Modlin kidney transplant techniques presentation
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Dr. Charles Modlin, Cleveland Clinic Kidney Transplant Surgeon, demonstrates innovative surgical techniques in kidney transplantation.
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The document describes the process of renal transplantation recipient surgery. It discusses:
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- Preparing the allograft kidney by inspecting and dissecting vessels and ligating branches
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- Exposing the iliac vessels through an incision and developing the retroperitoneal space
- Performing the anastomoses of the renal vessels to the iliac vessels and reperfusion
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This document provides information about intravenous urography (IVU), including its definition, history, indications, contraindications, technique, phases, and what is evaluated. Some key points:
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- IVU involves injecting iodine contrast intravenously and taking x-ray images as it passes through the kidneys, ureters, and bladder. It was introduced in 1929 by American urologist Moses Swick.
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- Contraindications include contrast allergy and renal failure. Advantages include clearly outlining the urinary system, while disadvantages include need for contrast and radiation exposure.
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Since 2001, we Krishna Scientific Suppliers are recognized as a coveted Manufacturer, Supplier, Exporter & Service Provider of Industrial Fermenter, Autoclave, Sterilizer & Machines, Incubator, Laminar Cabinets and laboratory instruments. The range offered by us encompasses rotary shaker, BOD incubator, fume hood, and plant growth chamber. Additionally, we offer our clients a wide assortment of hot plate, magnetic stirrers, Moisture Meter, pH Meter, Microscope, Distilled Water Still (Wall Mounted), BOD Incubator, and many more laboratory instruments.More Related Content
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- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
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- The anatomy of the intravesical and intramural portions of the ureter and factors that allow antegrade urine flow and prevent reflux under normal conditions.
- Grading systems used to classify the degree of reflux seen on voiding cystourethrogram.
- Evaluation methods for VUR including ultrasound, voiding cystourethrogram, radionuclide cystogram, and renal scintigraphy.
- Factors that can cause primary or secondary reflux such as congenital defects or increased
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This document describes procedures for anatrophic nephrolithotomy, pyelolithotomy, and managing residual stones. It provides details on: preoperative planning and preparation including imaging and antibiotics; surgical techniques for accessing the kidney/pelvis, making incisions, removing stones, and closing; managing complications; and using coagulum to fill the pelvis to detect residual fragments. It is a technical reference for open stone surgery techniques from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India.
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Trauma to Urinary Tract/ Urinary Tract Injury
1. The document discusses the management of various types of urinary tract injuries including renal, ureteric, bladder and urethral injuries.
2. It provides clinical scenarios for each type and discusses their relevant anatomy, epidemiology, signs and symptoms, investigations and treatment approaches.
3. Management depends on the grade of injury and may involve conservative approaches, surgical exploration or repair, with the goal of preserving renal function and maintaining hemodynamic stability in trauma patients.
Abdominal trauma : an overview
1. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas.
2. A thorough primary and secondary survey is essential to identify injuries. Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy help evaluate injuries. Conservative management is appropriate for many mild organ injuries.
3. Splenic injuries require close monitoring or surgery depending on grade. Liver injuries often stop bleeding spontaneously but may require packing or resection. Pancreatic injuries are difficult to diagnose and usually repaired surgically. Proper identification and treatment of abdominal injuries is critical for patient outcomes.
Abdominal injuries lit review .pptx
The document provides information on abdominal injuries, including:
1. The abdomen can be injured through penetrating or blunt trauma, involving the abdominal wall, solid organs, hollow viscus, or vasculature.
2. Assessment of abdominal injury focuses on recognizing conditions requiring immediate surgery and avoiding delayed intervention. Investigations include physical exam, paracentesis, diagnostic peritoneal lavage, FAST scan, and imaging.
