This document discusses sclerotherapy as a treatment for varicose and spider veins. It provides details on:
1) The technique of sclerotherapy, which involves injecting a caustic solution into veins to destroy the intima and obliterate the vessel.
2) Evaluation of patients prior to treatment, including physical exam and duplex ultrasound to identify refluxing veins.
3) Materials used, including sclerosing agents like sodium tetradecyl sulfate (STS) and polidocanol.
4) The procedure steps, including patient preparation, positioning, skin preparation, choice of sclerosant concentration, and injection.
How to use sclerotherapy successfully to cure telangiectasia and reticular va...Nessie Productions
The document discusses how to successfully use sclerotherapy to treat telangiectasia and reticular varices. It emphasizes performing a thorough initial examination using ultrasound imaging and visual inspection to map the vein layout. This allows targeting treatment from the largest to smallest veins. When injecting visible reticular veins, a two-handed technique is recommended for safety and control. For telangiectasia, very small doses should be injected tangentially at multiple points. Attention to injection technique and targeting the proper veins is essential for achieving effective results without complications.
This document provides guidelines for foam sclerotherapy treatment of varicose veins and superficial venous insufficiency. It discusses indications for treatment, sclerosing agents such as polidocanol and sodium tetradecyl sulfate, how to make and administer foam, and results from studies on occlusion rates. Foam sclerotherapy is recommended for treating saphenous veins and tributaries as it displaces blood better than liquid sclerosants, allowing for more effective endothelial contact and occlusion rates of 70-90% in studies with follow-up periods of 6-46 months and a single treatment session in most cases. Compression is also important after the procedure.
This article describes a novel technique of peri-venous compression following ultrasound-guided sclerotherapy (UGS) to treat incompetent great and small saphenous veins. The technique involves injecting normal saline around the vein following foam sclerotherapy injections to compress the vein. Early results on 47 limbs treated with this method found a 10.7% re-treatment rate to fully ablate the veins, lower than rates reported in other UGS studies. No significant adverse effects were observed with this technique. The authors conclude that peri-venous compression may reduce early recurrence rates after foam UGS for saphenous vein treatment by improving contact between the sclerosant and vein walls.
This document summarizes minimally invasive glaucoma surgery (MIGS) procedures. MIGS offers more modest intraocular pressure (IOP) lowering than traditional glaucoma surgery, but with a safer risk profile. The document describes various MIGS procedures including the iStent, Hydrus, CyPass, and XEN gel stent. It provides details on the mechanism of action, surgical technique, efficacy and safety data from clinical studies for each procedure. MIGS provides an alternative treatment option for glaucoma patients to lower IOP and reliance on eye drops without the risks of more invasive surgeries.
This document discusses minimally invasive glaucoma surgery (MIGS) procedures. It defines MIGS as glaucoma surgery that is ab interno, uses a small incision, spares the conjunctiva, causes minimal trauma and tissue disruption, has a high safety profile, allows for rapid visual recovery, and can be combined with cataract surgery. It then describes various MIGS procedures including trabecular micro-bypass stents, gonioscopy assisted transluminal trabeculotomy, excimer laser trabeculotomy, the iStent, and suprachoroidal shunts. It provides details on the mechanisms, surgical techniques, indications, and complications of these different MIGS procedures.
Glaucoma is a lifestyle disease. Its treatment via traditional surgery (ie. trabeculectomy) or via glaucoma medications, negatively impacts the lifestyle of patients. In this presentation, Dr. David Richardson presents the new, non-invasive glaucoma treatment, Canaloplasty. Canaloplasty is a lifestyle surgery for Glaucoma.
The Cosmetic Outcome Of External Dacryocystorhinostomy Scar And Factors Affec...Dr. Jagannath Boramani
Presented by- Dr. Saurabh Dhewale, Co-authors- Dr. Ajit Khune, Dr. Dhiraj Balwir ( Disclosure: Author has no financial interest ) Dr. Vasantrao Pawar Medical College, Nashik.
How to use sclerotherapy successfully to cure telangiectasia and reticular va...Nessie Productions
The document discusses how to successfully use sclerotherapy to treat telangiectasia and reticular varices. It emphasizes performing a thorough initial examination using ultrasound imaging and visual inspection to map the vein layout. This allows targeting treatment from the largest to smallest veins. When injecting visible reticular veins, a two-handed technique is recommended for safety and control. For telangiectasia, very small doses should be injected tangentially at multiple points. Attention to injection technique and targeting the proper veins is essential for achieving effective results without complications.
