1. Varicose veins result from increased pressure in the superficial veins due to gravity and malfunctioning valves. The document discusses various surgical procedures to treat varicose veins including stripping, ligation, and newer minimally invasive techniques like radiofrequency ablation, foam sclerotherapy, and endovenous laser therapy.
2. Precautions are discussed for different patient conditions and potential surgical complications include bruising, infection, nerve damage, and deep vein thrombosis. Proper pre-op evaluation and post-op compression are important to reduce risks.
3. Surgical techniques aim to eliminate reflux by ligating vein sources and removing incompetent veins like the long saphenous vein during stripping procedures or closing veins end
Central venous catheters can be inserted via the internal or external jugular veins using the Seldinger or cutdown techniques. The Seldinger technique involves inserting a needle and guidewire, then dilating and inserting the catheter under fluoroscopy guidance. The cutdown technique requires making an incision to directly access and puncture the vein. Port catheters involve inserting a catheter and subcutaneous reservoir, while Broviac/Hickman catheters have a Dacron cuff. Complications can include pneumothorax, hemothorax, malposition, or arterial puncture.
1. Duplex ultrasound, plethysmography, and venography are common non-invasive and invasive tests used to investigate varicose veins.
2. Treatment options include conservative measures, injection sclerotherapy, and surgery. Surgery involves stripping the saphenous vein and removing tributaries and perforators.
3. Newer treatments include endovenous laser ablation which closes the vein using laser without removal and subfascial endoscopic perforator surgery to ligate perforators through a small incision.
Diagnosis and radiological management of varicose veinsarfraj Ahmad
Varicose veins are abnormally dilated and twisted veins, most commonly occurring in the legs. They are caused by valve incompetence in the veins allowing blood to pool. Duplex ultrasound is the primary imaging method used to evaluate varicose veins and assess reflux. Endovenous ablation techniques like radiofrequency and laser ablation are now preferred over traditional surgical stripping and ligation due to lower risk of complications. These ablative procedures involve inserting a catheter under ultrasound guidance and using heat energy to seal the vein.
The document summarizes the anatomy of arteries in the neck and head region. It describes the branches and course of the common carotid artery, external carotid artery, internal carotid artery, and their major branches including the maxillary artery, lingual artery, facial artery, occipital artery, and ophthalmic artery. It provides details on ligations and surgical approaches for various arteries. Key anatomical structures and landmarks are highlighted.
Surgery for atrial fibrillation abhijit presentationAbhijit Joshi
this presentation starts with the description of atrial fibrillation and goes on to describe the basis of it's surgical cure, viz. The Maze procedure. I then describe the technical aspects of Maze 1,2,3,4...
This document discusses saphenous vein harvesting for coronary artery bypass grafting (CABG). It covers the anatomy of the saphenous vein, techniques for harvesting including open and endoscopic methods, tips for avoiding complications, and postoperative care. The saphenous vein is commonly used as a graft due to its accessibility and handling properties, though the internal mammary artery is preferred due to better long-term patency rates. Care must be taken during harvesting to avoid intimal injury, nerve damage, and ensure hemostasis and wound closure to prevent infection.
Central venous catheters can be inserted via the internal or external jugular veins using the Seldinger or cutdown techniques. The Seldinger technique involves inserting a needle and guidewire, then dilating and inserting the catheter under fluoroscopy guidance. The cutdown technique requires making an incision to directly access and puncture the vein. Port catheters involve inserting a catheter and subcutaneous reservoir, while Broviac/Hickman catheters have a Dacron cuff. Complications can include pneumothorax, hemothorax, malposition, or arterial puncture.
1. Duplex ultrasound, plethysmography, and venography are common non-invasive and invasive tests used to investigate varicose veins.
2. Treatment options include conservative measures, injection sclerotherapy, and surgery. Surgery involves stripping the saphenous vein and removing tributaries and perforators.
3. Newer treatments include endovenous laser ablation which closes the vein using laser without removal and subfascial endoscopic perforator surgery to ligate perforators through a small incision.
