Abdominal aortic aneurysm (AAA) is an enlargement of the aorta in the abdominal region. The most common cause is atherosclerosis. It can be asymptomatic and found incidentally or symptomatic with back pain, abdominal pain, or a pulsatile abdominal mass. Complications include rupture, infection, thrombosis, embolism, and erosion of nearby structures. Treatment involves surgical repair if the aneurysm reaches a certain size.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Chronic progressive sclerosing inflammatory dermatosis of unknown origin that results in white plaques with epidermal atrophy and scarring…… Lichen sclerosus. Penile Lichen sclerosus (LS) is the preferred term for Balanitis Xerotica Obliterans.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
Chronic progressive sclerosing inflammatory dermatosis of unknown origin that results in white plaques with epidermal atrophy and scarring…… Lichen sclerosus. Penile Lichen sclerosus (LS) is the preferred term for Balanitis Xerotica Obliterans.
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
STRICTURE URETHRA
CLASSIICATION -I
I: Aetiologically.
2. Congenital.
3. Inflammatory:
Post-gonococcal
is most common
Gonococcal stricture occurs one year after infection.
Retention develops only 10–15 years later.
RUPTURE OF URETHRA (Anterior Urethra)
Usually, due to a fall astride a projecting object, like in sailing ships, cycling, over loose manhole cover, gymnasium.
RENAL CALCULUS AETIOLOGY
Males- radio-opaque gall stones
Females - Radiolucent gall stones
Diet:Vitamin A deficiency
it causes desquamation of epithelium
which acts as a nidus for stone formation.
Climate:
In hot climate urinary solutes will increase with decrease in colloids,
PARAPHIMOSIS
DEFINITION
Inability to place back (cover) the retracted prepucial skin over the glans is called as paraphimosis.
It causes ring like constriction proximal to the corona and prepuceal skin.
HYPOSPADIAS
DEFINITION
It is the most common congenital malformation of urethra wherein external meatus is situated proximal than normal, over the ventral (under) aspect of the penis.
HYDRONEPHROSIS (HN)
DEFINITION
It is an aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction to the outflow of urine.
AETIOLOGY
unilateral
bilateral.
EPISPADIAS
Here the urethra opens on the dorsum of the penis, proximal to the glans.
COMMON SITES
abdominopenile junction.
It is associated with a dorsal chordee, ectopia vesicae, urinary incontinence, separated pubic bones.
It is uncommon in females.
BENIGN PROSTATE HYPERPLASIA (BPH)
AETIOLOGY
It is benign enlargement of prostate which occurs after 50 years, usually between 60 and 70 years.
BPH affects both glandular epithelium and connective tissue stroma.
It is involuntary hyperplasia due to disturbance of the ratio and quantity of circulating androgens and estrogens.
VARICOCELE
It is dilatation and tortuosity of the pampiniform plexus of veins and so also the testicular veins.
Normally, there will be numerous plexus of veins (pampiniform) in the scrotum,
↓
which all join together to form about 4–8 veins in the inguinal canal.
TESTICULAR TUMOURS
PREVALANCE
99% of testicular tumours are malignant.
Life time prevalence of getting testicular tumour is 0.2%.
Very common in Scandinavia; least common inAfrica andAsia.
4 times common in whites than blacks.
ORCHITIS
AETIOLOGY
It is an inflammation of the testis.
It is commonly associated with inflammation ofthe epididymis. Hence, called as epididymo-orchitis.
Orchitis is due to infection through blood, lymphatics or epididymis.
EPIDIDYMITIS,
CAUSES
Inflammation of epididymis is commonly associated with orchitis— epididymo-orchitis.
Nonspecific
viral like mumps.
Bacterial.
Filarial.
Tuberculosis
PERFORATED PEPTIC ULCER
PERFORATION
DEFINITION
It is the terminology used for perforation of duodenal ulcer or gastric ulcer or stomal ulcer.
Otherwise all clinical features and management are similar.
Perforation is common in duodenal ulcer
Mortality is more in gastric ulcer perforation and perforation in elderly
GASTRIC ULCER
AETIOLOGY
It occurs due to imbalance between protective and damaging factors of gastric mucosa.
Atrophic gastritis
duodenogastric bile reflux
gastric stasis
abnormalities in acid and pepsin secretion.
