This document discusses lymphedema, which is swelling caused by a blockage in the lymphatic system. It can affect the extremities, genitals, and breasts. There are two main types - primary lymphedema due to genetic issues or hypoplasia/aplasia of lymph vessels, and secondary lymphedema usually due to surgery, radiation, trauma, infection, or filariasis. Diagnosis is usually clinical but tests like lymphoscintigraphy can help assess lymphatic function. Treatment involves compression therapy, manual lymph drainage, exercise, and compression garments long-term, as well as surgical procedures to improve drainage or reduce tissue.
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest. Lymphedema is incurable, but with the right treatment, it can be controlled.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest. Lymphedema is incurable, but with the right treatment, it can be controlled.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Dr. Guy Nicastri, Associate Professor of Surgery and Family Medicine at the Warren Alpert School of Medicine at Brown University takes us through some of the pearls of the Acute Abdomen Examination in the Adult
Thyrotoxicosis- complete review of anatomy, physiology, types and clinical fe...Surjeet Acharya
this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
Summary - Neoplasms of infancy and childhood - Asem M. Shadid Asem Shadid
Neoplasms of infancy and childhood :
obj :
1. Describe the findings from the history and physical exam that suggest malignant disease.
2. Know the incidence rates of the major childhood neoplasms and the significance of neoplasms in childhood mortality.
3. Identify the presenting symptoms, physical findings, and diagnostic tests for the major neoplasms (leukemia, CNS tumors, lymphoma, neuroblastoma and Wilm's tumors).
4. Recognize the major therapeutic modalities for childhood neoplasms and the relative advantages and disadvantages of each (chemotherapy, surgery, irradiation, bone marrow transplants).
Massive Splenomegaly By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir Associa...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.Email drbashir123@gmail.com
Causes of Splenomegaly By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir Assoc...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.Email drbashir123@gmail.com
This pptx covers the basics of almost all stds.Use this and for sure you'll get a good score.
It is taken from very hugh yield and authenic sources.
The animations Adds further beauty to the presentation.
The animations itself are self explanatory just download and deliver you'll be very much appreciated for it no need to add further the pptx is well comprehensive.
Lymphoma by Sunil Kumar Daha (Hodgkins and Non-Hodgkins)sunil kumar daha
Please find the power point onLymphoma . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Topic of presentation: Lymphoma. Pathology of Lymphoma, stages of Lymphoma, types of Lymphoma. Hodgkin and Non-Hodgkin lymphoma are discussed along with their sub types clinical features, diagnosis, treatment and prognosis.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
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
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
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
5. Lympedema
Is hypertrophy of the skin
and subcutaneous tissue
caused by chronic lymphatic
obstruction .
It affects extremities ,
scrotum , external genitalia ,
and rarely the breasts
6. Lymphedema
oAn abnormal accumulation of
protein-rich fluid in the
interstitium, causing chronic
inflammation and reactive
fibrosis of the affected
tissues
11. Trunks & Ducts
oLargest lymph vessels
o Thoracic duct-largest, pumping by
the diaphram.
o Form in cisterna chyle
o Ducts empty into venous system
Lower Body Upper Body
•R & L Lumbar Trunks
•Intestinal Trunks
•R & L Jugular
•R & L
Subclavian
•R & L Broncho-
12.
13.
14. Types of Lymphedema
Primary
o Hypoplasia (not as many lymph
nodes)
o Hyperplasia
o Aplasia
o Inguinal Node Fibrosis
o (Kineley Syndrome
o Milroy’s Disease-congentital,
males, unilateral typically
o Meige’s Syndrome: most females
around puberty, Bilateral, webbing of
fingers and toes, two rows of
lashes
Secondary
o Surgery
o Radiation Therapy
o Trauma: blunt trauma
o Filariasis: parasite,
blocks lymph nodes
o Cancer (Malignant)
o Infection
o Obesity
o Self Induced
16. Pathology
Accumulation of large
amount of protein-rich
fluids in the tissue due to
stagnation of lymph.
Recurrent attacks of
lymphangitis lead to more
lymphatic obstruction.
17. Pathological changes
Swelling due to fluid
accumulation
Early pitting oedema
Skin changes –thickening ,
hyperkeratosis and lymphatic
vesicles but no ulcers
Huge bulges of the skin in
severe cases –elephantiasis
18. Skin changes
o Chronic eczema
o Dermatophytosis
o Fissuring
o Verrucae
o Ulcerations
o Stewart Treves syndrome
19.
20.
