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141. Clinically Suspected Vascular Malformation of the Extremities

element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Discussion of Procedures by Variant Variant 1: Upper or lower extremity. Suspected vascular malformation presenting with pain or findings of physical deformity including soft-tissue mass, diffuse or focal enlargement, discoloration, or ulceration. Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia (...) , contrast-enhanced MRA is preferred for improved depiction of smaller vessels and dynamic imaging assessment [6,25]. Arteriography Extremity There is no evidence to support the use of arteriography as the initial imaging evaluation for a suspected vascular malformation because of its invasive nature. MRA is noninvasive and can depict the vascular anatomy of a malformation nearly as well as arteriography [9], making it the preferred initial imaging evaluation. Arteriography does offer the highest

2019 American College of Radiology

142. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update Full Text available with Trip Pro

: An autologous fistula constructed between the proximal radial artery and a perforating branch of the cephalic or median cubital vein below the elbow. • Snuff-box fistula: An autologous fistula constructed between a branch of the radial artery and an adjacent vein in the anatomic snuff box of the hand. Fistula maturation: The process by which a fistula becomes suitable for providing prescribed dialysis. • Unassisted fistula (or unassisted AVF): An arteriovenous fistula that matures and is usable for dialysis

2019 National Kidney Foundation

143. Responsible use of high-risk medical devices: the example of 3D printed medical devices

) and ultrasound with the use of a digital imaging and communication (DICOM). 1 It enables manufacturers to create devices matched to a patient’s anatomy or devices with very complex internal structures. These capabilities have sparked huge interest in 3D printing of medical devices and other 3D printed applications in medicine. The medical and dental sectors together correspond to around 13.1% usage of Additive Manufacturing, and as such are after the industrial and aerospace sector the third largest 3D (...) to a patient’s anatomy. ? Software Workflow: The digital device design is converted to a buildable file that is sent to the printer. This file will often divide the design into layers, include additional support material to aid printing, and tell the printer where to build the device on the printer platform to prepare it for printing. The 3D printer often also requires some preparation to build different designs by changing settings for the material, type of design, and intended use. ? Material Controls

2018 Belgian Health Care Knowledge Centre

144. Onychomycosis

) cases are caused by the dermatophyte , T. rubrum . Candida albicans is involved in up to 5% of infections, most commonly in fingernails. Risk factors: Older age Gender – 2.4 times more common in males than females Tinea pedis infection (co-infection very common) Diabetes Peripheral vascular disease Immunodeficiency Psoriasis of the skin Nail trauma Occlusive footwear Sports or other activities involving bare feet Smoking Images: Anatomy of the nail Skinsight: Nail infections, fungal (Onychomycosis (...) atrophy (thinning); often associated with lichen planus lesions (purplish, flat-topped bumps) in other areas of the body – oral mucosa, wrists, shins, torso. – Curved, thickened claw-like nails frequently seen in older adults with vascular insufficiency. - Pitting of nails, symmetrical nail involvement. History of psoriasis, typical lesions (silvery scales) in other areas of body, e.g. knees, elbows. - Papilloma or warty involvement of paronychia (area where nail and skin meet), erosions and scaling

2018 medSask

145. ACR/SIR Practice Parameter for the Performance of Diagnostic Infusion Venography

Radiology (SIR) in collaboration with the American College of Radiology (ACR), was revised by the ACR in collaboration with the SIR. Diagnostic infusion venography is a radiographic study of venous anatomy using contrast media injection via a peripheral intravenous access. The term does not imply a specific method, type, or rate of contrast media injection. Such a study will often visualize the venous system to the right atrium. However, the term diagnostic infusion venography does not include central (...) or complementary in specific clinical situations [1-4]. In particular, duplex ultrasound has largely replaced diagnostic infusion venography of the upper or lower extremity since the sensitivity and specificity of duplex ultrasound above the elbow or knee are satisfactory for diagnosing acute deep venous thrombosis (DVT) and venous insufficiency [5-20]. Infusion venography has small but definite risks of complications including nephrotoxicity, contrast allergy, and/or infection [21-33]. Diagnostic infusion

