The document provides a historical review of splenomegaly and summarizes its evaluation and management. It discusses that historically, the spleen was thought to be the "seat of melancholy". It then reviews the anatomy, blood supply, functions and physical exam of the spleen. Common causes of splenomegaly are discussed such as infectious diseases like HIV, hematological malignancies like lymphoma, and liver diseases. Evaluation involves history, exam, bloodwork and imaging. Management may involve splenectomy for refractory causes or symptoms.
Etiologia, fisiopatologia, diagnostico y tratamiento de la Fascitis Necrotizante, entidad poco común pero sumamente mortal de no llegar a ser tratada de manera adecuada.
Etiologia, fisiopatologia, diagnostico y tratamiento de la Fascitis Necrotizante, entidad poco común pero sumamente mortal de no llegar a ser tratada de manera adecuada.
Problem oriented approach in pediatric radiologyAhmed Bahnassy
This hand book tries to address the most common clinical problems in pediatrics ,by building a problem based imaging algorithm ,which probes the different differential diagnosis and try to reach a final diagnosis.
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Abordaje de esplenomegalia
1. 266 Historical Review
Abordaje
de
Esplenomegalia
Fig 1. Hippocrates examining the upper abdomen (possibly pal-
pating the spleen?) of a patient. Photograph courtesy of Dr Barbara
Bain, St Mary’s Hospital, London.
golden age of lifeÕ (Stukeley, 1722; Fig 2). The prevailing
view for many centuries was, however, one of gloomy and
2. Introducción
• Se origina del mesodermo esplácnico a la 11ª SDG.
• Peso: 50 - 250 gr.
• Medidas:
• Largo: 11 a 13 cm.
• Ancho: 6 - 8 cm.
• Espesor: 3 - 4 cm.
• Situación: 9ª - 11ª costillas.
TRATADO DE ANTOMÍA HUMANA
Editorial Salval S.A. Tomo IV
Testut. L. Latarget A
3. Introducción
• Irrigación:
• Arterial: tronco celíaco.
• Venosa: forma la vena porta con la vena mesentérica
inferior.
• Linfática: hacia cadena esplénica.
• Inervación: plexo solar.
ANATOMÍA PARA ESTUDIANTES
Editorial El Sevier Gray España 2005
Richarch L. Drake
4. Funciones
• Reservorio de Sangre.
• Hematopoyética.
• Hematodestructora.
• Inmunológica.
• De depósito.
ANATOMÍA CON ORIENTACIÓN CLÍNICA
Keith L. Moore, 4a edición
Editorial Panamericana 2002
6. Exploración Física
Exactitud
• Comparación vs US:
• La palpación es más exacta en sujetos delgados.
• E: 92%; VPP: 92%.
• Percusión: S: 62%; E: 72%.
• Combinación de resultados positivos: S: 46%; E:
97%.
7. Esplenomegalia
• Definición “estándar de referencia”: peso mayor a 250 gr.
• Clínicamente palpable: 16% muestran un tamaño normal.
• Radiológica, US:
• Longitud craneocaudal ≥13 cm.
• Díametro AP ≥2/3 de la distancia entre la pared abdominal
anterior y la posterior.
• TC: Longitud ≥10cm. S: 81%; E: 90%.
Splenomegaly: Investigation, diagnosis and management Determination of splenomegaly by CT: is there a place for a single measurement?
Bezerra AS.
