Holoprosencephaly
Presentation by: Lindsay Higgins
Holoprosencephaly
* In holoprosencephaly, the prosencephalon fails to cleave down the midline, creating a single cerebral hemisphere and ventricle.
* The severity of holoprosencephaly is related to how completely the frontal regions of the brain are developed. The corpus callosum can be used as an approximate marker of brain development in holoprosencephaly. The further anterior the corupus forms, the better developed the brain.
* Three types: Alobar, Semilobar, and Lobar
Etiology of Holoprosencephaly
* Maternal Diabetes Mellitus
* Trisomy 13 (Patau Syndrome)
* Trisomy 18 (Edwards Syndrome)
* Fetal Alcohol Syndrome: Holoprosencephaly is the most severe manifestation of Fetal Alcohol Syndrome. It is especially associated with alcohol abuse during the first 4 weeks of pregnancy.
* Inherited mutations of genes HPE1, HPE2, HPE3, HPE4, HPE5
* Spontaneous mutations of Sonic Hedgehog Gene, which causes an autosomal dominant form of holoprosencephaly
Types of Holoprosencephaly
Alobar Holoprosencephaly
Semilobar Holoprosencephaly
Lobar Holoprosencephaly
References
Holoprosencephaly .ppt
Collection of free Downloadable Medical Videos,
Lecture Notes, Literature & PowerPoint Presentations
25 April 2009
Craniofacial Aging Impacts on the Eigenface Biometric
Craniofacial Aging Impacts on the Eigenface Biometric
Presentation by:K. Ricanek Jr., E. Patterson, and E. Boone
University of North Carolina Wilmington
Wilmington, NC
Outline
* Craniofacial Aging
* Craniofacial Morphologic Data Corpus
* Face Biometrics
* Algorithms
o PCA
o PCA+LDA
o Bayesian ML
o Bayesian MAP
* Evaluation
* Results
* Conclusions
Craniofacial Aging
Craniofacial changes continue throughout adulthood.
Craniofacial Morphologic Data Corpus
MORPH Album1
Face Biometrics
Algorithms
Eigenface Biometric
Fisherface Biometric
Bayesian ML and MAP
Evaluation
Conclusions
Craniofacial Aging Impacts on the Eigenface Biometric.ppt
Presentation by:K. Ricanek Jr., E. Patterson, and E. Boone
University of North Carolina Wilmington
Wilmington, NC
Outline
* Craniofacial Aging
* Craniofacial Morphologic Data Corpus
* Face Biometrics
* Algorithms
o PCA
o PCA+LDA
o Bayesian ML
o Bayesian MAP
* Evaluation
* Results
* Conclusions
Craniofacial Aging
Craniofacial changes continue throughout adulthood.
Craniofacial Morphologic Data Corpus
MORPH Album1
Face Biometrics
Algorithms
Eigenface Biometric
Fisherface Biometric
Bayesian ML and MAP
Evaluation
Conclusions
Craniofacial Aging Impacts on the Eigenface Biometric.ppt
Craniometry and Functional Craniology
Craniometry and Functional Craniology
Presentation by:
Michael S. Yuan, DDS, MA, PhD
Assistant Professor of Clinical Dentistry
Division of Orthodontics
School of Dental and Oral Surgery
Columbia University
Functional Craniology: Kinematics and Dynamics
Lecture outline
1. Introduction: definition, scope, and objectives
2. Kinematics and dynamics
3. Biomechanics: forces, deformation, stresses, strains
4. Form and Function
5. Bone remodeling and growth directions
6. Moss’ Hypothesis: Functional Matrix Hypothesis
7. Clinical applications
Functional Craniology
Dynamics
Kinematics
The description of measurement.
What is the true meaning of a measurement?
Force Compression, Tension, Shear, Bending, Torsion
Original status
Cranial Sutures
1. Edge-to-edge suture
* No force loading
2. Beveled suture
* Shear force [Squamosal suture]
3. Serrated suture
* Intermittent tension force
4. Beveled and serrated suture
* Intermittent tension and shear force
5. Butt-ended sutures
* Intermittent compressive force
1. Plane (gliding) joint
* Sliding motion of all directions
2. Hinge joint
* Flexion/extension
The Growth of Mandible
The Remodeling (Growth) Direction: The “V” Principle
Drift vs Displacement
Head (craniofacial complex) is a region, where a series of functions are carried out.
These functions include vision, hearing, speech, mastication, swallowing & digestion, respiration, neural integration, and others.
The successful execution of a function requires biomechanical protection and support.
Moss’ craniofacial growth theory:
Function of the craniofacial complex region is performed by the Functional Cranial Components (F.C.C).
Functional Matrix Hypothesis
Types of Functional Matrix
1. Orthodontics
2. Dentofacial Orthopedics and Orthognathic Surgery
3. Craniofacial surgery
Introduction: definition, scope, and objectives
Kinematics and dynamics
Biomechanics: forces, deformation, stresses, strains
Form and Function
Bone remodeling and growth directions
Moss’ Hypothesis: Functional Matrix Hypothesis
Clinical applications
References
Craniometry and Functional Craniology
Presentation by:
Michael S. Yuan, DDS, MA, PhD
Assistant Professor of Clinical Dentistry
Division of Orthodontics
School of Dental and Oral Surgery
Columbia University
Functional Craniology: Kinematics and Dynamics
Lecture outline
1. Introduction: definition, scope, and objectives
2. Kinematics and dynamics
3. Biomechanics: forces, deformation, stresses, strains
4. Form and Function
5. Bone remodeling and growth directions
6. Moss’ Hypothesis: Functional Matrix Hypothesis
7. Clinical applications
Functional Craniology
Dynamics
Kinematics
The description of measurement.
What is the true meaning of a measurement?
Force Compression, Tension, Shear, Bending, Torsion
Original status
Cranial Sutures
1. Edge-to-edge suture
* No force loading
2. Beveled suture
* Shear force [Squamosal suture]
3. Serrated suture
* Intermittent tension force
4. Beveled and serrated suture
* Intermittent tension and shear force
5. Butt-ended sutures
* Intermittent compressive force
1. Plane (gliding) joint
* Sliding motion of all directions
2. Hinge joint
* Flexion/extension
The Growth of Mandible
The Remodeling (Growth) Direction: The “V” Principle
Drift vs Displacement
Head (craniofacial complex) is a region, where a series of functions are carried out.
These functions include vision, hearing, speech, mastication, swallowing & digestion, respiration, neural integration, and others.
The successful execution of a function requires biomechanical protection and support.
Moss’ craniofacial growth theory:
Function of the craniofacial complex region is performed by the Functional Cranial Components (F.C.C).
Functional Matrix Hypothesis
Types of Functional Matrix
1. Orthodontics
2. Dentofacial Orthopedics and Orthognathic Surgery
3. Craniofacial surgery
Introduction: definition, scope, and objectives
Kinematics and dynamics
Biomechanics: forces, deformation, stresses, strains
Form and Function
Bone remodeling and growth directions
Moss’ Hypothesis: Functional Matrix Hypothesis
Clinical applications
References
Craniometry and Functional Craniology
Theories of Craniofacial Growth
Theories of Craniofacial Growth
Presentation by:Mark H. Taylor, D.D.S., F.A.C.D.
What are the Causes
Theories of Craniofacial Growth
* Sicher's Theory
* Scott's Theory
* Moss' Theory
* Van Limborg's Compromise
Sicher's Theory
* Sutural dominance theory
* States that all skull tissue is controlled largely by its own intrinsic genetic information
* States that all bone forming elements are growth centers as opposed to growth sites
* This theory fails
* Examples:
* Microcephaly/Hydrocephaly
* Enucleation of the eye
* Damaged suture
Damaged Suture
Site of damage
Shift of sagittal suture
Normal rat skull
Experimental
rat skull
Scott's Theory
* Cartilagenous dominance theory
* States that cartilage and periosteum are growth centers and sutures are passive; this is largely not true
* Contribution was that Scott correlated sutural adaptation with growth of other tissues, such as synchondrosis growth
Synchondrosis Growth
Occipital
Sphenoid
Ethmoid
Frontal
Posterior cranial base
Anterior cranial base
Spheno-occipital
synchondrosis
Moss' Theory
* Moss denies any intrinsic regulatory control in the growing bony tissues
* Good theory, except for no intrinsic regulatory control
* Examples:
* rapid palatal expansion
* functional jaw orthopedics
* tongue volume vs. lower dental arch sizes (Tamari, et al, Am J Orthod Dentofac Orthop 1991; 100:453-8)
Van Limborg's Compromise
* Chondrocranial growth is controlled by intrinsic genetic factors
* Growth of the desmocranium (calvarium) is mainly controlled by many epigenetic factors (genetically determined influences originating from adjacent structures and spaces, such as brain, eyes, etc.)
* Growth of the desmocranium (calvarium) is influenced by local environmental factors (external environment such as local external pressure, muscle forces, etc.)
* Fails to classify the controlling factors for the mandible
A Modern Compromise
* Chondrocranium is the dominant factor in craniofacial growth
* Postnatal cartilage remnants - spheno-occipital synchondrosis (SOS) and nasal cartilage act as growth centers and are largely influenced by intrinsic genetic factors
* SOS exerts a direct action on the desmocranium, which is also dominated by brain expansion; sutures are growth sites or growth adjusters
* Nasal cartilage displaces maxilla downward and forward; functional matrix may also influence maxilla; orbits are dominated by functional matrix
* Mandible is dominated by local epigenetic and environmental factors (ex. 02 supply)
* cranial base growth alters position of glenoid fossa and therefore the position of the mandible
* nasal cartilage displaces the maxilla; therefore mandible is displaced
Theories of Craniofacial Growth.ppt
Presentation by:Mark H. Taylor, D.D.S., F.A.C.D.
What are the Causes
Theories of Craniofacial Growth
* Sicher's Theory
* Scott's Theory
* Moss' Theory
* Van Limborg's Compromise
Sicher's Theory
* Sutural dominance theory
* States that all skull tissue is controlled largely by its own intrinsic genetic information
* States that all bone forming elements are growth centers as opposed to growth sites
* This theory fails
* Examples:
* Microcephaly/Hydrocephaly
* Enucleation of the eye
* Damaged suture
Damaged Suture
Site of damage
Shift of sagittal suture
Normal rat skull
Experimental
rat skull
Scott's Theory
* Cartilagenous dominance theory
* States that cartilage and periosteum are growth centers and sutures are passive; this is largely not true
* Contribution was that Scott correlated sutural adaptation with growth of other tissues, such as synchondrosis growth
Synchondrosis Growth
Occipital
Sphenoid
Ethmoid
Frontal
Posterior cranial base
Anterior cranial base
Spheno-occipital
synchondrosis
Moss' Theory
* Moss denies any intrinsic regulatory control in the growing bony tissues
* Good theory, except for no intrinsic regulatory control
* Examples:
* rapid palatal expansion
* functional jaw orthopedics
* tongue volume vs. lower dental arch sizes (Tamari, et al, Am J Orthod Dentofac Orthop 1991; 100:453-8)
Van Limborg's Compromise
* Chondrocranial growth is controlled by intrinsic genetic factors
* Growth of the desmocranium (calvarium) is mainly controlled by many epigenetic factors (genetically determined influences originating from adjacent structures and spaces, such as brain, eyes, etc.)
* Growth of the desmocranium (calvarium) is influenced by local environmental factors (external environment such as local external pressure, muscle forces, etc.)
* Fails to classify the controlling factors for the mandible
A Modern Compromise
* Chondrocranium is the dominant factor in craniofacial growth
* Postnatal cartilage remnants - spheno-occipital synchondrosis (SOS) and nasal cartilage act as growth centers and are largely influenced by intrinsic genetic factors
* SOS exerts a direct action on the desmocranium, which is also dominated by brain expansion; sutures are growth sites or growth adjusters
* Nasal cartilage displaces maxilla downward and forward; functional matrix may also influence maxilla; orbits are dominated by functional matrix
* Mandible is dominated by local epigenetic and environmental factors (ex. 02 supply)
* cranial base growth alters position of glenoid fossa and therefore the position of the mandible
* nasal cartilage displaces the maxilla; therefore mandible is displaced
Theories of Craniofacial Growth.ppt
Interpreting EEG/MEG data
Exploiting temporal delays in interpreting EEG/MEG data in terms of brain connectivity
Problem of volume conduction
Cross-spectrum
EEG-simulation of ERD (two sources)
Rest coherence
EEG-simulation of ERD (one source)
Change in coherence pt 1
Change in coherence pt 2
Observation
Explicit derivation
Coherence
Selfpaced movement - C3-C4 relationships
Significance - False Discovery Rate (FDR)
Simulated non-interacting sources
Results
Difference between cross-spectrum pt 1
Difference between cross-spectrum pt 2
Imaginary part - 5 dipoles
“Philosophy” pt 1
“Philosophy” pt 2
“Philosophy” pt 3
Pairwise Interacting Source Analysis (PISA)
EEG - imagined foot movement
Music pt 1
Music pt 2
Example 1
Example 2
Result ISA-pattern
Conclusion
Presentation Slides
Video
Problem of volume conduction
Cross-spectrum
EEG-simulation of ERD (two sources)
Rest coherence
EEG-simulation of ERD (one source)
Change in coherence pt 1
Change in coherence pt 2
Observation
Explicit derivation
Coherence
Selfpaced movement - C3-C4 relationships
Significance - False Discovery Rate (FDR)
Simulated non-interacting sources
Results
Difference between cross-spectrum pt 1
Difference between cross-spectrum pt 2
Imaginary part - 5 dipoles
“Philosophy” pt 1
“Philosophy” pt 2
“Philosophy” pt 3
Pairwise Interacting Source Analysis (PISA)
EEG - imagined foot movement
Music pt 1
Music pt 2
Example 1
Example 2
Result ISA-pattern
Conclusion
Presentation Slides
Video
Magnetoencephalography
Magnetoencephalography (MEG )
How It Works
* Currents in neurons create very tiny magnetic fields
* MEG uses SQUIDs to detect these magnetic fields.
