anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
Varicose veins:A never ending problem if mistreated!KETAN VAGHOLKAR
Varicose veins is one of the most distressing disorders affecting the lower limbs. It is commonly seen in individuals who stand for prolonged hours thus causing immense pain and discomfort. These days it is also found in individuals who sit for prolonged periods as seen in computer professionals. Proper treatment based on good understanding of the pathophysiology underlying the disease is pivitol for a successful outcome. the presentation outlines the approach to the problem for practitioners
Fwd: Bambury lecture on venous and lymphatic disorders of the limbJeku Jacob
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From: Henning L. Stokmo <helangen@gmail.com>
Date: 2009/2/12
Subject: Bambury lecture on venous and lymphatic disorders of the limb
To: ucdgrad09@gmail.com
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!
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
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
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
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.
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
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.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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
3. The Long & Short Saphenous Veins
Superficial veins of the leg.
• 1-Sapheno-femoral junction
(SFJ),
• 2-Great saphenous vein (GSV),
• 3-Anterior accessory saphenous
vein (AASV),
• 4-Posterior accessory
saphenous vein (PASV),
• 5-Anterior thigh circumflex vein
(ATCV),
• 6- Posterior thigh circumflex vein
(PTCV)
• 7-Sapheno-popliteal junction
(SPJ),
• 8-Small saphenous vein (SSV),
• 9-Thigh extension of the small
saphenous vein (TE SSV),
• 10-Intersaphenous vein
(Intersaph. V)
4. Mainsitesofsuperficialtodeepvenouscommunication
Medial
malleolus
Sapheno-femoral junction
Mid thigh perforator
(Hunter’s canal)
Medial calf
perforators
Just below
Just above
10 cm above
Just below the knee
The lower
perforators
are joined to
form the
Posterior
arch vein
Thigh
perforators
connect to
the long
saphenous
main trunk
May or Kuster
ankle perforators
Cockett lower leg
perforators(3)
Boyd
gastrocnemius
perforators
Dodd
perforator
5. Valves
• Connects the deep
and superficial
system via the
perforators
• Divide the veins into
segments
• Unidirectional (from
below upwards ,, or
from superficial to
deep )
6. Venous return
• Venomotor tone
[Upright position -- dependant
pooling – dec. cardiac output -
- inc. sympathetic discharge --
inc. venous tone -- inc. venous
return.]
• Calf muscle contraction
Blood is pushed upwards and
from superficial to deep sys.
prevented from retrograde
flow by competent venous
valves
7. Competent Veno-muscular
Pump is composed of:
1. Superficial &
deep veins with
competent valves.
2. Competent
perforating veins
communicating
the deep &
superficial
systems
3. Powerful lower
limb muscles.
8. Ambulatory venous pressure
• The ankle venous pressure
during walking.
• (AVP) is the "gold standard"
test of the efficiency of the
calf musculovenous pump
• by placing a small needle into
one of the veins on the back
of the foot and connecting
the needle to a blood
pressure measurement
machine. The test has three
parts
• standing venous pressure is
around 90 mmHg , During
exercise this should fall to
around 30 mmHg.
9. "Ankle blow out" syndrome for
varicose veins
• Perforator vein incompetence in
the gaiter areas have been shown
to increase ambulatory venous
pressures (venous hypertension),
a phenomenon which has also
been referred to "ankle blow-
out" syndrome in the gaiter
areas.
• The combination of incompetent
perforator veins and
resultant venous hypertension
over time causes damage to
capillaries in the skin and
subcutaneous capillaries,
allowing protein rich fluid and
red blood cells to escape into the
subcutaneous tissue around the
ankle
10. CVI (chronic venous
insufficiency)
• CVI collectively
describes the
manifestations of
impaired venous return
due to abnormal
venous system
function.
11. CVI
• Whatever the cause of CVI, it will eventually cause
venous hypertension of the microcirculation,
giving the same symptoms & signs.
• The severity of symptoms & signs depend on the
degree & duration of venous hypertension
When veins fail,
the microcirculation
suffers.
12. CVI(symptoms and signs)
• Early
1-Posture related
discomfort
2-Lower limb
oedema
3-Muscle cramps
• Persistent & Sever
4. Ankle brown
pigmentation
5. Venous eczema
6.Lipodermatosclerosis
7. Venous ulcer
8- Talipes
13. Varicose veins
• Tortuous dilated
elongated veins.
• Defective connective
tissue and smooth
muscle in the vain
wall.
• Valve not working.
• Gathering of blood
within veins.
14. CLASSIFICATION
• (CEAP) classification from the American Venous Forum, last revised 2004.
