This document summarizes Ebstein's anomaly, a congenital heart defect characterized by displacement of the tricuspid valve into the right ventricle. Key features include delamination of the tricuspid leaflets, apical displacement of the tricuspid annulus, and dilation of the right atrium. Presentation varies from no symptoms to heart failure. Diagnosis involves echocardiogram and cardiac catheterization. Surgical options aim to repair or replace the tricuspid valve, with newer techniques using a cone reconstruction approach. Outcomes depend on severity, with some patients living into their 80s while others require heart transplantation.
a cardiac surgery presentation about Atrioventricular septal defect,Definition, Prevalence,Anatomy,Classification,presentation ,diagnosis and management
This presentation is almost a complete Pictoral view of Radiograph chest.
This presentation will help radiologist in daily reporting.
This presentation will help physicians, surgeons, anesthetist and almost all medical professionals in diagnosing commonly presenting cardiac diseases.
This will also help all in preparaing TOACS examination.
ebstein anomaly is rare congenital disorder,with variable presentation in neonate to adults,early diagnosis and timely take decision make remarkable difference in patients life.
Ebstein’s anomaly is a rare congenital heart disorder occurring in ≈1 per 200 000 live births and accounting for <1% of all cases of congenital heart disease. This anomaly was described by Wilhelm Ebstein in 1866 in a report titled, “Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation.” The patient was a 19-year-old cyanotic man with dyspnea, palpitations, jugular venous distension, and cardiomegaly. At autopsy, Ebstein described an enlarged and fenestrated anterior leaflet of the tricuspid valve. The posterior and septal leaflets were hypoplastic, thickened, and adherent to the right ventricle. There was also a thinned and dilated atrialized portion of the right ventricle, an enlarged right atrium, and a patent foramen ovale. By 1950, only 3 cases of this anomaly had been published.
a cardiac surgery presentation about Atrioventricular septal defect,Definition, Prevalence,Anatomy,Classification,presentation ,diagnosis and management
This presentation is almost a complete Pictoral view of Radiograph chest.
This presentation will help radiologist in daily reporting.
This presentation will help physicians, surgeons, anesthetist and almost all medical professionals in diagnosing commonly presenting cardiac diseases.
This will also help all in preparaing TOACS examination.
ebstein anomaly is rare congenital disorder,with variable presentation in neonate to adults,early diagnosis and timely take decision make remarkable difference in patients life.
Ebstein’s anomaly is a rare congenital heart disorder occurring in ≈1 per 200 000 live births and accounting for <1% of all cases of congenital heart disease. This anomaly was described by Wilhelm Ebstein in 1866 in a report titled, “Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation.” The patient was a 19-year-old cyanotic man with dyspnea, palpitations, jugular venous distension, and cardiomegaly. At autopsy, Ebstein described an enlarged and fenestrated anterior leaflet of the tricuspid valve. The posterior and septal leaflets were hypoplastic, thickened, and adherent to the right ventricle. There was also a thinned and dilated atrialized portion of the right ventricle, an enlarged right atrium, and a patent foramen ovale. By 1950, only 3 cases of this anomaly had been published.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
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.
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.
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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.
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.
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.
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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
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
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.
2. Ebstein’s anomaly is a congenital malformation
of the heart that is characterized by
• Delamination failure of TV
leaflets(adherence of tricuspid leaflet to
underlying myocardium)
• Apical displacement of functional
annulus(septal>anterior>posterior)
• Atrialization & Dilatation of atrialized
portion of RV
• Redundency fenestration and tethering of
anterior leaflet
• Dilatation of true tricuspid annulus
• Variable ventricular myocardial
dysfunction
3. History and background
• Wilhelm Ebstein first described a patient with
cardiac defects typical of Ebstein anomaly in
1866.
• In 1927, Alfred Arnstein suggested the name
Ebstein's anomaly for these defects.
• It presented an ongoing challenge since its
initial repair attempts in 1958
• First successful replacement in 1963 by
Barnard and Schrire
4. epidemiology
The natural course of the disease varies according
to the severity of tricuspid valve displacement.
