Shadowing-Übung: Embolization of AV Malformations: Tips and Tricks - Englisch Sprechen Lernen mit YouTube
C2
Hi.
186 Sätze
Wenn Sätze zu kurz oder zu lang sind, klicke auf Edit, um sie anzupassen.
1
Hi.
2
I'd like to thank the organizers for inviting me here today.
3
So this is going to be a pretty quick review as well because it's kind of a complex topic.
4
So I'm going to focus mainly on the technical part of embolization procedures.
5
These are disclosures.
6
And so the AVM, as we all know,
7
are abnormal connections between arteries and veins.
8
Typically with the intervening nidus or collection of abnormal vessels with feeding arteries and draining veins.
9
They can be divided into different types,
10
the top being more fistulist-type connections,
11
which are a direct artery into a venous sac
12
and then going down to multiple arteries coming into a nidus and then an outflowing vein.
13
And these have been related to different genetic diseases,
14
such as hemorrhagic hereditary telangiectasia 1 and 2, capillary malformation AVM syndrome.
15
Then they—these do have genes associated with them,
16
but most AVMs are actually sporadic.
17
And then in, I am a neurointerventionalist,
18
so we divide our AVMs into many different types.
19
I'm not going to go over it very laboriously,
20
but depending on where it's located,
21
so in the cerebral matter itself,
22
peel malformations are ranging from nidal-type malformations to fistulas,
23
which occur mainly in pediatrics.
24
and galen malformations occur mainly in newborns.
25
And then there are malformations that are more fistulas
26
and acquired later in life that occur in the dura or lining of the brain.
27
And this can be found in the carotid cavernous region where you can also find direct fistulas from trauma.
28
And then there's a whole organization for spinal AVMs as well.
29
And so how, you know,
30
to get to the embolization part,
31
how do we close these malformations?
32
The focus and the goal really is to treat the nidus in the case of nidal aneurysms
33
and close this connection as well as in the fistula's connection,
34
the focus is really to get to the proximal part of the vein that's receiving the arteries and close that.
35
are sometimes used in these cases,
36
but actually less so because you really can only get to these medium-sized arteries or smaller,
37
even tinier arteries with coils,
38
so you can't really get good penetration into the nidus itself.
39
There have been use of sclerosing agents,
40
so taking a micro catheter sorry into a feeding artery injecting ethanol 100% ethanol to kind of burn the malformation
41
and and destroy it in that way but the more common uses liquid agents
42
and that can be there are really two
43
that are in use in the US right now there's NBC a which is a cyanoacrylate and then there's onyx
44
which is a polymer, and I'll go into those.
45
And then there's some neuroagents in development,
46
and these can be placed into the nidus or into the vein via a transarterial or a transvenous approach.
47
NBCA is closely related to crazy glue.
48
It's an adhesive, so it sticks to the arteries.
49
And the goals, as with any embolization of AVM,
50
is good penetration into the nidus.
51
And with NBCA, it is,
52
once it contacts the blood, it polymerizes very quickly.
53
And so you want to prevent proximal reflux along the catheter,
54
as prolonged contact with the catheter will cause adhesion to it.
55
And you can have a retained catheter or vessel injury when you try to pull it out.
56
Onyx was developed and approved by the FDA in the 1990s and actually in the mid-2000s.
57
And this is a copolymer of ethylene vinyl alcohol.
58
It's dissolved in a solvent, DMSO.
59
And then there's suspended micronized tantalum powder in it to achieve radio radio opacity,
60
so it needs to be shaken right before you inject it or else all the tantalum will settle out of it.
61
And then the traditional method of injecting onyx is to inject,
62
and it looks like this dark color because of the tantalum within it,
63
so you inject little bits along the tip of the microcatheter until you fill the proximal artery here,
64
refluxing a little bit along the catheter.
65
And then as soon as you create,
66
the goal of that is to create a plug within the proximal artery at the location of the tip of the catheter.
67
And then once you create that plug,
68
when you inject, it's going to go forward and penetrate into the nidus.
69
So like I said, a proximal plug is used,
70
and the catheter needs to be removed from the embolic cast at the end of the embolization.
71
So even though Onyx is not adhesive,
72
it can be, if you reflux too much along the catheter,
73
this can lead to a retained microcatheter as well,
74
just because of friction in trying to remove it.
75
And if you then pull too hard,
76
this can lead to rupture and hemorrhage.
77
So the tips and tricks,
78
I'm really just going to talk about a few newer techniques that we're using in the last few years.
79
And one of them is,
80
and it has to do with newer technology that's coming out.
81
So one is the use of the detachable tip microcatheter,
82
which is called the Apollo microcatheter.
83
And it's a single lumen catheter.
84
It has a tip that's actually held into a shaft here by pressure, by friction.
85
And this allows for a force being required to actually separate the two.
