This document discusses various granulomatous conditions that can affect the nose and paranasal sinuses. It begins by introducing granulomas and classifying them as specific or non-specific. Several specific granulomatous diseases are then described in detail, including tuberculosis, leprosy, syphilis, and rhinoscleroma. Diagnostic features, treatments, and complications are provided. Finally, some non-specific granulomas like sarcoidosis, Wegener's granulomatosis, and eosinophilic granuloma are briefly covered.
Granulomatous diseases affecting the nose can be classified as infective, inflammatory, or neoplastic. Infective causes include bacteria like rhinoscleroma, tuberculosis, and syphilis, as well as various fungi. Rhinoscleroma is caused by Klebsiella Rhinoscleromatis and presents in four stages from catarrhal to cicatricial, with granulomatous nodules appearing in the nasal mucosa. Syphilis presents differently based on whether it is acquired or congenital, but can cause gummatous lesions, septal perforation, and saddle nose deformity in the tertiary stage. Leprosy also involves the nose more in the lepromat
This document provides an overview of nasal polyposis. It defines nasal polyps as bags of edematous mucosa that protrude into the nose or sinuses. It describes the different types of polyps and classifications. Common predisposing factors include chronic infection, allergy, aspirin sensitivity, and cystic fibrosis. Signs and symptoms vary from being asymptomatic to nasal obstruction, headaches, and loss of smell. Examination involves nasal endoscopy to view the polyps. Management includes medical treatment with steroids and surgery to remove polyps.
This presentation discusses a case report of a 26-year-old male patient with a right nasal cavity mass. Examination found a solitary pinkish pedunculated mass attached to the lateral nasal cavity wall. CT scan showed a large mass arising from the right middle meatus. A provisional diagnosis of inverted papilloma was made. Inverted papilloma is a benign tumor that arises from the nasal mucosa but can recur, cause destruction, and transform into squamous cell carcinoma. Surgical resection is the main treatment approach.
1) Paediatric rhinosinusitis and its complications discusses the anatomy, development, and types of sinusitis in children. It can cause orbital or intracranial complications if not properly treated.
2) Acute bacterial rhinosinusitis is diagnosed clinically based on symptoms and confirmed with imaging or culture if severe. Treatment involves antibiotics, intranasal steroids, and surgery if abscesses form.
3) Orbital complications range from preseptal cellulitis to orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. IV antibiotics and surgical drainage may be needed for abscesses. Intracranial complications can also occur.
Granulomatous diseases of the nose include those caused by bacteria, fungi, and those of unknown etiology. Rhinoscleroma is caused by Klebsiella rhinoscleromatis and presents as progressive granulomatous lesions in the nose. Syphilis can cause primary, secondary, or tertiary lesions in the nose. Tuberculosis causes lupus vulgaris which presents as apple jelly nodules on the nose. Leprosy involves the nose in its lepromatous form, causing nodular thickening. Rhinosporidiosis is caused by Rhinosporidium seeberi and presents as a strawberry-like mass. Aspergillosis and mucormycos
- Granulomatous diseases of the nose and paranasal sinuses can be caused by infections like tuberculosis and leprosy, as well as non-infectious conditions.
- Tuberculosis of the nose commonly manifests as lupus vulgaris, presenting with nodular or ulcerative lesions. Leprosy can involve the nasal mucosa and cause destruction of the nasal cartilage and bone.
- Syphilis may cause primary chancres or mucous patches in the nasal vestibule and pharynx during its secondary stage.
This document discusses diseases that can affect the maxillary sinus. It begins by describing the anatomy and functions of the maxillary sinus. It then discusses several common diseases that may impact the sinus, including acute and chronic sinusitis, cysts, tumors, trauma, and infections. For each condition, it provides details on symptoms, clinical findings from examinations, and typical radiographic presentations. The document emphasizes the importance of thorough clinical and radiographic evaluation of the maxillary sinus for dentists to properly diagnose and manage diseases in this area.
