DOCSLIB.ORG

Vascular / Endovascular Surgery Vascular / Endovascular Surgery Combat Manual Combat Manual

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Vascular / Endovascular Surgery / Endovascular Vascular Vascular / Endovascular Surgery Combat Manual Combat Manual Combat W. L. Gore & Associates, Inc. Flagstaff, AZ 86004 +65.67332882 (Asia Pacific) 800.437.8181 (United States) 00800.6334.4673 (Europe) 928.779.2771 (United States) goremedical.com Stone Stone AbuRahma Campbell GORE®, EXCLUDER®, TAG®, VIABAHN®, and designs are trademarks of W. L. Gore & Associates. AbuRahma © 2012, 2013 W. L. Gore & Associates, Inc. AS0315-EN1 JULY 2013 Campbell Compliments of W. L. Gore & Associates, Inc. This publication, compliments of W. L. Gore & Associates, Inc. (Gore), is intended to serve as an educational resource for medical students, residents, and fellows pursuing training in vascular and endovascular surgery. Readers are reminded to consult appropriate references before engaging in any patient diagnosis, treatment, or surgery, including Prescribing Information (including boxed warnings and medication guides), Instructions for Use, and other applicable current information available from manufacturers. Gore products referenced within are used within their FDA approved / cleared indications. Gore does not have knowledge of the indications and FDA approval / clearance status of non-Gore products, and Gore does not advise or recommend any surgical methods or techniques other than those described in the Instructions for Use for its devices. Gore makes no representations or warranties as to the PERCLOSE®, PROSTAR®, SPARTACORE®, STARCLOSE®, and SUPRACORE® are trademarks of Abbott Laboratories. surgical techniques, medical conditions, or other factors that OMNI FLUSH and SIMMONS SIDEWINDER are trademarks of AngioDynamics. ICAST is a trademark of Atrium Medical Corporation. ASPIRIN® is a trademark of Bayer HealthCare, LLC. MORPH® is a trademark of BioCardia, may be described in this publication. Inc. AGGRENOX® and PRADAXA® are trademarks of Boehringer Ingelheim Pharma GmbH & Co. KG. AMPLATZ, GREENFIELD®, and WALLSTENT® are trademarks of Boston Scientific Corporation or its affiliates. COUMADIN® and GLUCOPHAGE® are trademarks of Bristol-Myers Squibb. CARDIVA CATALYST is a trademark of Cardiva Medical, Inc. BIRD’S NEST®, COOK®, CELECT, LUNDERQUIST®, PTX®, TX2®, ZENITH®, and ZILVER® are trademarks The opinions and advice expressed herein are those of the of COOK® Medical. GENESIS, OPTEASE®, PALMAZ®, and TRAPEASE® are trademarks of Cordis Corporation. FLAIR®, authors alone, and do not reflect the opinions or advice of FLUENCY®, and VECTRA® are trademarks of C. R. Bard, Inc. EFFIENT® is a trademark of Eli Lilly and Company. POWERLINK® is a trademark of Endologix, Inc. ANCEF® is a registered trademark of GlaxoSmithKline. ANCURE® Gore or the West Virginia University. is a trademark of Guidant Corporation. DACRON® is a trademark of INVISTA. SYVEK® is a trademark of Marine Polymer Technologies, Inc. SAFEGUARD® is a trademark of MAQUET. BENADRYL® is a trademark of McNEIL-PPC. ANEURX®, ENDURANT®, EVS, PIONEER®, and TALENT are trademarks of Medtronic, Inc. HIBICLENS® is a trademark of Mölnlycke® Healthcare US, LLC. NOVOSEVEN® is a trademark of Novo Nordisk A/S. PLETAL® is a trademark of Otsuka America Pharmaceutical, Inc. SOLU-MEDROL® and SOLU-CORTEF® are trademarks of Pfizer. LOVENOX® is a trademark of sanofi-aventis U.S. LLC. PLAVIX® is a trademark of Sanofi. CLO-SUR PLUS P.A.D is a trademark of Scion Cardio Vascular, Inc. ANGIO-SEAL, FEMOSTOP, and VASOSEAL are trademarks of St. Jude Medical, Inc. GLIDECATH® and GLIDEWIRE® are trademarks of Terumo Medical Corporation. ANGIOMAX® is a trademark of The Medicines Company. VECTRA® is a trademark of Thoratec Corporation. D-STAT® and DUETT are trademarks of Vascular Solutions, Inc. VANCOCIN® is a trademark of ViroPharma Incorporated. ZOSYN® is a trademark of Wyeth Pharmaceuticals Inc. This publication, compliments of W. L. Gore & Associates, Inc. (Gore), is intended to serve as an educational resource for medical students, residents, and fellows pursuing training in vascular and endovascular surgery. Readers are reminded to consult appropriate references before engaging in any patient diagnosis, treatment, or surgery, including Prescribing Information (including boxed warnings and medication guides), Instructions for Use, and other applicable current information available from manufacturers. Gore products referenced within are used within their FDA approved / cleared indications. Gore does not have knowledge of the indications and FDA approval / clearance status of non-Gore products, and Gore does not advise or recommend any surgical methods or techniques other than those described in the Instructions for Use for its devices. Gore makes no representations or warranties as to the