A.L. Pozo et al. / Blood Reviews 23 (2009) 105–111 AJR Am J Roentgenol. 2005;184(5):1510
9. Splenomegaly in 2,505 Patients at a Large University
Medical Center From 1913 to 1995
1963 to 1995: 449 Patients
ROBERT A. O'REILLY, MD, San Francisco, California
WIM, August
1998-Vol No. 2
Splenomegaly was studied retrospectively at the University of California, San Francisco (UCSF), School
-A WIM
of Medicine in 301 patients from 1963 to 1995 and compared with the UCSF service of the San Fran-
169,
Causas más comunes cisco General Hospital Medical Center (SFGH) in 148 patients from 1979 to 1994. The combined 449
patients were classified into several diagnostic groups and were studied by means of several clinical
and laboratory associations. Hepatic disease in the percentage of patients at UCSF (with those at SFGH
given in parentheses) was associated with splenomegaly in 290/o (41%), hematologic disease, 32%
diseases, 10% (4%); USED
(16%); infectious diseases, 16% (36%); congestive or inflammatoryABBREVIATIONSprimary IN TEXT
splenic disease, 6% (1%); other, 5% (1%); and cause unknown, 2% (1%). Massive splenomegaly oc-
curred in 27% of the patients of the combined series, particularly= acquired immunodeficiency syndrome
AIDS in patients with hematologic dis-
eases. The acquired immunodeficiency syndrome (AIDS) occurred in more than half of the patients
with infectious diseases at SFGH and was four times more frequent chronic lymphocytic leukemia
CLL = than in the patients at UCSF. The
• Enfermedad hepática (cirrosis): 33 % CML = chronic myelocytic (chronic
commonest diseases associated with splenomegaly were hematologic (lymphoma), hepatic leukemia
liver disease), infectious diseases (AIDS and endocarditis), congestive (congestive heart failure), pri-
HIV = human to the spleen). In 11 pa-
mary splenic (splenic vein thrombosis), and other (malignancy not metastaticimmunodeficiency virus
1ITP = idiopathic thrombocytopenic
tients with AIDS and massive splenomegaly, Mycobacterium avium complex occurred in 8 (73%). purpura
Splenectomy was performed in 117 patients (26%), primarily for hematologic amelioration. I conclude
PVT = choice vein thrombosis
that for splenomegaly of unknown origin, the invasive procedure ofportal for patients with hemato-
• Malignidad hematológica (linfoma) : 27% SFGH = San liver biopsy; and for infec-
logic associations may be a bone marrow biopsy; for hepatic associations, a Francisco General Hospital Medi
tious disease associations, a lymph node biopsy, before any SVT = splenic vein thrombosis
consideration of a diagnostic splenectomy.
(O'Reilly RA. Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449
patients. West j Med 1998; 169:88-97) UCSF = University of Califomia, San Francis
• Infección (VIH, Endocarditis): 23%. spleen from a surgical procedure
excised
Splenomegaly presents a diagnostic challenge because
nearly always it is due to another primary disorder.'
northern California. The centering of AIDS patients at the
SFGH and to a lesser extent at UCSF allowed the assess-
The only analyses from a developed country on ment of the development of AIDS on the diagnostic eval-
total of 331 patients
splenomegaly in general were two office-based studies coded having sp were
uation of splenomegaly and massive splenomegaly. as
•
performed decades ago in which no diagnosis was estab-
Congestión (ICC): 8%. UCSF for the
lished in more than 25% of the patients.23 Only a single
study of hospital-based patients in the United States has
could
been reported.4 Now, a second municipal hospital has
1963 1995; 30 medical
Patients and Methods
years
be found. Therefore, the study was
not
to
Patient Demographics
remaining 301 patients. A total of 193 pati
been studied, San Francisco General Hospital Medical
Center (SFGH), which has been compared with and con- All hospital records at SFGH for patients of any age diag-
coded having splenomegaly; 45 me
trasted to a university medical center at the University of were
nostically coded asas
splenomegaly from 1979 through 1994
• Enfermedad propia del bazo (trombosis): 4 be found. Therefore, the st
California, San Francisco (UCSF), School of Medicine
(23%) could
for about the same period. Infections with the human
immunodeficiency virus (HIV) and with diseases related
%.
were reviewed retrospectively. Splenomegaly was defined
not
as an enlarged spleen determined by one of the following:
palpable by at least two clinicians or noted on two written
the remaining 148 patients. The
to the acquired immunodeficiency syndrome (AIDS) are on observations, greater than 12 cm in length on radiologic
prevalent in the young male homosexual community of imaging study, or more than 250 grams wet weight on an
splenomegaly for these years at UCSF was
• Otras o desconocidas: Departments ofJose,A.California.MD, ofSCalifornia, Francisco,CAfrom about 90,000 admissions, or 0.3%.
the
5%.O'Reilly,University Bascom
Valley Medical Center, San
Reprint Robert
From
Medicine,
requests to 751
San
Stanford
Ave, San Jose,
School of Medicine;
Medical
95128.
Alto; University Center, Palo and the Santa Clara
Clinical and Laboratory Features
The detailed criteria for the analysis of th
laboratory features of the patients are all
first part of this study.5
Results
10. Esplenomegalia Masiva
• El polo inferior se encuentra dentro de la
pelvis o cruza la línea media hacia el
hemiabdomen derecho.