This document provides guidelines for foam sclerotherapy treatment of varicose veins and superficial venous insufficiency. It discusses indications for treatment, sclerosing agents such as polidocanol and sodium tetradecyl sulfate, how to make and administer foam, and results from studies on occlusion rates. Foam sclerotherapy is recommended for treating saphenous veins and tributaries as it displaces blood better than liquid sclerosants, allowing for more effective endothelial contact and occlusion rates of 70-90% in studies with follow-up periods of 6-46 months and a single treatment session in most cases. Compression is also important after the procedure.
This article describes a novel technique of peri-venous compression following ultrasound-guided sclerotherapy (UGS) to treat incompetent great and small saphenous veins. The technique involves injecting normal saline around the vein following foam sclerotherapy injections to compress the vein. Early results on 47 limbs treated with this method found a 10.7% re-treatment rate to fully ablate the veins, lower than rates reported in other UGS studies. No significant adverse effects were observed with this technique. The authors conclude that peri-venous compression may reduce early recurrence rates after foam UGS for saphenous vein treatment by improving contact between the sclerosant and vein walls.
This document summarizes minimally invasive glaucoma surgery (MIGS) procedures. MIGS offers more modest intraocular pressure (IOP) lowering than traditional glaucoma surgery, but with a safer risk profile. The document describes various MIGS procedures including the iStent, Hydrus, CyPass, and XEN gel stent. It provides details on the mechanism of action, surgical technique, efficacy and safety data from clinical studies for each procedure. MIGS provides an alternative treatment option for glaucoma patients to lower IOP and reliance on eye drops without the risks of more invasive surgeries.
This document discusses minimally invasive glaucoma surgery (MIGS) procedures. It defines MIGS as glaucoma surgery that is ab interno, uses a small incision, spares the conjunctiva, causes minimal trauma and tissue disruption, has a high safety profile, allows for rapid visual recovery, and can be combined with cataract surgery. It then describes various MIGS procedures including trabecular micro-bypass stents, gonioscopy assisted transluminal trabeculotomy, excimer laser trabeculotomy, the iStent, and suprachoroidal shunts. It provides details on the mechanisms, surgical techniques, indications, and complications of these different MIGS procedures.
Glaucoma is a lifestyle disease. Its treatment via traditional surgery (ie. trabeculectomy) or via glaucoma medications, negatively impacts the lifestyle of patients. In this presentation, Dr. David Richardson presents the new, non-invasive glaucoma treatment, Canaloplasty. Canaloplasty is a lifestyle surgery for Glaucoma.
The Cosmetic Outcome Of External Dacryocystorhinostomy Scar And Factors Affec...Dr. Jagannath Boramani
Presented by- Dr. Saurabh Dhewale, Co-authors- Dr. Ajit Khune, Dr. Dhiraj Balwir ( Disclosure: Author has no financial interest ) Dr. Vasantrao Pawar Medical College, Nashik.
MIGS procedures aim to lower IOP through minimally invasive surgery with fewer complications than traditional glaucoma surgeries. Procedures include trabecular micro-bypass stents and excimer laser trabeculotomy to increase outflow through the trabecular meshwork, as well as canaloplasty and the Hydrus microstent to dilate Schlemm's canal. Other options are suprachoroidal shunts and subconjunctival implants to divert aqueous humor through alternate outflow pathways. While showing modest IOP reduction, MIGS procedures offer rapid recovery and minimal risk compared to traditional surgeries.
This document provides a summary of the history and evolution of glaucoma surgery techniques. It discusses early procedures from the 19th century like iridectomy and the Lagrange operation. In later decades, techniques like Elliot operation, iridencleisis, Stallard operation, and trabeculectomy were developed to improve outcomes. The document also summarizes treatments for different types of glaucoma over time, such as peripheral iridectomy for acute/chronic angle closure glaucoma. It notes the ongoing search for new procedures with fewer complications than trabeculectomy that are closer to physiological outflow mechanisms.
This document discusses vascular closure devices (VCDs) which were introduced to reduce complications from manual compression used to close arterial puncture sites after cardiac catheterization procedures. VCDs can be categorized as active approximators that physically close the puncture site, passive approximators that deploy a plug or sealant, or external compression devices. Common VCDs discussed include suture-based devices, collagen plugs like Angio-Seal, and hydrogel seals. While VCDs provide benefits like faster hemostasis and mobilization compared to manual compression, they also carry risks of complications that may require surgery like infections. Operator experience also impacts successful use of various closure methods.
This document provides an outline and overview of lamellar keratoplasty techniques. It discusses the anatomy of the cornea and indications for lamellar keratoplasty such as keratoconus. Anterior lamellar keratoplasty techniques include deep anterior lamellar keratoplasty (DALK) using the big bubble technique or Melle's technique to remove the corneal stroma down to Descemet's membrane. Posterior lamellar keratoplasty techniques like Descemet's stripping endothelial keratoplasty (DSEK) are also summarized. Complications of lamellar keratoplasty procedures and advantages over penetrating keratoplasty are highlighted.