3. Management depends on injury mechanism and patient stability. Penetrating injuries may require laparotomy for bleeding control or foreign body removal. Indications for laparotomy include bleeding control, injury identification, and contamination protection. Specific organ repairs include splenectomy, tractotomy, and primary suturing
Liver trauma final
The document discusses liver trauma, providing details on the anatomy and physiology of the liver, classifications of traumatic liver injuries, clinical presentations, diagnostic imaging approaches including CT scans and angiography, and treatments. Key points covered include: the liver is the second most commonly injured abdominal organ from trauma but most common cause of death; injuries are often from blunt force such as motor vehicle accidents; CT scans are the diagnostic standard and can classify injuries on a scale of I-VI based on features like hematomas and lacerations; angiography can identify active bleeding for potential embolization treatment.
Abdominal trauma ,an overview
1) Abdominal trauma is commonly encountered and can be life-threatening. Identification of serious intra-abdominal injuries can be challenging.
2) Motor vehicle accidents account for 60% of abdominal trauma, with blunt trauma more common than penetrating injuries.
3) Injuries to solid organs like the spleen, liver, and kidneys require careful assessment and may be graded based on severity. Conservative management is often attempted initially if the patient is stable.
4) Diagnostic tools like FAST ultrasound, CT scans, and laparoscopy can help identify injuries, but repeated examinations are often necessary. Management may involve surgery or conservative approaches depending on injury severity and patient stability.
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The document discusses various imaging modalities used in trauma patients, including their applications and benefits. It recommends that initially for major trauma patients, lateral cervical spine and chest X-rays be performed to assess for fractures and pneumothorax. Abdominal ultrasound should also be done to check for hemorrhage. Computed tomography can further assess brain, vascular and solid organ injuries if available in the emergency department. Common imaging findings of injuries to vital organs like the liver, spleen and kidneys are also outlined.
Abdominal Trauma 3.pptx
(1) Perform a primary survey and assess for ABCDE issues.
(2) Consider a seatbelt sign and evaluate for abdominal tenderness or rigidity which suggest occult injury.
(3) Perform a FAST exam to check for hemoperitoneum which, if positive, indicates need for surgical consultation given the mechanism of injury.
(4) If the patient is stable, further evaluation with CT scan would be most accurate to diagnose potential solid organ or retroperitoneal injuries from the handlebar impact.
Abdominal trauma
This document provides an overview of abdominal trauma, including blunt and penetrating injuries. It discusses the anatomy, mechanisms of injury, assessment techniques like the FAST scan and CT scan, management principles, and specific injuries to the liver, spleen, diaphragm, and pelvis. Treatment may involve resuscitation, laparotomy, interventional radiology, or observation depending on the stability of the patient and findings on imaging and examination. Unrecognized abdominal injuries can be preventable causes of death, so early recognition and management of intra-abdominal injuries is important for saving lives.
Case presentation for Reading
A 43 year old male patient was transferred with an ambulance in the emergency department of the hospital with bleeding from right thigh after a motorcycle accident. He had become a trapped under the motorcycle.
Discuss the medical, surgical and anesthetic management of this patient.
Abdominal trauma
1) The document discusses the diagnosis and treatment of intra-abdominal injuries, including the external anatomy of the abdomen, classification of injuries as blunt, penetrating, or iatrogenic, signs and symptoms of potential abdominal injury, and priorities for diagnosis and management.
2) Key diagnostic tests discussed are physical exam, plain films, FAST ultrasound, CT scan, diagnostic peritoneal lavage, and exploratory laparotomy. Indications, advantages, limitations, and sensitivities of each test are provided.
3) Treatment priorities and approaches are outlined, including resuscitation, damage control resuscitation, identifying the source of bleeding, and surgical procedures for exploratory laparotomy and repair of specific organ injuries
Imaging in abdominal trauma
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
Triage &assesment of abdominal trauma
1. The document discusses the triage and assessment of abdominal trauma. It outlines the principles of trauma management including treating the greatest threat to life first.
2. The primary and secondary surveys are described in detail, covering the assessment of the airway, breathing, circulation, disability, and exposure. Specific injuries to the abdomen like liver and spleen injuries are also discussed.