Granulomatous diseases affecting the nose can be classified as infective, inflammatory, or neoplastic. Infective causes include bacteria like rhinoscleroma, tuberculosis, and syphilis, as well as various fungi. Rhinoscleroma is caused by Klebsiella Rhinoscleromatis and presents in four stages from catarrhal to cicatricial, with granulomatous nodules appearing in the nasal mucosa. Syphilis presents differently based on whether it is acquired or congenital, but can cause gummatous lesions, septal perforation, and saddle nose deformity in the tertiary stage. Leprosy also involves the nose more in the lepromat
This document provides an overview of nasal polyposis. It defines nasal polyps as bags of edematous mucosa that protrude into the nose or sinuses. It describes the different types of polyps and classifications. Common predisposing factors include chronic infection, allergy, aspirin sensitivity, and cystic fibrosis. Signs and symptoms vary from being asymptomatic to nasal obstruction, headaches, and loss of smell. Examination involves nasal endoscopy to view the polyps. Management includes medical treatment with steroids and surgery to remove polyps.
This presentation discusses a case report of a 26-year-old male patient with a right nasal cavity mass. Examination found a solitary pinkish pedunculated mass attached to the lateral nasal cavity wall. CT scan showed a large mass arising from the right middle meatus. A provisional diagnosis of inverted papilloma was made. Inverted papilloma is a benign tumor that arises from the nasal mucosa but can recur, cause destruction, and transform into squamous cell carcinoma. Surgical resection is the main treatment approach.
1) Paediatric rhinosinusitis and its complications discusses the anatomy, development, and types of sinusitis in children. It can cause orbital or intracranial complications if not properly treated.
2) Acute bacterial rhinosinusitis is diagnosed clinically based on symptoms and confirmed with imaging or culture if severe. Treatment involves antibiotics, intranasal steroids, and surgery if abscesses form.
3) Orbital complications range from preseptal cellulitis to orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. IV antibiotics and surgical drainage may be needed for abscesses. Intracranial complications can also occur.
Granulomatous diseases of the nose include those caused by bacteria, fungi, and those of unknown etiology. Rhinoscleroma is caused by Klebsiella rhinoscleromatis and presents as progressive granulomatous lesions in the nose. Syphilis can cause primary, secondary, or tertiary lesions in the nose. Tuberculosis causes lupus vulgaris which presents as apple jelly nodules on the nose. Leprosy involves the nose in its lepromatous form, causing nodular thickening. Rhinosporidiosis is caused by Rhinosporidium seeberi and presents as a strawberry-like mass. Aspergillosis and mucormycos
- Granulomatous diseases of the nose and paranasal sinuses can be caused by infections like tuberculosis and leprosy, as well as non-infectious conditions.
- Tuberculosis of the nose commonly manifests as lupus vulgaris, presenting with nodular or ulcerative lesions. Leprosy can involve the nasal mucosa and cause destruction of the nasal cartilage and bone.
- Syphilis may cause primary chancres or mucous patches in the nasal vestibule and pharynx during its secondary stage.
This document discusses diseases that can affect the maxillary sinus. It begins by describing the anatomy and functions of the maxillary sinus. It then discusses several common diseases that may impact the sinus, including acute and chronic sinusitis, cysts, tumors, trauma, and infections. For each condition, it provides details on symptoms, clinical findings from examinations, and typical radiographic presentations. The document emphasizes the importance of thorough clinical and radiographic evaluation of the maxillary sinus for dentists to properly diagnose and manage diseases in this area.
This document discusses several specific chronic infections that can involve the nose, including nasal tuberculosis, syphilis, leprosy, atrophic rhinitis, rhinitis sicca, and scleroma. For each condition, it describes the causative organism, clinical features, diagnosis, and treatment. Nasal tuberculosis is caused by Mycobacterium tuberculosis and can present as nodular or ulcerative lesions. Syphilis presents in primary, secondary, and tertiary forms depending on the stage of infection. Leprosy is caused by Mycobacterium leprae and can involve the nose in its tuberculoid or lepromatous forms. Atrophic rhinitis and rhinitis sic
This document discusses several infectious, inflammatory, and neoplastic conditions that can affect the nose and sinuses. It provides details on the causative agents, clinical presentation, diagnosis, and treatment of conditions like rhinoscleroma (caused by Klebsiella rhinoscleromatis), rhinosporidiosis (caused by Rhinosporidium seeberi), aspergillosis, mucormycosis, tuberculosis, leprosy, syphilis, Wegener's granulomatosis, and sarcoidosis. For each condition, it describes the characteristic clinical features, pathological findings, appropriate imaging and diagnostic tests, and recommended treatment approaches.
