Chronic venous insufficiency is a condition where the veins in the legs cannot pump enough blood back to the heart. It involves dilated, tortuous veins and valvular incompetence, mainly in the legs. Risk factors include age, gender, heredity, pregnancy, obesity, and prolonged standing or sitting. Symptoms include leg pain, swelling, skin changes like eczema or ulcers. Treatment options include compression therapy, sclerotherapy, and surgery to ligate or strip varicose veins.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Groin swelling is one of the commonest problem in general surgical practice. A groin swelling is always considered to be synonymous with a hernia. However this does not always hold true. there are a variety of other causes which present as an groin swelling.Awareness of the diferential diagnosis is therefore essential for aproper diagnosis thus preventing mismanagement. The presentation gives abroad outline of the various conditions depending upon the various areas of the groin from which the swelling arises.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Groin swelling is one of the commonest problem in general surgical practice. A groin swelling is always considered to be synonymous with a hernia. However this does not always hold true. there are a variety of other causes which present as an groin swelling.Awareness of the diferential diagnosis is therefore essential for aproper diagnosis thus preventing mismanagement. The presentation gives abroad outline of the various conditions depending upon the various areas of the groin from which the swelling arises.
This document include anatomy of venous system of lower limb , venous hypertension and venous pathology like varicose vein. ,DVT and venous ulcer useful for surgery postgraduate and graduate (MBBS ) students . Including pathophysiology ,management includes surgical and medical aspect
Varicose Veins are dilated, tortuous, elongated veins in the leg.
There is reversal of blood flow through its faulty valves.
It is permanently elongated, dilated vein/veins with tortuous path causing pathological circulation.
all about rabies
epidemiology of rabies,
pathogenesis of rabies,
clinical features of rabies,
treatment of rabies,
prevention of rabies,
rabies virus,
post exposure prophylaxis,
rabies in dogs
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
3. CVI-DEFINITION
• Medical condition where veins
cannot pump enough deoxy blood
back to the heart
• “impaired musculovenous pump”
• Mainly in a)Legs
b)CNS
c)Liver
5. Leg Vein Anatomy
• The venous system
is comprised of:
– Deep veins
– Superficial veins
– Perforator veins
VN20-03-B 10/04
6. Superficial veins
• Great saphenous vein
Begins from medial marginal vein on the
dorsum of foot
Ascends in front of tibial malleolus
In the medial aspect of leg(related to???)
behind medial condyles of tibia and femur
posteromedial surface of the knee
In anteromedial aspect of thigh
Terminates into femoral vein at fossa ovalis
2.5cm below and lateral to pubic tubercle
7. • TRIBUTARIES
Ankle-medial marginal vein
Leg-anastomose with SSV
communication-ant.& post.tibial veins
receives post. & ant.arch veins
Thigh-communicate with femoral vein
receives accessory saphenous vein and other cutaneous veins
Fossa ovalis-superficial epigastric vein
superficial iliac circumflex
superficial external pudental vein
8. • Short saphenous vein
Begins from the lateral marginal vein behind
lateral malleolous
Lateral margin of tendocalcaneous
Posterolateral aspect of calf
Perforates the deep fascia of poppliteal fossa
Empties into popliteal vein
Tributaries
• Superficial circumflex vein,superficial inferior
epigastric,ant.vein of leg,post.arch vein
• Long intersaphenous communicating vein(comm.vein of
Giacomini Cruveilhier)
• Ant.accesory great saphenous vein
9. Deep veins
1. Veins of conduits
2. Pumping veins/peripheral
heart-soleal venous sinus
gastronemial venous
sinus of Gilot
within the deep fascia
Blood flow in greater
pressure and volume
Accounts for 80 -90% venous
return
10. Perforators
• Perforating veins connect the
deep system with the superficial
system
• They pass through the deep
fascia
• Guarded by valves-unidirectional
flow from superficial to deep
veins
VN20-03-B 10/04
11. Types of perforators
1. Ankle perforators-may or kuster
2. Lower leg perforators of cockett-I,II,III
a)Posteroinferior to med malleolus
b)10cm above med.malleolus
c)15cm above med.malleolus
3. Gastrocnemius perforators of Boyd
4. Mid thigh perforators of Dodd
5. Hunter’s perforator in thigh
12.
13. Physiology of venous
blood flow
Venous return from leg is governed by
Arterial pressure
Calf musculovenous pump
Gravity
Thoracic pump
Vis a tergo of adjoining muscles
Valves in veins
14. Foot and calf muscles
act to squeeze blood out
of deep veins.
One way valve allow
only upward and inward
flow.
During muscle relaxation
blood is drawn inward
thru perforating veins.
15. Venous valvular function
Valve leaflets allow
unidirectional flow upward or
inward.
“nonrefluxing of valves”
Major valves-ostial valve
preterminal valve
19. ANY RISK FACTOR INCREASED VENOUS PRESSURE
DILATION OF VEIN WALLS
STRECHING OF VALVES-VALVULAR INCOMPETENCE
REVERSAL OF BLOOD FLOW
FAILURE OF MUSCLES TO PUMP BLOOD
VEINS DISTEND,ELONGATE,TORTOUS,POUCHED,INELASTIC
AND FRIABLE
20. Telangectasias
• Small(0.5-1mm) widened blood vessels in
skin-small intradermal varicosities
“SPIDER VEINS”/”venulectasias"
• In anywhere on the body esp-leg
• Usually no severe symptoms
• Rarely heamorhagic
• “corona phlebectatica”-blue
spiderveins on medial aspect ankle below
malleolus
21.
22. Reticular veins
• Subcutaneous dilated veins-enter
tributaries of main axial/trunk veins
• Size >spider veins (1-3mm)
<varicose vein
• “feeder veins”-
refluxing reticular veins spider veins
• Cause discomfort and is cosmetically
undesirable
23.