• Causas:
•LMC
•Mielofibrosis, idopática o postpolicitémica
•Enfermedad de Gaucher.
•Linfoma (incluída Leucemia de células peludas)
•Kala-azar
•Síndrome tropical esplenomegálico
•Talasemia mayor
•SIDA con complejo Mycobacterium avium
O’ReillyRA.Splenomegalyin2505patientsatalargeuniversitymedicalcentre
from 1913 to 1995. 1963 to 1995:449 patients. West J Med 1998;169:88–97
11. Síntomas
•Dolor en CSI
•Sensación de plenitud postprandial precoz
•Dolor referido a hombro ipsilateral
•Dolor tipo pleurítico agudo + dolor en CSI
sugiere absceso esplénico
12. including bone marrow, liver and rectal
y of these patients remained well for over
Table 2
eem to be a group of individuals with benign
Initial investigations in the patient with splenomegaly.
prevalence is not clear.
Abordaje
causes of splenomegaly have now been stud- In most patients In selected patients (depending on clinical
features)
US hospital inpatients.11–13 The estimated
o 1995 was 0.3% of admissions and a diagno- Haematology
Full blood count Direct antiglobulin test
Inicial
8%, but 12% required a diagnostic splenec-
Peripheral blood film Reticulocyte count
ents with splenomegaly, haematological ESR Malaria blood film
16–66%, hepatic disease in 9–41%, infectious Clotting screen Haemoglobin electrophoresis/HPLC
estive or inflammatory disease in 4–10% and Biochemistry
e (e.g. storage disease) in 1–6%.11–13 Within Urea and electrolytes Serum ACE
sorders, the most common diagnoses were Liver function tests Serum protein electrophoresis
all splenomegaly), CML (8–29%), haemoglo- C-reactive protein Urine Bence Jones protein
Bone biochemistry
L (0–20%) and myelofibrosis (9–16%).
•Historia Clínica
omegaly vary between hospitals in the same
ences between developing and developed
Serum LDH
Vitamin B12, red cell folate
Microbiology
re striking. 11–45% of massive splenomegaly Monospot test Peripheral blood cultures
•Exploración
opical Splenomegaly Syndrome of malarial
is due to schistosomiasis.14
Serology: hepatitis B/C Sputum microscopy, culture and AAFB
Mantoux test
Física Immunology
Serology: HIV, CMV, toxoplasmosis, brucella
tient with splenomegaly
Auto-antibodies incl. ANA
Rheumatoid factor
begins with a thorough history and exami-
Radiology
ay elicit symptoms of pressure effects from Ultrasound/CT abdomen Ultrasound abdomen with duplex-Doppler studies
uch as left hypochondrial discomfort or early Plain chest radiograph CT chest, abdomen and pelvis
symptoms of cytopenias due to hypersplen- Transthoracic/transoesophageal echocardiogram
prising splenomegaly; anaemia, leucopenia Bedside
enia; compensatory bone marrow hyperpla- Urine dipstick (protein,
t after splenectomy (if performed). General blood)
uch as fever, sweats, weight loss or lymphad- ESR: erythrocyte sedimentation rate; HPLC: high-performance liquid chromatog-
matological, malignant, infectious or inflam- raphy; LDH: lactate dehydrogenase; ACE: angiotensin-converting enzyme; AAFB:
horough systemic enquiry is essential to acid and alcohol-fast bacilli; and ANA: anti-nuclear antibodies.
13. Abordaje Adicional
Esplenectomía Why does my patient have Lymphadenopathy or splenomegaly?
Motyckova & Steensma
Hematol Oncol Clin N Am 26 (2012) 395–408
•Causa aún desconocida.
•Crecimiento refreactario a tratamiento
•Persistencia de síntomas.
•Paliativa: mielofibrosis, LCP.
•Víalaparoscópica: complicaciones del 6-22%.
Mortalidad 1.4%
14. Abordaje Adicional
Biopsia
•No recomendada actualmente.
•Poca utilidad clínica.
Why does my patient have Lymphadenopathy or splenomegaly?
Motyckova & Steensma
Hematol Oncol Clin N Am 26 (2012) 395–408