#Vascular Trauma Treatment

[drsumitblog]

7 Ways to Protect Your Legs from Varicose Veins at Work

Discover effective strategies to combat varicose veins for individuals who work long hours standing up. Learn how to protect your health and well-being. Should you experience discomfort or seek treatment options, seeking professional medical advice is paramount. Dr. Sumit Kapadia, a distinguished vascular surgeon in Vadodara, specializing in varicose vein treatments, offers tailored solutions and expert guidance to address varicose vein concerns effectively.

[myrawjcsmicasereports]

Retinal and choroidal vascular drop out in a case of severe phenotype of Flammer Syndrome. Rescue of the ischemic-preconditioning mimicking action of endogenous Erythropoietin (EPO) by off-label intra vitreal injection of recombinant human EPO (rhEPO) by Claude Boscher in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Erythropoietin (EPO) is a pleiotropic anti-apoptotic, neurotrophic, anti-inflammatory, and pro-angiogenic endogenous agent, in addition to its effect on erythropoiesis. Exogenous EPO is currently used notably in human spinal cord trauma, and pilot studies in ocular diseases have been reported. Its action has been shown in all (neurons, glia, retinal pigment epithelium, and endothelial) retinal cells. Patients affected by the Flammer Syndrome (FS) (secondary to Endothelin (ET)-related endothelial dysfunction) are exposed to ischemic accidents in the microcirculation, notably the retina and optic nerve.

Case Presentation: A 54 years old female patient with a diagnosis of venous occlusion OR since three weeks presented on March 3, 2019. A severe Flammer phenotype and underlying non arteritic ischemic optic neuropathy; retinal and choroidal drop-out were obviated. Investigation and follow-up were performed for 36 months with Retinal Multimodal Imaging (Visual field, SD-OCT, OCT- Angiography, Indo Cyanin Green Cine-Video Angiography). Recombinant human EPO (rhEPO)(EPREX®)(2000 units, 0.05 cc) off-label intravitreal injection was performed twice at one month interval. Visual acuity rapidly improved from 20/200 to 20/63 with disparition of the initial altitudinal scotoma after the first rhEPO injection, to 20/40 after the second injection, and gradually up to 20/32, by month 5 to month 36. Secondary cystoid macular edema developed ten days after the first injection, that was not treated via anti-VEGF therapy, and resolved after the second rhEPO injection. PR1 layer integrity, as well as protective macular gliosis were fully restored. Some level of ischemia persisted in the deep capillary plexus and at the optic disc.

Conclusion: Patients with FS are submitted to chronic ischemia and paroxystic ischemia/reperfusion injury that drive survival physiological adaptations via  the hypoxic-preconditioning mimicking effect of endogenous EPO, that becomes overwhelmed in case of acute hypoxic stress threshold above resilience limits. Intra vitreal exogenous rhEPO injection restores retinal hypoxic-preconditioning adaptation capacity, provided it is timely administrated. Intra vitreal rhEPO might be beneficial in other retinal diseases of ischemic and inflammatory nature.

Key words : Erythropoietin, retinal vein occlusion, anterior ischemic optic neuropathy, Flammer syndrome, Primary Vascular Dysfunction, anti-VEGF therapy, Endothelin, microcirculation, off-label therapy.

Introduction

Retinal Venous Occlusion (RVO) treatment still carries insufficiencies and contradictions (1) due to the incomplete deciphering of the pathophysiology and of its complex multifactorial nature, with overlooking of factors other than VEGF up-regulation, notably the roles of  retinal venous tone and Endothelin-1 (ET) (2-5), and of endothelial caspase-9 activation (6). Flammer Syndrome (FS)( (Primary Vascular Dysfunction) is related to a non atherosclerotic ET-related endothelial dysfunction in a context of frequent hypotension and increased oxidative stress (OS), that alienates organs perfusion, with notably changeable functional altered regulation of blood flow (7-9), but the pathophysiology remains uncompletely  elucidated (8). FS is more frequent in females, and does not seem to be expressed among outdoors workers, implying an influence of sex hormons and light (7)(9). ET is the most potent pro-proliferative, pro-fibrotic, pro-oxidative and pro-inflammatory vasoconstrictor, currently considered involved in many diseases other than cardio-vascular ones, and is notably an inducer of neuronal apoptosis (10). It is produced by endothelial (EC), smooth vascular muscles (SVMC) and kidney medullar cells,  and binds the surface Receptors  ET-A on SVMC and ET-B on EC,  in an autocrine and paracrine fashion. Schematically, binding on SVMC Receptors (i.e. through local diffusion in fenestrated capillaries or dysfunctioning EC) and on EC ones (i.e. by circulating ET) induce respectively arterial and venous vasoconstriction, and vasodilation, the latter via Nitrite oxide (NO) synthesis. ET production is stimulated notably by Angiotensin 2, insulin, cortisol, hypoxia, and antagonized by endothelial gaseous NO, itself induced by flow shear stress. Schematically but not exclusively, vascular tone is maintained by a complex regulation of ET-NO balance (8) (10-11).  Both decrease of NO and increase of ET production are both a cause and consequence of inflammation, OS  and endothelial dysfunction, that accordingly favour vasoconstriction; in addition ET competes for L-arginine substrate with NO synthase, thereby reducing NO bioavailability, a mechanism obviated notably in carotid plaques and amaurosis fugax (reviewed in 11).

Severe FS phenotypes are rare. Within the eye, circulating ET reaches retinal VSMC in case of Blood-Retinal-Barrier (BRB) rupture and diffuses freely via the fenestrated choroidal circulation, notably around the optic nerve (ON) head behind the lamina cribrosa, and may induce all pathologies related to acute ocular blood flow decrease (2-3)(5)(7-9). We previously reported two severe cases with rapid onset of monocular cecity and low vision, of respectively RVO in altitude and non arteritic  ischemic optic neuropathy (NAION) (Boscher et al, Société Francaise d'Ophtalmologie and Retina Society, 2015 annual meetings).

Exogenous Recombinant human EPO (rhEPO) has been shown  effective in humans for spinal cord injury (12), neurodegenerative and chronic kidney diseases (CKD) (reviewed in 13). Endogenous EPO is released physiologically in the circulation by the kidney and liver; it may be secreted in addition by all cells in response to hypoxic stress, and it is the prevailing pathway induced via genes up-regulation by the transcription factor Hypoxia Inducible Factor 1 alpha, among angiogenesis (VEGF pathway), vasomotor regulation (inducible NO synthase), antioxidation, and energy metabolism (14). EPO Receptor signaling induces cell proliferation, survival and differentiation (reviewed in 13), and targets multiple non hematopoietic pathways as well as the long-known effect on erythropoiesis (reviewed in 15). Of particular interest here, are its synergistic anti-inflammatory, neural antiapoptotic (16) pro-survival and  pro-regenerative (17) actions upon hypoxic injury, that were long-suggested to be also indirect, via blockade of ET release by astrocytes, and assimilated to ET-A blockers action (18). Quite interestingly, endogenous EPO’s pleiotropic effects were long-summarized (back to 2002), as “mimicking hypoxic-preconditioning” by Dawson (19), a concept applied to the retina (20). EPO Receptors are present in all retinal cells and their rescue activation targets all retinal cells, i.e. retinal EC, neurons (photoreceptors (PR), ganglion (RGG) and  bipolar cells), retinal pigment epithelium (RPE) osmotic function through restoration of the BRB, and  glial cells (reviewed in 21), and the optic nerve (reviewed in 22).  RhEPO has been tested experimentally in animal models of glaucoma, retinal ischemia-reperfusion (I/R) and light phototoxicity, via multiple routes (systemic, subconjunctival, retrobulbar and intravitreal injection (IVI) (reviewed in 23), and used successfully via IVI in human pilot studies, notably first in diabetic macular edema (24) (reviewed in 25 and 26). It failed to improve neuroprotection in association to corticosteroids in optic neuritis, likely for bias reasons (reviewed in 22). Of specific relation to the current case, it has been reported in NAION (27) (reviewed in 28) and traumatic ON injury (29 Rashad), and in one case of acute severe central RVO (CRVO) (Luscan and Roche, Société Francaise d’Ophtalmologie 2017 annual meeting). In addition EPO RPE gene therapy was recently suggested to prevent retinal degeneration induced by OS in a rodent model of dry Age Macular Degeneration (AMD) (30).

Case Report Presentation

This 54 years female patient was first visited on March 2019 4th, seeking for second opinion for ongoing vision deterioration OR on a daily basis, since around 3 weeks. Sub-central RVO (CRVO) OR had been diagnosed on February 27th; available SD-OCT macular volume was increased with  epiretinal marked hyperreflectivity, one available Fluorescein angiography picture showed a non-filled superior CRVO, and a vast central ischemia involving the macular and paraoptic territories. Of note there was ON edema with a para-papillary hemorrage nasal to the disc on the available colour fundus picture.

