This document discusses bilateral hilar enlargement as seen on clinical imaging and presents several examples. It includes chest x-rays and CT scans showing bilateral hilar adenopathy caused by conditions such as infectious mononucleosis, bronchogenic carcinoma, lymphoma, sarcoidosis, and others. One image also demonstrates enlarged pulmonary arteries due to pulmonary arterial hypertension.
This document discusses eosinophilic pneumonias, which are characterized by infiltration of the lungs with eosinophils. It begins by providing a brief history and classification, dividing causes into those of known cause (such as parasites, drugs, tropical pulmonary eosinophilia) and unknown cause (idiopathic acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, idiopathic hypereosinophilic syndrome). It then discusses several types of eosinophilic pneumonia in more detail, including their presentations, investigations, treatments, and key distinguishing features.
The document discusses various radiographic signs seen on chest x-rays. It describes signs such as the silhouette sign which indicates loss of contrast between adjacent structures, the hilum overlay sign which shows hilar vessels through a mediastinal mass, and air bronchograms which depict air-filled bronchi within consolidated lung. It also covers patterns of parenchymal opacities including alveolar, interstitial and nodular patterns, as well as signs of lung collapse like fissure deformities and compensatory lung changes. Specific findings like the luftsichel sign of left upper lobe collapse and the air crescent sign seen in fungal infections are also summarized.
1. Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies where abnormal dilated vessels provide a right-to-left shunt between the pulmonary artery and vein.
2. PAVMs are usually diagnosed through imaging like chest X-ray, CT, or MRI which show dilated vessels. Right-to-left shunting can be detected using echocardiography, oxygen studies, or pulmonary angiography.
3. Treatment involves embolization to occlude the abnormal vessels which successfully treats over 99% of PAVMs. Surgery is an alternative for cases that cannot be embolized or if embolization fails.
Describes the basic radiology of diffuse interstitial disease ,with differential diagnosis of nodular interstitial pattern and how to approach HRCT findings .
HP/EAA is a type of interstitial lung disease caused by hypersensitivity to inhaled organic antigens like bacteria, fungi or bird proteins. It is characterized by recurrent episodes of inflammation in the lungs following exposure. Acute HP presents with symptoms like cough and fever within hours of exposure, while chronic HP can develop after months to years of intermittent exposure and is associated with fibrosis and honeycomb lung changes on imaging and pathology. The diagnosis is based on clinical history, radiological findings, pulmonary function tests and exclusion of other potential causes of interstitial lung disease. Treatment involves avoiding the causative antigen with corticosteroids sometimes used.
This document discusses bilateral hilar enlargement as seen on clinical imaging and presents several examples. It includes chest x-rays and CT scans showing bilateral hilar adenopathy caused by conditions such as infectious mononucleosis, bronchogenic carcinoma, lymphoma, sarcoidosis, and others. One image also demonstrates enlarged pulmonary arteries due to pulmonary arterial hypertension.
This document discusses eosinophilic pneumonias, which are characterized by infiltration of the lungs with eosinophils. It begins by providing a brief history and classification, dividing causes into those of known cause (such as parasites, drugs, tropical pulmonary eosinophilia) and unknown cause (idiopathic acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, idiopathic hypereosinophilic syndrome). It then discusses several types of eosinophilic pneumonia in more detail, including their presentations, investigations, treatments, and key distinguishing features.
The document discusses various radiographic signs seen on chest x-rays. It describes signs such as the silhouette sign which indicates loss of contrast between adjacent structures, the hilum overlay sign which shows hilar vessels through a mediastinal mass, and air bronchograms which depict air-filled bronchi within consolidated lung. It also covers patterns of parenchymal opacities including alveolar, interstitial and nodular patterns, as well as signs of lung collapse like fissure deformities and compensatory lung changes. Specific findings like the luftsichel sign of left upper lobe collapse and the air crescent sign seen in fungal infections are also summarized.
1. Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies where abnormal dilated vessels provide a right-to-left shunt between the pulmonary artery and vein.
2. PAVMs are usually diagnosed through imaging like chest X-ray, CT, or MRI which show dilated vessels. Right-to-left shunting can be detected using echocardiography, oxygen studies, or pulmonary angiography.
3. Treatment involves embolization to occlude the abnormal vessels which successfully treats over 99% of PAVMs. Surgery is an alternative for cases that cannot be embolized or if embolization fails.
Describes the basic radiology of diffuse interstitial disease ,with differential diagnosis of nodular interstitial pattern and how to approach HRCT findings .
HP/EAA is a type of interstitial lung disease caused by hypersensitivity to inhaled organic antigens like bacteria, fungi or bird proteins. It is characterized by recurrent episodes of inflammation in the lungs following exposure. Acute HP presents with symptoms like cough and fever within hours of exposure, while chronic HP can develop after months to years of intermittent exposure and is associated with fibrosis and honeycomb lung changes on imaging and pathology. The diagnosis is based on clinical history, radiological findings, pulmonary function tests and exclusion of other potential causes of interstitial lung disease. Treatment involves avoiding the causative antigen with corticosteroids sometimes used.
Monitorizarea funcțională pulmonară a pacienților postcovidNOEMIPOROJANSUPPINI
Noemi Porojan-Suppini, Ovidiu Fira-Mladinescu
1 – Disciplina de Pneumologie, Centrul de Cercetare și Inovare în Medicina Personalizată a Bolilor Respiratorii, Universitatea de Medicină și Farmacie“Victor Babes”, Timișoara
2 – Secția Clinică Universitară Pneumologie II, Centrul de Expertiză pentru Boli Pulmonare Rare, Spitalul Clinic de Boli Infecțioase și Pneumoftiziologie „Dr. Victor Babeș” Timișoara
This document discusses coronasomnia, or insomnia related to the COVID-19 pandemic. It notes that insomnia has been one of the most searched terms online recently. Coronasomnia is a term created to describe sleep issues arising from the current health context. Factors like stress, anxiety, lack of exercise and sunlight exposure, and insufficient sleep can all contribute to insomnia. Evaluation of insomnia may involve questionnaires, while polysomnography is used in some cases. Treatment focuses on cognitive behavioral therapy techniques like sleep hygiene and stimulus control. The author's clinical experience has seen over a 30% increase in requests for sleep evaluations and treatments, with most cases being secondary to the current health situation.
Deschidere conferinta medicina la altiitudineTraian Mihaescu
The document discusses guidelines for airline travel for passengers with medical conditions from the Aerospace Medical Association and British Airways Health Services. It provides criteria for evaluating passengers with chronic illnesses, including cardiovascular, pulmonary and neurological conditions, for fitness to fly. It notes that an important proportion of passengers who develop medical issues in-flight later require hospitalization. The guidelines advise medical evaluation and clearance prior to travel for at-risk passengers and discuss contraindications and special precautions to ensure passenger safety during air travel.
Efectul presiunii barometrice asupra pasagerilor din cabina de zborTraian Mihaescu
The document discusses the effects of cabin pressure on passengers during air travel. It notes that the cabin is pressurized to an altitude of 1524-2438 meters, resulting in lower oxygen levels compared to sea level. For most healthy passengers this causes a decrease in arterial oxygen tension. However, for passengers with pre-existing lung conditions, it can cause oxygen saturation levels to drop significantly. The document also reviews guidelines for oxygen use during flights and studies examining passenger discomfort at different cabin altitudes.