3. Investigations for abdominal trauma including focused assessment with sonography, diagnostic peritoneal lavage, CT scans, and grades of injuries are provided. The management of positive findings is also summarized.
Abdominal trauma.pptx
- A 32-year-old male motorcyclist was in a high-speed collision where he was thrown from his bike after hitting a vehicle.
- On examination, he has right-sided chest, abdominal, and pelvic tenderness. Vital signs have stabilized with IV fluids.
- Given the mechanism of injury and physical exam findings, the patient has likely sustained injuries to intra-abdominal organs and/or pelvic structures on the right side from the high-speed impact. Further evaluation with tests like FAST ultrasound, CT scan, and possible diagnostic peritoneal lavage or laparoscopy may be needed to identify specific injuries.
Vascular
This document discusses various types of vascular injuries. It covers the basic principles of vascular injury including anatomy, type of injury, mechanisms, clinical manifestations, investigations and management. It describes different types of vascular injuries like laceration, transection, dissection, crush and thrombosis. It discusses evaluation and investigations like Doppler, duplex ultrasound, angiography, CT angiography and MRI. It covers management of vascular injuries in different body regions like neck, chest, abdomen and extremities. It provides guidelines on treatment approaches including operative versus endovascular management.
Abdominal trauma
This document discusses approaches to managing abdominal trauma in the emergency department. It begins by outlining learning objectives which include identifying abdominal trauma, learning assessment approaches, and trauma management. It then discusses the primary and secondary surveys as well as indications of shock. Specific injuries like solid organ injuries, hollow visceral injuries, retroperitoneal injuries, and diaphragmatic injuries are examined. Mechanisms of injury, physical exam findings, ultrasound, and management are also reviewed to provide emergency physicians with guidance on evaluating and treating abdominal trauma.
Liver abscess
1) Liver abscesses can be either pyogenic (caused by bacteria) or amoebic (caused by the parasite Entamoeba histolytica).
2) Pyogenic liver abscesses are more common in western countries and are usually caused by E. coli or Klebsiella pneumoniae, while amoebic liver abscesses are more common in Asia and Africa.
3) The most common causes of pyogenic liver abscesses are infections that spread from the biliary tract, while amoebic liver abscesses usually originate from ingesting cysts of E. histolytica through contaminated food or water.
Abdominal trauma (1)
This document provides guidance on the initial assessment and management of abdominal trauma. It discusses:
- Recognizing abdominal injuries through physical exam, ultrasound, CT, and diagnostic tools.
- Managing hemorrhage from abdominal injuries through damage control resuscitation including permissive hypotension, blood product transfusion, and early surgery to control bleeding.
- Evaluating different areas of the abdomen that could be injured, including the intraperitoneal cavity, retroperitoneum, thorax, heart, and diaphragm.
Blunt Abdominal Trauma
Blunt abdominal trauma can cause serious internal injuries that may not be apparent initially. Over one-third of patients considered asymptomatic based on initial exams were found to have abdominal organ injuries. A high index of suspicion is needed to properly evaluate patients for potential internal injuries. Evaluation involves thorough history and physical exam, along with diagnostic tools like ultrasound, CT scans, and possible exploratory surgery to identify injuries requiring treatment.
Resuscitation & abdominal trauma
Resuscitation and management of abdominal trauma patients involves a primary and secondary survey approach. During primary survey, airway, breathing, circulation, disability, and exposure are assessed and stabilized concurrently with resuscitation to address the lethal triad of coagulopathy, hypothermia and acidosis. Fluid resuscitation is aimed at restoring normal vital signs and urine output while assessing response. Secondary survey involves full history, exam, and investigation including FAST scan, CT scan if stable, to diagnose injuries which may often be managed conservatively but sometimes require surgery. Common injuries include spleen, liver and kidney injuries.