PERCLOSE®, PROSTAR®, SPARTACORE®, STARCLOSE®, and SUPRACORE® are trademarks of Abbott Laboratories. surgical techniques, medical conditions, or other factors that OMNI FLUSH and SIMMONS SIDEWINDER are trademarks of AngioDynamics. ICAST is a trademark of Atrium Medical Corporation. ASPIRIN® is a trademark of Bayer HealthCare, LLC. MORPH® is a trademark of BioCardia, may be described in this publication. Inc. AGGRENOX® and PRADAXA® are trademarks of Boehringer Ingelheim Pharma GmbH & Co. KG. AMPLATZ, GREENFIELD®, and WALLSTENT® are trademarks of Boston Scientific Corporation or its affiliates. COUMADIN® and GLUCOPHAGE® are trademarks of Bristol-Myers Squibb. CARDIVA CATALYST is a trademark of Cardiva Medical, Inc. BIRD’S NEST®, COOK®, CELECT, LUNDERQUIST®, PTX®, TX2®, ZENITH®, and ZILVER® are trademarks The opinions and advice expressed herein are those of the of COOK® Medical. GENESIS, OPTEASE®, PALMAZ®, and TRAPEASE® are trademarks of Cordis Corporation. FLAIR®, authors alone, and do not reflect the opinions or advice of FLUENCY®, and VECTRA® are trademarks of C. R. Bard, Inc. EFFIENT® is a trademark of Eli Lilly and Company. POWERLINK® is a trademark of Endologix, Inc. ANCEF® is a registered trademark of GlaxoSmithKline. ANCURE® Gore or the West Virginia University. is a trademark of Guidant Corporation. DACRON® is a trademark of INVISTA. SYVEK® is a trademark of Marine Polymer Technologies, Inc. SAFEGUARD® is a trademark of MAQUET. BENADRYL® is a trademark of McNEIL-PPC. ANEURX®, ENDURANT®, EVS, PIONEER®, and TALENT are trademarks of Medtronic, Inc. HIBICLENS® is a trademark of Mölnlycke® Healthcare US, LLC. NOVOSEVEN® is a trademark of Novo Nordisk A/S. PLETAL® is a trademark of Otsuka America Pharmaceutical, Inc. SOLU-MEDROL® and SOLU-CORTEF® are trademarks of Pfizer. LOVENOX® is a trademark of sanofi-aventis U.S. LLC. PLAVIX® is a trademark of Sanofi. CLO-SUR PLUS P.A.D is a trademark of Scion Cardio Vascular, Inc. ANGIO-SEAL, FEMOSTOP, and VASOSEAL are trademarks of St. Jude Medical, Inc. GLIDECATH® and GLIDEWIRE® are trademarks of Terumo Medical Corporation. ANGIOMAX® is a trademark of The Medicines Company. VECTRA® is a trademark of Thoratec Corporation. D-STAT® and DUETT are trademarks of Vascular Solutions, Inc. VANCOCIN® is a trademark of ViroPharma Incorporated. ZOSYN® is a trademark of Wyeth Pharmaceuticals Inc. TAFF VASCULAR/ENDOVASCULAR SURGERY S COMBAT MANUAL ISION ISION V Patrick A. Stone, MD, FACS Editor and Chief Associate Professor of Surgery Ali F. AbuRahma, MD, FACS Section Editor Open Vascular Reconstructions Professor of Surgery John E. Campbell, MD DI CHARLESTON ERSITY: Section Editor Vascular Medicine and Endovascular Surgery V Assistant Professor of Medicine and Surgery Contributing Authors Saadi Alhalbouni, MD Vascular Surgery Fellow WEST VIRGINIA UNI VIRGINIA WEST Mark C. Bates MD, FACC, FSCAI, FSVM Professor of Medicine and Surgery James R. Campbell II, MD Assistant Professor of Surgery and Medicine D. Daniel Dearing, MD Vascular Surgery Fellow Stephen M. Hass, MD, JD Assistant Professor of Surgery Albeir Y. Mousa, MD Associate Professor of Surgery Aravinda Nanjundappa, MD, FACC Associate Professor of Medicine and Surgery Mohit Srivastava, MD Assistant Professor of Surgery West Virginia University: Charleston Division Department of Surgery: Division of Vascular and Endovascular Surgery a DEDICATION This book is dedicated to James P. Boland, MD. No single individual has had such a significant impact on surgical education and retention of general surgeons in West Virginia. His devotion to patient care extended from university practice to the private practice community without reservation. His ability to bring chaos to order in the operating room was felt by hospital staff and physicians alike. His teachings and patience will not be forgotten, but preserved through generations of surgeons trained under his watch. “It feels good to be under the bright lights….” James P. Boland, MD Chairman Dept. of Surgery West Virginia University Charleston Division 1976–2011 VASCULAR SURGERY RULES OF ENGAGEMENT When talking to families postoperatively, explain your biggest 1. NGAGEMENT concerns about the case — no one likes surprises. E 2. When you talk to patients, always do it sitting down. 3. If you do it perfect it might work. OF LES RU Make claudicators beg for intervention. 4. RGERY RGERY Arterial access appears simple but can be deadly. 5. SU If you have not seen it done before, there is a reason why. 6. LAR LAR Amputation survival is equivalent to metastatic cancer. 7. CU 8. Close the skin like it is your baby’s face. Patients judge you more on the outside appearance than what you did on the inside. VAS 9. If it can get infected, it will. 10. Statistics apply to everything — the numbers always catch up to you eventually. 11. If you don’t like what it looks
Recommended publications
  • Subclavian Vein Obstruction Without Thrombosis