Acid becomes ulcerogenic even to normal gastric mucosa.
CURLING ULCER
DEFINITION
They are acute ulcers which develop after major burns, presenting as pain in epigastric region, vomiting or haematemesis.
Curling’s ulcer occurs when burn injury is more than 35%.
It is observed in the body and fundus not in antrum and duodenum
Congenital (infantile) hypertrophic pyloric stenosis by Dr.K.AmrithaAnilkumarDr. Amritha Anilkumar
CONGENITAL (INFANTILE) HYPERTROPHIC PYLORIC STENOSIS
DEFINITION
It is hypertrophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax.
Duodenum is normal.
CARCINOMA STOMACH
INCIDENCE
‘It is the captain of men of death’.
It is more common in Japan—70 per 1,00,000 population.
It is more common in males 2:1.
Decrease incidence in western world
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- 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
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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
4. ANEURYSM
DEFINITION
• It is an abnormal permanent
dilatation of localised
segment of arterial system.
• Atherosclerosis whichis the
most common (90%)
facilitating cause of
aneurysmis due to
destruction and loss of
stability of tunica media.
5. TYPES
True aneurysm
• contains all three layers of
artery.
False aneurysm
• contains singlelayer of
fibrous tissue as wall of the
sac and it usuallyoccurs
after trauma
6. Fusiform
• uniformdilatation of entire
circumference of arterial wall ™
Saccular
• dilatation of part of
circumference of the arterial
wall
Dissecting
• througha tear in the intima
blood dissects between
inner and outer part of
tunica media of the artery
7. CAUSES
• Acquired:
• Degenerative:
Atherosclerosis
• mucoid degenerationof
intima and media
• Traumatic:
• Direct
• indirect
• likein poststenotic
dilatation by cervical
rib
• traumaticAV
aneurysmal sac
• aneurysmdue to
irradiation (due to
drynessand
destruction of vasa
vasorumcausing
weakening).
9. • Congenital:
• Berry aneurysm
• cirsoidaneurysm
• congenital AV fistula.
COMMONSITE
• Aorta.
• Femoral.
• Popliteal.
• Subclavian.
• Cerebral, mesenteric,
renal, splenic arteries.
• The most commonis true,
fusiform, atherosclerotic,
aortic aneurysms.
• Berry aneurysms are
multipleaneurysms
occurring in circle of
Willis.
Cirsoid aneurysm
10. CLINICALFEATURES
• Swelling at the site which is
pulsatile (expansile),
smooth, soft, warm,
compressible, withthrill on
palpation and bruit on
auscultation
• Swelling reduces in size
whenpressed proximally.
• Distal oedema due to
venous compression.
• Alteredsensationdue to
compressionof nerves.
11. • Erosionintobones, joints,
tracheaor oesophagus.
• Aneurysmwith
thrombosis can throwan
embolus causing gangrene
of toes, digits, extending
often proximallyalso.
INVESTIGATION
• Doppler study
• Duplex scan
• Angiogram
• DSA.
• Tests relevant for the cause,
likeblood sugar, lipid
profile, echocardiography.
Angiogram
12. TREATMENT
• Reconstruction of artery
using arterial grafts.
• Arterial
endoaneurysmorrhaphy
• Therapeuticembolisation.
• Clipping the vessel under
guidance
13. MYCOTICANEURYSM
CAUSES
• It is a misnomer.
• It is not due to fungus but
due to bacterialinfection
• Commonbacteria are
grampositive organisms
like Staphylococcus aureus
(most common) and
Streptococcus.
• Common aetiologyis
bacterial endocarditis but
could be any infective site
14. COMMONSITE
• Common vessels involved
are aorta, visceral, head
and neckand
intracranial.
• Commonlyit is saccular,
multilobed, with a narrow
neck.
CLINICALFEATURES
• Fever
• Toxaemia
• tender pulsatile mass if it
is in the periphery.
Mycotic aneurysm
15. INVESTIGATION
• Investigations: Leucocytosis.
• Positive blood culture
• MRI or CT angiogramare
relevant.
TREATMENT
• Broad-spectrumantibiotics
• Resectionof aneurysm;
debridement and drainage
of theinfectedaneurysm
with adequateblood
transfusions.
