Angiography involves the use of x-ray imaging to examine blood vessels. The images generated during an angiography procedure are known as angiograms.

During an angiogram, a special dye is released into the coronary arteries from a catheter (special tube) inserted in a blood vessel. This dye makes the blood vessels visible when an X-ray is taken. Angiography allows doctors to clearly see how blood flows into the heart. This allows them to pinpoint problems with the coronary arteries.

Angiography may be recommended for patients with angina (chest pain) or those with suspected coronary artery disease (CAD). The test gives doctors valuable information on the condition of the coronary arteries, such as atherosclerosis, regurgitation (blood flowing backwards through the heart valves) or pooling of blood in a chamber because of a valve malfunction.

Angiography is performed via the groin and sometimes the arm of the patient. After disinfecting the groin or arm position, it will be covered with a cloth. You will be asked to lie on a table, and the site where the catheter is to be inserted (the groin or arm) will be cleaned. You will be given a local anesthetic to numb the skin so you feel no pain. Then, a catheter is carefully guided through a vein or artery to a position near the heart. When the catheter is in place, it releases a special dye into the bloodstream. X-rays are used to help guide the catheter to the right place. Contrast agent will then be injected through the catheter and a series of X-rays will be taken. This will allow a map of the arteries to be created. While the dye is being released, you might feel a brief sensation of heat, which usually passes quickly. A large x-ray camera will be above the table to take pictures of the procedure. The doctor, can see the pictures and check the complications.

Preparation for the angiogram

  • Generally, you should not eat or drink for 6 to 8 hours before having a coronary angiography.
  • Take a bath and shave the hair around the groin the night before the angiogram. The area is washed and disinfected and then numbed with an injection of local anesthetic.
  • Tell the doctor if you are allergic to any medicines.
  • Take all your medications with you to the hospital to show to your doctor. Stop taking insulin or other medicines like Glibenclamide and metformin tablets the night before the angiogram.
  • According to PT tests and the doctor’s prescription, stop taking Walfarin tablet.
  • Coronary angiogram consent form has to be signed by the patient and his companions.
  • Take your test results such as: HBSAg, HIV, BG, CBC, Cr, Uera, PTT, PT, K, Na, BS, and HCV.

Self care after angiography in hospital

  • The patient needs to lie flat for three or four hours to avoid bleeding. During this time, pressure may be applied to the incision to prevent bleeding and promote healing. A sandbag or other heavy item may be placed over the site for a time to prevent further bleeding or the formation of a hematoma at the site. If angiography is performed through the hand, there is no need to sandbags and immobilization of the hand will be shorter. In both cases, the patient should be stayed in bed for 4 to 12 hours.
  • Drink plenty of fluids to help flush the dye from your body.
  • The doctor will decide if the patient stays in the hospital or discharge.
  • The patient takes the CD of angiogram while discharging.

Self care after angiography at home

  • Two days after angiogram, the patient can take a bath or shower.
  • Continue to use your regular medications unless you have been told to stop them by the doctor.
  • Avoid strenuous activities and heavy lifting for one week.
  • Please notify your family doctor or nurse if the puncture site shows any of the following:
    • An increase in bruising or swelling.
    • Signs of infection such as pain, swelling, drainage, redness, chills, or fever.
    • A cold, numb, or “blue” foot or hand on the same limb as the puncture site.
  • After angiography, the patient may feel a little pain in groin after 2 or 3 days.
  • The patient with heart diseases should follow a low-fat and low-salt diets. The patients should consult with the Nutritionist if they have diabetes, high blood cholesterol, and high blood pressure.

 

If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery.

People with blockages in their heart arteries may need angioplasty if they are having lots of discomfort in their chest, or if their blockages put them at risk of a heart attack or of dying. A doctor numbs a spot on your groin or arm and inserts a small tube (catheter) into an artery. The catheter is threaded through the arterial system until it gets into a coronary (heart) artery. Watching on a special X-ray screen, the doctor moves the catheter into the artery. Next, a very thin wire is threaded through the catheter and across the blockage. Over this wire, a catheter with a thin, expandable balloon on the end is passed to the blockage.

