This document discusses elective neurosurgery, specifically related to raised intracranial pressure and hydrocephalus. It begins by defining normal intracranial pressure and the Monroe-Kellie hypothesis. It then describes the causes, signs, symptoms and treatments of raised intracranial pressure, including medical options like mannitol and surgical options like craniotomy. The document also discusses the physiology of cerebrospinal fluid, the pathophysiology and types of hydrocephalus, investigations for hydrocephalus, and treatments like ventriculoperitoneal shunting, external drains, and endoscopic third ventriculostomy. Complications of treatments are also outlined.
Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial
It is a presentation on anticoagulants and antiplatelets in anesthesia , starting from basis of coagulation , its tests and dugs and anesthetic implications
Based on latest ASRA (AMERICAN SOCIETY OF REGIONAL ANESTHESIA GUIDELINES)
Anticoagulants, antiplatelet drugs and anesthesiaRajesh Munigial
It is a presentation on anticoagulants and antiplatelets in anesthesia , starting from basis of coagulation , its tests and dugs and anesthetic implications
Based on latest ASRA (AMERICAN SOCIETY OF REGIONAL ANESTHESIA GUIDELINES)
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
CLINICAL CONSIDERATIONSNoncommunicating (obstructive) hydrocephalus occurs more frequentlyCSF of ventricles unable to reach subarachnoid spaceProduction of CSF continuesGyri are flattened against inside of skullIf skull is still pliable head may enlarge
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Objectives
To understand and know:
The physiology of CSF production and
understand the sign and symptoms of raised ICP
The pathophysiology of hydrocephalus and its
treatment
3. Intracranial Pressure
Intracranial pressure is the pressure inside the skull and
thus in the brain tissue and cerebrospinal fluid.
Normal ICP varies from 5 to 15 mmHg in the adult at rest.
ICP varies with venous pressure and is thus affected by
factors such as gravitational drainage an manoeuvres that
raise intrathoracic pressure .
Normal values in small children and infants are lower
than for adults.
4. Raised intracranial pressure
Results in reduced cerebral perfusion and
brain herniation
The major causes of raised ICP are
haematomas, tumours and hydrocephalus
5. Pathophysiology Of Raised ICP
The Monroe Kellie Hypothesis: It is the pressure volume
relationship between ICP, volume of CSF, brain tissue and
Cerebral Perfusion Pressure.
The hypothesis states that cranium is incompressible and
the volume inside the cranium is fixed.
The addition of a new mass lesion can initially be
compensated for by the egress of CSF and venous blood
from the skull. During this compensation phase, there is
only a small increase in ICP.
When compensation is maximal, there is then a rapid rise
in ICP. This increased pressure causes compression and
herniation of the brain
6. Raised ICP and Cerebrovascular Physiology
The brain does not store much energy and is
unable to utilise anaerobic metabolism.
Cerebral Perfusion Pressure=MAP – ICP
In normal circumstances, cerebral blood flow is
maintained at a constant rate despite fluctuations
in mean arterial pressure (MAP) of between 50 and
150 mmHg via mechanisms termed cerebral
autoregulation.
In the injured brain, cerebral autoregulation may
be impaired either locally or globally.
7. Cerebral Herniation
Sub-falcine herniation refers to shift of the cingulate gyrus of
one hemisphere under the falx cerebri .
Uncal herniation refers to shift of the medial temporal lobe
(uncus) medially towards the tentorial hiatus.
Tentorial herniation refers to a downwards shift of midbrain
structures through the tentorial hiatus. Tonsillar herniation
refers to a downwards shift of the cerebellar tonsils and
medulla through the foramen magnum. This type of
herniation is associated with death.
14. Treatment Of Raised ICP
Appropriate treatment depends on identifying the cause.
Medical
i) Mannitol : osmotic diuretic
ii) High-dose steroids. Steroids reduce the permeability of the blood–
brain barrier.
iii) carbonic anhydrase inhibitor such as Acetazolamide.
Surgical
i) Craniotomy: in trauma, acute extradural
and subdural haematomas, intracerebral contusions and chronic
subdural haematomas.
ii) Occasionally, surgical control of ICP will involve a large
bony decompression (craniectomy), such as in traumatic brain
injury or extensive middle cerebral artery (MCA) infarction
15. Hydrocephalus
Hydrocephalus is a condition in which there is
disequilibrium between CSF production and
absorption, leading to raised ICP, and is often
associated with dilated ventricles.
Not all patients with ventriculomegaly have
hydrocephalus and not all patients with
hydrocephalus necessarily have enlarged
ventricles.
It can be Obstructive or comunicating.