2018 Society of Interventional Radiology

147. CRACKCast E143 – Diving Injuries and Dysbarism

of small bubbles of nitrogen gas in the blood and tissues on ASCENT! LOCATION, location, location of the bubbles – determines the type of symptoms that arise Fetal circulation anatomy explains why pregnant women should not dive. Multiple small bubbles normally occur on ascent, but if they become persistent, large or too numerous for the lungs to filter → inflammatory cascades ensue, cytokines, thrombosis, ischemia, obstruction etc. can occur. These bubbles can cause ischemia and hypoxia if large (...) Constitutional: h/a, lightheadedness, inappropriate fatigue, malaise, N/V Dizziness/vertigo Motor weakness Skin findings Muscular stiffness, pressure, cramps Mental status changes dyspnea/cough Auditory Bladder bowel “Decompression-related illness” – all get treated the same!! Type I DCS “The 1’s” -MSK system, skin, lymphatics Type II DCS: the “doubles”; the SERIOUS stuff is SECOND -CNS, ear, lungs, heart Symptoms Periarticular pain in the arms, and legs. Elbow and shoulder pain most common. Watch for cutis

2018 CandiEM

148. Exam Series: Guide to the Shoulder Exam

in the glenohumeral joint, and finally along the spine of the scapula. Assess the muscles of the rotator cuff, biceps, and triceps for atrophy and tenderness especially at points of insertion. Range of Motion (ROM) : Allow the patient to perform active ROM first, followed by passive ROM feeling for crepitus. Normal ROM spans abduction to 180°, adduction (arms crossed in front of the body) to 45°, flexion to 180°, extension to 45°, external rotation (arms at the side and elbows flexed to 90°, ask the patient (...) suggests a supraspinatus tear, subacromial impingement, or subacromial bursitis : Instruct the patient to internally rotate their shoulder such that the back of their hand rests on their low back. Ask the patient to lift-off from their back against resistance. Pain suggests a subscapularis tear. : Place the seated patient in 90° of abduction and 90° elbow flexion. A positive test is failure to externally rotate against resistance, and indicates a tear to teres minor. Impingement: : Assist the patient

2018 CandiEM

149. Shoulder Pain - Atraumatic

, demonstrating accuracies in the detection of rotator cuff and adjacent soft-tissue abnormalities equivalent to MRI [6]. US is usually well tolerated and, as with MRI, involves no ionizing radiation. Imaging in real time allows direct functional assessment of the shoulder during provocative maneuvers (ie, impingement) as well as providing guidance for a variety of interventions. As in other modalities, the upper extremity must be positioned to optimally visualize the anatomy of interest. Discussion (...) of the lesser tuberosity on radiography and MRI: association with subscapularis tendon lesions. AJR Am J Roentgenol 2008;191:100-6. 15. Steinbach LS. MR Imaging of the Rotator Cuff. In: Chung CB, Steinbach LS, eds. MRI of the Upper Extremity : Shoulder, Elbow, Wrist and Hand. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:244. 16. Chung CB, Gentili A, Chew FS. Calcific tendinosis and periarthritis: classic magnetic resonance imaging appearance and associated findings. J Comput

2018 American College of Radiology

150. CRACKCast E180 – Labor & Delivery

out a baby! While deliveries in the ER are rare, they can be precipitous in a setting with little back up and missing equipment. To make matters worse we probably don’t know the woman’s gestational dates, placental anatomy and obstetric information! The perinatal mortality rate in ED births is 8-10%. This is probably because antepartum hemorrhage, premature rupture of membranes (PROM), eclampsia, premature labor, abruptio placentae, malpresentation, and umbilical cord emergencies (...) , the strength of the contractions correlates poorly with the tracing. The tracings are position and placement sensitive. Fetal heart rate tracings have several components that can be assessed—baseline heart rate, variability, accelerations, decelerations, and diagnostic patterns. Ultrasonography the gestational age, biophysical profile, amniotic fluid index, and a survey of fetal and placental anatomy may be obtained. What are the indications for foetal monitoring during labour? -> Labouring woman 4

2018 CandiEM

151. CRACKCast E176 – Pediatric Musculoskeletal Disorders

CRACKCast E176 – Pediatric Musculoskeletal Disorders CRACKCast E176 – Pediatric Musculoskeletal Disorders - CanadiEM CRACKCast E176 – Pediatric Musculoskeletal Disorders In by Adam Thomas May 10, 2018 Children can injure themselves just like adults, but their growing anatomy can be quite different. Today, let’s explore Rosen’s chapter 175 on paediatric musculoskeletal disorders. Shownotes – Text in italics is from Rosen’s 9 th edition, chapter 175 Key concepts [podcasted items in bold (...) and strengthening of the rotator cuff. Think of the 1-2-3 rule for clavicle fractures. Three parts to it Parts 1 and 3 are “odd” – because they are rare and should probably be run by the ortho on call if there is any displacement Part 2 (middle ⅓) is “even” more common and up to 2 cm of displacement is allowed. [2] List 5 Xray features of supracondylar fracture Until age 8 the ligaments and joint capsule around the elbow are stronger than the bone, so make sure you see three proper views: AP view