    Subclavian Vein Obstruction Without Thrombosis

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Subclavian vein obstruction without thrombosis Richard J. Sanders, MD,a and Sharon L. Hammond, MD,a,b Denver, Colo Background: Unilateral arm swelling caused by subclavian vein obstruction without thrombosis is an uncommon form of venous thoracic outlet syndrome (TOS). In 87 patients with venous TOS, only 21 patients had no thrombosis. We describe the diagnosis and treatment of these patients. Material and Methods: Twenty-one patients with arm swelling, cyanosis, and venograms demonstrating partial subclavian vein obstruction were treated with transaxillary first rib resection and venolysis. Results: Eighteen (86%) of 21 patients had good-to-excellent improvement of symptoms. There were two failures (9%). Conclusions: Unilateral arm swelling without thrombosis, when not caused by lymphatic obstruction, may be due to subclavian vein compression at the costoclavicular ligament because of compression either by that ligament or the subclavius tendon most often because of congenital close proximity of the vein to the ligament. Arm symptoms of neurogenic TOS, pain, and paresthesia often accompany venous TOS while neck pain and headache, other common symptoms of neurogenic TOS, are infrequent. Diagnosis was made by dynamic venography. First rib resection, which included the anterior portion of rib and cartilage plus division of the costoclavicular ligament and subclavius tendon, proved to be effective treatment. (J Vasc Surg 2005;41:285-90.) Unilateral arm swelling without thrombosis is uncom- system. Three separate injections were administered: one mon, and few papers have addressed this condition. The with the arm at the side, one with the arm abducted to 90 last article on this subject that we could find was published degrees; and one with the arm at 180 degrees.
  • ANGIOGRAPHY of the UPPER EXTREMITY Printed in the Netherlands by Koninklijke Drukkerij G.J.Thieme Bv, Nijmegen ANGIOGRAPHY of the UPPER EXTREMITY

    ANGIOGRAPHY of the UPPER EXTREMITY Printed in the Netherlands by Koninklijke Drukkerij G.J.Thieme Bv, Nijmegen ANGIOGRAPHY of the UPPER EXTREMITY