At presentation on March 4, Best Corrected Visual Acuity (BCVA) was reduced at 20/100 OR (20/25 OS). The patient described periods of acutely excruciating retro-orbital pain in the OR. Intraocular pressure was normal, at 12 OR and 18 OS (pachymetry was at 490 microns in both eyes). The dilated fundus examination was similar to the previous color picture and  did not disclose peripheral hemorrages recalling extended peripheral retinal ischemia. Humphrey Visual Field disclosed an altitudinal inferior scotoma and a peripheral inferior scotoma OR and was in the normal range OS, i.e. did not recall normal tension glaucoma OS . There were no papillary drusen on the autofluorescence picture, ON volume was increased  (11.77 mm3 OR versus 5.75 OS) on SD-OCT (Heidelberg Engineering®) OR,  Retinal Nerve Fiber (RNFL) and RGC layers thicknesses were normal  Marked epimacular hypereflectivity OR with foveolar depression inversion, moderately increased total volume and central foveolar thickness (CFT) (428 microns versus 328 OS), and a whitish aspect of the supero-temporal internal retinal layers recalling ischemic edema, were present . EDI CFT was incresead at 315 microns (versus 273 microns OS), with focal pachyvessels on the video mapping . OCT-Angiography disclosed focal perfusion defects in both the retinal and chorio-capillaris circulations , and central alterations of the PR1 layer on en-face OCT

Altogether the clinical picture evoked a NAION with venous sub-occlusion, recalling Fraenkel’s et al early hypothesis of an ET interstitial diffusion-related venous vasoconstriction behind the lamina cribrosa (2), as much as a rupture of the BRB was present in the optic nerve area (hemorrage along the optic disc). Choroidal vascular drop-out was suggested by the severity and rapidity of the VF impairment (31). The extremely rapid development of a significant “epiretinal membrane”, that we interpreted as a reactive - and protective, in absence of cystoid macular edema (CME) - ET 2-induced astrocytic proliferation (reviewed in 32), was as an additional  sign of severe ischemia.

The mention of the retro-orbital pain evoking a “ciliary angor”, the absence of any inflammatory syndrome and of the usual metabolic syndrome in the emergency blood test, oriented the etiology towards a FS. And indeed anamnesis collected many features of the FS, i.e. hypotension (“non dipper” profile with one symptomatic nocturnal episode of hypotension on the MAPA), migrains, hypersensitivity to cold, stress, noise, smells, and medicines, history of a spontaneously resolutive hydrops six months earlier, and of paroxystic episods of vertigo (which had driven a prior negative brain RMI investigation for Multiple Sclerosis, a frequent record among FS patients (33) and of paroxystic visual field alterations (7)(9), that were actually recorded several times along the follow-up.

The diagnosis of FS was eventually confirmed in the Ophthalmology Department in Basel University on April 10th, with elevated retinal venous pressure (20 to 25mmHg versus 10-15 OS) (4)(7)(9), reduced perfusion in the central retinal artery and veins on ocular Doppler (respectively 8.3 cm/second OR velocity versus 14.1 mmHg OS, and 3.1/second OR versus 5.9 cm OS), and impaired vasodilation upon flicker light-dependant shear stress on the Dynamic Vessel Analyser testing (7-9). In addition atherosclerotic plaques were absent on carotid Doppler.

On March 4th, the patient was at length informed about the FS, a possible off label rhEPO IVI, and a related written informed consent on the ratio risk-benefits was delivered.

By March 7th, she returned on an emergency basis because of vision worsening OR. VA was unchanged, intraocular pressure was at 13, but Visual Field showed a worsening of the central and inferior scotomas with a decreased foveolar threshold, from 33 to 29 decibels. SD-OCT showed a 10% increase in the CFT volume.

On the very same day, an off label rhEPO IVI OR (EPREX® 2000 units, 0,05 cc in a pre-filled syringe) was performed in the operating theater, i.e. the dose reported  by Modarres et al (27), and twenty times inferior to the usual weekly intravenous dose for treatment of chronic anemia secondary to CKD. Intra venous acetazolamide (500 milligrams) was performed prior to the injection, to prevent any increase in intra-ocular pressure. The patient was discharged with a prescription of chlorydrate betaxolol (Betoptic® 0.5 %) two drops a day, and high dose daily magnesium supplementation (600 mgr).

Incidentally the patient developed bradycardia the day after, after altogether instillation of 4 drops of betaxolol only, that was replaced by acetazolamide drops, i.e. a typical hypersensitivity reaction to medications in the FS (7)(9).

Subjective vision improvement was recorded as early as D1 after injection. By March 18 th, eleven days post rhEPO IVI, BCVA was improved at 20/63, the altitudinal scotoma had resolved (Fig. 5), Posterior Vitreous Detachment had developed with a disturbing marked Weiss ring, optic disc swelling had decreased; vasculogenesis within the retinal plexi and some regression of PR1 alterations  were visible on OCT-en face. Indeed by 11 days post EPO significant functional, neuronal and vascular rescue were observed, while the natural evolution had been seriously vision threatening.

However cystoid ME (CME) had developed . Indo Cyanin Green-Cine Video Angiography (ICG-CVA) OR, performed on March 23, i.e. 16 days after the rhEPO IVI, showed a persistent drop in ocular perfusion: ciliary and central retinal artery perfusion timings were dramatically delayed at respectively 21 and 25 seconds, central retinal vein perfusion initiated by 35 seconds, was pulsatile, and completed by 50 seconds only (video 3). Choroidal pachyveins matching the ones on SD-OCT video mapping were present in the temporal superior and inferior fields, and crossed the macula; capillary exclusion territories were present in the macula and around the optic disc.

By April 1, 23 days after the rhEPO injection, VA was unchanged, but CME and perfusion voids in the superficial deep capillary plexi and choriocapillaris were worsened, and optic disc swelling had recurred back to baseline, in a context of repeated episodes of systemic hypotension; and actually Nifepidin-Ratiopharm® oral drops (34), that had been delivered via a Temporary Use Authorization from the central Pharmacology Department in Assistance Publique Hopitaux de Paris, had had to be stopped because of hypersensitivity.

A second off label rhEPO IVI was performed in the same conditions on April 3, i.e. approximately one month after the first one.

Evolution was favourable as early as the day after EPO injection 2: VA was improved at 20/40, CME was reduced, and perfusion improved in the superficial retinal plexus as well as in the choriocapillaris. By week 4 after EPO injection 2, CME was much decreased, i.e. without anti VEGF injection. On august 19th, by week 18 after EPO 2, perfusion on ICG-CVA was greatly improved , with ciliary timing at 18 seconds, central retinal artery at 20 seconds and venous return from 23 to 36 seconds, still pulsatile. Capillary exclusion territories were visible in the macula and temporal to the macula after the capillary flood time that went on by 20.5 until 22.5 seconds (video 4); they  were no longer persistent at intermediate and late timings.

Last complete follow-up was recorded on January 7, 2021, at 22 months from EPO injection 2. BCVA was at 20/40, ON volume had dropped at 7.46 mm3, a sequaelar superior deficit was present in the RNFL  with some  corresponding residual defects on the inferior para central Visual Field , CFT was at 384 mm3 with an epimacular hyperreflectivity without ME, EDI CFT was dropped at 230 microns. Perfusion on ICG-CVA was not normalized, but even more improved, with ciliary timing at 15 seconds, central retinal artery at 16 seconds and venous return from 22 to 31 seconds, still pulsatile , indicating that VP was still above IOP. OCT-A showed persisting perfusion voids, especially at  the optic disc and within the deep retinal capillary plexus. The latter were present at some degree in the OS as well . Choriocapillaris and PR1 layer were dramatically improved.

Last recorded BCVA was at 20/32 by February 14, 2022, at 34 months from EPO 2. SD-OCT showed stable gliosis hypertrophy and mild alterations of the external layers .

Discussion

What was striking in the initial clinical phenotype of CRVO  was  the contrast between the moderate venous dilation,  and the intensity of ischemia, that were illustrating the pioneer hypothesis of Professor Flammer‘s team regarding the pivotal role of ET in VO (2), recently confirmed (3)(35), i.e. the local venous constriction backwards the lamina cribrosa, induced by diffusion of ET-1 within the vascular interstitium, in reaction to hypoxia. NAION was actually the primary and prevailing alteration, and ocular hypoperfusion was confirmed via ICG-CVA, as well as by the ocular Doppler performed in Basel. ICG-CVA confirmed the choroidal drop-out suggested by the severity of the VF impairment (31) and by OCT-A in the choriocapillaris. Venous pressure measurement, which instrumentation is now available (8), should become part of routine eye examination in case of RVO, as it is key to guide cases analysis and personalized therapeutical options.

Indeed, the endogenous EPO pathway is the dominant one activated by hypoxia and is synergetic with the VEGF pathway, and coherently it is expressed along to VEGF in the vitreous in human RVO (36). Diseases develop when the individual limiting  stress threshold for efficient adaptative reactive capacity gets overwhelmed. In this case by Week 3 after symtoms onset,  neuronal and vascular resilience mechanisms were no longer operative, but the BRB, compromised at the ON, was still maintained in the retina.

