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.
A 50 year old female patient was admitted to the female medicine ward with complaints of constipation (today), breathlessness, coughing, b/l pedal oedema, anasarca since 7 days.
A 50 year old female patient was admitted to the female medicine ward with complaints of constipation (today), breathlessness, coughing, b/l pedal oedema, anasarca since 7 days.
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.
Sports injury epidemiology: Its Treatment and Prevention in the Northeast India BhaskarBorgohain4
Love for sports is innate to youths of the north east India. the north eastern region of India is a sports talent pool. Mary Kom from Manipur captured the imagination of the nation by her boxing skills, Somdev Devvarman from Tripura by his tennis, Shiva Thapa by boxing...so on and so forth. There is a felt need but there is no regional sports injury management centre in the north eastern region. Sports injury surveillance is required for understanding, monitoring and formulate prevention strategy.
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.
Sports injury epidemiology: Its Treatment and Prevention in the Northeast India BhaskarBorgohain4
Love for sports is innate to youths of the north east India. the north eastern region of India is a sports talent pool. Mary Kom from Manipur captured the imagination of the nation by her boxing skills, Somdev Devvarman from Tripura by his tennis, Shiva Thapa by boxing...so on and so forth. There is a felt need but there is no regional sports injury management centre in the north eastern region. Sports injury surveillance is required for understanding, monitoring and formulate prevention strategy.
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
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
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
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
Patient with a toe gangrene coming to Emergency Department
Joel Arudchelvam
Atherosclerotic OAD – Risk factors
Presentation
FONTAINE CLASSIFICATION
Rutherford classification
SVS Lower Extremity Threatened Limb (WIFI) classification
Complications of cannulation
Accidental intra arterial cannulation
Infection
Extravasation and compartment syndrome
Fracture and retention of part of the cannula /embolisation
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
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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
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
1. Dr Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG), FCSSL.
Senior Lecturer, Department of Surgery, University of Colombo,
Consultant Vascular and Transplant Surgeon,
The National Hospital of Sri Lanka, Colombo.
Jaffna Medical association
Annual Scientific Sessions, 2022
Prof. C. Sivagnanasundram Memorial Oration
2. Professor C.Sivagnanasundram
Legend with multiple talents.
Simple and humble gentleman
Born in Jaffna on 30th of
March, 1928
Married madam Shanthi
Father of four daughters
3. Professor C.Sivagnanasundram
1955 - MBBS , University of Ceylon
Served in various hospitals of the country in various
posts
General Hospital Kurunegala
Peripheral unit Hiripitiya
Lady Ridgeway Hospital for children Colombo
Nawalapitiya
Jaffna
4. Professor C.Sivagnanasundram
1965 – 1967 - lecturer ,department of Preventive and
Social Medicine, University of Ceylon, Peradeniya
1967 - 1971 DPH (London), PhD (Uni. London)
1978 - Professor of Community Medicine, University
of Jaffna
1994 – Retired
Passed away in 2005
5. Professor C.Sivagnanasundram
Contributed immensely to the development of
the Faculty of Medicine, University of Jaffna.
Eminent researcher
Published in both local and international
journals.
Published many books ( medicine and other
fields).
7. Vascular trauma /injury
• Injury to
Arteries
Veins
• Anatomical regions
Extremity – limbs
Abdomen and pelvis
Thorax
Head and neck
8. Vascular trauma /injury
• Injury to
Arteries
Veins
• Anatomical regions
Extremity – limbs
Abdomen and pelvis
Thorax
Head and neck
9. Vascular Injuries
Unexpected .
Young and fit
Results in loss of limb or life
Loss of earning capacity, economic
burden
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
10. Vascular Injuries
Anuradhapura 2019*
Male - 22 (87.5%)
Mean age - 36.9 years (17–69)
Following trap gun - 25% amputation rate
Anuradhapura (THA) 2019 - popliteal arterial injuries
**
Males - 90%
Mean age - 38.7 years.
* Factor affecting the outcome of Major lower Limb arterial injuries; a single unit experience in a peripheral setting.
Sriharan, P and Arudchelvam, J. Anuradhapura : s.n., 2019. Anuradhapura Clinical Society , 13th Annual scientific
sessions, September 2019. p. 77
** Outcome of popliteal arterial injuries presenting to the Teaching Hospital, Anuradhapura. Parathan, S and
Arudchelvam, J. 4, 2019, Sri Lanka Journal of Surgery, Vol. 37, pp. 14–17.
11. Vascular Injuries
At the National hospital of Sri Lanka Colombo
(NHSL)
5802 trauma admissions (for 3 months)
93 vascular injuries (VI)
Incidence of VI in civilian trauma is 1.6%*
6.8% - 10.8% in war related injuries **
* Extremity Vascular trauma workload of a single vascular unit in a tertiary care Centre; it is time to establish a dedicated
trauma vascular surgery unit. Kapilan, G and Arudchelvam, J. Colombo : s.n., 2020.