* Magnetic signals from the brain are only a few fT in strength.
* Needs a magnetically shielded room
History
* First measured by David Cohen in 1968.
* He used a copper induction coil
* Presently, MEG technology uses SQUIDS
* Today, MEG machines can contain as many as 300 SQUID sensors
Diagram of MEG setup
SQUIDS
* Superconducting Quantum Interference Devices
* Superconducting material is niobium or lead alloy with gold/indium
* Cooled to low temperature with either liquid He (4K) or N (77K)
* Manufactured at NIST in Boulder!
* Noise levels about 3 fT*Hz^-1/2
Josephson Junctions
* Two superconductors separated by a thin insulating barrier
* A small current will tunnel across the barrier
* The constant current Ic depends on temperature and magnetic field
* SQUIDS measure fractions of the phase difference in terms of the flux quantum h/2e
Detecting Brain Activity
* 50,000 neurons need to fire to generate a readable signal
* Neurons near the outside of the brain generate the strongest signals
Magnetic Shielding
Forward Problem
The Inverse Problem
Synthetic Aperture Magnetometry
Magnetic Source Imaging
Dipole Model Source Localization
Lead-field-based imaging approach
Independent Component Analysis
Uses of MEG
* MEGs are used in research to measure the time course of brain activity
* MEGs can detect epilepsy, as well as detect areas of the brain that are most important to avoid during surgery
Advantages/Disadvantages
* High 1 ms time resolution
* Completely non-invasive
* Does not depend on head geometry like EEG
* Magnetic fields decay faster over distance than electric fields
* MEG is best used to complement other imaging techniques
References
Magnetoencephalography (MEG).ppt
How It Works
* Currents in neurons create very tiny magnetic fields
* MEG uses SQUIDs to detect these magnetic fields.
* Magnetic signals from the brain are only a few fT in strength.
* Needs a magnetically shielded room
History
* First measured by David Cohen in 1968.
* He used a copper induction coil
* Presently, MEG technology uses SQUIDS
* Today, MEG machines can contain as many as 300 SQUID sensors
Diagram of MEG setup
SQUIDS
* Superconducting Quantum Interference Devices
* Superconducting material is niobium or lead alloy with gold/indium
* Cooled to low temperature with either liquid He (4K) or N (77K)
* Manufactured at NIST in Boulder!
* Noise levels about 3 fT*Hz^-1/2
Josephson Junctions
* Two superconductors separated by a thin insulating barrier
* A small current will tunnel across the barrier
* The constant current Ic depends on temperature and magnetic field
* SQUIDS measure fractions of the phase difference in terms of the flux quantum h/2e
Detecting Brain Activity
* 50,000 neurons need to fire to generate a readable signal
* Neurons near the outside of the brain generate the strongest signals
Magnetic Shielding
Forward Problem
The Inverse Problem
Synthetic Aperture Magnetometry
Magnetic Source Imaging
Dipole Model Source Localization
Lead-field-based imaging approach
Independent Component Analysis
Uses of MEG
* MEGs are used in research to measure the time course of brain activity
* MEGs can detect epilepsy, as well as detect areas of the brain that are most important to avoid during surgery
Advantages/Disadvantages
* High 1 ms time resolution
* Completely non-invasive
* Does not depend on head geometry like EEG
* Magnetic fields decay faster over distance than electric fields
* MEG is best used to complement other imaging techniques
References
Magnetoencephalography (MEG).ppt
Diagnosing a Traumatic Head Injury
Diagnosing a Traumatic Head Injury
How are head injuries diagnosed? The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.
Diagnostic Tests
Blood Tests - your child may need to have blood obtained to check for normal levels. Sometimes we need to stick your child for blood each day until normal levels are reached. We have special lab staff that specializes in drawing blood from children.
CT scan - computer-enhanced procedure for obtaining x-ray images of the body. The machine looks like a big doughnut and your child will be placed on a platform that slides into the middle of the machine. During the scan an X-ray tube rotates around the body, generating hundreds of images. Your child must remain still during this test. The machine does not touch the child and is not painful. The scan will take 30-60 minutes.
MRI scan - uses a magnetic field to create two-dimensional images of the body. The machine looks like a big doughnut shaped tube. The child will be placed on a platform that slides into the middle of the machine. The MRI machine will make a loud knocking noise as the images are taken. Your child must remain still during this test. Young children, or a child with a fear of closed-in spaces, may need to be sedated for the procedure. If sedation is required your child may not be able to eat or drink before the test. The scan can last 60-90 minutes. One parent can go with the child to the MRI suite.
Ophthalmology Exam - this test is performed by a doctor specially trained to examine your child's eyes. The doctor may dilate the eyes with eye drops in order to visualize the internal structures of the eyes. The doctor may also examine how your child can see close-up and far away.
ICP monitor - this is a device that measures the pressure inside the head. This monitor is placed by a neurosurgeon either in the intensive care unit or operating room. The device is attached to a monitor that gives a constant reading of pressure inside the head. If the pressure goes up, it can be treated right away.
Modified Barium Swallow - an X-ray exam that assesses your child's oral skills and swallowing safety. A speech language pathologist will monitor this test. Based on the results your child's diet may be changed.
Neuropsychology Evaluation - this involves giving the child different types of tests by a doctor to determine the way the brain functions. These can include mental tests and physical skill tests. There is no invasive procedure involved.
Electroencephalography (EEG) - this test is used to record ongoing electrical brain waves. Sometimes children may have seizures after a traumatic head injury, and this test can help diagnose or evaluate for seizures. This test can determine if any brain waves are abnormal. This test is not invasive; the child will have the electrodes temporary glued to the scalp while monitored.
Source: LeBonheur Children Medical Centre
How are head injuries diagnosed? The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.
Diagnostic Tests
Blood Tests - your child may need to have blood obtained to check for normal levels. Sometimes we need to stick your child for blood each day until normal levels are reached. We have special lab staff that specializes in drawing blood from children.
CT scan - computer-enhanced procedure for obtaining x-ray images of the body. The machine looks like a big doughnut and your child will be placed on a platform that slides into the middle of the machine. During the scan an X-ray tube rotates around the body, generating hundreds of images. Your child must remain still during this test. The machine does not touch the child and is not painful. The scan will take 30-60 minutes.
MRI scan - uses a magnetic field to create two-dimensional images of the body. The machine looks like a big doughnut shaped tube. The child will be placed on a platform that slides into the middle of the machine. The MRI machine will make a loud knocking noise as the images are taken. Your child must remain still during this test. Young children, or a child with a fear of closed-in spaces, may need to be sedated for the procedure. If sedation is required your child may not be able to eat or drink before the test. The scan can last 60-90 minutes. One parent can go with the child to the MRI suite.
Ophthalmology Exam - this test is performed by a doctor specially trained to examine your child's eyes. The doctor may dilate the eyes with eye drops in order to visualize the internal structures of the eyes. The doctor may also examine how your child can see close-up and far away.
ICP monitor - this is a device that measures the pressure inside the head. This monitor is placed by a neurosurgeon either in the intensive care unit or operating room. The device is attached to a monitor that gives a constant reading of pressure inside the head. If the pressure goes up, it can be treated right away.
Modified Barium Swallow - an X-ray exam that assesses your child's oral skills and swallowing safety. A speech language pathologist will monitor this test. Based on the results your child's diet may be changed.
Neuropsychology Evaluation - this involves giving the child different types of tests by a doctor to determine the way the brain functions. These can include mental tests and physical skill tests. There is no invasive procedure involved.
Electroencephalography (EEG) - this test is used to record ongoing electrical brain waves. Sometimes children may have seizures after a traumatic head injury, and this test can help diagnose or evaluate for seizures. This test can determine if any brain waves are abnormal. This test is not invasive; the child will have the electrodes temporary glued to the scalp while monitored.
Source: LeBonheur Children Medical Centre
Chiropractic Care for High Blood Pressure
Chiropractic Care for High Blood Pressure
Chiropractic is a system of health care that emphasizes the relationship between structure and function in the body. Doctors of chiropractic believe that good health depends, in part, on the normal alignment of the body's parts, and that is alignments called subluxations - can be a major factor in illness. Chiropractors consider proper alignment of the spine to be of critical importance because of its central role in nervous system's function. Proper nerve function is essential in restoring and maintaining good health.
A video from ABC news about the effects of chiropractic care on high blood pressure.
Chiropractic is a system of health care that emphasizes the relationship between structure and function in the body. Doctors of chiropractic believe that good health depends, in part, on the normal alignment of the body's parts, and that is alignments called subluxations - can be a major factor in illness. Chiropractors consider proper alignment of the spine to be of critical importance because of its central role in nervous system's function. Proper nerve function is essential in restoring and maintaining good health.
A video from ABC news about the effects of chiropractic care on high blood pressure.
Herpes Labialis treatment with ND:YAG laser
Herpes Labialis treatment with ND:YAG laser
This video illustrates the treatment of an early stage HSV lesion of the lower lip with the PerioLase NdYAG laser. This treatment is performed without anesthesia and halts the progress of the lesion without topical or systemic medications and provides immediate relief of the pain associated with these lesions.
This video illustrates the treatment of an early stage HSV lesion of the lower lip with the PerioLase NdYAG laser. This treatment is performed without anesthesia and halts the progress of the lesion without topical or systemic medications and provides immediate relief of the pain associated with these lesions.
Privacy Policy
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24 April 2009
Fever During and After Childbirth
Fever During and After Childbirth
Advances in Maternal and Neonatal Health
Session Objectives
* Discuss best practices for management of infection during and after childbirth, especially:
o Amnionitis
o Metritis
* Describe strategies for prevention of infection
* Distinguish between prophylactic and therapeutic use of antibiotics
Providing Prophylactic Antibiotics
Providing Prophylactic Antibiotics for Cesarean Section: Objective and Design
Providing Prophylactic Antibiotics for Cesarean Section: Results
Providing Therapeutic Antibiotics
Principles of Treatment with Antibiotics
* Adequate dosing
* Adequate duration
* Continued re-evaluation of the patient
Fever During Pregnancy and Labor: Differential Diagnosis
* Cystitis
* Acute pyelonephritis
* Septic abortion
* Amnionitis
* Pneumonia
* Malaria
* Typhoid
* Hepatitis
Acute Pyelonephritis
Management of Acute Pyelonephritis
Subsequent Prophylaxis
Septic Abortion
Management of Septic Abortion
Amnionitis: Antibiotics
Management of Amnionitis
Aminoglycosides During Pregnancy: Objective and Design
Fever During and After Childbirth
Obstetric and Medical Factors Affecting Postpartum Sepsis
Health Service Factors Affecting Postpartum Sepsis
General Management
Management of Metritis
Antibiotics for Metritis
Managing Metritis: Objective and Design
Managing Metritis: Results
Septic Shock
Prevention Strategies
Three Cleans:
* Clean hands
* Clean surface
* Clean blade
Plus:
* Clean tie
* Clean perineum
* Clean nails
Summary
Fever During and After Childbirth.ppt
References
Advances in Maternal and Neonatal Health
Session Objectives
* Discuss best practices for management of infection during and after childbirth, especially:
o Amnionitis
o Metritis
* Describe strategies for prevention of infection
* Distinguish between prophylactic and therapeutic use of antibiotics
Providing Prophylactic Antibiotics
Providing Prophylactic Antibiotics for Cesarean Section: Objective and Design
Providing Prophylactic Antibiotics for Cesarean Section: Results
Providing Therapeutic Antibiotics
Principles of Treatment with Antibiotics
* Adequate dosing
* Adequate duration
* Continued re-evaluation of the patient
Fever During Pregnancy and Labor: Differential Diagnosis
* Cystitis
* Acute pyelonephritis
* Septic abortion
* Amnionitis
* Pneumonia
* Malaria
* Typhoid
* Hepatitis
Acute Pyelonephritis
Management of Acute Pyelonephritis
Subsequent Prophylaxis
Septic Abortion
Management of Septic Abortion
Amnionitis: Antibiotics
Management of Amnionitis
Aminoglycosides During Pregnancy: Objective and Design
Fever During and After Childbirth
Obstetric and Medical Factors Affecting Postpartum Sepsis
Health Service Factors Affecting Postpartum Sepsis
General Management
Management of Metritis
Antibiotics for Metritis
Managing Metritis: Objective and Design
Managing Metritis: Results
Septic Shock
Prevention Strategies
Three Cleans:
* Clean hands
* Clean surface
* Clean blade
Plus:
* Clean tie
* Clean perineum
* Clean nails
Summary
Fever During and After Childbirth.ppt
References
C-Sections and VBACs – Past, Present, and Future
C-Sections and VBACs – Past, Present, and Future
Presentation by:
Russell S. Kirby, PhD, MS, FACE
Professor and Vice Chair
Department of Maternal and Child Health
School of Public Health
University of Alabama at Birmingham
Objectives
* Identify trends in Cesarean delivery and VBAC
* Discuss the clinical and public health significance of recent trends
* Describe evidence-based practice and its role in clinical decision making
* Review several recent influential publications and their impact
* Speculate on the future of obstetrics and labor/delivery management
Percent of Live Births
Total C- Section
Rate
Primary C-Section
Rate
VBAC Rate
Trends
Risk Factors Associated with Cesarean Delivery
BMI Cesarean Vaginal
Clinical Documentation of Previous Cesarean Section
Operative Vaginal vs. C-Section Rates
The Realistic Evidence-Based Rating Scale
The Practice of Evidence-based Practice
How Do We Practice EBP?