This document discusses various conditions that can affect the external nose, including infections, tumors, vascular lesions, and dermatological diseases. It provides detailed descriptions of common acute infections like furunculosis, vestibulitis, erysipelas, and cellulitis. It also covers chronic infections such as lupus vulgaris and syphilis. Benign and malignant tumors of the nose are listed. Vascular lesions including hemangiomas and pyogenic granulomas are described. Finally, it discusses dermoid cysts and their potential intracranial extensions.
This document discusses various granulomatous diseases of the nose. It begins by defining a granuloma and classifying granulomatous diseases of the nose into bacterial, fungal, and those of unspecified cause. Several fungal infections are then discussed in more detail, including rhinosporidiosis, aspergillosis, mucormycosis, candidiasis, histoplasmosis, and blastomycosis. Bacterial causes such as syphilis, tuberculosis, and leprosy are also covered. Finally, granulomatous diseases of unspecified cause including Wegener's granulomatosis, sarcoidosis, and Churg-Strauss syndrome are mentioned.
Inflamatory diseases of the nose (1) 30.05.16 dr.davisophthalmgmcri
1. Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the nasal mucosa and bones. It causes crusting, foul smell, and an abnormally open nasal cavity.
2. The causes are unclear but may include certain bacteria, viruses, fungi, or genetic and environmental factors. Treatment involves nasal washing, ointments, antibiotics, steroids, and surgery to narrow the nasal cavity.
3. Complications include bleeding, saddle nose deformity, and loss of smell. Related conditions discussed include rhinosporidiosis, rhinoscleroma, and rhinitis medicamentosa caused by overuse of decongestants.
This document discusses pathology of the paranasal sinuses. It describes the different types of sinusitis including acute sinusitis, chronic sinusitis, and chronic sinusitis with polyps. It provides details on the anatomy and function of the paranasal sinuses, classifications of sinusitis, symptoms, diagnoses, and treatment approaches for the different types of sinusitis.
Disease of external nose deviated nasal septum, fb in nose 02.05.16, dr.bini...ophthalmgmcri
1. Cellulitis of the nose presents as a red, swollen, and tender nose caused by bacterial infection from streptococcus or staphylococcus. It is treated with systemic antibiotics, hot fomentation, and analgesics.
2. Deviated nasal septum is commonly caused by trauma but can also be due to developmental errors. It may cause nasal obstruction and other symptoms. Surgical correction by septoplasty or submucous resection is often needed.
3. Foreign bodies in the nose are commonly seen in children ages 2-4 and can cause infection, inflammation, and necrosis if not removed. Common objects include beads, peas, and batteries which cause severe tissue damage. Removal of objects
1. Granulomatous lesions of the nose can be caused by infections, inflammation, or neoplasms. Common infectious causes include tuberculosis, leprosy, rhinoscleroma, and fungal infections like aspergillosis.
2. Sarcoidosis is a common inflammatory cause of nasal granulomas. It is a systemic condition of unknown etiology characterized by non-caseating granulomas. Nasal manifestations include crusting, bleeding, and septal perforation.
3. Wegener's granulomatosis is a necrotizing vasculitis that causes granulomatous inflammation in the respiratory tract and kidneys. In the nose it can cause septal destruction
This document presents a case study of a 39-year old female patient diagnosed with Wergner's Granulomatosis (WG). She presented with left ear itching and drainage. Testing showed positive ANCA and PR3 antibodies. Imaging found lesions in the lung, ear, and sinus involvement. She was diagnosed with WG based on her clinical presentation and test results. She was treated with cyclophosphamide, corticosteroids, antibiotics, and other medications. WG is a rare autoimmune disease that involves inflammation and damage of small blood vessels. It commonly involves the upper respiratory tract, lungs, and kidneys. Without treatment, it can be fatal but prognosis has improved with immunosuppressive therapies.
Epistaxis, or nosebleeds, can occur in people of all ages and have many potential causes. Local causes within the nose include trauma, infections, tumors, and deviated nasal septum, while general causes may relate to cardiovascular, blood, liver or kidney diseases. Anterior nosebleeds, which are more common, usually occur in the front part of the nose and are often mild and easily controlled. Posterior nosebleeds occur deeper in the nasal cavity and may require hospitalization and posterior nasal packing to stop severe bleeding. Proper diagnosis involves determining if bleeding is anterior or posterior, as well as identifying risk factors and underlying medical conditions.
