Arthroscopy
What is arthroscopy?
Arthroscopy is a surgical endoscopic technique (literally "looking inside"). Arthroscopy, in particular, means "look in the joint." This name derives from the use of a fiber optic that allows, without opening the joint, to look inside and perform surgical gestures.
What are the instruments used?
The instruments used in arthroscopy are all small in size like a pencil drawing, so you can enter in through an incision no longer than an inch.
The key instrument, the arthroscope is a device that illuminates the interior of the joint (through a fiber optic cable connected to a light source) and at the same time filming the content using a micro-camera. The images captured
dall'artroscopio are displayed in real time on a monitor, which is the real field surgery '. It is clear why the arthroscopic surgery is considered the prototype of a closed sky.
There are several instruments used in arthroscopic surgery: see below, from left to right, a stylus (a sort of substitute for the fingers used to test the texture and tension of the tissues), and a duckbill pliers (cutting tool that "bites" the fabric to be removed, eg. a piece of meniscus).
What actions can be performed arthroscopically ?
With the further development of techniques, an increasing number are surgeries that can be accomplished in arthroscopy.
meniscal surgery is certainly the most commonly practiced. Through only two practical access point you can run the regularization of almost all lesions of the meniscus internal or external. The following image can be seen as an instrument similar to that seen above removes an unstable meniscal fragment:
Reconstructive surgery of the anterior cruciate ligament is another intervention which has become routine, in which case access to 2-3 arthroscopic incision should be added a little more extensive sampling at the site of the graft tendon (which is used to replace the torn ligament).
How the postoperative course? After surgery to stabilize
meniscal if this was not associated with a suture, you can walk in full load now. If the intervention was particularly surveys, protection of the load with two crutches for 4-5 days may be useful for the purpose analgesic.
From the rapidity of post-operative recovery follows the possibility to perform this procedure in outpatient surgery (hospital discharge in the morning and evening) or at the most one-night-surgery (hospital discharge in the morning and the next morning).
After a few weeks you can return to sporting activities, after proper preparation.
The anterior cruciate ligament reconstruction and recovery period in hospital was necessarily longer. Discharge usually takes 3-4 days after surgery when the patient has learned to walk with crutches without difficulty, bend the knee to 90 degrees and extends fully.
Within two months the majority of patients have returned to a normal active life, but only 5 months is allowed to return to contact sports, after proper preparation.
Are there risks?
arthroscopic surgery, it is very minimally invasive, is burdened with a much lower rate of complications than open surgery.
Although many complications are exceptional feedback is good but do not forget that throughout the surgery of the lower limb there is a risk, albeit modest, to develop a venous thrombosis or phlebitis. For this reason, adults are now routinely subjected to pharmacological prophylaxis.
Ultrasound Ultrasound or ultrasonography is a system of medical diagnostic procedure that uses no ionizing radiation but ultrasound and is based on the principle of the issue of eco and transmission of ultrasonic waves. This technique is used routinely in the field of internal medicine, surgery and radiology. Today, in fact this method is considered as an examination of basic or filter compared to more complex imaging techniques like CT , magnetic resonance imaging , angiography. Ultrasound is, however, operator-dependent, since special skills are required of manual and power of observation, as well as culture of the image and clinical experience.
Ultrasounds are used between 2 and 20 MHz . The frequency is chosen taking into account that higher frequencies have greater resolving power of the image, but penetrate less deeply into the subject. These waves are generated by a piezoceramic crystal inserted in a probe kept in direct contact with the patient's skin with the interposition of a separate gel (which eliminates the air interposed between the probe and the patient's skin, allowing ultrasound to penetrate the anatomical segment examined) and the same probe is able to collect the return signal, which is appropriately processed by a computer and presented on a monitor.
varying the opening of the probe station, you can change the aperture cone of ultrasound and thus the depth to which the beam can be considered parallel.
are becoming normal so-called real-time probes, in which ultrasound is produced and collected sequentially in different directions, through mechanical or electronic modulation of the probe.