Quality of Evidence
Commentary on Elective Cesareans
C-Sections and VBACs – Past, Present, and Future.ppt
Presentation by:
Russell S. Kirby, PhD, MS, FACE
Professor and Vice Chair
Department of Maternal and Child Health
School of Public Health
University of Alabama at Birmingham
Objectives
* Identify trends in Cesarean delivery and VBAC
* Discuss the clinical and public health significance of recent trends
* Describe evidence-based practice and its role in clinical decision making
* Review several recent influential publications and their impact
* Speculate on the future of obstetrics and labor/delivery management
Percent of Live Births
Total C- Section
Rate
Primary C-Section
Rate
VBAC Rate
Trends
Risk Factors Associated with Cesarean Delivery
BMI Cesarean Vaginal
Clinical Documentation of Previous Cesarean Section
Operative Vaginal vs. C-Section Rates
The Realistic Evidence-Based Rating Scale
The Practice of Evidence-based Practice
How Do We Practice EBP?
Quality of Evidence
Commentary on Elective Cesareans
C-Sections and VBACs – Past, Present, and Future.ppt
Cesarean Section in Nulliparous Women
Cesarean Section in Nulliparous Women
Presentation by:
Noelle Lefitz, RN, BSN, SNM
Nicole Carlson, RN, BSN, SNM
Nancy K. Lowe, CNM, PhD, FACNM, FAAN
Background
C-section rate for low-risk (full-term, singleton, vertex) nulliparous women:
Risks of Cesarean Section
Long term Maternal Risks
More Risks of C-Section
Aim of Study
Review of Literature
Characteristics of nulliparous women associated with CDD
BMI
Advanced Maternal Age
Epidural
Occiput Posterior (OP) Presentation
Anxiety
Continuous Labor Support
Decreased Hydration in Labor
Induction of Labor
Low Bishop Score/Unengaged Vertex Presentation
Diagnostic decision-making practices around dystocia
The Definition of Dystocia
Recommendations: SOGC (& ACOG)
Elective Induction
Questioning the Definition
CNMs: The Protective Effect from Cesarean Birth
Study Design
Variables Examined
Results
Conclusions
Pain Control
The OHSU CNMs
Cesarean Section in Nulliparous Women.ppt
Presentation by:
Noelle Lefitz, RN, BSN, SNM
Nicole Carlson, RN, BSN, SNM
Nancy K. Lowe, CNM, PhD, FACNM, FAAN
Background
C-section rate for low-risk (full-term, singleton, vertex) nulliparous women:
Risks of Cesarean Section
Long term Maternal Risks
More Risks of C-Section
Aim of Study
Review of Literature
Characteristics of nulliparous women associated with CDD
BMI
Advanced Maternal Age
Epidural
Occiput Posterior (OP) Presentation
Anxiety
Continuous Labor Support
Decreased Hydration in Labor
Induction of Labor
Low Bishop Score/Unengaged Vertex Presentation
Diagnostic decision-making practices around dystocia
The Definition of Dystocia
Recommendations: SOGC (& ACOG)
Elective Induction
Questioning the Definition
CNMs: The Protective Effect from Cesarean Birth
Study Design
Variables Examined
Results
Conclusions
Pain Control
The OHSU CNMs
Cesarean Section in Nulliparous Women.ppt
Pain Perception, Management And Assessment
Pain Perception, Management And Assessment
Amy C. Chavarria, RN, MSN, MBA, HCM, CCE
THE PAIN PROCESS
Mechanical
Chemical
Thermal
Pain receptors are stimulated
NOCICEPTORS
Spinal Cord
Brain
STRUCTURES RELATED TO PAIN PROCESS
Physiologic Pain
Neuropathic Pain
Four Processes Involved in Nociception
* Transduction
* Transmission
* Perception
* Modulation
Pain Theories
III. Pattern (Summation) Theory
IV. Endorphin/Enkephalin Theory
Gate Control Theory
CHARACTERISTICS OF PAIN
PAIN SCALES
Adult and Older Adult
FACTORS AFFECTING PAIN PERCEPTION/RESPONSE
MANIFESTATIONS OF PAIN
ASSESS THE PATIENT’S PAIN
Develop Nursing
Diagnosis
Develop a Nursing
Care Plan
Implement
Plan of Care
BEHAVIORAL RESPONSES
Pain Assessment
OTHER FACTORS
Causative Factors
Relieving Factors
Pain-related
Problems
Activities for daily living
Treatment Plan
COGNITIVE THERAPY
Mind Interventions
GUIDED IMAGERY
HEAT AND COLD APPLICATION
Spiritual
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
TENS ELECTRODE APPLICATION
SAFETY ISSUES
Implementation of Therapy
Maintenance of Therapy
Nonpharmacologic Invasive Techniques
Pharmacologic Interventions for Pain
Opioids (Narcotics)
Nonopioids/NSAIDS
Coanalgesic Drugs
WHO Ladder Step
Approach for Cancer Pain Control
Rational Polypharmacy
Oral Administration
Transmucosa/Transnasal and Transdermal Administration
Medication Administration
Subcutaneous Infusion Placement
Medication Administration
PATIENT CONTROLLED ANALGESIC (PCA)
Barriers to Effective Pain Management
DOCUMENTATION OF PAIN MANAGEMENT THERAPY
Pain is known as the 5th vital sign.
Specificity Theory
Clinical application of gate control theory:
Pain intensity and much more topcis are covered in this 143 slides presentation.
PAIN PERCEPTION, MANAGEMENT AND ASSESSMENT.ppt
Amy C. Chavarria, RN, MSN, MBA, HCM, CCE
THE PAIN PROCESS
Mechanical
Chemical
Thermal
Pain receptors are stimulated
NOCICEPTORS
Spinal Cord
Brain
STRUCTURES RELATED TO PAIN PROCESS
Physiologic Pain
Neuropathic Pain
Four Processes Involved in Nociception
* Transduction
* Transmission
* Perception
* Modulation
Pain Theories
III. Pattern (Summation) Theory
IV. Endorphin/Enkephalin Theory
Gate Control Theory
CHARACTERISTICS OF PAIN
PAIN SCALES
Adult and Older Adult
FACTORS AFFECTING PAIN PERCEPTION/RESPONSE
MANIFESTATIONS OF PAIN
ASSESS THE PATIENT’S PAIN
Develop Nursing
Diagnosis
Develop a Nursing
Care Plan
Implement
Plan of Care
BEHAVIORAL RESPONSES
Pain Assessment
OTHER FACTORS
Causative Factors
Relieving Factors
Pain-related
Problems
Activities for daily living
Treatment Plan
COGNITIVE THERAPY
Mind Interventions
GUIDED IMAGERY
HEAT AND COLD APPLICATION
Spiritual
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
TENS ELECTRODE APPLICATION
SAFETY ISSUES
Implementation of Therapy
Maintenance of Therapy
Nonpharmacologic Invasive Techniques
Pharmacologic Interventions for Pain
Opioids (Narcotics)
Nonopioids/NSAIDS
Coanalgesic Drugs
WHO Ladder Step
Approach for Cancer Pain Control
Rational Polypharmacy
Oral Administration
Transmucosa/Transnasal and Transdermal Administration
Medication Administration
Subcutaneous Infusion Placement
Medication Administration
PATIENT CONTROLLED ANALGESIC (PCA)
Barriers to Effective Pain Management
DOCUMENTATION OF PAIN MANAGEMENT THERAPY
Pain is known as the 5th vital sign.
Specificity Theory
Clinical application of gate control theory:
Pain intensity and much more topcis are covered in this 143 slides presentation.
PAIN PERCEPTION, MANAGEMENT AND ASSESSMENT.ppt
Insulin Administration
Insulin Administration
Pressentation by: Christie Candelaria, BSN, MA,RN,CCRN
Insulin Administration to Adult Clients
* What is insulin?
Insulin is a hormone used to treat Diabetes
* Why is insulin used?
Insulin is used when there are few or no beta cells in the pancreas secreting insulin
* What factors affect the amount of insulin administered?
Glucometer readings, exercise and nutritional habits, coexisting medical factors and medications
Different types of Insulin
* Six different types of insulin
* Rapid acting
* Regular
* NPH (N)-slower and longer acting
* Lente (L)- slower and longer acting
* Ultralente- slowest and longest acting
* Long acting basal-slowest and longest acting
Route of Administration
Subcutaneous (hypodermic) –into the subcutaneous tissue
* Injected into the adipose tissues beneath the skin, a drug moves into the blood stream more rapidly than if given by mouth.
* Allows slower, more sustained drug administration than IM injection.
* Common sites: outer aspect of the of the upper arm, anterior thigh, loose tissue of the lower abdomen, upper hips, buttocks, and upper back.
Subcutaneous Injections
* Advantages
o Allows slower absorption
o Minimal tissue Risk
o Minimal risk of hitting blood vessel
* Cautions
o Do not give in scarred areas, in moles, inflamed or edematous areas
* Sites
Outer, upper arm,
Anterior Thigh, Lower
abdomen, upper Hips,
buttocks, upper Back.
* Needles
o 25 to 27 G- 5/8” to ½”
* Syringes
o 1 ml = 100 unit of Insulin (U 30 & U 50)
* Position – 45-90 degree angle
Onset, Peak, and Duration of Insulin Types and Therapeutic Actions
* Onset. The length of time before insulin reaches the bloodstream and begins lowering blood glucose.
* Peak time. The time during which insulin is at its maximum strength in terms of lowering blood glucose levels.
* Duration. How long the insulin continues to lower blood glucose.
Insulin Injection Sites
Blood Glucose Monitoring
* Blood glucose levels are often checked q ac (30 minutes before meals), q hs (at bedtime), or prn (as needed)
* Preprandial* (fasting, or before a
meal)—70-130 mg/dl
* Postprandial* (1-2 hours after the start of a meal)—<180 mg/dl
* These ranges may very depending on institution and physician protocols.
Procedure of Withdrawing Insulin from a vial
WASH HANDS!
* Check the med order and make sure the solution in the vial matches the ordered solution. (7 Rights of Medication Administration)
* Obtain an insulin syringe.
* Pick up the vial and verify the type of insulin that is prescribed.
* Check the patient’s most recent blood glucose. If in doubt or assessment changes always recheck and reassess.
* If applicable, verify the blood glucose and use sliding scale insulin administration dosage on the patient’s MAR.
* Wipe the insulin vial with a sterile gauze alcohol pad, if the insulin is cloudy roll between palms of your hands.
* Withdraw the appropriate type and amount of insulin. Remember the order and dosage must be verified by 2 RNs before administration
* Pull back on barrel of syringe to draw in a volume of the ordered medication dose. Holding the vial between your thumb and fingers of the non-dominant hand, insert the needle through the rubber stopper into the air space – not the solution!!!!!!!!!!!!!!!!
* Invert the vial & withdraw the ordered dose of medication by pulling back on the plunger. Make sure the needle is in the solution to be withdrawn.
* Expel air bubbles and adjust dose if necessary.
* Remove needle from vial and cover the needle with guard using one hand or scoop method.
* Take Medication into client’s room and verify 7 rights, administer the SC injection. Remember to never massage the insulin injection site.
Mixing 2 types of Insulins
* Regular insulin can be mixed with all other types
* Semilente insulin (zinc suspension) can not be mixed with NPH insulin
* Remember to always draw up clear or regular/fasting acting insulin FIRST
* Then the cloudy or slower acting insulins i.e. NPH
Hypoglycemia
* Hypoglycemia is the most common adverse effect of insulin.
* Treatment of a blood sugar <70 may be reversed by giving the patient 15 g of glucose which is the equivalent to 4 oz of orange juice, 1 T jelly or 1 T honey.
* Diabetics will always have a standing order for a D50 injection <60, this is administered via IV or IVP.
Education
* Explain that the dose of insulin is adjusted according to their blood glucose level.
* Educate your patient, explain that the lowest blood glucose reading is usually obtained before meals.
* The highest level is obtained 1-2 hours after meals.
* Levels can very depending on the variables listed above.
Goal of Blood Glucose Monitoring and Insulin Administration
* The immediate goal is to obtain Blood Glucose levels between 70-130.
* The ultimate goal is to obtain a HgbA1c of <6.5.
* Overall good control of blood sugar levels in diabetes does correlate with decreased incidence of diabetic complications
Insulin Administration
Pressentation by: Christie Candelaria, BSN, MA,RN,CCRN
Insulin Administration to Adult Clients
* What is insulin?
Insulin is a hormone used to treat Diabetes
* Why is insulin used?
Insulin is used when there are few or no beta cells in the pancreas secreting insulin
* What factors affect the amount of insulin administered?
Glucometer readings, exercise and nutritional habits, coexisting medical factors and medications
Different types of Insulin
* Six different types of insulin
* Rapid acting
* Regular
* NPH (N)-slower and longer acting
* Lente (L)- slower and longer acting
* Ultralente- slowest and longest acting
* Long acting basal-slowest and longest acting
Route of Administration
Subcutaneous (hypodermic) –into the subcutaneous tissue
* Injected into the adipose tissues beneath the skin, a drug moves into the blood stream more rapidly than if given by mouth.
* Allows slower, more sustained drug administration than IM injection.
* Common sites: outer aspect of the of the upper arm, anterior thigh, loose tissue of the lower abdomen, upper hips, buttocks, and upper back.