Mucormycosis ppt by Dr. Bomkar bam ENT M.S.Bomkar Bam
mucormycosis in the covid era in India. it is mostly seen in the post-recovery patient of covid - 19. most of the data are derived from the 2nd wave of covid in India.
1) The document discusses various benign polypoidal etiologies of the sinonasal region including nasal polyps, antrochoanal polyps, mucoceles, and sinonasal papillomas.
2) Nasal polyps are soft tissue masses that commonly arise from the ethmoid and maxillary sinuses. Antrochoanal polyps originate in the maxillary sinus and extend into the nasal cavity and nasopharynx.
3) Mucoceles are mucus-filled cysts that develop from obstructed paranasal sinuses. Computed tomography is useful for evaluating their extent and bone changes.
4) Sinonasal papillomas include
This document provides information about otitis externa (ear infection of the outer ear canal). It discusses the anatomy and physiology of the outer ear, classifications and causes of otitis externa including bacterial, viral and fungal infections. It describes the signs and symptoms of acute and chronic otitis externa and treatments including ear cleaning, topical and oral antibiotics, antifungals and corticosteroids. Complications are outlined along with malignant otitis externa, a potentially lethal infection seen in immunocompromised individuals like diabetics.
Vocal cord nodules, polyps, and Reinke's edema are common laryngeal lesions caused by phonotrauma or repetitive vocal trauma. Vocal cord nodules appear as small, whitish lesions at the junction of the anterior and posterior vocal folds. Treatment involves speech therapy and possible microlaryngoscopy or laser excision. Vocal cord polyps are usually unilateral and pedunculated lesions located on the vocal folds. Treatment is surgical excision to confirm diagnosis and prevent recurrence. Reinke's edema causes diffuse swelling of the vocal folds and is associated with smoking. Treatment involves smoking cessation and possible surgery.
Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are defined as a form of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal polyps are most often caused by inflammation within the nose and sinuses and can be triggered by environmental irritants, infections, or genetic factors. Clinically, nasal polyps may cause nasal congestion, nasal discharge, facial pain or pressure, and reduced or loss of smell. They can range in size from small to large polyps that cause significant obstruction. Nasal polyps are often associated with conditions like asthma, aspirin sensitivity, cystic fibrosis, and immune system disorders.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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This document discusses several specific chronic infections that can involve the nose, including nasal tuberculosis, syphilis, leprosy, atrophic rhinitis, rhinitis sicca, and scleroma. For each condition, it describes the causative organism, clinical features, diagnosis, and treatment. Nasal tuberculosis is caused by Mycobacterium tuberculosis and can present as nodular or ulcerative lesions. Syphilis presents in primary, secondary, and tertiary forms depending on the stage of infection. Leprosy is caused by Mycobacterium leprae and can involve the nose in its tuberculoid or lepromatous forms. Atrophic rhinitis and rhinitis sic
This document discusses several infectious, inflammatory, and neoplastic conditions that can affect the nose and sinuses. It provides details on the causative agents, clinical presentation, diagnosis, and treatment of conditions like rhinoscleroma (caused by Klebsiella rhinoscleromatis), rhinosporidiosis (caused by Rhinosporidium seeberi), aspergillosis, mucormycosis, tuberculosis, leprosy, syphilis, Wegener's granulomatosis, and sarcoidosis. For each condition, it describes the characteristic clinical features, pathological findings, appropriate imaging and diagnostic tests, and recommended treatment approaches.
This document discusses various conditions that can affect the external nose, including infections, tumors, vascular lesions, and dermatological diseases. It provides detailed descriptions of common acute infections like furunculosis, vestibulitis, erysipelas, and cellulitis. It also covers chronic infections such as lupus vulgaris and syphilis. Benign and malignant tumors of the nose are listed. Vascular lesions including hemangiomas and pyogenic granulomas are described. Finally, it discusses dermoid cysts and their potential intracranial extensions.
This document discusses various granulomatous diseases of the nose. It begins by defining a granuloma and classifying granulomatous diseases of the nose into bacterial, fungal, and those of unspecified cause. Several fungal infections are then discussed in more detail, including rhinosporidiosis, aspergillosis, mucormycosis, candidiasis, histoplasmosis, and blastomycosis. Bacterial causes such as syphilis, tuberculosis, and leprosy are also covered. Finally, granulomatous diseases of unspecified cause including Wegener's granulomatosis, sarcoidosis, and Churg-Strauss syndrome are mentioned.