Aderenta la tratamentul inhalator in bolile respiratoriiTraian Mihaescu
The document discusses adherence to inhaler treatment for conditions like asthma and COPD. It begins by explaining how reward circuitry in the brain reinforces behaviors that promote survival. It then defines adherence and compliance, noting that adherence involves active patient participation while compliance is more passive following of doctor's orders. The document outlines factors influencing adherence like treatment complexity and social support. It reviews data showing poor adherence to inhalers and notes lower adherence for pulmonary diseases. Finally, it discusses the importance of patient education and inhaler type on adherence, emphasizing the need for simple, effective treatment plans to improve outcomes.
The Birmingham Gauge scale is used to measure the diameter of needles, catheters, sutures and other medical devices. It ranges from 5G, the largest diameter of 12.7 mm, to 36G, the smallest diameter of 0.102 mm. The gauge number does not necessarily correspond to needle color as colors can vary by manufacturer. A table is provided listing common medical devices like needles, syringes and catheters along with their gauge, diameter, flow rate and color.
PROIECT DE PARTENERIAT TRANSFRONTALIER „Educație online fără hotare”DusikaLevinta1
Colaborarea la nivel transfrontalier prin împărtășirea opiniilor, practicilor, metodelor și strategiilor de lucru cu cadrele didactice Republica Moldova și România pentru îmbunătățirea procesului educațional cu finalități comune.
OBIECTIVE Contribuirea la dezvoltarea unei educații de calitate;
Încurajarea formării continue a cadrelor didactice și manageriale;
Facilitarea accesului transfrontalier la resurse educative;
Promovarea dimensiunii interculturale a educației;
Încurajarea inovărilor în elaborarea materialelor didactice;
Utilizarea noilor tehnologii în educație.
Poveștile pentru copii au un rol complex și benefic în dezvoltarea lor, le vor oferi nu doar divertisment, ci și oportunități de învățare și creștere personală.
PARTENERIAT TRANSFRONTALIER REPUBLICA MOLDOVA-ROMÂNIAFlorinaTrofin
olaborarea la nivel transfrontalier prin împărtășirea opiniilor, practicilor, metodelor și strategiilor de lucru cu cadrele didactice din Republica Moldova și România pentru îmbunătățirea procesului educațional cu finalități comune.
1. SCURT ISTORIC AL EFR
Etimologic, spirometria (lat: spirare= a respira)
inseamna masurarea respiratiei.
Se poate atribui paternitatea conceptului lui
Lavoisier care, impreuna cu Seguin, a utilizat
pentru prima data echivalentul unui spirometru
pentru masurarea consumului de O2 la om
(1789).
2. SCURT ISTORIC AL EFR
A devenit clasica atribuirea paternitatii spirometriei moderne lui John
Hutchinson , medic englez nascut in 1811 la Newcastle si mort in
1861 in Insulele Fidji.Asistent la Brompton Hospital din Londra a
publicat intre 1844 si 1846 doua articole remarcabile in Lancet
descriind un instrument de masurare a “capacitatii plamanilor”.
