bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Acute type A dissection, is on of the highest mortality cases in cardiovascular surgery. It doubled it incident with concomitant complication such as malperfusion or pericardial tamponade. In this presentation, the patient have both coronary malperfusion and pericardial tamponade
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Acute type A dissection, is on of the highest mortality cases in cardiovascular surgery. It doubled it incident with concomitant complication such as malperfusion or pericardial tamponade. In this presentation, the patient have both coronary malperfusion and pericardial tamponade
Complication on avf play significant number of hospitalization & morbidity. Despite fistula first campaign are still beneficial for most patient, gathering knowlege to prevent complication are important.
Complication on avf play significant number of hospitalization & morbidity. Despite fistula first campaign are still beneficial for most patient, gathering knowlege to prevent complication are important.
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
RECENT ADVANCES IN THE MANAGEMENT OF REFRACTORY HEART FAILUREApollo Hospitals
Heart failure is a pathophysiological state in which structural or functional cardiac disorder impairs the ability of the heart to function as a pump to support the physiological circulation. The medical therapy remains the
mainstay of treatment in these patients. The medical therapy can improve the quality of life and the longevity in
these patients, but this becomes insufficient in refractory heart failure. The heart failure is considered refractory when patients continued to be symptomatic despite optimal dose of medications, characterized by advanced structural heart disease. These patients will need frequent hospitalizations and the overall prognosis is very poor.
simple word for future doctor. writing & drawing in pure white paper is always fun & feels like nothing to loose even if we knew that it will last almost forever
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Hybrid Aortic Procedures
1. Hybrid OR
for extra cardiac Procedures
Surgeon’s Perspective
Dicky Aligheri ,MD
Thoracic, Cardiac & Vascular Surgeon
National Cardiac & Vascular Centre Harapan Kita
Jakarta 2013
23. Ann Cardiothorac Surg 2013;2(5):629-630
Ann Cardiothorac Surg 2013;2(5):633-639
Hybrid arch techniques provide a safe alternative to open
repair with acceptable short- and mid-term results.
However, stroke and mortality rates remain noteworthy.
Future prospective trials that compare open conventional
techniques with the hybrid method or the entirely
endovascular method are needed.
24. In summary, this study analyzed the mid-term results of endovascular repair of aortic arch aneurysm and dissection.
The results are encouraging for endovascular aortic arch repair in combination with supra-aortic transposition in high
risk cases. Combined treatment for high risk cases offers as good results as
seen for conventional surgery for low risk patients.
25.
26.
27. CONCLUSION
• Complicated anatomy is dominating most of aortic cases nowadays
• Hybrid arch techniques provide a safe alternative to open repair with
acceptable short- and mid-term result
• Total arch debranching allow better landing zone and result, at the cost of
perioperatif mortality
• Open surgery still gold standart for TAAA, hybrid approach offer a new
and promising short term result
• Overall, hybrid procedures gives a significant lower morbidity and
mortality compare to open repair at appropriate cases.
28. THANK YOU VERYMUCH
Coming together is a beginning.
Keeping together is progress.
Working together is success.
Henry Ford
31. • The path to greatness is along with others.
• Baltasar Gracián y Morales
• every man is a piece of the continent.
• John Donne
• “Teamwork makes the dream work”
• ― Bang Gae
• “One hand washes the other.
• (Manus Manum Lavat)”
• ― Lucius Annaeus Seneca
Editor's Notes
Aorta.. Morbid ,mortal pts n fam n insurance n low curiosity on diag n complication. Perifer. Jelas keluhan.. Mortal ??
severance
ENDOV… FUTURE….LONGTERM PROBLEM… PATENCY(WORST), MORBIDITAS & MORTALITAS (IDEM OPEN),REINTERVENSION(SHORT & LONG TERM), N IF ADA COMPLICATION…PERLU OPEN….+ AKSES PROBLEM
OPEN…. NOT REALLY PAST… SHORT TERM PROBLEM … MORBIDITY & MORTALITY, SURGEON RESOURCE….cost..!!!?? really
Complicati tingg.. Sebagian disengaja. Sebagian predictable. Cause.. Hostile / compleks natomy.. Therefor needs a hybrida.
Straight forward.. Semakin lama semakin berkurang. Jd perlu hybrida.
Jadi.. Mostly complicated
DIRECT AORTIC REPLACEMENT… COPLICATED N PSEUDO ANEURYSM POST TOTAL ARCH WITHOUT EL TRUNK INSERTION
Almost 89% of the patients were referred for elective
treatment, while 11.2% of them experienced symptomatic or ruptured TAAA before admission. A single-stage approach was followed in 47.5% of the patients whereas 52.5% underwent a staged procedure with a mean intraprocedural interval of 29.6 days (95% CI: 4.2-54.9 days). Mean ICU stay was 6.2 days (95% CI: 4.7-7.6 days), mean hospital stay was 20.8 days (95% CI: 15.8-25.8 days), and mean follow-up period was 34.2 months (95% CI: 16.6-
51.8 months).
