1. Radical cystectomy is the surgical removal of the bladder and surrounding organs for bladder cancer treatment. It is often combined with pelvic lymphadenectomy.
2. There are three main types of urinary diversions performed after radical cystectomy: ileal conduit, continent cutaneous reservoir, and orthotopic neobladder.
3. The ileal conduit diverts urine through a segment of isolated ileum and out through an abdominal stoma. The continent cutaneous reservoir and orthotopic neobladder provide continent diversions using intestinal segments to form a pouch emptied through catheterization. Choice of diversion depends on disease factors, patient factors, and surgeon experience.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Bladder catheters are used for urinary drainage, or as a means to collect urine for measurement.
Alternatives to indwelling urethral catheterization should be considered and include external sheath (ie, condom) catheters, suprapubic catheters, intermittent catheterization, and, in some cases, supportive management with protective garments.
- 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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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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
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.
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!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. Modern Radical Cystectomy
• Radical Cystectomy
• Removal of bladder with surrounding fat
• Prostate/seminal vesicles (males)
• Uterus/fallopian tubes/ovaries/cervix (females)
• + Urethrectomy
• Pelvic Lymphadenectomy
• More is better
• Urinary Diversion
• Ileal conduit
• Continent cutaneous reservoir
• Orthotopic neobladder
4. Urinary Diversion
• Use of intestinal segment to bypass/ reconstruct/
replace the normal urinary tract
• Goals:
• Storage of urine without absorption
• Maintain low pressure even at high volumes to allow
unobstructed flow of urine from kidneys
• Prevent reflux of urine back to the kidneys
• Socially-acceptable continence
• Empties completely
• “Ideal” diversion has yet to be discovered
11. Other end is brought out through an
opening on the abdomen
12. Continent Cutaneous Reservoir
• Many variations (same theme)
• Indiana Pouch, Penn Pouch, Kock Pouch…
• All use various parts of the intestine
• Ileum, Right Colon most commonly
• Reservoir
• “Detubularized” intestine- low pressure storage
• Continence mechanism
• Ileocecal valve (Indiana)
• Flap valve (Penn, Lahey)
• Intussuscepted nipple valve (Kock)
13. • The surgeon takes a piece of bowel and makes it
into a pouch inside the body. The pouch opens out
from the abdomen through a stoma (like the
urostomy).
• The urine doesn't leak out of the stoma. The stoma
is made from the part of the bowel where the large
and small bowel join and there is a natural valve
that keeps the stoma closed. When patient wants
to empty the pouch, he puts a thin tube (catheter)
into the stoma and drain off the urine.
14. Continent Cutaneous Reservoir
INDIANA POUCH
Appendix
removed
Right colon
and distal
ileum isolated Right colon is
opened
lengthwise and
folded down to
create a sphere
15. Continent Cutaneous Reservoir
INDIANA POUCH
RESERVOIR
EFFERENT LIMB
(to skin)
catheter
Ureters attached to back of reservoir (not shown)
Continence maintained
by ileocecal valve
16. Orthotopic
Neobladder
WHAT IS AN ORTHOTOPIC NEOBLADDER?
“Orthotopic” means “in the same place” and
“neobladder” means new bladder.
So an orthotopic neobladder is a substitute or
“new” bladder that is placed in the same location as
the “old” bladder.
HOW IS THE ORTHOTOPIC NEOBLADDER
CONSTRUCTED?
The neobladder is made from loops of the intestine.
First, the surgeon removes a section of intestine.
He then reconnects the bowel so there are no
changes in bowel function.
The piece of intestine that was removed is cut open
to create a “flat piece” instead of a hollow tube.
The flat piece of intestine is sewn together to form
a pouch. The ureters (kidney tubes) are connected
to one end of this pouch, the other end of the pouch
is connected to the urethra. Urine will drain from
the kidneys through the ureters and into the new
“bladder.”
The new bladder will store the urine and the
individual will void through normal channels.