**Outcome of popliteal arterial injuries presenting to the Teaching Hospital, Anuradhapura. Parathan, S and Arudchelvam,
J. 4, 2019, Sri Lanka Journal of Surgery, Vol. 37, pp. 14–17.
12. Causes
Overall *, **
Road Traffic Accidents
– 54.2%
Trap Gun – 33.3%
Iatrogenic - 8.3%
Other- 4.2% (Stab, etc.)
*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
13. Trap gun
Made of a metal pipe, metal pallets and
explosives (from fire cracker)*
At THA;
About 75 trap gun injury / year
About 10 – 15 % with arterial injuries
Multilevel injury
25% amputation rate
* Outcome of major lower limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka.
Sriharan, P and Arudchelvam, J. 2019, Indian J Vasc Endovasc Surg , Vol. 6, pp. 266-8
14. Causes
Causes of upper limb vascular injuries (ULVI) -
NHSL *
Cuts (36%)
Fractures (34%)
Iatrogenic injuries (22%)
* Upper Limb Vascular Injuries, a Unique Problem. A Single Unit Experience in a. Kapilan, G and
Arudchelvam, J. Colombo : s.n., 2020. Sri Lanka Medical Association 133rd Anniversary International Medical
Congress, 2020. p. 17.
15. Causes
Accidental intra-arterial injection *
* Accidental Intra-Arterial Injection of a Drug in a Patient with Radial Artery Variation; A Rarity Leading
to a Disaster. Arudchelvam, J. 2, 2019, J Clinical Case Rep Case Stud, Vol. 2019, pp. 66-68
17. Mechanism of disruption at vascular level
Transection
Laceration
Contusion
Kink
Intimal flap
*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
21. Intimal flap
Due to injury the arterial
intima is raised as a flap
Resulting in dissection and
occlusion
22. Mechanism of disruption at vascular level
Our experience *
THA ( lower limb arterial injuries)
40% - Contusion
40% - lacerations
Trap gun injury
75% laceration
* Outcome of major lower limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka.
Sriharan, P and Arudchelvam, J. 2019, Indian J Vasc Endovasc Surg , Vol. 6, pp. 266-8
23. Spasm
Study done at NHSL with lower limb injuries and
absent pulses
31 patients with absent pulses
18 (58.1%) arterial spasm
Arterial spasm -common causes of diagnostic
dilemma
.
* Lower Limb Arterial Spasm following Trauma: a Common and an Important Cause. Kapilan, G and Arudchelvam, J. Colombo
: s.n., 2020. Sri Lanka Medical Association 133rd Anniversary International Medical Congress, 2020. p. 63.
$ Post- Traumatic Lower Limb Arterial Spasm: A Common Entity and an Important Cause for Diagnostic Dilemma: A Case Series.
Kapilan G, Arudchelvam J. 1057, 2020, Ann Short Reports, Vol. 3.
24. Spasm
Common in young patients
An underlying injury should be excluded
Confirmation with angiography is necessary
* Lower Limb Arterial Spasm following Trauma: a Common and an Important Cause. Kapilan, G and Arudchelvam, J. Colombo
: s.n., 2020. Sri Lanka Medical Association 133rd Anniversary International Medical Congress, 2020. p. 63.
$ Post- Traumatic Lower Limb Arterial Spasm: A Common Entity and an Important Cause for Diagnostic Dilemma: A Case Series.
Kapilan G, Arudchelvam J. 1057, 2020, Ann Short Reports, Vol. 3.
25. Signs of a vessel injury
Following vascular trauma – clinical features
are divided into;
Hard signs
Soft signs
27. Signs of a vessel injury
Soft signs
History of bleeding
Hematoma
Injury close to a known neurovascular bundle
Weak pulse
Hard signs – in sharp injury, 100% chance of Vascular
injury
Soft signs – 10-25%
The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury:
results at one year. Frykberg, ER, et al., et al. 4, 1991, J Trauma, Vol. 31, p. 502.
Penetrating nontorso trauma: the extremities. Ball, CG. 4, 2015, Can J Surg, Vol. 58, pp. 286-8
28. Late Signs of a vessel injury
Paresis and paresthesia
Viability of the limb is in immediate threat
Anesthesia and paralysis - Not viable
Should be evaluated and documented
29. Documentation following trauma
Teaching Hospital Anuradhapura Sri Lanka (2019) *
Cause of injury documented - 82.6%
Limb viability documented only in - 30.7%
* Completeness of documentation of patients with vascular trauma. Sriharan, P and
Arudchelvam, J. Anuradhapura : s.n., 2019. Anuradhapura Clinical Society , 13th Annual
scientific sessions. p. 74.
