The caroticocavernous fistula is a specific type of dural arteriovenousfistula characterized by abnormal arteriovenous shunting within the cavernous sinus.
A caroticocavernous fistula results in high-pressure arterial blood entering the low-pressure venous cavernous sinus.
This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit.
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The caroticocavernous fistula is a specific type of dural arteriovenousfistula characterized by abnormal arteriovenous shunting within the cavernous sinus.
A caroticocavernous fistula results in high-pressure arterial blood entering the low-pressure venous cavernous sinus.
This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
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Orbital fractures are a common finding in maxillofacial trauma. although a multi-disciplinary approach is essential, the role of ophthalmologist cannot be overemphazised. here we discuss the same.
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
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Model Attribute Check Company Auto PropertyCeline George
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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3. Why TAB ?
• Early recognition and initiation of steroid
treatment for a sufficient duration,
• Treatment (systemic steroids) is
associated with high risk of morbidity.
4. Steroids is “double-
edged” sword
Duhaut P et al. Biopsy proven and biopsy negative temporal arteritis: differences in clinical
spectrum at the onset of the disease. Ann Rheum Dis 1999
• Series of 207 biopsy-proven and 85 biopsy-negative
GCA cases.
• Potentially iatrogenic steroid complications might explain
up to 20% of the observed deaths in their study group.
5. ACR Criteria for GCA
Age 50 years or older
New-onset localized headache
Temporal artery tenderness or decreased temporal artery
pulse,
Erythrocyte sedimentation rate (ESR) of at least
50 mm/hour,
Abnormal artery biopsy specimen characterized by mononuclear
infiltration or granulomatous inflammation.
3 of 5
Sensitivity of 93.5% and specificity of
91.2% for the classification of GCA compared with other
vasculitides
6. TAB
• ACR criteria differentiate patients who
have vasculitis from those who do not
have vasculitis for diagnostic purposes.
• ACR Diagnostic criteria to identify a
patient with GCA is better when the
prevalence is high (e.g. Rheumatology
clinic).
7. TAB vs ACR Criteria
(Murchison AP et al, Am J Ophth 2012)
• Twenty five percent of patients who had
a positive biopsy did not meet ACR
criteria.
• Twenty eight percent of patients who
met ACR criteria did not have a positive
biopsy.
8. Occult GCA
• Twenty percent of GCA patients have
only visual symptoms (Occult GCA) -
Transient visual loss , transient diplopia
(Simmons RJ, Cogan DG. Occult temporal arteritis. Arch Ophthalmol
1962)
10. Unilateral vs Bilateral
Danesh-Meyer HV et al . J Neuroophthalmology 2000
• In 90 (99%) of the 91 patients, the histologic diagnoses in the
left and right superficial temporal arteries were the same.
• A concordance rate of 98.9% (38 of 39 positive biopsy
results)
• Low yield in obtaining a biopsy on the contralateral side.
11. How long is enough ?
Murchison AP et al. Ophthal Plast Reconstr Surg. 2012
• Review of 62 TAB biopsy specimens.
• 4.61-mm mean shrinkage with 2.97-mm
standard deviation
• A 27.58-mm specimen would have to be
obtained to consistently get 20 mm length
specimen
12. Indication of TAB
• Any patient who with clinical signs and
symptoms of GCA.
• Biopsy should be performed if clinical
suspicion is high regardless of
laboratory results.
20. Intraoperative Predictability of Temporal Artery Biopsy
Results
Cetinkaya, Altug M.D at al. Ophthalmic Plastic & Reconstructive Surgery, 2012
A. Nodular, thickened artery that appears pale throughout
the entire section->“grossly positive,”
B. The lumen is completely occluded.
No back-bleeding from anastomotic branches during
dissection.
23. Complications of TAB
• Brow ptosis
• Wrong biopsy (vein or nerve)
• Bleeding/echymosis
• Stroke ( extremely rare)
24. Brow Ptosis
• Injury to upper temporal branch of facial
nerve.
• Facial nerve runs deep to temporal branch
of STA beneath the fascia.
• Avoid dissection very deep to artery and
fascia.
• Don’t dissect close to lateral orbital rim or
brow.
25. Brow Ptosis
“danger zone”: contains temporal branches traveling
superficially and therefore presumably more susceptible
to injury.
Scott KR et al. Temporal artery biopsy technique: a clinico-anatomical approach.
26. Safety Line
• “Safety line”: from the tragus to a point 2.0 cm from
the most lateral brow cilia.
2 cm
27. Brow Ptosis after Temporal Artery Biopsy
Incidence and Associations
Ann P. Murchison et al. Ophthalmology 2012
Only 1 of 35 patients with incision > 35 mm from brow developed brow ptosis
28. Brow Ptosis
Ann P. Murchison et al. Ophthalmology 2012
One week Six months
29. Wrong biopsy
• Artery has a thicker wall smaller in
diameter and is whiter than a vein.
33. Summary
• TAB is an easy , low-risk procedure to
confirm GCA diagnosis (gold-standard).
• Good communication with the
pathologist is important.
• Complications (brow ptosis) can be
minimized by careful technique.