This document discusses vascular anomalies, which are soft tissue lesions caused by aberrant blood vessel growth. It focuses on arteriovenous malformations (AVMs), which are high-flow vascular malformations. The case report describes a 30-year old female patient with a maxillary AVM that caused swelling. Diagnostic angiography revealed the AVM was supplied by the internal maxillary artery. To treat the AVM, interventional radiography was performed using selective transarterial embolization of the maxillary artery with polyvinyl alcohol particles. This successfully occluded the vessels feeding the AVM with no complications for the patient.
The document discusses intimal hyperplasia, which is the abnormal proliferation of smooth muscle cells within the innermost layer of arteries. It describes the pathophysiology, stages, and response to different types of arterial injury. Intimal hyperplasia is a major contributor to restenosis and graft failure. The document outlines the key stages following arterial injury, including platelet activation, thrombosis, leukocyte migration, and smooth muscle cell proliferation. It also discusses the response of veins, prosthetic grafts, and dialysis access sites to injury and techniques to reduce intimal hyperplasia.
This document discusses vessel wall biology, including the anatomy and structure of arteries, veins, and lymphatics. It describes the layers of the arterial wall - intima, media, and adventitia - and their components. It also discusses the endothelium, internal elastic lamina, and mechanics of arterial walls. Hemodynamics and the effects of shear stress and circumferential stress on vascular cells are summarized.
Aneurysms of upper and lower extremities + aneurysmsTapish Sahu
The document discusses aneurysms of the upper and lower extremity arteries. It defines an aneurysm as a permanent localized dilation of an artery with at least a 50% increase in diameter compared to normal. The most commonly affected vessel is the abdominal aorta. The document discusses the classification, presentation, diagnosis and treatment options for various types of peripheral artery aneurysms including femoral, popliteal, profunda femoris and persistent sciatic artery aneurysms. Treatment involves open or endovascular surgical repair depending on the location and size of the aneurysm.
This case report describes a 69-year-old male patient who presented with an isolated right common iliac artery aneurysm measuring 8 cm in diameter. During pre-operative workup for planned open surgical repair, the patient's condition deteriorated and imaging showed rupture of the aneurysm. The patient underwent an emergency retroperitoneal surgical procedure to ligate the right iliac artery, perform an extra-anatomic femorofemoral bypass, and repair the ruptured aneurysm. Post-operatively, the patient recovered well with all pulses intact. Isolated iliac artery aneurysms are rare but can rupture with high mortality if not repaired. Both open surgical and endovascular techniques are used for treatment.
Peripheral arterial disease affects around 12% of the adult population in the US. It most commonly presents as intermittent claudication. This document discusses the diagnosis and management of various vascular conditions. It covers topics like aneurysms, arterial occlusions, and venous diseases. Evaluation involves history, exam, imaging studies like duplex ultrasound and angiography. Treatment depends on the specific condition but may include lifestyle changes, medications, endovascular procedures, or surgery.
The document discusses intimal hyperplasia, which is the abnormal proliferation of smooth muscle cells within the innermost layer of arteries. It describes the pathophysiology, stages, and response to different types of arterial injury. Intimal hyperplasia is a major contributor to restenosis and graft failure. The document outlines the key stages following arterial injury, including platelet activation, thrombosis, leukocyte migration, and smooth muscle cell proliferation. It also discusses the response of veins, prosthetic grafts, and dialysis access sites to injury and techniques to reduce intimal hyperplasia.
This document discusses vessel wall biology, including the anatomy and structure of arteries, veins, and lymphatics. It describes the layers of the arterial wall - intima, media, and adventitia - and their components. It also discusses the endothelium, internal elastic lamina, and mechanics of arterial walls. Hemodynamics and the effects of shear stress and circumferential stress on vascular cells are summarized.
Aneurysms of upper and lower extremities + aneurysmsTapish Sahu
The document discusses aneurysms of the upper and lower extremity arteries. It defines an aneurysm as a permanent localized dilation of an artery with at least a 50% increase in diameter compared to normal. The most commonly affected vessel is the abdominal aorta. The document discusses the classification, presentation, diagnosis and treatment options for various types of peripheral artery aneurysms including femoral, popliteal, profunda femoris and persistent sciatic artery aneurysms. Treatment involves open or endovascular surgical repair depending on the location and size of the aneurysm.
This case report describes a 69-year-old male patient who presented with an isolated right common iliac artery aneurysm measuring 8 cm in diameter. During pre-operative workup for planned open surgical repair, the patient's condition deteriorated and imaging showed rupture of the aneurysm. The patient underwent an emergency retroperitoneal surgical procedure to ligate the right iliac artery, perform an extra-anatomic femorofemoral bypass, and repair the ruptured aneurysm. Post-operatively, the patient recovered well with all pulses intact. Isolated iliac artery aneurysms are rare but can rupture with high mortality if not repaired. Both open surgical and endovascular techniques are used for treatment.
Peripheral arterial disease affects around 12% of the adult population in the US. It most commonly presents as intermittent claudication. This document discusses the diagnosis and management of various vascular conditions. It covers topics like aneurysms, arterial occlusions, and venous diseases. Evaluation involves history, exam, imaging studies like duplex ultrasound and angiography. Treatment depends on the specific condition but may include lifestyle changes, medications, endovascular procedures, or surgery.
Case of the week - superficial femoral artery pseudoaneurysmDr Abdalla M. Gamal
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 16 years old male, victim of stab wound in the lower part of the back of the right thigh, and was found to have a pseudoaneurysm in the superficial femoral artery when he was examined by ultasound one month after the injury.
