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En este nuevo 'Cualquier tiempo pasado fue anterior' de Nieves Concostrina vamos a contar los ajetreados traslados funerarios, al menos siete, que han tenido los escasos restos mortales del Cid y su esposa Jimena. También de la reciente estafa con la espada tizona y algunas cosas más del mucho y mejor español, aunque tal patria ni existiera. Y menos para él. Y las habituales colaboraciones de Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y la técnico de sonido María Jesús Rodríguez
Foot pain and knee pain are all too common ailments for runners, but it can be hard to pin down the source or figure out how to treat it. Nathan and Matt team up to take a look at some common sources of forefoot, heel, plantar, and anterior knee pains. They explore different possible causes, strategies for rehab/strengthening, and things to look for in shoes. Get your DOR Merch: https://doctors-of-running.myspreadshop.com/Get 20% off your first order from Skratch with code: DOCTORSOFRUNNING!Stryd's Race Power Calculator eliminates the uncertainty of race day by analyzing the course, weather, and your personal capability to create a custom power target. This lets you pace with precision—conquering hills, battling headwinds, or enduring heat without overdoing it. With Stryd, you're strategizing for your best performance. Ready to own race day? Visit stryd.com today.Chapters0:00 - Intro2:22 - In For Testing11:38 - Diagnosing Nate's foot pain24:32 - Plantar forefoot foot pain27:46 - The impact of shoes on plantar pain32:48 - Heel & plantar fascia pain36:04 - Maintaining a healthy foot42:10 - Anterior knee pain44:43 - Shoes & knee pain49:06 - Preventing & rehabbing knee pain53:27 - What about running form?1:00:16 - Wrap-up
Interview with Alphonsus Matovu, MD and Jenny Löfgren, MD, PhD authors of Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women: A Randomized Clinical Trial. Hosted byAmalia Cochran, MD Related Content: Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women Repairing Groin Hernias in Women—Another Reason to Democratize Laparoscopy
Interview with Alphonsus Matovu, MD and Jenny Löfgren, MD, PhD authors of Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women: A Randomized Clinical Trial. Hosted byAmalia Cochran, MD Related Content: Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women Repairing Groin Hernias in Women—Another Reason to Democratize Laparoscopy
El PSOE de La Rioja ha hecho balance del curso político y ha criticado la falta de diálogo de Capellán, además de que sus grandes proyectos son heredados del anterior gobierno socialista
Estimativa atual representa crescimento de 14,2% em relação à temporada passada
Uma das maiores bençãos do profeta Bilam foi a música e reza tão famosa:Má Tovu Ohalechá Yakov... Quão belas são tuas tendas Jacob.Ele estava se referindo à MODÉSTIA, Privacidade e Recato do povo de Israel, valores esquecidos na vida modernaParashá BALAK Curtiu a aula?Faça um pix RABINOELIPIX@GMAIL.COM , e nos ajude a darmos sequência neste projeto!#chassidut #mistica #judaismo #Parasha #tora #torah #balak #bilam #modestia #matovu #Midrashim #tzniut #tsniut #recato #privacidade #valores #judaismo #judeu #mashiach
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Jonathan Yerasimides and is titled "Determining Leg Lengths in Direct Anterior THA."Follow Orthobullets on Social Media:FacebookInstagram LinkedIn
Get a free demo of our back pain cure “Centralization Process”, by clicking here! https://bit.ly/sciatica-fixSubmit an application to work with us 1:1 and learn how to fix your low back! www.therehabfix.com/low-back-programTo view hundreds of free low back videos please follow us on instagram at @rehabfix www.instagram.com/rehabfixIn this video, Dr. Grant Elliott dives deep into the common misconceptions about lower cross syndrome and anterior pelvic tilt, showing you why they're not the true causes of your low back pain. If you've been told that a tilted pelvis is the source of your discomfort, this video will provide you with the real facts backed by evidence!What you'll learn in this video:The myth behind lower cross syndrome and its impact on low back pain.Why anterior pelvic tilt is actually normal and does not cause back pain.The real reasons for your low back pain and how to address them.A simple and effective 3-step routine to start feeling relief from low back pain.How proper core engagement and pelvic control can help you avoid pain flare-ups.Dr. Grant Elliott, the founder of RehabFix and a leading expert in low back rehabilitation, is here to help you see lasting pain relief through evidence-based practices. Don't let outdated myths dictate your health—get the facts and start your healing journey now!
