Arthroscopic treatment of bony Bankart lesions can be challenging. We present a new easy and reproducible technique for arthroscopic reduction and suture anchor fixation of bony Bankart fragments. A suture anchor is placed medially to the fracture on the glenoid neck, and its sutures are passed around the bony fragment through the soft tissue including the inferior glenohumeral ligament complex. The sutures of this anchor are loaded in a second anchor that is placed on the glenoid face. This creates a nontilting 2-point fixation that compresses the fragment into its bed. By use of the standard technique, additional suture anchors are used superiorly and inferiorly to the bony Bankart piece to repair the labrum and shift the joint capsule. We call this the “bony Bankart bridge” procedure. Key Words: Arthroscopy—Bony Bankart lesion—Suture bridge—Instability—Shoulder. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Greater Denver Area http://drmillett.com/shoulder-studies
ANATOMY
Meatcarpophalangeal joint- Condyloid joints
ROM at MCPJ- flexion and extension of the digits, as well as a very small degree of abduction and adduction when the digits are extended.
• Phalanges - has a base, shaft, neck and head that is formed from two condyles.
• PIPJ, DIPJ - Hinge joints,
ROM at PIP and DIP joint : flexion and extension.
VERDAN’S ZONES OF HANDS
VOLAR PLATE
Vinculum breve and Vinculum longum
MECHANISMS OF INJURY
Femoroacetabular impingement in young adults
Dr.sandeep agrawal agrasen hospital,gondia maharashtra
A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head
Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty
Pelvic osteotomy ,outerbridge classification
Treatment of displaced midshaft clavicle fracture with locking compression plate provides better biomechanical stability, good fracture union rates, high post-operative constant score, early pain resolution, early return to activity, high patient satisfaction rates and excellent functional outcome. These benefits of plating overweigh complications when used in specific indications like displaced with or without comminuted middle third clavicle fracture (Robinson Type 2B1, 2B2).
In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.
ANATOMY
Meatcarpophalangeal joint- Condyloid joints
ROM at MCPJ- flexion and extension of the digits, as well as a very small degree of abduction and adduction when the digits are extended.
• Phalanges - has a base, shaft, neck and head that is formed from two condyles.
• PIPJ, DIPJ - Hinge joints,
ROM at PIP and DIP joint : flexion and extension.
VERDAN’S ZONES OF HANDS
VOLAR PLATE
Vinculum breve and Vinculum longum
MECHANISMS OF INJURY
Femoroacetabular impingement in young adults
Dr.sandeep agrawal agrasen hospital,gondia maharashtra
A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head
Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty
Pelvic osteotomy ,outerbridge classification
Treatment of displaced midshaft clavicle fracture with locking compression plate provides better biomechanical stability, good fracture union rates, high post-operative constant score, early pain resolution, early return to activity, high patient satisfaction rates and excellent functional outcome. These benefits of plating overweigh complications when used in specific indications like displaced with or without comminuted middle third clavicle fracture (Robinson Type 2B1, 2B2).
In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.
Colorado shoulder surgeon, Dr. Peter Millett taught in Portland, Oregon on the Steelhead Surgical Advanced Shoulder Course. Here is a sneak peek of his presentation.
Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes.
Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates.
For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.
Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Open Operative Treatment for Anterior Shoulder Instability | Orthopedic Surge...Peter Millett MD
Open surgical treatment for primary anterior glenohumeral instability is reliable and time-tested and can yield excellent clinical results. With advancements in arthroscopic technique, there has been a growing trend toward arthroscopic treatment of anterior shoulder instability. In many instances, arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, obviating the need for releasing and repairing the subscapularis; because it allows better identification and treatment of associated pathological conditions; and because it decreases morbidity and facilitates an outpatient approach. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Management of Posterior Glenohumeral Instability with Large Humeral Head DefectPeter Millett MD
Traumatic posterior instability may occasionally cause a large osteochondral lesion when the anterior humeral head is compressed against the posterior glenoid rim. This is termed a reverse Hill–Sachs lesion. Such osteochondral defects may be very large in the case of chronic locked dislocations. Even in acute posterior disclocations, closed reduction may be difficult when the humeral head is locked posteriorly over the glenoid. In such cases closed or open reduction under general anesthesia with muscle relaxation may be necessary. In cases where the anterior humeral head defect is large, reconstruction may be necessary to maintain stability. Management must be tailored to the individual patient and depends on several factors, which include the size of the defect, the duration of the dislocation, the quality of the bone, the status of the articular cartilage, and the patient’s overall health. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Arthroscopic Treatment of Anterior Glenohumeral Instability Indications and T...Peter Millett MD
