An abnormal connection between two epithelialized surfaces, often organs
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Hugo Toovey has beaten cancer, twice. But this is far from the whole story.
In this episode, we review the high-yield topic of Tracheoesophageal Fistula from the Embryology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Enterocutaneous fistulas present one of the most complex challenges in clinical nutrition—and parenteral nutrition often plays a central role in management. In our latest episode, we're joined by Vanessa Kumpf, PharmD, leading expert in nutrition support, to discuss evidence-based strategies, real-world decision-making, and how to optimize outcomes for these high-risk patients.
Resources: Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ Venous Hypertension Definition A functioning AV circuit delivers high volume arterial flow towards a stenotic venous segment, causing buildup in pressure and venous hypertension. If there are few or no branching veins between the access and stenosis, thrombosis could occur Etiology The most common etiology is venous stenosis caused by a history of vessel wall trauma by centrally-inserted venous devices such as tunneled and non-tunneled dialysis catheters, central lines, pacemakers, or defibrillator. In a study performed at a large academic medical center1, new hemodynamically significant central venous stenosis was associated with the duration of catheter dependence (26% in patients with CVCs for more than 6 months, versus 11% in patients with CVCs for less than 6 months). PICC lines can directly damage cephalic and basilic veins Venous stenosis can often go undetected until AV access creation occurs Patient Presentation Symptoms of venous insufficiency will be present– most commonly regional edema, in the area of venous stenosis. If there are patent venous branches between the AV anastomosis and the stenotic area, swelling can occur throughout the arm. Pigmentation, induration, dermatosclerosis, and ulceration may also be observed. An extensive collateral network of veins may be visible throughout anterior chest, shoulder, or flank SVC obstruction can result in swelling of the head, neck and shoulders, as well as a feeling of head and neck fullness, airway compromise, and visual problems Normal palpable thrill can be replaced by a strong pulse Dialysis can be complicated by difficulty with needle access, recirculation syndrome, and arm swelling after dialysis sessions. Workup Central vein thrombosis can be hard to detect on ultrasound because clavicle and sternum can block transmission Venography is essential to determine the presence and severity of venous stenosis or occlusion. Prevention The ideal scenario is to avoid central dialysis catheters completely, and this involves evaluating CKD patients and placing AVF or AVG before the need for dialysis arises. If a patient presents placement of an AVF/AVG, it is important to perform venography if a patient has a history of a central venous catheter or clinical signs of venous hypertension. A history of SVC obstruction from any cause can preclude permanent AV access creation in both upper extremities Treatment Endovascular approaches to venous outflow stenosis can be first-line treatment options, due to their minimal risk. They can also be performed at the same time as a diagnostic venogram. Angioplasty alone or with stenting are the endovascular options. In a study by Bakken et al2 that compared primary high-pressure balloon angioplasty versus stenting, primary patency was equivalent between groups, with 30-day rates of 76% for both groups and 12-month rates of 29% for angioplasty and 21% for stenting. Assisted primary patency was also equivalent with a 30-day patency rate of 81% and 12-month rate of 73% for the angioplasty group, 84% at 30 days, and 46% at 12 months for the stenting group. This study, along with others, shows that the major downside of endovascular interventions, whether angioplasty or stenting, often require repeat intervention and have poor long-term patency. For subclavian vein stenosis, angioplasty alone is appropriate due to its anatomical location that can put a stent at risk for extrinsic compression from the first rib and clavicle. Surgical bypass can be performed Possible bypasses include axillary-axillary, axillary-jugular, axillary-right atrial, and axillary-femoral. In these bypasses, the preferred conduits are autogenous saphenous or femoral veins. In cases where the proximal subclavian vein is obstructed, a jugular vein turndown can be performed. In this procedure the distal jugular vein is transected, sewed end-to-side at the distal subclavian vein, effectively acting as a bypass route for that obstructed segment. The Hemoaccess Reliable Outflow (HeRO) Vascular Access Device can be used as a hybrid approach, combining endovascular and open surgical techniques to bypass a central venous occlusion and provide a reliable outflow for dialysis. This device has a PTFE inflow limb that is sewn end-to-side onto the brachial artery. This limb is tunneled subcutaneously and connected to a silicone-coated nitinol outflow catheter that is inserted into a central vein and tracked directly into the right atrium. This effectively bypasses central venous stenoses. In the largest study to date on HeRO access grafts placed in 167 patients,3 HeRO primary and secondary patency was 48.8% and 90.8%, respectively, at 12 months. Interventions to maintain or re-establish patency were required in 71.3% of patients resulting in an intervention rate of 1.5/year. Access-related infections were reported in 4.3% patients. The authors concluded that HeRO device had performed comparably to standard AVGs and had proven superior to tunneled dialysis catheters in terms of patency, intervention, and infection rates. If no treatment options for venous hypertension or outflow obstruction are available, an alternate AV access site can be created, either in the contralateral arm if the SVC is uninvolved, or through placement of femoral AV access or a peritoneal dialysis catheter. Bleeding Access Site Etiology and Risk Factors Bleeding can be caused by high venous pressure after dialysis, pseudoaneurysm rupture, or trauma. Patients with end stage renal disease (ESRD) have a baseline elevated risk of bleeding due to uremia-induced platelet