Clinical
•C0 - No visible or
palpable signs of
venous disease
•C1 - Telangiectases or
reticular veins
•C2 - Varicose veins
•C3 - Edema
•C4a - Pigmentation or
eczema
•C4b -
Lipodermatosclerosis
or atrophie blanche
•C5 - Healed venous
ulcer
•C6 - Active venous
ulcer
Etiologic
•Ec – Congenital
•Ep – Primary
•Es - Secondary (post-
thrombotic)
•En - No venous cause
identified
Anatomic
•As - Superficial veins
•Ap - Perforator veins
•Ad - Deep veins
•An - No venous
location identified
Pathophysiologic
•Pr – Reflux
•Po – Obstruction
•Pr,o – Reflux and
obstruction
•Pn - No venous
pathophysiology
identifiable
EXAMPLE : C6, Ep, As,p,d, Pr
16. 1-Superficial vein affected (long S. , short S.,
SFJ, SPJ , tributaries, stray V., perforators i.e
blow out ).
2-Describe the dilated superficial vein(s).
(Telangectasias-Reticular veins- varicose V.)
3-Look for signs of thrombophlebitis.
4-Inspect the ankle and look for signs of CVI.
5-Inspect the groin (static and dynamic)
,searching for masses, dilated V., Impulse, scar .
6-exclude ischemia.
17. Site and extent of the affected vein (in
the standing position)
18. 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
19.
20. Reticular veins
• Subcutaneous dilated
veins-enter
tributaries of main
axial/trunk veins
• Size >spider veins
<varicose vein
21. Blow out
• Defect in the deep
fascia at the site of
incompetent
perforator
23. Pigmentation & eczema
• The skin
pigmentation of
chronic venous
insufficiency is
associated both with
increased melanin
production and also
with deposition of
haemosiderin
24. Lipodermatosclerosis
• Progressive
scaring of skin
and subcutaneous
fat due to venous
insufficiency, area
affected becomes
thin and hard- area
above becomes
oedematous
(Champagne bottle
appearance)
25. Venous ulcer
• As a complication of
CVI and ankle
blowout syndrome
(due to increase the
AVP)
• At the gaiter area
(site of ankle
perforators)
26.
27. Clinical
features
Ischemic ulcer Venous ulcer
Gender Men > women Women > men
Age Usually presents > 60 years Typically develops 40-60 years
Risk factors Smoking, diabetes, hyperlipidemia and
hypertension
Previous DVT, thrombophilia, varicose
vein
Symptoms Severe pain unless there is diabetic
neuropathy
Pain but not severe, relieved by
elevation
Site Pressure area (heel, metatarsal head
and base)
Medial and lateral malleoli
Edge Regular, punched out Irregular, with neo-epithelium
Base Deep, green (sloughy) or black
(necrotic) with no granulation tissue,
may involve tendon, bone and joint
Pink and granulating
Surrounding
skin
Shows signs of ischemia (cold, pale,
atrophic….)
Varicose eczema, indurations,
pigmentation, redness.
Veins Empty Full, usually varicosed
Swelling Usually absent Often present
52. Doppler ultrasound
• The transducer sends and
receives sound waves that
are amplified through a
microphone.
• The sound waves bounce
off solid objects, including
blood cells.
• The movement of blood
cells causes a change in
pitch of the reflected
sound waves (called the
Doppler effect).
• If there is no blood flow,
the pitch does not change.
53. Duplex
• Combines Doppler flow
information and
conventional imaging
information.
• Sometimes called B-
mode, to allow physicians
to see the structure of
your blood vessels.
• It can also be useful to
estimate the diameter of a
blood vessel as well as the
amount of obstruction, if
any, in the blood vessel
54. Management
• For incompetent perforator
1-Trendelenburg operation (saphenofemoral disconnection)
2- saphenopoplitial disconnection
3-Subfascial ligation (OPEN OR ENDOSCPPIC= SEPS)
4-endovasculer occlusion
• For incompetent dilated vein
1-Stripping
2-Endoluminal occlusion of the saphenous vein by radiofrequency
(RF) ,laser energy or foam injection.
3-Stab avulsion of varices with or without saphenous vein stripping
(phlebectomy)
• For valve incompetence ??
• For the ulcer
1-biopsy if suspicious
2-Compression dressings (4 layer , Unna’s boot…atc)
3-coverage
56. • Brodie–Trendelenburg percussion test (also accredited to Sir
Benjamin Collins Brodie) is a test for incompetent valves
in superficial veins
• Trendelenburg's cannula: a cannula used during surgery of
the larynx to prevent the patient from swallowing blood during
surgery involving the head and neck
• Trendelenburg gait: an abnormal gait caused by weakness of
the abductor muscles of the lower limb, including the gluteus
medius and gluteus minimus muscles.
• Trendelenburg operation: ligation of the great saphenous vein, for
the treatment of varicose veins. This term may also apply
to pulmonary thrombectomy
• Trendelenburg position, in which the patient is placed on a bed
which is put into incline such that the patient's head is lower than
his feet
• Trendelenburg's sign: a sign of congenital dislocation of the hip
• Trendelenburg's test: a test for varicose veins as well as a test to
assess hip mobility
61. Profore system (four layers
compression)
• orthopaedic wadding
(Velband) was
applied over the
primary dressing
• crepe bandage
• Elset bandage
• final layer of a
cohesive bandage
(Coban)