Inflamatory diseases of the nose (1) 30.05.16 dr.davisophthalmgmcri
1. Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the nasal mucosa and bones. It causes crusting, foul smell, and an abnormally open nasal cavity.
2. The causes are unclear but may include certain bacteria, viruses, fungi, or genetic and environmental factors. Treatment involves nasal washing, ointments, antibiotics, steroids, and surgery to narrow the nasal cavity.
3. Complications include bleeding, saddle nose deformity, and loss of smell. Related conditions discussed include rhinosporidiosis, rhinoscleroma, and rhinitis medicamentosa caused by overuse of decongestants.
This document discusses pathology of the paranasal sinuses. It describes the different types of sinusitis including acute sinusitis, chronic sinusitis, and chronic sinusitis with polyps. It provides details on the anatomy and function of the paranasal sinuses, classifications of sinusitis, symptoms, diagnoses, and treatment approaches for the different types of sinusitis.
Disease of external nose deviated nasal septum, fb in nose 02.05.16, dr.bini...ophthalmgmcri
1. Cellulitis of the nose presents as a red, swollen, and tender nose caused by bacterial infection from streptococcus or staphylococcus. It is treated with systemic antibiotics, hot fomentation, and analgesics.
2. Deviated nasal septum is commonly caused by trauma but can also be due to developmental errors. It may cause nasal obstruction and other symptoms. Surgical correction by septoplasty or submucous resection is often needed.
3. Foreign bodies in the nose are commonly seen in children ages 2-4 and can cause infection, inflammation, and necrosis if not removed. Common objects include beads, peas, and batteries which cause severe tissue damage. Removal of objects
1. Granulomatous lesions of the nose can be caused by infections, inflammation, or neoplasms. Common infectious causes include tuberculosis, leprosy, rhinoscleroma, and fungal infections like aspergillosis.
2. Sarcoidosis is a common inflammatory cause of nasal granulomas. It is a systemic condition of unknown etiology characterized by non-caseating granulomas. Nasal manifestations include crusting, bleeding, and septal perforation.
3. Wegener's granulomatosis is a necrotizing vasculitis that causes granulomatous inflammation in the respiratory tract and kidneys. In the nose it can cause septal destruction
This document presents a case study of a 39-year old female patient diagnosed with Wergner's Granulomatosis (WG). She presented with left ear itching and drainage. Testing showed positive ANCA and PR3 antibodies. Imaging found lesions in the lung, ear, and sinus involvement. She was diagnosed with WG based on her clinical presentation and test results. She was treated with cyclophosphamide, corticosteroids, antibiotics, and other medications. WG is a rare autoimmune disease that involves inflammation and damage of small blood vessels. It commonly involves the upper respiratory tract, lungs, and kidneys. Without treatment, it can be fatal but prognosis has improved with immunosuppressive therapies.
Epistaxis, or nosebleeds, can occur in people of all ages and have many potential causes. Local causes within the nose include trauma, infections, tumors, and deviated nasal septum, while general causes may relate to cardiovascular, blood, liver or kidney diseases. Anterior nosebleeds, which are more common, usually occur in the front part of the nose and are often mild and easily controlled. Posterior nosebleeds occur deeper in the nasal cavity and may require hospitalization and posterior nasal packing to stop severe bleeding. Proper diagnosis involves determining if bleeding is anterior or posterior, as well as identifying risk factors and underlying medical conditions.
Mucormycosis ppt by Dr. Bomkar bam ENT M.S.Bomkar Bam
mucormycosis in the covid era in India. it is mostly seen in the post-recovery patient of covid - 19. most of the data are derived from the 2nd wave of covid in India.
1) The document discusses various benign polypoidal etiologies of the sinonasal region including nasal polyps, antrochoanal polyps, mucoceles, and sinonasal papillomas.
2) Nasal polyps are soft tissue masses that commonly arise from the ethmoid and maxillary sinuses. Antrochoanal polyps originate in the maxillary sinus and extend into the nasal cavity and nasopharynx.
3) Mucoceles are mucus-filled cysts that develop from obstructed paranasal sinuses. Computed tomography is useful for evaluating their extent and bone changes.