dysfunction and use of systemic anticoagulation within the hemodialysis circuit. Additional risk factors include dialysis through an AV graft, hypertension, longer duration of access use, and compromised integrity of the vascular access due to complications (clotting, infection) or invasive procedures. Dual antiplatelet therapy is also associated with overall bleeding events in ESRD patients. Dialysis patients could be on antiplatelet therapy for management of comorbid cardiovascular risk and/or patency of AV graft Patients with bleeding fistulas often present from their dialysis unit when standard digital pressure at the cannulation site fails to stop the bleeding. This is a very serious condition since most mature fistulas have high blood flow and the patients are at risk for hemorrhagic shock and death. Initial Management The first step of management is to obtain hemostasis. Elevate the limb above the level of the heart and apply firm and directed pressure at the site of bleeding using gauze for at least 30-40 minutes Milosevic et al4 reviewed non-operative management of bleeding fistulas and grafts and found that compared to standard dressings, the use of specialized hemostatic dressings decreased bleeding time at arterial and venous cannulation sites. These hemostatic materials included the IRIS compression bandage and cellulose-based, chitosan-based, poly-N-acetyl glucosamine-based, and thrombin-soaked dressings. There has been a “bottlecap method” described where the hollow side of a bottlecap is pressed on top of the puncture site. Maintaining pressure on the cap will cause the cap to fill with blood and clot, which tamponades the bleeding. The provider can also place a shallow figure-of-8 or purse string stitch just below the skin surface to aid in hemostasis. It is important to avoid placing the suture too deep as this can cause inadvertent fistula ligation. During this process, an assistant applies pressure just proximal and distal to the bleeding site to stop blood flow so the sutures can be placed. If these methods fail to achieve hemostasis, apply a tourniquet proximal to the fistula and tighten it until bleeding stops and the radial pulse is lost. This signifies complete occlusion of arterial inflow to the fistula. Tourniquet use should be limited to 3 hours or less, since limb ischemia beyond this timepoint is associated with permanent neuromuscular damage. Regardless of the method used for initial hemostasis, the patient is at risk for repeat hemorrhage, hematoma formation, vessel stenosis, and thrombosis. They should be evaluated by a vascular surgeon as soon as possible. Definitive Management Definitive management depends on etiology of each case, and there are a variety of interventions that can be pursued (i.e. aneurysmorrhaphy for aneurysmal bleeding) If skin erosion over the conduit is present, it should be assumed that the AV access is infected and emergency intervention should be pursued. A jump graft can be placed through with healthy tissue. A covered stent could be introduced through a separate percutaneous puncture site Finally, coagulopathy can be addressed by administering cryoprecipitate, DDAVP, erythropoietin, estrogen, tranexamic acid. Aneurysms and Pseudoaneurysms Definition and Etiology Aneurysms involve all three layers of the vessel wall and they develop due to hemodynamic changes causing remodeling of the vein wall in an AV fistula. This is necessary for vein maturation, but becomes problematic if the post-anastomotic vein continues to dilate and becomes aneurysmal. Aneurysms can also occur at anastomosis sites due to technical aspects of the surgery. Pseudoaneurysms only involve some layers of the vessel wall caused by repeated puncture for hemodialysis. Both aneurysms and pseudoaneurysms can enlarge due to venous outflow stenosis causing increased intraluminal pressures. Both true aneurysms and pseudoaneurysms can lead to overlying skin erosion and subsequent hemorrhage, pain, AV access dysfunction, and cannulation difficulties. Dialysis cannulation should be avoided at the aneurysmal sites to prevent bleeding complications. Diagnosis They can be diagnosed on ultrasound, which also provide information on flow rates, presence inflow/outflow/stenoses, and vessel diameters. Indications for Treatment Treatment is indicated for aneurysms that are rapidly expanding or ulcerating through the skin surface. These are at high risk for rupture and hemorrhage, which is life-threatening. Treatment is also indicated when the aneurysm occurs at the anastomotic site of the AV fistula, the patient has a cosmetic concern, cannulation becomes difficult, there is concern for infection, or the patient has high-output heart failure that could be exacerbated by high flow through the fistula. Treatment is not indicated in asymptomatic aneurysms, regardless of their size. True aneurysms and pseudoaneurysms are not prone to spontaneous rupture. Treatment Options Aneurysmorrhaphy is the most common treatment. It involves the resection of the aneurysmal vein wall to restore a normal diameter and removal of excess skin. Anastomosis is performed along the lateral wall to prevent issues with cannulation along the suture line. Aneurysm resection with interposition grafting is also possible. If multiple aneurysmal segments require treatment, staging their repairs can allow for continuation of dialysis without needing to place a temporary dialysis catheter. AV access ligation is an appropriate alternative to AV access salvage in certain situations but usually requires excision of the aneurysm/pseudoaneurysm due to the potential to develop thrombophlebitis and the cosmetic appearance of the thrombosed segment. If there is concern for an infected pseudoaneurysm or aneurysm, surgery should include removal of all infected material. References 1. Al-Balas A, Almehmi A, Varma R, Al-Balas H, Allon M. De Novo Central Vein Stenosis in Hemodialysis Patients Following Initial Tunneled Central Vein Catheter Placement. Kidney360. 2022;3(1):99-102. doi:10.34067/KID.0005202021 2. Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg. 2007;45(4):776-783. doi:10.1016/j.jvs.2006.12.046 3. Gage SM, Katzman HE, Ross JR, et al. Multi-center Experience of 164 Consecutive Hemodialysis Reliable Outflow [HeRO] Graft Implants for Hemodialysis Treatment. Eur J Vasc Endovasc Surg. 2012;44(1):93-99. doi:10.1016/j.ejvs.2012.04.011 4. Milosevic E, Forster A, Moist L, Rehman F, Thomson B. Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review. Clin Kidney J. 2024;17(5):sfae089. doi:10.1093/ckj/sfae089