86
So it's less than a third of the force that you would need to actually break any other part of the catheter.
87
So it's thought that it's a more gentle force of retrieving the catheter.
88
And you basically just pull slowly and stretch and stretch until it detaches or the whole thing pulls out of the onyx.
89
And this catheter comes with two tips.
90
So this is the distal tip,
91
the proximal marker here is where the detachment zone is.
92
So you can't, if you're injecting and you reflux all the way to this point,
93
you have to stop because you're going to then glue that detachment zone in place.
94
And this is an example of a vertebral peel fistula.
95
So this is an AP view and a lateral view,
96
the vertebral artery in the neck,
97
and this fistula's connection to posterior fossa vein.
98
And this is a navigation of the Apollo catheter to the fistula.
99
You could see it in place,
100
the distal marker and the proximal marker.
101
And there you see an injection of NBCA.
102
So this catheter can be used with both NBCA and ONIX.
103
And in this case, it looks like the catheter was completely removed without detaching.
104
So then in a second injection,
105
another Apollo catheter was brought up to a second fistula site.
106
And there's some injection of contrast showing the direct connection to the vein.
107
And this is a video here.
108
And this is high concentration of NBCA.
109
So this really, if you were using any standard microcatheter,
110
you would not keep it there that long because you'd be afraid of actually polymerizing and gluing the catheter in place.
111
But because now that we have the detachable tip,
112
we're more comfortable trying to get good penetration with NBCA.
113
And so that's the injection.
114
You can see more NBCA filling into the venous side of the fistula,
115
and then pull and out.
116
And then you can see kind of tiny here,
117
but that's the distal tip, and that's the catheter.
118
So it's actually detached, and the distal tip of it is left in place.
119
So the advantages with Onyx,
120
you make reflux purposefully to create a plug,
121
so you know how much you can reflux.
122
And with the NBCA, you have a controlled injection instead of trying to inject quickly and then pull it out.
123
So this allows for better penetration.
124
And then it requires less pressure to remove the catheter,
125
so less chance of injuring.
126
The disadvantage, it is a bit stiffer at the detachment zone,
127
so the connection between the tip and the proximal microcatheter
128
compared with the rest of the microcatheter and with some other softer microcatheters that we may use.
129
And then we've had now two cases where on navigating the catheter without attempting to detach the tip,
130
it's inadvertently detached in a proximal artery.
131
So that's something that that if you're navigating in torturous anatomy, it can happen.
132
And that's the tip.
133
So the other thing that's come about is the development of DMSO compatible balloon microcatheters.
134
So these are the SEPTR balloons.
135
And it's just, it's a dual lumen catheter.
136
So you have a lumen that you can inject onyx or glue or coils,
137
whatever you want, whatever you're doing,
138
and then a second port to inflate this balloon.
139
And then this is a case,
140
so this really allows for a really good penetration without having to worry about reflux or make a plug.
141
So So this is a case of a maxillary arteriovenous malformation.
142
This is the internal maxillary, the patient's maxilla.
143
And you see this abnormal AVM, capillary-type AVM right here.
144
And then this is the balloon catheter in place.
145
So it's in this branch here.
146
And this is the inflation of the balloon.
147
So you create a plug just by inflating the balloon.
148
It's very quick.
149
And then you can achieve great penetration into the entire AVM.
150
This required injection into a couple different feeders,
151
but by using this technique,
152
I was able to completely treat.
153
And at the end of this treatment,
154
there was no remaining shunting.
155
The important thing when you're using Onyx is you have to be able to recognize abnormal and normal and know your,
156
especially in the head and neck,
157
you have to know where you're located.
158
Avoid any abnormal connections to the internal carotid circulation
159
or any normal connections that you might not see
160
but you know are there because the onyx with this technique can penetrate into small collaterals that are otherwise closed.
161
And then just as This is a last example.
162
This is a 42-year-old man with headaches and tinnitus,
163
and he got this MRA,
164
which shows this markedly abnormal enlarged vessels on the left side of his head from external and as well internal circulation,
165
and all going into the left transverse sinus.
166
This is a typical dural arteriovenous fistula, and usually acquired.
167
This is the MRA showing that fistula.
168
You see some external carotid artery,
169
occipital branches, middle meningeal branches,
170
and then on angiography marked dilatation of these branches.
171
And really on the CAT scan,
172
we can see that they really all come down to this connection right here into the transverse sinus,
173
or so we thought.
174
However, when we closed that off,
175
we realized that the fistulas were coming to multiple locations along that sinus.
176
And this is one disadvantage of ONIX.
177
So after you have to close such a complex malformation with multiple vessels,
178
you're left with this sort of picture in which you can't really see anything afterwards.
179
So that leads to my last point,
180
which is the development of this new liquid embolic called Phil,
181
which is currently approved in Europe.
182
And this is going to be,
183
it's going to have iodine attached to the copolymer.
