracic and
head and neck
58. Device and instrument malfunctions, such as
falling of burnt/broken pieces of instruments into the patient (14.7%),
electrical arcing of instruments (10.5%),
unintended operation of instruments (8.6%),
system errors (5%), and video/imaging problems (2.6%), constituted a major
part of the reports.
Device malfunctions impacted patients
in terms of injuries or procedure interruptions. In 1,104 (10.4%) of the events,
the procedure was interrupted to restart the system (3.1%), to convert the
procedure to non-robotic techniques (7.3%), or to reschedule it to a later time
(2.5%)
8,061 device malfunctions (75.9%) were reported
59. Figure 2. Cumulative rates of malfunctions per
procedure
The rates of malfunctions per procedure were obtained
for each week (see Figure 2 in Appendix for more
details).
Limitations
The results of our study come with
the caveats that inherent risks
exist in all surgical procedures
(more so in complex procedures)
and that the MAUDE database
suffers from underreporting and
inconsistencies.
Thus, the estimated number of
adverse events per procedure are
likely to be lower than the actual
numbers in robotic surgery.
Further, the lack of detailed
information in the reports makes
it difficult to determine the exact
causes and circumstances
underlying the events.
Therefore, the sensitivity of
adverse event trends to changes
in reporting mechanisms, surgical
team expertise, and inherent risks
of surgery could not be assessed
here.
61. ِّهِّب واُرِّكُذ اَم واُسَن اَّمَلَفَْوبَأ ْمِّْهيَلَع اَنْحَتَفٍءْيَش ُِّلك َابِّب واُح ِّرَف اَذِّإ ٰىَّتَحمُهاَنْذَخَأ واُتوُأ اَم
َونُسِّلْبُّم مُه اَذِّإَف ًةَتْغَب(44)
األنعام سورة
So when they forgot that by which they had been reminded,
We opened to them the doors of every [good] thing until, when
they rejoiced in that which they were given, We seized
them suddenly, and they were [then] in despair.
Reviewing the history of mankind's cumulative
experience starting with the ancient very
primitive trials and ending with the presence
of Robotic and Telesurgery
Clearly show that the major and rapid
advances in the whole mankind's life occur
only in the last few decades especially the last
10 years ?