The presentation contains 37 slides, and is divided into the following parts :
1 - The case
2 - Pseudoaneurysms
3 - Imaging of pseudoaneurysms
4 - Treatment of pseudoaneurysms
This presentation was prepared and presented by me in cooperation with D.Mabroka Ellafi in the tutorials of the Radiology Department of Sebha Medical Center.
Management of Incompetence in the Axial VeinsOmar Haqqani
Authored by Dr. James Shpich, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Varicose veins are dilated, tortuous veins caused by valvular incompetence. Recurrence rates after treatment range from 20-60% within 5 years, often due to inadequate initial treatment or the development of new refluxing veins. Recurrent varicose veins can be caused by residual saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ) incompetence, accessory veins like the long or short saphenous vein, deep vein thrombosis (DVT), perforating veins, or neovascularization. Treatment depends on the underlying cause and includes surgery, thermal ablation like radiofrequency or laser ablation, and sclerotherapy.
1. Femoral pseudoaneurysms are defects in the femoral artery wall that allow blood to leak between the layers of the arterial wall. They are usually caused by complications from catheterization procedures.
2. Ultrasound is used to diagnose femoral pseudoaneurysms by detecting swirling blood flow within a sac connected to the artery.
3. Small, asymptomatic pseudoaneurysms may be monitored, as many will close on their own. Treatment options for problematic pseudoaneurysms include ultrasound-guided compression, thrombin injection under ultrasound-guidance, or surgery.
Varicose Vein dr Victor Jesron Nababan SpBTKV 160116Imelda Wijaya
Victor Jesron Nababan is a cardiothoracic and vascular surgeon who specializes in procedures related to the chest, heart, and blood vessels. His areas of focus include cardiac surgery, thoracic surgery to treat conditions of the lungs and chest wall, and vascular surgery for issues involving veins and arteries. Some common procedures he performs include surgery to treat congenital heart defects, coronary artery bypass surgery, varicose vein removal, and treatment of abdominal aortic aneurysms. He utilizes both open surgical techniques as well as minimally invasive endovascular approaches depending on the condition being treated.
A v presentations /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1. The document describes the procedure for creating a brachiocephalic fistula, which involves using the cephalic vein in the arm to access the brachial artery for hemodialysis access.
2. Key steps include identifying a suitable vein and artery via preoperative imaging and dissection, creating a longitudinal arteriotomy in the brachial artery, and performing a running anastomosis between the artery and vein using 6-0 suture.
3. Postoperatively, the fistula is examined for a thrill and hand ischemia before closure of the wound.
Acute mesenteric arterial disease can result from occlusion of the mesenteric arteries or veins, reducing or stopping blood flow to the intestines. It has high morbidity and mortality rates of 60-70% despite aggressive treatment. Diagnosis involves clinical evaluation, lab tests, CT angiography and mesenteric angiography. Treatment depends on the severity and includes resuscitation, antibiotics, surgery to remove dead bowel and restore blood flow, and endovascular procedures in some cases. Prompt diagnosis and treatment is needed to prevent intestinal infarction and improve outcomes.
Coil embolization of a palatine artery pseudoaneurysm in a geldingDane Tatarniuk
This document describes a case of a 24-year-old horse that was admitted for severe right-sided epistaxis. Imaging revealed diffuse hemorrhage filling the right paranasal sinuses. During a CT scan, profuse hemorrhage occurred, requiring carotid artery ligation and frontal sinus surgery. Surgery discovered pulsating masses in the right frontal and maxillary sinuses. Angiography then located a pseudoaneurysm of the right palatine artery, which was successfully embolized using coils to stop the hemorrhage. Follow up showed no further epistaxis, though the horse was later euthanized for unrelated colic issues. This case report describes an unusual cause of epist
This document provides information on hemodialysis catheters. It begins by describing the characteristics of an ideal catheter and then discusses permacath catheters, which are tunnelled central venous catheters often used for hemodialysis. The document outlines the advantages and disadvantages of catheters compared to arteriovenous fistulas. It also discusses various complications associated with catheters including thrombosis, fibrin sheath formation, infection, and vascular thrombosis. The document provides details on preventing, diagnosing, and treating these complications.
This document discusses surveillance and access survival in patients undergoing hemodialysis. It summarizes the clinical signs of access dysfunction and reviews studies looking at the effectiveness of increased access surveillance and preventative angioplasty on fistula thrombosis and longevity. While increased monitoring and angioplasty may decrease thrombosis rates, the data does not clearly show it prolongs access survival. Regular clinical monitoring is recommended for all accesses, with additional monitoring like ultrasound for grafts that have a higher thrombosis risk.
Graft thrombosis is a major cause of failed arterial bypass surgery. Several techniques can be used to assess grafts intraoperatively, including inspection, palpation, arteriography, ultrasonography, angioscopy, and intravascular ultrasonography. Early graft failure within 30 days is often due to technical errors, while late failure over 30 days is usually caused by atherosclerosis or intimal hyperplasia. Treatment depends on the timing and cause of failure. Early failures may be treated with thrombectomy or thrombolysis, while late failures respond better to thrombolysis or open revision. The optimal conduit depends on patient and graft factors. Close surveillance after treatment is important to monitor for recurrent stenosis.
1. Abdominal aortic aneurysm is a dilatation of the abdominal aorta to over 3cm in diameter, most commonly caused by atherosclerosis. It affects around 2% of the population and is more common in males and smokers.