18.2% attributable to aortic dissection; 5.9% attributable to visceral aortic patch aneurysm after open repair; 3.6% attributable to secondary aneurysms associated with connective tissue disorders (Marfan syndrome or Ehlers-Danlos syndrome); 0.9% attributable to mycotic aneurysms; and 7.0% attributable to other aortic pathologies
Different configurations of renal and visceral arteries rerouting during hybrid TAAA repair. A. customized Y-graft for revascularization of superior mesenteric artery and celiac trunk arising from the left side of distal abdominal aorta and single bypass for revascularization of right renal artery arising from the right side of distal abdominal aorta. The left renal artery was not grafted because of non-functional left kidney; B. single customized Y-graft for rerouting of superior mesenteric artery and celiac trunk. The pre-sewn branches arise from the distal part of the infrarenal aortic graft; C. double customized Y-graft arising from infrarenal aortic graft. The right-sided graft is routed to the celiac trunk (medial branch) and to the right renal artery (lateral branch); the left sided graft is routed to the superior mesenteric artery (medial branch) and to the left renal artery (lateral branch). Radiological markers were placed at the origin of the Y-grafts to identify the distal landing zone during TEVAR
Pre- and post-operative 3-dimensional CT angiography of the case presented in Figure 2. A. type III TAAA in a patient with previous descending thoracic aortic aneurysm surgical repair; B. surgical stage consisted of infrarenal aorta graft replacement and four- TAAA hybrid repair: surgical grafts represented safe proximal and distal landing zones for the endograft and no endoleaks were observed; all visceral bypasses were patent
Follow-up computed tomographic angiography (CTA) of a patient undergoing hybrid extent II TAAA repair demonstrating widely patent 4-vessel visceral debranching graft and thoracic endografts extending from just distal to the bovine trunk/left common carotid artery down to the aortic bifurcation. The left subclavian artery has been covered and a patent left common carotid to left subclavian artery bypass is seen (arrow); B. Detailed view of abdominal portion of CTA from the same patient demonstrating origin of 4-vessel visceral debranching graft from left common iliac artery with patent graft limbs to the left renal artery (L renal a.), celiac axis, superior mesenteric artery (SMA), and right renal artery (R renal a.). The stump of the antegrade conduit limb used for endograft introduction at the second stage endovascular portion of the repair is likewise indicated. The small arrow denotes one of the multiple radiographic markers on the
Aortic arch anatomy and the landing zones dictate the type of arch hybrid repair. In a type I arch hybrid, the great vessels are debranched to enable Z0 stent grafting, followed by concomitant antegrade or delayed retrograde TEVAR. For arch aneurysm without a good proximal Z0, but an adequate Z3/Z4 distal landing zone, type II arch hybrid repair is performed involving not only great vessel debranching, but creation of a proximal Z0 by reconstructing the ascending aorta. More complex aortopathies such as mega-aorta syndrome require type III arch hybrid repair
Hybrid approaches are classified into three types
according to the extent of aortic arch lesion and the presence of the proximal and distal landing zone:
(I) Type I: the debranching procedure consists of brachiocephalic bypass and endovascular repair of the aortic arch. This approach is reserved for patients with isolated aortic arch aneurysms that exhibit an adequate proximal landing zone in the ascending aorta and a distal landing zone in the descending thoracic aorta.
(II) Type II: this hybrid approach is designed for patients with ascending aortic lesions with a limited extension into the distal arch. A type II repair entails an open ascending aorta reconstruction that “creates” an appropriate proximal landing zone, great vessel revascularization, and endoluminal aneurysm exclusion.
(III) Type III: an elephant trunk procedure with a complete endovascular repair of the thoracoabdominal aorta. This technique is reserved for patients with extensive aortic lesions that involve the ascending, transverse arch, and descending thoracic aorta, or the “mega-aorta syndrome”.
The majority of the patients (62.0%) underwent arch debranching attributable to degenerative aneurysms, with 28.6% attributable to aortic dissection, 2.2% attributable to a pseudoaneurysm or traumatic transection, and 7.2% attributable to other aortic pathologies such as penetrating ulcers, intramural hematomas, aortobronchial fistula, intracranial aneurysm, endoleak correction after thoracic aortic aneurysm, and floating thrombus in the aortic arch. Zone 0 was involved in 342/820 (41.7%) patients, Zone 1 in 237/820 (28.9%) patients, and Zone 2 in 241/820 (29.4%). Almost 74% of the patients were referred for elective treatment, with the remainder operated on in an emergent/ urgent setting. A single-stage approach was implemented in 52.9% of patients, while 47.1% underwent a staged procedure with a mean intra-procedural interval of 18.5 days (95% CI: 7.6-29.4 days). Cardiac arrest was utilized in 9.2% (67/731) of the patients. Mean ICU stay was 2 days (95% CI: 1.1- 3.0 days), and mean length of hospital stay was 12.1 days (95% CI: 8.2-15.9 days). Mean follow-up period was 22.1 months (95% CI: 18.2-26.1 months).
With respect to the primary technical success, which was defined as complete aortic arch debranching and successful stent-graft deployment, the pooled estimate was 92.8% (95% CI: 89.1-95.3%) (Figure 3). Of the 894 patients for whom both stages of the procedure were completed, 149 (16.6%) experienced an endoleak. In particular, 165 endoleaks were detected in follow-up CT scans: 106 type I, 51 type II, and 8 type III. Among 17 studies which provided relative data, retrograde type A dissection was observed with a pooled rate of 4.5% (95% CI: 2.9-6.8%) (Figure S1).
