This document discusses acute ischemia of the lower limb (AILL). It outlines the main causes as embolism (70% from heart), thrombosis on top of stenosis, or popliteal aneurysm. Clinical features include the 5 Ps - pain, pallor, paresthesia, pulselessness, paralysis. Treatment options are intra-arterial thrombolysis, thrombectomy, or surgical embolectomy. Peripheral intra-arterial thrombolysis is a common procedure that rapidly restores blood flow and identifies lesions for intervention. It has better outcomes and fewer bleeding risks than systemic thrombolysis.
This presentation gives latest (2016) guidelines regarding acute limb ischemia (ALI), published in Journal of American College of Cardiology (JACC) in March 2017
ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
Presentation about the hazards and potential complications that could happen in any cardiac or peripheral catheterization procedure and how to avoid them
This presentation gives latest (2016) guidelines regarding acute limb ischemia (ALI), published in Journal of American College of Cardiology (JACC) in March 2017
ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
Presentation about the hazards and potential complications that could happen in any cardiac or peripheral catheterization procedure and how to avoid them
This is a recreation of a presentation that I created in the early 2000s for a nursing inservice about femoral vascular access site complications. Post cardiac catheterization and post interventional radiology patients were a new patient population for these nurses.
This is a recreation of a presentation that I created in the early 2000s for a nursing inservice about femoral vascular access site complications. Post cardiac catheterization and post interventional radiology patients were a new patient population for these nurses.
Critical Limb Ischemia is the condition with chronic ischemic at-rest pain that may progressively lead to severe skin ulcers, gangrene, or limb loss. The condition is typically related to the objectively proven severe blockage in the artery. The disease implies, chronicity and is usually associated with multiple sites of arterial obstruction that severely reduced blood flow to the tissues. The disease is clinically manifested as rest pain, non healing wounds and/or tissue necrosis.
Ischemic pain can be associated with the burning sensation in the ball of the foot and toes, which can be worsened at night may be because of the loss of gravity assisted flow to the foot. In the past few years the most significant change in the treatment of CLI has been the increasing tendency to shift from bypass surgery to less invasive stem cell treatment procedure as first-choice causing revascularization of the damaged tissue and removal of plaque deposits to a certain extent.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
A talk for general practitioners on the role of CT coronary angiography in cardiology practice in Australia.
To see more from dr alistair begg visit his website at www.dralistairbegg.com or visit the cardiac dvd dvd website at www.whatswrongwithmyheart.com
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
1. Dr. Rajdeep Agrawal
Acute Ischemia Of Lower Limb
(AILL)
AetiologyAetiology
1. Embolisation most common cause1. Embolisation most common cause
heart as a source - 70 %,heart as a source - 70 %,
Atrial Fibrillation,Atrial Fibrillation,
AMI with mural thrombusAMI with mural thrombus
2. Acute thrombosis superimposed upon2. Acute thrombosis superimposed upon
stenosisstenosis
3. Popliteal Aneurysm3. Popliteal Aneurysm
2. Dr. Rajdeep Agrawal
Acute Ischemia Of Lower Limb
The extent of ischemia & finalThe extent of ischemia & final
outcome depends uponoutcome depends upon
1. Size & location of clot1. Size & location of clot
2. Extent of collateral2. Extent of collateral
circulationcirculation
3. Time between onset of3. Time between onset of
occlusion & treatmentocclusion & treatment
4. Dr. Rajdeep Agrawal
Therapeutic Strategies in
Acute Ischemia
Most common vascular emergencyMost common vascular emergency
1. Intra arterial thrombolysis1. Intra arterial thrombolysis
