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Sports Hernia

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121. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm Full Text available with Trip Pro

47 Type I endoleak 47 Type II endoleak 47 Type III endoleak 48 Type IV endoleak 48 Endotension 48 Device migration 48 Limb occlusion 48 Graft infection 49 Prevention of an aortic graft infection Incisional hernia 50 Para-anastomotic aneurysm 51 Recommendation for postoperative surveillance 51 Surveillance imaging modality 51 Surveillance outcomes 51 Summary 51 COST AND ECONOMIC CONSIDERATIONS IN ANEURYSM REPAIR 51 CARE OF THE PATIENT WITH AN AAA: AREAS IN NEED OF FURTHER RESEARCH 53 REFERENCES 53

2018 Society for Vascular Surgery

123. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

? Lasting more than three weeks with exceptions for immunocompromised patients ? Following standard work-up to localize the source Hematoma / hemorrhage Computed Tomography (CT) AbdomenCT Abdomen | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 7 Common Diagnostic Indications Hernia ? For diagnosis of a hernia with suspected complications or presurgical planning including, but not limited to the following types of hernia: ? Femoral ? Internal ? Inguinal ? Spigelian (through semilunar line (...) , lateral to rectus abdominis muscle) ? Ventral Incisional hernia ? For diagnosis of a hernia with suspected complications or presurgical planning Note: Ultrasound should be considered as the initial imaging modality Infectious or inflammatory process ? Including but not limited to the following: ? Abscess ? Diffuse inflammation / phlegmon ? Fistula Iron deposition/overload in hemochromatosis ? When MRI is contraindicated; AND ? To exclude iron overload in patients with hemochromatosis who

2018 AIM Specialty Health

126. Low Back Pain, Adult Acute and Subacute

no effect on pain or function (Chou, 2016). A randomized trial of 269 adults with radicular pain found that patients with acute radiculopathy from a herniated lumbar disk who received a short course of oral steroids had modest improvement in function with no improvement in pain and no reduction in surgery incidence (Goldberg, 2015). Corticosteroids have side effects that patients need to be aware of, including osteonecrosis, mood changes, anxiety, blurred vision, numbness or tingling in the arms or legs (...) in glucose control. It is now considered standard of care to perform the injections under image guidance and with contrast in order to deliver the injectate as close to the disc herniation, area of stenosis or nerve root impingement as determined by advanced imaging. There are three approaches to the epidural space: interlaminar, transforaminal and caudal (McLain, 2005; Cannon, 2000). The different approaches allow the treatment to be tailored to the needs of the individual. With each of the three

2018 Institute for Clinical Systems Improvement

127. Percutaneous interlaminar endoscopic lumbar discectomy for sciatica

training and mentoring. It should only be done by surgeons who do the procedure regularly. 1.3 Details about all patients having percutaneous interlaminar endoscopic lumbar discectomy for sciatica should be entered onto the British Spine Registry. 2 2 Indications and current treatments Indications and current treatments 2.1 Lumbar disc herniation occurs when the nucleus pulposus of an intervertebral disc protrudes through a tear in the surrounding annulus fibrosus. Symptoms include pain in the back (...) interlaminar Percutaneous interlaminar endoscopic lumbar discectomy for sciatica (IPG555) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 8space. Dilators are used to expose the ligamentum flavum and the ruptured disc is accessed through this ligament. An endoscope and rongeurs are used to remove the herniated disc fragments. A laser may also be used to aid removal of the disc. The patient can usually mobilise within

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

128. CUA-PUC Canadian guideline for the diagnosis, management and followup of cryptorchidism

-scrotal position. In addition, exploration and orchidopexy aim to relocate viable testicular tissue outside of the abdomen in a position amenable to regular self-exam later in life, which aids in early diagnosis of testicular cancer. Surgical correction also decreases the risk of future testicu- lar torsion and addresses associated abnormalities (such as a patent processus vaginalis or clinically evident hernia). Orchidopexy may also aid in preventing direct testicular trauma against the pelvic bones (...) during intercourse or sports and provides psychological benefits by attempting to recre - ate normal anatomy. Long-term implications Reduced fertility Any correlation of infertility with undescended testis (UDT) must be tempered by the fact that 15?20% of couples in the general Canadian population have difficulty conceiving, 5 and there is often more than one factor involved. Paternity rates are largely unchanged for men with unilateral cryptorchidism compared to the general population (around 90

2017 Canadian Urological Association

129. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services

, the Netherlands; Ministerie van Gezondheid, Welzijn en Sport, Den Haag, the Netherlands), Florien Margareth Kruse (Celsus Academy for sustainable healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands), Mélanie Lefèvre (KCE), Yolande Lievens (Departement Radiotherapie, UZ Gent; Universiteit Gent), Patriek Mistiaen (KCE), Aude Vaandering (Cliniques Universitaires Saint-Luc), Elizabeth Van Eycken (Stichting Kankerregister), Ewout van Ginneken (European Observatory on Health