    1 f - h-' ^^ ANGIOGRAPHY OF THE UPPER EXTREMITY Printed in The Netherlands by Koninklijke drukkerij G.J.Thieme bv, Nijmegen ANGIOGRAPHY OF THE UPPER EXTREMITY PROEFSCHRIFT ter verkrijging van de graad van Doctor in de Geneeskunde aan de Rijksuniversiteit te Leiden, op gezag van de Rector Magni- ficus Dr. A. A. H. Kassenaar, Hoogleraar in de faculteit der Geneeskunde, volgens besluit van het college van dekanen te verdedigen op donderdag 6 mei 1982 te klokke 15.15 uur DOOR BLAGOJA K. JANEVSKI geborcn 8 februari 1934 te Gradsko, Joegoslavie MARTINUS NIJHOFF PUBLISHERS THE HAGUE - BOSTON - LONDON 1982 PROMOTOR: Prof. Dr. A. E. van Voorthuisen REPERENTEN: Prof. Dr. J. M. F. LandLandsmees r 1 Prof. Dr. J. L. Terpstra ! I Copyright © 1982 by Martinus Nijhoff Publishers, The Hague All rights reserved. No part of this publication may be repro- duced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the pub- lishers, Martinus Nijhoff Publishers,P.O. Box 566,2501 CN The Hague, The Netherlands if ••»• 7b w^ wife Charlotte To Lucienne, Lidia and Dejan h {, ,;T1 ii-"*1 ™ ffiffp"!»3^>»'*!W^iyJiMBiaMMrar^ ACKNOWLEDGEMENTS This thesis was produced in the Department of Radiology, Sirit Annadal Hospital, Maastricht. i Case material: Prof. Dr. H. A. J. Lemmens, surgeon. Technical assistence: Miss J. Crijns, Mrs. A. Rousie-Panis, Miss A. Mordant and Miss H. Nelissen. Secretarial help: Mrs. M. Finders-Velraad and Miss Y. Bessems. Photography: Mr. C. Evers. Graphical illustrations: Mr. C. Voskamp. Correction English text: Dr.
  • Training for Radiation Emergencies: First Responder Operations

    Training for Radiation Emergencies: First Responder Operations

    TRAINING FOR RADIATION EMERGENCIES: FIRST RESPONDER OPERATIONS STUDENT TEXT Developed by THE INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS ® Alfred K. Whitehead Vincent J. Bollon General President General Secretary-Treasurer Copyright © 1998 International Association of Fire Fighters 1750 New York Avenue, N.W. Washington, D.C. 20006 THE INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS ® Alfred K. Whitehead Vincent J. Bollon General President General Secretary-Treasurer Bradley M. Sant, Director Hazardous Materials Training The IAFF acknowledges the Hazardous Materials Training staff: Kimberly Lockhart, Michael Lucey, Diane Dix Massa, A. Christopher Miklovis, Carol Mintz, Michael Schaitberger, Scott Solomon, Linda Voelpel Casey, and consultants Jo Griffith, Eric Lamar, and Margaret Veroneau for their work in developing this manual. In addition, the IAFF thanks Paul Deane,Tommy Erickson, and Charlie Wright for their contributions to this project. Notice This manual was prepared as an account of work sponsored by an agency of the United States Government. Neither the United States government nor any agency thereof, nor any of their employees, nor any of their contractors, subcontractors nor their employees, make any warranty, expressed or implied, or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represent that its use would not infringe upon privately-owned rights. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or any agency thereof.
  • Thoracic Outlet and Pectoralis Minor Syndromes

    Thoracic Outlet and Pectoralis Minor Syndromes

    S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS).
  • New York Chapter American College of Physicians Annual