Se pare ca este o eroare istorica pentru ca prima publicatie ce
raporteaza masuratori de volume pulmonare ar fi o comunicare
efectuata de dr Bourgery pe 23 ianuarie 1843 la Academia de stiinte
din Paris
In 1947 ,Robert Tiffeneau doteaza spirometria cu un concept
major:VEMS
3. METODE DE INVESTIGARE
• A.Teste de ventilatie pulmonara
• B.Teste de perfuzie pulmonara
• C.Testele schimbului gazos
4. TESTELE VENTILATIEI PULMONARE masoara;
1.Functia de pompa aspiro-respingatoare a ansamblului plaman-cutie toracica
-volume si capacitati( definesc dimensiuni statice ale pompei)
-debite de aer (definesc cinetica, performantele pompei)
2.Proprietatile mecanice ale plamanului si cutiei toracice
-teste de elasticitate
-teste de rezistenta la fluxul de aer
3.Distributia intrapulmonara a aerului inspirat( efectul fiind homeostazia
compozitiei aerului alveolar) : scintigrafie de ventilatie
4.Testarea reglarii ventilatiei
5.Determinarea presiunilor musculare (muschii sunt organele efectoare ale
ventilatiei)
5. C.TESTELE DE SCHIMB GAZOS
( aduc informatii globale despre functia pulmonara)
• 1.Testul transferului gazos prin MAC :TL CO
• 2.Analiza gazelor sanguine in repaus
• 3.Testarea la efort
6. INDICATII GENERALE ALE EFR
1.Diagnosticarea unui tip de anomalie : ventilatorie, de transfer ,
circulatorie
2.Cuantificarea severitatii disfunctiei
3.Supravegherea eficientei unor masuri preventive sau curative
4.Masurarea tipului de raspuns la teste bronhomotorii
5.Evaluarea preoperatorie
7. DIAGNOSTICAREA UNEI ANOMALII RESPIRATORII
• -La un subiect la care este suspectata o afectiune respiratorie, pe
baza unor elemente clinice ,imagistice, biologice
• -In conditiile existentei unei afectiuni extratoracice susceptibile de a
avea un rasunet respirator
• -Antecedente personale sau familiale
• -Existenta de factori de risc exogeni –de mediu
• -fumat
• -medicamentosi
• (cu potential toxic pe aparatul respirator)
8. CUANTIFICAREA SEVERITATII DISFUNCTIEI
RESPIRATORII
• -Cuantificarea severitatii instantanee cu initierea si ghidarea unui
tratament medicamentos
• Stabilirea prognosticului unei afectiuni
• -Stabilirea gradului de handicap al unei afectiuni respiratorii cronice
• -Stabilirea capacitatii de munca
10. 5.EVALUAREA PREOPERATORIE
• -Rasunetul anesteziei generale si a interventiei chirurgicale pe
functia pulmonara(amputare functionala permanenta in exerezele
pulmonare sau tranzitorie in alte tipuri de interventii functie de calea
de abord).
• -Frecventa crescuta a complicatiilor respiratorii la cei cu afectiuni
cronice bronhopulmonare ( frecventa este variabila functie de tipul
de interventie)
• -Posibilitatea prevenirii aparitiilor complicatiilor la bolnavii cu risc
prin capacitatea EFR de a identifica si trata acesti bolnavi
11. METODE SI TEHNICI DE EFR
-SPIROMETRIA
-PLETISMOGRAFIA
-TRANSFER GAZOS PRIN MAC
-GAZE SANGHINE
-TESTE DE EFORT
12. SPIROMETRIA
• -Metoda de electie in determinarea volumelor pulmonare
mobilizabile: CVL ,CVF si debite ventilatorii fortate expiratorii:
VEMS, PEF, MEF 50, MEF 25 FEF 25-75 sau inspiratorii :VIMS,
PIF, MIF
• -Urmata de teste de bronhodilatatie in caz de DVO
• -Prima treapta in EFR
• -Nu poate determina volume pulmonare nemobilizabile deci este
incapabila sa defineasca restrictia
13. SPIROMETRIA INDICATII
1.Participa la dg unei afectiuni respiratorii
2.Rasunet pe ventilatie a unei afectiuni extrarespiratorii
3.Preventie si depistare (tabagism cumulativ >20 PA )
4.Preoperator
5.Supravegherea unui tratament
14. ATS/ERS 2005 CI EFR
-Absolute: IMA mai recent de o luna
-Relative: - durere toracica sau abdominala, indiferent de cauza
- durere bucala sau faciala exacerbata de piesa buc.