• Extra anatomicbypass
through uninfectedtissue
planes to avoid
contamination of the graft.
• Long termantibiotic
therapyis necessary
16. DISSECTINGANEURYSM
DEFINITION
• It is a misnomer.
• It is not an aneurysm,
only an aortic
dissection.
• It is the dissection of
media of the aorta after
splitting through
intima creating a
channel in the media of
thevessel wall.
DISSECTING
ANEURYSM
17. CAUSES
• Hypertension (It is
associatedin 80% of
dissecting aneurysms).
• Cysticmedial necrosis.
• Marfan’s syndrome and
collagen diseases.
• Trauma.
• Weakening of the elastic
layersof the media due to
shear forces.
18. SITES
• thoracicaorta- ascending
aorta
• other parts of aorta or other
vessels.
• aortic arch or thoracic
descending aorta.
PATHOLOGY
• This dissected aortic
channel gets linedby
endothelium, often reopens
distally into the aorta
causing double-barrelled
aorta which, in fact,
prevents complications
19. CLINICALFEATURES
• Painin the chest, back
whichis excruciating.
• Features of ischaemia due
to blockageof different
vessels
INVESTIGATION
• Chest X-ray shows
mediastinal widening
• Arterial Doppler
• Angiogram
Doppler – dissecting
aneurysm
20. COMPLICATION
• Acute: Rupture into the
pericardiumor pleura—
dangeroustype
• Chronic: Blockage of
coronary vessels and major
vessels like carotidand
subclavianarteries with
aortic insufficiency
TREATMENT
• Antihypertensives.
• Surgery: Using Dacron
graft reconstruction of
aorta has to be done with
cardiopulmonary bypass.
21. CIRSOIDANEURYSM
DEFINITION
• It is actuallya rare
arteriovenous fistula /
malformationof the scalp
usually of congenital origin
but occasionallycan be
traumatic.
• It is a rare variant of
capillary haemangioma
occurring in skin, beneath
whichabnormal artery
communicates with the
distendedveins.
CIRSOID
ANEURYSM
22. • 90%occur in relation to
superficial temporal artery
but few occur additionally
also in relationto occipital
arteries.
• It should be differentiated
fromthe true aneurysmof
the superficial temporal
artery.
• Cirsoidmeans varix.
23. COMMONSITE
• Commonly seenin
superficial temporal
arteryand its branches.
• Oftenthe underlying
bone gets thinned out
due to pressure.
• Occasionally extends
into the cranial cavity.
• Ulcerationis the
eventual problemwhich
will lead to
uncontrollable
haemorrhage.
24. CLINICALFEATURES
• Pulsatile swelling in
relationto superficial
temporal artery, whichis
warm, compressible,
witharteria lisationof
adjacentveins and with
bone thinning (due to
erosion).
• It feels likea ‘pulsating
bag of worms’
Bag of worms
26. TREATMENT
• Ligation of feeding artery
and excision of lesion, often
requires preliminary
ligation of external carotid
artery.
• Intracranial extension
requires formal neuro
surgical approach.
• Endovascular therapy is
also useful
27. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das
28. en love da Homoeopathy
ABDOMINAL
AORTIC
ANEURYSM
30. ABDOMINALAORTIC
ANEURYSM(AAA)
DEFINITION
An enlargement of the aorta, the
mainblood vessel that delivers
blood to the body , at the level of
abdomen
CAUSES
• Atherosclerosis (as
degenerative process)
• Familial aorticaneurysm -
more females
• Cysticmedial necrosis
• associationwith
Chlamydiapneumoniae
32. • ClassificationII
• Asymptomatic.
• Symptomatic.
• Symptomaticruptured
ASYMPTAMATICTYPE
• It is foundincidentally either
on clinical examinationor
on angiography or on
ultrasound.
• Repair is requiredif
diameter is over 5.5 cm on
ultrasound.
• It is identifiedduring routine
abdominal palpation or while
assessing or operating for
some other abdominal
conditions.
33. SYMPTAMATIC
• Backpain,
• Abdominal pain
• Mass abdomenwhichis
smooth, soft, nonmobile,
• not moving withrespiration,
• vertically placed abovethe
umbilical level,
• pulsatile both in supine as
well as kneeelbowposition
with
• same intensity
• Resonant on percussion.
