AAC Completa
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The document discusses petal midline anomalies in plants. It appears to be a medical record or case study from 2018 focusing on ACC Completa, a condition involving petal development. In 3 sentences or less, the summary provides a high-level overview of the topic and context but lacks detail due to the limited information provided in the original document.
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The document discusses petal midline anomalies in plants. It appears to be notes from an ACC Parcial exam focusing on Leombroni's 2018 work on normal petal development. The document is brief and does not provide many details to summarize.
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El documento describe el sistema GI-RADS para el diagnóstico de masas ováricas malignas. El sistema clasifica las masas en 5 categorías de acuerdo al riesgo de malignidad, que van desde definitivamente benigno (0%) hasta muy probablemente maligno (>20%). Cada categoría se describe por el riesgo de malignidad y los hallazgos típicos.
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The document discusses petal midline anomalies in plants. It appears to be notes from an ACC Parcial exam focusing on Leombroni's 2018 work on normal petal development. The document is brief and does not provide many details to summarize.
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El documento describe el sistema GI-RADS para el diagnóstico de masas ováricas malignas. El sistema clasifica las masas en 5 categorías de acuerdo al riesgo de malignidad, que van desde definitivamente benigno (0%) hasta muy probablemente maligno (>20%). Cada categoría se describe por el riesgo de malignidad y los hallazgos típicos.
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Treatment Options
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
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Fetal nuchal translucency thickness and the presence or absence of reversed flow in the ductus venosus can help determine the risk of major cardiac defects in a fetus during the first trimester. The risk increases with greater nuchal translucency thickness and is higher if reversed flow is present in the ductus venosus compared to if flow is normal.
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El documento presenta gráficos que muestran la distribución de hallazgos cardíacos congénitos (CC) asociados con hallazgos normales y anormales en el área retrocardíaca (ARC). También describe algunas anomalías específicas como isomerismo izquierdo con anomalías hepáticas y venosas, isomerismo derecho con anomalías del retorno venoso, y defectos como tetralogía de Fallot y dextrocardia con anomalías vasculares.
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La aorta normalmente cruza la línea media del cuerpo desde la derecha hacia la izquierda por delante de la tráquea. En el arco aórtico derecho, la aorta no cruza la línea media y permanece en el lado derecho de la tráquea.
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El documento habla sobre cómo determinar la telediástole cardiaca. Se determina realizando un clip del corte de 4 cámaras y evaluando hasta que se produce el primer movimiento sistólico descendente de la válvula tricúspide o mitral, seleccionando el cuadro anterior al movimiento.
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El documento proporciona mediciones del timo y del mediastino. El diámetro anteroposterior promedio del timo es de 0.44 ± 0.043 cm. Se mencionan condiciones como la síndrome de DiGeorge y la hipoplasia/aplasia tímica que afectan el desarrollo del timo.
Screening cardiopatías congénitas
Este documento proporciona una estrategia para el diagnóstico de cardiopatías congénitas en el feto y recién nacido. Recomienda realizar ecografías fetales de cribado entre las 11-14 y 20-22 semanas para evaluar la estructura y función cardíaca. También sugiere ecocardiografías fetales dirigidas entre las 13-16 y 20-22 semanas para fetos de alto riesgo. Finalmente, recomienda una ecocardiografía neonatal para confirmar cualquier hallazgo.
Imagen quística intraabdominal
El documento presenta una lista de posibles diagnósticos diferenciales para una imagen quística intraabdominal en un recién nacido, incluyendo quistes simples, vena umbilical dilatada o duplicada, várice de vena umbilical, quiste de colédoco, atresia o estenosis duodenal, duplicación intestinal, quiste mesentérico, quiste uracal, enfermedad de Hirschprung y atresia anorectal. También menciona quistes de ovario como un diagnóstico diferencial si el fenot
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Este documento describe varias posibles anomalías que podrían observarse en una ecografía abdominal. Incluye términos como calcificaciones hepáticas, peritonitis meconial, tumores renales, esplénicos y hemorrágicos, así como hemangiomas e hiperecogénicos intraabdominales.
Circunferencia gástrica
La circunferencia gástrica promedio en fetos con atresia esofágica sin fístula es de 0.9 mm, mientras que en fetos con atresia esofágica con fístula es de 33.8 mm, significativamente menor que la circunferencia gástrica promedio normal de 43.0 mm.
