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Vantage Total Ankle Replacement
Total Ankle Replacement Find out why the Exactech Ankle may be right for you. UNDERSTANDING ANKLE REPLACEMENT This brochure offers a brief overview of ankle anatomy, arthritis and ankle replacement. This information is for educational purposes only and is not intended to replace the expert guidance of your physician. Please direct any questions or concerns you may have to your doctor. 02 ANKLE ARTHRITIS YOUR ANKLE Your ankle is made up of a variety of bones, ligaments, tendons and cartilage that connect at the junction of your leg and foot. The joint works like a hinge and is responsible for moving your foot up and down. The tibia (shinbone), talus and fibula (smaller bone in the lower leg) are the bones that construct the ankle joint. Your ligaments border these bones on either side, holding them together to provide stability. Meanwhile the tendons connect the muscles to the bone and are responsible for the ankle and toe movements. Covering your bones is a smooth substance called cartilage, which acts as a cushion to reduce the friction between your bones as they move. If your cartilage wears down, arthritis can develop and cause loss of motion and pain. TIBIA FIBULA TALUS CALCANEUS METATARSAL V 03 ARTHRITIC ANKLE HEALTHY ANKLE Nearly half of individuals over the age of 60 have foot or ankle arthritis. 04 ARTHRITIS Nearly half of individuals over the age of 60 have foot or ankle arthritis that may not cause symptoms.1 However, for those suffering from ankle arthritis pain the most reported causes are:2 • Rheumatoid arthritis - It is an autoimmune disease that attacks multiple joints and typically starts in the hands and feet. -
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Medical Policy Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 130 BCBSA Reference Number: 7.01.101 Related Policies None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Uvulopalatopharyngoplasty (UPPP) may be MEDICALLY NECESSARY for the treatment of clinically significant obstructive sleep apnea syndrome (OSAS) in appropriately selected adult patients who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: Apnea/hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. Hyoid suspension, surgical modification of the tongue, and/or maxillofacial surgery, including mandibular- maxillary advancement (MMA), may be MEDICALLY NECESSARY in appropriately selected adult patients with clinically significant OSA and objective documentation of hypopharyngeal obstruction who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: AHI or RDI 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. -
Acr–Nasci–Sir–Spr Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (Cta)
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 47)* ACR–NASCI–SIR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF BODY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1. -
High Resolution Anoscopy Overview
High Resolution Anoscopy Overview Naomi Jay, RN, NP, PhD University of California San Francisco Email: [email protected] Disclosures No Disclosures Definition of HRA Examination of the anus, anal canal and perianus using a colposcope with 5% acetic acid and Lugol’s solution. Basic Principles • Office-based procedure • Adapted from gynecologic colposcopy. • Validated for anal canal. • Similar terminology and descriptors. may be unfamiliar to non-gyn providers. • Comparable to vaginal and vulvar colposcopy. • Clinicians familiar with cervical colposcopy may be surprised by the difficult transition. Anal SCJ & AnTZ • Original vs. current SCJ less relevant. • TZ features less common, therefore more difficult to appreciate. • SCJ more subtle, difficult to see in entirety requires more manipulation & acetic acid. • Larger area of metaplastic changes overlying columnar epithelium compared to endocervix. • Most lesions found in the AnTZ. Atypical Metaplasia • Atypical metaplasia may indicate the presence of HSIL. • Radiate over distal rectum from SCJ. • Thin, may wipe off. • Features to look for indicating potential lesions: • Atypical clustered glands (ACG) • Lacy metaplastic borders (LM) • Epithelial Honeycombing (EH) Lugol’s. Staining • More utility in anus compared to cervix. • Adjunctive to help define borders, distinguish between possible LSIL/HSIL. • Most HSIL will be Lugol’s negative • LSIL may be Lugol’s partial or negative • Applied focally with small cotton swabs to better define an acetowhite lesion. •NOT a short cut to determine presence or absence of lesions, acetic acid is used first and is applied frequently. Anal vs. Cervical Characteristics • Punctation & Mosaic rarely “fine” mostly “coarse”. • Mosaic pattern mostly associated with HSIL. • Atypical vessels may be HSIL or cancer • Epithelial honeycombing & lacy metaplasia unique anal descriptors. -