34. • Common in males
• commonin smokers.
• GIT
• urinary, venous symptoms
can also occur
• Hypertension
• Diabetes
• Cardiac problems
• In infrarenal type upper
border is clearlyfelt.
• Lower limb ischaemia
• embolicepisodes can occur.
35. • Being a retroperitoneal
mass back painis common
- due to retroperitoneal
stretching, nerve irritation
or vertebral erosion.
• inflammatoryaneurysm
adherent to ureters
• Aortocaval fistula-
presenting as GI bleed,
malaena, shock.
• highoutput cardiacfailure
withcontinuous bruitin
abdomen
• severe lower limb ischaemia
• (steal phenomenon).
41. ARTERIAL OCCLUSION
DEFINITION
• It is a condition of acutelack
of tissue perfusion due to
sudden cessation of
circulation.
• Mainaxial artery of thelimb
is blockedpresenting within
minutes to hour after
occlusion.
COMMONSITES
• It is common in lower limb
• upper limb
• Also occur in mesenteric,
cerebral, coronaryarteries.
42. CAUSES
• Embolismis the most
commoncausein developing
country.
• Trauma.
• Thrombosis of an artery
• polycythaemia rubra vera
• thrombocytosis.
• It is commonly observedin
external iliac artery,
profunda femoris arteryand
popliteal artery.
43. PATHOPHYSIOLOGY
• Distal ischaemia
↓
begins immediatelyafteracute
obstruction.
↓
Most sensitive peripheral nerves
are first involved
↓
and thenmuscles, subcutaneous
tissue and skin are affected in
order.
↓
Irreversible ischaemiaoccurs in 6
hours.
↓
Golden period is 1–6 hours.
↓
Ischaemia may get aggravatedby
↓
propagationof thrombus below
and abovethe block
↓
occluding the orifices of
collaterals
↓
44. fragmentationof embolus,
associatedthrombosis, acute
compartment syndrome.
• Acute ischaemia causes
endothelial injuryof
↓
capillaries, arterioles and venules
with luminal obliteration.
↓
Raisedcapillarypermeability
causes fluid leakageinto
extravascular space
↓
forming massive tissue
oedema deepto deepfascia
↓
whichby raising the
intracompartmental
pressure
↓
further reduces the
perfusionleading intoacute
compartment syndrome.
45. CLINICALFEATURES
• Painwhich is continuous,
severe, steady, bursting.
• Pallor of the distal part
withextreme coldlimb.
• Pulselessness—sudden
loss of earlier palpable
pulse.
• Paraesthesia—sensory
disturbances liketingling,
numbness or complete loss
of sensation.
PATHOLOGY
46. • Paresis—damage to motor
nerve and muscle leading
into paralysis as a late grave
feature.
• Poikilothermia—changein
thetemperature (cold).
• Pain, paraesthesia, paresis
are due to ischaemia of
peripheral nerves which are
sensitive to hypoxia.
48. CLINICALFEATURES
• Historyof trauma
• Pain
• Swelling at the site
• Pallor
• Pulselessness
• Cold limb.
INVESTIGATION
• Duplex scan
• Angiogram
TREATMENT
• Wound is exploredand tear
in the artery is identified.
• Proper antibiotics and
heparin are required to
prevent thrombosis of the
vesseL
ASSOCIAEDFEATURES
• Immediate decompression
by longitudinal fasciotomy
• Haematoma
• Vessel tear has to be
managed accordingly
49. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das
52. ARTERIOVENOUS FISTULA
(AVF)
DEFINITION
• It is an abnormal
communication betweenan
arteryand vein.
TYPES
• 1. Congenital—is
arteriovenous malformation.
2. Acquired (Trauma is
commoncause).
53. SITE
• Limbs, either part or
whole of the limb is
involved.
• It may be localisedto toes
or fingers.
• Lungs.
• Brain—incircle of Willis.
• Other organs likebowel,
liver.
54. CLINICALFEATURES
• Structural changes in the
limb:
↓
Limbis lengtheneddue to
increasein blood flow
↓
since developmental period.
↓
Limb girthis also increased.
↓
Limb is warm.
↓
Continuous thrill & continuous
machinerymurmur all over the
lesion.