    New York Chapter American College of Physicians Annual

    New York Chapter American College of Physicians Annual Scientific Meeting Poster Presentations Saturday, October 12, 2019 Westchester Hilton Hotel 699 Westchester Avenue Rye Brook, NY New York Chapter American College of Physicians Annual Scientific Meeting Medical Student Clinical Vignette 1 Medical Student Clinical Vignette Adina Amin Medical Student Jessy Epstein, Miguel Lacayo, Emmanuel Morakinyo Touro College of Osteopathic Medicine A Series of Unfortunate Events - A Rare Presentation of Thoracic Outlet Syndrome Venous thoracic outlet syndrome, formerly known as Paget-Schroetter Syndrome, is a condition characterized by spontaneous deep vein thrombosis of the upper extremity. It is a very rare syndrome resulting from anatomical abnormalities of the thoracic outlet, causing thrombosis of the deep veins draining the upper extremity. This disease is also called “effort thrombosis― because of increased association with vigorous and repetitive upper extremity activities. Symptoms include severe upper extremity pain and swelling after strenuous activity. A 31-year-old female with a history of vascular thoracic outlet syndrome, two prior thrombectomies, and right first rib resection presented with symptoms of loss of blood sensation, dull pain in the area, and sharp pain when coughing/sneezing. When the patient had her first blood clot, physical exam was notable for swelling, venous distension, and skin discoloration. The patient had her first thrombectomy in her right upper extremity a couple weeks after the first clot was discovered. Thrombolysis with TPA was initiated, and percutaneous mechanical thrombectomy with angioplasty of the axillary and subclavian veins was performed. Almost immediately after the thrombectomy, the patient had a rethrombosis which was confirmed by ultrasound.
  • Radiation Burn / Dermatitis, Chemical Burn & Necrobiosis Lipodica Case Studies

    Radiation Burn / Dermatitis, Chemical Burn & Necrobiosis Lipodica Case Studies

    Radiation Burn / Dermatitis, Chemical Burn & Necrobiosis Lipodica Case Studies By: Jeanne Alvarez, FNP, CWS, Independent Medical Associates, Bangor, ME Radiation Burn / Dermatitis Case Study 1: 63 year old female S/P lumpectomy with chemotherapy and radiation to the breast. She developed a burn to the area with noted dermatitis at the completion of radiation treatments. Area was very painful and blistered. Hydrofera Blue radiation dressing was applied and held in place with netting. There was significant pain reduction reported within hours of application. Wounds healed in 17 days of starting therapy. Started Healed in 17 Days Radiation Burn / Dermatitis Case Study 2: 85 year old male S/P excision of Squamous cell carcinoma of the right temple x 2, the second excision prompted the surgeon to treat area with radiation. The radiation caused the patient’s skin to burn and develop a dermatitis surrounding the wound. Started Hydrofera Blue on patient and he healed in 83 days. Started Healed in 83 Days Chemical Burn Necrobiosis Lipodica Case Study 1: 57 year old male spraying Case Study 1: 48 year old female with wounds on shins. Wounds present for 3 years. insecticide containing the cyhalothrin, Treated at wound care center and given diagnosis of pyoderma gangrenosum, tried came into contact with hands and arms. multiple treatments resulting in thick black and flesh colored eschar which festered and Flushed area with water after contact. drained on regular basis. Wounds did not resemble pyoderma gangrenosum, debrided Within 24 hours of exposure, developed eschar and obtained biopsy, which provided diagnosis of necrobiosis lipodica. Work-up for painful 10/10 blisters.
  • DVT Upper Extremity

    DVT Upper Extremity

    UT Southwestern Department of Radiology Ultrasound – Upper Extremity Deep Venous Thrombosis Evaluation PURPOSE: To evaluate the upper extremity superficial and deep venous system for patency. SCOPE: Applies to all ultrasound venous Doppler studies of the lower extremities in Imaging Services / Radiology EPIC ORDERABLE: • UTSW: US DOPPLER VENOUS DVT UPPER EXTREMITY BILATERAL US DOPPLER VENOUS DVT UPPER EXTREMITY RIGHT US DOPPLER VENOUS DVT UPPER EXTREMITY LEFT • PHHS: US DOPPLER VENOUS DVT UPPER EXTREMITY BILATERAL US DOPPLER VENOUS DVT UPPER EXTREMITY RIGHT US DOPPLER VENOUS DVT UPPER EXTREMITY LEFT INDICATIONS: • Symptoms such as upper extremity swelling, pain, fever, warmth, change in color, palpable cord • Suspected venous occlusion, or DVT based on clinical prediction rules (eg. Well’s score or D- Dimer) • Indwelling or recent PICC or central line • Chest pain and/or shortness of breath • Suspected or known pulmonary embolus • Follow-up known deep venous thrombosis (DVT) CONTRAINDICATIONS: No absolute contraindications EQUIPMENT: Preferably a linear array transducer that allows for appropriate resolution of anatomy (frequency range of 9 mHz or greater), capable of duplex imaging. Sector or curvilinear transducers may be required for appropriate penetration in patients with edema or large body habitus. PATIENT PREPARATION: • None EXAMINATION: GENERAL GUIDELINES: A complete examination includes evaluation of the superficial and deep venous system of the upper extremity including the internal jugular, innominate, subclavian, axillary, paired brachial, basilic, and cephalic veins. EXAM INITIATION: • Introduce yourself to the patient • Verify patient identity using patient name and DOB • Explain test • Obtain patient history including symptoms. Enter and store data page US DVT Upper Extremity 05-31-2020.docx 1 | Page Revision date: 05-31-2020 UT Southwestern Department of Radiology • Place patient in supine position with arm extended TECHNICAL CONSIDERATIONS: • Review any prior imaging, making note of any previous thrombus burden.
  • Brachial Artery