1311 Diploma in Medical Record Science Second
[LD 0212] AUGUST 2013 Sub. Code: 1311 DIPLOMA IN MEDICAL RECORD SCIENCE SECOND YEAR PAPER II – INTERNATIONAL CLASSIFICATION OF DISEASES (ICD-10) & SURGICAL PROCEDURES (ICM-9CM) Q.P. Code : 841311 Time : Three Hours Maximum : 100 marks Answer ALL questions I Write appropriate codes using ICD -10 (30 x 1 = 30) 1. Therapeutic introduction of hand tendon. 2. Excision of major partial thickness of eyelid excision. 3. Interphalangeal arthrodesis of Toe. 4. Division of percutaneous spinal cord nerve tracts. 5. Transfusion of allograft bone aetriosus. 6. Rastelli operation of truncus arteriosus. 7. Pyoloric sphincter dilatation. 8. Stapling of radius epiphyseal plate. 9. Suture of hands fascia. 10. Suture of hand fascia. 11. Repair of anterior wall (abdomen) hernia. 12. Foreign body removal without incision in t o the brain. 13. Repair of Tetrology of fallot. 14. Frontal Sinusectomy. 15. Urethral sling suspension. 16. Bone shaft transfer. 17. Coil of aneuryum repair. 18. Sling suspension. 19. Radio isotope scanning, pituitary gland. 20. Spinal shunt removal. 21. Acute lung edema. Due to external agent. 22. Proximal end tibial closed fracture was riding a two wheeler-slip & fell down. 23. Thrombosed internal hemorrhoids. 24. Secondary hypertension due to renal disorder. 25. Old myocardial infarction. 26. Fall from high place, injured elbow. 27. Chronic venous (peripheral) insufficiency. 28. Acute myeloid leukemia. 29. Post-operative intestine obstruction. 30. Abnormal pregnancy. II Writes appropriate codes using ICS-9CM (20 x 2 = 40) 1. Pregnant women suffering from acute salphingo oophoritis. 2. Accidental intake of ferrous salt. 3. Sprain of lumbar spine as stuck by another person. 4. -
The Importance of Orofacial Myofunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function
LASERfocus The Importance of Orofacial Myofunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function by Karen M. Wuertz, DDS, ABCDSM, DABLS, FOM, and Brooke Pettus, RDH, BSDH, COMS Frenectomy Methods ing, speaking, and breathing patterns may be Frenotomies performed with a scalpel or scissors can be accompanied by caused by incorrect oral posture and oral re- significant bleeding, obscuring the surgical field making it difficult to ensure strictions. Therefore, in the authors’ opinion, if the restriction has been completely removed. Because of the increased risk the removal of oral restrictions is necessary to of early primary closure of the site, postoperative active wound care is es- attain optimal orofacial function, and must be sential to reduce the risk of potential scarring. To properly restore and main- combined with regular pre- and post-frenecto- tain optimum function, active wound care should be implemented as soon my orofacial myofunctional therapy (OMT).1,4 as possible. However, if sutures are placed, the active wound care may be OMT helps re-educate the tongue and orofa- delayed so as not to cause early tearing of tissue. Due to the contact nature of cial muscles during movement and at rest to conventional procedure, there is a certain potential for infection; in addition, create new neuromuscular patterns for proper higher levels of postoperative pain and discomfort have been reported.1,2 Elec- oral function, including chewing, swallowing, trocautery and a hot glass tip of dental diodes may leave a fairly substantial speaking, and breathing.5,6 Camacho et al.7 zone of thermal tissue change3 and may result in delayed healing. -
Equilibrium Radionuclide Angiography/ Multigated Acquisition
EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION Equilibrium Radionuclide Angiography/ Multigated Acquisition S van Eeckhoudt, Bravis ziekenhuis, Roosendaal VJR Schelfhout, Rijnstate, Arnhem 1. Introduction Equilibrium radionuclide angiography (ERNA), also known as radionuclide ventriculography (ERNV), gated synchronized angiography (GSA), blood pool scintigraphy or multi gated acquisition (MUGA), is a well-validated technique to accurately determine cardiac function. In oncology its high reproducibility and low inter observer variability allow for surveillance of cardiac function in patients receiving potentially cardiotoxic anti-cancer treatment. In cardiology it is mostly used for diagnosis and prognosis of patients with heart failure and other heart diseases. 2. Methodology This guideline is based on available scientifi c literature on the subject, the previous guideline (Aanbevelingen Nucleaire Geneeskunde 2007), international guidelines from EANM and/or SNMMI if available and applicable to the Dutch situation. 3. Indications Several Class I (conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective) indications exist: • Evaluation of left ventricular function in cardiac disease: - Coronary artery disease - Valvular heart disease - Congenital heart disease - Congestive heart failure • Evaluation of left ventricular function in non-cardiac disease: - Monitoring potential cardiotoxic side effects of (chemo)therapy - Pre-operative risk stratifi cation in high risk surgery • Evaluation of right ventricular function: - Congenital heart disease - Mitral valve insuffi ciency - Heart-lung transplantation 4. Contraindications None 5. Medical information necessary for planning • Clear description of the indication (left and/or right ventricle) • Previous history of cardiac disease • Previous or current use of cardiotoxic medication PART I - 211 Deel I_C.indd 211 27-12-16 14:15 EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION 6. -
Lower Gastrointestinal Tract
Lower Gastrointestinal Tract Hemorrhoids—Office Management and Review for Gastroenterologists Mitchel Guttenplan, MD, FACS 1 and Robert A Ganz, MD, FASGE 2 1. Medical Director, CRH Medical Corp; 2. Minnesota Gastroenterology, Chief of Gastroenterology, Abbott-Northwestern Hospital, Associate Professor of Medicine, University of Minnesota Abstract symptomatic hemorrhoids and anal fissures are very common problems. This article provides a review of the anatomy and physiology of the anorectum along with a discussion of the diagnosis and treatment of hemorrhoids and the commonly associated matters of anal sphincter spasm and fissures. The various office treatment modalities for hemorrhoids are discussed, as are the specifics of rubber band ligation (rBL), and a strategy for the office treatment of these problems by the gastroenterologist is given. The crh o’regan system™ is a technology available to the gastroenterologist that provides a safe, effective, and efficient option for the non-surgical treatment of hemorrhoids in the office setting. Keywords hemorrhoids, anal fissure, rubber band ligation, crh o’regan system™ Disclosure: Mitchel guttenplan is Medical Director of crh Medical Products corporation, the manufacturer of the crh o’regan system™. robert A ganz is a consultant to and holds equity in crh Medical Products corporation. Received: 2 november 2011 Accepted: 30 november 2011 Citation: Touchgastroentorology.com ; December, 2011. Correspondence: Mitchel guttenplan, MD, fAcs, 3000 old Alabama rd, suite 119 #183, Alpharetta, gA 30022-8555, us. e: [email protected] Diseases of the anorectum, including hemorrhoids and anal fissures, are experience also makes it clear that hemorrhoid sufferers frequently very common. The care of these entities is typically left to general and have additional anorectal issues that may both confuse the diagnosis colorectal surgeons. -
ICD~10~PCS Complete Code Set Procedural Coding System Sample
ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00 -
Portal Hypertensionand Its Radiological Investigation
Postgrad Med J: first published as 10.1136/pgmj.39.451.299 on 1 May 1963. Downloaded from POSTGRAD. MED. J. (I963), 39, 299 PORTAL HYPERTENSION AND ITS RADIOLOGICAL INVESTIGATION J. H. MIDDLEMISS, M.D., F.F.R., D.M.R.D. F. G. M. Ross, M.B., B.Ch., B.A.O., F.F.R., D.M.R.D. From the Department of Radiodiagnosis, United Bristol Hospitals PORTAL hypertension is a condition in which there branch of the portal vein but may drain into the right is an blood in the branch. abnormally high pressure Small veins which are present on the serosal surface portal system of veins which eventually leads to of the liver and in the surrounding peritoneal folds splenomegaly and in chronic