Prática de Shadowing: A pediatric cerebrovascular approach: techniques and challenges - Aprenda a falar inglês com o YouTube
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practice is unique in the fact that I do about 90 percent,
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85 percent of what I do is all children.
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children with vascular malformations, both of the brain and the neck, maxillofacial areas.
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We receive them from newborn actually to 19, 18 years of age.
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We do of course also adults with vascular malformations,
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but as things are evolving and you can see how fantastic this course is and the tremendous progress that has exist.
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So children are not small adults and that has happened throughout medicine.
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There was the general doctor first,
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then became pediatricians, which was obviously that required different things.
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So within the vascular lesions of the human body,
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there's a certain amount of diseases that occur in children primarily,
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and that affect children sometimes exclusively.
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So, based on my practice,
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I have dedicated myself to improve the treatment in those children,
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decrease the radiation, decrease the time of the procedure,
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being very meticulous with the technique, very meticulous with fluids.
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For small children that are in severe heart problems with brain problems,
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if you use the same techniques in adults,
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you actually could have a lot of harm.
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So there are dedicated, specific problems that occur in children.
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There are specific, dedicated challenges,
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technical, medical, physiological, that are specific for children.
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And there's even difference between children and newborns.
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We have newborns that are born in severe heart failure with a disease called vein of gallant malformation
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that even treated is lethal within the first year of life.
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So those children require techniques,
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for example, we develop techniques to go through the umbilical artery.
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So we can actually place a cathode from the umbilical artery to enter the body,
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to then navigate into the brain.
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In this pediatric population, the diseases are rare,
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so it's very hard to do really trials.
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We're more involved in developing devices,
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actually because coming from children,
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they can be translated towards adults.
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We also have a lot of patients,
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or practices, patients of rare diseases,
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such as vascular malformation of the maxillofacial area.
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very difficult to treat.
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So we have developed techniques like direct percutaneous puncture.
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Instead of going from the femoral artery and trying to catheterize them,
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it's to actually use 3D angiography or the eye guide
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or the different types of technologies that have been developed for adults
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and try to use them to place catheters or needles directly into the malformation.
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And that has changed the whole ballgame.
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We also involve trying to develop things which are called sclerotherapy.
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Sclerotherapy is a technique in which you inject something that will damage the endothelium.
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And then the healing of that scarring,
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that will produce scarring, will actually sclerose or thrombose or close and scar those vascular malformations that they cannot feel.
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And that includes venous malformation.
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That includes lymphatic malformations.
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That includes arteriovenous malformation.
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And we're using biological substances such as chemotherapeutic agents, bleomycin for example.
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And they've made a tremendous change in the outcome of this patient.
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Actually, we're trying to use more and more ultrasound to guide ourselves to do these procedures.
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Also, within the medical industry of x-rays,
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we're forcing the manufacturers to create things like last image hold.
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And then with that last image hold,
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will, for example, collimate, try to center memories so that we don't have to radiate these children.
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Mothers come to me and ask me that,
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will my child have a stroke while you're doing this horrible malformation?
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They ask me how much radiation are they gonna get?
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Or the anesthesia?
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Well, there is a potential role for endovascular radiosurgery.
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I worked like 15, 20 years ago to try to treat vascular malformations that way.
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But radiation is a difficult thing to control.
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It's a difficult thing to prove,
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a difficult thing to get approved through a regulatory pathway like the Food and Drug Administration and so on.
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And dangerous for everyone, including you as an operator.
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Everything is dangerous if it's improperly used.
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You know, if you have a genie and you let the genie out of the box and there's no control,
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it can be very, very dangerous.
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So I would say that radiation has a potential,
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but it is not something that is around the corner.
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The tools that we have today are pretty much adaptation of adults to children.
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So we're still at the beginning.
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We're very much interested in developing tools that are designed for newborns and for children,
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which today do not exist.
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So we take a catheter that is a meter and a half,
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because it's the only catheter that we have.
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The technology exists, but the market is so small
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that industry is not very interested in developing high technology for a very small market.
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And this is not simply the question of smaller arteries.