The balloon is inflated. It pushes the plaque to the side and stretches the artery open, so blood can flow more easily. This may be done more than once. In many patients a collapsed wire mesh tube (stent) mounted on a special balloon, is moved over the wire to the blocked area. As the balloon is inflated, it opens the stent against the artery walls. The stent locks in this position and helps keep the artery open. The balloon and catheters are taken out. Now the artery has been opened, and your heart will get the blood it needs.

1) Drug-Eluting Stent: Drug-eluting stents are metal stents that have been coated with a pharmacologic agent (drug) that is known to suppress restenosis: the reblocking or closing up of an artery after angioplasty due to excess tissue growth inside or at the edge of the stent. It is more expensive than bare-metal stent.

2) Bare-Metal Stent:  Bare-metal stent is used more than drug-eluting stent because it is less expensive than drug-eluting stent. It is more used among the patients with lower risk of restenosis. The patients who have stents to prevent restenosis should take some medications such as aspirin, Plavix. Taking Plavix may continue for more than one year and the patient should not stop taking it without counseling with the doctor. Aspirin is also used long-term. In order to prevent gastrointestinal complications, take aspirin after meal.

Preparation for the Angioplasty

  • Do not eat or drink anything for 6 to 8 hours before the angiography.
  • An area of your arm or groin will be cleaned and shaved the night before angiography.
  • Angioplasty consent form has to be signed by the patient and his companions.
  • Take your test results such as: CBC, PTT, PT, Cr, Uera, K, Na, BS, BG, HIV, HCV, and HBsAg.
  • Tell your doctor if you are allergic to any medications.
  • Please bring all your medicines in their original packaging. You may need to stop, start, or adjust some of your medicines before the procedure.
  • Stop taking insulin or other medicines like Glibenclamide and metformin tablets the night before the angioplasty. After some tests, the doctor may order to stop taking Warfarin tablet.
  • The patients have to bring all of their medical records on admission.
The ACL is a tough band of tissue joining the thigh bone to the shin bone at the knee joint.
It runs diagonally through the inside of the knee and gives the knee joint stability. It also helps to control the back-and-forth movement of the lower leg.

ACL Injuries

Knee injuries can occur during sports such as skiing, tennis, squash, football and rugby. ACL injuries are one of the most common types of knee injuries.
You can tear your ACL if your lower leg extends forwards too much. It can also be torn if your knee and lower leg are twisted.
Common causes of an ACL injury include:
  • landing incorrectly from a jump
  • stopping suddenly
  • changing direction suddenly
  • having a collision, such as during a football tackle
If the ACL is torn, your knee may become very unstable and lose its full range of movement.
This can make it difficult to perform certain movements, such as turning on the spot. Some sports may be impossible to play.

Deciding to have surgery

The decision to have knee surgery will depend on the extent of damage to your ACL, if there is other knee damage and if your quality of life is affected.
If your knee feels stable and you do not have an active lifestyle, you may decide not to have ACL surgery.
But delaying surgery could cause further damage to your knee, if it gives way or becomes unstable.
Your doctor will discuss options with you and assess if you need surgery, once swelling goes down and if rest and physio has helped to treat your symptoms.

Before having surgery

Before having ACL surgery, you may need to wait for any swelling to go down and for the full range of movement to return to your knee.
You may also need to wait until the muscles at the front of your thigh (quadriceps) and back of your thigh (hamstrings) are as strong as possible.
If you do not have the full range of movement in your knee before having surgery, your recovery will be more difficult.
It’s likely to take at least 3 weeks after the injury occurred for the full range of movement to return.
Before having surgery, you may be referred for physiotherapy to help you regain the full range of movement in your knee.
Your physiotherapist may show you some stretches that you can do at home to help keep your leg flexible. They may also recommend low-impact exercise, such as swimming for fitness or cycling.
These types of activities will improve your muscle strength without placing too much weight on your knee. You should avoid any sports or activities that involve twisting, turning or jumping.