21. Stages of Lymphedema
Latency Stage
o Reduced transport capacity
o No noticeable edema
Stage I
o Pitting edema
o Edema reduces with elevation (no fibrosis)
o Tight sleeve during the day
Stage II
o Pitting becomes progressively more difficult
o Connective tissue proliferation (fibrosis)
Stage III
o Non pitting
o Fibrosis and Sclerosis
o Skin changes (papillomas, hyperkeratosis, etc)
22. Brunner Classification
0 Histological abnormalities
Not clinical evident
I Pitting edema,
Subsides with elevation
II Non pitting edema
Not relieved with elevation
III Irreversible skin changes,
fibrosis, papillae
23. Presentation of lymphedema
o Characteristically foot involvement
o Ankle contours are lost with infilling of
the submalleolar depressions
o Buffalo hump on foot dorsum
o Square shaped toes
o Stemmer’s sign
26. a-Congenital lymphedema
o < 1year of age
o 10-25% of all primary lymphedema
o Sporadic or familial (Milroy's disease)
o More common in males
o Lower extremity is involved 3 times more
frequently than the upper extremity
o 2/3 patients have bilateral lymphedema
o Aplasia pattern without subcutaneous
lymphatic trunks involvement
27.
28. o Evident after birth and before age 35 years
o Most often arises during puberty
o 65-80% of all primary lymphedema cases
o Females are affected 4 times
o 70% of cases are unilateral, with the left
lower extremity being involved
o Hypoplastic pattern, with the lymphatics
reduced in caliber and number
b-Lymphedema Precox
29.
30.
31. o Clinically not evident until 35 years or
older
o Rarest form of primary lymphedema
o Only 10% of cases
o Hyperplasic pattern, with tortuous
lymphatics increased in caliber and number
o Absent or incompetent valves
c-Lymphedema Tarda
(Meige disease )
36. 11-Secondary lymphedema
o There is a known cause for the presence
of edema
o Surgery: breast cancer, melanoma,
prostate/bladder cancer, lymphoma,
ovarian cancer, Radiation therapy
o Trauma – scarring, crush injury
o Infection
o CVI -- Obesity
37. 11– Secondary lymphedema
1 – post-traumatic
o a- circumferential scar
ob- block dissection of regional nodes
o c- burns
od- irradiation of regional l. nodes
38.
39.
40. 11– Secondary lymphedema
2 – post-inflammatory
o a- non-specific
recurrent lymphangitis
recurrent cellulitis
post-erysipelas
o b- specific
Ffilaria filaria ---T.B.
45. Filarial lymph-edema
of lower limbs
o Caused by Wuchereria bancrofti
o Common in Damietta – Giza –
Sharkia and Assiut.
o Due to obstruction of lymph nodes
by the adult worms.
o Lymph stagnation leads to
accumulation of proteins in the
subcutaneous tissues.
51. Filarial lymph-edema
of lower limbs
oCellular reaction to proteins
in the form of plasma cells –
eosinophils –lymphocytes –
monocytes and polymorpho-
nuclear leukocytes.
oFibrosis and collage fibers
oAllergy to filarial antigens
52. Skin changes
o Chronic eczema
o Dermatophytosis
o Fissuring
o Verrucae
o Ulcerations
o Stewart Treves syndrome
62. Malignant lymphedema
oSwelling and nodules in
supraclavicular fossa
oHematoma-like
discoloration (angiosarcoma)
oUlcers and non-healing
open wounds
oRecurrent malignancy
66. Differential Diagnosis
o Lipidema: females, symmetrical (no feet), no
pitting, very painful to palpations, bruise
easily, tissue is softer.
o Chronic Venous Insufficiency: gaiter
distribution, non-pitting, hemosiderin staining,
fibrotic.
o Acute Deep Venous Thrombophlebitis: swelling,
redness, painful, sudden onset
o Cardiac Edema: bilateral, pitting, complete
resolution when legs elevate above heart, no
pain.
67. Differential Diagnosis
.
oCongestive Heart Failure: pitting,
dyspnea, jugular vein distention.
oMalignancy:
o Filariasis:
o Myxedema: decreased ability to
sweat, orange skin
o Complex Regional Pain Syndrome
(RSD, Sudeck’s)
92. Klippel–Trénaunay–Weber :
o Large port-wine stain
o Varicose vein with or without
A – V fistula
o Hypertrophy of soft tissue and bone
o Most commonly lower limb
Treatment = expectancy and supportive
elastic stocking – orthopedic
procedures embolization tech. or pulsed -
dye laser.
