ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
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
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.
Deep Vein Thrombosis is an important and frequently missed out diagnosis that can often lead to sudden death in post operative patients. Did this powerpoint for an O&G seminar. Mainly focusses on DVT in OBG and its management and prevention. Kindly leave a comment and let me know what you think.
Acute limb ischaemia
Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG)
Consultant Vascular and Transplant Surgeon
The National Hospital of Sri Lanka , Colombo
Definition
Causes
Differentiating thrombosis and embolism
Cardiology 1.3. Syncope - by Dr. Farjad IkramFarjad Ikram
Introduction to one of the more challenging symptoms to investigate. Syncope is transient loss of consciousness with loss of postural tone due to diffuse hypoperfusion of cerebral cortex, followed by rapid, complete and spontaneous recovery.
Template design credits - http://www.slidescarnival.com
Principles of management of Neck vascular trauma
Pre Congress Workshop on
Vascular Trauma
September 2023
Joel Arudchelvam
Causes
Impalement
Signs of neck vascular injuries
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Changing concepts
Ligation Vs Repair
Neurological status and carotid repair
Diabetic foot and Foot care
Dr Joel Arudchelvam
Definition
Prevalence
Teaching Hospital Anuradhapura [THA]
High risk foot
Neuropathy
Pathogenesis of neuropathy
Charcot foot
Testing for neuropathy
Local Ulcer care
Managing Venous Ulcers Pre-congress Workshop
Wound Care in the Elderly
Scientific Conference of the Sri Lankan Association of Geriatric Medicine
Dr Joel Arudchelvam
Chronic Venous Diseases
CEAP Classification
Chronic Venous Ulcer
Pathophysiology
Investigations
Venous Duplex Scan
Treatment
LASER - Light Amplification by Stimulated Emission of Radiation
Sclerotherapy
Multi layer compression dressing (strapping)
Compliance
Cost and problems
Methods of leg elevation
Annual Academic Conference
SLSVS 23
Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon
Aortic aneurysms
Abnormal focal dilatation of a vessel of more than 50 % of its normal diameter
Abdominal aorta more than 3 cms (normal diameter - 2 cms)
Open AAA repair
Endo Vascular Aneurysm Repair (EVAR)
Arch de-branching
Sri Lankan Experience
15 Vascular and transplant units
Emergency AAA repair
Open TAA repair
Future directions
ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications
Carotid artery injuries, Joel Arudchelvam, SLSC 2022, Carotid artery injuries
Causes
Hard signs of vascular injury
Associated signs
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Management – changing concepts
Vascular surgical intervention
Open surgery
Certificate in Teaching in Higher Education (CTHE) 2022
Post ward round discussion in medical student teaching results in better understanding
Joel Arudchelvam
Advantages of ward round teaching
Problems related to the wards
The responses from the students
Future plans
Joel Arudchelvam
Definition
Donor types
HISTORY OF TRASNPLANTATION in Sri Lanka
Transplantation procedure
Organ preservation
BASIC COMPONENTS OF PRESERVATION SOLUTIONS
135TH ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS 2022
30th September 2022
At BMICH, Colombo.