Patients presenting in infancy generally have severe
disease and unfavorable prognosis.
Mean age of presentation is in the middle teenage
years.
approximately 5% of these patients survive beyond
age 50 years.
The oldest recorded patient lived to age 85 years.
5. pathophysiology
The ultimate hemodynamic consequences of Ebstein’s
anomaly is heart failure due to
•malformed tricuspid leaflets leading to regurgitation(The
severity of regurgitation depends on the extent of leaflet
displacement)
•The atrialized portion of the right ventricle(although
anatomically part of the right atrium) contracts paradoxically
Leads to stagnation of blood in RA during RV relaxation and
causes a backward flow of blood into the right atrium during
RV systole
And deformed TV leaflet may lead to RVOT obstruction and
cyanosis
6. presentation
• Patients can have a variety of symptoms related
to the anatomical abnormalities of Ebstein’s
anomaly and their hemodynamic effects or
associated structural and conduction system
disease.
SOB on exertion
Occasional palpitation
fatigue
Features of heart failure
7. Physical examination findings
• Cyanosis
• JVP- normal or large V wave
• Liver palpable but not pulsatile
• Ascitis & Peripheral oedema at advanced stage
• Apex beat shifted to left
• Left parasternal heave
• Wide splitting of both 1st
and 2nd
heart sound
• Soft Systolic murmur over left parasternal area due to TR
15. Risk Assessment Great Ormond Street
Echo Score
Area of (RA + aRV)
Area of (RV + LV + LA)
1 <0.5 8%
2 0.5-1.0 8%
3 (acyanotic) 1.1-1.4 10% E, 45% L
3 (cyanotic) 1.1-1.4 100%
4 >1.5 100%
GOSE Ratio Mortality
Score
16. Treatment options
• Mostly Surgical management
biventricular repair approach
Univentricular /RV exclusion approach
Heart lung transplant
Medical treatment can be given for symptom
alleviation and control of heart failure
17. Indication of surgical management
• Severe symptomatic
• NYHA Class III/IV
• Severe cyanotic
• Paradoxical embolism
• Cardiomegaly
• Systolic dysfunction
18. Relative contra indication of surgery
• Relative Contra indications:
• Older age(>50 years)
• Moderate pulmonary hypertension
• LVEF <30%
• Complete failure /poor delamination of leaflets
• Severe RV enlargement
• Severe dilatation of true tricuspid annulus
19. Surgical Procedures
• Danielson (valvuloplasty by annuloplasty with/without
annuloplasty ring +horizontal plication of non
functional/atrialized portion of RV)
• Modified Danielson( annular remodeling)
• Carpentier ( rotation valvuloplasty –annuloplasty)
• Cone procedure
• Bichell procedure
• TVR (without plication)
• Starnes procedure (single ventricle palliation strategy)
20. Cone procedure of TV repair -the latest option
• Surgical Delamination Of Fibrous &
Muscular Attachments
• Clockwise rotation of the leaflets and
Suturing margin of PL to SL to form a
cone
• Vertical Plication of Large Atrialized
RV
• Annular Reduction and Re suturing of
leaflets
• Complete reconstruction with partial
closure of ASD/PFO
24. Advantage of Cone repair
Leaflet to leaflet coaptation
Re constractedTV reattached to true annulus
Hinge part of valve is in normal anatomical position
Plication of thin transparent atriaalized RV eliminates chance
of dyskinesia
Excision of redundant RA
Vertical plication allow mentainance of near normal
ventricular anatomy
28. Univentricular/RV exclusion approach (Starnes and Colleagues)
• Patch closure of TV (4-5 mm
fenestrated patch for RV
decompression as it progressively fills
with thebesian venous return)
• Enlargement of interatrial connection
• Placement of systemic to pulmonary
arterial shunt
• RA reduction
• Ligation of MPA (if there is
incompetent PV with patent RVOT
29.
30. Modified Starnes/total RV exclusion(Sano and Associates)
Resection of Free wall of RV followed by
primary closure
PTFE closure