Reconstructive ACL surgery

A torn ACL cannot be repaired by stitching it back together, but it can be reconstructed by attaching (grafting) new tissue on to it.
The ACL can be reconstructed by removing what remains of the torn ligament and replacing it with a tendon from another area of the leg, such as the hamstring or patellar tendon.
The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia).

Risks of ACL surgery

ACL surgery fully restores the functioning of the knee in more than 80% of cases.
But your knee may not be exactly like it was before the injury, and you may still have some pain and swelling.
This may be because of other injuries to the knee, such as tears or injuries to the cartilage, which happened at the same time as or after the ACL injury.
As with all types of surgery, there are some small risks associated with knee surgery, including infection, a blood clot, knee pain, and knee weakness and stiffness.

Recovering from surgery

After having reconstructive ACL surgery, a few people may still experience knee pain or instability.
Recovering from surgery usually takes around 6 months, but it could be up to a year before you’re able to return to full training for your sport.

A cesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb. The cut is usually made across your tummy, just below your bikini line. A cesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.

Why cesareans are carried out?

A cesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky. Planned cesareans are usually done from the 39th week of pregnancy. A cesarean may be carried out because:

  • your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you’d prefer they did not try this
  • you have a low-lying placenta (placenta praevia)
  • you have pregnancy-related high blood pressure (pre-eclampsia)
  • you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
  • your baby is not getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
  • your labour is not progressing or there’s excessive vaginal bleeding

If there’s time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a cesarean compared with a vaginal birth.

Asking for a cesarean

Some women choose to have a cesarean for non-medical reasons. If you ask your midwife or doctor for a cesarean when there are not medical reasons, they’ll explain the overall benefits and risks of a cesarean to you and your baby compared with a vaginal birth.

If you’re anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned cesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

What happens during a cesarean?

Most cesareans are carried out under spinal or epidural anaesthetic. This mean you’ll be awake, but the lower part of your body is numbed so you will not feel any pain.

During the procedure:

  • A screen is placed across your body so you cannot see what’s being done – the doctors and nurses will let you know what’s happening.
  • A cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered.
  • You may feel some tugging and pulling during the procedure.
  • You and your birth partner will be able to see and hold your baby as soon as they have been delivered if they’re well – a baby born by emergency cesarean because of foetal distress may be taken straight to a paediatrician for resuscitation.

The whole operation normally takes about 40 to 50 minutes.

Occasionally, a general anaesthetic (where you’re asleep) may be used, particularly if the baby needs to be delivered more quickly.

Recovering from a cesarean

Recovering from a cesarean usually takes longer than recovering from a vaginal delivery. Providing there are no complications, most women can go home 1 to 2 days after having a cesarean.

You may experience some discomfort in your tummy for the first few days. You’ll be offered painkillers to help with this.

When you go home, you’ll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks.

The wound in your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Risks of a cesarean

A cesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk. It’s important to be aware of the possible complications, particularly if you’re considering having a cesarean for non-medical reasons.

Possible complications include:

  • infection of the wound or womb lining
  • blood clots
  • excessive bleeding
  • damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
  • temporary breathing difficulties in your baby
  • accidentally cutting your baby when your womb is opened

Future pregnancies after a cesarean

If you have a baby by cesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way. Most women who have had a cesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after cesarean (VBAC). But you may need some extra monitoring during labour just to make sure everything is progressing well. Some women may be advised to have another cesarean if they have another baby. This depends on whether a cesarean is still the safest option for them and their baby.

Cesarean sections are carried out in hospital. If there’s time to plan your cesarean, you’ll be given a date for it to be carried out.

The operation

Preparation

You’ll need to stop eating and drinking a few hours before the operation. Your doctor or midwife will tell you when. You’ll be asked to change into a hospital gown when you arrive at the hospital on the day of the cesarean section. A thin, flexible tube called a catheter will be inserted into your bladder to empty it while you’re under the anaesthetic, and a small area of pubic hair will be trimmed if necessary. You’ll be given the anaesthetic in the operating room. This will usually be a spinal or epidural anaesthetic, which numbs the lower part of your body while you remain awake. This means you’ll be awake during the delivery and can see and hold your baby straight away. General anaesthetic (where you’re asleep) is used in some cases if you cannot have a spinal or epidural anaesthetic.