16. Cerebrospinal Fluid Physiology
The total CSF volume in an adult is about 150 ml.
CSF production occurs at a rate of approximately 0.33 ml per min
or 450 ml per day, resulting in a turnover of three volumes per day.
CSF production is primarily by the choroid plexus of the ventricles
and is an active process independent of ICP.
CSF flows from the lateral ventricles, through the foramen of
Munro, into the third ventricle and then into the cerebral aqueduct
and fourth ventricle before exiting into the subarachnoid space via
the midline foramen of Magendie and lateral foramina of Lushka.
CSF absorption is a pressure-dependent passive process involving
filtration across the arachnoid villi, which are abundant along the
superior sagittal sinus into which the CSF is absorbed.
23. Investigations
Lumbar puncture is contraindicated in obstructive hydrocephalus
because of the risk of causing tonsillar herniation and death.
Ventricular size can be assessed with a computerised tomography
(CT) scan of the brain. The ventricles may be enlarged as a result of
generalised cerebral atrophy or localised neuronal cell loss (ex vacuo
dilatation) as well as by hydrocephalus.
In children, chronic raised ICP can result in copperbeating of the
skull.
A magnetic resonance imaging (MRI) scan of the brain can provide
better anatomical detail of lesions causing hydrocephalus and is
particularly useful in the diagnosis of aqueduct stenosis.
24. Investigations
ICP monitoring with a parenchymal probe placed into the
frontal lobe via a twist drill burrhole is a useful diagnostic
tool for patients in whom hydrocephalus or CSF shunt
dysfunction is suspected.
In communicating hydrocephalus, a lumbar puncture may
be both diagnostic, by measurement of opening pressure,
and therapeutic, by draining a volume of CSF that allows
the closing pressure to be within normal limits.
In the diagnosis of normal pressure hydrocephalus, other
diagnostic procedures include the CSF tap test and CSF
infusion studies.
25. Management
Management of hydrocephalus will depend on
the underlying cause. Options include
Removing a causative mass lesion
Ventricular shunting or third ventriculostomy.
Removing a causative mass lesion
26. External Drains
External drains can be placed within the
ventricle (EVD) or the lumbar thecal sac
(lumbar drain).
These are useful for temporary CSF drainage
and can be used to administer intrathecal
antibiotics to treat CSF infection.
27. Removing Causative Mass Lesion
Intracranial mass lesions may present with
obstructive hydrocephalus.In some circumstances
it may be appropriate to treat the hydrocephalus
by tumour removal and decompression of the CSF
pathways.
In other cases, such as a patient who presents
with an impaired conscious level secondary to
obstructive hydrocephalus, it may be appropriate
to treat the hydrocephalus with an EVD or
ventriculoperitoneal shunt and allow the patient
to recover before undertaking tumour surgery.
28. Ventriculoperitoneal shunt
A ventriculoperitoneal shunt involves the insertion of
a catheter into the lateral ventricle (usually right
frontal or occipital).
The catheter is then connected to a shunt valve under
the scalp and finally to a distal catheter, which is
tunnelled subcutaneously down to the abdomen and
inserted into the peritoneal cavity.
If the CSF pressure exceeds the shunt valve pressure,
then CSF will flow out of the distal catheter and be
absorbed by the peritoneal lining.
32. Complications Of VP Shunt
Most common complications include shunt blockage and
infection. Approximately 15–20% of shunts are revised
withinthe first 3 yrs.
Shunt blockage may affect the ventricular catheter, shunt
valve or distal catheter. Causes of blockage are choroid
plexus adhesion, blood, cellular debris or misplacement of
the distal catheter in the pre-peritoneal space.
Shunt infection affects between 1% and 7% of shunt
insertions and is usually caused by skin commensals, such
as Staphylococcus epidermidis. Most infections become
apparent clinically by 6 weeks and over 90% are apparent
within 6 months. Treatment is by removal of the shunt,
external CSF drainage and treatment of infection prior to
33. Endoscopic Third Ventriculostomy
ETV involves the insertion of a neuroendoscope into the frontal horn
of the lateral ventricle and then into the third ventricle through the
foramen of Munro. A stoma can be created in the floor of the third
ventricle in between the mamillary bodies and infundibular
(pituitary)recess.
CSF can then communicate freely between the ventricular system
and interpeduncular subarachnoid space. It is useful when there is
obstruction of the CSF pathways below the third ventricle such
aqueduct stenosis or posterior fossa mass lesions.
Advantage over shunting in that no tubing is left in the patient and
so infection rates are lower. ETVs may block off, however, with about
one-half of these patients ending up with a shunt. Rare, but serious,
complications include basilar artery rupture or memory impairment
from injury to the fornix.