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!
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
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!
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Deep vein thrombosis (DVT), is the formation of a blood clot in a deep vein, most commonly the legs.[2][a] Symptoms may include pain, swelling, redness, or warmth of the affected area. About half of cases have no symptoms. Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.[2][3]
Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation. The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Deep vein thrombosis (DVT), is the formation of a blood clot in a deep vein, most commonly the legs.[2][a] Symptoms may include pain, swelling, redness, or warmth of the affected area. About half of cases have no symptoms. Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.[2][3]
Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation. The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.
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.
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
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
2. 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
4. Leg Vein Anatomy
• The venous system
is comprised of:
– Deep veins
– Superficial veins
– Perforator veins
VN20-03-B 10/04
5. 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
6. • 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
7. • 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
8. 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
9. 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
10. 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
11.
12. 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
13. 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.
14. Valve leaflets allow
unidirectional flow upward or
inward.
“nonrefluxing of valves”
Major valves-ostial valve
preterminal valve
Venous valvular function
18. 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
19. 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
20.
21. Reticular veins
• Subcutaneous dilated veins-enter
tributaries of main axial/trunk veins
(1-3mm)• Size >spider veins
<varicose vein
• “feeder veins”-
refluxing reticular veins spider veins
• Cause discomfort and is cosmetically
undesirable
22.
23.
24. 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
26. 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
27. • Secondary varicosities
recurrent thrombophlebitis
Occupational
Obstruction to venous return
Pregnancy
Iatrogenic-in AV fistula
Deep vein thrombosis
28.
29. 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
Symptoms
32. 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
33. Champagne bottle sign
• Inverted beer bottle look
• Contraction of ankle skin and s/c tissue
with prominent edematous calf
35. 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
36.
37. 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
38.
39. 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
40. Hemorrhage
Ulcerations
phlebitis
Pigmentations
Eczema
lipodermatosclerosis
Periostitis
Calcification of vein
Equinus deformity
Acute fat necrosis can occur, esp: at ankle
Deep vein thrombosis
41. 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
Reasons for complications
42. 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
43. 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
47. 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
Classiffication-CEAP
48. 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.
50. Management
• Conservative treatment
Elevation of limb
Support hosiery-elastic crepe bandage /unna boots
drugs-dioxmin,toxerutin
N’S TECHNIQUE)
sodium tetradecyl sulphate
of endothelial cells
• Injection-s
Inje
dest
shed
thro
clerotherapy(FEGA
cting sclerosants into vein –
ruction of lipid membranes
ding of endothelial cells
mbosis,fibrosis,obliteration of veins
51.
52.
53. • Surgical treatment- Trendelenburg procedure
(High tie and strip)
1. High saphenous ligation
2. Long saphenous strip
3. Avulsion of varicosities-multiple ligation