Do anterior restorations fire you up—or freak you out? This week on Dentistry Unmasked, David and Pam sit down with Dr. Luana Oliveira-Haas, a renowned educator in anterior composites and veneers, to tackle the fine line between esthetics and efficiency. If you've ever struggled with technique sensitivity, time management, or getting the results you envision, Dr. Oliveira-Haas offers real-world strategies and material tips that can transform your outcomes. Want to create stunning smiles and stay on schedule? Then you won't want to miss this practical, inspiring episode! ** In Partnership with Ivoclar
Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' con Nieves Concostrina sobre el fascinante Francisco de Quevedo que, conocido sobre todo por su actividad literaria, presentaba otros matices personales muy interesantes: su trabajo como diplomático fullero y como espía, su tramposo matrimonio y su muerte. Y también hablaremos de su misoginia. Con las secciones de arte con Ana Valtierra, la invitada de Jesús Pozo, la música con Emma Vallespinós, la colaboración de Pepe Rubio y en la técnica, como siempre, María Jesús Rodríguez
Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' con Nieves Concostrina sobre el fascinante Francisco de Quevedo que, conocido sobre todo por su actividad literaria, presentaba otros matices personales muy interesantes: su trabajo como diplomático fullero y como espía, su tramposo matrimonio y su muerte. Y también hablaremos de su misoginia. Con las secciones de arte con Ana Valtierra, la invitada de Jesús Pozo, la música con Emma Vallespinós, la colaboración de Pepe Rubio y en la técnica, como siempre, María Jesús Rodríguez
¡Conocé la nueva apertura de los subsectores público nacional y público provincial! Ya está disponible en el sitio web institucional desde enero de 2022.https://www.indec.gob.ar/uploads/informesdeprensa/salarios_06_255530587A22.pdf
Interproximal Reduction, When, Why, and How | 9 MINUTE SUMMARY In this episode, I dive into the fundamentals of interproximal reduction(IPR) when to use it, why it matters, and how to do it effectively.We'll cover how much IPR can safely be carried out, compare differentclinical protocols and their pros and cons, and take a critical look at howaligner software plans IPR (and where it may fall short).This summary is based on Dr. Flavia Artese's insightful lecture at therecent American Association of Orthodontists Annual Session in Philadelphia,along with insights from my own clinical research and experience. How much IPR is possible? Recommended amount ½ to 1/3 of outer enamel Estimate with periapical radiographs are inaccurate, under-estimateas well as over estimate Meredith 2017 Brine 2001 Quantity of the enamel each interproximal surface Kailasam2021 systematic review, with an excellent table created by Bosio in 2022 highlightingthe enamel present and hypothetical safe reduction, ranging from 0.3-0.7mm,with 5-10% greater enamel on the distal surfaces Can all teeth have IPR?· Triangular teeth are idealo Large interradicular distance, roots canapproximate with no issue· Square shaped teeth not idealo Reduced interradicular distance, rootapproximation of 0.8mm = loss of crestal bone Taera 2008 Are we accurate with IPR? Johner 2013 AJODO· Manual strips Vs rotary disc Vs oscillatingstrips = all underperformed IPR by up to 0.1mm Protocols: Small Vs Large · 0.1-0.2mm manual strips· 0.3mm+ larger reduction · Polishing required – If not = 25 um furrows retainplaque Jack Sheridan1989 Separation posterior region· Separator – Requires measuring of premolarbefore and after· Bur – needle buro Parallel occlusal planeo Recontour tooth surface to create contact point· No separator - requires contact point to be broken, advantageis the measurement of the IPR site is accurate Bolton's