As mentioned in the introduction, the scientific rationale for the use of EPO was well demonstrated by that time, as well as the capacities of exogenous EPO to mimic endogenous EPO vasculogenesis, neurogenesis and  synaptogenesis, restoration of  the balance between ET-1 and NO. Improvement of chorioretinal blood flow was actually illustrated by the evolution of the choriocapillaris perfusion on repeated OCT-A and ICG-CVA. The anti-apoptotic effect of EPO (16) seems as much appropriate in case of RVO as the caspase-9 activation is possibly another overlooked co-factor (6).

All the conditions for translation into off label clinical use were present: severe vision loss with daily worsening and  unlikely spontaneous favourable  evolution, absence of toxicity in the human pilot studies, of contradictory comorbidities and co-medications, and of context of intraocular neovascularization that might be exacerbated by EPO (37).

Why didn’t we treat the onset of CME by March 18th, i.e. eleven days after EPO IVI 1, by anti-VEGF therapy, the “standard-of-care” in CME for RVO ?

In addition to the context of functional, neuronal and vascular improvements obviated by rhEPO IVI by that timing in the present case, actually anti VEGF therapy does not address the underlying causative pathology. Coherently, anti-VEGF IVI :  1) may not be efficient in improving vision in RVO, despite its efficiency in resolving/improving CME (usually requiring repeated injections), as shown in the Retain study (56% of eyes with resolved ME continued to loose vision)(quoted in (1) 2) eventually may be followed by serum ET-1 levels increase and VA reduction (in 25% of cases in a series of twenty eyes with BRVO) (38) and by increased areas of non perfusion in OCT-A (39). Rather did we perform a second hrEPO IVI, and actually we consider open the question whether the perfusion improvement, that was progressive, might have been accelerated/improved via repeated rhEPO IVI, on a three to four weeks basis.

The development of CME itself, involving a breakdown of the BRB, i.e. of part of the complex  retinal armentorium resilience to hypoxia, was somewhat paradoxical in the context of improvement after the first EPO injection, as EPO restores the BRB (24), and as much as it was suggested that EPO inhibits glial osmotic swelling, one cause of ME, via VEGF induction (40). Possible explanations were: 1) the vascular hyperpermeability induced by the up-regulation of VEGF gene expression via EPO (41) 2) the ongoing causative disease, of chronic nature, that was obviated by the ICG-CVA and the Basel investigation, responsible for overwhelming the gliosis-dependant capacity of resilience to hypoxia 3) a combination of both. I/R seemed excluded: EPO precisely mimics hypoxic reconditioning as shown in over ten years publications, including in the retina (20), and as EPO therapy is part of the current strategy for stabilization of the endothelial glycocalix against I/R injury (42-43). An additional and not exclusive possible explanation was the potential antagonist action of EPO on GFAP astrocytes proliferation, as mentioned in the introduction (18), that might have counteracted the reactive protective hypertrophic gliosis, still fully operative prior to EPO injection, and that was eventually restored during the follow-up, where epiretinal hyperreflectivity without ME and ongoing chronic ischemia do coincide (Fig. 6 and video 6), as much as it is unlikely that EPO’s effect would exceed one month (cf infra). Inhibition of gliosis by EPO IVI might have been also part of the mechanism of rescue of RGG, compromised by gliosis in hypoxic conditions (44). Whatever the complex balance initially reached, then overwhelmed after EPO IVI 1, the challenge was rapidly overcome by the second EPO IVI without anti-VEGF injection, likely because the former was powerful enough to restore the threshold limit for resilience to hypoxia, that seemed no longer reached again during the relapse-free follow-up. Of note, this “epiretinal membrane “, which association to good vision is a proof of concept of its protective effect, must not be removed surgically, as it would suppress one of the mecanisms of resilience to hypoxia.

To our best knowledge, ICG-CVA was never reported in FS; it allows real time evaluation of the ocular perfusion and illustration of the universal rheological laws that control choroidal blood flow as well. Pachyveins recall a “reverse” veno-arteriolar reflex in the choroidal circulation, that is NO and autonomous nervous system-dependant, and that we suggested to be an adaptative choroidal microcirculation process to hypoxia (45).  Their persistence during follow-up accounts for a persisting state of chronic ischemia.

The optimal timing for reperfusion via rhEPO in a non resolved issue:

in the case reported by Luscan and Roche, rhEPO IVI was performed on the very same day of disease onset, where it induced complete recovery from VA reduced at counting fingers at 1 meter, within 48 hours. This clinical human finding is on line with a recent rodent stroke study that established the timings for non lethal versus lethal ischemia of the neural and vascular lineages, and the optimized ones for beneficial reperfusion: the acute phase - from Day 1 where endothelial and neural cells are still preserved,  to Day 7 where proliferation of pericytes and Progenitor Stem Cells are obtainable - and the chronic stage, up to Day 56, where vasculogenesis, neurogenesis and functional recovery are still possible, but with uncertain efficiency (46). In our particular case, PR rescue after rhEPO IVI 1 indicated that Week 3 was still timely. RhEPO IVI  efficacy was shown to last between one (restoration of the BRB)  and four weeks (antiapoptotic effect) in diabetic rats (24). The relapse after Week 3 post IVI 1 might indicate that it might be  approximately the interval to be followed, should repeated injections be necessary.

The bilateral chronic perfusion defects on OCT-A at last follow-up indicate that both eyes remain in a condition of chronic ischemia and I/R, where endogenous EPO provides efficient ischemic pre-conditioning, but is potentially susceptible to be challenged during episodes of acute hypoxia that overwhelm the resilience threshold.

Conclusion

The present case advocates for individualized medicine with careful recording of the medical history, investigation of the systemic context, and exploiting of the available retinal multimodal imaging for accurate analytical interpretation of retinal diseases and their complex pathophysiology. The Flammer Syndrome is unfortunately overlooked in case of RVO; it should be suspected clinically in case of absence of the usual vascular and metabolic context, and in case  of elevated RVP. RhEPO therapy is able to restore the beneficial endogenous EPO ischemic pre-conditioning in eyes submitted to challenging acute hypoxia episodes in addition to chronic ischemic stress, as in the Flammer Syndrome and fluctuating ocular blood flow, when it becomes compromised by the overwhelming of the hypoxic stress resilience threshold. The latter physiopathological explanation illuminates the cases of RVO where anti-VEGF therapy proved functionally inefficient, and/or worsened retinal ischemia. RhEPO therapy might be applied to other chronic ischemia and I/R conditions, as non neo-vascular Age Macular Degeneration (AMD), and actually EPO was listed in 2020 among the nineteen promising molecules in AMD in a pooling of four thousands (47).

[san-myshuno-er]

Shawn: Alright, here we go! Let's get this gentleman to Trauma 2.

Cam Landry: What's your name, Sir? Sir, can you tell me your name?

Patient: It's Wilson.

Shawn: Okay, Mr. Wilson, I'm Dr. Jones, this is Nurse Cam, and we're going to take very good care of you.

Mike Davis: What's your name, sir?

Patient: It's Canelli. George Canelli.

Paramedic: Suspected MI, 500cc of Saline are in. Slight head trauma, he must have hit his head on the steering wheel.

Quinn: Alright, Mr Canelli. I'm Dr. Roe, let's get you down to Trauma 1.

Mr Canelli: Could someone perhaps call my son and daughter? I was... (heavy breathing) on my way to my son's house to see my grandchildren...

Quinn: Of course. Why don't you give the number to Nurse Mike here, he'll see to it.

Mr Canelli: (chuckles) men are nurses, and women are doctors...

Quinn: It's a changed world, sir.

Quinn: Alright, let's have a listen.

Mike: Pulse Ox is 97, BP is 117 to 87. Pulse is 135.

Mr. Canelli: That's not so bad, is it, Doctor?

Quinn: Sir, if you speak I can't hear your heart. I hear some crackling there. Let's get a EKG, CBC, Chem-7-

Mr. Canelli: What's that?

Quinn: Some blood tests, we look for your blood urea nitrogen, carbon dioxide, creatinine, glucose, chloride, potassium, and sodium values. Other than that, I want cardiac enzymes and, just to be safe, a cross table head and chest X-Ray. Once we get those back, we'll know more.

Mike: First saline is in.

Quinn: Good. Let's see what those tests say.

Shawn: Okay, let's have a looksie. Lights, please! Oh wow. Have some nice and pleasant thoughts, sir. (to the nurses) Let's have a CBC, type and cross-match. We got a pre-op here... Notify the OR, we need a room.

Cam: It's not completely severed, is it?

Shawn: No... still some attachment left. That's a good sign, sir.

Shawn: Call Vascular and Orthopedic. Tell them to get down here right now. This is their lucky day! Mr. Wilson, your hand is barely attached, but it's gonna be okay. Get me an EKG and an X-Ray of his wrist and hand... can you feel anything in your hand?

Mr. Wilson: No...

Shawn: We'll save your hand, don't worry.

Quinn: Mr. Canelli, we are going to call Cardiology as soon as those tests are back, and then they can decide what kind of treatment you might need.

Mike: Quinn, pulse ox and pressure are going down!

Quinn: I'm losing his pulse; Mr Canelli? Mr Canelli?!

Previous | Beginning | Next

(sorry this post took so long!! real life got into the way...)

[a-forbidden-detective]

Just when I think the story’s end is near… Akira pulls out this stunt that makes me want to scream!