2. Surgical or endovascular repair is recommended when the aneurysm reaches 5.5cm in men or 5cm in women to prevent rupture, which has a high risk of death. Endovascular repair involves placing a stent graft via catheterization to exclude the aneurysm from blood flow.
3. Postoperative monitoring involves imaging to check for endoleaks, where blood flows into the excluded aneurysm sac, which may require further intervention. Smoking cess
Av fistula 3 al mansoura aldawly - nephrolody day dr aboelfotohFarragBahbah
This document provides guidance on using color Doppler ultrasound to assess arteriovenous (AV) fistulas in hemodialysis patients. It outlines the objectives of teamwork, patient respect, and basic clinical knowledge. It describes the strategy for color Doppler exams in three stages: preoperative mapping, postoperative assessment of maturity and function, and assessment of complications. The basics of Doppler are reviewed, and the normal and abnormal ultrasound findings for each stage are presented, including criteria for fistula maturity. Complications such as stenosis, thrombosis, aneurysm, steal syndrome, and high output cardiac failure are described. The importance of clinical findings and interdisciplinary teamwork to prevent, predict, and early manage fistula complications is emphasized.
This document discusses endovenous laser ablation (EVLA) for treating varicose veins. It begins with definitions of different types of abnormal veins like telangiectasias, reticular veins, and varicose veins. It then discusses patient assessment, which involves medical history, physical examination, and duplex ultrasound scan. For patients with superficial venous reflux and varicose veins, treatment options discussed include conservative management, sclerotherapy, and thermal ablation techniques like EVLA. EVLA involves using laser energy to close off diseased veins. The document provides details on patient selection, procedural technique, and outcomes of EVLA for varicose vein treatment.
An aneurysm is an abnormal dilation of a blood vessel wall due to weakening. It can cause thrombosis, alterations in blood flow, rupture, and compression of nearby structures. Aneurysms are classified based on wall composition, shape, and cause. The most common sites for aneurysms are the abdominal aorta and thoracic aorta. Symptoms depend on the specific type of aneurysm but can include rupture, obstruction, embolism, and masses. Diagnosis and treatment involve identifying the type and managing risks like rupture.
This document discusses endomyocardial biopsy, an invasive procedure used to obtain heart muscle samples for histological examination to diagnose heart muscle disease. It provides a brief history of endomyocardial biopsy, describing early studies in the 1950s-1960s and the development of specialized biopsy catheters. The document outlines the current techniques for endomyocardial biopsy via the femoral, jugular, and subclavian veins. Potential complications are noted to be 3% for access site issues, 3% for biopsy related, and 1% each for arrhythmias and conduction abnormalities.
About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
A retired colonel presented to the emergency room with chronic chest pain. Further evaluation revealed he had a massive haemothorax secondary to a ruptured aortic aneurysm. Autopsy showed aortic aneurysms are caused by alterations to the delicate balance in the aortic wall that leads to dilatation. Thoracic aortic aneurysms are generally repaired electively when they reach a diameter of 6 cm or greater to prevent fatal rupture. Treatment options include open surgical repair or endovascular stent graft placement depending on the location and extent of the aneurysm.
This document summarizes various anomalies of the oral and para-oral regions including anomalies of the jaws such as macrognathia, micrognathia, and Pierre-Robin syndrome. It also discusses anomalies of the lips such as cleft lip, commissural lip pits, and cheilitis glandularis. Finally, it mentions several anomalies of the tongue including aglossia, macroglossia, bifid tongue, and lingual thyroid nodule.
The document discusses craniofacial anomalies such as clefts. It describes different types of craniofacial clefts including Tessier cleft classifications 0 through 11. For each classification, it provides details on the anatomical location of the cleft and associated soft tissue deformities. The document also discusses mechanisms, genetics, teratogens, and management considerations for various craniofacial anomalies.
Case of the week - superficial femoral artery pseudoaneurysmDr Abdalla M. Gamal
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 16 years old male, victim of stab wound in the lower part of the back of the right thigh, and was found to have a pseudoaneurysm in the superficial femoral artery when he was examined by ultasound one month after the injury.
The presentation contains 37 slides, and is divided into the following parts :
1 - The case
2 - Pseudoaneurysms
3 - Imaging of pseudoaneurysms
4 - Treatment of pseudoaneurysms
This presentation was prepared and presented by me in cooperation with D.Mabroka Ellafi in the tutorials of the Radiology Department of Sebha Medical Center.
Management of Incompetence in the Axial VeinsOmar Haqqani
Authored by Dr. James Shpich, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Varicose veins are dilated, tortuous veins caused by valvular incompetence. Recurrence rates after treatment range from 20-60% within 5 years, often due to inadequate initial treatment or the development of new refluxing veins. Recurrent varicose veins can be caused by residual saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ) incompetence, accessory veins like the long or short saphenous vein, deep vein thrombosis (DVT), perforating veins, or neovascularization. Treatment depends on the underlying cause and includes surgery, thermal ablation like radiofrequency or laser ablation, and sclerotherapy.
1. Femoral pseudoaneurysms are defects in the femoral artery wall that allow blood to leak between the layers of the arterial wall. They are usually caused by complications from catheterization procedures.
2. Ultrasound is used to diagnose femoral pseudoaneurysms by detecting swirling blood flow within a sac connected to the artery.
3. Small, asymptomatic pseudoaneurysms may be monitored, as many will close on their own. Treatment options for problematic pseudoaneurysms include ultrasound-guided compression, thrombin injection under ultrasound-guidance, or surgery.
