The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
How to have quality of life in Advanced ovarian malignancyRajesh Gajbhiye
Presentation given by Dr Rakhi Gajbhiye, Mauli Hospital Nagpur at MGIMS sewagram for an International conference on Womens Health Fatal Disorders Survival with Quality in collaboration with FOGSI.
This was the function to commemorate 100 th birth centenary of Dr Sushila
inflammation of the ear, usually distinguished as otitis externa (of the passage of the outer ear), otitis media (of the middle ear), and otitis interna (of the inner ear; labyrinthitis).
Vaginoplasty..... by peritoneal pull through (davydovs technique)Ravi7209
Tubularized peritoneal neovaginoplasty is a simple
and effective method with good outcome and
minimal morbidity to the patient. Though laparoscopic
modification of original Davydov procedure
is common now-a-days but laparotomy can still be
done. It avoids the problems associated with graft
use from other sites and has good form and
function to enable satisfactory intercourse
In this manuscript we show the successful laparoscopical treatment of a ruptured cornual ectopic pregnancy. In many settings this condition is treated by open approach due to the advanced skills required to control bleeding. This is a case report with the aim of showing images of the procedure, how to easily prevent bleeding and the management of it.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Management of Intraoperative Haemorrhage in Gynaecological Abdominal SurgeriesRajesh Gajbhiye
This presentation discusses how to tackle intraoperative haemorrhage during Abdominal Gynaecological Surgeries.Various modalities to control haemorrhage,knowledge of vascular anatomy to promptly manage such situation
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
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
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!
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
- 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
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Uterus preserving surgeries for prolapse
1. Uterus sparing techniques for
Prolapse for young
DR Rajesh Gajbhiye
Consultant Gynecologist & Lap Surgeon
Mauli Women’s Hospital.
Nagpur
2. Introduction
Conservative surgeries- young
nulliparous women where menstrual
and reproductive function in desired.
Vaginal hysterctomy with repair.
Advent of minimal invasive surgery
Resuspend
Uterine conserving re-suspension
surgery
Augmenting weak connective tissue
Stronger apical support
12. Complications
Presacral bleeding. Hence a vascular
sacral plexus is a relative
contraindication for this surgery.
Sigmoid colon and sigmoid mesocolon
injury hence short sigmoid
mesocolon is relative contraindication
for this surgery.
Geintofemoral nerve irritation,
damage to ureter, recto-vaginal fascia,
recurrence, osteomyelitis and bowel
13. Reproductive performance following Shirodkar's
abdominal sling operation.
Allahbadia GN1, Ambiye VR.
Over a period of 4 years from January 1986 to
December 1989, 79 cases in whom Shirodkar's
abdominal sling operation carried out, were studied. All
the patients were admitted either in active labour or as
cases of abortions or for the treatment of infertility. The
incidence of full term normal vaginal delivery in this
study was 69.56% and the incidence of caesarean
section was only 2.9%. There was one case of posterior
wall rupture following previous Shirodkar's sling
operation. The recurrence rate of prolapse was only
8.69%
14. Evaluation of Shirodkar’s Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
Group
Suchitra Narayan Pandit, Vaman Babu Ghodake,
Vijay Chandrakant Pawar
15. Observations: One thousand three hundred and
eighty patients having uterovaginal descent were
admitted at L.T.M. General Hospital, Sion, Mumbai,
from Jan ‘03 - Dec ‘04. 139 patients underwent
conservative surgery. Sixty four (46.67%) patients
were in the child-bearing age group and underwent
Shirodkar’s sling surgery. Twenty four patients
(41.37%) conceived post surgery. Nineteen patients
delivered normally. Only three patients required
L.S.C.S. for obstetric indications.
Conclusion: Shirodkar’s Sling operation plays an
important role in the conservative management of
prolapse in the child bearing age group. It does not
affect fertility and course of normal labour in fact it
improves it by maintaining the pelvic anatomy.
16.
17. Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse, particularly
enterocele.