Neck injuries constitute a lot of organs that can be harmed (total carotid arteries and internal junial veins, larynx, trachea, esophagus, thyroid and various nerves), so this is quite alarming if Ron not only damaged his vocal cords.

Assuming that he is knowledgeable of anatomy like he should be as a Holmes/Moriarty descendant, Ron stabbing his neck is worrying.

Penetrating neck injuries are life-threatening emergencies. The ATLS guidelines outline the initial management of neck trauma patients. Airway management is the first action, if the patient has no significant vascular injury. All patients who have penetrating neck trauma should be examined periodically for hematoma or edema of the neck. Voice quality and airway patency might be improved if laryngeal repair is performed within 24 hours of trauma. CT angiography should be performed for all neck penetration patients whose injuries penetrate the platysma. CT might be helpful for diagnosing laryngeal fractures in intubated patients. A patient who has a neck injury should be admitted and monitored for 24 hours after surgical treatment. This could prevent morbidity or mortality from hemorrhage or respiratory distress. If possible, the injured laryngeal tissues should be preserved and not sacrificed.

Because of it I am forced to look at the health journals online. (Click at your own risk as it can get a little graphic on the descriptions.) I’d like to know the potential damage it would cause if he didn’t get an immediate medical attention.

This is Ron’s Reichenbach Fall.

[leebird-simmer]

Psychopathology, Ch. 14

Describe the diagnostic features of neurocognitive disorders and identify three major types.

A neurocognitive disorder involves a significant disturbance or deficit of thinking or memory that represents a marked decline in cognitive functioning. They are caused by physical or medical conditions or drug use or withdrawal affecting the functioning of the brain. The three major types identified in DSM-5 are delirium, major neurocognitive disorder, and mild neurocognitive disorder.

Agnosia: a disturbance of sensory perception, usually affecting visual perception.

Describe the key features and causes of delirium.

Delirium: characterized by symptoms such as impaired attention, disorientation, disorganized thinking and rambling speech, reduced level of consciousness, and perceptual disturbances. Delirium is most commonly caused by alcohol withdrawal, as in the form of DTs, but may also occur in hospitalized patients, especially after major surgery.

Describe the key features and causes of major neurocognitive disorder.

Major neurocognitive disorder: a significant cognitive deterioriation or impairment, as evidenced by memory deficits, impaired judgment, personality changes, and disorders of high cognitive functions such as problem-solving ability and abstract thinking. Dementia is not a normal consequence of aging; rather, it is a sign of a degenerative brain disorder. There are various causes of major neurocognitive disorder, including Alzheimer’s disease and Pick’s disease, and brain infections and disorders.

General paresis: a form of dementia resulting from neurosyphilis.

Late-onset dementia: forms of dementia that begin after age 65.

Early-onset dementia: forms of dementia that begin before age 65.

Describe the key features of mild neurocognitive disorder.

Mild neurocognitive disorder: a milder decline in cognitive functioning. The person with the disorder is able to function but needs to expend greater effort or use compensatory strategies to compensate for cognitive declines.

Describe the key features and causes of Alzheimer’s disease and evaluate current treatments.

Alzheimer’s disease (AD): a progressive brain disease characterized by progressive loss of memory and cognitive ability, as well as deterioration in personality functioning and self-care skills. There is neither a cure nor an effective treatment for AD. Currently available drug treatments offer only modest effects at best. Research into the causes of the disease points to roles for genetic factors and factors involved in the accumulation of amyloid plaques in the brain.

Identify other subtypes of neurocognitive disorders.

Other medical conditions can lead to neurocognitive disorders, including vascular disease, Pick’s disease, Parkinson’s disease, Huntington’s disease, prion disease, HIV infection, and head trauma.

Cerebrovascular accident (CVA): a stroke or brain damage resulting from a rupture or blockage of a blood vessel supplying oxygen to the brain.

Vascular neurocognitive disorder: dementia resulting from repeated strokes that cause damage in the brain.

Aphasia: impaired ability to understand or express speech.

Pick’s disease: a form of dementia, similar to Alzheimer’s disease, but distinguished by specific abnormalities (Pick’s bodies) in nerve celles and the absence of neurofibrillary tangles and plaques.

Amnesia: memory loss that frequently follows a traumatic event such as a blow to the head, an electric shock, or a major surgical operation.

Retrograde amnesia: loss or impairment of ability to recall past events.

Anterograde amnesia: loss or impairment of ability to form or store new memories.

Hypoxia: decreased supply of oxygen to the brain or other organs.

Infarction: the development of an infarct (an area of dead or dying tissue) resulting from the blocking of blood vessels that normally supply the tissue.

Korsakoff’s syndrome: a syndrome associated with chronic alcoholism that is characterized by memory loss and disorientation.

Wernicke’s disease: a brain disorder, associated with chronic alcoholism, characterized by confusion, disorientation, and difficulty maintaining balance while walking.

Ataxia: loss of muscle coordination.

Lewy bodies: abnormal protein deposits in brain cells that cause a form of dementia.

Parkinson’s disease: a progressive disease characterized by muscle tremors and shakiness, rigidity, difficulty walking, poor control of fine motor movements, lack of facial muscle tone, and (in some cases) cognitive impairment.

Huntington’s disease: an inherited degenerative disease that is characterized by jerking and twisting movements, paranoia, and mental deterioration.

Identify anxiety-related disorders and their treatments in older adults.

Generalized anxiety disorder and phobic disorders are the most common anxiety disorders among older people. Problems with anxiety are often treated with anti-anxiety medical or psychological treatment such as cognitive behavioral therapy.

Identify factors associated with depression in late adulthood and ways of treating it.

Factors include the challenge of coping with life changes, such as retirement, physical illness or incapacitation, placement in a residential facility or nursing home; lack of social support as the result of death of a spouse, siblings, lifetime friends, and acquaintances; and need to care for a spouse whose health is declining. Among immigrant groups and people of color, factors such as acculturative stress and coping with racism also play a role. Available treatments for depression in older as well as younger adults include anti-depressant medication, cognitive behavioral therapy, and interpersonal psychotherapy.

Identify factors involved in late-life insomnia and ways of treating it.

Sleep problems, especially insomnia, are common among older adults – more common in fact than depression. Insomnia is often linked to other psychological disorders, medical illness, psychosocial factors such as loneliness and sleeping alone after losing a spouse, and dysfunctional thoughts. Behavioral techniques are effective for treating insomnia in older as well as younger adults.

[universitypenguin]

I’ve worked in a trauma center long enough to have seen someone get stabbed directly in the heart and still survive because of how quickly they were treated. Even if an artery is cut, tourniquets and a vascular surgeon can work wonders. There’s literally like four or five places on the body that could result in an injury serious enough to kill someone (assuming they had prompt access to first aide and got treatment for the wound in a reasonable timeframe.) A portion of people who are stabbed in those vulnerable places do end up with life altering physical damage, but they still survive.

Writers who are looking to make their stories realistic should be aware of this, but it’s not common knowledge outside of the medical field.

one of my greatest pet peeves in fiction, and it is truly stupid I know, is that no one seems to understand how genuinely hard it is to kill someone via stabbing. stab wounds have a mortality rate of like 5%. especially abdominal stabbing. tv shows and movies show dudes getting stabbed one time in the lower abdomen with a tiny knife and then they fall over. like what did he die of precisely. that man died of Small Knife

[tulasihealthcare24]

Treatment of Male Sexual Disorders by a Sexologist in Delhi

Male sexual disorders are more common than often acknowledged, yet they remain shrouded in stigma and misinformation. In Delhi, a growing number of men are seeking professional help from expert sexologists to address these issues and reclaim their confidence and well-being. This article delves into the treatment options available, highlighting the role of a sexologist in Delhi in diagnosing and managing male sexual disorders.

Understanding Male Sexual Disorders

Male sexual disorders refer to a range of conditions that affect sexual health, including:

Erectile Dysfunction (ED): Difficulty in achieving or maintaining an erection suitable for sexual activity.

Premature Ejaculation (PE): Ejaculating earlier than desired, often leading to distress and interpersonal challenges.

Delayed Ejaculation (DE): Difficulty in achieving orgasm despite adequate stimulation.

Low Libido: A reduced interest in sexual activity, often linked to hormonal, psychological, or medical factors.

Peyronie’s Disease: Development of scar tissue inside the penis, causing curved or painful erections.

Why Consult a Sexologist in Delhi?

Sexual health issues can stem from a combination of physical, psychological, and lifestyle factors. A qualified sexologist in Delhi can provide a personalized approach to identify and address these underlying causes.

Delhi is home to some of the best sexologists who specialize in modern, evidence-based treatments. These professionals combine medical expertise with a deep understanding of the psychological aspects of sexual health, ensuring comprehensive care for their patients.

Diagnosis and Treatment Approaches

Treatment of male sexual disorders typically begins with a thorough assessment, including:

Medical History: Understanding past medical conditions, medications, and lifestyle habits.

Physical Examination: Identifying physical issues like hormonal imbalances or vascular problems.

Psychological Evaluation: Addressing stress, anxiety, or relationship concerns that may impact sexual performance.