Diagnosis and radiological management of varicose veinsarfraj Ahmad
Varicose veins are abnormally dilated and twisted veins, most commonly occurring in the legs. They are caused by valve incompetence in the veins allowing blood to pool. Duplex ultrasound is the primary imaging method used to evaluate varicose veins and assess reflux. Endovenous ablation techniques like radiofrequency and laser ablation are now preferred over traditional surgical stripping and ligation due to lower risk of complications. These ablative procedures involve inserting a catheter under ultrasound guidance and using heat energy to seal the vein.
The document summarizes the anatomy of arteries in the neck and head region. It describes the branches and course of the common carotid artery, external carotid artery, internal carotid artery, and their major branches including the maxillary artery, lingual artery, facial artery, occipital artery, and ophthalmic artery. It provides details on ligations and surgical approaches for various arteries. Key anatomical structures and landmarks are highlighted.
Surgery for atrial fibrillation abhijit presentationAbhijit Joshi
this presentation starts with the description of atrial fibrillation and goes on to describe the basis of it's surgical cure, viz. The Maze procedure. I then describe the technical aspects of Maze 1,2,3,4...
This document discusses saphenous vein harvesting for coronary artery bypass grafting (CABG). It covers the anatomy of the saphenous vein, techniques for harvesting including open and endoscopic methods, tips for avoiding complications, and postoperative care. The saphenous vein is commonly used as a graft due to its accessibility and handling properties, though the internal mammary artery is preferred due to better long-term patency rates. Care must be taken during harvesting to avoid intimal injury, nerve damage, and ensure hemostasis and wound closure to prevent infection.
1) The latissimus dorsi myocutaneous flap is one of the largest soft tissue flaps that can be harvested. It receives its blood supply from the thoracodorsal artery and vein.
2) It has several advantages including a long vascular pedicle and arc of rotation, minimal donor site morbidity, and skin paddle color and texture match for head and neck reconstruction.
3) Disadvantages include the inability to perform simultaneous ablative and reconstructive surgery, risk of vascular pedicle compression, and increased risk of minor complications like seroma formation.
This document describes various extraoral approaches to the mandible, including the submandibular approach. The submandibular approach involves making an incision 1-2 cm below the mandible. Key anatomical structures like the facial artery and vein and marginal mandibular nerve are discussed. The technique involves incising skin and platysma muscle before dissecting through layers to expose the mandible. Care must be taken to protect important nerves and vessels during the dissection.
This document describes the surgical technique for middle fossa surgery. It discusses the important anatomical landmarks in the middle fossa approach including the greater superficial petrosal nerve and arcuate eminence. It provides details on patient positioning, incision, craniotomy, exposure of the middle fossa floor, and finding the internal auditory canal medially and laterally. Applications of the middle fossa approach are summarized, including vestibular schwannoma surgery, vestibular neurectomy, facial nerve surgery, repair of tegmen defects, and petrous apicectomy. The middle fossa approach provides superior access while preserving inner ear function and the proximal intratemporal facial nerve.
Recent advances in minimal access surgery.pptxManoj H.V
This document summarizes recent advances in minimally invasive surgery techniques. It discusses laparoscopic inguinal hernia repair procedures like transabdominal preperitoneal repair and total extraperitoneal repair. It also describes newer natural orifice transluminal endoscopic surgery techniques, bikini line laparoscopic cholecystectomy, and transanal total mesorectal excision for rectal cancer surgery. The document provides details of techniques, advantages, and limitations of various minimally invasive procedures.
This document provides information on techniques for treating priapism. It discusses:
1) Pre-operative evaluation including distinguishing between ischemic and non-ischemic priapism through history, exam, and blood tests.
2) Treatment for ischemic priapism includes immediate decompression through aspiration and irrigation of blood from the corpus cavernosum along with alpha-adrenergic drugs.
3) For non-ischemic priapism, initial observation is recommended and other options include embolization or androgen ablation if it persists.
4) Surgical techniques for refractory cases include percutaneous distal shunts like Winter and Ebbehoj techniques or open distal shunt
This document describes the procedure for jugular venography. It begins with the anatomy of the transverse and sigmoid sinuses which drain into the jugular foramen. It then lists indications for the procedure such as evaluating tumors in the jugular fossa region. The technique involves accessing the internal jugular vein in the neck under fluoroscopy and injecting contrast dye to image the dural sinuses that drain into it. Images are taken in multiple projections to visualize the venous anatomy and check for obstructions.