Subcutaneous Injections
* Advantages
o Allows slower absorption
o Minimal tissue Risk
o Minimal risk of hitting blood vessel
* Cautions
o Do not give in scarred areas, in moles, inflamed or edematous areas
* Sites
Outer, upper arm,
Anterior Thigh, Lower
abdomen, upper Hips,
buttocks, upper Back.
* Needles
o 25 to 27 G- 5/8” to ½”
* Syringes
o 1 ml = 100 unit of Insulin (U 30 & U 50)
* Position – 45-90 degree angle
Onset, Peak, and Duration of Insulin Types and Therapeutic Actions
* Onset. The length of time before insulin reaches the bloodstream and begins lowering blood glucose.
* Peak time. The time during which insulin is at its maximum strength in terms of lowering blood glucose levels.
* Duration. How long the insulin continues to lower blood glucose.
Insulin Injection Sites
Blood Glucose Monitoring
* Blood glucose levels are often checked q ac (30 minutes before meals), q hs (at bedtime), or prn (as needed)
* Preprandial* (fasting, or before a
meal)—70-130 mg/dl
* Postprandial* (1-2 hours after the start of a meal)—<180 mg/dl
* These ranges may very depending on institution and physician protocols.
Procedure of Withdrawing Insulin from a vial
WASH HANDS!
* Check the med order and make sure the solution in the vial matches the ordered solution. (7 Rights of Medication Administration)
* Obtain an insulin syringe.
* Pick up the vial and verify the type of insulin that is prescribed.
* Check the patient’s most recent blood glucose. If in doubt or assessment changes always recheck and reassess.
* If applicable, verify the blood glucose and use sliding scale insulin administration dosage on the patient’s MAR.
* Wipe the insulin vial with a sterile gauze alcohol pad, if the insulin is cloudy roll between palms of your hands.
* Withdraw the appropriate type and amount of insulin. Remember the order and dosage must be verified by 2 RNs before administration
* Pull back on barrel of syringe to draw in a volume of the ordered medication dose. Holding the vial between your thumb and fingers of the non-dominant hand, insert the needle through the rubber stopper into the air space – not the solution!!!!!!!!!!!!!!!!
* Invert the vial & withdraw the ordered dose of medication by pulling back on the plunger. Make sure the needle is in the solution to be withdrawn.
* Expel air bubbles and adjust dose if necessary.
* Remove needle from vial and cover the needle with guard using one hand or scoop method.
* Take Medication into client’s room and verify 7 rights, administer the SC injection. Remember to never massage the insulin injection site.
Mixing 2 types of Insulins
* Regular insulin can be mixed with all other types
* Semilente insulin (zinc suspension) can not be mixed with NPH insulin
* Remember to always draw up clear or regular/fasting acting insulin FIRST
* Then the cloudy or slower acting insulins i.e. NPH
Hypoglycemia
* Hypoglycemia is the most common adverse effect of insulin.
* Treatment of a blood sugar <70 may be reversed by giving the patient 15 g of glucose which is the equivalent to 4 oz of orange juice, 1 T jelly or 1 T honey.
* Diabetics will always have a standing order for a D50 injection <60, this is administered via IV or IVP.
Education
* Explain that the dose of insulin is adjusted according to their blood glucose level.
* Educate your patient, explain that the lowest blood glucose reading is usually obtained before meals.
* The highest level is obtained 1-2 hours after meals.
* Levels can very depending on the variables listed above.
Goal of Blood Glucose Monitoring and Insulin Administration
* The immediate goal is to obtain Blood Glucose levels between 70-130.
* The ultimate goal is to obtain a HgbA1c of <6.5.
* Overall good control of blood sugar levels in diabetes does correlate with decreased incidence of diabetic complications
Insulin Administration
The Urinary System
The Urinary System
Presentation by: Jennifer Brewster RN, MSN
Kidney Blood Flow
Kidneys
Regulatory functions
Regulatory
Hormonal
Ureters
Urinary bladder
Urethra
Renal changes in older adult
Patient history
Physical assessment
Lab tests
* Serum creatinine
* Blood urea nitrogen
* Urine culture and sensitivity
* 24 hr urine
* Urine- Creatinine clearance
UA Strip
Urinalysis
* Color, odor, turbidity
* Specific gravity
* pH
* Glucose
* Ketones
* Protein
* Leukoesterase
* Nitrites
* Sediment
Radiology
* Kidney, Ureter, Bladder x-rays
* Intravenous urography (IVP)
* CT, US
* VCUG
* Renal scan
* Cystoscopy
Renal biopsy
Cystitis
Factors for UTI
Nursing diagnosis
Treatment
Patient education
Incontinence
Nursing diagnosis
Additional diagnosis
Management
Urolithiasis
Kidney Stones
Physical assessment
Lithotripsy
Acute and chronic renal failure
Renal failure and electrolytes
Body changes
Patient education for prevention
Hemo vs peritoneal
HD system
Care of HD patient
Peritoneal dialysis
Care of PD patient
Kidney Transplant
Post operative
The Urinary System.ppt
Presentation by: Jennifer Brewster RN, MSN
Kidney Blood Flow
Kidneys
Regulatory functions
Regulatory
Hormonal
Ureters
Urinary bladder
Urethra
Renal changes in older adult
Patient history
Physical assessment
Lab tests
* Serum creatinine
* Blood urea nitrogen
* Urine culture and sensitivity
* 24 hr urine
* Urine- Creatinine clearance
UA Strip
Urinalysis
* Color, odor, turbidity
* Specific gravity
* pH
* Glucose
* Ketones
* Protein
* Leukoesterase
* Nitrites
* Sediment
Radiology
* Kidney, Ureter, Bladder x-rays
* Intravenous urography (IVP)
* CT, US
* VCUG
* Renal scan
* Cystoscopy
Renal biopsy
Cystitis
Factors for UTI
Nursing diagnosis
Treatment
Patient education
Incontinence
Nursing diagnosis
Additional diagnosis
Management
Urolithiasis
Kidney Stones
Physical assessment
Lithotripsy
Acute and chronic renal failure
Renal failure and electrolytes
Body changes
Patient education for prevention
Hemo vs peritoneal
HD system
Care of HD patient
Peritoneal dialysis
Care of PD patient
Kidney Transplant
Post operative
The Urinary System.ppt
Molecular techniques used in medical diagnosis
Molecular techniques used in medical diagnosis
Separation of DNA Fragments by Gel Electrophoresis
Restriction Endonucleases
Methods of Sequence Analysis
The human genome project
Big Dye Sequencing
Polymerase Chain Reaction
PCR Analysis - Multiple rounds of amplification
Polymorphisms
Types of polymorphisms
X-linked Inheritance
RFLP Analysis
Southern Blotting
An example of VNTR linkage analysis
The use of PCR in Forensics Medicine
Fragile X syndrome is caused by the expansion of a VNTR region
DNA microarray analysis
Preparation of cDNA from mRNA
Molecular techniques used in medical diagnosis.ppt
Separation of DNA Fragments by Gel Electrophoresis
Restriction Endonucleases
Methods of Sequence Analysis
The human genome project
Big Dye Sequencing
Polymerase Chain Reaction
PCR Analysis - Multiple rounds of amplification
Polymorphisms
Types of polymorphisms
X-linked Inheritance
RFLP Analysis
Southern Blotting
An example of VNTR linkage analysis
The use of PCR in Forensics Medicine
Fragile X syndrome is caused by the expansion of a VNTR region
DNA microarray analysis
Preparation of cDNA from mRNA
Molecular techniques used in medical diagnosis.ppt
Graft vs. host skin disease
Graft vs. host skin disease
Chronic graft vs. host disease
A paradigm for the study of skin disease co-morbidity
by: Dermatotoxicity session
Society for Investigative Dermatology
Burden of Skin Disease Co-Morbidity Conference
Edward W. Cowen, MD, MHSc
Dermatology Branch, CCR
National Cancer Institute, NIH
Objectives
* Epidemiology of chronic graft-versus-host disease (cGVHD)
* Brief review of skin and other organ manifestations
* Barriers to effective management and a few (possible) solutions
Graft-versus-host disease (GVHD)
* Allogeneic hematopoietic stem cell transplantation (Allo-SCT)
* Autologous-SCT, solid organ, transfusion-related
* Host: Patient
o Hematopoietic ablation (chemotherapy/radiation)
* Graft: Donor stem cells
o Bone marrow
o Cord blood
o Peripheral blood (PBSCT)
+ Mobilization (Filgrastim;Neupogen®) - apheresis
* NIH Clinical Center
o 100+ allogeneic transplants/year
* 15,000 allogeneic transplants/year
* Indications
o Hematologic malignancies
o Primary immunodeficiencies
o Inherited enzymatic defects
o Solid tumors
o Autoimmune disease
Diseases treated by transplantation
Chronic GVHD
Incidence of chronic GVHD
Homeostasis
Hematopoeitic chimerism
All other tissues
All hematopoeitic cells
Hematopoeitic chimerism
Lymphocyte Infusion
Graft vs. leukemia/
Graft vs. tumor effect
Hematopoeitic cells
Other tissues
Homeostasis
Immunosuppressive therapy
Recurrent malignancy,
Opportunistic infection
Hematopoeitic cells
cGVHD: non-dermatologic manifestations
Erythema and ulcers
Viral or fungal infection
Abnormal motility
Secondary viral or fungal infection
Bronchiolitis obliterans
Dryness, strictures
Myasthenia gravis
cGVHD: a polymorphous skin disorder
Epidermal cGVHD
Dermal cGVHD
Subcutaneous cGVHD
cGVHD is a cutaneous mimic
Co-morbidity of cutaneous cGVHD
cGVHD: management
cGVHD salvage therapy
cGVHD: (barriers to) management
Barriers to effective management
Possible solutions
Barriers to effective management
Possible solutions
Chronic Cutaneous GVHD Skin Assessment
Erosion vs. Ulceration
Biology Blood Marrow Transplant 2005-6.
cGVHD
Hematology/Oncology
Dermatology
Dentistry/Oral Surgery
Rheumatology
Infectious Diseases
Ophthalmology
Pain/Palliative Care
Nutritional Support
Rehabilitation Medicine
NIH: multidisciplinary approach to cGVHD
Natural history of disease
Montelukast (Singulair®)
Extracorporal photopheresis
Imatinib for sclerotic cGVHD
DNA Microarray analysis
High-resolution MRI/US
Topical thalidomide
Cyclosporine implants
NIH National Consensus Guidelines for cGVHD Clinical Trials and Management
Barriers to effective management
Possible solutions
A final thought
Graft vs. host skin disease.ppt
Chronic graft vs. host disease
A paradigm for the study of skin disease co-morbidity
by: Dermatotoxicity session
Society for Investigative Dermatology
Burden of Skin Disease Co-Morbidity Conference
Edward W. Cowen, MD, MHSc
Dermatology Branch, CCR
National Cancer Institute, NIH
Objectives
* Epidemiology of chronic graft-versus-host disease (cGVHD)
* Brief review of skin and other organ manifestations
* Barriers to effective management and a few (possible) solutions
Graft-versus-host disease (GVHD)
* Allogeneic hematopoietic stem cell transplantation (Allo-SCT)
* Autologous-SCT, solid organ, transfusion-related
* Host: Patient
o Hematopoietic ablation (chemotherapy/radiation)
* Graft: Donor stem cells
o Bone marrow
o Cord blood
o Peripheral blood (PBSCT)
+ Mobilization (Filgrastim;Neupogen®) - apheresis
* NIH Clinical Center
o 100+ allogeneic transplants/year
* 15,000 allogeneic transplants/year
* Indications
o Hematologic malignancies
o Primary immunodeficiencies
o Inherited enzymatic defects
o Solid tumors
o Autoimmune disease
Diseases treated by transplantation
Chronic GVHD
Incidence of chronic GVHD
Homeostasis
Hematopoeitic chimerism
All other tissues
All hematopoeitic cells
Hematopoeitic chimerism
Lymphocyte Infusion
Graft vs. leukemia/
Graft vs. tumor effect
Hematopoeitic cells
Other tissues
Homeostasis
Immunosuppressive therapy
Recurrent malignancy,
Opportunistic infection
Hematopoeitic cells
cGVHD: non-dermatologic manifestations
Erythema and ulcers
Viral or fungal infection
Abnormal motility
Secondary viral or fungal infection
Bronchiolitis obliterans
Dryness, strictures
Myasthenia gravis
cGVHD: a polymorphous skin disorder
Epidermal cGVHD
Dermal cGVHD
Subcutaneous cGVHD
cGVHD is a cutaneous mimic
Co-morbidity of cutaneous cGVHD
cGVHD: management
cGVHD salvage therapy
cGVHD: (barriers to) management
Barriers to effective management
Possible solutions
Barriers to effective management
Possible solutions
Chronic Cutaneous GVHD Skin Assessment
Erosion vs. Ulceration
Biology Blood Marrow Transplant 2005-6.
cGVHD
Hematology/Oncology
Dermatology
Dentistry/Oral Surgery
Rheumatology
Infectious Diseases
Ophthalmology
Pain/Palliative Care
Nutritional Support
Rehabilitation Medicine
NIH: multidisciplinary approach to cGVHD
Natural history of disease
Montelukast (Singulair®)
Extracorporal photopheresis
Imatinib for sclerotic cGVHD
DNA Microarray analysis
High-resolution MRI/US
Topical thalidomide
Cyclosporine implants
NIH National Consensus Guidelines for cGVHD Clinical Trials and Management
Barriers to effective management
Possible solutions
A final thought
Graft vs. host skin disease.ppt
Clinical Decision making and Decision Analysis
Clinical Decision making and Decision Analysis
Presentation by: Dr. Dinesh P Mital
Hospital Based Decision Support
Medication prescribed
-Allergies -Physical examination
-Blood gases -Admit/discharge info.