When the wave reaches a point of variation of ' acoustic impedance, can be reflected, refracted, diffused, attenuated. The percentage reflected carries information on the difference in impedance between the two tissues, and amounts to:
Given the large difference in impedance between a bone and tissue, the ultrasound can not see behind it. Areas of air or gas (Z small) do, however, shadow, due to a total reflection.
The time it takes the wave to travel the path forward, and back reflection is supplied to the computer, which calculates the depth from which came the echo, this refers to a subdivision surface between tissues.
basically an ultrasound consists of three parts:
a probe that transmits and receives signals
an electronic system: the pilot
transducer
generates the impulse transmission
receives the return echo to probe
the received signal is a display system
/ /
Scanning Systems
scanning systems are characterized by a format that turn derives from the transducer you use.
linear scanning probe line scan image size rectangular
Linear Transducers
groups of elements (from 5 or 6 ) are part of a curtain of crystals (from 64 to 200 or more) placed in a contiguous, are excited in succession in order to form a linear scan.
sector scan format image
sector mechanical sector transducer single crystal, ring, array.
In the case of a mechanical sector (single crystal or ring) the scan is given through a gear system that swings the crystal of a sector (typically 90 °). During the oscillation the crystal is excited with a certain timing, so as to send ultrasonic pulses to receive the returning echoes, and then allow you to create the image in the ultrasound field of view.
convex
Format Scan image of a truncated cone transducers
In the case of a convex convex transducer crystals are excited just as in the linear transducer, but the field of view will be a truncated cone, as the crystals are placed on a curved surface.
modes of presentation
You can get different representations of the structures being examined according to the calculations performed on the output signal from the probe
Mode A (amplitude modulation)
Each echo is presented as a peak whose amplitude is echo intensity itself.
B mode (brightness modulation)
Each echo is presented as a bright spot in the shade of gray is proportional to the echo.
real-time mode waves are generated and collected in different directions in sequence, so you can associate a direction at all times. In this way you can have an image simultaneously over the entire field of observation. Most ultrasound systems currently operating in this way.
M mode (motion scan)
is a representation of B-mode, but with the added feature of being sequenced, is used in order to display on the screen in real time the position variable of a barrier through the echo it produces .
amplification and compensation depth
Most important is the amplification system of echoes and the remuneration deep.
Amplification
The echoes are received echo amplitude lower than an accident. The tension generated by the crystal as a result of the returning echo is very low, then must be amplified before being sent to computer systems and then submitted.
Compensation depth
Because of the attenuation of ultrasound in human tissue (1 dB / cm / MHz) from structures distal echoes will be of lesser magnitude than those from similar structures but proximal . To compensate for this it is necessary to amplify the echoes more distant than closer. This is carried out by an amplifier where the gain increases as a function of time (TGC Time Gain Compensation) that is a function of depth of penetration.
Mode Doppler
When a wave is reflected on a moving object, the reflected part changes its frequency depending on the speed of the object (Doppler effect ). The amount of change in the frequency depends on the speed of the target.
Doppler shift (frequency change)
incident wave frequency f0 = C = Speed \u200b\u200bof sound in human tissue (1540 m / sec) V = Velocity of target
Θ = Angle of incidence the ultrasound beam with the target.
The ultrasound computer, knowing the frequency difference, it can calculate the speed of the vehicle on which the wave is reflected, while the depth is known from the time taken. The speed information is presented on screen with color-coded (usually red and blue) depending on whether the expulsion or speed to the intensity of the color this time is related to the frequency of return. Typical use is the study of vascular ( flow).
Color Doppler of Carotid
There are two possible ways of interpretation: Color Doppler (you have information on speed average half - suitable for a large volume of study) and Gated Doppler (to obtain the spectrum of all the speed in the middle, with their importance - suitable for a study on a particular).
In Doppler mode, the system normally also provides an audible signal that simulates the flow of blood, it is still a virtual signal that does not exist, only used for convenience (you may know what plays on the monitor without looking at him).
The ultrasound images are low resolution (typically 256x256 to 8 bits / pixel. Usually, the radiologist makes the diagnosis directly on the monitor, through the press only for documentation.
