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The Arterial Highway

Metaphors and analogies have long been used to turn complex medical concepts into everyday ones, albeit with fancy terminology. Having been involved with many 3D animations on the topics of Blood Pressure, arteriosclerosis, cholesterol and the like, we find that often a metaphor goes a long way to building understanding, credibility and even compliance with patients. One of my favorite analogies is what we call the arterial highway. Much like their tarmacked counterparts, arteries act as conduits for all the parts that make your body go. A city typically uses highways, gas lines, water pipes, railways and other infrastructure to distribute important materials to its people. Your body is much the same, except that it does it all in one system, the cardiovascular system. This is used to deliver nutrients, extract waste, transport and deliver oxygen and even to maintain the temperature! The arteries can do all these things because of their smart three-layered structure. Our arteries consist of a muscular tube lined by smooth tissue. They have three layers named – the Adventitia, Media and Intima. Each is designed with a specific function and through the magic of evolution has developed to perform its function perfectly. The first is the Tunica Adventitia, or just adventitia. It is a strong outer covering over the arteries and veins. It has special tissues that are fibrous. The fibers let the arteries flex, expanding and contracting to accommodate changes in blood pressure as the blood flows past it. Unlike a steel pipe, arteries pulsate and so must be at once be flexible, and strong. Tunica Media - the middle layer of the walls of arteries and veins is made up of a smooth muscle with some elasticity built in. This layer expands and contracts in a rhythmic fashion, much like a Wave at a baseball game, as blood moves along it. The media layer is thicker in arteries than in veins, and importantly so, as arteries carry blood at a higher pressure than veins. The innermost layer of arteries and veins is the Tunica Intima. In arteries, this layer is composed of an elastic lining and smooth endothelium - a thin sheet of cells that form a type of skin over the surface. The elastic tissue present in the artery can stretch and return, allowing the arteries to adapt to changes in flow and blood pressure. The intima is also a very smoothe, slick layer so that blood can easily flow past it. Every layer of the artery has developed evolutionary traits that help your arterial system to maintain flexibility, strength and promote blood flow. Diseases and conditions like high cholesterol or high blood pressure, diabetes and others prevent the arteries from doing their function well by creating blockages or increasing the stress on one or more of the layers. For example, high blood pressure causes rips in the smooth lining of the Intima. Anybody who has experienced a pipe burst in a house knows that the damage can be extreme and can never fully be restored. Understanding the delicate functions of the arterial structure gives good incentive to treat them better. Conditions like high blood pressure, high cholesterol and lifestyle diseases such as diabetes create tears, holes, blockages, and can disrupt the functions of one or more layers. Getting patients to visualize the effect of bad eating habits on their anatomy helps to increase patient compliance. In modern society, the concept of highways goes hand in hand with the concept of traffic jams. Patients understand that the arterial highway is one that can never be jammed.  
Mr. Rohit Singh
about 7 years ago
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12

FDA approves closure system to permanently treat varicose veins

The U.S. Food and Drug Administration has approved the VenaSeal closure system (VenaSeal system) to permanently treat varicose veins of the legs by sealing the affected superficial veins using...  
medicalnewstoday.com
over 5 years ago
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9

Physicians pioneer the use of stereotactic body radiation for deadly kidney cancer complication

Investigators have published what is believed to be the first reported successful use of stereotactic body radiation therapy for an often deadly complication of kidney cancer. The stereotactic ablative radiation therapy (SABR) was used to treat inferior vena cava tumor thrombus (IVC-TT) that reached the heart, a complication of kidney cancer in which the tumor extends into the venous system ? the system of veins that return blood to the heart. An estimated 4 to 36 percent of kidney tumors are associated with IVC-TT.  
sciencedaily.com
over 5 years ago
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21

Coffee consumption and coronary artery calcium

Stream Coffee consumption and coronary artery calcium by BMJ talk medicine from desktop or your mobile device  
feeds.bmj.com
over 5 years ago
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19

Long chain n-3 polyunsaturated fatty acids and coronary artery calcification in Japanese men

Stream Long chain n-3 polyunsaturated fatty acids and coronary artery calcification in Japanese men by BMJ talk medicine from desktop or your mobile device  
feeds.bmj.com
over 5 years ago
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21

SGEM#47: Hail to the Chief (Coronary Artery Stents)