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Este documento describe la detección prenatal de la fistula traqueoesofágica y la atresia esofágica. Explica que la fistula traqueoesofágica y la atresia esofágica pueden ocurrir solas o como parte del síndrome VACTERL, que incluye anomalías vertebrales, anales, cardiacas, traqueoesofágicas, renales y de extremidades. También discute que la atresia esofágica puede presentarse con el síndrome CHARGE.
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La tasa de muerte fetal intrauterina por cada 100 gestaciones con diagnóstico de gastrosquisis es de 1. La gastrosquisis es una malformación congénita en la que los intestinos o parte de ellos se desarrollan fuera del abdomen del feto a través de una abertura en la pared abdominal. El diagnóstico prenatal de gastrosquisis permite un seguimiento más estrecho del embarazo y un parto programado en un centro especializado para mejorar el pronóstico neonatal.
Gastrosquisis: GPS
This document describes a scoring system called the Gastroschisis Prognostic Score (GPS) that is used to predict outcomes for infants born with gastroschisis. The GPS assigns points based on factors present at birth like intestinal atresia, perforation, and necrosis. A score of 1 or less indicates low risk while a score of 2 or more indicates high risk. The GPS aims to help clinicians determine which infants are likely to have more severe outcomes and require longer hospitalization so that care can be tailored appropriately.
Onfalocele: pronóstico
El documento discute si la relación del diámetro del omphalocele en relación al perímetro cefálico (CA) puede predecir los resultados posteriores al nacimiento. El estudio encontró que una relación de 0,26 o menos entre el diámetro del omphalocele y el CA se asoció con resultados normales, mientras que una relación mayor predijo resultados adversos.
PFE en defectos de la pared abdominal
This document presents formulas for estimating fetal weight for fetuses with abdominal wall defects. It compares the mean absolute percentage errors of several existing formulas that use measurements like biparietal diameter, head circumference, abdominal circumference, and femur length to formulas developed specifically for fetuses with abdominal wall defects that use biparietal diameter, occipitofrontal diameter, and femur length. The new formula developed for fetuses with abdominal wall defects that uses these three measurements was found to have the lowest mean absolute percentage error of 8.90% compared to errors ranging from 11.26% to 13.75% for the existing formulas.
Hidrotórax distribución
This document discusses prenatal diagnosis and outcomes of fetuses found to have pleural effusions. It reports that in reviewed cases, 71.4% of fetuses with pleural effusions were found to have no other abnormalities. The remaining cases had various other issues identified. Prenatal diagnosis allows doctors to counsel parents on prognosis and managements options.
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Fetal pleural effusion is a condition where excess fluid builds up in the pleural space surrounding the lungs of a fetus. This condition can be caused by genetic abnormalities, infections, or other issues. If detected prenatally, fetal pleural effusion requires careful monitoring and may necessitate interventions like thoracentesis after birth.
Grado gástrico en HDC
This study examined the relationship between stomach position and survival rates in infants born with left-sided congenital diaphragmatic hernia (CDH) who underwent fetal endoscopic tracheal occlusion (FETO) or did not have FETO. The researchers found that infants with CDH who had their stomach located below the diaphragm had higher survival rates than those with their stomach located above the diaphragm, regardless of whether they received FETO. Stomach position was a stronger predictor of survival than undergoing FETO.
Doppler Arteria Pulmonar
Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia
Rogelio Cruz-Martínez, Monica Cruz-Lemini, Antonio Mendez,Miriam Illa,
Víctor García-Baeza, Josep Maria Martinez, Eduard Gratacós. 2016
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The document discusses a study examining the ratio of observed to expected lung area to head circumference (LHR) in predicting survival rates of fetuses with isolated diaphragmatic hernias. The study found that fetuses with higher LHR ratios had higher survival rates, and that liver herniation decreased survival rates for those with left-sided hernias but not right-sided hernias.
Cystic adenomatoid marformation volumen ratio
Este documento presenta una tabla para calcular el cociente de volumen/ratio (CVR) de una malformación adematoidea quística en un feto o recién nacido, comparando el volumen de la masa con la circunferencia cefálica para determinar si es normal, hidrópico o requiere más seguimiento.
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
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Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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