-IUE
-confuzia mentala sau dementa
15. PLETISMOGRAFIA
• -Metoda de electie pentru determinarea :
• -volumelor pulmonare statice :CRF, VR, CPT
• -rezistenta la flux in caile aeriene :Raw, Gaw, sGaw
• INDICATII
• CONTRAINDICATII
16. TESTE DE BRONHODILATATIE
INDICATII
-Se realizeaza ca urmare a unei spirometrii sau pletismografii ce
evidentiaza o DVO pentru evidentierea componentei bronhospastice
a acelei obstructii
-Dupa un test pozitiv de provocare bronsica
-Pentru alegerea unui BD si supravegherea unui tratament BD in astm
-Pentru relevarea unei componente spastice bronsice induse de
inflamatie intr-un astm tratat fara CS (dupa testul de CS)
-Este inutila repetarea acestui test cu ocazia fiecarei spirograme in
supravegherea BPOC care nu au prezentat reversibilitate la teste
anterioare
17. TESTE DE BRONHODILATATIE
CONTRAINDICATII
•
-Se utilizeaza BDSA (beta 2 mimetice sau AC) inhalatorii
-Optima pentru marii obstructivi sau la copii folosirea spacer-ului sau
nebulizarii
-contraindicatii- intoleranta cunoscuta cu:palpitatii, tulburari de ritm
-tireotoxicoza
-ICC
-administrare concomitenta de glicozizi cardiotonoci
-HTA severa ,necontrolata de medicatie
-diabet zaharat
-glaucom, adenom de prostata
Risc minimal la utilizarea singulara pentru TBD
18. TESTUL DE PROVOCARE BRONSICA
• Pune in evidenta existenta unei HRB nespecifice ce este
capacitatea muschiului neted bronsic de a se contracta ca raspuns
la un stimul: -farmacologic (histamina, metacolina administrate in
doze care nu au nici un efect la normal)
• -agent fizic (solutii hipo sau hiperosmolare, effort fizic,
aer rece)
• TPB la metacolina foloseste doze crescatoare de aerosol de
metacolina pana la o doza maxim admisibila.Obtinerea unui
bronhospasm (evidentiabil spirometric sau pletismografic ) cu o
doza cumulata din acest interval semnifica pozitivitatea testului.
19. TESTAREA LA EFORT
• Testul la efort este o explorare integrata a functiilor pulmonara ,
cardio-circulatorie si musculara in conditia in care organismul face
apel la rezervele fiecarui sistem in parte.
• Obiectivele testarii la effort:
-stabilirea sau precizarea diagnosticului
-obictivarea unor simptme (dispnee)
-determinarea mecanismului de limitare a tolerantei la effort:
ventilator ( obstructiv / restrictiv ) , cardio-circulator, muscular
-evaluarea severitatii unui handicap functional
-evaluarea evolutiei bolii, evaluarea unui efect terapeutic
-individualizarea unui reantrenament la effort
-aprecierea riscului preoperator, mai ales la interventii pe torace
20. CONTRAINDICATIILE TESTARII LA EFORT
• 1.Absolute : - cardiace : IMA recent; angor instabil; ICC; miocardite ,
pericardite acute; HTA severa fara raspuns la tratament; SA stransa;
anevrism disecant;
-pulmonare : VEMS < 30% din prezis
insuficienta pulmonara cu Pa02< 40 mm Hg si
PaCO2 >70 mm Hg
-afectiuni febrile acute
2.Relative : -cardiace :BAV grad II / III ; tahicardie in repaus >.120 b/min; aritmii
atriale/ventriculare rapide; maladie valvulara aortica; anomalii ale ECG in
repaus
-tulburari electrolitice severe , tulb neurologice ce impiedica
adaptarea la effort, epilepsie; afectiuni ortopedice
-afectiuni tromboembolice ( inclusiv pulmonare)