Guest Skeptic: Dr. David Newman. Associate Professor of Emergency Medicine, Mt. Sinai School of Medicine, NY. The creator of The NNT and SMART EM.  Author of Hippocrates’ Shadow: Secrets from the House of Medicine.  
thesgem.com
over 5 years ago
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17

Warmed fluids for preventing hypothermia during operations | Cochrane

During surgical operations, patients may become cold as the result of a combination of factors including the action of anaesthetic drugs, the presence of uncovered skin and the administration of cold fluids into the veins or to parts of the body where surgery is taking place to wash them. Becoming cold during surgery can be unpleasant and can cause excessive shivering after the operation. It can also cause heart problems and bleeding problems and can contribute to problems with pressure sores and wound healing and longer hospital stay. This review seeks to find out whether warming the fluids given into veins or used to wash parts of the body may prevent patients from becoming cold.  
cochrane.org
over 5 years ago
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7

Ablation of pulmonary veins works as well as more extensive treatment in persistent atrial fibrillation, study finds

Extensive catheter ablation is no more effective than more targeted ablation to isolate the pulmonary veins in reducing the rate of recurrent atrial fibrillation in patients with persistent atrial fibrillation, a trial reported in the New England Journal of Medicine has found.1  
feeds.bmj.com
over 5 years ago
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17

Spontaneous Coronary Artery Dissection - emdocs

emDocs post containing very useful emergency medicine information  
emdocs.net
over 5 years ago
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19

Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension | Cochrane

Acute bleeding from ruptured gastric varices (enlarged veins), the most severe consequence of portal hypertension (that is increased pressure in the veins leading to the liver), is associated with high death rates. The most promising treatment for this condition is considered to be endoscopic sclerotherapy (passing a flexible tube with a camera at the end down the oesophagus (swallowing tube) allowing direct visualisation and treatment of bleeding varices) with N-butyl-2-cyanoacrylate (cyanoacrylate), which is a glue that causes blood clots to form and stops the bleeding. However, incidence of re-bleeding and complications have opened a debate on when this glue should be used compared with other endoscopic procedures.  
cochrane.org
over 5 years ago
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11

Y-GRAFT TECHNIQUE For coronary artery anastomosis

http://www.facebook.com/pages/Cardiothoracic-Surgery-Department-Tanta-University/172964712755810  
youtube.com
over 5 years ago
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11

Antibiotic lock to prevent catheter infection in infants | Cochrane

Babies in the neonatal intensive care unit require medicines and fluids through their veins. To do this, a small tube (described as a central venous catheter, CVC) is inserted into the infant's vein through the umbilical cord or through the skin. This tube is placed just outside the heart. This tube is then used to give medicines and fluid without causing any discomfort. However, this tube does lead to an increased risk of infection, which can be life threatening. There are many measures taken to try to prevent this, but infection still occurs. This review looks at one way to prevent this infection by putting an antibiotic solution into the tube and leaving it to stay there for a certain length of time (called antibiotic lock) compared with a solution containing no antibiotic.  
cochrane.org
over 5 years ago
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Effectiveness of dressings and other devices that are used to keep a peripheral venous catheter in place | Cochrane

Most people admitted to an acute/emergency hospital ward require the insertion of a peripheral venous catheter/cannula (PVC), often known as a 'drip' or 'IV'. A PVC is a flexible, hollow, plastic tube that is inserted in a peripheral vein, most commonly in the hand, or lower arm. Up to half of all PVCs stop working before treatment has finished and a new one has to be inserted. This is uncomfortable for the patient and costly for the healthcare system. One of the reasons PVCs fail, is that the products used to hold them in place are not fully effective, and allow the PVC to move around. This movement causes redness, inflammation and even blood infections. The PVC can become blocked, or leak into the surrounding tissues, or even fall out as a consequence of the movement. The function of PVC dressings and/or securement devices is to keep the PVC in the vein, and to cover the insertion site so that it is kept dry and clean and protected from infection.  
cochrane.org
over 5 years ago
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Prevention of blood clots in patients undergoing cardiac or thoracic surgery | Cochrane

Patients undergoing surgery have an increased probability of developing blood clots in their veins (venous thromboembolism). These clots may be in the deep veins (deep vein thrombosis) or travel to the lungs (pulmonary embolism). As in other types of surgery, effective prevention of blood clots (thromboprophylaxis) after cardiac or thoracic surgery may reduce the risk of postoperative vein clots. These potential benefits, however, have to be balanced against the associated risks of bleeding. This systematic review looked at the effectiveness and safety of anticoagulants (medicines that reduce the ability of the blood to clot), mechanical interventions (such as pneumatic pumps on the legs to promote blood flow), and caval filters (a type of vascular filter, implanted into the main abdominal vein to prevent movement of clots from the legs to the lungs) in patients undergoing cardiac or thoracic surgery.  
cochrane.org
over 5 years ago
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12