What happens

During the procedure:

  • you lie down on an operating table, which may be slightly tilted to begin with
  • a screen is placed across your tummy so you cannot see the operation being done
  • a 10 to 20cm cut is made in your tummy and womb – this will usually be a horizontal cut just below your bikini line, although sometimes a vertical cut below your bellybutton may be made
  • your baby is delivered through the opening – this usually takes 5 to 10 minutes and you may feel some tugging at this point
  • your baby will be lifted up for you to see as soon as they have been delivered, and they’ll be brought over to you
  • you’re given an injection of the hormone oxytocin once your baby is born to encourage your womb to contract and reduce blood loss
  • your womb is closed with dissolvable stitches, and the cut in your tummy is closed either with dissolvable stitches, or stitches or staples that need to be removed after a few days

The whole procedure usually takes around 40 to 50 minutes.

After the operation

You’ll usually be moved from the operating room to a recovery room straight after the procedure. Once you have started to recover from the anaesthetic, the medical staff will make sure you’re well and continue to observe you every few hours.

You’ll be offered:

  • painkillers to relieve any discomfort
  • treatment to reduce the risk of blood clots – this may include compression stockings or injections of medicine to help prevent blood clots, or both
  • food and water as soon as you as you feel hungry or thirsty
  • help with breastfeeding your baby if you want it – read more about the first few days of breastfeeding

The catheter will usually be removed from your bladder around 12 to 18 hours after the operation, once you’re able to walk around. You’ll probably be in hospital for 1 or 2 days after a cesarean section, and may need to take things easy for several weeks.

Recovering in hospital

Most women can leave hospital 1 or 2 days after having a cesarean section.

While in hospital:

  • you’ll be given painkillers to reduce any discomfort
  • you’ll have regular close contact with your baby and can start breastfeeding
  • you’ll be encouraged to get out of bed and move around as soon as possible
  • you can eat and drink as soon as you feel hungry or thirsty
  • a thin, flexible tube called a catheter will remain in your bladder for at least 12 hours
  • your wound will be covered with a dressing for at least 24 hours

When you’re well enough to go home, you’ll need to arrange for someone to give you a lift as you will not be able to drive for a few weeks.

Looking after your wound

Your midwife should also advise you on how to look after your wound.

You’ll usually be advised to:

  • gently clean and dry the wound every day
  • wear loose, comfortable clothes and cotton underwear
  • take a painkiller if the wound is sore – for most women, it’s better to take paracetamol or ibuprofen (but not aspirin) while you’re breastfeeding
  • watch out for signs of infection

Non-dissolvable stitches or staples will usually be taken out by your midwife after 5 to 7 days.

Your scar

The wound in your tummy will eventually form a scar. This will usually be a horizontal scar about 10 to 20cm long, just below your bikini line. In rare cases, you may have a vertical scar just below your bellybutton. The scar will probably be red and obvious at first, but should fade with time and will often be hidden by your pubic hair. On darker skin, the scar tissue may fade to leave a brown or white mark.

Controlling pain and bleeding

Most women experience some discomfort for the first few days after a cesarean, and for some women the pain can last several weeks. You should make sure you have regular painkillers to take at home for as long as you need them, such as paracetamol or ibuprofen. Aspirin and the stronger painkiller codeine present in co-codamol is not usually recommended if you’re breastfeeding. Your doctor will be able to advise you on the most suitable painkiller for you to take. You may also have some vaginal bleeding. Use sanitary pads rather than tampons to reduce the risk of spreading infection into the vagina, and get medical advice if the bleeding is heavy.

Returning to your normal activities

Try to stay mobile and do gentle activities, such as going for a daily walk, while you’re recovering to reduce the risk of blood clots. Be careful not to overexert yourself. You should be able to hold and carry your baby once you get home. But you may not be able to do some activities straight away, such as:

  • driving
  • exercising
  • carrying anything heavier than your baby
  • having sex

Only start to do these things again when you feel able to do so and do not find them uncomfortable. This may not be for 6 weeks or so. Ask your midwife for advice if you’re unsure when it’s safe to start returning to your normal activities. You can also ask a GP at your 6-week postnatal check.