Once diagnosed, treatment may involve a combination of the following:

1. Medical Interventions

Medications: Drugs like phosphodiesterase inhibitors (e.g., sildenafil) for erectile dysfunction or antidepressants for premature ejaculation.

Hormone Therapy: Testosterone replacement therapy for men with low libido linked to hormonal deficiencies.

Surgical Solutions: In cases of Peyronie’s Disease or severe erectile dysfunction, surgery may be recommended.

2. Psychological Counseling

Sexual disorders often have a psychological component. Counseling sessions with a sexologist in Delhi can help address performance anxiety, relationship issues, or past trauma.

3. Lifestyle Modifications

Sexologists also emphasize the importance of healthy lifestyle choices, such as regular exercise, balanced nutrition, stress management, and avoiding alcohol and tobacco.

4. Advanced Therapies

Delhi-based sexologists are equipped to offer cutting-edge treatments, including:

Vacuum Erection Devices (VEDs): For erectile dysfunction.

Low-Intensity Shockwave Therapy (LiSWT): Stimulates blood flow to improve erections.

Sexual Therapy Exercises: Guided practices to manage premature ejaculation and enhance sexual stamina.

Choosing the Right Sexologist in Delhi

When selecting a sexologist in Delhi, ensure they have credible qualifications, such as a degree in sexual medicine or urology, and a proven track record of treating male sexual disorders. It’s also essential to find a practitioner who prioritizes confidentiality and creates a safe space for open communication.

Breaking the Stigma

Seeking help for sexual health issues is a sign of strength, not weakness. The stigma surrounding male sexual disorders often prevents men from addressing these concerns, leading to unnecessary distress. A qualified sexologist in Delhi can help break this cycle, offering professional care and support tailored to individual needs.

Conclusion

Male sexual disorders can significantly impact self-esteem, relationships, and overall well-being. Consulting a sexologist in Delhi provides access to expert diagnosis, effective treatments, and a path to improved sexual health. If you or someone you know is struggling with such concerns, don’t hesitate to reach out to a trusted professional. With the right care, a fulfilling and confident life is well within reach.

This article is optimized for the keyword sexologist in Delhi, ensuring visibility and relevance for those seeking information on the topic.

[drchristophedelongsblog]

The geriatric neuropsychologist: an expert in cognitive functions

Neuropsychologists are health professionals specialising in the assessment and rehabilitation of cognitive functions. In geriatric medicine, neuropsychologists play a crucial role in diagnosing and supporting elderly people suffering from problems with memory, attention, language or executive functions.

The role of the geriatric neuropsychologist

The geriatric neuropsychologist's main tasks are to:

- Assess cognitive functions: They carry out precise neuropsychological tests to evaluate the cognitive abilities of the elderly person and establish a precise diagnosis.

- Diagnosing cognitive disorders: They identify cognitive disorders (Alzheimer's disease, vascular dementia, etc.) and draw up a detailed neuropsychological profile.

- Monitor the progress of disorders: They carry out regular assessments to monitor the progress of cognitive disorders and adapt the care provided.

- Proposing compensatory strategies: They implement strategies to compensate for difficulties encountered in daily life (use of diaries, memorisation techniques, etc.).

- Supporting the person and their family and friends: They inform the person and their family and friends about the nature of the disorders, possible treatments and coping strategies.

- Working with the care team: They work in close collaboration with doctors, nurses and other healthcare professionals.

The fields of intervention of the neuropsychologist in geriatrics

There are many areas in which neuropsychologists work in geriatrics:

- Neurodegenerative diseases: Alzheimer's disease, Parkinson's disease, vascular dementia.

- Mild cognitive disorders: memory, attention and language problems.

- Cerebrovascular accident (CVA) sequelae.

- Cerebral tumours.

- Cranial trauma.

The benefits of neuropsychological treatment

Neuropsychological treatment in geriatric medicine offers a number of advantages:

- Accurate diagnosis: enabling appropriate treatment to be put in place.

- Personalised follow-up: enabling strategies to be adjusted as disorders progress.

- A better understanding of disorders: for the elderly person and those around them.

- Improved quality of life: by developing strategies to maintain independence and social activities.

- Psychological support: to help cope with the changes associated with the disease.

When should you consult a neuropsychologist?

It is advisable to consult a neuropsychologist in the event of :

- Memory problems (frequent forgetfulness, difficulty finding one's bearings in time and space).

- Language difficulties (comprehension and expression problems).

- Attention problems (difficulty concentrating, following a conversation).

- Behavioural changes (irritability, agitation, disorientation).

- Difficulty performing activities of daily living.

Go further

[businessmarketreports]

An Overview of Canada Atherectomy Procedures Market: Trends and Insights

The Canadian atherectomy procedures market is experiencing steady growth, driven by increasing prevalence of peripheral artery disease (PAD), technological advancements in atherectomy devices, and a growing preference for minimally invasive treatments.

For more insights on the key segments of the Canada Atherectomy Procedures Market, download a free sample report

As an essential component of vascular interventions, atherectomy procedures are widely used to restore blood flow in patients with arterial blockages caused by plaque buildup.

Key Trends in the Canada Atherectomy Procedures Market

1. Rising Prevalence of PAD and Cardiovascular Diseases

PAD Incidence: An aging population and lifestyle-related risk factors, such as smoking, obesity, and diabetes, have contributed to the increasing prevalence of PAD in Canada.

Market Impact: This rise in PAD cases is driving demand for atherectomy procedures as an effective treatment option.

2. Shift Towards Minimally Invasive Procedures

Patient Preference: Minimally invasive techniques like atherectomy offer reduced recovery times, lower complication rates, and shorter hospital stays compared to traditional surgical interventions.

Market Driver: The shift toward minimally invasive vascular interventions is accelerating the adoption of atherectomy procedures.

3. Technological Advancements in Atherectomy Devices

Innovations: Modern atherectomy devices incorporate advanced features like laser technology, directional cutting, and rotational mechanisms, improving procedural outcomes and safety.

Market Impact: These advancements enhance the efficacy of atherectomy procedures, supporting their increased utilization.

4. Expanding Applications Beyond PAD

Broader Usage: Atherectomy procedures are being used in coronary and other vascular interventions beyond PAD, further driving market growth.

Clinical Trials: Ongoing studies evaluating the safety and effectiveness of atherectomy in various applications are contributing to its broader adoption.

5. Growing Awareness and Diagnosis Rates

Increased Diagnosis: Efforts to improve awareness of PAD among patients and healthcare professionals are leading to earlier diagnosis and treatment, boosting procedure volumes.

Healthcare Policies: Government initiatives and campaigns promoting vascular health also play a crucial role in market expansion.

Market Insights: Drivers and Challenges

Key Drivers

Aging Population: The increasing number of elderly individuals in Canada, who are more prone to PAD and other vascular conditions, drives demand for atherectomy procedures.

Favorable Reimbursement Policies: Coverage for atherectomy procedures under Canada's healthcare system makes them more accessible.

Specialist Training: Enhanced training programs for interventional radiologists and vascular surgeons improve procedural success rates and adoption.

Key Challenges

Cost Constraints: The high cost of advanced atherectomy devices and procedures can limit adoption, particularly in smaller healthcare facilities.

Competition from Alternative Treatments: Procedures such as angioplasty and stenting remain popular alternatives, posing competition to atherectomy.

Regulatory Approvals: Strict regulatory processes for new atherectomy devices may delay market entry and limit availability.

Procedure Types

1. Directional Atherectomy

Mechanism: Removes plaque by cutting it away with a specialized catheter.

Applications: Commonly used for large, calcified plaques in peripheral arteries.

Advantages: Provides precise plaque removal with minimal vessel trauma.

2. Rotational Atherectomy

Mechanism: Utilizes a high-speed rotating burr to grind hard, calcified plaques into fine particles.

Applications: Frequently employed in coronary artery disease cases.

Advantages: Effective for treating heavily calcified lesions.

3. Laser Atherectomy

Mechanism: Uses laser energy to vaporize plaque into tiny particles.

Applications: Suitable for soft plaques and in-stent restenosis.

Advantages: Reduces the risk of vessel damage and embolization.

4. Orbital Atherectomy

Mechanism: A rotating, eccentrically shaped sanding device removes plaque while preserving healthy tissue.

Applications: Effective for eccentric and calcified lesions.

Advantages: Provides uniform plaque modification with low complication rates.

Key Market Players

The Canadian atherectomy procedures market includes a mix of global and regional device manufacturers offering a wide range of solutions:

Medtronic

Devices: HawkOne™ and TurboHawk™ directional atherectomy systems.

Strengths: Comprehensive product portfolio and strong presence in the vascular devices market.

Boston Scientific

Devices: Rotablator™ rotational atherectomy system.

Strengths: Innovation in coronary and peripheral vascular devices.

Cardiovascular Systems, Inc. (CSI)

Devices: Diamondback 360® orbital atherectomy system.

Strengths: Focus on novel technologies for treating calcified lesions.

Philips (Spectranetics)

Devices: Turbo-Elite™ laser atherectomy catheter.

Strengths: Expertise in laser technology for vascular interventions.