-astm bronsic care nu raspunde la tratament
-
21. SIMBOLURI UNITATI DE MASURA
SIMBOLURI PRIMARE C concentratia ( unui gaz in sange)
P presiunea
Q volum de sange
Q debit de sange( volum de sange in unitatea
de timp)
S saturatie
V volumul unui gaz
V debitul unui gaz ( volum de gaz in unitatea
de timp)
22. SIMBOLURI UNITATI DE MASURA
• SIMBOLURI SECUNDARE PT FAZA GAZOASA
A alveolar
B atmosferic ( barometric)
D spatiu mort ( dead space)
E expir
I inspir
L plaman ( lung)
T curent ( tidal)
23. SI MBOLURI UNITATI DE MASURA
SIMBOLURI SECUNDARE PT FAZA SANGUINA
a arterial
c capilar
i ideal
v venos
v venos amestecat
24. UNITATI DE MASURA
Pentru volum : ml ; litri
Pentru presiune : mm Hg ; torr ( echivalent cu mm Hg)
K Pa =7,5 mm Hg
25. MIC DICTIONAR DE EFR
ATPS
(ambient temperature and barometric pressure) = conditiile de masurare
a unui gaz; temp, presiune barometrica si saturatie in vapori de apa)
BE / EB exces de baze
BHR /HRB hiperreactivitate bronsica
BMI (body mass index) / IMC
BP (Blood pressure) / PA / TA mm Hg 100 mm Hg =13.33 KPa
BSA (body surface area / SC
BTPS
(body temperature and barometric pressure , satureted with water vapore)
C complianta l/KPa
26. MIC DICTIONAR EFR
CF / FC frecventa cardiaca batai / minut
CI / IC index cardiac litri / minut
Co (cardiac output) / DC litri / minut
Cv (closing volume) / VF volum de inchidere litri
CVP / PVC (presiune venoasa centrala) mm Hg / K Pa
CxO2 continut in oxigen (x=a;c;v;v)
Δ (A-a)O2 diferenta alveolo-arteriala de O2
Δ (a-v)O2 diferenta arterio-venoasa de O2
E elastanta
EIA / AIE astm indus de effort
ERV / VRE / VER volum expirator de rezerva
EVC / CVE capacitate vitala expiratorie
27. MIC DICTIONAR EFR
FEF 25-75 (forced mid-expiratory flow) / MEF 25-75
(debit expirator fortat median intre 25 si 75% CVF)
FEFV – curve / CDVF
FET (forced respiratory time) / TEF
FEV1 / VEMS
FEV0.5 ; FEV6
FEV1 / CV (indice Tiffeneau)
FEV1 / CVF
FIF (forced inspitarory flow) / DIF debit inspirator fortat
FiO2 ; FeO2 concentratia fractionata de O2 in E , I
FRC / CRF
FVC / CVF (CVI sau CVL ; CVF poate fi mai mic decat CVL in DVO)
28. MIC DICTIONAR EFR
G conductanta
IC / CI capacitate inspiratorie
IRV / VIR volum inspirator de rezerva
IVC / CVI
K coeficient de transfer KCO
MEF25 / DEM25
MEF50 / DEM50
MEF25-75 / DEM25-75 debite expiratorii maximale
(MMEF) (DEMM)
MIF / DIM debit inspirator maximal
PAP / PAP presiunea in artera pulmonara
29. MIC DICTIONAR EFR
PC20 / PC20 concentratia de bronhoconstrictor ce determina scaderea
VEMS cu 20%
PD20 / PD20 doza de BC ce determina scaderea cu 20%
PEF (peak expiratory flow) / DEP
PIF
PVR / RVP rezistenta vasculara pulmonara
Q volum sangvin
Qc (cardiac output) / DC
QoL / QdV calitatea vietii
R rezistanta
Raw (airway resistance) / RVa
RV / VR volumul rezidual
30. MIC DICTIONAR EFR
SVC (slow vital capacity) / CVL
SxO2 ; CO2 saturatia hemoglobinei in O2 ; CO2
TE timp expirator ; TI timp inspirator
TGV (thoracic gas volume) / VGIT
TL (factor de transfer gazos) TLCO
TL / VA (K) coeficient de transfer
TLC / CPT
TV (tidal) / VT volum curent
VA ventilatie alveolara VA / Q raport V/Q
VD ventilatia spatiului mort
Z impedanta