2. Thrombo-aspiration with catheter2. Thrombo-aspiration with catheter
3. Mechanical thrombolysis3. Mechanical thrombolysis
4. Surgical embolectomy – Fogarty4. Surgical embolectomy – Fogarty
cathetercatheter
5. Dr. Rajdeep Agrawal
Peripheral Intra-arterial
Thrombolysis (PIAT)
Rapidly restores blood flow to ischemicRapidly restores blood flow to ischemic
limb & identifies underlying lesions forlimb & identifies underlying lesions for
percutaneous or surgical interventionpercutaneous or surgical intervention
Catheter directed local delivery ofCatheter directed local delivery of
thrombolytic agents directly at the sitethrombolytic agents directly at the site
of thrombosis is significantly moreof thrombosis is significantly more
effective than systemic thrombolysis &effective than systemic thrombolysis &
is associated with lower bleedingis associated with lower bleeding
complicationscomplications
6. Dr. Rajdeep Agrawal
Thrombolytic Agents
StreptokinaseStreptokinase
UrokinaseUrokinase
Recombinant human tissue typeRecombinant human tissue type
plasminogen activator (rtpA,plasminogen activator (rtpA,
alteplase)alteplase)
In recent years UK & rtpA have largelyIn recent years UK & rtpA have largely
superceded & replaced SK assuperceded & replaced SK as
preferred agentpreferred agent
7. Dr. Rajdeep Agrawal
Peripheral Intra-arterial Thrombolysis
(PIAT)
PIAT – Common procedurePIAT – Common procedure
Angiography is doneAngiography is done
Thrombus is locatedThrombus is located
Multiple end hole catheter is advanced to theMultiple end hole catheter is advanced to the
upper limit of the thrombusupper limit of the thrombus
One of the infusion methods shown next isOne of the infusion methods shown next is
then usedthen used
8. Dr. Rajdeep Agrawal
PIAT– Infusion Methods
Stepwise infusionStepwise infusion
Done by stepwise advancement of infusionDone by stepwise advancement of infusion
catheter as thrombus dissolvescatheter as thrombus dissolves
Graded infusionGraded infusion ( McNamara’s( McNamara’s protocolprotocol))
gradual tapering of infusion rategradual tapering of infusion rate
Continuous infusionContinuous infusion
Pulse spray techniquePulse spray technique
9. Dr. Rajdeep Agrawal
PIAT--McNamara’s Protocol
UK 4000 units/min x 2hrsUK 4000 units/min x 2hrs
2000 units/min x next 2hrs2000 units/min x next 2hrs
1000 units/min x next 4-24 hrs or1000 units/min x next 4-24 hrs or
until the lysis is completeduntil the lysis is completed
Systemic heparin continued during PIAT And tillSystemic heparin continued during PIAT And till
definite endovascular or surgical Rx ofdefinite endovascular or surgical Rx of
underlying lesion is doneunderlying lesion is done
10. Dr. Rajdeep Agrawal
PIAT--McNamara’s Protocol
Complete lysis is considered if > 75%Complete lysis is considered if > 75%
of the clot dissolvesof the clot dissolves
Initial reestablishment of flowInitial reestablishment of flow
takes on an 3.3 hrs avg.takes on an 3.3 hrs avg.
complete clot lysis up to 13hrs avgcomplete clot lysis up to 13hrs avg
Systemic Heparin is continued through thisSystemic Heparin is continued through this
periodperiod
11. Dr. Rajdeep Agrawal
Predictors Of Successful
Thrombolysis
Easy traversability of clot withEasy traversability of clot with
non-hydrophilic guide wire 0.035”non-hydrophilic guide wire 0.035”
Significant lysis within 2hrsSignificant lysis within 2hrs
12. Dr. Rajdeep Agrawal
Thrombolysis-Contraindications
AbsoluteAbsolute
1. Recent Cerebro Vascular Accident,1. Recent Cerebro Vascular Accident,
neurosurgery, intracranial trauma,neurosurgery, intracranial trauma,
within the last 3 monthswithin the last 3 months
2. Active bleeding diathesis2. Active bleeding diathesis
3. Recent GI bleed (< 10days)3. Recent GI bleed (< 10days)
4. Irreversible ischemia4. Irreversible ischemia
13. Dr. Rajdeep Agrawal
Thrombolysis-Contraindications
RelativeRelative
1. Cardiopulmonary resuscitation,1. Cardiopulmonary resuscitation,
major nonvascular surgery, traumamajor nonvascular surgery, trauma
within last 10 dayswithin last 10 days
2. Uncontrolled HT systolic > 1802. Uncontrolled HT systolic > 180
diastolic >110 3.diastolic >110 3.