Future Outlook

The Canadian atherectomy procedures market is poised for growth in the coming years, supported by:

Advancements in Imaging: Integration of advanced imaging modalities, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), for precise plaque characterization.

Improved Patient Outcomes: Continued innovation in device design to reduce complications and improve efficacy.

Emerging Technologies: Adoption of robotic-assisted atherectomy systems for enhanced procedural precision.

Collaborations: Increased partnerships between device manufacturers and healthcare providers to improve access and affordability.

Conclusion

The atherectomy procedures market in Canada is undergoing significant advancements, fueled by growing demand for minimally invasive vascular treatments and technological innovations. With an aging population, increasing PAD prevalence, and strong healthcare infrastructure, the market offers substantial growth opportunities. By addressing cost barriers and expanding the scope of applications, stakeholders can capitalize on this evolving segment.

[drsumitblog]

What can you do for bleeding varicose veins?

Say goodbye to the unsightly pain and discomfort of bleeding varicose veins with our advanced treatment options. From minimally invasive procedures to customized care plans, we are here to help you achieve healthier, happier legs. Contact us today for a consultation and take the first step towards smoother, happy legs.

[kdlmedtech]

Easy Slide Catheter : What Every Vet Should Know

Catheterization is a critical procedure in veterinary care, used for various purposes ranging from fluid administration to diagnostic sampling. Among the different types of catheters available, easy slide catheter have become a popular choice among veterinarians due to their ease of use and efficiency. This guide will walk you through everything you need to know about easy slide catheters, from why they are essential to how you can use them effectively in your practice.

What is an Easy Slide Catheter?

Veterinary Easy Slide Catheters are designed to offer veterinarians a simple and efficient solution for catheterization procedures. These catheters feature a smooth, hydrophilic coating that allows them to glide easily into place, minimizing discomfort for the animal and reducing the time spent on the procedure. Ideal for a range of applications such as fluid therapy, medication administration, and blood sampling easy slide catheters are essential tools for veterinary professionals aiming to ensure the highest standard of care for their animal patients.

Thanks to their user-friendly design, these catheters have gained popularity in veterinary clinics worldwide. They are available in various sizes, ensuring suitability for pets of different sizes and medical needs. Whether you are a seasoned veterinarian or a student just starting, understanding how to choose and use Easy Slide Catheters will significantly improve your catheterization skills and efficiency in practice.

Key Benefits of Using an Easy Slide Catheter for Veterinary Care

The use of Veterinary Easy Slide Catheter is becoming more widespread among veterinarians due to their numerous benefits in patient care. These catheters offer several advantages, making them an essential tool in your veterinary practice:

1. Ease of Insertion : The hydrophilic coating on Easy Slide Catheters reduces friction, allowing them to slide smoothly into the vessel or body cavity. This ease of insertion helps minimize discomfort for the animal and lowers the likelihood of causing trauma during the procedure. 2. Reduced Risk of Complications : The smooth surface minimizes the chances of causing vascular irritation, phlebitis, or accidental punctures, which can lead to complications. This feature is particularly important when working with animals that may be sensitive or difficult to handle.

3. Versatility : Easy Slide Catheters are available in various sizes and designs to meet the needs of different veterinary applications. Whether you’re using them for intravenous fluid administration or as part of a diagnostic procedure, these catheters are adaptable to a wide range of treatment protocols.

4. Time Efficiency : In a busy veterinary clinic, saving time while ensuring precision is essential. Easy Slide Catheters facilitate quicker procedures, allowing veterinarians to focus on other aspects of patient care.

5. Increased Patient Comfort : Minimizing stress and discomfort for animals during medical procedures is a top priority. Easy Slide Catheters reduce the time and effort required for insertion, improving overall patient experience.

With these significant benefits, it’s clear that Easy Slide Catheters are indispensable tools for any veterinary professional seeking to provide the best care for their animal patients.

How to Choose the Right Easy Slide Catheter for Your Veterinary Practice

Choosing the right Easy Slide Catheter is essential to ensure the comfort and safety of your patient. Here are some factors to consider when selecting the appropriate catheter for a specific procedure:

1. Size and Gauge

Selecting the correct catheter size is crucial. Catheters come in different diameters (gauges) and lengths. The size needed will depend on the animal’s size, age, and the procedure being performed. For example, larger animals may require a larger gauge catheter, while smaller animals or certain delicate procedures may benefit from a finer gauge.

2. Material and Coating

Look for catheters with a hydrophilic coating for smoother insertion and reduced friction. The coating also helps reduce the risk of tissue damage. Easy Slide Catheters are known for their excellent coating that enhances the sliding experience, making them ideal for sensitive or small patients.

3. Application Type

Consider the specific application of the catheter. If you are using it for intravenous fluid administration, a catheter designed for long-term use might be necessary, whereas for diagnostic purposes, a shorter catheter might be more appropriate. Always ensure the catheter meets the needs of the procedure for optimal results.

4. Patient Needs

Finally, always take into account the patient’s condition and size. A catheter that is too large for a small animal or too small for a larger animal may cause complications. Be sure to consult manufacturer guidelines and use your professional judgment.

By considering these factors, you’ll be able to choose the right Easy Slide Catheter to ensure a successful and comfortable procedure for your animal patient.

Step-by-Step Guide: How to Use a Veterinary Easy Slide Catheter

The proper technique for using Easy Slide Catheters is vital to prevent complications and ensure the comfort of the animal. Below is a step-by-step guide to using these catheters effectively in veterinary practice:

1. Prepare the Equipment

Before starting, gather all the necessary equipment, including the catheter, sterile gloves, antiseptic solution, and dressing materials. Ensure that the catheter and all materials are sterile to reduce the risk of infection.

2. Restrain the Animal

Proper restraint is key to a successful catheterization procedure. Depending on the animal’s size and temperament, you may need an assistant or a specialized restraint technique. For smaller animals, gentle handling may suffice, while larger animals may require sedatives or specialized equipment.

3. Clean the Insertion Site

Clean the area where the catheter will be inserted with an antiseptic solution. This will help reduce the risk of infection. Be sure to follow standard aseptic techniques during this step to maintain sterility.

4. Hydrate the Catheter

Before insertion, hydrate the catheter to activate its hydrophilic coating. This will ensure smooth insertion and reduce the risk of discomfort. Many Easy Slide Catheters are designed to be hydrated quickly and easily for maximum effectiveness.

5. Insert the Catheter

Carefully insert the catheter into the chosen vessel or body cavity, applying gentle pressure. The smooth surface of the Easy Slide Catheter should allow it to glide effortlessly into place. Avoid forcing the catheter in, as this could cause injury.

6. Secure the Catheter

Once the catheter is in place, secure it with adhesive or sutures, depending on the procedure and the catheter’s design. Ensure that the catheter is securely fixed to prevent displacement.

7. Monitor the Animal

After catheter insertion, monitor the animal closely for any signs of discomfort or complications. Regular checks are necessary to ensure the catheter remains properly positioned and that there are no signs of infection or other issues.

Common Mistakes to Avoid When Using an Easy Slide Catheter in Veterinary

Even experienced veterinarians can make mistakes during catheterization. Here are some common errors to watch out for:

Improper Sizing: Choosing the wrong size catheter can lead to complications such as insufficient fluid administration or tissue damage. Always choose the appropriate size for the animal and procedure.

Forcing the Catheter In: Applying too much force can cause trauma to the vessel or tissue. Always insert the catheter gently, allowing it to glide naturally into place.

Neglecting Sterility: Maintaining sterility during the procedure is essential to prevent infection. Never compromise on sterilization, even for routine procedures.

Failing to Secure the Catheter: Not securing the catheter properly can lead to displacement, which can cause discomfort for the animal and require the procedure to be repeated.

Tips for Maximizing the Benefits of an Easy Slide Catheter

To maximize the benefits of an Easy Slide Catheter, veterinary professionals should focus on proper handling, ensuring a smooth insertion to minimize discomfort for the animal. Start by choosing the appropriate catheter size for each specific patient and procedure. Always check that the catheter is properly lubricated and sterile to reduce the risk of infection and improve ease of use. Regular training on insertion techniques can also help prevent common mistakes, such as incorrect placement, which may lead to complications. Additionally, storing catheters in a clean, accessible area can help streamline procedures and ensure optimal performance every time.

Conclusion

Easy Slide Catheters are invaluable tools for veterinarians looking to improve the efficiency and comfort of catheterization procedures. By choosing the right catheter and following the proper techniques, you can enhance the care you provide to your animal patients.

Source : Easy Slide Catheter : What Every Vet Should Know

[drdilipkiyawatneurosurgeon]

Advanced Neurosurgery with Dr. Dilip S. Kiyawat: Precision and Care for Complex Brain and Spine Conditions

Neurosurgery is a highly specialized medical field that requires precision, skill, and advanced knowledge. Dr. Dilip S. Kiyawat, a seasoned neurosurgeon, brings all of these qualities to the forefront of his practice, providing exceptional care for complex brain and spine conditions. With extensive experience and expertise, Dr. Kiyawat is dedicated to helping patients achieve better health through state-of-the-art neurosurgical techniques and compassionate care.

What is Neurosurgery?