2017 Belgian Health Care Knowledge Centre

130. Low back pain and radicular pain: development of a clinical pathway

pain” will not be added because it appeared to have inconsistent significations in the literature. Low back pain can be associated with leg pain originating from nerve root compression and associated inflammation (or sometimes inflammation alone). It is called ‘radicular pain’. The compression can result from a disc herniation or from degenerative stenosis of the spinal canal or intervertebral foramen. In a significant subset of patients, the radicular pain is dominant over the back pain and some (...) do not have back pain at all. Radicular pain should be differentiated from other causes of leg pain, such as coxarthrosis, gonarthrosis or gluteal tendinopathies. Typical for radicular pain is that the pain: • Usually follows one (or several) dermatome patterns; • Usually can be provoked: in disc herniation patients by flexion (Valsalva-manoeuvers, straight leg raising test, bending or sitting); in stenosis patients by extension (standing, walking) 14 Low back pain and radicular pain: development

2017 Belgian Health Care Knowledge Centre

131. CRACKCast E027 – Abdominal Pain

% mortality Mesenteric venous thrombosis – associated with hypercoagulable states Haematological, inflammation, trauma Types of lesions: Arterial occlusion – sudden / emboli / low flow atherosclerosis Symptoms: periumbilical then diffuse pain, with nausea and vomiting, at times postprandial. May have a normal exam Labs: Metabolic acidosis with lactic acidemia. NEED CT to diagnosis. Intestinal obstruction Peaks in infants and the elderly or post-operative Etiology: Adhesions , cancer, hernias, volvulus (...) , 1 visits today) Adam Thomas CRACKCast Co-founder and newly minted FRCPC emergency physician from the University of British Columbia. Currently spending his days between a fellowship in critical care and making sure his toddler survives past age 5. - 10 hours ago Latest posts by Adam Thomas ( ) - July 2, 2018 - June 25, 2018 - June 21, 2018 Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine. His

2017 CandiEM

133. CRACKCast E099 – Urological Disorders

stones Small bowel diseases (Crohns) [3] List 8 alternative diagnoses (other than renal colic) for pain associated with urolithiasis Random list AAA rupture / dissection Ectopic pregnancy Ovarian cyst Bowel obstruction Incarcerated inguinal hernia Pancreatitis Cholecystitis Renal infarction, thrombosis, malignancy PE Appendicitis Organized list, but not in order of life threats: Urologic disease Upper urinary tract Renal infarct Renal tumour Pyelonephritis Ureter Tumor Stricture / hemorrhage Lower (...) of the ipsilateral testicle is considered evidence of a normal reflex. This reflex normally is absent in 50% of male infants younger than 30 months.” [1] List causes of acute scrotal swelling by age groups (infant, child, adolescent, adult) Infant Child Adolescent Adult Hernia Hydrocele Hernia Torsion Epididymitis Epididymitis Torsion Trauma Epididymitis Hernia Trauma Tumor Torsion Fournier’s gangrene [2] Describe the physiology, diagnosis and management of testicular torsion Bimodal onset: <1 yr and at puberty

2017 CandiEM

134. CRACKCast E106 – Spinal Cord

syndromes and list 3 most likely causes of each Central Cord syndrome Central contusion to grey matter and CS+ST tracts from hyperextension falls Brown-Sequard syndrome Hemisection of spinal cord penetrating trauma Anterior cord syndrome hyperflexion/herniation/hypotension ● Most common ● hyperExtension injury due to bulging lig. Flavum ● Falls, MVCs in the elderly with OA and stenosis ● Cerv. canal narrowing: disc protrusion / tumour ● Penetrating injury ● Tumours, epidural hematoma, AVMs (...) , spondylolysis, DDD, herpes zoster myelitis, radiation or iatrogenic spinal injury ● Post-op hypotension in aortic surgery (injury to vertebral art) ● Infection, MI, vasospasm ● Herniated bone frag/discs ● Bilateral MOTOR paresis ● Upper > lower extremities ● Distal muscle groups > proximal (anatomy!) ● Sensory burning dysesthesias UE ● +/- bladder dysfunction ● Ipsilateral motor loss (CS) ● Ipsilateral vib/proprioception loss (PC) ● CONtralateral sensation of pain and temperature (ST) ● MOST pts do not have