• 3-congenital A-V fistula
93.
94.
95. Differential diagnosis
o Congestive heart failure
o Liver and renal failure
o Deep vein thrombosis
o Venous insufficiency
o Hypoalbuminemia
o Vascular malformations
96. Differential Diagnosis
oLipedema ( usually sparing the
feet )
oidiopathic
oFilariasis
oMyxedema
oComplex regional pain syndrome
oMalignancy / active cancer
99. Lipedema
o Mainly in women
o Bilateral, symmetrical edema
o from iliac crest to ankles
o Dorsum of feet never
involved
o (-) Stemmer’s sign
o Little or no pitting
o No cellulitis
o Painful to palpation
100.
101.
102. Acute DVT
o Sudden onset
o Unilateral
o Painful
o Cyanosis
o (+) Homan’s sign
o Potentially lethal (PE)
o Diagnosis with venous doppler
103.
104. Cardiac edema
o Right heart insufficiency
o Greatest edema distally
o Always bilateral
oPitting
o Complete resolution with elevation
oNo pain
o May treat with PT if cleared by
Cardiologist
107. Filarial lymphedema of
lower limbs
Diagnosis
o1 – clinical
o2 – midnight blood film to
show microfilaria
o3 – intradermal skin test
108. Investigations
o Infrequently required to establish
the diagnosis
o To determine residual lymphatic
function
o To establish treatment preferences
o To evaluate therapy
109. Other Diagnostic
Tests
o Lymphography
o Venous Doppler or Venous
Sonography
o Indirect Lymphography
o Fluorescence Microlymphography
o Lymphoscintigraphy
o CT Scan
oMRI
110. Contrast Lymphangiography
Was gold standard for mapping
Damages the normal lymphatic
channels
due to inflammation
Very painful procedure and needs GA
112. Lymphoscintigram
T 99 labelled colloidal particles with antimony sulphide
Normally after 90 min. 40%of the radioactive dye disappear at site of inj.
113. o An indication for
CT scan or MRI
o is suspicion of
malignancy,
o for which these
tests offer the
most information
MRI Scan
121. Compression Therapy
• Compression therapy is the
application of external pressure
on body tissue to support the
elasticity of the skin and its
underlying vessels
• Phase I with Compression
Bandages
• Phase II with medical
compression Garments
122. Compression bandages
• Compression bandages have
been shown to produce a
micromassage effect that
improves lymph transport.
• Increase temperature of up
to 5 degrees enhances the
lymphangion mobility
123. Compression bandaging
Short stretch bandages (Rosidal, Comprilan)
are applied to increase the tissue pressure
in the edematous extremity.
• Reduces the ultrafiltration rate
• Improves efficiency of the muscle and joint
pumps
• Prevents re-accumulation of evacuated
lymph fluid
• Helps break down fibrous connective tissue
that has developed
124.
125. Sequential Pneumatic Devices
• Mobilizes interstitial fluid into the
venous system
• Single chamber - JOBST vs.
sequential Compression (gradient)
• Use MLD prior to using the pump
• Studies show that it moves only
venous fluid
• Pump never to exceed 40 mmHg for
extended periods of time
135. treatment
•2 – surgical :-
oa – physiological i.e. improve
lymph drainage
ob – excisional i.e. reduce the
bulk of tissue
oc - Physiological and excisional
140. treatment
ob – excisional operations :
Charies ,excision of skin and
subcutaneous tissues and split
thickness skin graft
Sistrunk”s , excision of skin
and subcut. Ellipse , then close
the defect
144. Charles Procedure
(1912)
Excision of all
skin/subcutaneous tissue
down to deep fascia
Covering by split thickness
skin grafts from the excised
skin
Girth can be greatly reduced
Unsatisfactory cosmetic
results
145. Sistrunk Procedure (1918)
Wedge of skin & subcutaneous
tissue excised & wound closed
primarily
Most commonly used to reduce
girth of thigh
146. Homan Procedure
Skin flaps are elevated
Subcutaneous tissue
excised
Skin flap trimmed &
closed
Usually staged procedure
with lateral & medial
separated by 3-6 months
to avoid necrosis
Mostly for calf
147.
148. Treatment
oc – phsiological and excisional
Thompson”s , swiss roll ,
excision of skin and subcut.
Tissues then implantation of
the flaps between the muscles
149.
150.
151. Thompson Procedure (1962)
Denuded skin flaps sutured to deep fascia &
buried (buried dermal flap)
To establish connection b/w superficial and
deep systems
Formation of pilonidal sinus