Novel oral anticoagulants for the treatment of deep vein thrombosis | Cochrane

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in the deep vein of the leg or pelvis. It affects approximately 1 in 1000 people. If it is not treated, the clot can travel in the blood and block the arteries in the lungs. This life-threatening condition is called a pulmonary embolism (PE) and occurs in approximately 3 to 4 per 10,000 people. The chances of getting a DVT can be increased if people have certain risk factors. These include previous clots, prolonged periods of immobility (such as travelling on aeroplanes or bed rest), cancer, exposure to oestrogens (pregnancy, oral contraceptives or hormone replacement therapy), trauma and blood disorders such as thrombophilia (abnormal blood clotting). A DVT is diagnosed through determining the risk factors and performing an ultrasound of the leg veins. If a DVT is confirmed, people are treated with an anticoagulant. This medicine prevents further clots from forming. Until recently, the drugs of choice were heparin, fondaparinux and vitamin K antagonists. However, these drugs can cause side effects and have limitations. Two further classes of novel oral anticoagulants have been developed: these are called direct thrombin inhibitors (DTI) and factor Xa inhibitors. There are particular reasons why oral DTIs and factor Xa inhibitors might now be better medicines to use. They can be given orally, they have a predictable effect, they do not require frequent monitoring or re-dosing and they have few known drug interactions. This review measures the effectiveness and safety of these new drugs with conventional treatment.  
cochrane.org
about 5 years ago
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31

CHIVA method for the treatment of varicose veins | Cochrane

Chronic venous insufficiency (CVI) is a disorder in which veins fail to pump blood back to the heart adequately. It can cause varicose veins, skin ulcers, and superficial or deep vein thrombosis in the legs. The ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) method is a minimally invasive surgical technique to treat varicose veins. The aim of the CHIVA treatment is to eliminate the venous-venous shunts by disconnecting the escape points, preserving the saphenous vein and normal venous drainage of the superficial tissues of the limb.  
cochrane.org
about 5 years ago
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Dressings and topical agents for arterial leg ulcers | Cochrane

People with blood circulation problems in their legs can develop leg ulcers. The majority of ulcers result from poor blood flow in the veins and are treated by compression. Arterial leg ulcers occur because of poor blood supply to the legs when there is a block in a leg artery or narrowing of the arteries (atherosclerosis). Without treatment of the underlying poor arterial blood supply, ulcers take a long time to heal or may never heal. These ulcers are treated by covering them with dressings, or using creams or ointments (topical agents), or both to promote healing and protect the ulcers from infection. A variety of types of dressings can be used depending on the overall aim of the treatment. The intention is to select dressings to reduce ulcer pain, manage exudate if present (the fluid that can leak from these ulcers) and promote healing.  
cochrane.org
about 5 years ago
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7

Electromagnetic therapy (EMT) for treating venous leg ulcers | Cochrane

Venous leg ulcers (which appear as open sores) can be caused by a blockage or breakdown in the veins of the legs. Compression of the leg, using bandages or hosiery (stockings), can help heal most of these ulcers. Electromagnetic therapy is also sometimes offered. Electromagnetic therapy is not a form of radiation or heat, but uses an electromagnetic field to try to promote healing. This review of clinical trials concluded that there is no high quality evidence about whether electromagnetic therapy speeds the healing of venous leg ulcers and its effect is unclear.  
cochrane.org
about 5 years ago
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WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

I’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down.  A typical scenario could be a patient in shock were all you can get in is a pathetic 22-24G cannula on the hand, when what you really want to do is a rapid infusion through a 14-16G in the cubital vein.  
scancrit.com
about 5 years ago
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Lidocaine for prevention of a sore throat following an operation under general anaesthetic | Cochrane

We reviewed the evidence of the effect of lidocaine for preventing a sore throat in people following an operation under general anaesthetic. (General anaesthetics are medicines used to send people asleep. They can be given via an intravenous line (IV) into the person's veins, via a mask, or via an endotracheal tube placed through the mouth past the larynx (voicebox) into the trachea. In this review the anaesthetic was given via an endotracheal tube.)  
cochrane.org
about 5 years ago