Canaloplasty Overview 3 Year Clinical Results Burchfield111510Pickrel777
The document provides an overview of canaloplasty, a non-penetrating glaucoma surgery technique. Canaloplasty aims to restore normal aqueous outflow by accessing and dilating Schlemm's canal using a microcatheter. This allows placement of a tensioning suture to maintain canal patency. Clinical studies show canaloplasty reduces intraocular pressure by 35-41% at 3 years with a low complication rate, providing an alternative to traditional glaucoma surgeries.
This document discusses various minimally invasive glaucoma surgery (MIGS) procedures and devices. MIGS procedures are minimally traumatic, avoid complications of traditional glaucoma surgery, and provide rapid recovery with minimal impact on quality of life. Devices discussed include the Trabectome, iStent, CyPass microstent, Hydrus microstent, Aquasys stent, canaloplasty, Ex-PRESS shunt, and Gold Microshunt. Laser procedures like cyclophotocoagulation are also summarized.
This document discusses non-penetrating glaucoma surgery techniques that facilitate the drainage of aqueous humor through the trabecular meshwork and Schlemm's canal without opening the anterior chamber. It describes several procedures including deep sclerectomy, viscocanalostomy, canaloplasty, ab-externo trabeculectomy, and laser trabecular ablation. The goal is to bypass the highest resistance point to outflow in the juxtacanalicular meshwork. Advantages include lower risks of complications like hypotony compared to penetrating surgeries. Indications and contraindications are provided for various non-penetrating glaucoma procedures.
This document discusses deep anterior lamellar keratoplasty (DALK), a type of corneal transplant surgery. It provides:
1) A brief history of DALK, beginning with early successful transplants in the late 19th century and developments in techniques in the 1950s and 1980s.
2) Indications for DALK including keratoconus, post-LASIK ectasia, hereditary stromal dystrophies, infectious keratitis, and tectonic indications.
3) An overview of various surgical techniques for DALK including manual dissection, air-assisted dissection, and techniques using viscoelastic or femtosecond lasers.
4) Preparation of
MIGS procedures are newer glaucoma surgeries that offer more modest intraocular pressure (IOP) lowering than traditional surgeries, but with a safer risk profile. They are targeted at patients with mild to moderate glaucoma and involve minimally traumatic, ab-interno approaches that preserve the conjunctiva. Common MIGS procedures include implants that bypass the trabecular meshwork (iStent, Hydrus), drain into the suprachoroidal space (CyPass), or excise the trabecular meshwork (Trabectome). Studies show that MIGS procedures lower IOP by 15-20% on average when combined with cataract surgery. Complications are generally mild and
Acs0613 Surgical Treatment Of The Infected Aortic Graftmedbookonline
This document discusses surgical treatment options for infected aortic grafts. The primary goal is to remove all infected material while maintaining adequate circulation. Options include extra-anatomic bypass, aortic allografts, antibiotic-treated prosthetic grafts, and in situ replacement with a femoral-popliteal vein graft. The preferred method is in situ replacement with an autogenous femoral-popliteal vein graft due to its excellent long-term patency and resistance to reinfection. The procedure involves harvesting the vein, controlling the femoral vessels, removing the infected graft, and reconstructing with the vein graft. Meticulous technique is required to minimize complications.
Early diagnosis, repair and common post operative complications of hypospadiasRustem Celami
Early diagnosis and treatment of hypospadias can now be achieved through advances in prenatal ultrasound technology. Modern surgical techniques have improved outcomes for repairing this congenital abnormality of the penis. Complications are still common after hypospadias surgery due to the delicate tissues involved. Immediate concerns include bleeding and infection, which are usually minor, while long term issues like urethrocutaneous fistulas remain a challenge. Proximal forms of hypospadias and less surgical experience are associated with higher complication rates.
What's New In Glaucoma Surgery [OD CE 2 credit hours] - PPT Slides and VideosDr David Richardson
What's New In Glaucoma Surgery Presentation. A Continuing Education course for Optometrists presented by Patient-Focused Ophthalmologist, Dr. David Richardson.
At the end of the presentation audience participants became familiar with the main benefits and risks of currently available glaucoma treatments as well as had awareness of the most promising potential future surgical glaucoma treatments.
This OD CE Course was held at Green Street Tavern, Pasadena, CA last May 20, 2015.
=========================
[Glaucoma Surgeon, California] Dr. David Richardson is a board certified Ophthalmologist and Eye Surgeon in California specializing in the treatment of Cataract and Glaucoma. He is the Medical Director of San Marino Eye (Vision Center), located in San Marino, California. He’s the former Chief of Surgery and now Vice Chief of Staff at San Gabriel Valley Medical Center. Dr. Richardson has performed thousands of advanced cataract and Canaloplasty glaucoma procedures with excellent results.