2018 CandiEM

153. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction

. Participants and Methods This multidisciplinary coalition, called the Central Vein Work Group (CVWG), consists of clinicians and basic scientists from academic and private practices. The clinical specialties of interventional radiology, nephrology, vascular surgery, transplant surgery, pediatrics, hematology/ oncology, cardiology, and clinical anatomy were represented. This docu- ment was drafted during a series of Web-based meetings and conference calls.Afteranorganizationaloutlinewasestablished (...) method was used because most work is retrospective, without consistent de?nitions or endpoints. Additionally, anatomy and terminology of TCVO vary. The axillary vein is sometimes considered a thoracic central vein (45), and the brachioce- phalic vein (BCV) has been incorrectly termed the innominate vein (45,53). Therefore, the foremost purpose of these reporting standards is to provide a simple, consistent, and useful way for clinicians and researchers to describe TCVO across all disciplines

2018 Society of Interventional Radiology

154. Spasticity in adults: management using botulinum toxin - 2nd edition

that: E1 E2 Strong • all remediable aggravating factors have been addressed • an appropriate physical management programme is in place • a suitable programme of ongoing coordinated management is planned. 2.3 BoNT-A must only be injected by clinicians who have: E1 E2 Strong • appropriate understanding of functional anatomy • experience in the assessment and management of spasticity, and the use of BoNT-A in this context • knowledge of appropriate clinical dosing regimens and the ability to manage any

2018 British Society of Rehabilitation Medicine

156. CRACKCast 107 – Peripheral Nerve Disorders

of the ulnar nerve. How can you discern between an ulnar nerve lesion at the elbow or at the wrist? Anatomy: C7 to T1 roots – passes through the brachial plexus to descend medially, without branching, to the ulnar (medial) condylar groove at the elbow. Then goes from cubital canal, it branches to the ulnar wrist flexor and the deep flexors of the fourth and fifth digits. At the wrist it enters Guyon’s Canal between the pisiform and hook of the hamate, after which it bifurcates into the superficial terminal (...) ), or a local issue, e.g., atrophic, dry skin. Refer to figure 97.2 in Rosen’s 9 th Edition for schematic representation of the anatomy of the peripheral nervous system and its interface with the central nervous system When something goes wrong with the PNS, 1 of 3 issues may develop: Myelinopathies , in which the primary site of involvement is limited to the myelin sheath surrounding the axon; Axonopathies , in which the primary site of involvement is the axon, with or without secondary demyelination

2017 CandiEM

157. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

in severity but complicates the evaluation and management. Emery-Dreifuss Muscular Dystrophy EDMD is another nondystrophinopathy with associated cardiac involvement characterized by early-onset joint contractures (elbows, ankles, and cervical spine), slowly progressive muscle weakness, and cardiac conduction defects that increase the risk of sudden death. EDMD has significant clinical variability and is caused by mutations in genes that code for nuclear envelope proteins. X-linked EDMD, the prevalence

2017 American Heart Association

159. High Blood Pressure in Adults: Guideline For the Prevention, Detection, Evaluation and Management

and legs uncrossed. n Keep arm supported on a ?at surface (such as a table), with the upper arm at heart level. n Bottom of the cuff should be placed directly above the antecubital fossa (bend of the elbow). n Take multiple readings: n Takeatleast2readings1minapartinmorningbeforetakingmedicationsandineveningbeforesupper.Optimally,measureandrecordBPdaily.Ideally, obtain weekly BP readings beginning 2 weeks after a change in the treatment regimen and during the week before a clinic visit. n Record all

2017 American College of Cardiology

160. AIUM Practice Parameter for the Performance of a Musculoskeletal Ultrasound Examination

-thickness tear, tendinosis, and/or calcification. Both long- and short-axis views should be obtained. To examine the subscapularis tendon, the elbow remains at the side while the arm is placed in external rotation. The subscapularis is imaged from the musculotendinous junction to the insertion on the lesser tuberosity of the humerus. Dynamic evaluation as the patient moves from internal to external rotation is helpful to evaluate dynamic biceps tendon subluxation or subcoracoid impingement and assess (...) the integrity of the subscapularis tendon. To examine the supraspinatus tendon, the arm is extended posteriorly, and the palmar aspect of the hand can be placed against the superior aspect of the iliac wing with the elbow flexed and directed toward the midline (instruct the patient to place the hand in the ipsilateral back pocket). To scan the supraspinatus and infraspinatus tendons along their long axes, it is important to orient the transducer approximately 45° between the sagittal and coronal planes

2017 American Institute of Ultrasound in Medicine

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