-Electrocardiogram -X-ray findings
-Demographic information -Dietary information
-Cardiac data -Surgical procedures
-Biopsy results -Procedures reports
-Hematology -Respiratory notes
-Pulmonary functions -Microbiological data
-Nursing data -Pathology department data
Categories of Decision Support Technologies
1. Processes which respond to clinical data by issuing an alert.
2. Programs that respond to recorded decision to alter care by critiquing the decisions and proposing alternate care - as appropriate.
3. Applications that respond to a request by decision maker by suggesting a set of diagnosis of therapeutic maneuvers fitted to patient’s needs.
4. Retrospective quality assurance applications where clinical data are abstracted from patient’s records and decisions about the quality of care are made and fed back to care providers.
Alerting Systems
Manual approach.
Antibiotic Assistant and much more topics are discussed in this presentation
Clinical Decision making and Decision Analysis.ppt
Presentation by: Dr. Dinesh P Mital
Hospital Based Decision Support
Medication prescribed
-Allergies -Physical examination
-Blood gases -Admit/discharge info.
-Electrocardiogram -X-ray findings
-Demographic information -Dietary information
-Cardiac data -Surgical procedures
-Biopsy results -Procedures reports
-Hematology -Respiratory notes
-Pulmonary functions -Microbiological data
-Nursing data -Pathology department data
Categories of Decision Support Technologies
1. Processes which respond to clinical data by issuing an alert.
2. Programs that respond to recorded decision to alter care by critiquing the decisions and proposing alternate care - as appropriate.
3. Applications that respond to a request by decision maker by suggesting a set of diagnosis of therapeutic maneuvers fitted to patient’s needs.
4. Retrospective quality assurance applications where clinical data are abstracted from patient’s records and decisions about the quality of care are made and fed back to care providers.
Alerting Systems
Manual approach.
Antibiotic Assistant and much more topics are discussed in this presentation
Clinical Decision making and Decision Analysis.ppt
Diagnostic Tests and Specimen Collection
Diagnostic Tests and Specimen Collection
Diagnostic Testing and the Nursing Process
Planning
Diagnostic Tests
Laboratory Tests
Hematology Tests
* Complete blood count (CBC)
o Information about the state of health or presence of illness
o Number of red blood cells (erythrocytes)
o Type and number of white blood cells (differential)
o Platelet count, PT, PTT, INR
* During infection, the number and type of white blood cells increase.
* Neutrophil counts can be significant.
* In severe infections, bone marrow releases more granulocytes.
* Immature polymorphonuclear neutrophils are released (called bands).
* The result is a shift to the left (more bands).
* Drug therapy may cause leukopenia (a decrease in leukocytes).
* Hemoglobin shows the capacity of the blood to transport oxygen from the lungs to the tissues.
* A normal platelet count is essential to clotting.
* Coumadin therapy is guided by prothrombin time (reported in INR numbers).
* The erythrocyte sedimentation rate (ESR) gives clues about inflammatory conditions.
Chemistry Tests
* Whole blood, plasma, and serum
* Body fluids such as:
o Urine, spinal fluid, gastric contents
* Chemistry tests provide information about biochemical reactions such as electrolyte balances and organ function.
* Some institutions use automated computerized blood chemistry testing.
* Examples of tests available are:
o Serum albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST)
o Total bilirubin, serum calcium, cholesterol, glucose, LDH, phosphate, total protein, BUN, uric acid
Blood Glucose
* Blood glucose is a test commonly performed at the bedside or in the physician’s office by the nurse.
* Guides insulin therapy for diabetics
* Guidelines for performing test depend on manufacturer of testing equipment
* Requires a finger stick to obtain capillary blood
Serology Tests
* Based on analysis of serum
* Used to diagnose both viral and bacterial diseases or determine antibody levels for:
o Dysentery, rheumatic fever, typhoid, influenza, rubella, and syphilis
* Can also be used to determine titers in response to vaccines
* May use radionuclides such as iodine-125 and iodine-131
* Examples of serology tests ordered
* Agglutination test for specific organisms
* Antistreptolysin-O titer
* Blood typing: ABO groups and Rh
* Carcinoembryonic antigen assay (CEA)
* Coombs’ test
* C-reactive protein antiserum
* Heterophil antibody titer
* Tests for syphillis
Urinalysis
* Provides information about kidney function or other body functions and diseases
* Single, catheterized, or random specimens can be collected anytime, with no special preparation. First voided specimen is preferred.
* Urine deteriorates quickly and should be tested soon after collection.
Midstream collections
* External genitalia are cleansed
* A small amount of urine is passed.
* Urine is collected from midvoiding in a sterile container.
* Used for cultures when a bladder infection is suspected
Timed, long-period specimens
* Collected over 12- or 24-hour period
* Container may be kept on ice and has some form of preservative.
* Used to determine kidney function and possible glomerulonephritis or acute tubular necrosis
Other Laboratory Tests
* Bacteriology
* Histology
* Cytology
* Ova and parasites
* Cultures from specimens of feces, blood, urine, wound drainage, or samples of body tissue or fluids
Ultrasonography
* Records the reflection of sound wave directed into the tissues
* Used to diagnose pathologic conditions of
o Uterus, ovaries, prostate, heart, liver, kidneys, pancreas, gallbladder, lymph nodes, thyroid, eyes, and peripheral blood vessels
* Often used in conjunction with nuclear medicine scans
Radiology Procedures
* Most common test is radiation by x-ray
* Produces images in varying densities on film after it passes through the body
* Commonly performed radiology procedures:
o Chest x-ray
o Barium swallow and upper GI series
o KUB (kidneys, ureters, and bladder)
o Gallbladder series
* IVP (intravenous pyelogram)
* X-ray of bony skeleton
* Arthrogram
* Myelogram
* Radionuclide scan
* Computed tomography (CT) scan
Magnetic Resonance Imaging
* Noninvasive method of differentiating body tissue (commonly used for brain, knee joint, spine and spinal cord, and abdominal organs)
* Requires that all metal be removed from the patient
* Contraindicated in patients with hip prostheses, implanted pacemakers or defibrillators, artificial cardiac valves, or vascular clips or staples from recent surgery
* Patient teaching is very important before this procedure; patient needs to know the duration of the test and that it requires being in a noisy environment.
* Patient may become claustrophobic during test.
* Patient needs to know deep-breathing and relaxation techniques.
Cardiopulmonary Studies
EKG/ECG
* Diagnoses heart rhythms and heart disease; measures electrical activity of the heart
Cardiac catheterization
* An invasive procedure used to determine function of heart valves, coronary artery blood flow, and oxygenation at different points in the heart and to diagnose coronary artery disease
o Abnormal blood in cardiac vessels can be detected as can valvular dysfunction.
* Surgical procedure that requires consent
* Procedure is performed under sterile technique in radiology or a surgical suite.
* Postprocedure requires checking insertion site every 10 to 15 minutes for possible bleeding.
* If the femoral approach is used, the patient’s leg may be immobilized for several hours.
* New angioseal devices may preclude the need for post procedure pressure.
Treadmill Stress Test
* A cardiac-monitored ECG test
* Patient is on a treadmill, which is used to increase heart rate and blood pressure with controlled activity.
* Test may be done with radioisotope imaging
* Patient should avoid smoking, dairy products, or drinking caffeine for 4 hours before the test.
* Angiography/Arteriography
* Used to locate lesions, occluded vessels, tumors, and malformed blood vessels
* A contrast medium is injected during the procedure (check for allergies).
* Consent is required.
* Patient should be NPO for at least 6 hours before the test.
* Patient may be given preprocedure sedation.
Other Tests
* Endoscopic examinations of:
o The stomach (gastroscopy)
o The sigmoid colon (proctosigmoidoscopy)
o The entire colon (colonoscopy)
o The bladder (cystoscopy)
o The gallbladder and common bile duct (endoscopic retrograde cholangiopancreatograhy [ERCP])
Electroencephalography (EEG)
* Measures neurologic and physiologic activities of the brain via the electrical discharges from the brain
* Performed to localize and diagnose brain lesions, scars, epilepsy, infections, or clots
* Performed to determine brain death in comatose patients on life support
Things to Remember
* All invasive tests requiring injection of a medium require a consent.
* Tests requiring premedication or sedation usually require a consent.
* Many tests have some form of preparation; review the laboratory manual for your facility to determine what must be done before the patient has the test and after the patient has had the test.
Diagnostic Tests and Specimen Collection.ppt
Diagnostic Testing and the Nursing Process
Planning
Diagnostic Tests
Laboratory Tests
Hematology Tests
* Complete blood count (CBC)
o Information about the state of health or presence of illness
o Number of red blood cells (erythrocytes)
o Type and number of white blood cells (differential)
o Platelet count, PT, PTT, INR
* During infection, the number and type of white blood cells increase.
* Neutrophil counts can be significant.
* In severe infections, bone marrow releases more granulocytes.
* Immature polymorphonuclear neutrophils are released (called bands).
* The result is a shift to the left (more bands).
* Drug therapy may cause leukopenia (a decrease in leukocytes).
* Hemoglobin shows the capacity of the blood to transport oxygen from the lungs to the tissues.
* A normal platelet count is essential to clotting.
* Coumadin therapy is guided by prothrombin time (reported in INR numbers).
* The erythrocyte sedimentation rate (ESR) gives clues about inflammatory conditions.
Chemistry Tests
* Whole blood, plasma, and serum
* Body fluids such as:
o Urine, spinal fluid, gastric contents
* Chemistry tests provide information about biochemical reactions such as electrolyte balances and organ function.
* Some institutions use automated computerized blood chemistry testing.
* Examples of tests available are:
o Serum albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST)
o Total bilirubin, serum calcium, cholesterol, glucose, LDH, phosphate, total protein, BUN, uric acid
Blood Glucose
* Blood glucose is a test commonly performed at the bedside or in the physician’s office by the nurse.
* Guides insulin therapy for diabetics
* Guidelines for performing test depend on manufacturer of testing equipment
* Requires a finger stick to obtain capillary blood
Serology Tests
* Based on analysis of serum
* Used to diagnose both viral and bacterial diseases or determine antibody levels for:
o Dysentery, rheumatic fever, typhoid, influenza, rubella, and syphilis
* Can also be used to determine titers in response to vaccines
* May use radionuclides such as iodine-125 and iodine-131
* Examples of serology tests ordered
* Agglutination test for specific organisms
* Antistreptolysin-O titer
* Blood typing: ABO groups and Rh
* Carcinoembryonic antigen assay (CEA)
* Coombs’ test
* C-reactive protein antiserum
* Heterophil antibody titer
* Tests for syphillis
Urinalysis
* Provides information about kidney function or other body functions and diseases
* Single, catheterized, or random specimens can be collected anytime, with no special preparation. First voided specimen is preferred.
* Urine deteriorates quickly and should be tested soon after collection.
Midstream collections
* External genitalia are cleansed
* A small amount of urine is passed.
* Urine is collected from midvoiding in a sterile container.
* Used for cultures when a bladder infection is suspected
Timed, long-period specimens
* Collected over 12- or 24-hour period
* Container may be kept on ice and has some form of preservative.
* Used to determine kidney function and possible glomerulonephritis or acute tubular necrosis
Other Laboratory Tests
* Bacteriology
* Histology
* Cytology
* Ova and parasites
* Cultures from specimens of feces, blood, urine, wound drainage, or samples of body tissue or fluids
Ultrasonography
* Records the reflection of sound wave directed into the tissues
* Used to diagnose pathologic conditions of
o Uterus, ovaries, prostate, heart, liver, kidneys, pancreas, gallbladder, lymph nodes, thyroid, eyes, and peripheral blood vessels
* Often used in conjunction with nuclear medicine scans
Radiology Procedures
* Most common test is radiation by x-ray
* Produces images in varying densities on film after it passes through the body
* Commonly performed radiology procedures:
o Chest x-ray
o Barium swallow and upper GI series
o KUB (kidneys, ureters, and bladder)
o Gallbladder series
* IVP (intravenous pyelogram)
* X-ray of bony skeleton
* Arthrogram
* Myelogram
* Radionuclide scan
* Computed tomography (CT) scan
Magnetic Resonance Imaging
* Noninvasive method of differentiating body tissue (commonly used for brain, knee joint, spine and spinal cord, and abdominal organs)
* Requires that all metal be removed from the patient
* Contraindicated in patients with hip prostheses, implanted pacemakers or defibrillators, artificial cardiac valves, or vascular clips or staples from recent surgery
* Patient teaching is very important before this procedure; patient needs to know the duration of the test and that it requires being in a noisy environment.
* Patient may become claustrophobic during test.
* Patient needs to know deep-breathing and relaxation techniques.
Cardiopulmonary Studies
EKG/ECG
* Diagnoses heart rhythms and heart disease; measures electrical activity of the heart
Cardiac catheterization
* An invasive procedure used to determine function of heart valves, coronary artery blood flow, and oxygenation at different points in the heart and to diagnose coronary artery disease
o Abnormal blood in cardiac vessels can be detected as can valvular dysfunction.
* Surgical procedure that requires consent
* Procedure is performed under sterile technique in radiology or a surgical suite.
* Postprocedure requires checking insertion site every 10 to 15 minutes for possible bleeding.
* If the femoral approach is used, the patient’s leg may be immobilized for several hours.
* New angioseal devices may preclude the need for post procedure pressure.
Treadmill Stress Test
* A cardiac-monitored ECG test
* Patient is on a treadmill, which is used to increase heart rate and blood pressure with controlled activity.