In this episode, we review the high-yield topic of Tracheoesophageal Fistula from the Embryology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Recorded on 17 July 2025 for ICMDA Webinars.Dr Peter Saunders chairs a webinar with Dr Beatrice Ambauen-BergerThough many doctors in the West may have never treated female genital fistula, there are still an estimated 0.5 million women worldwide suffering from this preventable and treatable disease, mostly in African and Asian countries.Sufferers are living with full incontinence of urine or stool and are often treated as outcasts. Where access to medical care has improved, the numbers of obstetric fistula have decreased, but sadly there is a concerning increase of fistula caused by low quality pelvic surgeries.This webinar gives an overview of the causes and challenges of female genital fistula today, with focus on the example of Bangladesh.Dr. Bea is a Swiss Obstetrician and Gynaecologist working at LAMB hospital in rural Bangladesh since 2010. Besides practising and training local doctors in Obstetrics and Gynaecology she lead and expanded the LAMB fistula project including performing and training nationals in fistula surgeries, consultancy for community projects, local and national advocacy work as well as fistula related research. She is a member of ISOFS (International Society of Obstetric Fistula Surgeons) since 2012 and has been a member of the ISFOS Executive Committee from 2022-24.To listen live to future ICMDA webinars visit https://icmda.net/resources/webinars/
In this episode, ICS Education Committee member Shannon Wallace speaks with Workshop Chair Sherif Mourad about his team's highly anticipated workshop at ICS-EUS 2025 in Abu Dhabi: “Female Urogenital Fistula; From Simple to the Complex Scenario.”Together, they explore the workshop's comprehensive agenda, which spans the classification, diagnosis, and surgical repair of female urogenital fistulas (FUGF), including both common and rare presentations. The session will feature expert insights and video demonstrations from a distinguished panel of speakers:Cuneyd Ozkurkcugil – on aetiology, pathology, and rare fistula typesWally Mahfouz – on classification systemsSandip Prasan Vasavada – on complex repairs and robotic techniquesRiyad Taher Al Mousa – on post-diversion and malignant fistulasSherif Mourad – on surgical approaches and case-based learningWhy attend?This workshop is ideal for urologists, urogynaecologists, and pelvic floor specialists seeking to:Understand the full spectrum of FUGF presentationsLearn surgical tips and tricks for complex repairsExplore the role of laparoscopy and robotic techniquesImprove patient outcomes through better diagnosis and treatment planningSeats are limited, and this is a ticketed session with lunch provided — so register early to secure your place: Workshop 10 – ICS-EUS 2025 Through its annual meeting and journal, the International Continence Society (ICS) has been advancing multidisciplinary continence research and education worldwide since 1971. Over 3,000 Urologists, Uro-gynaecologists, Physiotherapists, Nurses and Research Scientists make up ICS, a thriving society dedicated to incontinence and pelvic floor disorders. The Society is growing every day and welcomes you to join us. If you join today, you'll enjoy substantial discounts on ICS Annual Meeting registrations and free journal submissions. Joining ICS is like being welcomed into a big family. Get to know the members and become involved in a vibrant, supportive community of healthcare professionals, dedicated to making a real difference to the lives of people with incontinence.
In this episode, join Dr. Rachel Pope and her colleagues, Dr. Anne Sammarco and Dr. Maria Shaker, as they reflect on their recent trip to Tanzania. Dr. Pope shares the personal connection she has with the country, dating back to her early career when she worked on a research project about obstetric fistulas. Fast forward nearly two decades, and she returns with her colleagues to assist with fistula surgeries, childbirth injuries, obstetrics, and women's health care.Key Takeaways: The Early Days in Tanzania: Dr. Pope recounts her initial time in Tanzania working with Utu Mwanamke (Women's Dignity Project) and conducting a study on the social reintegration of women who underwent obstetric fistula surgeries. CCBRT Hospital: Now a much larger charity hospital, Dr. Pope reflects on how much the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) hospital has grown, offering services for vulnerable populations and providing high-quality care in a resource-limited setting. A Team of Experts: Dr. Pope, alongside Dr. Sammarco and Dr. Shaker, shares their unique collaboration during the trip, combining their skills in obstetrics, gynecology, and urogynecology to provide critical care and training at CCBRT. Cultural Exchange: The episode highlights the importance of exchanging knowledge with local medical professionals, offering education to Tanzanian medical students and residents while learning valuable insights from their practices. Global Health Impact: The trio discusses the complexities of global health, including how resources and cultural factors shape patient care. They stress the importance of capacity building and sustainable healthcare practices that extend beyond short-term missions.The episode also covers the broader themes of women's healthcare advocacy, access to surgery, and the need for global solidarity in providing equitable health services to underserved populations.Resources Mentioned: CCBRT – Comprehensive Community Based Rehabilitation in Tanzania Roe Green Foundation – Support for global health initiatives What is Obstetric Fistula?If you're passionate about global health, women's empowerment, or the importance of providing sustainable medical care, this episode will inspire you to consider the ways we can all make a positive impact.A huge thank you to the Roe Green Foundation for sponsoring this impactful journey, CCBRT for hosting the team, and all the medical professionals involved for their dedication to women's health globally.