Puncture of non compressible vesselPuncture of non compressible vessel
4. Intracranial tumor, diabetic proliferative4. Intracranial tumor, diabetic proliferative
retinopathy, bacterial endocarditis,retinopathy, bacterial endocarditis,
pregnancypregnancy
15. Dr. Rajdeep Agrawal
Post PIAT Management
Underlying flow limiting lesion is presentUnderlying flow limiting lesion is present
in more than 70% cases & surgery orin more than 70% cases & surgery or
PTA can be performed immediatelyPTA can be performed immediately
after thrombolysis with no additional riskafter thrombolysis with no additional risk
of hemorrhageof hemorrhage
No underlying lesion -- anticoagulationNo underlying lesion -- anticoagulation
16. Dr. Rajdeep Agrawal
Treatment of Acute Occlusion
Embolectomy - Using Fogarty’s catheter ->Embolectomy - Using Fogarty’s catheter ->
Catheter passed beyond emblous, balloonCatheter passed beyond emblous, balloon
inflated & pulled back till blood comesinflated & pulled back till blood comes
Direct Embolectomy - Artery exposed,Direct Embolectomy - Artery exposed,
transverse incision, clot removed.transverse incision, clot removed.
Intra-arterial Thrombolysis - TPA preferred.Intra-arterial Thrombolysis - TPA preferred.
Arteriography done and a catheter embeddedArteriography done and a catheter embedded
in clot - Thrombolytic agent infused overin clot - Thrombolytic agent infused over
several hrsseveral hrs
17. Dr. Rajdeep Agrawal
Surgical Embolectomy
Relatively simple procedureRelatively simple procedure
Done under LA, small incision in theDone under LA, small incision in the
groin, using Fogarty’s cath.groin, using Fogarty’s cath.
ProblemsProblems
1. Blind procedure, can be traumatic1. Blind procedure, can be traumatic
2. Not successful in 10 – 30% cases2. Not successful in 10 – 30% cases
3. Inefficient in multistenosed artery3. Inefficient in multistenosed artery
4. Complete removal of thrombus4. Complete removal of thrombus
difficult in leg arteriesdifficult in leg arteries
18. Dr. Rajdeep Agrawal
Post PTA MX
Antiplatelet agentsAntiplatelet agents
LMW Heparin X 7 – 10 DLMW Heparin X 7 – 10 D
IV / oral TrentalIV / oral Trental
StatinsStatins
Aggressive control of riskAggressive control of risk
factorsfactors
20. Dr. Rajdeep Agrawal
Directional Atherectomy
It excises the atheromatousIt excises the atheromatous
plaque material into very fineplaque material into very fine
slices which can be retrievedslices which can be retrieved
outside bodyoutside body
22. Dr. Rajdeep Agrawal
LASER
A LASER produces an intenseA LASER produces an intense
beam of light in uniformbeam of light in uniform
wavelength that can be preciselywavelength that can be precisely
focused to deliver high energyfocused to deliver high energy
levels to a small arealevels to a small area
It converts solid plaque to gasIt converts solid plaque to gas
which is soluble in bloodwhich is soluble in blood
23. Dr. Rajdeep Agrawal
Stent
An expandable metallic helicalAn expandable metallic helical
device which is permanentlydevice which is permanently
implanted in the arteryimplanted in the artery ..
MechanismMechanism
The prosthesis acts as aThe prosthesis acts as a
scaffold to hold the artery openscaffold to hold the artery open
Prevents recoil of the vesselPrevents recoil of the vessel
Reduces RestenosisReduces Restenosis
24. Dr. Rajdeep Agrawal
Lower Limb Ischemia -
Approach to therapy
Risk factor managementRisk factor management
** Abstinence from smokingAbstinence from smoking
** Control of diabetesControl of diabetes
** Control of hyperlipidemiaControl of hyperlipidemia
25. Dr. Rajdeep Agrawal
Lower Limb Ischemia -
Approach to therapy
Risk factor managementRisk factor management
** Weight reductionWeight reduction
• Control of hypertension, CHF, CRFControl of hypertension, CHF, CRF
• Chronic anticoagulation oral withChronic anticoagulation oral with
judicious use of PT PIjudicious use of PT PI
measurementsmeasurements
26. Dr. Rajdeep Agrawal
Lower Limb Ischemia -
Role of Drugs
Pentoxyfylline – not usefulPentoxyfylline – not useful
Antiplatelet AgentsAntiplatelet Agents
ProstaglandinsProstaglandins
VasodilatorsVasodilators