More information about Dr. Richardson: http://David-Richardson-MD.com
New Glaucoma Treatments is a GLAUCOMA HealthHub maintained by David Richardson, M.D. It’s primary purpose is to provide valuable information to glaucoma patients and their caregivers worldwide about the latest developments and treatments for glaucoma, while providing answers to commonly asked questions about glaucoma, care and treatment options.
More information about new glaucoma treatments here: http://new-glaucoma-treatments.com
1) Hysteroscopy is a procedure that allows direct visualization of the uterine cavity and cervical canal using a thin telescope inserted through the vagina and cervix.
2) Key components of modern hysteroscopy include a telescope, light source, distention media (such as saline or CO2), and single- or multi-channel sheaths.
3) Hysteroscopy is used diagnostically to evaluate abnormal bleeding and infertility and operatively for procedures such as endometrial ablation, polyp removal, and septum division. Complications can include fluid overload, perforation, and infection.
This document discusses the evolution of donor nephrectomy techniques from open surgery to minimally invasive approaches like laparoscopic and robotic-assisted surgery. It provides a brief overview of different surgical techniques for donor nephrectomy and summarizes outcomes research comparing techniques. Minimally invasive approaches are associated with less blood loss, shorter hospital stays, and faster recovery compared to open surgery without compromising graft or donor outcomes. Laparoscopic donor nephrectomy has become the standard technique.
The document discusses office-based hysteroscopic procedures including using the Versapoint and Essure sterilization systems. It finds that 70-80% of fibroids under 3cm and polyps under 4cm can be removed in an office setting using Versapoint. Essure sterilization can also be performed in an office without anesthesia using the Bettocchi approach, with an average pain score of 2.5 and procedure time of 10-15 minutes depending on parity. Placement is verified after 3 months using transvaginal ultrasound instead of X-ray or HSG.
Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
This document discusses uterine distention media used in hysteroscopy. It compares the advantages and disadvantages of gaseous (CO2) and liquid media, including electrolytic (NS, RL) and non-electrolytic (dextran, glycine, sorbitol, mannitol) options. CO2 is well-suited for diagnostic procedures but can obscure visibility in operative cases. Liquid media allow for better visualization but carry risks of fluid absorption and related complications like hyponatremia or renal failure. Proper distention pressure and monitoring of fluid intake and output are essential to prevent adverse effects.
This document summarizes the history and developments in vascular access for hemodialysis. It discusses key milestones like the first hemodialysis in 1924, the Quinton-Scribner shunt in 1960, and the Brescia-Cimino fistula in 1966. It then compares arteriovenous fistulas, grafts, and catheters and their primary failure rates, infection risks, and longevity. The document outlines criteria for successful fistulas and grafts and factors that can lead to stenosis. It also discusses strategies to prevent stenosis and reduce catheter use, such as earlier patient referral and education on permanent access options.
This document discusses the management of cervical intraepithelial neoplasia (CIN). It covers who and when to treat CIN, treatment options including cryotherapy, laser vaporization, loop electrosurgical excision procedure, and conization. It provides guidance on treatment based on CIN grade, patient characteristics like pregnancy, and risk factors. The main treatment goals are prompt treatment of CIN 2-3 while allowing regression of many CIN 1 cases. Complications, reproductive outcomes, and prognosis after treatment are also reviewed.
Liposuction used to treat deep vascular accesses for hemodialysis.pptxGierelma J.T.
This study evaluated the use of liposuction to superficialize deep arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in 14 hemodialysis patients. Liposuction was performed to remove excess fat overlying the access to allow for cannulation. Following liposuction, the mean access depth decreased from 7mm to 5.3mm after 4 weeks of healing. For patients who previously could not use their deep access, 2 out of 3 were able to remove their tunneled catheters. For other patients, the length of accessible access increased on average from 5cm to 12.7cm. The procedure was well-tolerated with only minor bleeding in one case.
MIGS procedures aim to lower IOP through minimally invasive surgery with fewer complications than traditional glaucoma surgeries. Procedures include trabecular micro-bypass stents and excimer laser trabeculotomy to increase outflow through the trabecular meshwork, as well as canaloplasty and the Hydrus microstent to dilate Schlemm's canal. Other options are suprachoroidal shunts and subconjunctival implants to divert aqueous humor through alternate outflow pathways. While showing modest IOP reduction, MIGS procedures offer rapid recovery and minimal risk compared to traditional surgeries.