Want to Be Among the Best in Veterinary Dentistry? Request your invitation to the Veterinary Dental Practitioner Program at: https://ivdi.org/inv Take your veterinary dental skills to the next level with the Veterinary Dental Practitioner Program—hands-on training and proven protocols for better patient outcomes. More CE & Resources: Explore Dr. Beckman's full CE library on extractions, radiology, oral surgery, and home care protocols: https://veterinarydentistry.net ---------------------------------------------------------------------- Host: Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM Welcome back to The Vet Dental Show, your weekly source for practical skills and expert insights in veterinary dentistry. In this episode, Dr. Beckman walks through real-world techniques to simplify extractions, enhance home care compliance, and manage complex cases like oral-nasal fistulas and periodontal furation defects. Whether you're a general practitioner or tech, these insights are clinically transformative. What You'll Learn in This Episode: ✔️ Why and how to sharpen periosteal elevators for safer, more efficient extractions ✔️ How to expose canine roots fully using proper elevation techniques ✔️ Greenies vs. Oravet: what works best for plaque control—and why ✔️ How Oravet's wax coating technology reduces plaque adhesion ✔️ Advanced approach to oral-nasal fistula closure using flap techniques ✔️ Clinical decision-making on furation bone loss in cats and dogs ✔️ Why most furation cases lead to extractions—unless very specific criteria are met Key Takeaways for Veterinary Dental Practice: ✔️ Regular instrument sharpening dramatically improves surgical control ✔️ Bone removal during extraction accelerates healing, not complications ✔️ Oravet's wax coating targets all teeth—not just cheek teeth like Greenies ✔️ Oral-nasal fistula closure requires undermining and tension-free flaps ✔️ Extraction is typically required in furation cases due to cleaning limitations ✔️ Watch for non-inflamed gingival recession in large breeds—it's not always pathological --------------------------------------------------------------------------------- Want to Be Among the Best in Veterinary Dentistry? Request your invitation to the Veterinary Dental Practitioner Program at: https://ivdi.org/inv More CE & Resources: Explore Dr. Beckman's advanced CE library: https://veterinarydentistry.net Questions or case insights? Leave a comment below! Like, subscribe, and join us weekly on The Vet Dental Show for real-world strategies in veterinary oral surgery, periodontics, and client communication. veterinary dentistry, canine extraction techniques, periosteal elevator sharpening, oral nasal fistula closure, plaque control dog chews, Oravet vs Greenies, furation bone loss vet dentistry, veterinary dental CE, Dr. Brett Beckman podcast, dental tips for vet technicians, healthy mouth for pets, VOHC approved chews, dog tooth resorption, veterinary dental extractions, vet tech dental training
In 2015, Daniel Garza experienced bloating and difficulty completing a bowel movement. A subsequent digital rectal exam revealed a mass on his sphincter, which led to a diagnosis of anal cancer. A surgical procedure got rid of the cancer, but it also resulted in his losing half of his sphincter and the temporary presence of a fistula, a tear which was like a second anus. He underwent a chemotherapy regimen of 5-fluorouracil, followed by radiation treatment, but another major challenge awaited Daniel, as he had to wear an ostomy bag, which he does to this day. He deals with the bag and has continued his work as an advocate for those with HIV and anal cancer, in addition to being an actor and a comic. Daniel Garza thought he was in good health until he was plagued by a nasty variety of symptoms. He experienced bloating, stomach pain, bowel movement blockage and anal bleeding. The initial conclusion of his doctor was that he had a strangulated intestine tied to a hernia he suffered years earlier. He prescribed a number of treatments, which did no good. Daniel went back to the doctor and went through blood tests and a CT scan. But it was a subsequent digital rectal exam that revealed a mass on his sphincter. That led to a biopsy and a diagnosis of squamos cell carcinoma of the anus, also known as anal cancer. The mass was on one side of Daniel's sphincter. Surgery removed the cancer but also removed half of his sphincter. Next up was chemotherapy, a type known as 5-fluorouracil, then radiation treatment and time in a hyperbaric chamber. The cancer was gone, the aforementioned fistula healed, but to dispose of the waste in his system, Daniel had to be fitted with an ostomy bag, which he eventually named Tommy. He went through three ostomy nurses and two types of bags before he felt comfortable managing the bag. These days, Daniel Garza says he is doing his best to make peace with Tommy. It hasn't stopped him from continuing his life as an advocate for those dealing with HIV and anal cancer. He also travels the world as an actor and a comic. Additional Resources: Support Groups: Man Up To Cancer: https://www.manuptocancer.org Cheeky Charity: https://www.cheekycharity.org
In this week's Listener Series episode of The Birth Trauma Mama Podcast, Scarlett bravely shares her story a layered, and still-unfolding journey through birth trauma, postpartum hemorrhage, and complex pelvic floor injuries that continue to impact her life more than five years later.She speaks candidly about the realities of:
Why do anal fistulas return even after treatment? In this insightful episode, colorectal surgeon Dr. Manas Ranjan Tripathy dives deep into the reasons behind the recurrence of anal fistulas. Learn about the common causes, risk factors, and the role of proper diagnosis and follow-up. He also sheds light on advanced laser fistula treatment in HSR Layout, Bangalore—a minimally invasive approach with promising outcomes. Don't miss this episode if you or a loved one is struggling with recurrent anal fistulas.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
Is Laser Treatment the Right Choice for Anal Fistula? Let's Break It Down with Dr. Manas Ranjan TripathyIn this episode, join expert colorectal surgeon Dr. Manas Ranjan Tripathy as he explores one of the most talked-about advancements in anorectal surgery — laser treatment for anal fistula. Is it truly the best option? What makes it different from traditional surgery? Who is the right candidate?We'll discuss:How laser treatment works for fistulasAdvantages over conventional methodsRecovery time and risks involvedWhen laser surgery is not recommendedExpert recommendations based on real casesWhether you're a patient, caregiver, or just curious about modern medical techniques — this episode will give you clear, evidence-based insights on managing anal fistulas with precision and safety.
Holmberg's Morning Sickness - Thursday February 20, 2025 Learn more about your ad choices. Visit podcastchoices.com/adchoices
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Better Edge : A Northwestern Medicine podcast for physicians
Aziz Aadam, MD, interventional endoscopist, Daniel Borja-Cacho, MD, transplantation surgeon, and Ahsun Riaz, MD, vascular and interventional radiologist, discuss a complex biliary case involving a patient with advanced stage cancer. They explore the innovative, multidisciplinary approach taken to manage the patient's biliary fistula and hepatic duct obstruction. The physicians highlight the collaborative efforts and advanced techniques that led to a successful outcome and improved quality of life for the patient.