36. Vascular injuries - History
Outcome of the vascular injuries have improved
dramatically over time
Experience gained from various war injuries
World Wars 1 / 2
Ligation - Amputation rate - > 40%.
Vietnam / Korean wars - repair - amputation rate - 15%
Iraq / Afghanistan wars - Amputation rate - 8%.
Advances in vascular repair methods
Antibiotics
Advances in trauma care
37. Surgical Repair
Resuscitation
General anesthesia
Clean the entire limb
Thigh prepared – for venous harvest
Control of proximal and distal ends and trimming
47. Surgical repair
Synthetic grafts
Lower patency
Infection
Parathan, S., Arudchelvam, J. and Marasinghe, A., 2019. Outcome of popliteal arterial injuries presenting to the Teaching
Hospital, Anuradhapura. Sri Lanka Journal of Surgery, 37(4), pp.14–17. DOI: http://doi.org/10.4038/sljs.v37i4.8642
Outcome of major lower limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Sriharan, P and
Arudchelvam, J. 2019, Indian J Vasc Endovasc Surg , Vol. 6, pp. 266-8.
48. Combined Vascular and Skeletal Trauma
Our experience (NHSL and THA)
41 / 985 (4.2%) of lower limb fractures had vascular
injuries *
17/ 150 (11.3%)of Humerus fractures had VI*
17/20 (85%) with popliteal arterial injury had fractures or
dislocation (p0.003)**
• Vascular injuries associated with upper extremity skeletal trauma , a cross sectional study.
Ranaweera, RS, Arudchelvam , J. ,Priatharshan, M.Kandy : s.n., 2021. The Kandy Society of medicine,
43rd annual academic sessions. .p.96
• ** Parathan S, Arudchelvam J, Marasinghe A. Outcome of popliteal arterial injuries presenting to the
Teaching Hospital, Anuradhapura. Sri Lanka Journal of Surgery. 2019;37(4):14–7
49. Combined Vascular and Skeletal Trauma
Revascularization / skeletal fixation (External
Fixator – EF)
Bone fixation first if limb is not threatened
Revascularisation first if limb is threatened
51. Mangled limb
National hospital of Sri Lanka Colombo*
Total vascular injuries – 81
Limbs were mangled - 2 (2.5%) .
Extremity Vascular trauma workload of a single vascular unit in a tertiary care Centre; it is
time to establish a dedicated trauma vascular surgery unit. Kapilan, G and Arudchelvam,
J. Colombo : s.n., 2020
52. How soon we should we repair
Complications of delayed arterial repair
Limb death
Reperfusion syndrome
53. How soon we should we repair
As soon as possible
Canine vascular occlusion / ischemia model 1947
Ischemic time < 6 hours - limb salvage rate
90%.
“Golden period” of 6 hours as a threshold
In practice patients often reach beyond 6 hours
* Outcome after revascularisation of marginally viable limbs and dead limbs following lower limb arterial injuries.
Arudchelvam, J. 3, 2017, Ceylon Medical Journal, Vol. 63, pp. 203-204.
£ Revascularisation of Marginally Viable Limbs; A Long-Term Follow-Up Study. Joel, Arudchelvam and Manel, De
Soyza. 1, 2020, J Surgery, Vol. 1, p. 1002.
60. How soon we should we repair
At the teaching hospital Anuradhapura
13 cases
Mean ischaemic time – 11.3 hours (0.5 to 48)
4/9 (30.8%) limbs were either non-viable or
marginally viable
Arudchelvam, J., 2017. Outcome after revascularisation of marginally viable limbs and dead limbs following
lower limb arterial injuries. Ceylon Medical Journal, 62(3), pp.203–204.
61. Marginally viable limbs
Revascularization was attempted on such patients
despite having > 6 hours of ischemia * £
provided ;
Patients consenting
Systemically well and stable
Limb not mangled
Not infected
* Outcome after revascularisation of marginally viable limbs and dead limbs following lower limb arterial injuries.
Arudchelvam, J. 3, 2017, Ceylon Medical Journal, Vol. 63, pp. 203-204.
£ Revascularisation of Marginally Viable Limbs; A Long-Term Follow-Up Study. Joel, Arudchelvam and Manel, De
Soyza. 1, 2020, J Surgery, Vol. 1, p. 1002.
62. Marginally viable limbs Outcome
Long term follow-up
All were happy to have a limb
All reported improvement in sensory function
Only had partial recovery of motor functions * £
* Outcome after revascularisation of marginally viable limbs and dead limbs following lower limb arterial injuries.
Arudchelvam, J. 3, 2017, Ceylon Medical Journal, Vol. 63, pp. 203-204.