analysis· Based on excess, rather than tooth removal Proportionality· Width o Canine 90% of central incisoro Lateral 70% of central incisor IPR planningBolton's discrepancy + Tooth proportionality= whento add or remove tooth structure However· “Don't do pre-emptive stripping for balancingtooth mass ratios between arches. Chances are it will work out just fine” Jack Sheradin 2007 JCO Method of use for 4 mm of IPR:· Posterior to anterior – Jack Sheridano Posterior IPR first, followed by distalisation,e.g. 4-5 first, distalise 4o Maintain arch length with stops etc, maintainanchorage· Anterior to posterior – Farooq o Anchorage preserving o Tony Weir 2021 the most common site in clinicalpractice was the lower anterior segment IPR on overlapping teeth· Not possible to achieve ideal anatomy withmotorised IPR instruments · Posterior IPR first, distalise, followed byanterior alignment and IPR – Flavia· Use of handstrips is possible on overlappingteeth - Farooq Limits of IPR· 4-5mm, although Sheridan described possible 8.9mm,technically challenging· IPR is not a possibility for sagittaldiscrepancy: Greater Bolton's discrepancies in class 3 and class 2malocclusions, SR 53 studies Machado 2020, greater in class 2 and 3 casesalbeit a small difference of 0.3-0.8% Retained primary 2nd molars· Idealise occlusion· Consider root morphology divergence, as post IPRspace may not closeo If divergence greater than crown, reconsider asspace closure unlikely Why do we need to use IPR with aligners? Dahhas 2024· Alogrythm reduces the number of aligners· More IPR rather than saggital correction· IPR staged inappropriately with large IPR whilstcontact point overlap, which is difficult to perform adequate anatomicalreduction
Armazenagem e a pressão sobre a infraestrutura de transporte geram alerta no setor, que projeta estoques robustos e a possibilidade de milho a céu aberto nesta safra.
ADVERTENCIA: No apto para quienes se ofenden de todo. “La Bella y La Bestia Podcast". Nuevos episodios todos los domingos, con el NuevoOficial & JulietteDays, disponible en todas las plataformas: Spotify, Amazon, Apple, Ivoox, Google. Aquí contamos anécdotas propias y de la audiencia.Síguenos en redes sociales:Instagram: @juliettedays // @elnuevooficial // @labellaylabestia_podcastTwitter: @juliettdays // @elnuevooficialFacebook: @labellaylabestiapodcastTiktok: @juliettedays
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. John Cooper and is titled "Direct Anterior Approach - My Wound Care and Prevention of Infection"Follow Orthobullets on Social Media:FacebookInstagram LinkedIn
06 16-06-25 LHDW ¿Hará Xabi Alonso cambios tácticos en este Mundial de Clubes?, tiene que romper con la etapa anterior de Carlo Ancelotti. Poco margen
ADVERTENCIA: No apto para quienes se ofenden de todo. “La Bella y La Bestia Podcast". Nuevos episodios todos los domingos, con el NuevoOficial & JulietteDays, disponible en todas las plataformas: Spotify, Amazon, Apple, Ivoox, Google. Aquí contamos anécdotas propias y de la audiencia.Síguenos en redes sociales:Instagram: @juliettedays // @elnuevooficial // @labellaylabestia_podcastTwitter: @juliettdays // @elnuevooficialFacebook: @labellaylabestiapodcastTiktok: @juliettedays
Manuel Jabois reflexiona sobre la situación del PSOE tras la dimisión de Santos Cerdán
Manuel Jabois reflexiona sobre la situación del PSOE tras la dimisión de Santos Cerdán
Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113
Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113
Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113
Já é conhecido o segundo executivo de Montenegro e a lista não surpreende. O PM viu nos resultados eleitorais motivo para seguir com a mesma equipa ou não percebeu que a subida do Chega pede mudanças?See omnystudio.com/listener for privacy information.