This document provides a summary of the history and evolution of glaucoma surgery techniques. It discusses early procedures from the 19th century like iridectomy and the Lagrange operation. In later decades, techniques like Elliot operation, iridencleisis, Stallard operation, and trabeculectomy were developed to improve outcomes. The document also summarizes treatments for different types of glaucoma over time, such as peripheral iridectomy for acute/chronic angle closure glaucoma. It notes the ongoing search for new procedures with fewer complications than trabeculectomy that are closer to physiological outflow mechanisms.
This document discusses vascular closure devices (VCDs) which were introduced to reduce complications from manual compression used to close arterial puncture sites after cardiac catheterization procedures. VCDs can be categorized as active approximators that physically close the puncture site, passive approximators that deploy a plug or sealant, or external compression devices. Common VCDs discussed include suture-based devices, collagen plugs like Angio-Seal, and hydrogel seals. While VCDs provide benefits like faster hemostasis and mobilization compared to manual compression, they also carry risks of complications that may require surgery like infections. Operator experience also impacts successful use of various closure methods.
This document provides an outline and overview of lamellar keratoplasty techniques. It discusses the anatomy of the cornea and indications for lamellar keratoplasty such as keratoconus. Anterior lamellar keratoplasty techniques include deep anterior lamellar keratoplasty (DALK) using the big bubble technique or Melle's technique to remove the corneal stroma down to Descemet's membrane. Posterior lamellar keratoplasty techniques like Descemet's stripping endothelial keratoplasty (DSEK) are also summarized. Complications of lamellar keratoplasty procedures and advantages over penetrating keratoplasty are highlighted.
Canaloplasty Overview 3 Year Clinical Results Burchfield111510Pickrel777
The document provides an overview of canaloplasty, a non-penetrating glaucoma surgery technique. Canaloplasty aims to restore normal aqueous outflow by accessing and dilating Schlemm's canal using a microcatheter. This allows placement of a tensioning suture to maintain canal patency. Clinical studies show canaloplasty reduces intraocular pressure by 35-41% at 3 years with a low complication rate, providing an alternative to traditional glaucoma surgeries.
This document discusses various minimally invasive glaucoma surgery (MIGS) procedures and devices. MIGS procedures are minimally traumatic, avoid complications of traditional glaucoma surgery, and provide rapid recovery with minimal impact on quality of life. Devices discussed include the Trabectome, iStent, CyPass microstent, Hydrus microstent, Aquasys stent, canaloplasty, Ex-PRESS shunt, and Gold Microshunt. Laser procedures like cyclophotocoagulation are also summarized.
This document discusses non-penetrating glaucoma surgery techniques that facilitate the drainage of aqueous humor through the trabecular meshwork and Schlemm's canal without opening the anterior chamber. It describes several procedures including deep sclerectomy, viscocanalostomy, canaloplasty, ab-externo trabeculectomy, and laser trabecular ablation. The goal is to bypass the highest resistance point to outflow in the juxtacanalicular meshwork. Advantages include lower risks of complications like hypotony compared to penetrating surgeries. Indications and contraindications are provided for various non-penetrating glaucoma procedures.
This document discusses deep anterior lamellar keratoplasty (DALK), a type of corneal transplant surgery. It provides:
1) A brief history of DALK, beginning with early successful transplants in the late 19th century and developments in techniques in the 1950s and 1980s.
2) Indications for DALK including keratoconus, post-LASIK ectasia, hereditary stromal dystrophies, infectious keratitis, and tectonic indications.
3) An overview of various surgical techniques for DALK including manual dissection, air-assisted dissection, and techniques using viscoelastic or femtosecond lasers.
4) Preparation of
MIGS procedures are newer glaucoma surgeries that offer more modest intraocular pressure (IOP) lowering than traditional surgeries, but with a safer risk profile. They are targeted at patients with mild to moderate glaucoma and involve minimally traumatic, ab-interno approaches that preserve the conjunctiva. Common MIGS procedures include implants that bypass the trabecular meshwork (iStent, Hydrus), drain into the suprachoroidal space (CyPass), or excise the trabecular meshwork (Trabectome). Studies show that MIGS procedures lower IOP by 15-20% on average when combined with cataract surgery. Complications are generally mild and
Acs0613 Surgical Treatment Of The Infected Aortic Graftmedbookonline
This document discusses surgical treatment options for infected aortic grafts. The primary goal is to remove all infected material while maintaining adequate circulation. Options include extra-anatomic bypass, aortic allografts, antibiotic-treated prosthetic grafts, and in situ replacement with a femoral-popliteal vein graft. The preferred method is in situ replacement with an autogenous femoral-popliteal vein graft due to its excellent long-term patency and resistance to reinfection. The procedure involves harvesting the vein, controlling the femoral vessels, removing the infected graft, and reconstructing with the vein graft. Meticulous technique is required to minimize complications.