17. Choice of Urinary Diversion
• Disease Factors
• Urethral margin
• Patient Factors
• Kidney function / liver function
• Manual dexterity
• Preoperative urinary continence/ urethral strictures
• Motivation
• Surgeon Factors
• Familiarity with various types of diversions
Surgery for bladder cancer can really be divided into 3 main components:
First, the radical cystectomy which is removal of the bladder with its surrounding fat. In males that also routinely includes the prostate and seminal vesicles, and in women, the uterus, cervix, tubes, and ovaries. Depending on the stage of disease, the urethra may also need to be removed.
The removal of the pelvic lymph nodes is also a critical component to the completeness of the surgical resection.
And finally, the urinary diversion which typically has the most direct impact on the patient’s quality of life.
Now for the part of the talk that I think most of you are interested in- the urinary diversion.This is basically using a portion of the intestine to bypass, reconstruct, or replace the normal urinary tract.The goals of a urinary diversion are straight forward:To store urine without absorption of the waste products.To store that urine at low pressures so that the urine can continue to drain from the kidneys.To prevent reflux of urine back into the kidneys.To hold on to the urine until it is socially-acceptable to empty, and then to empty completely.If you think about it, this is what our normal bladders do everyday.Having said that, the ideal form of diversion has yet to be discovered.
There are 3 main types of diversions practiced at this time.The ileal conduit which is an incontinent diversion to the skin. This is also known as a urostomy in which an external bag collects the urine continuously.Continent reservoir was constructed with an opening to the skin which would then have to be catheterized in order to empty.And it really wasn’t until the 1990’s that the neobladder became popular, which is a continent diversion connected to the native urethra.
The ileal conduit is created from 15-20 cm of small intestine (ileum). This segment of intestine is separated from the rest of the intestinal tract. The intestines are obviously sewn back together so that one can still have bowel movements.
For the continent cutaneous reservoir- These go by many names with slight variations but all with a similar theme. You may hear these referred to as an Indiana pouch, or a Kock pouch.All use various parts of the intestine, most commonly the ileum and right colon.The intestine is detubularized to create a low pressure storage reservoir. The main difference between these pouches are in terms of how they provide continence. The Indiana uses the natural valve between the small and large intestine called the ileocecal valve. This normally prevents the stool in the colon from backing up into the small intestine. A variety of other techniques have been created to also prevent leakage from the reservoir, including flap valves and nipple valves.
The Indiana Pouch is probably the most commonly used cutaneous reservoir.Here, the right colon and ileum are isolated. The appendix is removed.The right colon is opened lengthwise and folded down to create a sphere.
The ureters are attached to the back of the reservoir and the ileum becomes that efferent limb that is brought up to the skin opening.
Continence is maintained by this one way ileocecal valve. So that the only way to empty the reservoir is by passing a catheter through the skin opening through the efferent limb (or ileum) and into the pouch.This needs to be done at regular intervals throughout the day, usually every 4-6 hours.
Just as with the catheterizable cutaneous diversions, there are a number of different type of neobladders, though all are based on the same principles.
The internal reservoir is created from detubularized intestine. The continence mechanism here is the body’s own urethral sphincter that we naturally depend upon for our urine control normally.
The main differences between the various neobladders is how the ureters are attached to the reservoir.
With all of these options, how does one decide. Well, I think there are really 3 main factors that go into the decision.First is the bladder cancer itself. If the cancer involves the urethra, it does not make sense to create a fancy diversion and connect it to any area where there is cancer. So, if the urethra is involved, the urethra is removed and one of the skin diversions is performed.
Secondly, patient factors are clearly important. Due to the potential for absorption of the urine through the intestine, a continent diversion requires normal kidney and liver function to compensate. Good manual dexterity is needed for diversions that may require intermittent catheterization. It’s good to know if there are any preexisting problems with the urethra or urinary sphincter when considering a neobladder. The continent diversions do require a bit of work and patients do need to be motivated to take care of themselves, catheterize when needed, and to be diligent about medical followup to prevent problems down the road.And finally, the surgeon’s familiarity and experience will also play into the choice of diversion.