Varicose Vein dr Victor Jesron Nababan SpBTKV 160116Imelda Wijaya
Victor Jesron Nababan is a cardiothoracic and vascular surgeon who specializes in procedures related to the chest, heart, and blood vessels. His areas of focus include cardiac surgery, thoracic surgery to treat conditions of the lungs and chest wall, and vascular surgery for issues involving veins and arteries. Some common procedures he performs include surgery to treat congenital heart defects, coronary artery bypass surgery, varicose vein removal, and treatment of abdominal aortic aneurysms. He utilizes both open surgical techniques as well as minimally invasive endovascular approaches depending on the condition being treated.
A v presentations /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1. The document describes the procedure for creating a brachiocephalic fistula, which involves using the cephalic vein in the arm to access the brachial artery for hemodialysis access.
2. Key steps include identifying a suitable vein and artery via preoperative imaging and dissection, creating a longitudinal arteriotomy in the brachial artery, and performing a running anastomosis between the artery and vein using 6-0 suture.
3. Postoperatively, the fistula is examined for a thrill and hand ischemia before closure of the wound.
Acute mesenteric arterial disease can result from occlusion of the mesenteric arteries or veins, reducing or stopping blood flow to the intestines. It has high morbidity and mortality rates of 60-70% despite aggressive treatment. Diagnosis involves clinical evaluation, lab tests, CT angiography and mesenteric angiography. Treatment depends on the severity and includes resuscitation, antibiotics, surgery to remove dead bowel and restore blood flow, and endovascular procedures in some cases. Prompt diagnosis and treatment is needed to prevent intestinal infarction and improve outcomes.
Coil embolization of a palatine artery pseudoaneurysm in a geldingDane Tatarniuk
This document describes a case of a 24-year-old horse that was admitted for severe right-sided epistaxis. Imaging revealed diffuse hemorrhage filling the right paranasal sinuses. During a CT scan, profuse hemorrhage occurred, requiring carotid artery ligation and frontal sinus surgery. Surgery discovered pulsating masses in the right frontal and maxillary sinuses. Angiography then located a pseudoaneurysm of the right palatine artery, which was successfully embolized using coils to stop the hemorrhage. Follow up showed no further epistaxis, though the horse was later euthanized for unrelated colic issues. This case report describes an unusual cause of epist
This document provides information on hemodialysis catheters. It begins by describing the characteristics of an ideal catheter and then discusses permacath catheters, which are tunnelled central venous catheters often used for hemodialysis. The document outlines the advantages and disadvantages of catheters compared to arteriovenous fistulas. It also discusses various complications associated with catheters including thrombosis, fibrin sheath formation, infection, and vascular thrombosis. The document provides details on preventing, diagnosing, and treating these complications.
This document discusses surveillance and access survival in patients undergoing hemodialysis. It summarizes the clinical signs of access dysfunction and reviews studies looking at the effectiveness of increased access surveillance and preventative angioplasty on fistula thrombosis and longevity. While increased monitoring and angioplasty may decrease thrombosis rates, the data does not clearly show it prolongs access survival. Regular clinical monitoring is recommended for all accesses, with additional monitoring like ultrasound for grafts that have a higher thrombosis risk.
Graft thrombosis is a major cause of failed arterial bypass surgery. Several techniques can be used to assess grafts intraoperatively, including inspection, palpation, arteriography, ultrasonography, angioscopy, and intravascular ultrasonography. Early graft failure within 30 days is often due to technical errors, while late failure over 30 days is usually caused by atherosclerosis or intimal hyperplasia. Treatment depends on the timing and cause of failure. Early failures may be treated with thrombectomy or thrombolysis, while late failures respond better to thrombolysis or open revision. The optimal conduit depends on patient and graft factors. Close surveillance after treatment is important to monitor for recurrent stenosis.
1. Abdominal aortic aneurysm is a dilatation of the abdominal aorta to over 3cm in diameter, most commonly caused by atherosclerosis. It affects around 2% of the population and is more common in males and smokers.
2. Surgical or endovascular repair is recommended when the aneurysm reaches 5.5cm in men or 5cm in women to prevent rupture, which has a high risk of death. Endovascular repair involves placing a stent graft via catheterization to exclude the aneurysm from blood flow.
3. Postoperative monitoring involves imaging to check for endoleaks, where blood flows into the excluded aneurysm sac, which may require further intervention. Smoking cess
Av fistula 3 al mansoura aldawly - nephrolody day dr aboelfotohFarragBahbah
This document provides guidance on using color Doppler ultrasound to assess arteriovenous (AV) fistulas in hemodialysis patients. It outlines the objectives of teamwork, patient respect, and basic clinical knowledge. It describes the strategy for color Doppler exams in three stages: preoperative mapping, postoperative assessment of maturity and function, and assessment of complications. The basics of Doppler are reviewed, and the normal and abnormal ultrasound findings for each stage are presented, including criteria for fistula maturity. Complications such as stenosis, thrombosis, aneurysm, steal syndrome, and high output cardiac failure are described. The importance of clinical findings and interdisciplinary teamwork to prevent, predict, and early manage fistula complications is emphasized.
This document discusses endovenous laser ablation (EVLA) for treating varicose veins. It begins with definitions of different types of abnormal veins like telangiectasias, reticular veins, and varicose veins. It then discusses patient assessment, which involves medical history, physical examination, and duplex ultrasound scan. For patients with superficial venous reflux and varicose veins, treatment options discussed include conservative management, sclerotherapy, and thermal ablation techniques like EVLA. EVLA involves using laser energy to close off diseased veins. The document provides details on patient selection, procedural technique, and outcomes of EVLA for varicose vein treatment.