24.
25. Varicose veins
• Dilated,tortuous and elongated veins
with reversal of blood flow mainly
due to valvular incompetence
• Only in humans
• Includes
varicose veins in legs
Hemorrhoids
Varicocele
Oesophageal varices
27. Aetiology
• More common in lower limb due to erect posture
• Primary varicosities
Congenital incompetence/absence of valves
Weakness or wasting of muscles
Stretching of deep fascia
Inheritance with FOXC2 gene
Klippel-trenaunay syndrome
28. • Secondary varicosities
recurrent thrombophlebitis
Occupational
Obstruction to venous return
Pregnancy
Iatrogenic-in AV fistula
Deep vein thrombosis
29.
30. Symptoms
Dilated tortuous veins
Dragging pain worsening on prolonged standing/sitting
Bursting pain on walking
Swelling of the ankle
Ithcing,oedema,thickening.eczema of feet
Night cramps
Appearance of spider veins in affected leg.
Discoloration/ulceration
Skin above ankle may shrink (lipodermatosclerosis) b/c fat
underneath skin becomes hard.
Bleeding blow outs
Local gigantism
33. Saphena varix
• A saphena varix is a dilatation at the top of the
long saphenous vein due to valvular
incompetence. It may reach the size of a golf
ball or larger.
• The varix is:
soft and compressible
disappears immediately on lying down
exhibits an expansile cough impulse
demonstrates a fluid thrill
34. Champagne bottle sign
• Inverted beer bottle look
• Contraction of ankle skin and s/c tissue
with prominent edematous calf
36. Special Tests
1. The Trendelenburg test
Used to assess the competence of SFJ
Patient lies flat
Elevate the leg and gently empty the veins
Palpate the SFJ and ask the patient to stand
whilst maintaining pressure
Findings:
Rapid filling after thumb released→ SFJ is
incompetent
Filling from below upwards without releasing
thumb →presence of distal incompetent
perforators
37.
38. 2. Tourniquet test
Uses a tourniquet to control the junction rather than fingers
Advantage of moving the tourniquet lower (mid-thigh region)
Test is unreliable below the knee
3. Perthes Test
Empty the vein as above, place a tourniquet around the thigh,
stand the patient up.
Ask them to rapidly stand up and down on their toes – filling of
the veins indicated deep venous incompetence. This is a painful
and rarely used test.
4. Schwartz test
In standing position,tap the lower part of vein
Impulse felt on saphenofemoral junction
39.
40. 5.Pratt’s test-
Esmarch bandage applied on the leg from below upward with tourniquet
on saphenofemoral junction
Release of bandages
Perforators seen as blow outs
6.Morrissey’s cough impulse test
limb elevated and veins emptied
Patient is asked to cough
Expansile impulse in saphenofemoral junction
7.Fegan’s test
Line of varicosities marked
Site where perforators pierce deep fascia-bulges on standing
circular depressions on lying
41. Hemorrhage
Ulcerations
phlebitis
Pigmentations
Eczema
lipodermatosclerosis
Periostitis
Calcification of vein
Equinus deformity
Acute fat necrosis can occur, esp: at ankle
Deep vein thrombosis
42. Reasons for complications
1. Fibrin cuff theory
valvular incompetence venous stasis
c/c ambulatory venous hypertension
Defective micro circulation Excessive RBC lysis eczema
Excessive release of hemosiderin and fibrin
Pigmentation,dermatitis and lipodermatosclerosis
capillary endothelial damage lack of exchange of nutrients
Anoxia
ULCER
43. 2.WBC TRAPPING THEORY
• Raised venous pressure reduced capillary perfusion trapping of WBC
• Venous hypertension expression of leucocyte adhesion molecules
adhesion of WBC to capillary endothelial cells
release of proteolytic enzymes and free radicals
Endothelial damage, tissue destruction, local ischemia
44. Varicose ulcer
• During recanalization of varicose veins or DVT
• Most common in medial malleolus
• Gaiter’s zone-handbreadth area around ankle where varicose
ulcerations occur
• Ulcer-shallow,flat
edge-sloping,pale blue
slope-filled with pink granulation tissue
• c/c ulcer-edge-ragged
floor-fibrous
seropurulent discharge with trace of blood
surrounding skin-induration,tenderness,pigmentation
• Rarely proceed to scarring,ankylosis,malignancy-Marjolin’s ulcer
48. Classiffication-CEAP
C. (Clinical class):
- Class 0: No visible or palpable signs of
venous disease.
- Class I : Telangiectasis or reticular veins.
- Class 2: Varicose veins.
- Class 3: Edema.
- Class 4: Skin changes e.g. venous eczema,
pigmentation and lipodermatosclerosis.
- Class 5: Skin changes with healed ulceration
- Class 6: Skin changes with active ulceration
49. E. (Etiology):
Congenital.
Primary (undetermined cause).
Secondary:- Post-thrombotic - Post-traumatic
A. (Anatomic distribution of veins):
Superficial.
Perforator.
Deep.
P. (Pathophysiologicmechanism):
Reflux.
Obstruction.
Reflux and obstruction.
51. Management
• Conservative treatment
Elevation of limb
Support hosiery-elastic crepe bandage /unna boots
drugs-dioxmin,toxerutin
• Injection-sclerotherapy(FEGAN’S TECHNIQUE)
Injecting sclerosants into vein –sodium tetradecyl sulphate
destruction of lipid membranes of endothelial cells
shedding of endothelial cells
thrombosis,fibrosis,obliteration of veins
52.
53.
54. • Surgical treatment- Trendelenburg procedure
(High tie and strip)
1. High saphenous ligation
2. Long saphenous strip
3. Avulsion of varicosities-multiple ligation