In this episode, we spotlight the ASCRS QI Fistula Collaborative, an initiative dedicated to improving outcomes for patients with complex fistulas. Dr. Julia Saraidaridis and Dr. Bob Hollis share their insights on the importance of data collection and discuss the collaborative's mission to advance fistula care through shared knowledge and research. They also highlight the critical need for more participants, inviting colorectal surgeons to join the effort and contribute to this project. If you're interested in joining the project, reach out to Dr. Bob Hollis at rhhollis@uabmc.edu.
Guest: Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine. He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic. Resources: Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ Outline: Steal Syndrome Definition & Etiology Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand. Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow. Incidence and Risk Factors The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits. Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4 Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries' ability to vasodilate and adjust to decreased blood flow. Patient Presentation, Symptoms, Grading Steal syndrome is diagnosed clinically. Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation. Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years. The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss. There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow. Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5 Workup Duplex ultrasound can be used to analyze flow volumes. A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery. Upper extremity angiogram can identify proximal arterial lesions. Prevention Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter. SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal. If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal. Indications for Treatment Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases. If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs. Treatment Options Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously. Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent) Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses. Flow limiting procedures can address high volumes through the AV access. Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft. The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis. A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis. There are also surgical treatments focused on reroute arterial inflow. The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery. The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow. Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow. Thrombosis of the conduit would put the fistula at risk, rather than the native artery. The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery's continuity and does not require vein harvest. Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow. 2. Ischemic Monomelic Neuropathy Definition Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation. Etiology IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia. Incidence and Risk Factors IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6 IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves. IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions. Patient Presentation Symptoms usually present rapidly, within minutes to hours after AV access creation. The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis. Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination. Treatment Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss. 3. Perigraft Seroma Definition A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane. Etiology and Incidence Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material. Seromas most commonly form at anastomosis sites in the early postoperative period. Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9 Patient Presentation and Workup Physical exam can show a subcutaneous raised palpable fluid mass Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess) Indications for Treatment Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis Persistent seromas can also serve as a nidus for infection. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas. Treatment The majority of early postoperative seromas are self-limited and tend to resolve on their own Persistent seromas have been treated using a variety of methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only. Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9 4. Infection Incidence and Etiology The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11 Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma. Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption. Patient Presentation and Workup Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis. Ultrasound can be used to screen for and determine the extent of graft involvement by the infection. Treatments In AV fistulas: Localized infection can usually be managed with broad spectrum antibiotics. If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field. In AV grafts: If infection is localized, partial graft excision is acceptable. Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified. For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued. References 1. Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206 2. Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1 3. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848 4. Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301 5. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025 6. Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365 7. Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002 8. Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046 9. Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204. 10. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001 11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067
Your post op day #4 right pneumonectomy patient is suddenly coughing up large volumes of serosanguinous sputum! What are you worried about and what do you need to do? Join your Swedish thoracic surgery team, Drs. Chloe Hanson, Peter White, and Brian Louie as we discuss the management of this dangerous and frustrating surgical complication. Hosts: Chloe E. Hanson, M.D., PGY3 Brian E. Louie, MD, Thoracic Attending Peter T. White, MD, Thoracic Attending Learning Objectives: What is a bronchopleural fistula (BPF) and what different ways do they present? Describe the acute management of an early BPF. Describe the differences in operative considerations between an early and late BPF. Describe different options for closure of a pneumonectomy space. References: - Sugarbaker's Adult Chest Surgery, 3e Sugarbaker DJ, Bueno R, Burt BM, Groth SS, Loor G, Wolf AS, Williams M, Adams A. Sugarbaker D.J., & Bueno R, & Burt B.M., & Groth S.S., & Loor G, & Wolf A.S., & Williams M, & Adams A(Eds.),Eds. David J. Sugarbaker, et al. https://shc.amegroups.org/article/view/3787/html - Dal Agnol G, Vieira A, Oliveira R, Ugalde Figueroa PA. Surgical approaches for bronchopleural fistula. Shanghai Chest 2017;1:14. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
King Louis XIV underwent risky surgery to remove a painful anal fistula on 18th November, 1686: an event that created a sensation at court, leading to 1686 being declared the ‘year of the fistula'. Louis's choice to undergo such a dangeous procedure signalled an unspoken endorsement of surgery, bringing it a semblance of respectability - though the risk to Royal health had been highly mitigated in advance, as Royal Surgeon Félix de Tassy had already experimented on (and killed) dozens of peasants in preparation. In this episode, Arion, Rebecca and Olly take a deep dive into the Royal bottom, discovering the salves made from luxurious ingredients which had previously failed to cure Louis; reveal how Felix developed his special “Royal Scalpel” just for the king's surgery; and explore how the “Grand Operation,” as it became known, inspired a highly peculiar trend… Further Reading: • ‘Sciences at Versailles part 6: fit for a king, medicine and surgery' (Google Arts & Culture): https://artsandculture.google.com/story/sciences-at-versailles-part-6-fit-for-a-king-medicine-and-surgery-palace-of-versailles/pwXBUrLu24XTIg?hl=en • ‘It is good to be the king: The French surgical revolution' (Hektoen International, 2019): https://hekint.org/2019/10/31/it-is-good-to-be-the-king-the-french-surgical-revolution/ • ‘The Many Diseases of Louis XIV, King of France' (SLICE, 2020): https://www.youtube.com/watch?v=3V68ws3K0Qk Learn more about your ad choices. Visit podcastchoices.com/adchoices
okay now im serious, subscribe to our patreon: patreon.com/westernpromises.com oh boy we are so back. teratomas, fistulas, kris angel uterus freak, current events, ahmeds big day, Mohamed's Theorem, metal gear solid V, standing on business. this week all three boys are in it to win it and we can see that checkered flag. kept ya waiting huh? also i am on a work field trip and Paris is dealing with a mysterious water situation so we are both on airpods. honestly its is pretty good. Please tell your brothers and sisters about our show.