    Brachial Artery

    VASCULAR Anatomy of the upper limb Dr Jamila EL M edany & Dr. Essam Eldin Salama Objectives At the end of the lecture, the students should be able to: • Identify the origin of the vascular supply for the upper limb. • Describe the main arteries and their branches of the arm, forearm & hand. • Describe the vascular arches for the hand. • Describe the superficial and deep veins of the upper limb Arteries Of The Upper Limb Right subclavian Left subclavian artery artery Axillary artery Brachial artery Ulnar artery Radial artery Palmar arches The Subclavian Artery The right artery originates from the brachiocephalic artery. The left artery Cotinues as originates from Axillary artery at the arch of the the lateral border aorta of the 1st rib The Axillary Artery Begins at the lateral border of the st 1 rib as continuation of the Subclavian artery subclavian artery. Continues as brachial artery at lower border of teres major muscle. Is closely related to the cords of brachial plexus and their branches Is enclosed within the axillary sheath. Is crossed anteriorly by the pectoralis minor muscle, and is st nd divided into three parts; 1 , 2 & Brachial artery Axillary artery 3rd. The 1st part of the axillary artery . Extends from the lateral st border of 1 rib to upper 1st part border of the pectoralis 2nd part minor muscle. Highest thoracic artery a. Related: 3rd part Pectoralis • Anterioly: to the minor pectoralis major muscle • Laterally: to the cords Teres of the brachial plexus. major . It gives; ONE branch: Highest thoracic artery The 2nd part of the axillary artery .
  • Ionizing Radiation Mediates Dose Dependent Effects Affecting the Healing Kinetics of Wounds Created on Acute and Late Irradiated Skin

    Ionizing Radiation Mediates Dose Dependent Effects Affecting the Healing Kinetics of Wounds Created on Acute and Late Irradiated Skin

    Article Ionizing Radiation Mediates Dose Dependent Effects Affecting the Healing Kinetics of Wounds Created on Acute and Late Irradiated Skin Candice Diaz 1,2, Cindy J. Hayward 1,2, Meryem Safoine 1,2, Caroline Paquette 1,2, Josée Langevin 3, Josée Galarneau 3, Valérie Théberge 4, Jean Ruel 5,6 , Louis Archambault 6,7,8 and Julie Fradette 1,2,6,* 1 Centre de Recherche en Organogénèse Expérimentale de l’Université Laval (LOEX), Québec, QC G1J 1Z4, Canada; [email protected] (C.D.); [email protected] (C.J.H.); [email protected] (M.S.); [email protected] (C.P.) 2 Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada 3 Department of Radiation Oncology, Cégep de Sainte-Foy, Québec, QC G1V 1T3, Canada; [email protected] (J.L.); [email protected] (J.G.) 4 Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec–Université Laval, Québec, QC G1R 2J6, Canada; [email protected] 5 Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Québec, QC G1V 0A6, Canada; [email protected] 6 Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1E 6W2, Canada; [email protected] 7 Department of Physics, Université Laval, Québec, QC G1V 0A6, Canada 8 Centre de Recherche sur le Cancer de l’Université Laval, Québec, QC G1R 2J6, Canada * Correspondence: [email protected] Citation: Diaz, C.; Hayward, C.J; Abstract: Radiotherapy for cancer treatment is often associated with skin damage that can lead to Safoine, M.; Paquette, C.; Langevin, J.; incapacitating hard-to-heal wounds.
  • Review of Cardiothoracic Surgery