The arthroscopic treatment of anterior glenohumeral instability is becoming increasingly accepted as a viable treatment option because reported success rates parallel those of open stabilization techniques. This improved success rate is largely the result of advances in surgical techniques and technology. An improved understanding of the pathoanatomy associated with shoulder instability and continuing education initiatives have also been instrumental in expanding the indications for arthroscopic stabilization of the unstable shoulder. For more shoulder surgery and instability studies, visit Peter Millett, Shoulder Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...Peter Millett MD
Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
A 57-year-old man with type II diabetes mellitus presented with right shoulder pain and weakness. The onset of symptoms was insidious and progressive over a two year period. The patient thought he initially injured his shoulder while swimming but noted that his symptoms had become much worse since re-injuring it while throwing a tennis ball 6 months before presentation. The pain was localized to his right shoulder and often awakened him from sleep. He had taken nonsteroidal anti-inflammatory drugs (NSAIDS) for the 6 months after re-injuring the shoulder and completed an intermittent course of physical therapy that included a rotator cuff strengthening program. He was an active person who enjoyed hunting and fishing but had been unable to do either because of the shoulder problems. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, Orthopedic Surgeon, Vail Colorado http://drmillett.com /shoulder-studies
Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...Peter Millett MD
Isolated ruptures of the subscapularis and anterosuperior rotator cuff lesions are encountered more rarely than supraspinatus or anteroposterior rotator cuff tears. In certain circumstances, reconstruction of the tendon may not be possible due to fatty degeneration and atrophy of the subscapularis muscle or poor tendon quality. Tendon transfer may represent the only surgical option for treatment. A pectoralis major tendon transfer is an acceptable salvage option for irreparable subscapularis tendon ruptures. Although limited functional goals may be expected in most cases, the majority of patients obtain a good pain relief, which improves their function below chest level. Addition of the teres major component to the transfer may be beneficial in cases where both the upper and lower portion of the subscapularis muscle is irreparable. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Shoulder Problems in Older Adults | Rotator Cuff | Sports Medicine Doctor - C...Peter Millett MD
Shoulder problems occur frequently in older adults. Four syndromes are particularly frequent, and they all share the common symptom of pain when reaching overhead: (1) rotator cuff tendinitis or impingement syndrome, (2) rotator cuff tear, (3) osteoarthritis, and (4) frozen shoulder. In addition to pain, each can cause significant long-term disability. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Shoulder pain is the third most common musculoskeletal symptom encountered in medical practice after back and neck pain, accounting for almost 3 million patient visits each year in the United States. A wide range of potential pathoanatomic entities can give rise to shoulder pain, from simple sprains to massive rotator cuff tears. The majority of these conditions are amenable to conservative treatment. Rotator cuff dysfunction is a particularly important entity because it occurs frequently and may necessitate surgical treatment. This report will provide a critical overview of current diagnostic and treatment techniques for rotator cuff disease. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, shoulder surgeon, Greater Denver http://drmillett.com/shoulder-studies
Patient Management with Greater Tuberosity Fracture and Rotator Cuff Tear | G...Peter Millett MD
Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear.
For more shoulder surgery and rotator cuff studies, visit Dr. Millett, Greater Denver Area http://drmillett.com/shoulder-studies
Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...Peter Millett MD
Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row suture anchor rotator cuff repair technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Shoulder Injuries in Throwing Athletes | Peter Millett MD - Shoulder Surgeon ...Peter Millett MD
Due to the ongoing controversy regarding the exact causes of injury in the thrower's shoulder, the authors will not attempt to provide a single unifying theory. Instead, we will provide an overview clarifying the terminology and describing common pathologic findings, and presenting the various theories on shoulder injuries in throwing athletes. The purpose of this chapter is to discuss the biomechanics, presentation, diagnosis and treatment of common shoulder injuries in overhead throwing athletes. For more studies on athletic shoulder injuries, please visit http://drmillett.com/shoulder-studies
Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain. Physical therapy and rehabilitation for shoulder injuries should be, with only a few exceptions, the primary treatment for a throwing athlete before operative treatment is considered. Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment for shoulder injuries can be successful when nonoperative measures have failed. Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule. For more studies visit Dr. Millett, orthopedic surgeon, http://drmillett.com/shoulder-studies
Golf Shoulder Injuries | Dr. Peter Millett | Orthopedic Surgeon - Vail Colorado Peter Millett MD