Symposium on
Solid Organ transplantation
Kidney transplantation - Challenges and
Experiences
Kidney transplantation
Causes for chronic kidney dise
Chronic Kidney Disease of unkn
Paediatric kidney transplant
Teaching Hospital Anuradhapura
The university transplant unit
Live donor nephrectomy
Organ preservation
Iliac vessel mobilisation
Renal vessels ananstomosis
Ureter anastomois
Surgical aspects
user experience
Relationship of live donors (T
Area of residence of donors
Live Donor profile
Donor vascular variations
Vascular reconstruction
Jaffna Medical association
Annual Scientific Sessions September, 2022
Professor C.Sivagnanasundaram memorial oration
Introduction
Vascular injuries are potentially life or limb threatening. Vascular trauma occurs in 1.6% of civilian injuries (1) and 6.8% to 10.8% in war related injuries (Afghanistan, Iraq and Lebanon war). In a study done at the National hospital of Sri Lanka Colombo (NHSL) out of 5802 trauma admissions there were 93 patients with vascular injuries (VI). Therefore the incidence of VI in civilian trauma is 1.6% (1). After the end of civil war in Sri Lanka in 2009 there is a reduction in the number of war related vascular injuries. But due to the increase in the number of Road Traffic Accidents (RTA), the number of vascular trauma also increased (i.e. from 1938 to 2013 road traffic injuries increased from 35.1 to 98.6 per 100 000 population in Sri Lanka). One of the reasons for this is the increased number two and three wheeled vehicles which are involved more with accidents (2). Trauma and vascular injuries often involve young males. They are the breadwinners of the family. In one study done at the Teaching Hospital Anuradhapura (THA) among patients presenting with popliteal arterial injuries, 18 (90%) were males with a mean age of 38.7 years (2). And in another study done at the same institution among patients with major lower limb arterial injuries, 22 (87.5%) were males and the mean age was 36.9 years (3). These studies confirm the fact of young males often getting involved with vascular injuries.
Vascular injuries occur
• Unexpected
• Young and fit
• Results in loss of limb or life
• Loss of earning capacity, economic
Our experience at Anuradhapura
Mean age - 36.9 years (17–69)
Arterial injury following trap gun - 25% amputation rate (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8
Causes - Road Traffic Accidents – 54.2%,Trap Gun – 33.3%,Iatrogenic - 8.33%,Other- 4.2% (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8)
Mechanism of injury
• Sharp / penetrating
• Blunt
“Vascular injury” is a nonspecific term. Because this is used to describe the injuries
to blood vessels in all parts of the body that includes neck vascular injuries, thoracic and
abdominal vascular injuries, and injuries to the blood vessels of the limbs. And in addition
vascular injury also describes injuries to the arteries and veins. Injuries to the blood vessels of
the limbs are called extremity vascular injury. This chapter will concentrate on the extremity
vascular injuries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Hot Selling Organic intermediates
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
4. Differentiating thrombosis and
embolism
Sudden onset pain Sub acute onset
Young patient Elderly patient
Has a source of emboli* No source of emboli
No history of occlusive
arterial disease
History of occlusive arterial
disease
Other pulses are present Other pulses may be absent
5. Sources of emboli
Heart – recent MI, Atrial fibrillation,Valvular
heart disease.
Blood vessels – aneurysms
An embolus gets stuck at sites of bifurcation
as the diameter of the vessels reduces at
these places.
6. Acute limb Ischaemia
Presentation
“ P ”s
Pain
pallor
Perishing cold
Pulselessness
Paresis / paralysis
Paraesthesia / anaesthesia.
Beware
After trauma
After anaesthesia
Acute limb ischemia is a clinical diagnosis -there is no need of
imaging.
7. Acute limb Ischaemia
Management
Recognize
Start unfractionated heparin
Loading dose 75 – 100 IU/Kg ( approximately 5000 IU )
Followed Infusion of heparin -18U/kg (approximately -
1000U/hr)
Refer to vascular surgeon
Pain relief
Keep fasting
Inform theatre and anaesthetist
Consent – for embolectomy and fasciotomy
Check theViability of the limb - note.
8. Acute limb Ischaemia
Surgery
Embolectomy with fogarty
catheter
Can be done under LA
9. Post operative management
Monitor distal pulse
Keep foot elevated
Monitor movements and sensation
Continue Heparin – 18U/kg per hour infusion
Start warfarin when surgical bleeding is not a
concern
Monitor for reperfusion effects
10. Complications of Acute limb
Ischaemia
Limb loss
Death
Compartment syndrome
Reperfusion effects
Volkmann ischemic contracture
11. Reperfusion effects
Local
Reperfusion injury – paradoxical death of already
dying muscles after reperfusion
Systemic
Reperfusion syndrome
Hypotension
ARDS
Lactic acidosis
Hyperkalemia
Renal failure
25. Compartment syndrome
Clinical features
Excessive pain - pain on passive movements
Numbness -e.g. anterior compt. first toe web (deep peroneal N )
Tense swollen leg
Do not look for absent distal pulse – late