When to get medical advice

Contact your midwife or a GP straight away if you have any of the following symptoms after a cesarean:

  • severe pain
  • leaking urine
  • pain when peeing
  • heavy vaginal bleeding
  • your wound becomes more red, painful and swollen
  • a discharge of pus or foul-smelling fluid from your wound
  • a cough or shortness of breath
  • swelling or pain in your lower leg

These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible. A cesarean section is generally a very safe procedure, but like any type of surgery it does carry a risk of complications. The level of risk will depend on things such as whether the procedure is planned or carried out as an emergency, and your general health. If there’s time to plan your cesarean, your doctor or midwife will talk to you about the potential risks and benefits of the procedure.

 

A hysterectomy is a surgical procedure to remove the womb (uterus). You’ll no longer be able to get pregnant after the operation. If you have not already gone through the menopause, you’ll no longer have periods, regardless of your age. It’s more common for women aged 40 to 50.

Why do I need a hysterectomy?

Hysterectomies are carried out to treat health problems that affect the female reproductive system. These include:
  • heavy periods
  • long-term pelvic pain
  • non-cancerous tumours (fibroids)
  • ovarian cancer, womb cancer, cervical cancer or cancer of the fallopian tubes
A hysterectomy is a major operation with a long recovery time and is only considered after less invasive treatments have been tried.
Things to consider
If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to also have your cervix or ovaries removed. Your decision will usually be based on your personal feelings, medical history and any recommendations your doctor may have.

Types of hysterectomy

There are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place. The main types of hysterectomy are:
  • total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
  • subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place
  • total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy) are removed
  • radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue

There are 3 ways to carry out a hysterectomy:

  • laparoscopic hysterectomy (keyhole surgery) – where small cuts are made in the tummy and the womb is removed through a cut in the vagina
  • vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina
  • abdominal hysterectomy – where the womb is removed through a cut in the lower tummy

Complications of a hysterectomy

There’s a small risk of complications, including:
  • heavy bleeding
  • infection
  • damage to your bladder or bowel
  • a serious reaction to the general anaesthetic

Recovering from a hysterectomy

A hysterectomy is a major operation. You can be in hospital for up to 5 days after surgery, and it can take about 6 to 8 weeks to fully recover. Recovery times can also vary depending on the type of hysterectomy. Rest as much as possible during this time and do not lift anything heavy, such as bags of shopping. You need time for your abdominal muscles and tissues to heal.

Surgical menopause

If your ovaries are removed during a hysterectomy, you’ll go through the menopause immediately after the operation, regardless of your age. This is known as a surgical menopause. If 1 or both of your ovaries are left intact, there’s a chance you’ll have the menopause sooner than you would have if you did not have a hysterectomy. If you experience a surgical menopause after having a hysterectomy, you should be offered hormone replacement therapy (HRT).

Side effects

After having a hysterectomy, you may have some temporary side effects.

Bowel and bladder disturbances

After your operation, there may be some changes in your bowel and bladder functions when going to the toilet. Some women develop urinary tract infections or constipation. Both can easily be treated. It’s recommended that you drink plenty of fluids and increase the fruit and fibre in your diet to help with your bowel and bladder movements. For the first few bowel movements after a hysterectomy, you may need laxatives to help you avoid straining. Some people find it more comfortable to hold their abdomen to provide support while passing a stool.

Vaginal discharge

After a hysterectomy, you’ll experience some vaginal bleeding and discharge. This will be less discharge than during a period, but it may last up to 6 weeks. Visit your GP if you experience heavy vaginal bleeding, start passing blood clots or have a strong-smelling discharge.