Although often perceived as a leisurely activity, golf can be a demanding sport, which can result in shoulder injuries, usually from overuse and sometimes from poor technique. The shoulder is a commonly affected site, with the lead shoulder, or the left shoulder in the right-handed golfer, particularly vulnerable to injury. A thorough understanding of the biomechanics of the golf swing is help- ful in diagnosing and managing these injuries. Common shoulder injuries affecting golfers include subacromial impingement, acromioclavicular arthrosis, rotator cuff tear, glenohumeral instability, and glenohumeral arthrosis. Although the majority of patients with these disorders will respond to nonsurgical treatment, including rest and a structured program of physical therapy, further benefits can be obtained with subtle modifications of the golf swing. Those golfers who fail to respond to nonsurgical management can often return to competitive play with appropriate surgical treatment. For more studies visit Dr. Peter Millett, Orthopedic Surgeon - Vail Colorado http://drmillett.com/shoulder-studies
Peter Millett MD | Orthopaedic Surgeon | The Steadman Clinic Sports Medicine ...Peter Millett MD
Dr. Millett is a Partner at the Steadman Hawkins Clinic. An expert in shoulder disorders, he also specializes in disorders of the knee, and elbow as well as all sports-related injuries. He uses advanced open and arthroscopic surgical techniques to restore damaged joints, ligaments, and bones. A focus of his is complex and revision shoulder surgery. He held a faculty appointment at Harvard Medical School, and was formerly Co-Director of the Harvard Shoulder Service, and Co-director of the Harvard Shoulder Fellowship. He also directed the Musculoskeletal Proteomics Research Group at Harvard. His clinical practice in Boston was based at the prestigious Brigham & Women's and Massachusetts General Hospitals. He has authored over numerous peer-reviewed, scientific articles, numerous book chapters, and a review book on orthopaedics. His academic work has been recognized with awards from several international societies. Dr. Millett serves as a shoulder and sports medicine consultant for Bermuda. A member of numerous societies including AAOS, AOSSM, ASES, AANA, and ORS, Dr. Millett has cared for athletes from the NFL, MLB, NHL, USTA, PGA, US ski team, and X-games. Dr. Millett serves as a team physician for the U.S. Ski Team. He is a consultant to the Montreal Canadiens Professional Hockey Club and the Volkl/Marker ski companies. Dr. Millett has performed live surgery for courses in North America (Massachusetts, Florida, California, Colorado, Missouri, Illinois), Europe (Germany, The Netherlands, France) and the Caribbean (Bermuda).
A native of Pennsylvania, Dr. Millett received his undergraduate degree from the University of Scranton, and his medical degree from Dartmouth Medical School in Hanover, New Hampshire. He also served as a visiting research scholar at the University of Cambridge in England, where he was awarded a master’s degree in science (M.Sc.) for his work in skeletal biology.
Dr. Millett performed his orthopaedic residency training at the Hospital for Special Surgery in New York City, part of Cornell University's Medical School and the oldest and most prestigious orthopaedic residency program in the country. While there, he received the Lewis Clark Wagner Award for excellence in orthopaedic research as well as the American Orthopaedic Association – Zimmer Travel Award, a national award for orthopaedic research.
Dr. Millett earned additional subspecialty, fellowship training in sports medicine, knee and shoulder surgery at the internationally renown Steadman Hawkins Sports Medicine Foundation in Vail, CO. While there, he also served as an associate physician for the Denver Broncos professional football team, the Colorado Rockies Major League Baseball team, and the U.S. Ski Team.
Specialty:
Shoulder, knee, and elbow surgery
Sports medicine
Orthopaedic trauma
Joint replacement surgery
Orthopedic Surgery
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!
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
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
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.
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. TECHNIQUE
The patient is placed in the beach-chair position
with the index arm in a pneumatic arm holder (Spider;
Tenet Medical Engineering, Calgary, Alberta, Canada).
After an examination under anesthesia to assess the
grade of instability, a standard posterior portal for
arthroscopy is established. The diagnostic arthroscopy
evaluates all aspects of the glenohumeral joint to
ensure all pathologies will be diagnosed.
A high anterosuperior portal is established with a
5.0-mm cannula (Arthrex, Naples, FL) in the rotator
interval, and the bony Bankart lesion is assessed with
a probe. Subsequently, an accessory anteroinferior
portal is established, entering the joint just superior to
the subscapularis tendon. An 8.25-mm cannula (Ar-
threx) is used in this portal to assist with suture man-
agement. A 70° arthroscope is used to visualize the
neck of the glenoid, medial to the fracture. Typica-
lly, the labrum and inferior glenohumeral ligament
(IGHL) complex are attached to the bony fragment.
These attachments should be preserved. Instruments
are placed through both anterior portals to mobilize
the bony Bankart and the entire IGHL as a sleeve of
continuous tissue, inferiorly to the 6-o’clock position.
The glenoid neck and the fractured surface of the bony
fragment are prepared by use of an elevator and a
shaver to create bleeding surfaces to enhance bone-to-
bone healing.