184
And so therefore that should absorb and it will be less radio-opaque when you come back for later treatments.
185
And that's it.
186
Thank you for your attention.
App herunterladen
KI-Bewertung für jeden gesprochenen Satz
TRENDING
Beliebt
Kontext & Hintergrund
In dem Video „Embolisation von AV-Malformationen: Tipps und Tricks“ spricht der Referent über komplexe medizinische Verfahren zur Behandlung von arteriovenösen Malformationen (AVMs). Diese pathologischen Verbindungen zwischen Arterien und Venen können schwerwiegende gesundheitliche Probleme verursachen. Der Referent, ein Neurointerventionalist, gibt technischen Einblick in die Embolisationstechniken, die zur Schließung dieser Malformationen eingesetzt werden. Für Englischlernende bietet dieser Vortrag nicht nur medizinisches Wissen, sondern auch wertvolle Beispiele für die englische Sprache und Fachterminologie.
Top 5 Phrasen für die tägliche Kommunikation
- „These are disclosures.“ – Diese Aussage zeigt, wie wichtig Transparenz in der medizinischen Praxis ist.
- „The focus and the goal really is to treat the nidus.“ – Hier wird die Zielsetzung in der Behandlung deutlich.
- „How do we close these malformations?“ – Diese Frage regt zum Nachdenken über Problemlösungen an.
- „We can find direct fistulas from trauma.“ – Dies veranschaulicht den Zusammenhang zwischen Trauma und AVMs.
- „The goals are good penetration into the nidus.“ – Eine anschauliche Beschreibung des Embolisationprozesses.
Schritt-für-Schritt Shadowing-Anleitung
Um die englische Aussprache zu verbessern und den Inhalt des Videos besser zu verstehen, können Sie folgende Schritte befolgen:
- Schritt 1: Hören Sie aktiv zu. – Sehen Sie sich das Video mehrmals an und versuchen Sie, den Inhalt im Kontext zu verstehen. Achten Sie besonders auf die medizinischen Begriffe und Phrasen.
- Schritt 2: Nutzen Sie das Englisch Shadowing. – Sprechen Sie die Sätze laut nach. Wiederholen Sie dabei sowohl kurze als auch lange Phrasen, um Ihre mündliche Ausdrucksweise zu verbessern. Versuchen Sie, den Rhythmus und die Intonation des Sprechers nachzuahmen.
- Schritt 3: Wiederholung und Variation. – Üben Sie die ausgewählten Phrasen mehrmals mit Variationen oder in unterschiedlichen Satzstrukturen. Dies hilft dabei, sicherer zu werden, wenn Sie Englisch sprechen üben.
- Schritt 4: Notieren Sie sich neue Wörter. – Schreiben Sie unbekannte Wörter oder medizinische Begriffe auf, die Ihnen während des Shadowings begegnen, und suchen Sie deren Bedeutung nach. Versuchen Sie, diese neuen Vokabeln in Ihren aktiven Wortschatz zu integrieren.
- Schritt 5: Erstellen Sie eigene Sätze. – Kreieren Sie eigene Sätze mit den gelernten Phrasen. Dies fördert Ihr kreatives Denken und hilft Ihnen, das Gelernte anzuwenden.
Durch das Üben mit Videos wie diesem, in Kombination mit Englisch lernen mit YouTube, können Sie nicht nur medizinisches Wissen erwerben, sondern auch Ihre Englischkenntnisse effektiv verbessern. Nutzen Sie diese Gelegenheiten, um Ihre Sprachfähigkeiten kontinuierlich zu erweitern!
Was ist die Shadowing-Technik?
Shadowing ist eine wissenschaftlich fundierte Sprachlerntechnik, die ursprünglich für die professionelle Dolmetscherausbildung entwickelt und durch den Polyglotten Dr. Alexander Arguelles populär gemacht wurde. Die Methode ist einfach aber wirkungsvoll: Du hörst englisches Audio von Muttersprachlern und wiederholst es sofort laut — wie ein Schatten, der dem Sprecher mit nur 1–2 Sekunden Verzögerung folgt. Anders als passives Hören oder Grammatikübungen zwingt Shadowing dein Gehirn und deine Mundmuskulatur, gleichzeitig echte Sprachmuster zu verarbeiten und zu reproduzieren. Studien zeigen, dass es Aussprachegenauigkeit, Intonation, Rhythmus, verbundene Sprache, Hörverständnis und Sprechflüssigkeit signifikant verbessert — was es zu einer der effektivsten Methoden für die IELTS Speaking-Vorbereitung und reale englische Kommunikation macht.
☕ Kauf uns einen Kaffee
ShadowingEnglish bleibt 100% kostenlos dank deiner Unterstützung. Server- und KI-Kosten sind hoch — dein Kaffee hält uns am Laufen! 🙏