An aneurysm is an abnormal dilation of a blood vessel wall due to weakening. It can cause thrombosis, alterations in blood flow, rupture, and compression of nearby structures. Aneurysms are classified based on wall composition, shape, and cause. The most common sites for aneurysms are the abdominal aorta and thoracic aorta. Symptoms depend on the specific type of aneurysm but can include rupture, obstruction, embolism, and masses. Diagnosis and treatment involve identifying the type and managing risks like rupture.
This document discusses endomyocardial biopsy, an invasive procedure used to obtain heart muscle samples for histological examination to diagnose heart muscle disease. It provides a brief history of endomyocardial biopsy, describing early studies in the 1950s-1960s and the development of specialized biopsy catheters. The document outlines the current techniques for endomyocardial biopsy via the femoral, jugular, and subclavian veins. Potential complications are noted to be 3% for access site issues, 3% for biopsy related, and 1% each for arrhythmias and conduction abnormalities.
About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)
Grand Rounds given at Holy Redeemer hospital 1/2017 on the many amazing treatments offered by interventional radiologists.
Including microwave ablation, Y90 radioembolization, UFE, Arterial inteventions, Varicose veins, and more!
A retired colonel presented to the emergency room with chronic chest pain. Further evaluation revealed he had a massive haemothorax secondary to a ruptured aortic aneurysm. Autopsy showed aortic aneurysms are caused by alterations to the delicate balance in the aortic wall that leads to dilatation. Thoracic aortic aneurysms are generally repaired electively when they reach a diameter of 6 cm or greater to prevent fatal rupture. Treatment options include open surgical repair or endovascular stent graft placement depending on the location and extent of the aneurysm.
This document summarizes various anomalies of the oral and para-oral regions including anomalies of the jaws such as macrognathia, micrognathia, and Pierre-Robin syndrome. It also discusses anomalies of the lips such as cleft lip, commissural lip pits, and cheilitis glandularis. Finally, it mentions several anomalies of the tongue including aglossia, macroglossia, bifid tongue, and lingual thyroid nodule.
The document discusses craniofacial anomalies such as clefts. It describes different types of craniofacial clefts including Tessier cleft classifications 0 through 11. For each classification, it provides details on the anatomical location of the cleft and associated soft tissue deformities. The document also discusses mechanisms, genetics, teratogens, and management considerations for various craniofacial anomalies.
3 keratoses and related disorders of oral mucosa iRmz Study
This document discusses normal oral mucosa and white patches of the oral mucosa. It defines keratosis and describes different types of white patches, including those caused by increased keratin production that cannot be scraped off and those caused by accumulation of keratinous debris that can be scraped off. It also summarizes hereditary keratoses including oral epithelial nevus and leukoedema, as well as traumatic, infective, idiopathic, and neoplastic keratoses. Key histopathological terms are defined and various genodermatoses associated with oral mucosal lesions are outlined.
The presentation expalin major anomilies terminology and it's classification according to the site as: jaws, palate, lips gingivae, tongue, salivary gland, line of fusion and teeth
Developmental disturbances of LIP,PALATE and ORAL MUCOSAaanchalshruti
This document summarizes several developmental disturbances of the lip, palate, and oral mucosa. It describes congenital lip and commissural pits/fistulas, which can occur alone or with clefts. It also discusses Van der Woude syndrome, cleft lip and palate, cheilitis glandularis, cheilitis granulomatosa, hereditary intestinal polyposis syndrome, labial and oral melanotic macules, Fordyce's granules, and focal epithelial hyperplasia. For each condition, it provides information on etiology, clinical features, histological features if applicable, differential diagnosis, and treatment approaches.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
This document discusses a case of a 3-year-old female child who presented with recurrent seizures over 2 hours followed by loss of consciousness for 2 days. On examination, she had right upper and lower limb weakness, difficulty speaking, and right 7th nerve palsy. Imaging and surgery revealed a ruptured aneurysm at the left ICA bifurcation, which was clipped. The document then reviews characteristics of pediatric intracranial aneurysms, including their etiology, location, presentation, treatment approaches, and outcomes.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Vascular malformations are difficult to treat and patients are affected psychologically and physically. The aim of the presentation is to discuss various treatment modalities available for management of venous malformations of Hand.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Austin Journal of Urology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Urology.
The aim of the journal is to provide a forum for urologists, nephrologists, research scholars, physicians, and other healthcare professionals to find most recent advances in the field of Urology.
Austin Journal of Urology accepts original research articles, review articles, case reports and short communication on all the aspects of Urology and relevant basic science issues.
This document discusses sonographic evaluation for diagnosing upper extremity deep venous thrombosis (UEDVT). It provides an overview of the risk factors and complications of UEDVT. Color Doppler sonography is outlined as the preferred noninvasive screening technique, with sensitivity of 78-100% and specificity of 82-100% for diagnosing UEDVT. The normal venous anatomy of the upper extremity is described and techniques for performing the sonographic examination are explained. Examples of sonographic appearances of acute and chronic UEDVT are illustrated and described.
This case report describes an 85-year-old male who presented with recurrent painless bleeding from reddish spots on his scrotal skin. On examination, there were over 100 small red maculopapular lesions. No immediate diagnosis was made. After literature review, a provisional diagnosis of angiokeratoma of the scrotum was made. The patient underwent excision of the involved skin, which confirmed the diagnosis histopathologically by showing epithelial hyperplasia, dilated superficial blood vessels, and other features. The patient recovered well with no recurrence after 1 year of follow up.