This throwback episode features Dr. Kris Aadland joining Kevin and Zach from the Voices of Dentistry 2023 event in Scottsdale, Arizona! They discuss the myth that in-house CAD/CAM crowns are inferior to lab crowns, with Kris sharing insights from her extensive experience. The conversation covers various aspects of dental technology, including the efficiency of using multiple milling machines, digital designs, and standard operating procedures (SOPs) for running a smooth dental practice. Additionally Kris offers practical tips on using dental tools like dry shields and isolites to enhance productivity in the face of staffing shortages. Some links from the show: The Pathway (where Kris teaches) Dryshield Isolite Optragate Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy" or "Lipscomb!" Very Clinical is brought to you by Zirc Dental Products, Inc., your trusted partner in dental efficiency and organization. The Very Clinical Corner segment features Kate Reinert, LDA, an experienced dental professional passionate about helping practices achieve clinical excellence. Connect with Kate Reinert on LinkedIn: Kate Reinert, LDA Book a call with Kate: Reserve a Call Ready to upscale your team? Explore Zirc's solutions today: zirc.com
La directora general de Producciones y Mercados Agrarios del Ministerio de Agricultura, Elena Busutil, ha presidido este miércoles la reunión sectorial de fruta de verano y hueso. Los primeros Avances de Superficies y Producciones de Cultivos del Ministerio a mes de marzo -sin datos de nectarina- estiman un aumento de la producción de la fruta de hueso respecto a la campaña anterior de un 13 % y de un 21 % en relación a las cinco últimas campañas. Pero es muy probable que las próximas estimaciones disminuyan estas cifras, una vez que pueda ser cuantificado el impacto de los fenómenos meteorológicos adversos. La Oficina Comarcal Agraria de Muniesa, que da servicio a 11 municipios de Cuencas Mineras, cerraba este martes al mediodía por falta de personal. Desde el Departamento de Agricultura aseguran que el cierre será hasta el 2 de junio y que la OCA de Montalbán está supliendo el servicio de emisión de guías ganaderas. Este miércoles por la mañana ha tenido lugar la Asamblea General de la Comunidad de Regantes de Bardenas.
Today's throwback episode features an in person interview with Dr. Brian Baliwas...the one and only @sfdentalnerd! Zach and Kevin were asking about dental myths and Brian delivered! The discussion navigated through occlusion myths and explores contemporary approaches to occlusion. Brian shares insights from his education at the Kois Center, advocating for an 'outside in' approach to checking occlusion. The conversation further delves into the importance of orthodontics in setting up a stable bite for long-term restorative success. Brian also touches upon practical tips to avoid issues with veneers and crowns, emphasizing the significance of clearing the pathway for a more functional bite. Some links from the show: Brian's Instagram handle Kois Center Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy" or "Lipscomb!" Very Clinical is brought to you by Zirc Dental Products, Inc., your trusted partner in dental efficiency and organization. The Very Clinical Corner segment features Kate Reinert, LDA, an experienced dental professional passionate about helping practices achieve clinical excellence. Connect with Kate Reinert on LinkedIn: Kate Reinert, LDA Book a call with Kate: Reserve a Call Ready to upscale your team? Explore Zirc's solutions today: zirc.com
Skin of Color Issues - with Dr. Tia Paul! -Anterior cervical hypertrichosis -A new vascular anomaly: SeCVAUS -Can you just observe SCCis? -Early inflammatory morphe can mimic port-wine stains -Learn more about Dr. Paul at balancedskin.com/ or on Instagram/Tiktok @dr.tiapaul!Join Luke's CME experience on Jak inhibitors! rushu.gathered.com/invite/ELe31Enb69Register for the U of U Practical Derm course!medicine.utah.edu/dermatology/educ…ities/practicalLearn more about the U of U Dermatology ECHO model!physicians.utah.edu/echo/dermatology-primarycareWant to donate to the cause? Do so here! Donate to the podcast: uofuhealth.org/dermasphere Check out our video content on YouTube: www.youtube.com/@dermaspherepodcast and VuMedi!: www.vumedi.com/channel/dermasphere/ The University of Utah's Dermatology ECHO: physicians.utah.edu/echo/dermatology-primarycare - Connect with us! - Web: dermaspherepodcast.com/ - Twitter: @DermaspherePC - Instagram: dermaspherepodcast - Facebook: www.facebook.com/DermaspherePodcast/ - Check out Luke and Michelle's other podcast, SkinCast! healthcare.utah.edu/dermatology/skincast/ Luke and Michelle report no significant conflicts of interest… BUT check out our friends at: - Kikoxp.com (a social platform for doctors to share knowledge) - www.levelex.com/games/top-derm (A free dermatology game to learn more dermatology!