£ Revascularisation of Marginally Viable Limbs; A Long-Term Follow-Up Study. Joel, Arudchelvam and Manel, De
Soyza. 1, 2020, J Surgery, Vol. 1, p. 1002.
64. Post perfusion syndrome
Substances Released into circulation
Lactic Acid
K+
Myoglobin
Resulting in organ failure and death of the
patient
65. Post perfusion syndrome
Study done at NHSL 2011 *
Total arterial repairs – 42
Mean ischemic time - 7.25 hours
Severe reperfusion syndrome - 3 (7.1%)
Treatment – ligation of repaired vessels
Amputation
*. Injury profiles, Referral delay, management options and Short Term Outcome Of Traumatic Acute Limb
Ischaemia (ALI) Managed At A Tertiary Referral Center. JD, Arudchelvam and JASB, Jayasundara.
Colombo : s.n., 2011. Annual Academic Sessions Of The College Of Surgeons Of Sri Lanka August 2011. pp.
185-186.
66. Compartment syndrome
Reduced organ perfusion due to increased intra
compartment pressure
Mean Arterial Pressure
(MAP)
Intra Compartmental
Pressure (ICP)
70. Fasciotomy
Teaching Hospital Anuradhapura . 2019
Popliteal arterial injury – 24
No patients underwent fasciotomy before the transfer*
* Outcome of major lower limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka.
Sriharan, P and Arudchelvam, J. 2019, Indian J Vasc Endovasc Surg , Vol. 6, pp. 266-8
71. Vascular trauma how to improve the
situation
Prevention of injuries
Transfer of patients
Improving infrastructure
Establishment of dedicated trauma centres
72. Prevention of injuries
After 2009
Reduction in war related vascular injuries
But an increase in civilian injuries
Increase Road Traffic Accidents (RTA) - i.e. from 1938 to
2013 - RTA injuries increased - 35.1 to 98.6 /100000
Two and three wheeled vehicles
World Bank Group, GRSF
73. Prevention of injuries
Study done at TH Anuradhapura 2019
Patients with popliteal arterial injuries
40 % - Motorcycle accidents
Parathan S, Arudchelvam J, Marasinghe A. Outcome of popliteal arterial injuries presenting to the
Teaching Hospital, Anuradhapura. Sri Lanka Journal of Surgery. 2019;37(4):14–7.
75. Transfer of patients
Communication before transfer
Series at the NHSL 2011
Transfers - 39
Notified before - 8 (20.5%)
Injury profiles, Referral delay, management options and Short Term Outcome Of Traumatic Acute Limb
Ischaemia (ALI) Managed At A Tertiary Referral Center. JD, Arudchelvam and JASB, Jayasundara. Colombo :
s.n., 2011. Annual Academic Sessions Of The College Of Surgeons Of Sri Lanka August 2011. pp. 185-186.
76. Transfer of patients
In 2020 at NHSL
Limb vascular injuries - 81
Unnecessary transfers – 8 (9.9%)
Non -viable - 4 (4.9%)
Mangled - 2 (2.5%)
Traumatic amputations not suitable for re-
implantation - 2 (2.5%)
Extremity Vascular trauma workload of a single vascular unit in a tertiary care Centre; it is time to establish a dedicated trauma
vascular surgery unit. Kapilan, G and Arudchelvam, J. Colombo : s.n., 2020
85. Accident service
The National Hospital of Sri Lanka
Delay due to;
Lack / non availability of staff
Lack of equipment
Lack of protocol
86. Vascular and Transplant Surgeons
At present only 10 vascular and
transplant surgeons in Ministry of
Health.
Vascular and transplant work
(routine and emergency)
Vascular trauma account for 63.9%
emergency surgeries* (NHSL 2021)
? Routine Vascular work
? Transplant Work
*Extremity vascular trauma workload of a single vascular unit in a tertiary care centre: vascular trauma contributes to significant
emergency workload, Bandara LMPM, Kapilan G, Arudchelvam J, s.n., 2021. The Kandy Society of medicine, 43rd annual academic
sessions
87. Vascular and Transplant Surgeons
Train more Vascular and Transplant surgeons
Train other surgeons to handle the traumatic vascular
emergencies
94. Outcome after limb vascular injuries
In studies done at NHSL and THA the overall limb salvage rates
after vascular trauma were 75.0% - 98.6% (1) (2).
1. Extremity Vascular trauma workload of a single vascular unit in a tertiary care Centre; it is time to
establish a dedicated trauma vascular surgery unit. Kapilan, G and Arudchelvam, J. Colombo : s.n., 2020.
2. Outcome of popliteal arterial injuries presenting to the Teaching Hospital, Anuradhapura. Parathan, S
and Arudchelvam, J. 4, 2019, Sri Lanka Journal of Surgery, Vol. 37, pp. 14–17.