    Review of Cardiothoracic Surgery

    TSRA Review of Cardiothoracic Surgery Carlos M. Mery Joseph W. Turek TSRA Review of Cardiothoracic Surgery Edited by: Carlos M. Mery, MD, MPH Cardiothoracic surgery fellow University of Virginia Charlottesville, VA President TSRA 2010 – 2011 Joseph W. Turek, MD, PhD Congenital cardiac surgery fellow Children’s Hospital of Philadelphia Philadelphia, PA President TSRA 2009 – 2010 Thoracic Surgery Residents Association www.tsranet.org TSRA Review of Cardiothoracic Surgery Copyright © 2011 by the Thoracic Surgery Residents Association, Carlos M. Mery, Joseph W. Turek TSRA / TSDA 633 N. Saint Clair Street Suite 2320 Chicago, IL 60611 www.tsranet.org Disclaimer The material presented herein is, to the best of our knowledge, accurate and factual to date. The information is provided as a basic guideline for the study of cardiothoracic surgery and should be used in conjunction with a variety of other educational references and resources. The TSRA Re- view of Cardiothoracic Surgery should not be construed as a definitive study guide for either the TSDA In-Training Exam or the ABTS Certification Exam. TSRA makes no claims regarding the study guide's value in preparing for, or its contribution toward performance on, either the TSDA In-Training Exam or the ABTS Certification Exam. All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying or the use of any information storage and retrieval system without written permission from the copyright owners. Cover artwork by: Carmina Mery, Ramón Mery, and Mari Pili Guzmán (age 3) To all cardiothoracic surgery residents, present and future.
  • Denture Technology Curriculum Objectives

    Denture Technology Curriculum Objectives

    Health Licensing Agency 700 Summer St. NE, Suite 320 Salem, Oregon 97301-1287 Telephone (503) 378-8667 FAX (503) 585-9114 E-Mail: [email protected] Web Site: www.Oregon.gov/OHLA As of July 1, 2013 the Board of Denture Technology in collaboration with Oregon Students Assistance Commission and Department of Education has determined that 103 quarter hours or the equivalent semester or trimester hours is equivalent to an Associate’s Degree. A minimum number of credits must be obtained in the following course of study or educational areas: • Orofacial Anatomy a minimum of 2 credits; • Dental Histology and Embryology a minimum of 2 credits; • Pharmacology a minimum of 3 credits; • Emergency Care or Medical Emergencies a minimum of 1 credit; • Oral Pathology a minimum of 3 credits; • Pathology emphasizing in Periodontology a minimum of 2 credits; • Dental Materials a minimum of 5 credits; • Professional Ethics and Jurisprudence a minimum of 1 credit; • Geriatrics a minimum of 2 credits; • Microbiology and Infection Control a minimum of 4 credits; • Clinical Denture Technology a minimum of 16 credits which may be counted towards 1,000 hours supervised clinical practice in denture technology defined under OAR 331-405-0020(9); • Laboratory Denture Technology a minimum of 37 credits which may be counted towards 1,000 hours supervised clinical practice in denture technology defined under OAR 331-405-0020(9); • Nutrition a minimum of 4 credits; • General Anatomy and Physiology minimum of 8 credits; and • General education and electives a minimum of 13 credits. Curriculum objectives which correspond with the required course of study are listed below.
  • Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: the New Gold Standard of Treatment?

    Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: the New Gold Standard of Treatment?

    Journal of Clinical Medicine Article Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment? Adrian Zehnder 1,2,†, Jon Lutz 2,† , Patrick Dorn 2, Fabrizio Minervini 3 , Peter Kestenholz 3, Hans Gelpke 1, Ralph A. Schmid 2 and Gregor J. Kocher 2,* 1 Department of Surgery, Cantonal Hospital of Winterthur, 8401 Winterthur, Switzerland; [email protected] (A.Z.); [email protected] (H.G.) 2 Division of General Thoracic Surgery, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; [email protected] (J.L.); [email protected] (P.D.); [email protected] (R.A.S.) 3 Department of Thoracic Surgery, Kantonsspital Luzern, 6004 Lucerne, Switzerland; [email protected] (F.M.); [email protected] (P.K.) * Correspondence: [email protected]; Tel.: +41-31-632-0471; Fax: +41-31-6322-2739 † The first two authors contributed equally to this paper. Abstract: In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS Citation: Zehnder, A.; Lutz, J.; Dorn, were performed in 23 patients at our institutions.