Neurosurgery focuses on diagnosing and treating disorders of the brain, spine, and nervous system. Conditions treated by neurosurgeons range from brain tumors to spine disorders, and each case requires a unique and carefully considered approach. Advanced neurosurgical techniques are vital for improving patient outcomes and enhancing their quality of life.

Dr. Dilip S. Kiyawat: A Specialist in Advanced Neurosurgery

Dr. Dilip S. Kiyawat is a neurosurgeon with an M.Ch. in Neurosurgery, bringing extensive knowledge and specialized skills to his practice. His expertise encompasses a wide range of neurosurgical procedures and treatments. Known for his precision and commitment to patient care, Dr. Kiyawat provides comprehensive care for patients dealing with brain and spine conditions.

Specialized Areas of Neurosurgery

Dr. Kiyawat’s expertise spans various areas of neurosurgery, including:

Brain Tumor Surgery

Brain tumors require precise surgical intervention to remove or reduce tumor growth while minimizing impact on surrounding healthy tissue. Dr. Kiyawat utilizes advanced techniques to manage tumors effectively, aiming for optimal patient recovery and minimal side effects.

Minimally Invasive Spine Surgery

Spine surgeries can often be daunting for patients due to the complexity of the spine and its importance to overall body function. Minimally invasive spine surgery allows Dr. Kiyawat to treat spinal disorders with smaller incisions, less pain, faster recovery times, and minimal disruption to surrounding tissue.

Vascular Neurosurgery

Vascular neurosurgery deals with blood vessels in the brain and spine, treating issues such as aneurysms, arteriovenous malformations (AVMs), and strokes. This specialty requires highly technical skills, as even minor errors can have significant effects on brain function. Dr. Kiyawat’s expertise in vascular neurosurgery ensures the highest level of care for his patients.

Trauma and Injury Care

Traumatic injuries to the brain and spine are often life-threatening and require immediate and effective surgical intervention. Dr. Kiyawat is well-equipped to handle such emergencies, providing trauma care with a focus on minimizing long-term damage and aiding in a full recovery.

Why Choose Advanced Neurosurgery with Dr. Dilip Kiyawat?

Opting for advanced neurosurgery under Dr. Kiyawat’s care provides patients with several advantages:

Cutting-Edge Techniques: Dr. Kiyawat stays updated with the latest developments in neurosurgery, ensuring that patients receive the most modern and effective treatment.

Compassionate Care: Dr. Kiyawat’s approach to neurosurgery is not just technical; he believes in treating patients with empathy and understanding, providing comfort throughout the treatment journey.

Patient-Focused Treatment Plans: Every patient’s condition is unique, and Dr. Kiyawat creates customized treatment plans that cater to each individual’s needs.

Consultation and Contact Information

Dr. Kiyawat is available for consultations at two locations in Pune:

Jehangir Hospital

Address: 32, Sassoon Road, near Pune Railway Station, Pune 411001

Sainath Hospital

Address: Sant Nagar, Pune - Nashik Highway, Moshi Pradhikaran, Moshi, Pimpri-Chinchwad, Maharashtra 411070

Patients can book an appointment by contacting Dr. Kiyawat at:

Phone: +91 98220 46043

Email: drdilipkiyawatneurosurgeon@gmail.com

Website: www.drdilipkiyawatneurosurgeon.com

Moving Toward a Healthier Future

Choosing advanced neurosurgery with Dr. Dilip Kiyawat is a step toward a healthier tomorrow. With his expertise in treating complex brain and spine conditions, Dr. Kiyawat is a trusted name in neurosurgery, helping patients overcome neurological challenges and enhancing their quality of life. Whether you or a loved one are facing a brain tumor, spinal disorder, or other neurological conditions, Dr. Kiyawat’s experience and dedication make him a valuable partner in your journey to recovery.

[manishaz]

Finding the Best Neurosurgeon in Hisar: Key Qualities to Look For

When it comes to neurological health, choosing the best neurosurgeon in Hisar is a decision that can significantly impact your well-being. Neurosurgery is a specialized field dealing with complex conditions affecting the brain, spine, and nervous system. This guide will cover what makes a top neurosurgeon, what treatments they provide, and tips for finding the best neurosurgeon in Hisar.

Why Choosing the Best Neurosurgeon in Hisar is Crucial

Seeking treatment from the best neurosurgeon in Hisar ensures you receive the highest quality of care for serious neurological conditions. With expertise in advanced procedures and the latest technology, a skilled neurosurgeon can diagnose and treat conditions more accurately, improving your chances of recovery and quality of life.

Key Qualities of the Best Neurosurgeon in Hisar

1. Expertise and Qualifications

A top neurosurgeon will have extensive qualifications, often holding certifications from recognized medical boards. Their educational background and training reflect their expertise in handling complex neurological conditions. The best neurosurgeon in Hisar will also have years of specialized experience, enabling them to offer optimal treatment strategies.

2. Advanced Diagnostic and Surgical Techniques

The best neurosurgeon in Hisar uses state-of-the-art diagnostic and surgical equipment, including MRI, CT scans, and robotic-assisted surgery. Advanced techniques like minimally invasive procedures reduce patient discomfort and lead to faster recovery times. Such expertise in modern technology is crucial for successful outcomes.

3. Patient-Centered Approach

The best neurosurgeon in Hisar prioritizes a patient-centered approach, taking the time to understand individual needs, explain treatment options, and offer personalized care. This approach helps patients make informed decisions and feel more confident in the care they receive.

4. Positive Patient Reviews and Testimonials

Reviews from previous patients provide insights into the neurosurgeon’s skill, communication style, and approach to patient care. The best neurosurgeon in Hisar will often have positive feedback from patients who have experienced successful outcomes and quality care, making reviews a useful resource when choosing a provider.

Services Offered by the Best Neurosurgeon in Hisar

1. Brain Tumor Surgery

One of the most complex types of surgeries performed by the best neurosurgeon in Hisar is brain tumor removal. With advanced techniques and imaging, they ensure precision in targeting the tumor while minimizing damage to surrounding tissues.

2. Spine Surgery

Spine conditions, such as herniated discs, spinal stenosis, and fractures, are managed by the best neurosurgeon in Hisar using a combination of conservative treatments and, if necessary, surgical intervention. Minimally invasive techniques are often used, leading to less pain and shorter recovery times.

3. Vascular Neurosurgery

The best neurosurgeon in Hisar also specializes in vascular neurosurgery, addressing issues like aneurysms and vascular malformations. Using advanced endovascular techniques, they can often perform these delicate surgeries with minimal invasiveness.

4. Pediatric Neurosurgery

When children require neurosurgical treatment, the best neurosurgeon in Hisar offers compassionate, age-appropriate care. Pediatric neurosurgery often involves conditions like congenital abnormalities, epilepsy, and head trauma, which require specialized knowledge and a gentle approach.

The Process of Choosing the Best Neurosurgeon in Hisar

Initial Consultation

During an initial consultation, the best neurosurgeon in Hisar will assess your symptoms, review your medical history, and conduct necessary imaging tests. They will discuss your diagnosis in detail, outlining treatment options and potential outcomes to ensure you are fully informed before proceeding.

Treatment Planning and Care Coordination

Once a diagnosis is made, the best neurosurgeon in Hisar will develop a tailored treatment plan that suits your specific needs. To offer a comprehensive approach to care, they might collaborate with other medical specialists like neurologists and physical therapists.

Surgery and Post-Operative Care

If surgery is required, the best neurosurgeon in Hisar will ensure you understand the procedure, recovery expectations, and any risks involved. Post-operative care, including follow-up visits and rehabilitation, is essential for a successful recovery, and the best neurosurgeons provide attentive support during this phase.

Why the Best Neurosurgeon in Hisar Stands Out

The best neurosurgeon in Hisar not only possesses the technical skills required to perform intricate surgeries but also has a compassionate approach that puts patients at ease. They are committed to staying updated with the latest medical advancements and delivering high-quality, patient-centered care.

Conclusion

Finding the best neurosurgeon in Hisar requires careful consideration of the surgeon’s qualifications, experience, patient reviews, and treatment approach. With the right neurosurgeon, you can be assured of receiving comprehensive care that addresses both the physical and emotional aspects of treatment. Prioritize a provider who blends expertise with empathy for a positive experience and successful outcome.

FAQs

1. How do I find the best neurosurgeon in Hisar?Start by researching qualified neurosurgeons with strong credentials, positive patient reviews, and expertise in the specific area you need treatment for.

2. What types of conditions does the best neurosurgeon in Hisar treat?They treat various neurological conditions, including brain tumors, spinal disorders, vascular abnormalities, and pediatric neurological issues.

3. Is minimally invasive surgery an option with the best neurosurgeon in Hisar?Yes, the best neurosurgeons often employ minimally invasive techniques to reduce recovery time and minimize scarring.

4. How important are patient reviews when choosing the best neurosurgeon in Hisar? Patient reviews provide valuable insight into the surgeon's skill, communication, and overall care quality, helping you make an informed choice.

5. What should I expect during my initial consultation with the best neurosurgeon in Hisar? During the consultation, expect a thorough evaluation, diagnostic tests, and a detailed discussion of treatment options and possible outcomes.