* Test may be done with radioisotope imaging
* Patient should avoid smoking, dairy products, or drinking caffeine for 4 hours before the test.
* Angiography/Arteriography
* Used to locate lesions, occluded vessels, tumors, and malformed blood vessels
* A contrast medium is injected during the procedure (check for allergies).
* Consent is required.
* Patient should be NPO for at least 6 hours before the test.
* Patient may be given preprocedure sedation.
Other Tests
* Endoscopic examinations of:
o The stomach (gastroscopy)
o The sigmoid colon (proctosigmoidoscopy)
o The entire colon (colonoscopy)
o The bladder (cystoscopy)
o The gallbladder and common bile duct (endoscopic retrograde cholangiopancreatograhy [ERCP])
Electroencephalography (EEG)
* Measures neurologic and physiologic activities of the brain via the electrical discharges from the brain
* Performed to localize and diagnose brain lesions, scars, epilepsy, infections, or clots
* Performed to determine brain death in comatose patients on life support
Things to Remember
* All invasive tests requiring injection of a medium require a consent.
* Tests requiring premedication or sedation usually require a consent.
* Many tests have some form of preparation; review the laboratory manual for your facility to determine what must be done before the patient has the test and after the patient has had the test.
Diagnostic Tests and Specimen Collection.ppt
POCT and Laboratory Medicine / Accreditation
POCT and Laboratory Medicine / Accreditation
Diagnostic Accreditation Program
POCT and Lab Medicine
Presentation by: Arun K. Garg PhD, MD, FRCPC
Medical Director, Lab Medicine/Pathology
Fraser Health/RCH
330 E. Columbia Street
New Westminster
Point of Care Testing Accreditation (POTC)
Colin Semple ART
Accreditation & Research Development Officer
Diagnostic Accreditation Program of BC
Forces Changing Lab Medicine
Intitutional Testing
In vivo Point of Care Testing
* Institutional Acute Care
* Traditional Lab Services – ER, ICU, OR, Wards, Ambulance
* Physician office
* Ambulatory clinics
* Community clinics
* Pharmacies
* Long-term/Extended Care
* Home Care
* Ambulance
* Glucose meters
* Urinalysis
* Blood gases/electrolytes
* Coagulation studies
* Rapid Bacterial Strips
* Glycalated HbA1c
* Cardiac BioMarkers
* Hormones, Pregnancy testing
* Non blood skin reflectance - bilirubin
Some examples:
Cost
Therapeutic Turnaround Time
Medical Quality/Outcome
Forces of POCT
Acute Care and POCT
Chronic Care and POCT
Technology and POCT
Challenges of POCT
POCT and Non Lab Personnel
General Principles
Scientific/Technical
(Pre-Analytical – Post)
Fraser Health and POCT
References
Point of Care Testing-Definition
For accreditation purposes:
Accreditation Standards
2006-7 Draft standards developed
08/2007 Standards released for testing
03/2008 Revisions to POCT Standards
05/2008 Advisory Committee Approval
05/2008 Board Approval
Advisory Committees
POCT Accreditation Standards
On-site survey protocols (technical)
Talk to the laboratory staff involved in POCT oversight: overview, QC, PT
Speak with a nurse educator
POCT QC: selection, review
Laboratory medical leader’s role in POCT
Method/Instrument Selection/Validation
Roles and Responsibilities
Overall responsibility for POCT is assigned to the facility or regional laboratory leader or designate
The Laboratory Medical Leader defines the scope of POCT in consultation with the MAC, interdisciplinary practice groups or other appropriate groups.
Roles and Responsibilities
Accreditation surveys
“Rogue” POCT issues
Method and instrument selection, evaluation and validation
Roles and responsibilities
Training and competence testing
Documentation
Quality Control and Proficiency Testing
Instrument maintenance and monitoring
Reagents, chemicals and supplies
Results, records and reporting processes
Training/Orientation/Competence Testing
Documented Procedures
Quality Control
QC policies
Survey information
Proficiency Testing
Advisory Committees
Proficiency Testing
Mandated analytes:
Instruments and equipment
Reagents and Supplies
Recording of Results
Summary
AACC Annual Meeting
Washington DC
July 27-31, 2008
International POCT Symposium
Critical and Point of Care Testing: Managing Technology for the Benefit of all Populations
September 18-20, 2008 Barcelona, Spain
POCT and Laboratory Medicine/Accreditation.ppt
Diagnostic Accreditation Program
POCT and Lab Medicine
Presentation by: Arun K. Garg PhD, MD, FRCPC
Medical Director, Lab Medicine/Pathology
Fraser Health/RCH
330 E. Columbia Street
New Westminster
Point of Care Testing Accreditation (POTC)
Colin Semple ART
Accreditation & Research Development Officer
Diagnostic Accreditation Program of BC
Forces Changing Lab Medicine
Intitutional Testing
In vivo Point of Care Testing
* Institutional Acute Care
* Traditional Lab Services – ER, ICU, OR, Wards, Ambulance
* Physician office
* Ambulatory clinics
* Community clinics
* Pharmacies
* Long-term/Extended Care
* Home Care
* Ambulance
* Glucose meters
* Urinalysis
* Blood gases/electrolytes
* Coagulation studies
* Rapid Bacterial Strips
* Glycalated HbA1c
* Cardiac BioMarkers
* Hormones, Pregnancy testing
* Non blood skin reflectance - bilirubin
Some examples:
Cost
Therapeutic Turnaround Time
Medical Quality/Outcome
Forces of POCT
Acute Care and POCT
Chronic Care and POCT
Technology and POCT
Challenges of POCT
POCT and Non Lab Personnel
General Principles
Scientific/Technical
(Pre-Analytical – Post)
Fraser Health and POCT
References
Point of Care Testing-Definition
For accreditation purposes:
Accreditation Standards
2006-7 Draft standards developed
08/2007 Standards released for testing
03/2008 Revisions to POCT Standards
05/2008 Advisory Committee Approval
05/2008 Board Approval
Advisory Committees
POCT Accreditation Standards
On-site survey protocols (technical)
Talk to the laboratory staff involved in POCT oversight: overview, QC, PT
Speak with a nurse educator
POCT QC: selection, review
Laboratory medical leader’s role in POCT
Method/Instrument Selection/Validation
Roles and Responsibilities
Overall responsibility for POCT is assigned to the facility or regional laboratory leader or designate
The Laboratory Medical Leader defines the scope of POCT in consultation with the MAC, interdisciplinary practice groups or other appropriate groups.
Roles and Responsibilities
Accreditation surveys
“Rogue” POCT issues
Method and instrument selection, evaluation and validation
Roles and responsibilities
Training and competence testing
Documentation
Quality Control and Proficiency Testing
Instrument maintenance and monitoring
Reagents, chemicals and supplies
Results, records and reporting processes
Training/Orientation/Competence Testing
Documented Procedures
Quality Control
QC policies
Survey information
Proficiency Testing
Advisory Committees
Proficiency Testing
Mandated analytes:
Instruments and equipment
Reagents and Supplies
Recording of Results
Summary
AACC Annual Meeting
Washington DC
July 27-31, 2008
International POCT Symposium
Critical and Point of Care Testing: Managing Technology for the Benefit of all Populations
September 18-20, 2008 Barcelona, Spain
POCT and Laboratory Medicine/Accreditation.ppt
Hemostasis / Thrombosis
Hemostasis / Thrombosis II
Congenital/Acquired Hemorrhagic Disorders & Their Treatment
COAGULATION TESTING
PLATELET FUNCTION DEFECTS
Prolonged Bleeding Time
PLATELET FUNCTION DEFECTS
Platelet Adhesion
Acquired - Drug Induced
Platelet Function Disorders
Treatment
THROMBOCYTOPENIA
Increased Destruction - Causes
IDIOPATHIC THROMBOCYTOPENIA PURPURA
HIV-ASSOCIATED THROMBOCYTOPENIA
CONGENITAL CLOTTING DISORDERS
COAGULATION TESTING
Clotting Factor Deficiency
Determination of missing factor
VON WILLEBRAND DISEASE
VON WILLEBRAND FACTOR
Diagnostic Studies
Classification
Treatment
HEMOPHILIA
Clinical Severity - Correlates with Factor Level
Platelet Activation
HEMOPHILIA vs. VON WILLEBRAND DISEASE
HEMOPHILIA – General Rules
Initial Therapy of Hemophilia A
Initial Therapy of Hemophilia B
HEMOPHILIA Rx
Subsequent Treatment
Factor Concentrates
FACTOR XI DEFICIENCY
Other coagulation factor disorders
Clotting Factor Deficiency Treatment
CLOTTING DISORDERS
VITAMIN K DEFICIENCY
Acquired
LIVER DISEASE
HEMOSTASIS / THROMBOSIS II.ppt
Congenital/Acquired Hemorrhagic Disorders & Their Treatment
COAGULATION TESTING
PLATELET FUNCTION DEFECTS
Prolonged Bleeding Time
PLATELET FUNCTION DEFECTS
Platelet Adhesion
Acquired - Drug Induced
Platelet Function Disorders
Treatment
THROMBOCYTOPENIA
Increased Destruction - Causes
IDIOPATHIC THROMBOCYTOPENIA PURPURA
HIV-ASSOCIATED THROMBOCYTOPENIA
CONGENITAL CLOTTING DISORDERS
COAGULATION TESTING
Clotting Factor Deficiency
Determination of missing factor
VON WILLEBRAND DISEASE
VON WILLEBRAND FACTOR
Diagnostic Studies
Classification
Treatment
HEMOPHILIA
Clinical Severity - Correlates with Factor Level
Platelet Activation
HEMOPHILIA vs. VON WILLEBRAND DISEASE
HEMOPHILIA – General Rules
Initial Therapy of Hemophilia A
Initial Therapy of Hemophilia B
HEMOPHILIA Rx
Subsequent Treatment
Factor Concentrates
FACTOR XI DEFICIENCY
Other coagulation factor disorders
Clotting Factor Deficiency Treatment
CLOTTING DISORDERS
VITAMIN K DEFICIENCY
Acquired
LIVER DISEASE
HEMOSTASIS / THROMBOSIS II.ppt
Lymphatic Filariasis
Lymphatic Filariasis
presentation by: B.Ganesh
Regional Filaria Training & Research Centre
National Institute of Communicable Diseases
Kozhikode, Kerala, India
Lymphatic Filariasis
Infection with 3 closely related Nematodes
* Wuchereria bancrofti
* Brugia malayi
* Brugia timori
Disease Manifestation
Distribution
Lymphatic Filariasis Endemic Countries & Territories
Endemic Countries
Global Distribution Map
Global Scenario
Agent Factors
Culicoides
Host Factors
Social & Environmental Factors
Mode of Transmission & Incubation Period
Lymphatic Filariasis Diagnostic Methods
Laboratory Diagnosis
Immuno Chromatographic Test (ICT)
Quantitative Blood Count (QBC)
Ultrasonography
Lymphoscintigraphy
X-ray Diagnosis
Haematology
Lymphatic Filariasis
Clinical Manifestations
Clinical Spectrum
Chronic pathology
Stages in Lymphatic Filariasis
Stage of Asymptomatic amicrofilaraemic
Stage of Acute Manifestation
Chronic Manifestation
Occult Filariasis (TPE)
Hydrocele
Scrotum
Penis
Leg
Arm
Breast
Chyluria & Haematuria
Classification of Lymphoedema
Stages of Lymphoedema
Pathology of Lymphatic Filariasis
Lymphatic Filariasis Management
Management of Lymphatic Filariasis
Chemotherapy of Filariasis
Surgical Treatment
Lymphoedema Management
Basic Components and Benefits
Basic Components
Prevention & Cure of Entry lesions
Lymphatic Filariasis Control Programme
Vector Control
Filariasis.ppt
presentation by: B.Ganesh
Regional Filaria Training & Research Centre
National Institute of Communicable Diseases
Kozhikode, Kerala, India
Lymphatic Filariasis
Infection with 3 closely related Nematodes
* Wuchereria bancrofti
* Brugia malayi
* Brugia timori
Disease Manifestation
Distribution
Lymphatic Filariasis Endemic Countries & Territories
Endemic Countries
Global Distribution Map
Global Scenario
Agent Factors
Culicoides
Host Factors
Social & Environmental Factors
Mode of Transmission & Incubation Period
Lymphatic Filariasis Diagnostic Methods
Laboratory Diagnosis
Immuno Chromatographic Test (ICT)
Quantitative Blood Count (QBC)
Ultrasonography
Lymphoscintigraphy
X-ray Diagnosis
Haematology
Lymphatic Filariasis
Clinical Manifestations
Clinical Spectrum
Chronic pathology
Stages in Lymphatic Filariasis
Stage of Asymptomatic amicrofilaraemic
Stage of Acute Manifestation
Chronic Manifestation
Occult Filariasis (TPE)
Hydrocele
Scrotum
Penis
Leg
Arm
Breast
Chyluria & Haematuria
Classification of Lymphoedema
Stages of Lymphoedema
Pathology of Lymphatic Filariasis
Lymphatic Filariasis Management
Management of Lymphatic Filariasis
Chemotherapy of Filariasis
Surgical Treatment
Lymphoedema Management
Basic Components and Benefits
Basic Components
Prevention & Cure of Entry lesions
Lymphatic Filariasis Control Programme
Vector Control
Filariasis.ppt
Medical profession
Medical profession
Detailed Presentation by: Janos Lonovics MD
Diagnostic examinations
Medical history
Physical examination
Laboratory examination
Special examinations (US, CT, MR, Endoscopy, etc)
Consultations with other professionals
Treatment procedures
Medical treatment
Surgical treatment
Structure of a medical record
Medical history
Findings of the physical examination
Reports of the laboratory tests
Conclusions from special examinations
(US, CT, MR, Endoscopy etc)
Report and suggestions of the consultants
Diagnosis by (competent) attending physician
Notes on treatment (medications, interventions)
Progress notes
Discharge summary\
Medical diagnosis
Tentative diagnosis (at the end of the case history)
Provisional diagnosis (to begin the diagnostic work)
Working diagnosis (to put things on the right track)
Final diagnosis (if achieved)
PURPOSES OF THE PATIENT’S MEDICAL RECORD
LEGAL PURPOSES
Medical history - anamnesis
* Identifications and vital statistics
* Present illness and chief complaints
* Past history
* Social history
* Family history
Identifications and vital statistics
Name, Date of birth, Place of birth
Sex, Nationality, Race, Residence,
Marriage status, Occupation
Source of information: patient, others
Interpreter
Present illness and chief complaints
Heart of medical history
Searching for diagnostic clues (complaints, symptoms)
Accumulation of facts
Evaluation of facts
Preparation of hypotheses
Insist upon symptoms, do not accept patient’s diagnosis
Nature of symptoms
Quantification of symptoms
Chronology of symptoms
Current medication
Past history
Previous illnesses
Previous operations, injuries
Previous hospitalization
Infectious diseases
General health issues
Appetite, Body weight, Weight loss
Stool habits
Urine complaints
Family history
Parents, Siblings
Age and health
Death and causes
History of diseases
Hypertension, Hearth disease, Diabetes
Obesity, Endocrine disorders
Tuberculosis, Syphilis, AIDS
Malignancies
Alcoholism, Mental disturbances, etc.