2017 CandiEM

135. CRACKCast E109 – CNS Infections

“It has been conventionally asserted that an LP in the presence of increased ICP may be harmful or fatal to the patient. Up to 30% of patients with bacterial meningitis will herniate even if they do not have an LP , suggesting that the herniations observed in some studies are the result of the underlying disease process and not the test. “ You should also consider getting an MRI to evaluate for cases of viral HSV encephalitis. In fact…”In subtle cases, LP can create meningeal enhancement (...) suggested that a normal CT scan does not always mean that performance of an LP is safe and that certain clinical signs of impending herniation (ie, deteriorating level of consciousness, particularly a Glasgow coma scale <11; brainstem signs including pupillary changes, posturing, or irregular respirations; or a very recent seizure) may be predictive of patients in whom an LP should be delayed.” [12] What are indications for LP in CNS infection? What are contraindications to LP? Indications: Whenever

2017 CandiEM

136. CRACKCast E092 – Small Intestine

Rosen’s 9th Ed. Closed loop vs. open loop An open loop (or simple) obstruction = blockage at one point only (e.g. someone pinching a garden hose). A closed loop obstruction = TWO locations are pinched off. This creates a section of ischemic bowel E.g. internal hernia (mesentery twists on itself) → twice the mortality rate due to necrosis. Question 2) What are potential etiologies of mechanical small bowel obstruction? External = compress the gut from the outside, preventing peristalsis Adhesions (...) (scarring post-op) > 60% Hernias (internal or external) Volvulus Usually occurs in the normal abdominal cavity; may have increased incidence during Ramadan; small bowel volvulus can commonly occur in children < 1 month of age Compressing masses (tumours, abscess, hematomas) Internal = something stuck inside! Primary intra-intestinal neoplasm (e.g. polyp) Inflammatory strictures (Crohn’s disease, radiation enteritis) Infectious causes (intestinal TB) Intussusception #1 cause of intestinal obstruction

2017 CandiEM

137. CRACKCast E095 – Large Intestine

related to ?removal of the outer fiber on wheat kernels by the milling process. Supposedly 80% of people over 85 have diverticula. The colon wall has weak points where the vasa recta run, it is thought that chronic low fiber stools (causing the colon to stressfully process stool), chronic inflammation, and altered bowel flora lead to diverticula. These weak points are prone to herniation of the colonic mucosa – usually small, but can be > 1cm. A couple important points: Diverticula doesn’t equal (...) (painless bleeding, often associated with NSAID use) Mis-diagnosis of colonic thickening as diverticulitis, when it is actually a malignancy 5) List the types and potential causes of large bowel obstruction. Much less common > SBO; usually is a symptom of some underlying malignancy (>50% are due to colo-rectal CA) Types: Mechanical vs. pseudo-obstruction (Ogilvie’s syndrome) Causes: Malignancy (53%) Adhesions Volvulus (17%) Diverticular disease (12%) Fecal impaction Strictures (due to IBD) Hernias

2017 CandiEM

138. CRACKCast E093 – Appendicitis

the right leg as it is flexed at the hip Sensitivity: 8 Specificity: 94 4) McBurney’s point tenderness has a low correlation with appendiceal location and is not highly sensitive for appendicitis, tenderness at this location does have a modest predictive value for appendicitis. 5) “A genitourinary examination should be performed to assess for testicular pathology or hernias in males and pelvic pathology in females. Cervical motion tenderness (CMT) is not specific for pelvic pathology and is noted in 28 (...) between a fellowship in critical care and making sure his toddler survives past age 5. - 59 mins ago Latest posts by Adam Thomas ( ) - July 2, 2018 - June 25, 2018 - June 21, 2018 Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine. His interests are in endurance sports, exercise as medicine, and wilderness medical education. When he isn’t outdoors with his family, he's brewing a coffee or dreaming up

2017 CandiEM

139. CrackCAST E129 – Bacteria

eema Subconjunctival hemorrhage Petechiae Epistaxsis Hemoptysis Subcutaneous emphysema Pneumothorax Pneumomediastinum Diaphragmatic rupture Umbilical and inguinal hernias Rectal Prolapse [6] What is the mechanism of action of the tetanus toxin? What are 4 types of tetanus? Tetanus is a toxin-mediated disease characterized by severe uncontrolled skeletal muscle spasms. Respiratory muscle involvement leads to hypoventilation, hypoxia, and death. Mechanism of action – C. tetani produces the neurotoxin (...) . This post was copyedited and uploaded by Andrew Guy. (Visited 1,290 times, 1 visits today) Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine. His interests are in endurance sports, exercise as medicine, and wilderness medical education. When he isn’t outdoors with his family, he's brewing a coffee or dreaming up an adventure….. Latest posts by Chris Lipp ( ) - July 2, 2018 - June 25, 2018 - June 21, 2018

2017 CandiEM

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