This document discusses rotator cuff tears, including the anatomy and function of the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis). It describes the clinical examination for rotator cuff tears including specific tests. Imaging options like x-ray, MRI, ultrasound and arthrogram are discussed. Treatment options include conservative treatment or surgery like arthroscopic debridement or repair. Surgical technique, complications, and outcomes are summarized. Rotator cuff tears can range from partial to full thickness tears and prognosis depends on factors like age, tear size, and muscle atrophy.
The document provides an outline for performing an open appendectomy surgery. It discusses the relevant anatomy of the appendix, causes of appendicitis, pre-operative care including investigations and antibiotic treatment. It describes the surgical technique including common incisions used, identifying and ligating the appendix and closing the wound. Post-operative care involves monitoring for complications and managing patients depending on whether the case was complicated or uncomplicated.
This document provides an overview of neck dissection procedures, including:
- A classification system for neck dissections and descriptions of radical, modified radical, extended, and selective neck dissections.
- Generic steps for all neck dissections including incision, exposure, and lymph node removal.
- Detailed descriptions of performing a radical neck dissection, focusing on three areas of special attention: the lower end of the internal jugular vein, the junction of the clavicle and trapezius muscle, and the upper end of the internal jugular vein.
Rib cartilage is a potential donor site for autologous grafts in rhinoplasty. Experienced radiologists can determine the extent of calcification in rib cartilage, which indicates its suitability for grafting. The procedure involves marking and incising the skin over the 5th-7th rib and dissecting the cartilage subperichondrially. Potential complications include pneumothorax, which can usually be treated without a chest tube. Proper technique aims to minimize complications and maximize graft viability.
The document provides detailed anatomical information about the sellar and suprasellar region. It describes the structures of the sphenoid bone, sphenoid sinus, diaphragma sellae, pituitary gland, cavernous sinus and their relationships. It also discusses the anatomy of the third ventricle and surrounding structures important for pituitary adenoma surgery, including cranial nerves, blood vessels and cisterns. Common tumors of the sellar region are also listed, along with surgical techniques for tumor removal such as transphenoidal hypophysectomy, transcranial hypophysectomy and computer-assisted surgery.
1) Tracheostomy is a surgical procedure to create an opening into the trachea through the neck. It allows direct access to the breathing tube and is used when a patient requires long-term ventilation or airway clearance.
2) The procedure involves making an incision through the neck, separating the strap muscles, and opening the trachea between the second and fourth tracheal rings. A tracheostomy tube is then inserted.
3) Complications can include bleeding, tube displacement or obstruction, and long-term issues like stenosis. Proper care is needed to suction and change the tube to prevent complications and allow for recovery.
Radial artery access ,complications and magementS S SRINIVASAN
1. Radial artery access is an alternative to femoral artery access for coronary procedures that offers advantages like lower bleeding risks and faster recovery times.
2. The radial artery anatomy and variations like tortuosity must be considered to select appropriate patients and techniques.
3. Radial artery puncture and navigation of wires and catheters through the arm requires specialized techniques to prevent complications like spasm or dissection.
4. Maintaining radial artery patency with anticoagulation, proper compression, and monitoring is important to prevent radial artery occlusion following the procedure.
The radial forearm flap is based on the radial artery and its venae comitantes. It has a long history of use since the 1970s for reconstructing various head and neck, facial, and extremity defects. The radial forearm flap has reliable anatomy, can be harvested as a pedicle or free flap, and provides a thin, pliable skin that is well-suited for reconstruction. The flap is elevated along a fascial plane, with the radial artery and venae comitantes preserved. While it is very reliable, complications can include tendon tethering, infection, and donor site morbidity like weakness or pain.
This document discusses venesection, which is a surgical procedure to access veins for intravenous access. It describes indications for the procedure such as hemorrhagic shock or when peripheral veins are not visible. The preferred site is the great saphenous vein at the ankle or groin. Equipment needed and steps of the procedure are outlined. Potential complications include failed cannulation, hemorrhage, and infection. Venous cutdown remains an option when other intravenous access methods have failed.