↓
Dilatedarterialised varicose
veins
↓
due to increasedblood flow &
valvular incompetence.
↓
bone erosionor extensionof
AVF into the bone as such.
55. • Physiological changes
↓
Because of the hyperdynamic
circulation
↓
there is increasedcardiacoutput
↓
congestive cardiac failure
COMPLICATION
• Haemorrhage
• Thrombosis
• Cardiac failure (CCF)
57. ACQUIREDARTERIOVENOUS
FISTULA
CAUSES
• Trauma in (most common
cause): Femoral region.
Popliteal region. Brachial
region. Wrist. Aorta—
vena caval. Abdomen.
• After surgical intervention
of major vessels.
• Therapeutic: For renal
dialysis, AVF is created
(Cimino fistula) to achieve
arterialisation of veins and
also to have hyperdynamic
circulation.
• It is done to have easy and
adequatevenous accessfor
long time haemodialysis.
• Common sites
• Wrist
• Brachial
• Femoral region
58. PATHOPHYSIOLGY
Physiological changes:
• Cardiac failure due to
hyperdynamiccirculation.
Structural changes:
• Changes at theLevel of
Fistula
↓
Blood flows fromhighpressure
arteryto low pressurevein
↓
causing diversion of most of the
blood.
↓
Between the artery and vein, at
the site of fistula
59. ↓
dilatation develops with
formation of fibrous sac called
as Aneurysmal sac.
↓
This presents as warm, pulsatile,
smooth, soft, compressible
swelling at the site
↓
with continuous thrill and
continuous machinerymurmur
60. • Changes Belowthe Level of
the Fistula
↓
Because of diversionof arterial
blood distal part
↓
becomes ischaemic
↓
Because of highpressure
arterialisationof veins
↓
& valvular incompetence occurs
causing varicoseveins.
61. • Changes Proximal to the
Fistula
↓
Hyperdynamiccirculation
causes cardiac failure.
↓
Cardiac failure may be very
severe in traumaticAVF
↓
If pressure is appliedto the
arteryproximal to the fistula,
↓
swelling will reduce in size
↓
thrill and bruit will disappear,
pulserate and pulsepressure
becomes normal.
↓
This is calledas Nicoladoni’s
signor Branham’s sign.
62. INVESTIGATION
• Doppler
• Angiogram.
• ECG
• Echocardiography.
TREATMENT
• Excision of fistula and
reconstructionof artery
and vein with graft.
• Done in early stages—
larger vessels.
• Venous or Dacrongraft is
used.
63. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgery by Das
3. A Concise textbookof
Surgery by Das
66. ARTHROSCLEROSIS
Definition
• It is a chronic, complex
inflammatorycondition of
elasticand muscular
arteries, involving as
systemicand segmental. It
begins in childhood as fatty
streaks.
68. PATHOGENESIS
• It develops as a chronic
inflammatoryresponse of
the arterial wall to
endothelial injury
• Interactions of modified
lipoproteins
↓
monocycte –derived
macrophages ,T-lymphocyctes
& normal consituents of the
arterial wall
↓
Lesion progression
• It is expressedby the
Response to – injury
Hypothesis
70. 2.Accumulation of lipoproteins
MainlyLDL
Endothelial injuryis Oxidized
by free radicals
↓
it comes into contact with an
arterywall
↓
series of reactions occurs for
repair mechanism
↓
cholesterol can be transported
only by lipoproteins
71. 3. Monocyte adhesionto the
endothelium
Body’s immune system
responds to the damaged
arterial wall
↓
by sending specializedwhite
blood cells(macrophages & T-
lymphocytes) to absorb the
oxidizedLDL forming
specialised Foamcells
↓
they growmore & then
ruptures
↓
depositing cholestrol in the
arterial wall
↓
continuing the cycle
72. 4. Platelet adhesion
5.Factor release Fromactivated
plaelet, Macrophages , Vascular
wall cells
6.SMCproliferations &ECM
production
Cholesterol plague causes the
smoothmuscle cellsto enlarge
↓
forma hardcover over affected
area
↓
it causes the narrowing of the
artery
↓
reduces the blood flow
increases the blood pressure
75. FEATURES
• Smoking
• Hypertension
• Diabetes
• raised cholesterol
• Thrill and bruit over
femoral, renal, carotid
arteries may be felt/heard
• Signs of a pulsating
bulge(aneurysm)- in
abdomenor behindknee
• localised stenosis
• Absence/ feeble pulses
76. INVESTIGATION
• Blood sugar
• Doppler ultrasound
• Ankle-brachial index-
detectatherosclerosis in the
arteries in legs & feet
• Angiogram
• Electrocardiogram
• fasting lipid profile
• ECG
Ankle-brachial index
77. COMPLICATION™
• Narrowing of the arteries:
• Coronary
• Cerebral
• renal,
• Ischaemia
• ulcerations,
• gangrene can occur.