Tracheoesophageal Fistula with Dr. Satish Nagula
The Flame Con hangover is real, folks! While Joey, Aaron, and John are "out on assignment," Bob, Chris, and Steve recap the good times at Flame Con 2024, discuss the intense terror of Alien: Romulus, get real about medical history, and talk about some of their favorite comics from the past week! Flame Con might be over, but we're still riding the high!Books: Houses of the Unholy OGN, Batman: City of Madness #1-3, Starfighters Vol. 1-4, Sherperd's Sword, Saint's Quarter Vol. 1, Magical Boy Basil #1-2, Fantastic Four #23, Sensational She-Hulk #10[https://open.spotify.com/playlist/6G4cO7QwDsaEJ61fwJOtj6?si=ee9525c7c2cf4fd0]
Sherif Mourad, chair of the ICS Developing World Committee, discusses his team's ICS 2024 Madrid workshop with Shannon Wallace. During the workshop, participants will learn about female urogenital fistula, including simple and complex cases. The workshop is free and open to everyone. There will also be presentations from Cüneyd Zkürkçügil, Riyad Taher Al Mousa, Wally Mahfouz, and Sandip Prasan Vasavada on the panel of experts participating in the workshop. Find out more at https://www.ics.org/2024/session/7701 Early registration for ICS 2024 Madrid is now open at www.ics.org/2024The ICS annual meeting is the must-attend, multidisciplinary event for clinical and research scientists interested in: Urology Urogynaecology Female and functional urology Gynaecology Bowel dysfunction Neurourology Pure and applied science Physiotherapy Nursing Geriatrics The ICS 2024 Madrid conference fosters collaboration between all disciplines involved in continence care.
This recording features audio versions of June 2024 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Virtual Reality for the Management of Pain and Anxiety for IR Procedures: A Prospective, Randomized, Pilot Study on Digital Sedation ReadFinal 3-Year Study Outcomes from the Evaluation of the Zilver Vena Venous Stent for the Treatment of Symptomatic Iliofemoral Venous Outflow Obstruction (VIVO Clinical Study) ReadTwo-Year Cumulative and Functional Patency after Creation of Endovascular Arteriovenous Hemodialysis Fistulae ReadPercutaneous Disc Biopsy versus Bone Biopsy for the Identification of Infectious Agents in Osteomyelitis/Discitis ReadComparison of a Patient-Mounted Needle-Driving Robotic System versus Single-Rotation CT Fluoroscopy to Perform CT-Guided Percutaneous Lung Biopsies ReadPercutaneous Microwave Ablation versus Cryoablation for Small Renal Masses (≤4 cm): 12-Year Experience at a Single Center ReadPre-emptive Aortic Side Branch Embolization during Endovascular Aneurysm Repair Using the Excluder Stent-Graft System: A Prospective Multicenter Study ReadA Claims-Based Method for Identification and Characterization of Practicing Interventional Radiologists ReadJVIR and SIR thank all those who helped record this episode:Host:Manbir Singh Sandhu, University of California Riverside School of MedicineAudio editor:Sonya Choe, University of California Riverside School of MedicineAbstract readers:Dhanush Reddy, MBBS, Massachusetts General HospitalVasan Jagadeesh, University of California San Diego Alena Khalil, MA, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic MedicineJacob Knittel, Creighton University School of Medicine, PhoenixNour Homsi, University of California Riverside School of MedicineMillennie Chen, University of California Riverside School of MedicineColin Standifird, Kirk Kirkorian School of Medicine at UNLV, NevadaTaji Kommineni, MD, JD, LLM, Emory © Society of Interventional RadiologySupport the Show.
"I think one of the most important things about fistula is that it is completely preventable and treatable. So this is a solvable problem. We used to have this problem here in the US and now we don't." – Bonnie RuderObstetric fistula affects around 2 million women globally, with 50,000 to 100,000 new cases each year. This devastating, yet entirely preventable condition profoundly impacts women's lives, causing chronic infections, incontinence, and severe social ostracism and isolation.In this powerful new episode, I'm joined by Bonnie Ruder, midwife, medical anthropologist, and co-founder of Terrewode Women's Fund. Together, we explore the: The definition and causes of obstetric fistula - and why this should never happen to any woman, anywhere in the world The nefarious history of obstetric fistula surgery on enslaved women in the United StatesThe medical, personal, and social impacts of fistula on women's lives — and their incredible resilienceBonnie's journey from home birth midwife to fistula activistHolistic treatment approaches: medical care, social reintegration, and economic empowermentEfforts to prevent fistula through better access to maternal healthcare and the role of traditional birth attendants in fistula preventionTune into this heart-wrenching yet inspiring episode to learn more about the impact of obstetric fistula and the incredible work being done to confront it.Terrewode Women's Fund's mission to end obstetric fistula in Uganda are truly inspiring.
Obstetric fistula is a birth-related injury that results when women go through prolonged and obstructed labor. As a result, some women experience stigma and exclusion from their families and the community. This study focuses on understanding how these women are included in their families and communities after receiving surgical correction. For upcoming interviews check out […]
VISIT US AT NCLEXHIGHYIELD.COM No matter where you are in the world, or what your schedule is like, access the entire course at www.NCLEXHighYieldCourse.com The NCLEX High Yield Podcast was featured on Top 15 NCLEX Podcasts! Make sure you JOIN OUR NEW VIP FACEBOOK GROUP! https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: @NCLEXHighYield or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. Subscribe to our newsletter at nclexhighyield.com --- Support this podcast: https://podcasters.spotify.com/pod/show/nclexhighyield/support
The Do One Better! Podcast – Philanthropy, Sustainability and Social Entrepreneurship
Kate Grant, Chief Executive of the Fistula Foundation, on receiving $15M from philanthropist MacKenzie Scott and treating women with devastating childbirth injuries. Obstetric fistula is a devastating childbirth injury. It leaves a woman incontinent, humiliated, and—all too often—shunned by her community. Surgery is the only cure. The Fistula Foundation is the global leader in fistula treatment, providing more surgeries to more women than any other organization, including the U.S. government and United Nations. Since 2009, they have supported treatment in 33 countries in Africa and Asia. Thank you for downloading this episode of the Do One Better Podcast. Visit our Knowledge Hub at Lidji.org for information on 250+ case studies and interviews with remarkable leaders in philanthropy, sustainability and social entrepreneurship.