This document discusses posterior urethral distraction defects (PFUDD) following pelvic fractures. It describes that a hematoma-fibrosis complex forms between the separated urethral ends rather than a simple stricture. Multimodality management including orthopedics may be needed. Imaging like retrograde urethrogram can show a characteristic S-bend deformity. A transpubic approach like the Waterhouse procedure combines perineal and abdominal incisions to allow a tension-free anastomosis but may cause complications like incontinence or impotence.
This document provides an overview of the surgical anatomy of the retina. It describes the dimensions and structures of the normal globe, including the sclera, conjunctiva, tenon's capsule, extraocular muscles, uvea, vitreous body, and vasculature. It also discusses variations seen in conditions like myopia and considerations for pediatric patients. Key surgical tips are provided, such as instrument selection and port placement for different procedures to avoid damaging important anatomical structures like the vortex veins and ciliary arteries.
Frontal venography is a technique where contrast dye is injected into the frontal vein or its tributaries to visualize the orbital veins. Radiographs are then taken to determine if there is an orbital space-occupying lesion in patients with unilateral exophthalmos. It can help diagnose the nature, site and size of orbital lesions when other imaging fails. The technique involves injecting contrast into the frontal vein to outline the venous drainage from the superior ophthalmic vein to the internal jugular vein. Proper positioning and subtraction techniques are important to clearly visualize the cavernous sinuses.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
1) The latissimus dorsi myocutaneous flap is one of the largest soft tissue flaps that can be harvested. It receives its blood supply from the thoracodorsal artery and vein.
2) It has several advantages including a long vascular pedicle and arc of rotation, minimal donor site morbidity, and skin paddle color and texture match for head and neck reconstruction.
3) Disadvantages include the inability to perform simultaneous ablative and reconstructive surgery, risk of vascular pedicle compression, and increased risk of minor complications like seroma formation.
This document describes various extraoral approaches to the mandible, including the submandibular approach. The submandibular approach involves making an incision 1-2 cm below the mandible. Key anatomical structures like the facial artery and vein and marginal mandibular nerve are discussed. The technique involves incising skin and platysma muscle before dissecting through layers to expose the mandible. Care must be taken to protect important nerves and vessels during the dissection.
This document describes the surgical technique for middle fossa surgery. It discusses the important anatomical landmarks in the middle fossa approach including the greater superficial petrosal nerve and arcuate eminence. It provides details on patient positioning, incision, craniotomy, exposure of the middle fossa floor, and finding the internal auditory canal medially and laterally. Applications of the middle fossa approach are summarized, including vestibular schwannoma surgery, vestibular neurectomy, facial nerve surgery, repair of tegmen defects, and petrous apicectomy. The middle fossa approach provides superior access while preserving inner ear function and the proximal intratemporal facial nerve.
Recent advances in minimal access surgery.pptxManoj H.V
This document summarizes recent advances in minimally invasive surgery techniques. It discusses laparoscopic inguinal hernia repair procedures like transabdominal preperitoneal repair and total extraperitoneal repair. It also describes newer natural orifice transluminal endoscopic surgery techniques, bikini line laparoscopic cholecystectomy, and transanal total mesorectal excision for rectal cancer surgery. The document provides details of techniques, advantages, and limitations of various minimally invasive procedures.
This document provides information on techniques for treating priapism. It discusses:
1) Pre-operative evaluation including distinguishing between ischemic and non-ischemic priapism through history, exam, and blood tests.
2) Treatment for ischemic priapism includes immediate decompression through aspiration and irrigation of blood from the corpus cavernosum along with alpha-adrenergic drugs.
3) For non-ischemic priapism, initial observation is recommended and other options include embolization or androgen ablation if it persists.
4) Surgical techniques for refractory cases include percutaneous distal shunts like Winter and Ebbehoj techniques or open distal shunt
This document describes the procedure for jugular venography. It begins with the anatomy of the transverse and sigmoid sinuses which drain into the jugular foramen. It then lists indications for the procedure such as evaluating tumors in the jugular fossa region. The technique involves accessing the internal jugular vein in the neck under fluoroscopy and injecting contrast dye to image the dural sinuses that drain into it. Images are taken in multiple projections to visualize the venous anatomy and check for obstructions.
This document discusses rotator cuff tears, including the anatomy and function of the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis). It describes the clinical examination for rotator cuff tears including specific tests. Imaging options like x-ray, MRI, ultrasound and arthrogram are discussed. Treatment options include conservative treatment or surgery like arthroscopic debridement or repair. Surgical technique, complications, and outcomes are summarized. Rotator cuff tears can range from partial to full thickness tears and prognosis depends on factors like age, tear size, and muscle atrophy.