An elevator is introduced from the anterosuperior
portal to lift the bony fracture piece off the glenoid
neck so that the first anchor can be placed medially on
the glenoid neck. This will form the medial fixation
point for the Bankart bridge. Depending on the size of
the fragment, 1 or 2 anchors can be used. If 1 anchor
is to be used, it is placed medial (axial plane) to the
donor site on the glenoid neck and in the midportion
(sagittal plane) of the fracture. A 3.0-mm Bio-SutureTak
anchor (Arthrex) loaded with FiberWire (Arthrex)
is used. Both limbs of the suture are passed through
the soft tissues, medial to the bony piece, by use of a
shuttling technique with a 45° curved SutureLasso
(Arthrex). The sutures are then parked outside the
anteroinferior cannula.
The next step is to place a suture anchor inferior to
the bony fracture piece on the glenoid rim. This an-
chor will secure the labrum and IGHL complex, infe-
rior to the bony fragment. As for a typical arthroscopic
repair, the medial suture limb is passed through the
IGHL complex, shifting the IGHL complex and la-
brum superiorly and medially tightening the axillary
pouch. Pulling the tissue superiorly and medially from
the anterosuperior portal with a grasper, before secur-
ing the knot, helps control the size of the shift. The
FIGURE 1. Arthroscopic view of a left shoulder from posterior
standard portal. The anchor on the glenoid face is placed through
a cannula in a standard anterosuperior portal to reduce the bony
Bankart piece. The anchor is loaded with the 2 suture limbs of the
anchor, which had been placed medially to the fragment on the
glenoid neck previously.
FIGURE 2. Cross-section: anchor position relative to fracture.
103BONY BANKART BRIDGE PROCEDURE
3. sutures are then tied by use of a sliding-locking
Weston knot that is backed up with 2 alternating
half-hitches. The free limbs are cut. Typically, 1 an-
chor is placed inferior to the bony fragment; however,
depending on the size of the bony piece and its posi-
tion on the glenoid face, 2 inferior anchors may be
used on occasion.
The bony Bankart is now fixed with a bridging
technique. The sutures will span the bony fragment
and provide 2-point fixation of the fragment. The
sutures from the medial anchor are retrieved out the
anteroinferior cannula, and the tension can be assessed
to test the fracture reduction and to evaluate the opti-
mal position for the lateral fixation anchor on the
glenoid face before drilling. The drill hole should be
placed on the glenoid face at the cartilage-fracture
margin. The 2 free limbs of the medial suture anchor
are fed into a 3.5-mm Bio-PushLock anchor (Arthrex),
which is then pushed into the drill hole on the glenoid
face (Fig 1). The suture limbs are tensioned before
final fixation of the anchor. By these means, the bony
fragment is reduced and compressed back into its
donor bed, and an arthroscopic osteosynthesis is
achieved (Fig 2). This “bony Bankart bridge” provides
secure 2-point fixation and compression of the frac-
ture, without tilting of the bony piece. The security of
the construct can be tested with a probe. The free
limbs are cut flush with the Bio-PushLock anchor.
Additional repair of the superior capsule, labrum,
and middle glenohumeral ligament should then be
performed superior to the Bankart bridge. We recom-
mend placing at least 1 anchor superior to the Bankart
bridge because this will provide additional rotational
stability. Depending on the size of the bony Bankart
lesion, 1 or more bony Bankart bridges can be used to
secure the fragment. Figure 3 illustrates the final re-
pair.
DISCUSSION
In acute cases or when radiographic and arthro-
scopic assessment show a mobile bony Bankart frag-
ment, the technique presented can be used to treat
these lesions arthroscopically. In cases of older frac-
FIGURE 3. Final repair with reduced bony Bankart piece, repaired labrum, and shifted capsule and IGHL complex.
104 P. J. MILLETT AND S. BRAUN
4. tures or bone loss with fragments that cannot be re-
duced or when there has been resorption of the bone
fragment, other techniques such as an open or arthro-
scopic Latarjet procedure or iliac crest bone graft
reconstruction should be considered.12-15
The bony Bankart bridge technique can restore the
glenoid cavity by reducing the Bankart fracture under
direct visual control while at the same time restoring
tension in the IGHL complex. The anchors placed
superior and inferior to the Bankart bridge provide
additional rotational control, whereas the Bankart
bridge itself compresses the fracture down onto the
glenoid with 2-point fixation, creating a large surface
area for bony healing. Compression and rotational
stability comprise the main difference between our
technique and previously published arthroscopic tech-
niques with 1-point fixation.6 Our technique uses the
same principles as recently published techniques for
arthroscopic approaches to fractures of the greater
tuberosity.9-11 Thus the described technique combines
the advantages of the arthroscopic Bankart repair with
its ability to selectively shift the capsule and repair the
labrum while at the same time restoring the bony
anatomy with stable, compressing, nontilting fracture
fixation. The bony Bankart bridge technique is repro-
ducible and easy to perform and is an excellent way of
arthroscopically treating bony Bankart lesions.
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105BONY BANKART BRIDGE PROCEDURE