METHODS IN THE PHYSICAL EXAMINATION
* Inspection
* Palpation
* Percussion
* Auscultation
* Smelling
o Heigh and weight
o Body temperature
o Blood pressure
o Rectal digital examination
o Eye (fundoscopic) examination
o Bimanual (gynecological) examination
o Basic neurological examination
INSPECTION
Inspection of the body as a whole
Motor activity
Body build
Anatomic malformation
Nutrition
Appearance of illness
Behaviour
Speech
LOCAL INSPECTION
Focuses observation on a single anatomic region
o Observation with unaided eyes
o Observation through special equipments
ophtalmoscope
otoscope, nasoscope
laryngoscope
bronchoscope
gastroscope, anoscope, colonoscope
thoracoscope, peritoneoscope
gonioscope
cystoscope
microscope
PALPATION
Palpation in the act of feeling by sense of touch
Physican’s hands perceives physical signs by his (her)
Tactile sense
Temperature sense
Kinesthetic sense of position and vibration
Sensitive parts of the hands
Tactile sense - the tips of the fingers
Temperature sense – the dorsa of hands
Vibratory sense – palmar base of the fingers
Sense of position and consistency – grasping fingers
Structures examined by palpation
All external structures
Solid abdominal viscera
Solid contents of hollow viscera
Lymph nodes
Thrombosed veins
Structures accesible through body orifices
Qualities elicited by palpation
Texture – the skin and hair
Moisture – The skin and mucosa
Masses – The size, shape, consistency, etc.
Precordial cardiac thrust
Crepitus – in bones, pleura, etc.
Tenderness – in all accesible tissues
Thrills – over the heart, and blood vessels
Vocal fremitus – over the lung
Special methods of palpation
Light palpation
Deep palpation
Ballottement
Fluctuation
Fluid wave
LIGHT ABDOMINAL PALPATION
* Ticklishness
* Direct Tenderness
* Rebound Tenderness
* Voluntary Rigidity of Muscle
* Involuntary Rigidity of Muscle
* Subcutaneous Crepitus
* Abdominal Masses
DEEP ABDOMINAL PALPATION – RUQ AND RLQ
* Liver
* Enlarged (Tender and Nontender) Gallbladder
* Enlarged Right Kidney
* Masses in Cecal Region
DEEP ABDOMINAL PALPATION – LUQ AND LLQ
* Spleen
* Enlarged Left Kidney (Ballottement)
* Masses in Sigmoid Region
Vibratory palpation of the lungs and pleura
Detection of vocal fremitus
PERCUSSION
A method of examination in which the surface of the body is struck to emit sounds that vary in quality according to the density of the underlying tissue
Methods:
* Bimanual, Mediate or Indirect
* Immediate or Direct
SONOROUS PERCUSSION
Its purpose to ascertain the density of the tissue
* Percussion Notes
Tympani – air-filled stomach
Resonance –air-filled lungs
Hyperresonance – emphysematous lungs
Dullness – blood-filled heart
Flatness - thigh
DEFINITIVE PERCUSSION
Its purpose to determine the size and borders of a structure
Lung borders: bases, apices
Size of the heart
Size of the liver and spleen
Size of the distended gallbladder
Level of ascites fluid
Sizes of different masses
Percussion map of the thorax
* Procedure of thoracic percussion
SUPRAPUBIC MASSES
* Distended Urinary Bladder
* Ovarian Cyst
AUSCULTATION
Act of hearing through the stethoscope
Skull – bruit
Neck – carotid artery, jugular vein
Lungs – breath sounds, rales, friction rub
Heart – valve sounds, rhythm, murmurs
Abdomen – bowel sounds, murmurs
Crepitus – bones, pleural layer
Auscultation of the lungs and pleura
Breath sounds
* Vesicular breathing
Vesicular breath sounds have a long inspiratory and a short expiratory phase
* Broncial breathing
Bronchial breath sounds have a short inspiratory and a long expiratory phase
* Bronchovesicular breathing
The two respiratory phases are about equal in duration
* Ashmatic breathing
Voice sounds
* Whispered pectoriloquy (Whispered voice sounds)
* Bronchophony (Spoken voice sounds)
ASK the patients to repeat the test word ”ninety-nine” or ”one-two-three”
COMPARE symmetric parts of the lung sequentially by stethoscope
* Are increased in:
Pulmonary consolidation
Pulmonary infarction
Pulmonary atelectasis
* Are diminished or absent in:
Pleural effusion
Pneumothorax
Thickened pleura
Alveoli filled with
Fluid, red and white cells
Pleural fluid or thickening
Adventitious sounds - Rales
* Moist Rales
Inspiratory crackels or crepitation
Bronchial rales (heard in both phases)
Moist fine or subcrepitant rales
Moist medium or crepitant rales
Moist coarse or gurgling rales
* Dry rales
Musical (sibilant) rales
Sonorous rales
Ronchus
* Pleural friction rub
* Special sounds in hydropneumothorax Succusion splash Falling drop sounds, etc.
* Bruit in the lungs
* Subcutaneous crepitus
* Bone crepitus
Interpretation of pulmonary and pleural findings Pulmonary consolidation
Dullness and increased vibration
* Percussion: dull or flat
* Breath sounds: bronchial
* Voice sounds: increased
* Rales: crepitation or subcrepitation
* Vocal fremitus: increased
Alveoli filled with
Fluid, red and white cells
Interpretation of pulmonary and pleural findings
Pleural fluid (Hydrothorax, Pyothorax, Hemothorax)
Dullness and diminished vibration
* Percussion: dull or flat
* Breath sounds: absent
or bronchial
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the unaffected side
Pleural fluid
or thickening
Interpretation of pulmonary and pleural findings
Thickened pleura
Dullness and diminished vibration
* Percussion: dull or flat
* Breath sounds: absent
or bronchial
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the affected side
Pleural fluid or thickening
Interpretation of pulmonary and pleural findings
Pneumothorax
Resonance or hyperresonance
Percussion: resonant hyperresonant or tympanitic
Breath sounds: diminished absent
Voice sounds: diminished absent
Rales: absent absent
Vocal fremitus: absent absent
Tracheal deviation: no yes
Interpretation of pulmonary and pleural findings
Hydropneumothorax
Resonance or hyperresonance
* Percussion: a. hyperresonant b. flat
* Breath sounds: absent
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Sucussion splash, shifting dullnes may be present
* Tracheal deviation to the unaffected side
Interpretation of pulmonary and pleural findings
Pulmonary edema
Resonance and Dyspnea
* Causes: left sided heart failure, pulmonary diseases, noxious gases
* Characteristics:
Cyanosis, dyspnea, frothy (bloody) sputum
Prolonged exspiratory phase, accompanied
with musical rales (may resemble to asthma)
Moist bronchial (gurgling) rales
Interpretation of pulmonary and pleural findings
Bronchial asthma
Resonance and Dyspnea
* Characteristics: Dyspnea (pts rising to sitting position) Unproductive cough
Anxiety expressed by facial muscles Prolonged exspiratory phase, accompanied
with musical and sonorous rales Wheezing may be heard at a distance
* Between attacks pts may be perfectly well
Auscultation of the heart
* Cardiac valve areas
Normal heart sounds
* First heart sound (S1): produced by vibration of the left ventricular muscle, during early v. systole
accentuated in mitral stenosis, fever, etc
diminished in pericardial effusion, etc
* Second heart sound (S2: A2, P2): produced by vibration of great vessels and closed valves
accentuated A2 in arterial hypertension
accentuated P2 in pulmonary hypertension
splitting of P2: may be normal or pathologic
Abdominal auscultation
Abdominal murmurs
Clinical occurence:
Aortic aneurism
Renal artery stenosis
Arteriovenous fistula in renal vessels
Abdominal auscultation
Peristaltic sounds
Increased peristalsis Abscence of sounds
early pyloric obstruction peritonitis
early intestinal obstruction mesenteric thrombosis
brisk diarrhea electrolite abnormality
spinal cord injury
advanced intest. obstr.
Abdominal auscultation
Succussion splash
The sound is produced by the combination of air and fluid in the stomach and intestine
* Clinical significance: obstruction in the stomach or anywhere in the gut gastric dilatation
It can be elicitated by moving the patient or by palpation of the viscera
Abdominal auscultation
Peritoneal friction rub
Its presence indicates peritoneal inflammation
carcinoma of the liver or liver abscess
splenic infartion or abscess
syphilitic or gonococcal hepatitis
after liver biopsy
Medical profession.ppt
Detailed Presentation by: Janos Lonovics MD
Diagnostic examinations
Medical history
Physical examination
Laboratory examination
Special examinations (US, CT, MR, Endoscopy, etc)
Consultations with other professionals
Treatment procedures
Medical treatment
Surgical treatment
Structure of a medical record
Medical history
Findings of the physical examination
Reports of the laboratory tests
Conclusions from special examinations
(US, CT, MR, Endoscopy etc)
Report and suggestions of the consultants
Diagnosis by (competent) attending physician
Notes on treatment (medications, interventions)
Progress notes
Discharge summary\
Medical diagnosis
Tentative diagnosis (at the end of the case history)
Provisional diagnosis (to begin the diagnostic work)
Working diagnosis (to put things on the right track)
Final diagnosis (if achieved)
PURPOSES OF THE PATIENT’S MEDICAL RECORD
LEGAL PURPOSES
Medical history - anamnesis
* Identifications and vital statistics
* Present illness and chief complaints
* Past history
* Social history
* Family history
Identifications and vital statistics
Name, Date of birth, Place of birth
Sex, Nationality, Race, Residence,
Marriage status, Occupation
Source of information: patient, others
Interpreter
Present illness and chief complaints
Heart of medical history
Searching for diagnostic clues (complaints, symptoms)
Accumulation of facts
Evaluation of facts
Preparation of hypotheses
Insist upon symptoms, do not accept patient’s diagnosis
Nature of symptoms
Quantification of symptoms
Chronology of symptoms
Current medication
Past history
Previous illnesses
Previous operations, injuries
Previous hospitalization
Infectious diseases
General health issues
Appetite, Body weight, Weight loss
Stool habits
Urine complaints
Family history
Parents, Siblings
Age and health
Death and causes
History of diseases
Hypertension, Hearth disease, Diabetes
Obesity, Endocrine disorders
Tuberculosis, Syphilis, AIDS
Malignancies
Alcoholism, Mental disturbances, etc.
METHODS IN THE PHYSICAL EXAMINATION
* Inspection
* Palpation
* Percussion
* Auscultation
* Smelling
o Heigh and weight
o Body temperature
o Blood pressure
o Rectal digital examination
o Eye (fundoscopic) examination
o Bimanual (gynecological) examination
o Basic neurological examination
INSPECTION
Inspection of the body as a whole
Motor activity
Body build
Anatomic malformation
Nutrition
Appearance of illness
Behaviour
Speech
LOCAL INSPECTION
Focuses observation on a single anatomic region
o Observation with unaided eyes
o Observation through special equipments
ophtalmoscope
otoscope, nasoscope
laryngoscope
bronchoscope
gastroscope, anoscope, colonoscope
thoracoscope, peritoneoscope
gonioscope
cystoscope
microscope
PALPATION
Palpation in the act of feeling by sense of touch
Physican’s hands perceives physical signs by his (her)
Tactile sense
Temperature sense
Kinesthetic sense of position and vibration
Sensitive parts of the hands
Tactile sense - the tips of the fingers
Temperature sense – the dorsa of hands
Vibratory sense – palmar base of the fingers
Sense of position and consistency – grasping fingers
Structures examined by palpation
All external structures
Solid abdominal viscera
Solid contents of hollow viscera
Lymph nodes
Thrombosed veins
Structures accesible through body orifices
Qualities elicited by palpation
Texture – the skin and hair
Moisture – The skin and mucosa
Masses – The size, shape, consistency, etc.
Precordial cardiac thrust
Crepitus – in bones, pleura, etc.