In this episode, we review the high-yield topic of Fistula-in-Ano/Perianal Fistula from the Gastrointestinal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
Nursing Mnemonics Show by NRSNG (Memory Tricks for Nursing School)
Download for FREE today - special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down: bit.ly/nursing-memory Outline The 3 C's C-Choking C-Coughing C-Cyanosis Description A tracheal esophageal fistula (TEF) is a congenital abnormality in which there is an opening between the trachea and the esophagus. Surgery is required to repair the opening before a baby can receive oral nutrition. Signs and symptoms to identify TEF are choking, coughing, and cyanosis.
Insider's Look into Anal Fistulas: Dr. Ude and Dr. Ritha Belizaire Collaborate on Weekly Dose. A Must-Listen Episode for those Seeking Comprehensive Medical Information!Dr. Ritha Belizaire, MD, a leading general and colorectal surgeon based in Houston, Texas she opened her solo surgical practice, Houston Community Surgical, in July 2023, and is passionate about accessible, inclusive surgical care. Dr. Belizaire is a "single mother by choice" to Amelia (4) and Raffaela (2).Tune in for an enlightening conversation!Here's the Social Media link of Dr. Ritha BelizaireFB https://lnkd.in/g4NQMXimIG @rithabelizairemdTT @rithabelizairemdWebsite: https://lnkd.in/gM38swTJLooking for a quality primary-care physician?Call 3043501087https://lnkd.in/gAbRjVUTAccepting New PatientsOpen 7 days a weekEvening Hours Available!Subscribe herehttps://lnkd.in/gEin8mQHhttps://lnkd.in/gh9sn3GpPlease Like and Share…Disclaimer: This content is for information purposes only. While I am a Physician, I am not your personal physician. Nothing discussed should be taken as intentional personal medical advice. Any personal medical questions or concerns must be directed to your personal physician.#applevalleyfamilymedicine #primarycarephysician
Click to know more about Easy Ayurveda Hospitalhttps://www.easyayurveda.com/hospital/Buy our new course on Marma Therapyhttps://www.easyayurveda.com/marma1Subscribe to Easy Ayurveda Video Classes https://www.easyayurveda.com/video-classes/Subscribe to our free Easy Ayurveda newsletter here (you can unsubscribe and stop them anytime) - https://forms.aweber.com/form/58/2129766958.htm Buy our course on diabetes reversal, powered by Madhavbaug https://www.easyayurveda.com/diabetes Buy our online video course on Treatment of cardiac disorders with Ayurveda https://www.easyayurveda.com/heartMaster ECG in one week. Sign up for video course https://www.easyayurveda.com/ecgContact Dr. MB Gururaja BAMS MD (Ayu)https://www.easyayurveda.com/gururaja Contact Dr. Raghuram YS BAMS MD (Ayu)https://www.easyayurveda.com/raghuram Buy Easy Ayurveda Ebooks https://www.easyayurveda.com/my-book Buy Easy Ayurveda Printed Books https://www.easyayurveda.com/books/
The 6th of January is Nollaig Na mBan, or Women's Little Christmas. It will also mark the release of FISTULA, a powerful new film directed by Dearbhla Glynn, the award-winning Irish filmmaker who lives in Clare. If you haven't heard of Fistula, it's a condition that over 2 million women live with, causing immeasurable suffering and social isolation. To find out more about it and the film, on Friday's Morning Focus, Alan Morrissey was joined by Dearbhla Glynn, Award-winning Irish filmmaker who lives in Clare.
Can you imagine a world without Obstetric Fistula? Brooke Sulahian and Cara Brooks, the driving forces behind Hope for Our Sisters, share their inspiring stories, fervor, and dedication in advocating for and providing support to women battling with this condition. This episode is not just about shedding light on Obstetric Fistula; it's about humanizing the struggle. Brooke and Cara emphasize the role of Hope for Our Sisters in making a tangible difference through the prevention of Fistula and empowerment of their sisters affected by Fistula. We take a hard look at the aftermath of surviving Fistula - the rehabilitation and reintegration back into society. We touch on the empowerment of these survivors, the uplifting stories of their strength, and the tireless efforts made to bring about change. Check out the shownotes to learn more!__________________Thank you to our partners at CHIMUK: A sustainable and ethical handmade fashion brand transforming women's lives through knitting. Purchase one of a kind, high quality baby alpaca, and cotton handmade scarves, hats, and more! Each product comes with a special QR code linking you to a photo/bio of the artisan who handmade your product! Click here to see the impact you can make by shopping with Chimuk. >>Use the code GHP10 for 10% off at checkout!
