Dunbar syndrome or celiac artery compression syndrome was described for the first time by Harjola in 1963. It’s an infrequent clinical condition, with few criteria for diagnosis and with obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic
neural fibers. This syndrome is as uncommon cause for upper abdominal angina. The classic sympthoms include vomiting associated to pos prandial pain, weight loss and soufle
in the epigastric region. Diagnosis is made by abdominal angiotomography, arteriography and magnetic resonance imaging. Surgical ligament release is indicated in case of severe
compression of the celiac trunk or in patient’s refractory to clinical treatment [1].
Hibernoma is a rare, painless, and benign soft tissue tumor arising from brown fat cells. We present a 28 year old gentleman with a large and tender left anterior neck swelling associated with restricted left shoulder movement for one week duration after he was involved in a motor vehicle accident. Due to the nature of the injury and presentation, it was unexpected to fi nd a well encapsulated fat density suggestive of lipoma from Computed Tomography (CT) scan. Surgical exploration and excision were performed, and the histopathological examination of the excised mass noted to be hibernoma. Patient recovered well and regained full shoulder movement post operatively.
This case illustrated the importance of having broad differentials when approaching patients with post traumatic neck swelling.
Dunbar syndrome or celiac artery compression syndrome was described for the first time by Harjola in 1963. It’s an infrequent clinical condition, with few criteria for diagnosis and with obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic
neural fibers. This syndrome is as uncommon cause for upper abdominal angina. The classic sympthoms include vomiting associated to pos prandial pain, weight loss and soufle
in the epigastric region. Diagnosis is made by abdominal angiotomography, arteriography and magnetic resonance imaging. Surgical ligament release is indicated in case of severe
compression of the celiac trunk or in patient’s refractory to clinical treatment [1].
Hibernoma is a rare, painless, and benign soft tissue tumor arising from brown fat cells. We present a 28 year old gentleman with a large and tender left anterior neck swelling associated with restricted left shoulder movement for one week duration after he was involved in a motor vehicle accident. Due to the nature of the injury and presentation, it was unexpected to fi nd a well encapsulated fat density suggestive of lipoma from Computed Tomography (CT) scan. Surgical exploration and excision were performed, and the histopathological examination of the excised mass noted to be hibernoma. Patient recovered well and regained full shoulder movement post operatively.
This case illustrated the importance of having broad differentials when approaching patients with post traumatic neck swelling.
Benign Metastasizing Leiomyoma: A Case Reportsuppubs1pubs1
Metastasizing benign leiomyoma is an extrauterine smooth muscle tumour. Leiomyoma in spine is extremely rare. We report a case of a 47-year-old female with benign leiomyoma metastasizing to the spine. To our knowledge no case of benign leiomyoma metastasizing to the spine has been reported before. Magnetic Resonance Imaging (MRI) revealed C6, C7 vertebral involvement, T2, T4, T7, T8, T11, L2, L3, L4, L5 moderate spinal canal stenosis and cord impingement and cord compression at T12 level. She also presented with growth over her right elbow and psoas muscle.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
Liposarcoma of the spermatic cord is a rare entity with only two series and less than 100 cases reported in literature. We report a case of a giant liposarcoma of the spermatic cord.
I report a case of rare type of anal cancer in a relatively young individual. A 35-year-old male presented to the OPD Clinic from Nigeria with pain in anal region. Patient was referred for CT scan which showed anal mass. Biopsy showed highly aggressive adenocarcinoma with no metastasis. Patient was started on radiation therapy and multi-drug regimen chemotherapy. After receiving 2 appointments of radiation therapy, patient contracted community acquired pneumonia. Patient’s condition deteriorated and was admitted to ICU for 15 days aggressively treated with antibiotics. Patient was scheduled to undergo abdominoperineal resection. Financially drained and post- surgery complications, patient decided on not receiving any further treatment and returning back home.
Liposarcoma of the spermatic cord is a rare entity with only two
series and less than 100 cases reported in literature. We report a case of a giant liposarcoma
of the spermatic cord.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
- 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
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
DITI Sample Conditions and Injuries
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• 8 years 4,294,967,296 cells ….(Doubled 32 times)*
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7. RSD (CRPS) of the left hand.
Glove-like hypothermia.
The return of normal sympathetic
function after treatment was short
term.
8. This elderly lady had undergone a left hip
replacement surgery 3 months previously and her
continued leg pain raised a suspicion for DVT.
The thermographic findings were not consistent
with DVT, but showed a focal area of
inflammation that guided a sonographer to a
deep abscess near the bone. This was lanced and
successfully treated with antibiotics.
Small metastatic tumors
indicated by focal areas of
hypothermia over the lumbar
spine
9. The primary finding here is the local area of
hyperthermia over the hepatic flexure of the
colon. Diverticulitis was diagnosed after
clinical correlation with thermographic
findings.
This patient presented with low back pain,
there were no thermal findings in the back but
the abdomen showed a well defined area of
inflammation over the right kidney which
could refer pain to the back. Subsequent tests
confirmed a kidney infection.
15. MVA, Steering wheel impacted
the low chest, subsequent x-ray
as a result of thermal findings
showed fractures in the low
sternum and left last rib.
Local inflammation over lumbar
joint spaces .
22. Focal hypothermia relating to
a malignant cyst
One per cent of breast cancers are found in men. The
survival rate is much lower than in women as most
breast cancers in men are only detected in advanced
stages.
This tumor was palpable at the time of imaging, there
is a well established vascular feed which has even
caused increased blood flow at the left brachial
plexus and there is also drainage toward the sternum
that extends to below the left breast.
Metastasis were later found in other organs and this
patient did not survive.
23. Indian Elephant with infection in
the bed of the nail of the fifth
toe of the left front foot
26. Three stress fractures of the
transverse processes of the lumbar
spine.
This patient fell from a ladder. X-ray
was inconclusive, Scintigraphy
showed the fractures.
Mid lumbar disc bulge to the right
After several clinical examinations no cause could be diagnosed for the lameness in the left front foot. Nerve block injections were to be the next test tried.
Thermography clearly identified a localized area of infection which was easily treated once found.