Early diagnosis, repair and common post operative complications of hypospadiasRustem Celami
Early diagnosis and treatment of hypospadias can now be achieved through advances in prenatal ultrasound technology. Modern surgical techniques have improved outcomes for repairing this congenital abnormality of the penis. Complications are still common after hypospadias surgery due to the delicate tissues involved. Immediate concerns include bleeding and infection, which are usually minor, while long term issues like urethrocutaneous fistulas remain a challenge. Proximal forms of hypospadias and less surgical experience are associated with higher complication rates.
What's New In Glaucoma Surgery [OD CE 2 credit hours] - PPT Slides and VideosDr David Richardson
What's New In Glaucoma Surgery Presentation. A Continuing Education course for Optometrists presented by Patient-Focused Ophthalmologist, Dr. David Richardson.
At the end of the presentation audience participants became familiar with the main benefits and risks of currently available glaucoma treatments as well as had awareness of the most promising potential future surgical glaucoma treatments.
This OD CE Course was held at Green Street Tavern, Pasadena, CA last May 20, 2015.
=========================
[Glaucoma Surgeon, California] Dr. David Richardson is a board certified Ophthalmologist and Eye Surgeon in California specializing in the treatment of Cataract and Glaucoma. He is the Medical Director of San Marino Eye (Vision Center), located in San Marino, California. He’s the former Chief of Surgery and now Vice Chief of Staff at San Gabriel Valley Medical Center. Dr. Richardson has performed thousands of advanced cataract and Canaloplasty glaucoma procedures with excellent results.
More information about Dr. Richardson: http://David-Richardson-MD.com
New Glaucoma Treatments is a GLAUCOMA HealthHub maintained by David Richardson, M.D. It’s primary purpose is to provide valuable information to glaucoma patients and their caregivers worldwide about the latest developments and treatments for glaucoma, while providing answers to commonly asked questions about glaucoma, care and treatment options.
More information about new glaucoma treatments here: http://new-glaucoma-treatments.com
1) Hysteroscopy is a procedure that allows direct visualization of the uterine cavity and cervical canal using a thin telescope inserted through the vagina and cervix.
2) Key components of modern hysteroscopy include a telescope, light source, distention media (such as saline or CO2), and single- or multi-channel sheaths.
3) Hysteroscopy is used diagnostically to evaluate abnormal bleeding and infertility and operatively for procedures such as endometrial ablation, polyp removal, and septum division. Complications can include fluid overload, perforation, and infection.
This document discusses the evolution of donor nephrectomy techniques from open surgery to minimally invasive approaches like laparoscopic and robotic-assisted surgery. It provides a brief overview of different surgical techniques for donor nephrectomy and summarizes outcomes research comparing techniques. Minimally invasive approaches are associated with less blood loss, shorter hospital stays, and faster recovery compared to open surgery without compromising graft or donor outcomes. Laparoscopic donor nephrectomy has become the standard technique.
The document discusses office-based hysteroscopic procedures including using the Versapoint and Essure sterilization systems. It finds that 70-80% of fibroids under 3cm and polyps under 4cm can be removed in an office setting using Versapoint. Essure sterilization can also be performed in an office without anesthesia using the Bettocchi approach, with an average pain score of 2.5 and procedure time of 10-15 minutes depending on parity. Placement is verified after 3 months using transvaginal ultrasound instead of X-ray or HSG.
Photodynamic Therapy (PDT)
Therapeutic procedure
Utilizes the photosensitive intravenous drug, verteporfin (Visudyne)
With a low power, long duration infrared laser
In ophthalmology it is used to treat
Neovascular age related macular degeneration (AMD)
Polypoidal choroidal vasculopathy (PCV)
Haemangioma
Central serus retinopathy(CSR)
This document discusses uterine distention media used in hysteroscopy. It compares the advantages and disadvantages of gaseous (CO2) and liquid media, including electrolytic (NS, RL) and non-electrolytic (dextran, glycine, sorbitol, mannitol) options. CO2 is well-suited for diagnostic procedures but can obscure visibility in operative cases. Liquid media allow for better visualization but carry risks of fluid absorption and related complications like hyponatremia or renal failure. Proper distention pressure and monitoring of fluid intake and output are essential to prevent adverse effects.
This document summarizes the history and developments in vascular access for hemodialysis. It discusses key milestones like the first hemodialysis in 1924, the Quinton-Scribner shunt in 1960, and the Brescia-Cimino fistula in 1966. It then compares arteriovenous fistulas, grafts, and catheters and their primary failure rates, infection risks, and longevity. The document outlines criteria for successful fistulas and grafts and factors that can lead to stenosis. It also discusses strategies to prevent stenosis and reduce catheter use, such as earlier patient referral and education on permanent access options.