Menopausal symptoms

If your ovaries are removed, you’ll usually experience severe menopausal symptoms after your operation.
These may include:
  • hot flushes
  • anxiety
  • weepiness
  • sweating
You may have hormone replacement therapy (HRT) after your operation. This can be given in the form of an implant, injections or tablets.
Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart.
According to the National Heart, Lung, and Blood Institute (NHLBI) Trusted Source, coronary artery bypass grafting (CABG) is the most common type of heart surgery done on adults. During this surgery, a healthy artery or vein is grafted (attached) to a blocked coronary artery. This allows the grafted artery to “bypass” the blocked artery and bring fresh blood to the heart.

When is open-heart surgery needed?

Open-heart surgery may be done to perform a CABG. A coronary artery bypass graft may be necessary for people with coronary heart disease.
Coronary heart disease occurs when the blood vessels that provide blood and oxygen to the heart muscle become narrow and hard. This is often called “hardening of the arteries.”
Hardening occurs when fatty material forms a plaque on the walls of the coronary arteries. This plaque narrows the arteries, making it difficult for blood to get through. When blood can’t flow properly to the heart, a heart attack may occur.
Open-heart surgery is also done to:
  • repair or replace heart valves, which allow blood to travel through the heart
  • repair damaged or abnormal areas of the heart
  • implant medical devices that help the heart beat properly
  • replace a damaged heart with a donated heart (heart transplantation)

How is open-heart surgery performed?

A  CABG takes from three to six hours. It’s generally done following these basic steps:
  • The patient is given general anesthesia. This ensures that they will be asleep and pain free through the whole surgery.
  • The surgeon makes an 8- to 10-inch cut in the chest.
  • The surgeon cuts through all or part of the patient’s breastbone to expose the heart.
  • Once the heart is visible, the patient may be connected to a heart-lung bypass machine. The machine moves blood away from the heart so that the surgeon can operate. Some newer procedures do not use this machine.
  • The surgeon uses a healthy vein or artery to make a new path around the blocked artery.
  • The surgeon closes the breastbone with wire, leaving the wire inside the body.
  • The original cut is stitched up.

What are the risks of open-heart surgery?

  • chest wound infection (more common in patients with obesity or diabetes, or those who’ve had a CABG before)
  • heart attack or stroke
  • irregular heart beat
  • lung or kidney failure
  • chest pain and low fever
  • memory loss or “fuzziness”
  • blood clot
  • blood loss
  • breathing difficulty
  • pneumonia

How to prepare for open-heart surgery

Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
It’s important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.

What happens after open-heart surgery?

When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart. You may have intravenous (IV) lines in your arm to supply you with fluids, as well as a catheter (thin tube) in your bladder to remove urine.
You will also be attached to machines that monitor your heart. Nurses will be nearby to help you if something should arise.
You will usually spend your first night in the intensive care unit (ICU). You will then be moved to a regular care room for the next three to seven days.

Recovery, follow-up, and what to expect

Taking care of yourself at home immediately after the surgery is an essential part of your recovery.

Incision care

Incision care is extremely important. Keep your incision site warm and dry, and wash your hands before and after touching it. If your incision is healing properly and there is no drainage, you can take a shower. The shower shouldn’t be more than 10 minutes with warm (not hot) water. You should ensure that the incision site isn’t hit directly by the water. It’s also important to regularly inspect your incision sites for signs of infection, which include:
  • increased drainage, oozing, or opening from the incision site
  • redness around the incision
  • warmth along the incision line
  • fever

Pain management

Pain management is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia. You may feel muscle pain, throat pain, pain at incision sites, or pain from chest tubes. Your doctor will likely prescribe pain medication that you can take at home. It’s important that you take it as prescribed. Some doctors recommend taking the pain medication both before physical activity and before you sleep.

Get enough sleep

Some patients experience trouble sleeping after open-heart surgery, but it’s important to get as much rest as possible. To get better sleep, you can:
  • take your pain medication a half hour before bed
  • arrange pillows to decrease muscle strain
  • avoid caffeine, especially in the evenings
In the past, some have argued that open-heart surgery leads to a decline in mental functioning. However, most recent research has found that not to be the case. Though some patients may have open-heart surgery and experience mental decline later on, it’s thought that this is most likely due to the natural effects of aging.
Some people do experience depression or anxiety after open-heart surgery. A therapist or psychologist can help you manage these effects.

