This document provides an overview of peripheral vascular diseases (PVD), including definitions, pathophysiology, causes, clinical examination, investigations, management, and specific conditions like atherosclerosis, thromboangitis obliterans (Buerger's disease), Raynaud's disease, acute arterial disease, and gangrene. It describes the clinical features, risk factors, and pathology of different types of PVD and provides guidance on evaluating patients through history, physical examination, tests, and setting treatment plans which may involve lifestyle changes, medications, procedures like angioplasty, or surgeries such as bypass or amputation.
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.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
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.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Teaching Clinical Pathology of Disorders of RBC covered using a clinical case of Anemia. Pathology lecture and tutorials are delivered through short video clips covering parts of topic. this is the first part with overview of whole topic and clinical case. Each powerpoint is screen recorded using camtasia studio and saved as MP4 video.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. What is PVD?
Definition:
• Also known as PAD or
PAOD.
• Occlusive disease of the
arteries of the extremity.
charac. by a reduction in
blood flow and hence 02
through the peripheral
vessels
when the need of the
tissues for 02 exceeds the
supply, areas of ischemia
and necrosis will develop
3. Pathophysiology:
• Arterial narrowing Decreased blood
flow = Pain
• Pain results from an imbalance between
supply and demand of blood flow that
fails to satisfy ongoing metabolic
requirements.
4. Factors that can contribute to the development
of peripheral vascular disorders :
atherosclerotic changes
thrombus formation
embolization
coagulability of blood
hypertension
inflammatory process/infection
5. CAUSES OF ISCHEAMIA
LARGE ARTERY OCCLUSION
-Atherosclerosis
-Embolism.
SMALL ARTERY OCCLUSION
-Buerger`s disease
-Raynaud`s disease
-embolism
-scleroderma
-physical agents –Trauma,radiation,electric
burns,pressure necrosis
6. ATHEROSCLEROSIS
AGE- above 50yrs
Vessels involved– medium sized & large vessels
aorta,femoral,carotids.
Nature of vessel- Thickned
Pathology – Deposition of atheromatous plaque in
the intima.
Risk factors – smoking, diabetes,hypertensive,
obesity,hypercholesterolaemia.
7. TAO (BUERGER`S DISEASE)
Age -20-40 yrs
Sex – Exclusively males
Vessel involved –Small & medium sized arteries.
Nature of vessel –Not thickned.
Pathology – Diffusion inflammatory reaction
involving all coats of vessels results
obliterans.
Risk factors – Smoking, hypercoagulable,
autonomic hyperactivity,
low socioeconomic.
8. RAYNAUD`S DISEASE
(PRIMARY RAYNAUD`S PHENOMENON)
-Occur in young females.
-Upper limbs more involved than lower limbs.
- Its episodic digital ischeamia on exposure to
cold
- Peripheral pulses are normal.
- Recurrent attacks.
11. CLINICAL EXAMINATION
HISTORY
1. AGE & SEX
Atherosclerosis – Older AGE M~ F
BURGER`S Disease - Mostly men
age 20-40yrs
RAYNAUD`S DISEASE – Young women
Diabetic arteriopathy - middle age
16. 5.EFFECTS OF HEAT & COLD
Raynaud`s phenomenon
Raynaud`s disease
-local syncope
- local asphyxia
- local recovery ----- local gangrene
17. 6. PARAESTHESIA
- Numbness.
- pins and needles sensation.
7.HISTORY OF SUPERFICAIL PHLEBITIS:
8.INVOLVMENT OF OTHER ARTERIES
-Transient attack, fainting .(stroke)
- chest pain (coronary arteries)
- abdominal pain (mesentric arteries)
- blurred vision (retinal areteries)
18. HISTORY IMPOTENCE
B/L internal iliac artey occlusion.
PAST HISTORY
cardiac attacks, embolic, frost bite.
PERSONAL HISTORY: Smoking.
FAMILY HISTORY:
20. 2.SIGNS OF ISCHEMIA
1.Thinning of skin
2.Diminished growth of hair,
3.Loss of subcutaneous fat,
4.Trophic changes in nails
5.Muscle wasting
6.Minor ulceration over pressure area
21. 3.BUERGER`S POSTURAL TEST:
Bauerger angle (vascular angle)
-normal indiviual legs will be pink raised
above 90degree
-severe ischemia buerger angle less than 30
degree
4.CAPILLARY FILLING TIME
-severe ischaemic it take 20-30 sec.
5.VENOUS FILLING TIME
-Noramal 5 sec.
-In ischaemic limb veins collapsed.
22. IN GANGRENE
- Extent & color of gangrene.
-TYPE
dry (mummified) .
wet (putrefying).
-LINE OF DEMARCATION.
- SKIP LESIONS
23. PALPATION
1. Skin temperature.
2.capillary filling time.
3.venous filling time.
4.crossed leg test (fuchsig test):
oscillatory movements obsent popliteal block.
5.Cold and warm water test.
24. TEST FOR UPPER LIMBS:
-Elevated arm test.
-Allen`s test.
-Costoclavicular compressive manoeurve.
-Hyperabduction manoeurve
-GANGREANGENOUS AREA.
-CREPITUS.
-LIMB ABOVE GANGRENOUS AREA.
26. Examination of arterial wall
-PIulse
-condition of wall
- thrombosis of vessel.
CERVICAL RIB
-Adson`s test.
NEUROLOGICAL EXAMINATION:
AUSCULTATION
systolic bruit. In occlusion
-Blood pressure of both arms.
-Ankle brachial pressure index.
-Heart for murmur etc.
31. PCI / SURGERY
Indications/Considerations:
• Poor response to exercise rehabilitation + pharmacologic
therapy.
• Significantly disabled by claudication, poor QOL
• The patient is able to benefit from an improvement in
claudication
• The individual’s anticipated natural hx and prognosis
• Morphology of the lesion (low risk + high probabilty of
operation success)
• PCI:
• Angioplasty and Stenting
• Should be offered first to patients with significant
comorbidities who are not expected to live more than 1-2
years
32. • Bypass Surgery:
• Reverse the saphenous vein for femoro-
popliteal bypass
• Synthetic prosthesis for aorto-iliac or ilio-
femoral bypass
• Others = iliac endarterectomy & thrombolysis
• Current Cochrane review = not enough
evidence for Bypass>PCI
• Amputation: Last Resort
33. ACUTE ARTERIAL DISEASE
sudden occlusion of major peripheral artery.
due to:
-Arterial embolus
-Trauma
-Acute arterial thrombosis
34. FEATURES OF ACUTE LIMB
ISCHEAMIA
1.PAIN
2.PALLOR
3.PULSELESNESS
4.PERISHING COLD
(POIKILOTHERMIA)
5.PARASTHESIAS
6.PARALYSIS
36. GANGRENE
• Gangrene implies death of macroscopic
portions of tissue; the term necrosis
may be used synonymously.
• It often affects the distal part of a limb
because of arterial obstruction (from
thrombosis, embolus or arteritis).
37. TYPES
- Dry gangrene
- Wet gangrene.
Signs of gangrene.
1.change of colour
pale,bluish purple and finally black.
2. loss of temperture.
3.loss of sensation.
4.loss of pulsation.
5.loss of function.