This document discusses total anomalous pulmonary venous connection (TAPVC), including its definition, history, types, pathophysiology, clinical features, surgical techniques, outcomes, complications like pulmonary vein stenosis, and controversies. TAPVC is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium, and instead connect to the right atrium or its tributaries. Surgical repair is indicated but carries risks of mortality from pulmonary vein obstruction or stenosis.
Tetralogy of Fallot
Tetralogy of Fallot with Pulmonary
Stenosis
TETRALOGY OF FALLOT WITH CONGENITAL PULMONARY ATRESIA
Tetralogy of Fallot with Absent Pulmonary Valve
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
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.
Tetralogy of Fallot
Tetralogy of Fallot with Pulmonary
Stenosis
TETRALOGY OF FALLOT WITH CONGENITAL PULMONARY ATRESIA
Tetralogy of Fallot with Absent Pulmonary Valve
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
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.
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
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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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
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
3. Total Anomalous Pulmonary
Venous Connection
Definition
Cardiac malformation in which there is no direct
connection between any pulmonary vein & left atrium,
but all the pulmonary veins connect to right atrium
or one of it’s tributaries. A PFO or an ASD is present
essentially all persons who survive after birth.
History
Wilson : 1st description in 1798
Muller : 1st closed partial approach in 1951
Lewis & Varco : Successful open repair in 1956
4. Total Anomalous Pulmonary
Venous Connection
Origin of anomalous connection
1. Drainage to right atrium
2. Drainage to right common cardinal system
(SVC or azygous vein)
3. Drainage to left common cardinal system
(Left innominate vein or coronary sinus)
4. Drainage to umbilical-vitelline system
(Portal vein, ductus venosus, and so on)
5. Pulmonary Vein
Splanchnic plexus provides drainage of the lung buds into cardinal &
umbilicovitelline venous system. Common pulmonary vein evaginates
from the left atrium and merges with the splanchnic plexus.
Connections of pulmonary drainage to systemic venous system regress.
Development
6. TAPVC
Pathophysiology
• Entire pulmonary venous return drains into the
right atrium, usually via a common pulmonary
vein confluence, resulting in complete pulmonary
and systemic venous mixing.
• Oxygenated blood reaches the left heart via an
inter-atrial connection (i.e.,ASD, PFO).
• Mechanical or functional obstruction of the
pulmonary venous return leads to cyanosis,
acidosis, pulmonary hypertension, & congestion.
7. TAPVC
1. Pulmonary venous anatomy
1) Type : Supracardiac 45%
Cardiac 25%
Infracardiac 25%
Mixed 5%
2) Pulmonary venous obstruction
. Junction of connecting vein
or compression, or long
narrow connect vein
. Functional obstruction
(restrictive PFO)
2. Chamber & septal anatomy
. LA & LV : small
. ASD or PFO : small in 1/2,
rarely no ASD or PFO
3. Pulmonary vasculature
. Increased arterial muscularity
. Structural change
4. Associated condition
. PDA : 15%
. VSD : occasionally
. TOF, DORV, IAA : rarely
Morphology
12. TAPVC
Clinical features & diagnosis
1. Presentation
. Critically ill infants during 1st few week of life
. Unexplained tachypnea & unimpressive cyanosis
. Metabolic acidosis : pulmonary venous obstruction
2. Examination
. No particularly overactive heart & unimpressive heart sound
3. Chest radiography
. Normal heart size with diffuse haziness or ground glass
if pulmonary venous obstruction
. Large heart size with high pulmonary blood flow
. Figure of 8, snowman configuration
4. Echocardiography
5. Cardiac catheterization & cineangiography
13. TAPVC
Natural history
1. Incidence
. Relatively uncommon anomaly, 1.5~3% of CHD
2. Survival
. Unfavorable prognosis
50% survival in 3months
20% survival in one year
. Usually have pulmonary venous obstruction due to
long pulmonary venous pathway & a small PFO
. Those who survive the first year of life usually have
large ASD, no pulmonary venous obstruction
14. TAPVC
Indications for operation
• Investigation must be undertaken promptly in any
neonate or infant, no matter how young, who develops
signs or symptoms suggestive of TAPVC
• Immediate operation in any neonate or infant
whom are importantly ill with TAPVC
• Prompt operation in any 6-12 months old infant
• Advisable if severe pulmonary vascular disease
has not developed in old patients (under 8 units)
15. TAPVC
Operative techniques
• Operation should be undertaken as an emergency after
diagnosis by echocardiography who enter the hospital
critically ill. Preoperative preparation & stabilization
is contraindicated.
1. TAPVR to Lt. innominate vein
2. TAPVR to SVC
3. TAPVR to coronary sinus
4. TAPVR to right atrium
5. TAPVR to infradiaphragmatic vein
19. • Suturelesstechnique for the relief of
PV stenosis. A, Theincision is made
into the left atrium and extended into
both upper and lower PVostia
separately. B, Suturing is begun in
thepericardium just above the junction
of the superior PV with the left atrium.