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Abdominal trauma can result from blunt or penetrating injuries and is a leading cause of death worldwide, especially in young people. Assessment involves a primary survey to evaluate life threats and ongoing resuscitation, followed by a secondary survey and investigation of potential injuries. Common abdominal injuries include injuries to the spleen, liver, hollow organs, and retroperitoneal structures. Treatment depends on the severity and location of injuries, with many solid organ injuries now managed conservatively through observation rather than surgery, provided the patient is stable. CT scan is useful for diagnosis, while laparotomy may be needed for severe or uncertain injuries or ongoing bleeding.
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Modlin kidney transplant techniques presentation
- 1. Sunrise in Shaker Heights
- 2. Charles Modlin, M.D., MBA • College: Northwestern • Medical School: • Internship/Residency: • Fellowship Renovascular Surgery/ Renal Transplant: University Northwestern University New York University Cleveland Clinic • Staff: Cleveland Clinic
- 7. Dual Deceased Allograft Donor
- 21. Pediatric Enbloc Post Perfusion
- 25. Dual Kidney with 3 Arteries
- 26. Dual Kidney with 4 Arteries
- 27. Capsular Repair Vicryl Mesh
- 28. Capsular Repair
- 29. Renal Angiomyolipoma in Living Donor
- 30. ADPCK
- 31. Autosomal Dominant Polycystic Kidney Disease
- 32. Renal Trauma • • • • 19 y/o AA male Admitted with 2 Gun Shot Wounds: ER Physical Exam: - Vitals BP 90/50, Pulse 150 regular, RR labored breathing, no breath-sounds left lung semiconscious, uncooperative, pain, abdomen distended and tender +rebound, rigidity, bullet entry posterior left chest, exit site right anterior abdominal wall, another entry site left gluteus - Stat Hematocrit 18%, ABG 7.28 pH,pCO2 60,pO2 68 - Bladder Catheterized: Urine Clear (NO Hematuria) WHAT WOULD YOU DO????
- 33. Immediate Resuscitation • • • • • • • • • • Femoral Venous Lines/ Large Bore IVs Normal Saline Hydration Albumin Blood FFP (PT/PTT coagulopathic) CXR: Pneumothorax: Chest Tube Insertion Hypoventilation/ Acidotic /Intubation Serial Hematocrits; Hct Stable/ BP stable What would you do????
- 34. What would you do??? • • • Admit to the ICU and Observe. Obtain a CT scan. Prepare the O.R. for Immediate Surgical Exploration.
- 35. Surgical Exploration • • • • • Midline-abdominal Incision made Trauma to Gallbladder, L Kidney, Tail of Pancreas Retroperitoneal Hematoma Bilaterally Gallbladder removed Retroperitoneal Hematoma Non-Expanding - Kidney Partially Visualized (trauma to lower pole) - Retroperitoneal hematoma - Drains Placed, Patient Closed
- 52. Surgical Exploration • • What type of incision? - Left Flank Incision - Left Thoraco-Abdominal - Abdominal Midline - Chevron Why? Hint: What is the most important thing you must do upon entering the patients body?
- 53. Renal Trauma Grading • Renal injuries are graded by the American Association for the Surgery of Trauma (AAST) - on the basis of the depth of injury and the involvement of vessels or the collecting system as follows (Moore, 1989).
- 54. Grading Classified according to the Organ Injury Scaling (OIS) Committee Scale • Minor • Contusion Microscopic or gross haematuria, Urological studies normalHaematomaSubcapsular, nonexapnding without parenchymal laceration. I II • • Haematoma Nonexapnding perirenal haematoma confined to renal retroperitoneum. Laceration<1cm parenchymal depth of renal cortex without urinary extravasation. Major III • Laceration>1cm depth of renal cortex, without collecting system rupture or urinary extravasation IV • LacerationParenchymal laceration extending through the renal cortex, medulla and collecting system.VascularMain renal artery or vein injury with contained haemorrhage. V • Laceration Completely shattered kidney. Vascular Avulsion of renal hilum which devascularizes kidney.
- 55. Grade III Renal Injury