Este nuevo programa de 'Cualquier tiempo pasado fue anterior' no es apto para oyentes que se consideren católicos, apostólicos y romanos; y que hayan seguido con fervor cristiano el espectáculo mediático en el que se ha convertido la muerte de Bergoglio y la elección de Prevost. Nieves Concostrina nos habla del “otro” vaticano y sus papas desde su punto de vista crítico. Acompañan las secciones de arte con Ana Valtierra, el invitado de Jesús Pozo, la música con Emma Vallespinós y la colaboración de Pepe Rubio. En la técnica, como siempre, María Jesús Rodríguez
Este nuevo programa de 'Cualquier tiempo pasado fue anterior' no es apto para oyentes que se consideren católicos, apostólicos y romanos; y que hayan seguido con fervor cristiano el espectáculo mediático en el que se ha convertido la muerte de Bergoglio y la elección de Prevost. Nieves Concostrina nos habla del “otro” vaticano y sus papas desde su punto de vista crítico. Acompañan las secciones de arte con Ana Valtierra, el invitado de Jesús Pozo, la música con Emma Vallespinós y la colaboración de Pepe Rubio. En la técnica, como siempre, María Jesús Rodríguez
Carlos Antonio Vélez, en sus Palabras Mayores del 26 de mayo de 2025, habló de la Selección Colombia y del director técnico Néstor Lorenzo. Vélez analizó la convocatoria de Perú, rival de Colombia en la fecha 15. Carlos Antonio se refirió a la conformación de los grupos en los cuadrangulares semifinales de la Liga BetPlay. Finalmente, habló de las recientes denuncias en el FPC por técnico que piden coima para poner a jugar a futbolistas.
Este nuevo programa de 'Cualquier tiempo pasado fue anterior' no es apto para oyentes que se consideren católicos, apostólicos y romanos; y que hayan seguido con fervor cristiano el espectáculo mediático en el que se ha convertido la muerte de Bergoglio y la elección de Prevost. Nieves Concostrina nos habla del “otro” vaticano y sus papas desde su punto de vista crítico. Acompañan las secciones de arte con Ana Valtierra, el invitado de Jesús Pozo, la música con Emma Vallespinós y la colaboración de Pepe Rubio. En la técnica, como siempre, María Jesús Rodríguez
Este nuevo programa de 'Cualquier tiempo pasado fue anterior' no es apto para oyentes que se consideren católicos, apostólicos y romanos; y que hayan seguido con fervor cristiano el espectáculo mediático en el que se ha convertido la muerte de Bergoglio y la elección de Prevost. Nieves Concostrina nos habla del “otro” vaticano y sus papas desde su punto de vista crítico. Acompañan las secciones de arte con Ana Valtierra, el invitado de Jesús Pozo, la música con Emma Vallespinós y la colaboración de Pepe Rubio. En la técnica, como siempre, María Jesús Rodríguez
Fala pessoal, esse é o nosso episódio de número 200, então resolvi fazer algo um pouco diferente para vocês. O primeiro relato vai ser contado pela própria ouvinte, o segundo é de terror da vida real e por fim relatos sobrenaturais, espero que curtam!
¿Siempre repites el mismo patrón en pareja? Este vídeo te muestra por qué... y cómo romperlo para siempre. Este es el segundo vídeo de la serie El Laberinto del Eneagrama. Es la herramienta para transformar tu realidad en salud, dinero y amor.
Welcome to episode 156 of the Bodybuilding Down Under podcast! In this episode, we dive deep into optimising your push day training, breaking down the best approaches for chest and delt hypertrophy, and tackling some of the most debated questions around pressing and isolation work. Here's what we cover:
No es el amor lo que te duele. Es lo que viviste cuando lo confundiste con otra cosa. Porque cuando no sanas lo anterior… terminas alejando lo que sí te haría bien. Desconfías de lo sano. Y repites lo que un día te rompió. Este vídeo no es para quien quiere excusas. Es para quien está listo para dejar de huir de lo que realmente necesita. Más herramientas para romper tus patrones y volver a confiar en ti, en el amor y en la vida: paconavas.com Tu vida, tus normas.