3D mode
The most recent development is represented by three-dimensional technique, which, unlike the classical two-dimensional image is based on the acquisition, using a special probe, a "volume" of tissue examined. The volume to be studied is scanned and digitized in fractions of seconds, after which it can then be examined in both two-dimensional, with infinite consideration of "slices" of the sample (the three axes x, y and z), or volume rendering with examination of tissue or organ to study, which appears on the monitor as a solid that can be rotated about three axes. This will particularly clearly shows its real appearance in three dimensions. With the method "Real time", adds to the effect this "movement", for example, the fetus which moves in the amniotic fluid .
Use This analysis instrument used to analyze and verify the presence of certain diseases depending on the instruments used:
Doppler for the neck vessels: stenosis
plates
ulceration
dissection
transcranial Doppler:
Vasospasm ( aneurysm )
vascular occlusion (atherosclerosis )
Cystoscopy Cystoscopy, or cystourethroscopy, is a diagnostic procedure, usually performed by a urologist, which allows the visualization of the inside of the lower urinary tract (urethra, prostate, bladder neck and bladder). Cystoscopy is indicated for the diagnosis of diseases of the lower urinary tract and prostate. During this procedure, a cystoscope (a thin tube-like instrument with an internal 'optics connected to a camera and a light source) is inserted into the bladder through the' urethra (the tube that carries urine).
rigid cystoscope cystoscopy can be used to assess and diagnose the following conditions: • bladder cancer • Blood in urine (haematuria ) • Chronic Pelvic Pain • recurrent urinary tract infections • interstitial cystitis • Painful urination • Urinary retention (due, for example, the enlarged prostate [BPH ], narrowing of the 'urethra [stenosis]) • urinary incontinence or overactive bladder • Urinary Moreover, 'the physician uses cystoscopy to evaluate abnormalities of the lining of the urinary tract such as: • diverticula (protrusions of the mucosa) • ureter ectopic (displaced) • fistula (abnormal communication between the bladder and other organs) • trabeculation (hypertrophy tissue muscle) • Cancer • Ureterocele (dilatation of the lower end of the ureter) Cystoscopy procedure can be performed under local anesthesia or surgery in an operating room with the patient sedated, in regional or general anesthesia. Before being subjected to a cystoscopy, patients should communicate if taking anticoagulant medication (eg aspirin, anti-inflammatory or warfarin [Coumadin ®]). Patients must fast for at least 4 hours before the procedure if it will be subjected to regional or general anesthesia. 'S local anesthetic, a topical anesthetic (eg lidocaine) is injected into the' urethra before the procedure. During cystoscopy, the cystoscope, flexible or rigid, is slowly inserted into the bladder through the 'urethra. A camera can be attached to the cystoscope in order to transmit the images on a monitor. L 'physician examines the' urethra and introduces a sterile liquid (eg distilled water) into the bladder to improve vision. As the bladder fills up, the patient may experience an uncomfortable urge to urinate. L 'urologist may introduce some additional instruments through the cystoscope to perform procedures such as removal, bladder biopsy, resection of a tumor and cauterization (application of a small electrical charge to minimize bleeding). In some cases, the 'urologist using another instrument called a ureteroscope, very similar to the cystoscope to view the 'ureter (the tube that carries urine from the kidney to the bladder). This procedure is called ureteroscopy can be used to diagnose and treat calculations of the upper respiratory tract. L 'ureteroscopy is usually performed under regional or general anesthesia. Cystoscopy usually takes a few minutes. The execution time of the method can be prolonged if you perform other procedures such as removing a calculation or a biopsy. After the procedure can be placed a urinary catheter. The most common side effects are a burning sensation during urination and blood in the urine (hematuria ) that can last a few hours to several days. If you used a local anesthesia, patients can go home immediately after the procedure, in case of regional or general anesthesia is required observation period (usually 1-4 hours). Complications are rarely serious and can include the following: • Adverse reaction to 'anesthesia • Bleeding • Formation of scar tissue that can cause narrowing of the' urethra (stricture) • Infection (fever, chills, severe pain, vomiting) • Breaking or perforation of the 'urethra, bladder or of' ureter • Pain or swelling testicular (index of infection) • Urinary retention (inability to urinate), usually as a result of excessive distension of the bladder or anesthesia
urography
urography is a radiographic examination contrast that allows 'exploration and study of the various sections of' urinary tract.