cases, to haematem- draining the diaphragm and stomach are known as esis and melaena. accessory portal veins. They may unite with the portal The circulation is in that it vein or enter the liver independently. portal unique The hepatic artery arises normally from the coeliac exists between two sets of capillaries, i.e. the axis but it may arise as a separate trunk from the aorta. capillaries of the spleen, pancreas, gall-bladder It runs upwards and to the right and divides into a and most of the gastro-intestinal tract on the left and right branch before entering the liver at the one hand and the sinusoids of the liver on the porta hepatis. The venous return starts as small thin-walled branches other hand. The liver parallels the lungs in that in the centre of the lobules in the liver. -
Joint Replacement Surgery Table of Contents
Everything You Want to Know About Joint Replacement Surgery Table of Contents Understanding Your Joints: PG.3 How, when and why joint pain occurs Diagnosing Joint Pain: PG.4 The most common conditions and injuries Exploring the Options: PG.5 A look at partial and total joint replacement Seeing What’s New: PG.6 Medical advances in joint replacement surgery Answering Your Questions: PG.7 A discussion with Dr. Donald Hohman, Joint Replacement Program Medical Director Learning More: PG.9 Connecting with Texas Health Center for Diagnostics and Surgery Getting Ready: PG.10 My questions about joint replacement surgery Texas Health Center for Diagnostics & Surgery is a joint venture owned by Texas Health Resources and physicians dedicated to the community and meets the definition under federal law of physician-owned hospital. Physicians on the medical staff practice independently and are not employees or agents of the hospital. PAGE 2 Understanding Your Joints: How, when and why joint pain occurs Healthy joints aren’t just necessary for performing the physical activities we enjoy. They are the mechanical instruments that make virtually every movement possible. When our joints begin to succumb to years of natural wear and tear or degenerative conditions like arthritis, even the most common movements — like walking or climbing stairs — can become painful. Left untreated, joint pain can be potentially debilitating, severely diminishing one’s quality of life. New hope for joint pain Here’s the good news: it is possible to significantly reduce joint pain. Medical advancements in joint surgery have come a long way, particularly partial and total joint replacement. -
Realignment Surgery As Alternative Treatment of Varus and Valgus Ankle Osteoarthritis
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 462, pp. 156–168 © 2007 Lippincott Williams & Wilkins Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis Geert I. Pagenstert, MD*; Beat Hintermann, MD*; Alexej Barg, MD*; André Leumann, MD†; and Victor Valderrabano, MD, PhD† In patients with asymmetric (varus or valgus) ankle osteo- Level of Evidence: Level IV, therapeutic study. See the arthritis, realignment surgery is an alternative treatment to Guidelines for Authors for a complete description of levels of fusion or total ankle replacement in selected cases. To deter- evidence. mine whether realignment surgery in asymmetric ankle os- teoarthritis relieved pain and improved function, we clini- cally and radiographically followed 35 consecutive patients Surgical treatment for patients with symptomatic ankle with posttraumatic ankle osteoarthritis treated with lower osteoarthritis (OA) is controversial, particularly in me- leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average chanically induced, malaligned ankle OA in which joint patient age was 43 years (range, 26–68 years). We used a cartilage is partially preserved. These patients typically are standardized clinical and radiographic protocol. Besides dis- in their economically important, active middle ages be- tal tibial osteotomies, additional bony and soft tissue proce- cause early trauma is the predominant (70–80%) etiology dures were performed in 32 patients (91%). At mean fol- of their ankle OA.49,58 Currently, treatment recommenda- lowup of 5 years (range, 3–10.5 years), pain decreased by an tions after failed nonoperative therapy are polarized be- average of 4 points on a visual analog scale; range of ankle tween fusion2,11,33 and total ankle replacement motion increased by an average of 5°.