Rehabilitation

Most people who’ve had a CABG benefit from participating in a structured, comprehensive rehabilitation program. This is usually done outpatient with visits several times a week. The components to the program include exercise, reducing risk factors, and dealing with stress, anxiety, and depression.

Long-term outlook for open-heart surgery

Expect a gradual recovery. It may take up to six weeks before you start feeling better, and up to six months to feel the full benefits of the surgery. However, the outlook is good for many people, and the grafts can work for many years.
Nevertheless, surgery does not prevent artery blockage from happening again. You can help improve your heart health by:
  • eating a healthy diet
  • cutting back on foods high in salt, fat, and sugar
  • leading a more active lifestyle
  • not smoking
  • controlling high blood pressure and high cholesterol

 

Source: www.healthline.com

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

The PCL and ACL are intracapsular ligaments because they lie deep within the knee joint. They are both isolated from the fluid-filled synovial cavity, with the synovial membrane wrapped around them. The PCL gets its name by attaching to the posterior portion of the tibia.

The PCL, ACL, MCL, and LCL are the four main ligaments of the knee in primates.

Structure

The PCL is located within the knee joint where it stabilizes the articulating bones, particularly the femur and the tibia, during movement. It originates from the lateral edge of the medial femoral condyle and the roof of the intercondyle notch then stretches, at a posterior and lateral angle, toward the posterior of the tibia just below its articular surface.

In this medial view of the extended knee, the lateral femoral condyle has been removed to reveal the structure of the PCL. Because the posteromedial bundle is stretched and the anterolateral bundle relaxed during extension, excessive extension in the form of hyperextension causes tensile stress on the posteromedial bundle of the PCL that leads to PCL injury.

Function

Although each PCL is a unified unit, they are described as separate anterolateral and posteromedial sections based on where each section’s attachment site and function. During knee joint movement, the PCL rotates such that the anterolateral section stretches in knee flexion but not in knee extension and the posteromedial bundle stretches in extension rather than flexion.

The function of the PCL is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. The posterior cruciate ligament is located within the knee. Ligaments are sturdy bands of tissues that connect bones. Similar to the anterior cruciate ligament, the PCL connects the femur to the tibia.

Clinical significance

Posterior cruciate ligament injury

There are four different grades of classification in which medical doctors classify a PCL injury:

Grade I, the PCL has a slight tear.

Grade II, the PCL ligament is minimally torn and becomes loose.

Grade III, the PCL is torn completely and the knee can now be categorized as unstable.

Grade IV, the ligament is damaged along with another ligament housed in the knee (i.e. ACL).

With these grades of PCL injuries, there are different treatments available for such injuries

The posterior cruciate ligament is located within the knee.

Mechanism

In this medial view of the flexed knee, the lateral femoral condyle has been removed to reveal the structure of the PCL. Because the anterolateral bundle is stretched and the posteromedial bundle relaxed during flexion, excessive flexion in the form of hyperflexion causes tensile stress, shown in red, on the anterolateral bundle of the ACL that leads to ACL injury.

In this position, the PCL functions to prevent movement of the tibia in the posterior direction and to prevent the tilting or shifting of the patella. However, the respective laxity of the two sections makes the PCL susceptible to injury during hyperflexion, hyperextension, and in a mechanism known as a dashboard injury. Because ligaments are viscoelastic they can handle higher amounts of stress only when the load is increased slowly. When hyperflexion and hyperextension occur suddenly in combination with this viscoelastic behavior, the PCL deforms or tears. In the third and most common mechanism, the dashboard injury mechanism, the knee experiences impact in a posterior direction during knee flexion toward the space above the tibia. These mechanisms occur in excessive external tibial rotation and during falls that induce a combination of extension and adduction of the tibia, which is referred to as varus-extension stress, or that occur while the knee is flexed.