En la próxima hora contamos por qué los norteamericanos se comen durante la hipócrita fiesta de acción de gracias un pavo. Celebran la llegada en 1621 de 102 miembros de la secta de los puritanos y que arrasó con todo humano que no era tan blanco como ellos. Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' de Nieves Concostrina con Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y María Jesús Rodríguez en la técnica
En la próxima hora contamos por qué los norteamericanos se comen durante la hipócrita fiesta de acción de gracias un pavo. Celebran la llegada en 1621 de 102 miembros de la secta de los puritanos y que arrasó con todo humano que no era tan blanco como ellos. Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' de Nieves Concostrina con Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y María Jesús Rodríguez en la técnica
En la próxima hora contamos por qué los norteamericanos se comen durante la hipócrita fiesta de acción de gracias un pavo. Celebran la llegada en 1621 de 102 miembros de la secta de los puritanos y que arrasó con todo humano que no era tan blanco como ellos. Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' de Nieves Concostrina con Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y María Jesús Rodríguez en la técnica
En la próxima hora contamos por qué los norteamericanos se comen durante la hipócrita fiesta de acción de gracias un pavo. Celebran la llegada en 1621 de 102 miembros de la secta de los puritanos y que arrasó con todo humano que no era tan blanco como ellos. Un nuevo episodio de 'Cualquier tiempo pasado fue anterior' de Nieves Concostrina con Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y María Jesús Rodríguez en la técnica
Los problemas en las rodillas pueden provocar dolor y dificultades para caminar.
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Darwin Chen and is titled Mitigating Femoral Fractures in Direct Anterior Hip Arthroplasty.Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedIn
Este nuevo “Cualquier Tiempo pasado fue anterior”, además de la perdida de los restos del más grande autor teatral, va de su afición a las mujeres, de por qué es el pionero en el marketing literario y, también, de lo actual que es en el siglo XXI para casi todo el mundo del arte.Un genio y un ‘trueno vestido de nazareno'. Todo esto lo cuentan Nieves Concostrina, Ana Valtierra, Jesús Pozo, Pepe Rubio y Emma Vallespinós con letras y músicas. Y con la técnica de María Jesús Rubio.
Este nuevo “Cualquier Tiempo pasado fue anterior”, además de la perdida de los restos del más grande autor teatral, va de su afición a las mujeres, de por qué es el pionero en el marketing literario y, también, de lo actual que es en el siglo XXI para casi todo el mundo del arte.Un genio y un ‘trueno vestido de nazareno'. Todo esto lo cuentan Nieves Concostrina, Ana Valtierra, Jesús Pozo, Pepe Rubio y Emma Vallespinós con letras y músicas. Y con la técnica de María Jesús Rubio.
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Coinflips, where expert speakers discuss grey zone decisions in orthopedic surgery. This episode will feature doctors Grant Garrigues, Joseph Abboud, Patrick Denard, & Brian Waterman. They will discuss the case titled "Anterior Shoulder Instability with Bipolar Bone Loss in 38F." Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedln
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Coinflips, where expert speakers discuss grey zone decisions in orthopedic surgery. This episode will feature doctors Grant Garrigues, Joseph Abboud, Patrick Denard, & Brian Waterman. They will discuss the case titled "Anterior Shoulder Instability with Bipolar Bone Loss in 38F." Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedln
En este nuevo episodio Nieves Concostrina cuenta cómo el cristianismo aprovechó un invento, un supuesto Edicto de Milán, que ni era edicto, ni decreto, ni nunca se redactó, para justificar que los emperadores Constantino y Licinio reconocían así oficialmente al cristianismo. Y, con esa primera mentira, empezó la expansión de la secta. Completan este programa las colaboraciones de Ana Valtierra, Jesús Pozo, Emma Vallespinós, Pepe Rubio y, en la técnica, María Jesús Rodríguez