Aneurysmformation
• Carotidarterydiseases
• Peripheral arterydiseases
• Aneurysms
78. TREATMENT
• Avoid smoking
• control of hypertension
• Diabetes
• Hypercholesterolaemia
• Percutaneous
transluminal angioplasty
(PTA)
83. DEFINITION
• It is a segmental,
progressive, occlusive,
inflammatorydiseases of
small & mediumsized
vessels with superficial
thrombophlebitis oftenmay
present as Raynaud’s
Phenomenonwithmicro
abscess, along with
neutrophil & giant cell
infiltrationwithSkiplesion
84. • commonly seenin young
and middle aged males
• smokers and tobaccousers
AFFECTIONS
• starts in lower limb one
side and later on the other
side.
• Upper limb involvement
occurs only afterlower limb
is diseased. More common in lower limb
85. CAUSES
• It is common in Jewish
people
• Hormonal influence
• familial nature,
• hypersensitivity to
cigarette,
• alteredautonomic
functions
• Lower socioeconomic
group,
• poor hygiene are other
factors.
86. PATHOGENESIS
• PANARTERITIS.
• due to smoking
↓
produce-vasospasms and
Hyperplasia of Intima in Artery
↓ Foll.by-
Thrombosis and obliteration of
vessels (mostlyMediumsize
vessels involved.)
produce- PANARTERITIS.
• Nerve involvementcause
REST PAINISCHAEMIA
87. • Once blockageoccurs,
collaterals blood supply is
maintained called as
Compensatory Peripheral
Vascular Diseases
CRITICAL LIMP ISCHAEMIA
CLASSIFICATION
Type I: Upper limbTAO—
rare.
Type II: Involving leg/s and
feet—crural/infrapopliteal.
Type III: Femoropopliteal.
Type IV: Aortoiliofemoral.
Type V: Generalised.
PANARTERITIS
95. BEDSORE
DEFINITION
• Bedsore is a trophic ulcer
with bone as the base. It is
nonmobile, deep, punched
out ulcer.
COMMON
• Old age
• Bedridden
• Tetanus
• Patients with orthopaedic
and head injuries
• Diabetic
• Paraplegic
• Comatose
96. SITES
• Sites of bedsore are occiput
• Heel
• Sacrum
• Ischium
• Scapula
FACTORS
• Malnutrition
• Pressure
• Anaemia
• sensory loss
• moisture
TREATMENT
• Changeof positions is
alwaysencouraged.
• Use of waterbed, ripple
bed is advised.
• Moisture has to be
avoided.
• Soaking by urine, sweat,
pus, and faeces has to be
takencare off.
• Good nursing, regular
dressing, good nutrition
are necessary.
97. • Antibiotics, blood
transfusions are very
essential.
• Excision of dead tissue
followedby skin grafting or
local rotation flaps may have
to be done.
• Rehabilitation.
Water bed
98. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das
101. FROSTBITE
DEFINITION
• It is due to exposure to cold
windor highaltitude.
• It is common in old age
during cold spells.
CLINICALFEATURES
• Damage to vessel wall
occurs causing oedema
• Blistering
• Gangrene formation
• Part is painlessand waxy.
105. TREATMENT
• Gradual warming is
done.
• Part shouldbe wrapped
with cottonwool and
rested.
• Warming is gradually
done with44°C in 30
minutes withwarm
water.
• Limb elevation is done to
reduce oedema.
• Intraarterial vasodilators
may help.
106. • Warmdrinks, analgesics,
paravertebral injections to
sympathetic chain,
hyperbaricoxygen are
effective.
• If gangrene develops,
amputation is needed.
REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das