The document provides an outline for performing an open appendectomy surgery. It discusses the relevant anatomy of the appendix, causes of appendicitis, pre-operative care including investigations and antibiotic treatment. It describes the surgical technique including common incisions used, identifying and ligating the appendix and closing the wound. Post-operative care involves monitoring for complications and managing patients depending on whether the case was complicated or uncomplicated.
This document provides an overview of neck dissection procedures, including:
- A classification system for neck dissections and descriptions of radical, modified radical, extended, and selective neck dissections.
- Generic steps for all neck dissections including incision, exposure, and lymph node removal.
- Detailed descriptions of performing a radical neck dissection, focusing on three areas of special attention: the lower end of the internal jugular vein, the junction of the clavicle and trapezius muscle, and the upper end of the internal jugular vein.
Rib cartilage is a potential donor site for autologous grafts in rhinoplasty. Experienced radiologists can determine the extent of calcification in rib cartilage, which indicates its suitability for grafting. The procedure involves marking and incising the skin over the 5th-7th rib and dissecting the cartilage subperichondrially. Potential complications include pneumothorax, which can usually be treated without a chest tube. Proper technique aims to minimize complications and maximize graft viability.
The document provides detailed anatomical information about the sellar and suprasellar region. It describes the structures of the sphenoid bone, sphenoid sinus, diaphragma sellae, pituitary gland, cavernous sinus and their relationships. It also discusses the anatomy of the third ventricle and surrounding structures important for pituitary adenoma surgery, including cranial nerves, blood vessels and cisterns. Common tumors of the sellar region are also listed, along with surgical techniques for tumor removal such as transphenoidal hypophysectomy, transcranial hypophysectomy and computer-assisted surgery.
1) Tracheostomy is a surgical procedure to create an opening into the trachea through the neck. It allows direct access to the breathing tube and is used when a patient requires long-term ventilation or airway clearance.
2) The procedure involves making an incision through the neck, separating the strap muscles, and opening the trachea between the second and fourth tracheal rings. A tracheostomy tube is then inserted.
3) Complications can include bleeding, tube displacement or obstruction, and long-term issues like stenosis. Proper care is needed to suction and change the tube to prevent complications and allow for recovery.
Radial artery access ,complications and magementS S SRINIVASAN
1. Radial artery access is an alternative to femoral artery access for coronary procedures that offers advantages like lower bleeding risks and faster recovery times.
2. The radial artery anatomy and variations like tortuosity must be considered to select appropriate patients and techniques.
3. Radial artery puncture and navigation of wires and catheters through the arm requires specialized techniques to prevent complications like spasm or dissection.
4. Maintaining radial artery patency with anticoagulation, proper compression, and monitoring is important to prevent radial artery occlusion following the procedure.
The radial forearm flap is based on the radial artery and its venae comitantes. It has a long history of use since the 1970s for reconstructing various head and neck, facial, and extremity defects. The radial forearm flap has reliable anatomy, can be harvested as a pedicle or free flap, and provides a thin, pliable skin that is well-suited for reconstruction. The flap is elevated along a fascial plane, with the radial artery and venae comitantes preserved. While it is very reliable, complications can include tendon tethering, infection, and donor site morbidity like weakness or pain.
This document discusses venesection, which is a surgical procedure to access veins for intravenous access. It describes indications for the procedure such as hemorrhagic shock or when peripheral veins are not visible. The preferred site is the great saphenous vein at the ankle or groin. Equipment needed and steps of the procedure are outlined. Potential complications include failed cannulation, hemorrhage, and infection. Venous cutdown remains an option when other intravenous access methods have failed.
This document discusses posterior urethral distraction defects (PFUDD) following pelvic fractures. It describes that a hematoma-fibrosis complex forms between the separated urethral ends rather than a simple stricture. Multimodality management including orthopedics may be needed. Imaging like retrograde urethrogram can show a characteristic S-bend deformity. A transpubic approach like the Waterhouse procedure combines perineal and abdominal incisions to allow a tension-free anastomosis but may cause complications like incontinence or impotence.