[drsaurabhjaiswal12]

Best CTVS Surgeon in Jaipur: Comprehensive Care for Advanced Heart and Vascular Surgery

Finding the best CTVS (Cardio-Thoracic and Vascular Surgery) surgeon is essential for those dealing with complex heart conditions, particularly for patients who need skilled expertise in cardiac and vascular surgeries. In Jaipur, patients have access to experienced CTVS surgeons who specialize in a range of procedures that offer life-saving treatments for heart and vascular diseases. Known for their excellence, CTVS surgeons in Jaipur provide advanced cardiac care to patients across all age groups, covering procedures such as open-heart surgeries, minimally invasive cardiac surgeries, bypass surgeries, valve replacements, and more.

Why Choose a CTVS Surgeon?

A CTVS surgeon has specialized training in handling both cardiac and thoracic (lung-related) surgeries, making them experts in complex heart and vascular conditions. Their training allows them to perform delicate and life-saving surgeries that demand high precision and expertise. Choosing a qualified and reputed CTVS surgeon is important because they bring together knowledge, skill, and modern technology to offer optimal care.

Expertise and Services of the Best CTVS Surgeon in Jaipur

The best CTVS surgeons in Jaipur have extensive experience and are often recognized for their contributions to heart and vascular health. Here’s a look at some of the primary procedures they specialize in:

Heart Bypass Surgery (CABG) Coronary Artery Bypass Graft (CABG) surgery, commonly known as bypass surgery, is performed to improve blood flow to the heart. A skilled CTVS surgeon in Jaipur can carry out this surgery using advanced techniques, including total arterial beating heart bypass, which is less invasive and promotes faster recovery.

Minimally Invasive Heart Surgery Minimally invasive cardiac surgeries are becoming a popular choice for patients as they involve smaller incisions, reduced trauma, and quicker recovery. In Jaipur, top CTVS surgeons are trained in minimally invasive techniques, allowing patients to return to their normal lives faster and with fewer complications.

Valve Replacement and Repair Valve diseases, including stenosis and regurgitation, require surgical intervention to restore normal blood flow. CTVS surgeons in Jaipur specialize in valve replacement and repair, utilizing the latest advancements in prosthetic and biological valves to improve patient outcomes.

Vascular Surgery Aside from heart-related procedures, vascular surgeries are a crucial aspect of a CTVS surgeon’s expertise. Treating aneurysms, blocked arteries, and other vascular conditions require precision, and Jaipur’s CTVS surgeons offer a range of vascular interventions to restore healthy blood flow.

Open-Heart Surgery Open-heart surgery is a standard procedure for various cardiac conditions that require direct access to the heart. The best CTVS surgeons in Jaipur have the experience and expertise needed to perform open-heart surgeries safely and efficiently, ensuring positive patient outcomes.

Thoracic Surgeries These surgeries, addressing issues in the lungs and chest cavity, are critical for patients with pulmonary conditions. The top CTVS surgeons offer thoracic surgery as part of their comprehensive treatment.

Choosing the Best CTVS Surgeon in Jaipur

When choosing a CTVS surgeon, it’s essential to consider their experience, reputation, patient reviews, and success rates in surgeries. A trusted CTVS surgeon in Jaipur will always prioritize patient safety, conduct detailed pre-operative assessments, and provide clear explanations about the surgery, recovery, and post-surgical care. Additionally, Jaipur’s leading hospitals and clinics are equipped with advanced cardiac facilities, supporting CTVS surgeons in delivering top-tier treatment.

Advancements in Cardiac and Vascular Surgery in Jaipur

Jaipur’s healthcare system has seen impressive advancements, especially in cardiac care. With state-of-the-art technology, like high-definition imaging for vascular mapping and robotic-assisted surgeries, Jaipur’s CTVS surgeons have access to the best resources to enhance surgical outcomes. Moreover, Jaipur’s surgeons continually keep pace with global innovations in cardiac surgery, ensuring patients receive the most advanced treatments available.

The Road to Recovery with a CTVS Surgeon

Post-surgery care is critical in cardiac and vascular surgeries, and Jaipur’s CTVS surgeons prioritize comprehensive recovery plans for their patients. After surgery, a detailed rehabilitation program is established to aid in physical recovery and monitor heart health. A highly qualified CTVS surgeon will provide follow-up consultations to ensure smooth recovery and address any concerns the patient may have.

Conclusion

The best CTVS surgeons in Jaipur are committed to delivering life-changing cardiac and vascular care. They bring a blend of experience, compassion, and technological expertise to their practice, giving patients confidence in their treatment journey. With a focus on quality and patient-centered care, these surgeons stand out as leaders in Jaipur’s medical community, helping patients regain heart health and improve their quality of life.

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PDEK surgery | American Laser Eye Hospitals

When it comes to corneal transplant operations, PDEK (Pre-Descemet's Endothelial Keratoplasty) is of great significance. Given the level of precision and better results that such surgery provides to patients who suffer from endothelial dysfunction and corneal decompensation, PDEK techniques have changed the entire attitude towards corneal diseases and transplants. At American Laser Eye Hospitals, we are proud to be one of the leading centres offering advanced PDEK surgery in India, more so in Hyderabad. This procedure incorporates all the advantages of precision and effectiveness as well as faster recovery rates, therefore providing hope for patients who wish to restore their vision.

What is PDEK Surgery in brief

PDEK surgery is another form of endothelial keratoplasty that focuses on replacing only the inner diseased layers of the cornea and not the outer healthy layers. In a conventional corneal transplantation, where the entire cornea is replaced, the recovery is likely to be longer and also more complications are likely to develop. Such, however is the case that PDEK does not involve anything of that sort. This is because this technique can do away with disease endothelial tissue without removing the whole cornea and only a healthy thin tissue from a donor cornea is fitted into the vascular bed. This innovative technique is useful especially for patients with Fuchs' endothelial dystrophy and other diseases associated with the damage of the corneal endothelium.

The research adopts the technique of implanting so called pre-Descemet’s layer together with endothelium which enhances the strength of the graft and helps to maintain it in its position. The use of ultra-thin grafts during PDEK procedure reduces trauma to the eye, leaving the patients with a safe and effective surgical option. The added benefit of stability from the PDEK surgery translates to less rejection rates and good vision, even years after the surgery, increasing the overall success of the surgery as compared to the conventional means used.

What Are the Benefits of Getting PDEK Surgery from American Eye Laser Hospitals?

Technologically Advanced: American Eye Laser Hospitals have the latest technology and sophisticated instruments that enable them to perform safe and accurate PDEK surgeries. Our expenditure on sophisticated technology signifies our desire to provide quality services and successful results.

Surgeons of Global Standards: All the surgeons make sure that they have worked enough and trained for corneal transplants and PDEK surgery. The doctor’s ability to perform successful PDEK surgery enables each of the operations done to provide optimal visual outcomes while minimizing risks.

Specialized Solutions: We are aware that no two patients will have the same condition regarding their eyesight. At American Laser Eye Hospitals, we focus on individualized treatment strategies in order to meet the particular requirements, which means that every individual is provided with the best surgical approach and care during the treatment period.

Support After Surgery: Recovery and care after undergoing PDEK surgery is of higher importance. Generally, post-operative care is complete with regular check-ups, control of medications, and provision of guidance so that patients get the best vision possible after the surgery.

How PDEK Surgery Benefits the Patient

There are many benefits PDEK has to offer that are considered to be advantageous for this kind of surgery corneal transplantation, for example:

Quick PostOperative Recovery: In contrast to the conventional corneal vanity surgery performed on patients, which takes a long time to heal, recovery after surgery of this kind is much shorter and patients are able to get back to their normal daily activities rather fast.

Less Chance of Rejection: Because of the keyhole nature of this procedure and the use of tissue layers that are very thin, rejection rates are low, and hence, the transplant is more stable and long-lasting.

Lower Quality Vision: Since everything is done so perfectly, the vision after surgery is better, and clearer, and less peaceful compared to the vision with other kinds of corneal transplants where the tissue is disturbed in some ways and allows more light into the optical element.

Allows for Lesser Surgical Attention: This surgery typically has less aggressiveness of postoperative rehabilitation, and a smaller number of control visits is required in comparison with traditional corneal transplants.

Is PDEK Surgery Indicated for You?

People suffering retinopathy on the basis of structural changes in the endothelium and those with diseases associated with opacity of the cornea causing vision impairment, are likely to benefit from PDEK surgery. With consultation to a highly qualified cornea expert from American Laser Eye Hospitals, you will get to know if the PDEK procedure makes sense for your eye condition. Our team is focused on ensuring that all your inquiries are resolved, the procedure is understood in every detail and the buy decision is made easily.

Reach out to American Laser Eye Hospitals for Professional Eye Care Services

American Laser Eye Hospitals has proven to be a reliable and trustworthy institution in the eye hospitals context by embracing advanced procedures such as PDEK surgery to improve your vision quality. Get in touch with us now if you would like to book an appointment to find out more about how we can assist in restoring your vision and enhancing your ocular health with the help of our advanced surgical procedures. With our advanced services and personalized care, we assure the safety of your vision.