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It's a whole question of a different anatomy that you're dealing with.
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It's a different anatomy.
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It's a different technology necessary for the stiffness, for example.
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You know, the blood vessels in children are more fragile in a sense.
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But on the other hand, they're more elastic.
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So they have their own specific problems,
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both technically as well as physiological.
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One of the biggest questions that we have is if we take a device,
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for example a stent, that is developed for adults which have stopped growing and we put them in small children,
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what would happen to those vessels as we increase in size?
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And therefore, personally, we have a lot of skepticism of using stents unless we are really forced.
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And the other side of the coin is we're going to press
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and push industry to develop bioactive or biodegradable devices so that
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if I put a stent in a little child and that stent will then be reabsorbed,
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it will permit then the normal physiologic growth.
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Biodegradable, bioabsorbable, biocompatible.
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It's one of the great, great, great potential expansion.
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If we can develop it for children,
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it can then be transferred to adults.
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What is interesting is that we've done very small devices based on trying to do it for pediatrics,
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and those have translated to go to the adult,
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which permits you to go to more distal circulation.
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I think that's very valuable for the training of physicians.
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You know, when I started,
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it was see one, do one,
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teach one, that no longer applies.
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We're not, it's just so much better to train,
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and I'm very involved in the training of physicians,
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training physicians in a in vitro model.
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You know, get all, I mean,
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you actually today, the reproduction is, Dr. Moret, so fantastic.
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You know, it's literally like the real thing.
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But then you get the physician to learn.
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You get the physician to train,
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you get the physician to try,
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you get the physician to make the mistake in a model.
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By the time you transfer that to the real patient,
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you have a much better trained physician.
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And I think industry is now more and more turning to these models.
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And the regulatory agencies are saying,
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wait a second, you not only have to go and train in a model first.
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You know, it used to be sometimes an animal.
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Then, you know, as you know,
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there's a lot of movement against training in animals.
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So these things have replaced a lot of the training.
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The regulatory agencies will force us to train physicians in this type of models that are now readily available.
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3D printing can make exactly the same aneurysm immediately, right away.
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And not only that, I can make 20 of those,
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or 50, or 100 to train physicians.
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So that I do believe that following that comes the proctoring.
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In other words, now you're going to go,
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this individual who's trained in the model is going to go do humans.
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So when you go humans,
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you go with somebody experience,
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the fracture you, I think that is absolutely the way to go.
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Nesta lição, os alunos praticarão a conversação em inglês focando em contextos médicos, especificamente na abordagem pediátrica de lesões vasculares. Através deste vídeo, você terá a oportunidade de aprender como médicos abordam o tratamento de crianças com malformações vasculares, o que exigirá não apenas vocabulário técnico, mas também uma compreensão das nuances envolvidas em procedimentos delicados. Essa prática ajudará você a expandir seu léxico em situações médicas, aprimorando sua fluência e capacidade de comunicação em inglês.
Vocabulário e Frases-Chave
- vascular malformations - malformações vasculares
- pediatric approach - abordagem pediátrica
- techniques - técnicas
- sclerotherapy - escleroterapia
- umbilical artery - artéria umbilical
- heart problems - problemas cardíacos
- rare diseases - doenças raras
- catheterization - cateterização
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Para aproveitar ao máximo este vídeo e melhorar sua prática de conversação em inglês, sugerimos a técnica de shadowing em inglês. Isso significa que você deve assistir ao vídeo e, em seguida, repetir em voz alta o que ouve, imitando o tom e a velocidade do falante. Lembre-se de que, devido ao conteúdo técnico, a taxa de fala pode ser um pouco mais lenta. Portanto, comece a praticar algumas partes mais curtas antes de tentar acompanhar o discurso completo. Além disso, ouça atentamente as inflexões e a pronúncia das palavras-chave. Utilize um dicionário para entender completamente os termos complexos e, se necessário, pause o vídeo para repetir trechos que você achar desafiadores. Incorporar essa prática de shadow speech com vídeos do YouTube é uma excelente maneira de aprender inglês com YouTube e se familiarizar com o vocabulário específico.
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