C, A second inferior suture is started
below theinferior PV and continued in
the same manner to the left atrial
incision to jointhe superior suture line.
Sutureless technique
TAPVC
20. Primary Sutureless Repair
Rationale
• Small size of the pulmonary vein is a major risk factor
forlater development of PVS after conventional
TAPVD repair and that high mortality of right atrial
isomerism is related, at least in part, to intrinsically
small pulmonary veins.
• Furthermore, most of the patients with RAI are not
anatomic candidates for biventricular repair. PVS is a
risk factor for poor Fontan operation outcome
• The acute anatomic benefit for the sutureless repair is
that each vein is its own native size, without any suture
material to cause an excessive inflammatory reaction or
luminal compromise
21. TAPVC
1. Survival
2. Modes of death
. Hypertensive crisis
. Pulmonary venous stenosis
3. Incremental risk factors
for death
. Infracardiac drainage
. Pulmonary venous obstruction
. Poor preoperative state
. Small size of pulmonary vein
. Increased PVR
. Small left ventricle
4. Functional status
5. Hemodynamic result
6. Cardiac rhythm
7. Reoperation
. Anastomotic stricture
(5~10%)
. Pulmonary vein stenosis
Surgical results
22. TAPVC
Special situation & controversies
1. Delayed operation
In critical patients with obstruction at atrial level,
balloon dilation and 1-2 days later operation
2. Mixed total anomalous venous connection
3. Operative exposure
4. Surgical enlargement of left atrium
Decrease in atrial volume of more than 50%
result in reduction in cardiac output ?
5. Pulmonary vein stenosis
23. Residual TAPVC
PVD in remained anomalous veins
• Possible pressure-sensitive receptors at
the anomalous vein-vena cava junction
• Axon reflex triggered by right atrial
distention
• Results of the increased blood flow
24. Pulmonary Vein Stenosis
Etiology
1. Low grade venous obstruction presents at the
end of procedure results in reactive fibrosis
( diffuse fibrosis & thickening of vein )
2. Self perpetuating stenosis
3. Intraatrial thickening
4. Diffuse pulmonary vein stenosis
5. Congenital nature ( hypoplasia, focal stenosis,
discrete ostial stenosis)
25. Pulmonary Vein Stenosis
Factors of development
1. Small confluent pulmonary vein
2. Suture material
3. TAPVC type?
4. Undue trauma toward pulmonary
vein ostium and tension
5. Steroid therapy
26. Congenital PV Stenosis
Clinical features
• Occur in about 0.4% of congenital heart defects and
one or multiple veins may be affected.
• Histologically, the lesion is characterized by fibrous
intimal thickening in most cases and medial
hypertrophy in many
• The first surgical repairof congenital PV stenosis was
reported by Kawashima and colleagues in 1971 and
surgical approaches have evolved over the years, but
results have been generally disappointing.
• Diffuse restenosis has been documented as a significant
cause of late mortality after repair
27. Acquired PV Stenosis
Characteristics
• Anatomically localized to the anastomosis, and the
natural history is more favorable, or the stenosis may
extend diffusely into the branch pulmonary veins.
• It can sometimes be difficult to distinguish these forms of
acquired PV stenosis at the time of presentation.
• Acquired PV stenosis occurs in approximately 7% to
11% of early survivors after total anomalous pulmonary
venous connection repair
• Results of repairof acquired PV stenosis have also been
less than optimal due to the problem of restenosis
28. Acquired PV Stenosis
Anatomic features
• Post-repair pulmonary vein stenosis appears to have
three basic subtypes.
• The most minimal form of the disease is limited to the
anastomotic area with sparing of the pulmonary veins
and confluence, suggesting a technical error or
imperfection at the time of initial repair.
• The intermediate form is limited to the pulmonary
venous confluence in addition to the anastomotic area.
• The most extensive form of the disease includes a
fibrous reaction extending retrograde deep into the
lung parenchyma.
29. Pulmonary Vein Stenosis
Strategy for treatment
1. Minimize trauma at suture line
Suture line (tension or inflexibility, deformation)
Suture material
Handling the vein tissue
2. Avoid postoperative turbulence
Constraints imposed by restrictive characteristics
3. Surgical methods
Operative patch venoplasty
Sutureless pericardial marsupialization
Catheter dilation
Stent placement and combination
30. Complex TAPVC
Etiology of high mortality
1. The interplay of systemic shunt with abnormal
pulmonary vasculature contributes to difficulty in
maintaining postoperative pulmonary to systemic
flow ratio.
2. To limit excessive pulmonary blood flow with banding,
or augmentation with shunt, the end result is similar.
3. The static matching of this resistance to the cardiac
output in face of abnormal pulmonary vasculature may
not allow appropriate regulation of pulmonary blood
flow during dynamic changes.