Tenderness – in all accesible tissues
Thrills – over the heart, and blood vessels
Vocal fremitus – over the lung
Special methods of palpation
Light palpation
Deep palpation
Ballottement
Fluctuation
Fluid wave
LIGHT ABDOMINAL PALPATION
* Ticklishness
* Direct Tenderness
* Rebound Tenderness
* Voluntary Rigidity of Muscle
* Involuntary Rigidity of Muscle
* Subcutaneous Crepitus
* Abdominal Masses
DEEP ABDOMINAL PALPATION – RUQ AND RLQ
* Liver
* Enlarged (Tender and Nontender) Gallbladder
* Enlarged Right Kidney
* Masses in Cecal Region
DEEP ABDOMINAL PALPATION – LUQ AND LLQ
* Spleen
* Enlarged Left Kidney (Ballottement)
* Masses in Sigmoid Region
Vibratory palpation of the lungs and pleura
Detection of vocal fremitus
PERCUSSION
A method of examination in which the surface of the body is struck to emit sounds that vary in quality according to the density of the underlying tissue
Methods:
* Bimanual, Mediate or Indirect
* Immediate or Direct
SONOROUS PERCUSSION
Its purpose to ascertain the density of the tissue
* Percussion Notes
Tympani – air-filled stomach
Resonance –air-filled lungs
Hyperresonance – emphysematous lungs
Dullness – blood-filled heart
Flatness - thigh
DEFINITIVE PERCUSSION
Its purpose to determine the size and borders of a structure
Lung borders: bases, apices
Size of the heart
Size of the liver and spleen
Size of the distended gallbladder
Level of ascites fluid
Sizes of different masses
Percussion map of the thorax
* Procedure of thoracic percussion
SUPRAPUBIC MASSES
* Distended Urinary Bladder
* Ovarian Cyst
AUSCULTATION
Act of hearing through the stethoscope
Skull – bruit
Neck – carotid artery, jugular vein
Lungs – breath sounds, rales, friction rub
Heart – valve sounds, rhythm, murmurs
Abdomen – bowel sounds, murmurs
Crepitus – bones, pleural layer
Auscultation of the lungs and pleura
Breath sounds
* Vesicular breathing
Vesicular breath sounds have a long inspiratory and a short expiratory phase
* Broncial breathing
Bronchial breath sounds have a short inspiratory and a long expiratory phase
* Bronchovesicular breathing
The two respiratory phases are about equal in duration
* Ashmatic breathing
Voice sounds
* Whispered pectoriloquy (Whispered voice sounds)
* Bronchophony (Spoken voice sounds)
ASK the patients to repeat the test word ”ninety-nine” or ”one-two-three”
COMPARE symmetric parts of the lung sequentially by stethoscope
* Are increased in:
Pulmonary consolidation
Pulmonary infarction
Pulmonary atelectasis
* Are diminished or absent in:
Pleural effusion
Pneumothorax
Thickened pleura
Alveoli filled with
Fluid, red and white cells
Pleural fluid or thickening
Adventitious sounds - Rales
* Moist Rales
Inspiratory crackels or crepitation
Bronchial rales (heard in both phases)
Moist fine or subcrepitant rales
Moist medium or crepitant rales
Moist coarse or gurgling rales
* Dry rales
Musical (sibilant) rales
Sonorous rales
Ronchus
* Pleural friction rub
* Special sounds in hydropneumothorax Succusion splash Falling drop sounds, etc.
* Bruit in the lungs
* Subcutaneous crepitus
* Bone crepitus
Interpretation of pulmonary and pleural findings Pulmonary consolidation
Dullness and increased vibration
* Percussion: dull or flat
* Breath sounds: bronchial
* Voice sounds: increased
* Rales: crepitation or subcrepitation
* Vocal fremitus: increased
Alveoli filled with
Fluid, red and white cells
Interpretation of pulmonary and pleural findings
Pleural fluid (Hydrothorax, Pyothorax, Hemothorax)
Dullness and diminished vibration
* Percussion: dull or flat
* Breath sounds: absent
or bronchial
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the unaffected side
Pleural fluid
or thickening
Interpretation of pulmonary and pleural findings
Thickened pleura
Dullness and diminished vibration
* Percussion: dull or flat
* Breath sounds: absent
or bronchial
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the affected side
Pleural fluid or thickening
Interpretation of pulmonary and pleural findings
Pneumothorax
Resonance or hyperresonance
Percussion: resonant hyperresonant or tympanitic
Breath sounds: diminished absent
Voice sounds: diminished absent
Rales: absent absent
Vocal fremitus: absent absent
Tracheal deviation: no yes
Interpretation of pulmonary and pleural findings
Hydropneumothorax
Resonance or hyperresonance
* Percussion: a. hyperresonant b. flat
* Breath sounds: absent
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Sucussion splash, shifting dullnes may be present
* Tracheal deviation to the unaffected side
Interpretation of pulmonary and pleural findings
Pulmonary edema
Resonance and Dyspnea
* Causes: left sided heart failure, pulmonary diseases, noxious gases
* Characteristics:
Cyanosis, dyspnea, frothy (bloody) sputum
Prolonged exspiratory phase, accompanied
with musical rales (may resemble to asthma)
Moist bronchial (gurgling) rales
Interpretation of pulmonary and pleural findings
Bronchial asthma
Resonance and Dyspnea
* Characteristics: Dyspnea (pts rising to sitting position) Unproductive cough
Anxiety expressed by facial muscles Prolonged exspiratory phase, accompanied
with musical and sonorous rales Wheezing may be heard at a distance
* Between attacks pts may be perfectly well
Auscultation of the heart
* Cardiac valve areas
Normal heart sounds
* First heart sound (S1): produced by vibration of the left ventricular muscle, during early v. systole
accentuated in mitral stenosis, fever, etc
diminished in pericardial effusion, etc
* Second heart sound (S2: A2, P2): produced by vibration of great vessels and closed valves
accentuated A2 in arterial hypertension
accentuated P2 in pulmonary hypertension
splitting of P2: may be normal or pathologic
Abdominal auscultation
Abdominal murmurs
Clinical occurence:
Aortic aneurism
Renal artery stenosis
Arteriovenous fistula in renal vessels
Abdominal auscultation
Peristaltic sounds
Increased peristalsis Abscence of sounds
early pyloric obstruction peritonitis
early intestinal obstruction mesenteric thrombosis
brisk diarrhea electrolite abnormality
spinal cord injury
advanced intest. obstr.
Abdominal auscultation
Succussion splash
The sound is produced by the combination of air and fluid in the stomach and intestine
* Clinical significance: obstruction in the stomach or anywhere in the gut gastric dilatation
It can be elicitated by moving the patient or by palpation of the viscera
Abdominal auscultation
Peritoneal friction rub
Its presence indicates peritoneal inflammation
carcinoma of the liver or liver abscess
splenic infartion or abscess
syphilitic or gonococcal hepatitis
after liver biopsy
Medical profession.ppt
23 April 2009
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Taking Control of Your Diabetes
Dr. Steven Edelman talks to Kriss Halpern, JD, about stretching health care dollars in a downturned economy. Mr. Halpern answers questions about COBRA, HIPAA, limited insurance plans, state and federal plans, health savings accounts (HSAs) and patient assistance programs. Examining recent court rulings, Mr. Halpern discusses the protections provided people with diabetes by the Americans with Disabilities Act. App. 27 minutes
Dr. Steven Edelman talks to Kriss Halpern, JD, about stretching health care dollars in a downturned economy. Mr. Halpern answers questions about COBRA, HIPAA, limited insurance plans, state and federal plans, health savings accounts (HSAs) and patient assistance programs. Examining recent court rulings, Mr. Halpern discusses the protections provided people with diabetes by the Americans with Disabilities Act. App. 27 minutes
Understanding Uterine Fibroids video
Understanding Uterine Fibroids video
Fibroids [A type of benign tumour found in the uterus, composed of fibrous and muscular tissue and varying in size from 1 or 2 mm to a mass weighing several kilograms.] are non-cancerous growths that develop in the uterus, effecting as many as 30 percent of women. Learn about the latest fibroid education and treatment options from the UCSF Comprehensive Fibroid Center and the UCSF National Center of Excellence. App. 90 minutes video
Fibroids [A type of benign tumour found in the uterus, composed of fibrous and muscular tissue and varying in size from 1 or 2 mm to a mass weighing several kilograms.] are non-cancerous growths that develop in the uterus, effecting as many as 30 percent of women. Learn about the latest fibroid education and treatment options from the UCSF Comprehensive Fibroid Center and the UCSF National Center of Excellence. App. 90 minutes video
Taking Control of Your Diabetes video
Taking Control of Your Diabetes video
This episode is about the millions of loved ones of those with diabetes. Special guest Susan Guzman, PhD, is co-founder of the Behavioral Diabetes Institute, and clinical psychologist specializing in the emotional health of people with diabetes and their loved ones. Dr. Guzman talks with Steven Edelman, MD, about the range of frequently experienced emotions, frustrations and challenges, and offers guidance on navigating through the tough issues brought on by caring about someone who has diabetes. App. 27 minutes video
This episode is about the millions of loved ones of those with diabetes. Special guest Susan Guzman, PhD, is co-founder of the Behavioral Diabetes Institute, and clinical psychologist specializing in the emotional health of people with diabetes and their loved ones. Dr. Guzman talks with Steven Edelman, MD, about the range of frequently experienced emotions, frustrations and challenges, and offers guidance on navigating through the tough issues brought on by caring about someone who has diabetes. App. 27 minutes video
Alzheimers Disease Update video
Alzheimers Disease Update video
The field of Alzheimers Disease [A degenerative brain disorder characterized by premature senility and dementia] research is rapidly evolving. Dr. Charles DeCarli, Director of UC Davis Alzheimers Disease Center, provides an overview of recent scientific developments in Alzheimers Disease research and their relevance for clinicians. Topics covered include: the role of vascular disease in the pathogenesis of Alzheimers Disease, assessment and management of mild cognitive impairment, and use of cognitive enhancers in persons with Alzheimers Disease and related dementias.
The field of Alzheimers Disease [A degenerative brain disorder characterized by premature senility and dementia] research is rapidly evolving. Dr. Charles DeCarli, Director of UC Davis Alzheimers Disease Center, provides an overview of recent scientific developments in Alzheimers Disease research and their relevance for clinicians. Topics covered include: the role of vascular disease in the pathogenesis of Alzheimers Disease, assessment and management of mild cognitive impairment, and use of cognitive enhancers in persons with Alzheimers Disease and related dementias.
Choosing Treatments for Autism [Brain disorder] video
Choosing Treatments for Autism [Brain disorder] video
Autism is a brain development disorder marked by communication disorders and short attention span and inability to treat others as people.
Treatment of children with autism is complex, time intensive and expensive. Research has shown that the most effective treatment is a combination of specialized and supportive educational programming, communication training, social skills support, behavioral intervention and intensive parent support and training. Learn about standard and novel treatments, report rationales for treatment selection by families and caregivers, and discuss the evidence based support for selected treatments and lessons learned. app. one hour video
Autism is a brain development disorder marked by communication disorders and short attention span and inability to treat others as people.
Treatment of children with autism is complex, time intensive and expensive. Research has shown that the most effective treatment is a combination of specialized and supportive educational programming, communication training, social skills support, behavioral intervention and intensive parent support and training. Learn about standard and novel treatments, report rationales for treatment selection by families and caregivers, and discuss the evidence based support for selected treatments and lessons learned. app. one hour video
SmartXide Dot Therapy Live Procedure video
SmartXide Dot Therapy Live Procedure video
DOT Therapy with the SmartXide DOT CO ² laser offers the ultimate in skin rejuvenation in just under an hour for most treatments. DOT Therapy is ideal for the treatment of sun damage, brown spots, fine lines, wrinkles, skin laxity/texture and acne scars. Not only does the DOT offer amazing results, but it does so safely and quickly with little downtime. The secret is out and the benefits of DOT Therapy speak for themselves:
* Minimal downtime
* Rapid healing
* Quick procedure
* Low risk
* Accurate results
* Customized treatment
* Minimally invasive
* Renewed skin
* Treatment of multiple issues at once
* Little or no anesthesia
DOT Therapy with the SmartXide DOT CO ² laser offers the ultimate in skin rejuvenation in just under an hour for most treatments. DOT Therapy is ideal for the treatment of sun damage, brown spots, fine lines, wrinkles, skin laxity/texture and acne scars. Not only does the DOT offer amazing results, but it does so safely and quickly with little downtime. The secret is out and the benefits of DOT Therapy speak for themselves:
* Minimal downtime
* Rapid healing
* Quick procedure
* Low risk
* Accurate results
* Customized treatment
* Minimally invasive
* Renewed skin
* Treatment of multiple issues at once
* Little or no anesthesia
Nerve Repositioning Procedure video
Nerve Repositioning Procedure video
This is a video of a surgery, in which the inferior alveolar nerve of the mandible is lateralized, in order to facilitate the placement of dental implants of proper length
This is a video of a surgery, in which the inferior alveolar nerve of the mandible is lateralized, in order to facilitate the placement of dental implants of proper length
Sinus Augmentation
Sinus Augmentation for Dental Implants
his video shows a very frequently employed bone grafting procedure usually associated with dental implants: The Sinus Augmentation. Unfortunately there is no original sound, so music was chosen to enhance the viewing experience. Also, the video starts after the incision and tissue reflection have been completed and the sinus window has already been outlined. Again, this is a very graphic video, intended for professional audiences.
his video shows a very frequently employed bone grafting procedure usually associated with dental implants: The Sinus Augmentation. Unfortunately there is no original sound, so music was chosen to enhance the viewing experience. Also, the video starts after the incision and tissue reflection have been completed and the sinus window has already been outlined. Again, this is a very graphic video, intended for professional audiences.