Percutaneous Sclerotherapy For Spongiform Venous Malformations- Analysis of Patient-evaluated Outcome And Satisfaction.
Percutaneous sclerotherapy for spongiform venous malformations - analysis of patient-evaluated outcome and satisfaction.
Clemens RK, Baumann F, Husmann M, Meier TO, Thalhammer C, MacCallum G, Ruth Amann-Vesti B, Alomari AI. Vasa. 2017 Aug 25:1-7.
doi: 10.1024/0301-1526/a000650.
This document discusses preoperative MRI for perianal fistulas. It notes that while MRI is generally considered the most sensitive imaging tool, it can sometimes provide false positive results that may lead to unnecessary surgery. The study aims to determine MRI's value as well as detect any fallacious results. It presents results from a study of 100 patients, finding that 2 patients in the MRI-guided group had false positive MRI results, while 3 patients in the non-MRI group had false positive clinical assessments. The conclusion is that MRI is very helpful but false positive results can be addressed by standardizing IV contrast protocols or using complementary color Doppler ultrasound.
A 55-year-old male presented to the emergency department with confusion, irritability, and dyspnea. His medical history included diabetes, hypertension, possible COPD, and a prior myocardial infarction. On examination, he had tachycardia, oxygen saturation of 50%, and a blood pressure of 130/80 mmHg. He was intubated for ventilation. An electrocardiogram showed abnormal findings. An echocardiogram found an ejection fraction of 23%. The patient's electrocardiogram and condition are discussed in detail over multiple messages.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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1. Vascular anomalies are soft tissue lesions of congeni-
tally aberrant blood vessel growth that affect up to 10%
of newborns.1
Vascular anomalies are divided into two
main categories: vascular tumors and vascular malfor-
mations.1,2
The vascular tumors mainly include hemangiomas. They
are made up of rapidly proliferating endothelial cells. The
blood vessel architecture is incomplete and surrounded by
hyperplastic cells in these tumors. Clinically, hemangio-
mas usually appear in early infancy, grow rapidly during
the first 18-24 months of life and slowly involute over the
next 5 or 6 years. In contrast, vascular malformations
consist of progressively enlarging aberrant and ectatic ves-
sels of particular vascular architecture such as arteries,
veins, lymphatic vessels.
The vascular malformations are further subdivided into
low-(slow) and high-(fast) flow lesions based upon the
velocity of fluid motion through their system. Capillary,
venous, and lymphatic malformations are considered low-
flow malformations while arteriovenous malformations
(AVMs) have fast-flow characteristics. Unlike hemangio-
mas, vascular malformations are uncommon, rarely regress,
continue to expand, and have high rates of recurrence fol-
lowing intervention.3-5
Approximately 51% of vascular malformations occur in
the head and neck region, and the male-to-female ratio is
1 : 1.5.3
Extracranial AVMs of the head and neck (extra-
cranial) are high-flow lesions and among the most serious
of the vascular malformations because they are difficult
to diagnose, treat, and cure. They grow throughout life
with frequent, dramatic, and aggressive growth spurts under
various environmental influences. AVMs are very destruc-
tive, infiltrative and often life-threatening secondary to
massive bleeding. Most common areas of occurrence are
the cheek, lips, neck, scalp, neck, ear, tongue, and mandi-
ble.1
Signs and symptoms reported are commonly soft tis-
sue swelling, pain of variable intensity, teeth mobility and
migration, discoloration of overlying skin and intraoral mu-
cosal surface, paresthesia, facial asymmetry, local pulsa-
tions, bruits, erythematous gingivae and bleeding around
the teeth, and bone resorption with palpable thrill as well
as resorption of the roots in the affected area with no
evidence of related cause or periapical pathoses.6
─ 123 ─
Interventional radiography in management of high-flow arteriovenous malformation of
maxilla: report of a case
Neha Khambete, Mukund Risbud, Nikit Mehta*
Department of Oral Medicine, Diagnosis and Radiology, Vasantdada Patil Dental College and Hospital, Kavalapur, India
*S.D.M. College of Medical Sciences, Dharwad, India
ABSTRACT
Arteriovenous malformations are extremely rare conditions in that can result from abnormalities in the structure of
blood vessels, which may be potentially fatal. A 30-year-old female patient visited our hospital with a complaint of
swelling on the right maxillary posterior gingiva along with the large port-wine stain on right side of face. On clini-
cal examination, the swelling was compressible and pulsatile. Radiographic examination revealed a lytic lesion of
maxilla. Diagnostic angiography revealed a high-flow arteriovenous malformation of maxilla which was treated by
selective transarterial embolization of maxillary artery using polyvinyl alcohol particles. (Imaging Sci Dent 2011;
41 : 123-8)
KEY WORDS : Arteriovenous Malformations; Maxilla; Interventional Radiography; Angiography
Received April 13, 2011; Revised May 2, 2011; Accepted May 23, 2011
Correspondence to : Prof. Mukund Risbud
Department of Oral Medicine, Diagnosis and Radiology, Vasantdada Patil Dental
College and Hospital, A/P Kavalapur, Tal: Miraj, Dist: Sangli, Maharashtra, India
Tel) 91-988-1260939, Fax) 91-233-2364400, E-mail) mukundrisbud@gmail.com
Imaging Science in Dentistry 2011; 41 : 123-8
http://dx.doi.org/10.5624/isd.2011.41.3.123
Copyright ⓒ 2011 by Korean Academy of Oral and Maxillofacial Radiology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0)
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Imaging Science in Dentistry∙pISSN 2233-7822 eISSN 2233-7830
2. Various treatment modalities have been discussed for
the management of AVM.7,8
Many studies have reported
the use of selective transarterial embolization of AVM
with various substances.6,9,10
This may be followed by sur-
gical resection or sclerotherapy. Here we report a case in
which high flow AVM of maxilla was imaged using angio-
graphy. The angiogram revealed the feeder vessel which
was branch of internal maxillary artery. Selective trans-
arterial embolization of the feeder artery was performed
using polyvinyl alcohol particles.