This document provides an overview of the surgical anatomy of the retina. It describes the dimensions and structures of the normal globe, including the sclera, conjunctiva, tenon's capsule, extraocular muscles, uvea, vitreous body, and vasculature. It also discusses variations seen in conditions like myopia and considerations for pediatric patients. Key surgical tips are provided, such as instrument selection and port placement for different procedures to avoid damaging important anatomical structures like the vortex veins and ciliary arteries.
Frontal venography is a technique where contrast dye is injected into the frontal vein or its tributaries to visualize the orbital veins. Radiographs are then taken to determine if there is an orbital space-occupying lesion in patients with unilateral exophthalmos. It can help diagnose the nature, site and size of orbital lesions when other imaging fails. The technique involves injecting contrast into the frontal vein to outline the venous drainage from the superior ophthalmic vein to the internal jugular vein. Proper positioning and subtraction techniques are important to clearly visualize the cavernous sinuses.
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
15. Indications for Surgery
* Better results with early treatment:
For operative treatment:-
1.Positive Trendelenburg Test
2.Particularily saphenofemoral
incompetence
3.Causing discomfort to the patient
4.Complications like venous ulcer
5.Cosmetic reasons
16.
DVT- superficial varices developing after a venous
thrombosis, may be the only route of venous drainage
in lower limb and should not be removed until the
patency of deep veins of limb has been shown
*patient will depend on superficial veins for venous
drainage
Pregnancy
Woman on contraceptive pills
Thrombophlebitis
17. Pre-op
Operation postponed till
complications are rid of
Complete Local
examination : Perform all
Tests
Further investigations for
diagnosis:-
-Duplex USG imaging
-Doppler USG
-USG abdomen- rule out
abdominal pathology in
suspected cases
18. • Explain investigations
• Explain planned surgery
• Describe anaesthetic technique
• Risk of DVT
• Risk of superficial phlebitis
• Risk of bruising and swelling
• Risk of wound infection
• Damage to superficial nerves- sural,
saphenous,cutaneous
21. an oblique incision made in
the groin centered
2.5 cm below and lateral to
pubic tubercle
22. Skin incision exposes
the membraneous layer
of supericial fascia.
Incision deepened
adequately to expose
SFJ safely
23. Fat is brushed downwards .Long saphenous vein
found by blunt dissection & traced upto T-shaped
termination with femoral vein (must confirm the T
junction, before ligation)
24. Check correct identity of saphenous vein ,its junction
with the junction with the common femoral vein seen
from both medial and lateral aspects.
25. Once certain of its correct identity ,the saphenous vein is
divided and drawn forward to facilitate division of its
branches
26. When fully isolated,the saphenous stump is
ligated flush with the common femoral vein and
then again,more peripherally,with a transfixion
27. • All the tributaries that join the
saphenous vein near its termination
( supericial inferior epigastric,superficial
circumflex iliac,superficial external
pudendal) must be dissected out ,ligated
with 2/0 polyglactin ÷d.In
addition to this anterolateral and
posteromedial thigh veins terminate
close to s-f junction
29. • Main principle of surgical treatement is to
ligate source of venous reflux and remove
incompetent saphenous trunk
• Done alone, there is a high chance of
recurrence
• To ensure elimination of as much as reflux
as possible, must remove LSV
30. • Place a ligature around the
LSV trunk& hold it up ,to
occlude the flow of blood
from below.
• Make a side hole in the
vein above the ligature
through which the tip of
the stripper can be
introduced.
31. The conventional way of removing
the saphenous vein is with a
Babcock stripper.
Babcock stripper or a rigid metal
'pin stripper' consists of a flexible
wire that is passed down the long
saphenous vein
End is identified in the the upper
third of the calf and a 2mm incision
made to retrieve the stripper
An olive of about 8mm in diameter
is attached to the upper end and the
saphenous vein is removed by firm
traction on the wire in the calf
Closure: incision sutured and limb
elevated
32.
33. Saphenopopliteal Junction
Ligation & Stripping
• Pre-op USG for localization of junction
• A transverse skin incision made in popliteal fossa
just below termination of vein
• Deep fasia incised to reveal short saphenous vein
beneath
• Vein followed to SPJ, where SSV enters the side of
popliteal vein
• Vein then ligated and divided close to popliteal vein
• Can strip SSV using inverting technique; stripper
passed upwards from the ankle, carefully dissecting
off the sural nerve to ensure that the whole of the
lesser saphenous vein is removed
34.