Lecel B evidence
28. The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes.
41. LSC
Int Urogynecol J. 2014 Jan;25(1):131-8. doi:
10.1007/s00192-013-2209-5. Epub 2013 Nov 6.
Laparoscopic hysteropexy: 1- to 4-
year follow-up of women
postoperatively.
Rahmanou P1, White B, Price N,
Jackson S.
42. Laparoscopic hysteropexy is a safe
and effective treatment.
High patient satisfaction and low rates
of apical prolapse recurrence.
Longer term follow-up and randomized
controlled studies are required.
43. Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence.
44.
45. Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy:
experience of 402 patients.
Stepanian AA1, Miklos JR, Moore RD, Mattox TF
J Minim Invasive Gynecol. 2008 Mar-Apr;15(2):188-96. doi:
10.1016/j.jmig.2007.11.006.
46. Risk of mesh extrusion or other mesh-related
complications after laparoscopic sacral
colpopexy using soft macroporous Y-shaped
polypropylene mesh is about 1% .
No significant increase in risk of mesh-
related complications was observed in
patients receiving concurrent hysterectomy
when compared with patients who had a
previous hysterectomy.
The sample size of almost 2000 patients was
needed to detect a statistically significant
difference in rate of mesh-extrusion in this
study.
47. Gutman and Maher reviewed the
literature on sacral colpopexy and
uterine prolapse in 2012 and in meta-
analysis found 339 cases of sacral
colpopexy with hysterectomy and 129
cases of sacral hysteropexy.
While the success rate was over 90% in
each group the rate of mesh exposures
was more than five times higher after
sacral colpopexy and hysterectomy
as compared to hysteropexy (8.5%
versus 1.5%).
48. Sacral colpopexy: long-term mesh
complications requiring reoperation(s).
Arsene E1, Giraudet G, Lucot JP, Rubod C,
Cosson M.
Int Urogynecol J. 2015 Mar;26(3):353-8. doi: 10.1007/s00192-014-
2514-7. Epub 2014 Oct 17.
excellent success rates, there are
risks of complications and reoperation
may be required. The purpose of this
study was to evaluate the extent of
complications following SC, requiring
reoperation(s), and to describe the
reoperations performed.
49. Surgery for complications after SC.-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection,-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle.-1.
50. The median time between the initial
SC and the first reoperation was
3.9 ± 5.7 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy. These complications may
be serious and occur years after the
initial surgery
51. Cochrane Database Syst Rev. 2013
Apr 30;4:CD004014. doi:
10.1002/14651858.CD004014.pub5.
Surgical management of pelvic
organ prolapse in women.
Maher C1, Feiner B, Baessler K,
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women.
52. Sacral colpopexy has superior
outcomes to a variety of vaginal
procedures including sacrospinous
colpopexy, uterosacral colpopexy and
transvaginal mesh.
These benefits must be balanced
against a longer operating time, longer
time to return to activities of daily
living, and increased cost of the
abdominal approach
53. Shirodkar’s Extended Manchester Repair:
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape:
Retrospective and Prospective Study
Roohi Shaikh,Suman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology, ISSN 2277-2812 E-ISSN 2249-8109, Vol
ume 10, Issue 2, 2014 pp 263-266
56. Two randomized trials in women with
stage II or higher POP that compared
transvaginal sacrospinous
hysteropexy with vaginal hysterectomy
(with uterosacral or sacrospinous
ligament suspension of the vaginal
vault) yielded consistent results: the
rate of prolapse recurrence after 9 to
12 months was higher in women who
underwent hysteropexy in both trials.
57. Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it.
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus.
58. conclusions
In nulliparous prolapse, shirodkars
sling the operation of choice. If not
comfortable then Khanna sling, joshi
sling
Sacrohysteropexy is indicated in
young prolapse.
It is better than vaginal SSF in terms
of recurrence and patient satisfaction.
Mesh erosion compication is less as
compared to hysterectomy with SC.