Case Report
A 30-year-old female patient reported to the outpatient
department of Vasantdada Patil Dental College and Hos-
pital, Sangli with a chief complaint of gingival swelling on
the right maxillary posterior region. The patient noticed a
painless swelling 6 months ago, which was small in size
initially, started growing gradually and reached the present
size. The patient revealed a history of similar swelling in
the same region 2 years ago. Surgical removal of the
mass had been attempted, however it had been unsuccess-
ful due to heavy bleeding from the site. The bleeding had
been controlled by cauterization.
On general examination, the patient showed unilateral
port-wine stain on the right side of her face extending
from the superior border of the upper lip to the bridge of
the nose superoinferiorly and from the midline to the
preauricular region anteroposteriorly since her birth. On
clinical examination, the patient revealed about 3×3 cm
sized solitary extraoral swelling on the right maxilla ex-
tending from the midline to the midpupilary line antero-
posteriorly and from the superior border of the upper lip to
the base of the nose superoinferiorly. The swelling was
roughly ovoid in shape with diffuse borders. The overly-
ing skin was erythematous. There was a local increase in
temperature of the overlying skin. The swelling was soft
in consistency and non-tender on palpation. Intraorally,
about 3×6 cm sized solitary swelling, reddish pink in
color was found extending from the right central incisor
to the third molar on the buccal and palatal gingivae of
the maxilla. The swelling involved marginal, papillary,
and attached gingivae, and had smooth surface. It was
soft in consistency, non-tender on palpation, compressi-
ble, pulsatile and blanched on pressure. No bleeding on
palpation was noted. The right maxillary first and second
premolars showed grade II mobility. The right maxillary
lateral incisor was displaced laterally (Fig. 1). A provi-
sional diagnosis of vascular lesion was given and the pat-
ient was subjected to radiographic examination. Intraoral
periapical radiographs showed coarse bony trabeculae
─ 124 ─
Interventional radiography in management of high-flow arteriovenous malformation of maxilla: report of a case
Fig. 1. A. Extraoral photograph shows port- wine stain and ex-
traoral swelling. B. Intraoral photograph shows the extent of the
lesion from buccal aspect. C. Intraoral photograph shows the pal-
atal extent of lesion.
A
B
C
3. and enlarged marrow spaces on the right maxillary ante-
rior and posterior regions. Alveolar bone loss was reveal-
ed on the maxillary central and lateral incisor regions.
Widening of periodontal ligament space was seen with
lateral incisor, first and second premolar and the first
molar was supraerupted (Figs. 2A and B). Panoramic
radiograph showed ill-defined, irregular area of bone
destruction extending from the mesial surface of the left
maxillary central incisor upto the mesial surface of the
right maxillary canine. The maxillary central and lateral
incisors showed marked displacement (Fig. 2C).
The patient was referred to The Wanless Hospital, Miraj.
The ultrasound examination showed a high-flow arterio-
venous malformation. Admission laboratory tests showed
hemoglobin (Hb) of 7.3 g/dL, a platelet count of 63,000 per
mm3
, prothrombin time of 17 seconds, activated partial th-
romboplastin time of 35 sec, and international normalized
ratio of 1.3. The patient was then given blood and platelet
transfusions after which the blood investigations showed
hemoglobin of 13.3 g/dL, platelet count of 1,96,000, proth-
rombin time 15 seconds, activated partial thromboplastin
time of 28 seconds and international normalized ratio of
1.1. Diagnostic angiography was performed after gaining
access from the right femoral artery. Selective catheteriza-
tion of the right external carotid artery was performed un-
der fluoroscopic guidance. The diagnostic angiogram show-
ed a high-flow vascular malformation supplied princi-
pally by the alveolar branch of the internal maxillary arte-
ry. Surgical treatment of such lesion required extensive
resection of the maxilla and might result in the dysfunction
and disfigurement. Ligation of the external carotid artery
was not advisable, since many anastomoses promoted the
rapid appearance of a collateral circulation. Therefore,
embolization which consisted of occlusion of the vessels
which contributed to the lesion was considered. Further
selective catheterization of the maxillary artery was per-
formed. Embolization was performed using polyvinyl alco-
hol (PVA) particles (Fig. 3). The patient tolerated the pro-
─ 125 ─
Neha Khambete et al
Fig. 2. Intraoral periapical radio-
graphs show coarse bony trabecu-
lae and enlarged marrow spaces. A.
Right maxillary posterior portion.
B. Right maxillary anterior portion.
C: Panoramic radiograph shows an
ill-defined irregular area of bone de-
struction in right maxillary anterior
region.
A B
C
4. cedure well and had an unremarkable postoperative course.