Fistula repair surgery originated in the late 19th century. Yet, at least one million women today suffer for want of this surgery that can transform their lives. In this episode, Jesse Chu, the senior program manager at Fistula Foundation, shares her personal quest in encountering the world of obstetric fistula. We dive into the tireless work of Fistula Foundation, how they are building trust in communities, leading women to the right care, and harnessing a network of dedicated surgeons. We learn about their community outreach, partnerships, free treatment awareness, and surgeon training. Despite innumerable challenges, they are making a significant difference in places like Kenya, Zambia, Democratic Republic of Congo, and Tanzania. Check out the shownotes to learn more!__________________Thank you to our partners at CHIMUK: A sustainable and ethical handmade fashion brand transforming women's lives through knitting. Purchase one of a kind, high quality baby alpaca, and cotton handmade scarves, hats, and more! Each product comes with a special QR code linking you to a photo/bio of the artisan who handmade your product! Click here to see the impact you can make by shopping with Chimuk. >>Use the code GHP10 for 10% off at checkout!
Coping with kidney disease and dialysis can be difficult. Sometimes you have to think outside the box! Have you considered music or art therapy? Today Social Worker Melissa Fry and patient Steve Light are here to share their experiences with using music and art as coping strategies. In this episode we spoke with, Melissa Fry, MSW, CAPSW is a dialysis social worker at Mile Bluff Medical Center. She has worked in the dialysis unit for the past 25 years. She has focused on assisting her patients with anxiety, depression and other mental health issues. She has used music as one technique to assist her patients with coping with various life stressors. Steven Light is an artist from Swindon UK. He used his art as a way to express himself though a second wave of kidney failure, and created an exhibition around this experience called ‘Fistula'. His brother lovingly donated a kidney to him in July 2022 and both have fully recovered. Additional Resources Effect of music therapy on dialysis patients Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.
Though childbirth injuries are practically eradicated in the developed world, they still hold a devastating grip on the lives of countless women in sub-Saharan Africa and South Asia. Obstetric fistula, a result of prolonged, obstructed labor, leaves women socially ostracized and emotionally shattered, with many enduring the consequences for an average of five years before receiving treatment. Today's conversation with Jesse Chu, program manager of Fistula Foundation, takes us deep into the harsh realities of this childbirth injury and the work being done to combat it.Check out the shownotes to learn more!__________________Thank you to our partners at CHIMUK: A sustainable and ethical handmade fashion brand transforming women's lives through knitting. Purchase one of a kind, high quality baby alpaca, and cotton handmade scarves, hats, and more! Each product comes with a special QR code linking you to a photo/bio of the artisan who handmade your product! Click here to see the impact you can make by shopping with Chimuk. >>Use the code GHP10 for 10% off at checkout!
A practical case-based approach to the management of bronchopleural fistulas while patients are on positive pressure ventilation.
Habiba C Mohamed is a social change activator, and trained psychotherapist advocating for women's bio-psychosocial health and rights. Ms Mohamed supports marginalized women and girls to tap into their inner strengths and amplify their potential and impact in society. Habiba Mohamed works with Fistula Foundation as the Regional Director, Programs (Africa, Asia). Habiba Joined the Foundation in 2014 as the outreach manager. In this role, she designed and spearheaded the community strategy for the Fistula Foundation Treatment Network in Kenya. Later, she was promoted to country director to oversee the entire network of hospital and community partners. Her work has contributed to provision of fistula surgeries, and restoring of dignity to more than 11,000 women in the last 8 years. In her role as regional director of programs, Habiba is responsible for the expansion of the treatment network model throughout the African region.Before joining the Fistula Foundation, Ms. Mohamed worked on the fistula program for nearly a decade. She is the Founder and Lead Director of Women and Development Against Distress in Africa (WADADIA), a nonprofit organization that advocates for sexual reproductive health and rights for the marginalized women. Since establishing the organization in the year 2006, she has been actively involved in the formulation of policies, procedures and strategies that has led to its growth and expansion. Besides her work with WADADIA, Habiba also supported a community program funded by the United Nations Population Fund for six years, and served as a consultant program specialist for One By One, a US-based nonprofit focused on fistula treatment. She has worked and volunteered with several other organizations, giving her an in-depth understanding of community dynamics and engagement. Ms Mohamed was the lead consultant in the development of the female genital fistula training curriculum for community health volunteers in Kenya, and a contributor for the new global fistula guidance. She is the author of the psychosocial effects of obstetric fistula on young mothers in Western Kenya, obstetric fistula post-repair follow up; an outreach workers perspective, and the obstetric fistula community-based assessment tool (OF-COMBAT) - a verbal screening tool, that has helped reduce the number of women being referred to fistula treatment centers with other forms of incontinences.Ms Mohamed began her career as a veterinarian, assisting livestock farmers in Western Kenya. Through this close contact with the community, she began to see the social challenges faced by rural, communities and became passionate about working with marginalized women. She has a higher diploma in Social Work and Community Development, a first and a master's degree in counseling psychology and is an ongoing PhD candidate of counselling psychology at Kenyatta University. Links:https://fistulafoundation.org/https://www.facebook.com/fistulafoundation/ https://www.facebook.com/WADADIA/https://www.wadadia-nonprofits.org/https://www.facebook.com/WADADIA/Support the showPlease support us at daysforgirls.org
This episode is for all the women who have messaged me begging for a positive story about vaginal birth after a severe perineal tear. Here is all the inspiration (and information) you'll need! Diana shares her experience with a fourth-degree tear and details her shock when she was told that she had a recto-vaginal fistula. She admits that she did very little birth preparation and was happy to go with the flow but when it was time to birth her baby, she couldn't feel anything because of the epidural. Furthermore, her baby was born in one push. Diana's complications made for a physically and mentally challenging postpartum and motivated her to do things differently for her subsequent birth. Determined to embrace support and preparation, she worked closely with her doula and MGP midwife and had a physiological labour with perineal support that resulted in a small second-degree tear. ___________ Have you heard the news? My new book, The Complete Australian Guide to Pregnancy and Birth, is now available for purchase. This book covers everything you need as you journey through pregnancy and prepare for a positive birth experience. --> Get yours today. I hope you love it.
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