The survey is based on the elimination through the renal emunctory of iodinated contrast media that can dull the urine and thus make visible on radiographs natural cavities delegated to its elimination: pelvis kidney, ureter, urinary bladder . Urography allows exploration both morphological and functional : Morphological
, as it provides a true and fair view of the kidneys and excretory apparatus;
functional, as it gives precise information on the filtering system of the kidneys. Preparation for
• To highlight situations of risk, are preliminarily performed the following controls: electrocardiogram, blood urea nitrogen , glucose, creatinine , protidogramma electrophoresis. You need a good cleanser, made with diet of food poor waste in the days before the examination, with use of purgative and cleansing enemas the day before, and with a fast for at least 8 hours before the examination. The conduct of
contrast media used are water-soluble organic compounds triode is injected intravenously or slow infusion. After the injection of contrast medium performing serial radiographs:
the first 2-3 minutes after injection or after stopping;
others 10, 15, 30 and 45 minutes from the first, and even more late in some cases.
A survey carried out correctly should allow the exploration and study of the kidneys, renal pelvis, ureters and bladder. The latter must be considered in terms of complete filling and then after urination. In suspicion of renal ptosis be appropriate to carry out a radiogram in an upright position, allowing a more precise documentation on the degree of ptosis
Jobs
urography can then view and study the various sections of the urine excretory apparatus: renal calices, bulbs, ureters and bladder. Each of these sections will assess the shape, location, size, course (for the ureters), the appearance of the walls. In addition to these morphological, you can find lots of information as the appearance of a functional type, length and symmetry elimination the intensity and homogeneity dell'opacizzazione, motility of the various sections (pelvis, ureters, bladder).
All these data permit an accurate assessment of kidney function and excretory apparatus of the various sections. Urography is the examination of first choice in all disorders of the urinary tract such as inflammation
malformations
stones
tumors
trauma
Contraindications Contraindications are limited to: BUN high serious heart disease, myeloma . The use of iodinated contrast media may rarely cause intolerance allergic basis, with nausea, vomiting, pruritus, generalized malaise, rashes, coughing, collapses, but almost always minor and not properly respond to therapeutic measures
Cystography
WHAT '? The cystography is the X-ray examination for the study of lower urinary excretory (urinary bladder and urethra). It requires the use of a water-soluble iodinated contrast material with which the bladder is filled so that it becomes visible on radiographs. Radiographs are acquired during the retrograde filling (Cystography retrograde) and the next phase of emptying (voiding cystography). The test may be done in conjunction with a urodynamic examination in the presence of a radiologist and a urologist, in which case we speak of videourodinamico examination. The average duration of about 40 minutes.
WHY 'YOU DO IT? The main indications are: - Clinical suspicion of vesico-renal reflux in children which is in the adult population .- In the case of urinary incontinence is stress incontinence or urgency incontinence, which in some cases of incontinence post- Difficulty voiding
surgical .- WHAT IS? With the exception of the examination videourodinamico examination begins to empty the bladder with subsequent filling with contrast medium until it reaches the maximum bladder capacity (400-500 ml in adults). The mode of conduct of the acquisition and the number of mammograms varies by clinical question and the findings found during the examination. The examination is performed directly from the radiologist.
DISAGIL'esame is not painful. It can be slightly annoying the initial catheter placement (in women the peak is in the bladder, urethra in humans in the terminal).
Who interprets the results? The same radiologist who performs the examination material, interprets the radiographs obtained and draws up the report that is delivered to the patient together with the documentation radiografica.LIMITAZIONI TO cystography The pregnant represents the only downside being examined. Any allergies to contrast medium should be reported to your doctor before undergoing the examination: adverse reactions, although much rarer than in tests involving other routes of administration, are also possible during a cystography
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