This document discusses the management of cervical intraepithelial neoplasia (CIN). It covers who and when to treat CIN, treatment options including cryotherapy, laser vaporization, loop electrosurgical excision procedure, and conization. It provides guidance on treatment based on CIN grade, patient characteristics like pregnancy, and risk factors. The main treatment goals are prompt treatment of CIN 2-3 while allowing regression of many CIN 1 cases. Complications, reproductive outcomes, and prognosis after treatment are also reviewed.
Liposuction used to treat deep vascular accesses for hemodialysis.pptxGierelma J.T.
This study evaluated the use of liposuction to superficialize deep arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in 14 hemodialysis patients. Liposuction was performed to remove excess fat overlying the access to allow for cannulation. Following liposuction, the mean access depth decreased from 7mm to 5.3mm after 4 weeks of healing. For patients who previously could not use their deep access, 2 out of 3 were able to remove their tunneled catheters. For other patients, the length of accessible access increased on average from 5cm to 12.7cm. The procedure was well-tolerated with only minor bleeding in one case.
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...asclepiuspdfs
Purpose: Computed tomography (CT) guidance and general anesthesia have recently been recommended as the approach of choice for percutaneous ablation of small renal cell carcinoma (RCC), whereas ultrasound (US) guidance and conscious sedation have been tagged as inadequate. Aim of the study was to assess the safety and effectiveness of percutaneous thermal ablation of small RCC under ultrasound (US)-guidance and conscious sedation. Methods: The records of 74 patients with small RCC (≤5 cm), who underwent US-guided thermal ablation under conscious sedation were retrospectively reviewed. Conscious sedation was usually induced by means of intravenous bolus of midazolam 50–100 μg/kg plus continuous infusion of a 25 μg/mL solution of remifentanil at a rate of 0.05 μg/kg/min. Technical success, technical efficacy, local tumor progression (LTP), primary and secondary efficacy rates, complication rate, and 1-, 3-, and 5-year survival rates were analyzed.
prophylatic inferior vena cava (IVC) filters in traumaMubasharHashmi1
This document summarizes a multicenter randomized controlled trial that evaluated the use of retrievable inferior vena cava (IVC) filters for thromboprophylaxis in severely injured trauma patients. The trial randomized 240 patients with contraindications to anticoagulation and Injury Severity Score >15 to either receive an IVC filter within 72 hours or no filter. The primary endpoints were symptomatic pulmonary embolism and death within 90 days. Secondary endpoints included DVT rates, bleeding complications, and costs. Preliminary results found the groups to be balanced at baseline. The study aims to determine if early IVC filter placement reduces pulmonary embolism rates compared to no filter in high-risk trauma patients who cannot receive antico
This document discusses adnexal torsion in adolescents. It defines adnexal torsion and notes that it most commonly affects ovaries in females aged 10-20 years due to hormonal influences. Ultrasound is the preferred imaging method and can show signs like ovarian edema and twisted vascular pedicles. Emergent laparoscopy is the standard treatment to detorse the ovary, which often remains viable even if initially discolored. Oophoropexy may be considered in cases of recurrent torsion. The conclusion emphasizes that adnexal torsion should be considered in adolescent abdominal pain and that preservation of ovarian tissue is prioritized.
1 Journal Club Presentation - Clinical Study on Management of Venous Ulcer.pptxManishChoudary
This study evaluated the management of venous ulcers through conservative and surgical treatments. 80 patients with venous ulcers were treated either conservatively with dressings and compression therapy or through surgical procedures like vein ligation and stripping. The majority (71 patients, 88.75%) achieved ulcer healing within 3 months, with surgical management showing faster healing times on average. Conservative treatment alone was less effective, with ulcers taking on average 6 more weeks to heal. Recurrence rates were low, with only 5 patients (6.25%) experiencing ulcer recurrence by the 1-year follow up point. The study demonstrates the effectiveness of surgical correction of underlying venous issues in addition to conservative care for treating venous ulcers.
Jc sclerotherapy in pyogenic granuloma and mucoceleSunbultabrez
Its a journal club on the topic of pyogenic granuloma and mucocele which can be treated with sclerotherapy. Even though the gold standard still remains as a biopsy, sclerotherapy is a non invasive procedure for needle phobic patients. It also has other article as references to support sclerotherapy.