One week postoperatively the patient showed complete
regression of the palatal lesion (Fig. 4). One year follow-
up revealed a significant reduction of clinical symptoms
and signs of the lesion without any further complications.
Discussion
AVMs are extremely rare conditions that can be fatal if
left untreated.6
They are caused by disturbances in the late
stages of angiogenesis, mainly abnormal differentiation
of vascular system.10
Vascular malformations can be sub-
divided further into high-flow and low-flow lesions.1,2
In
the present case, angiography was performed which de-
monstrated a high-flow AVM.
The diagnosis of AVMs can be made clinically in con-
junction with imaging studies. Most AVMs have a history
that includes the presence of a vascular blush in the overly-
ing skin in the childhood, which begins to expand more
rapidly as the patient enters puberty or undergoes other
hormonal changes. They may also reveal a history of trau-
ma to the involved area prior to the notification of the le-
sion. Bleeding, pain, and tissue destruction are often sub-
sequent signs in AVM.1,6
On physical examination, early
AVMs may have an overlying vascular blush in the skin
similar to an early port-wine stain. The mucosa is usually
thickened and vascular, and pulsation is usually present.
─ 126 ─
Interventional radiography in management of high-flow arteriovenous malformation of maxilla: report of a case
Fig. 3. A. Pre-embolization angio-
gram shows the abnormal blush in
central incisor region. B and C. An-
giogram during embolization shows
passage of polyvinyl alcohol parti-
cles. D. Post-embolization angio-
gram shows occlusion of feeder ves-
sel.
A B
C D
Fig. 4. Post-operative intraoral photograph shows regression of
palatal lesion after selective embolization.
5. The teeth may be loose or may exhibit pumping move-
ment when pressure is applied and released.1,3,4,6
AVMs
can invade the skin where ulcerations and bleeding are
common.1,11
Some “high-flow” lesions may result in con-
sumption coagulopathy, requiring transfusion therapy.12,13
Multiple imaging modalities should be used to evaluate
characteristics of AVMs such as size, flow velocity, flow
direction, relation to the surrounding structures and lesion
contents.2
There are no pathognomonic radiographic fea-
tures to distinguish AVMs on plain radiographs. They may
appear as bone erosion, sclerotic change, periosteal reac-
tion or a cyst like radiolucent lesion. A sunburst effect,
created by spicules radiating from the center, is often pre-
sent.2,14
The lesions most often have a multiloculated
appearance due to residual bone trapped around vessels.
Small radiolucent locules may resemble enlarged marrow
spaces surrounded by coarse, dense, and well defined trabe-
culae. They may have a honey comb or soap-bubble pattern
that is well demarcated from adjacent bone. The roots of
the teeth in proximity of the lesion may show displacement
or resorption. High-flow lesions tend to result in more
destructive skeletal changes, appearing as moth-eaten and
poorly defined areas of radiolucency.12
The radiographic
differential diagnosis of these lesions include amelobla-
stoma, ameloblastic fiboma, odontogenic myxoma, cent-
ral giant cell granuloma and metastatic malignant tumors.6
Color Doppler ultrasound examination can provide infor-
mation about the flow velocity. Contrast enhanced CT
can be useful in assessing the AVMs. The drawbacks of
CT are considerable exposure to ionizing radiation and
limited information about blood flow.2
Angiography and
MR imaging are the preferred imaging modalities.2,6,10,15
MRI depicts the anatomic relation of the vascular lesion
with adjacent organs and the flow velocity of lesions. It is
useful for evaluating the lesions postoperatively.2
Angio-
graphy is currently the gold standard for the determina-
tion of location and flow characteristics of vascular le-
sions. Angiography is useful to determine blood vessels
supplying blood to the lesion, and the relative venous out-
flow characteristics, and the presence or absence of arte-
riovenous shunts.3
According to Orbach, the angiographic
features of AVMs include dilatation and lengthening of
afferent arteries, early and preferential filling of shunts,
delayed filling of associated normal arteries, early opaci-
fication of draining veins and rapid flow to collateral ves-
sels.16
Intentional transarterial embolization was originally des-
cribed in 1969 by Lalli and coworkers.17
Treatment of vas-
cular malformation with selective embolization procedure
is currently highly recommended and often used. The pur-
pose of the selective embolization is to abruptly cut off the
blood supply of the lesion, reducing the risk of potentially
massive and lethal blood loss after its rupture, enabling a
more focused and selective surgical procedure with less
morbidity and with maximal preservation of important
structures.18
Various materials can be used for emboli-
zation. They can be classified as either temporary or per-
manent. Temporary materials include autologous clot or
muscle, Gelfoam19,20
and microfibrillar collagen. Perma-
nent agents include silicone spheres, lyophilized dura,
PVA, isobutyl cyanoacrylate and stainless steel or plati-
num coils. The most commonly used materials are Gel-
foam and PVA. PVA was used in present case as it is nona-
bsorbable and denser than Gelfoam.9
To conclude, vascular malformations represent some of
the most difficult lesions to diagnose and treat. Interven-
tional radiography plays an essential role in diagnosis and
management of such lesions. With the use of this techni-
que, extensive surgical procedures can be avoided so as to
avoid facial disfigurement and functional compromise.
Acknowledgements
The authors are thankful to Dr. Rahul Kumar for his
great help during preparation of manuscript. The authors
would like to thank Dr. Avinash Kshar, Dr. Nivedita Ba-
jantri, Dr, Alka Hazari, Dr. Praveen Kumar, Dr. Amit Ma-
thur and Dr. Arati Oka for their co-operation.
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