Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
Lecture on the various hernia afflicting humans for medical students. Encompasses basic sciences, various classifications, clinical presentations including complications and types of repair. Another pet topic of the author.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
4. Ventral Hernia
Any protrusion of viscera through anterior abdominal
wall
Categorized as spontaneous and acquired
Spontaneous hernia:
Umbilical and paraumbilical-71 %
Epigatric-25%
Others-4%
5. Acquired Hernia
Incisional
o Laparotomy 89%
o Laparoscopy 5%
Parastomal 6%
9. Umbilical Hernia:
Umbilical hernia occurs when the umbilical
scar closes incompletely in the child or fails
and stretches in later years in the adult
patient
In infants
Congenital and common
Closes spontaneously by 2 years of age
If persist after 5 years –surgical repair
10. In adults
Largely acquired
Female>male
hernia does not protrude through umbilical cicatrix
protrusion through the linea alba just above the
the umbilicus -supraumbilical
occasionally below the umbilicus (infraumbilical) –
so called as paraumbilical hernia
11. Etiology
multifactorial, commonly found in association with
processes that increase intraabdominal pressure
pregnancy
obesity
ascites
persistent or repetitive abdominal distention in
bowel obstruction or peritoneal dialysis
12. Clinical Features
Pain and swelling are the main symptoms
Pain increases on prolonged standing or heavy
exercise
Content: mostly omentum
13. Treatment
Reduce weight of the patient
Treat the cause of ascites
Mayo’s operation – vest over pants repair :
imbrication of superior and inferior fascial edges
For smaller defects – open umbilical hernia repair
For larger defects - >2 cm – mesh repair – open
or laparoscopic
14. Epigastric Hernia :
Hernia protruding through interlacing fibres of the linea
alba anywhere between umbilicus and xiphisternum
protrusion of extraperitoneal fat - fatty hernia of linea alba
Multiple in up to 20% of patients and approximately 80%
are in midline
15. Etiology:
Sudden strain leading to tearing of interlacing
fibers of linea alba
Clinical Features:
Symptomless
Painful- in partial strangulation of fat
Referred dyspepsia
On palpation – feels firm, no cough impulse and
cannot be reduced
16. Treatment:
Midline defect is usually elliptical in nature with the
long axis oriented transversely
Hernia will often not be seen on laparoscopy owing
to the lack of peritoneal involvement through the
hernia defect
Open repair – excision of incarcerated preperitoneal
tissue and simple closure of defect
17. Incisional Hernia
It is herniation through a weak abdominal scar (scar of
previous surgery)
Etiology:
Factors related to patients:
1. Obesity – due to fat encroaching in between the muscle layers
2. Advanced age
3. Multiparity,malnutrition,peritoneal
dialysis,jaundice,hypoproteinemia,anaemia, malignant diseases
4. Coughing,vomting and overzealous ventilation in early postoperative
period
5. Steroids and chemotherapy
18. 6.Smoking in postoperative period.
7.Causes which increases the intra-abdominal pressure(BPH, straining,
stricture urethra or rectum, ascites)
Factors related to procedure:
o Vertical incision higher chances of incisional hernia than horizontal
incision
o Layered closure of the abdomen has got higher chance than single
layer
o Continuous closure has got higher chances than interrupted closure
19. o Using absorbable suture material
o Emergency surgical wound has higher chances than elective
surgical wound
o Laparotomy wound
20. Clinical Features:
Pain and swelling in the vicinity of previous scar
Bulging more prominent on standing and coughing,reduces
spontaneously on lying down
Attacks of subacute intestinal obstruction
Expansile impulse on cough
skin over the hernia is thin and atrophic
21. Treatment :
Preventive measures
Reduction of weight in obese before elective procedures
Treat any respiratory diseases- chr.bronchitis
Very careful closure of abdomen
Single layer closure 5-8mm
5mm apart
2-0 suture
4:1 suture length
All precautions to prevent immediate postoperative wound
infection should be taken
22. Operative treatment:
Primary repair
Defect small <2cm
Viable surrounding tissue
As a result of technical error in initial operation
Prosthetic repair
Larger defect >2 to 3cm
23. Mesh placement options:
Onlay technique: after primary
closure of the fascial defect
mesh is placed over the
anterior fascia
Advantages: no direct contact
with viscera
Disadvantages:
More chances of seroma
formation
superficial location of mesh-
more prone for infection
24. Inlay technique: interposition of prosthetic mesh
between the fascial edges.
Very high recurrence rates
Sublay/ underlay technique:prosthetic mesh placed
below the fascial components
25. Retromuscular technique:
also called as Rives-Stoppa-Wantz Retrorectus Repair
placement of mesh under the rectus muscle & above the
posterior rectus sheath
Advantage
intraabdominal forces hold the prosthesis against the muscles.
Forces that created the hernia now are used to prevent its
recurrence
26. Component separation technique
skin and subcutaneous fat dissected
free
from the anterior sheath of the
rectus abdominis muscle and the
aponeurosis of the external oblique
muscle.
external abdominal oblique is
incised 1 to 2 cm lateral to the
rectus abdominis muscle.
27. • external oblique separated
from the internal oblique
Dissection carried to posterior
axillary wall
Additional length can be achieved by incising post rectus sheath
above the arcuate line
28. Laproscopic surgical repair
IPOM(intraperitoneal onlay mesh)
IPOM plus:
defect >2cm
6 to 10 cm difficult to close
>10 cm: laproscopic TAR or Robotic TAR
29. Lap vs open
Whenever feasible laproscopic repair is preferred.
30. Advantages of LAP
Lower rate of wound infection
Shorter hospital stay
Quicker return to work
Presence of swiss cheese defect can be seen
32. Parastomal hernia
Common complication after stoma creation
Incidence highest in colostomies-50%
Usually asymptomatic
Complications like bowel obstruction and
strangulation rare
Treatment :
Primary fascial repair-recurrence
Stoma relocation
Prosthetic repair
33. Spigelian hernia
Unusual hernia
Occurs through the
Spigelian fascia –composed
of aponeurotic layer
between rectus muscle
medially and semilunar line
laterally
Often interparietal
34. Clinical features:
more common in 4th to 7th decade
small swelling lateral to rectus muscle- above level of
umbilicus(10%),below umbilicus(90%)
sharp pain or tenderness at this site
ultrasound abdomen and CT scan are useful to
establish the diagnosis
Complications: high risk of incarceration due to
narrow neck
Treatment: Primary Repair or Mesh repair
35. References:
sabiston textbook of surgery,south asia edition
Schwartz’s principles of surgery,10th edition