Made by:
Dr. Sunbul Tabrez
3. VNVDAII - Venous diseases of lower extremitiesssuser787e5c1
This document discusses venous diseases of the lower extremities, including common conditions like varicose veins and deep vein thrombosis (DVT). It describes signs and symptoms, investigations like duplex venous scans, and treatment options for various conditions. Treatment may include compression stockings, sclerotherapy, surgery, laser ablation, radiofrequency ablation (RFA), mechanical occlusion and chemical ablation (MOCA). Endovascular options for DVT include catheter-directed thrombolysis, ultrasound-accelerated thrombolysis, percutaneous mechanical thrombectomy, and venoplasty or stenting. Preventing venous thromboembolism and reducing long-term morbidity from DVT involves considering endovascular treatments in addition to anticoagulation for
This document discusses soft tissue sarcomas (STS). It notes that STS are rare malignant tumors that arise from connective tissues. Specific syndromes like neurofibromatosis can increase the risk of certain STS. Imaging like MRI and biopsy are used to evaluate STS. Surgery is the primary treatment and radiation or chemotherapy may be used as well, depending on the grade and stage of the tumor. Recurrence rates are high for certain types of STS like retroperitoneal sarcomas. Overall prognosis depends on factors like grade, size, and whether clear margins can be obtained with surgery.
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This document discusses the management of small renal masses (SRMs). Key points include:
1. SRMs are detected more frequently due to increased use of imaging and are usually less than 4cm.
2. Goals for managing early stage renal cell carcinoma include cancer survival, preserving renal function, and avoiding treatment morbidity.
3. Treatment options for SRMs include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Partial nephrectomy is the gold standard.
4. Cryoablation and radiofrequency ablation are emerging minimally invasive techniques for treating SRMs but long term data on oncologic outcomes is still lacking.
This document discusses avoiding radiation injuries from interventional medical procedures. It notes that while such procedures provide benefits, both patients and staff can be exposed to high radiation doses, especially during complex or lengthy procedures. It emphasizes the need for proper training, equipment, and techniques to minimize radiation exposure to acceptable levels. This includes optimizing parameters, limiting exposure times, changing angles, and using protective gear. It also stresses informing and following up with patients when radiation skin doses may be high to check for any late effects.
This document provides an overview of pilonidal disease management. It discusses the epidemiology, etiology, risk factors, evaluation, and various treatment approaches for both acute and chronic pilonidal disease. For acute disease, incision and drainage is the mainstay of treatment. For chronic disease, options include excision with primary closure, healing by secondary intention, marsupialization, or flap procedures. The document recommends uniform guidelines to reduce recurrence rates and time to return to work.
This document provides information on diabetic foot. It begins by defining diabetic foot as infection, ulceration or destruction of deep tissues of the lower limb associated with neurological abnormalities and peripheral vascular disease in diabetic patients.
Some key points made include:
- The prevalence of foot ulcers in diabetic patients ranges from 4% to 27% and they account for a large burden on healthcare systems.
- Risk factors for diabetic foot ulcers include neuropathy, foot deformities, and poor blood sugar control.
- Treatment requires a multidisciplinary approach including wound care, offloading, infection management, and improving blood sugar and blood flow.
1) A 74-year-old male developed a large radial artery pseudoaneurysm following transradial coronary angiography. Ultrasound-guided compression was unsuccessful in treating the pseudoaneurysm.
2) Due to the large size of the pseudoaneurysm and failure of conservative treatment, the patient underwent surgical repair.
3) At one month follow up after surgical repair, the radial artery patency was restored with complete healing of the access site and no recurrence of the pseudoaneurysm.
Many people suffer from venous disease. A good percentage of them are having superficial venous disease. Mostly these diseases are neglected due to ignorance or lack of awareness. Here is a brief description on management of superficial venous disease.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). These non-drug therapies can help reduce seizure frequency or render patients completely seizure-free for those with drug-resistant epilepsy.
Non pharmacological therapies in epilepsyQamar Zaman
This document discusses various non-pharmacological therapies for epilepsy, including surgical procedures, neurostimulation techniques, dietary therapies, and alternative medicine. It provides details on different types of surgery for epilepsy like resective surgery, corpus callosotomy, and multiple subpial transection. It also discusses neurostimulation methods like vagus nerve stimulation (VNS), trigeminal nerve stimulation (TNS), deep brain stimulation (DBS), and repetitive transcranial magnetic stimulation (rTMS). The document outlines selection criteria for surgery, risks/benefits of different procedures, and success rates.
Hemorrhoids: which is the best therapeutic option?KETAN VAGHOLKAR
Hemorrhoids are one of the commonest of rectal diseases seen all across the globe. Constipation and bleeding are the main symptoms associated with this condition. The condition maybe associated with an underlying carcinoma as well. Understanding the pathophysiology will enable the surgeon to determine the best therapeutic option for this condition. A brief review of clinical evaluation and treatment options is presented in this paper.
1. There are three main types of vascular access for hemodialysis in children: tunneled catheters, arteriovenous fistulas, and arteriovenous grafts.
2. It is important to educate children with declining kidney function about their vascular access options and the importance of vein preservation for potential future access.
3. The choice of vascular access depends on multiple patient-specific factors and a dedicated vascular access clinic can help increase use of arteriovenous fistulas and decrease use of catheters.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.