35. What is inversion stripping?
Aim is to reduce damage to tissues around vein
Less pain and bleeding
Rigid metal pin stripper (Oesh) passed down
the inside of the saphenous vein and recovered
through a small incision in the upper part of calf
A strong suture attached to the end of the
stripper and firmly ligated to the proximal end of
the vein
During pulling of stripper, LSV will invert and
can be delivered through 2mm incision in midcalf
region
No olive used
41. 1. A tourniquet is placed above the knee and an
Esmarch band is placed tightly around the
lower extremity to empty the blood from the
surgical site.
2. The tourniquet is inflated to supra systolic
blood pressure (usually 300 mm Hg).
3. An incision is made one-hand’s width below
the tibial prominence and two-finger’s
breadth posterior to the anterior border of the
tibia. This provides access for the camera and
carbon dioxide insufflation.
42. 4. A large balloon trocar is placed through
this incision into the subfascial plane
and filled with 180 cc of saline to
expand the space. The balloon is
emptied and removed. Carbon dioxide
insufflation is started through the
trocar, maintaining a pressure of 30
mm Hg to keep the subfascial space
expanded and to allow visualization of
the structures.
43. 5. Frequently, a second incision is placed
inferior and posterior to the first,
allowing insertion of the instruments
that perform the vein ligation (either
cautery hook or clip applier and
scissors).
6. The camera follows the instruments in
a caudal direction and perforating
veins are identified traversing the
subfascial space. The veins are divided
and the instruments are removed. The
incisions then are closed in two layers
and a pressure dressing is applied
before the tourniquet is released
44. .7.The procedure is frequently performed
in an ambulatory care setting. The
pressure dressing is left in place for 2 to
5 days. Lower extremity activity is
limited for 5 to 7 days. Full recovery is
usually attained in 2 weeks.
46. Involves a long incision along the
medial or posterior aspect of the calf
and blind division of the perforators.
Has a high chance of haematoma and
chronic skin changes and is rarely used
today.
47.
48. A Detergent is injected directly into the superficial veins
The detergent destroys the lipid membranes of endothelial cells
causing them to shed,leading to thrombosis,fibrosis and
obliteration.
Continued local compression is given following sclerosant injection
to reduce the incidence and amount of superficial thrombosis and
improve the sclerosis of the vein.
49.
50.
51.
52.
53. Foam injected under ultrasound
monitoring
Top of saphenous vein
compressed by ultrasound to
prevent foam entering the deep
veins,until spasm in the main trunk
develops
POLIDOCANOL
56. •A laser probe is passed up inside a
catheter inserted ino the lower part o the
saphenous
vein under ultrasound guidance
•Crystalloid fluid - L.A& prevents burns
•Duplex ultrasound confirms LASER probe
is at SFJ and the LASER probe is then
withdrawn, administering a set number of
joules to the endothelial lining
57.
58. Aim is to remove all the varicosities through incisions
that require no suture
After stripping, residual veins and tributaries are left
behind.
Veins are taken care of by means of small hooks,
inserted through incisions of 1-2mm size
Hook is used to capture a small section of a varicosity
and bring it to the surface, where it is grasped with large
artery forceps; remaining vein is then teased through
tiny incision.
Closure of small incision achieved using adhesive
strips ;Very good cosmetic outcome
59.
60.
61. THIS IS A PERCUTANEOUS
TECHNIQUE FOR REMOVING
SUPERFICIAL VEINS BY
SUCTION FOLLOWING
INJECTION OF LARGE
QUANTITIES OF FLUID
THIS IS A PERCUTANEOUS
TECHNIQUE FOR REMOVING
SUPERFICIAL VEINS BY
SUCTION FOLLOWING
INJECTION OF LARGE
QUANTITIES OF FLUID
I
INDURATION
BRUISING
SUBCUTANEOUS GROOVES
62. •Legs are elevated
•Analgesia given
•Compression bandaging
applied to the limb to
prevent excessive
bruising ;1-2 days later,
replaced with thigh-
length compression
stocking