Treatment

It is possible for the PCL to heal on its own. Even if the PCL does not heal normally, it is unusual for surgery to be required. Treatment is usually physiotherapy to strengthen the muscles around the knee; usually they provide adequate stability even without a functional PCL. Only if there are ongoing symptoms down the track, or if there are other injuries in the knee (e.g. posterolateral corner injury) will ligament reconstruction be required. Ligament reconstruction is used to replace the torn PCL with a new ligament, which is usually a graft taken from the hamstring or Achilles tendon from a host cadaver. An arthroscope allows a complete evaluation of the entire knee joint, including the knee cap (patella), the cartilage surfaces, the meniscus, the ligaments (ACL & PCL), and the joint lining. Then, the new ligament is attached to the bone of the thigh and lower leg with screws to hold it in place. Surgery to repair the posterior cruciate ligament is controversial due to its placement and technical difficulty.

It is possible for the PCL to heal on its own without surgery when it is a Grade I or Grade II injury. PCL injuries that are diagnosed in these categories can have their recovery times reduced by performing certain rehabilitative exercises.

A vaginal delivery is the birth of offspring in mammals (babies in humans) through the vagina (also called the “birth canal”). It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower morbidity and mortality than Caesarean sections.

Benefits of vaginal delivery

Mother

Benefits for the mother include:
  • Avoiding surgery and resulting quicker recovery time and shorter hospital admission.
  • Quicker onset of lactation.
  • Decreased complications in future pregnancies, including placenta previa.

Infant

 
Benefits for the infant include:
  • Develop microbiota from exposure to the bacteria from the mother’s vagina, while the microbiota of babies born by caesarean section have more bacteria associated with hospital environments.
  • Decreased infant respiratory conditions, including infant respiratory distress syndrome, transient tachypnea of the newborn, and respiratory-related NICU admissions.
  • Improved immune function, possibly due to the infant’s exposure to normal vaginal and gut bacteria during vaginal birth.

Types of vaginal delivery

Different types of vaginal deliveries have different terms:
  • A spontaneous vaginal delivery (SVD) occurs when a pregnant woman goes into labor without the use of drugs or techniques to induce labor and delivers their baby without forceps, vacuum extraction, or a cesarean section.
  • An induced vaginal delivery is a delivery involving labor induction, where drugs or manual techniques are used to initiate labor. Vaginal delivery can be either spontaneous or induced.
  • An assisted vaginal delivery (AVD) or instrumental vaginal delivery occurs when a pregnant woman requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally. It is usually performed when the pregnancy does not progress during the second stage of labor. If the goal is to avoid the adverse effects of pushing that a cardiac patient may experience, it may also be performed in this case. Both spontaneous and induced vaginal delivery can be assisted. Examples of instruments to assist delivery include obstretical forcepts and vacuum extraction with a vacuum cup device.
A normal vaginal delivery (NVD) is defined as any vaginal delivery, assisted or unassisted.

Stages of labor

Labor is characterized by uterine contractions which push the fetus through the birth canal and results in delivery. Labor is divided into three stages.
  1. First stage of labor starts with the onset of contractions and finishes when the cervix is fully dilated at 10 cm. This stage can further be divided into latent and active labor. The latent phase is defined by cervical dilation of 0 to 6 cm. The active phase is defined by cervical dilation of 6 cm to 10 cm.
  2. Second stage of labor starts when the cervix is dilated to 10 cm and finishes with the birth of the fetus. This is stage is characterized by strong contractions and active pushing by the mother. It can last from 20 minutes to 2 hours.
  3. Third stage of labor starts after the birth of the fetus and is finished when the placenta is delivered. It can last from 5 to 30 minutes.

Risks and complications of vaginal delivery

Complications of vaginal delivery can be grouped into the following criteria; failure to progress, abnormal fetal heart rate tracing, intrapartum hemorrhage, and post-partum hemorrhage.
Failure to progress occurs when the labor process slows or stops entirely, indicated by slowed cervical dilation. Factors that place a woman’s pregnancy at higher risk include advanced maternal age, Premature Rupture of Membranes (PROM) and induction of labor. Oxytocin, an uterotonic agent, can be administered to augment labor. Cesarean section is also commonly considered when the pregnancy fails to progress.