4) Sinonasal papillomas include
This document provides information about otitis externa (ear infection of the outer ear canal). It discusses the anatomy and physiology of the outer ear, classifications and causes of otitis externa including bacterial, viral and fungal infections. It describes the signs and symptoms of acute and chronic otitis externa and treatments including ear cleaning, topical and oral antibiotics, antifungals and corticosteroids. Complications are outlined along with malignant otitis externa, a potentially lethal infection seen in immunocompromised individuals like diabetics.
Vocal cord nodules, polyps, and Reinke's edema are common laryngeal lesions caused by phonotrauma or repetitive vocal trauma. Vocal cord nodules appear as small, whitish lesions at the junction of the anterior and posterior vocal folds. Treatment involves speech therapy and possible microlaryngoscopy or laser excision. Vocal cord polyps are usually unilateral and pedunculated lesions located on the vocal folds. Treatment is surgical excision to confirm diagnosis and prevent recurrence. Reinke's edema causes diffuse swelling of the vocal folds and is associated with smoking. Treatment involves smoking cessation and possible surgery.
Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are defined as a form of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal polyps are most often caused by inflammation within the nose and sinuses and can be triggered by environmental irritants, infections, or genetic factors. Clinically, nasal polyps may cause nasal congestion, nasal discharge, facial pain or pressure, and reduced or loss of smell. They can range in size from small to large polyps that cause significant obstruction. Nasal polyps are often associated with conditions like asthma, aspirin sensitivity, cystic fibrosis, and immune system disorders.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Building trust with communities online and offline
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
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.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
2. Introduction
◼ The nose and paranasal sinus are the site of election
of some dramatic ulcerative granulomatous diseases.
◼ McBride (1897) described a patient with a rapid
destruction of nose and face proceeding to fatal
termination.
◼ Kraus (1929) described a patient with granuloma and
extensive destruction of nose, oral cavity, pharynx
and suggested the term “granuloma
gangraenescens”.
3. ◼ The principle element of a granulomatous condition is a self
evident granuloma consisting of macrophages, epitheloid
cells and a multinucleated giant cell.
◼ Inflammation of blood vessels may be primary or secondary
depending upon the size of vessels affected.
4. .
◼ Large > Giant cell arteritis
medium > Granulomatous arteritis
small
◼ Medium > Polyarteritis nodosa
small >Wegener’s syndrome
◼ Misc > Behcet’s disease
> Kawasaki disease
◼ Secondary vasculitis
◼ Infection related vasculitis
◼ Serum sickness
◼ Malignancy related
6. Tuberculosis:
◼ Tuberculous lesions involving nasal mucosa is very rare. It is
always associated with primary pulmonary tuberculosis.
◼ Macroscopic appearance:
1. Ulcers
2. Polypoidal lesions
3. Nodular lesions
◼ Ulcers are commonly found on the anterior part of the nasal
septum, inferior turbinate and anterior choanae
7. .
Lupus vulgaris
◼ Chronic from of tuberculous infection affecting the skin and
mucous membrane of nose.
◼ The mucocutaneous junction of the nasal septum is the most
common site.
◼ Females more affected than males.
◼ Histopathology:
Sections of these lesions show the classic features of tuberculous
granuloma. These lesions show collection of reticuloendothelial
cells. These cells soon necrose . This necrotic centre is
surrounded by a ring of Reticuloendothelial cells. Lymphocytes,
plasma cells and fibroblasts.
◼ Giant cells are found scattered throughout the tubercle and are
usually multinucleated.
8. ◼ Clinical features
◼ Symptoms:
1. Nasal discharge / obstruction
2. Presence of non foul smelling crusts
3. Epistaxis
◼ Ulceration of nasal mucosa is usually followed by fibrosis
◼ The typical early lesion in the nose is a reddish firm nodule at the
mucocutaneous junction of the nasal septum. These nodules are
known as “Apple jelly nodules”
◼ Septal perforation (cartilage part)
9. ◼ Diagnostic features of Lupus nodules:
1. Blanching
2. Bacterial examination for AFB
3. Biopsy is diagnostic
◼ Complications:
1. Dacryocystitis
2. Lupus of face
3. Atrophic rhinitis
4. Development of epithelioma
10. Treatment
Antituberculous drugs:
◼ Rifampicin 450-600 mg per day or 10 -12 mg /kg body weight
and for intermittent therpy 900mg
◼ Isoniazid 4-5 mg /kg body weight daily and for intermittent
therpy its 14-15 mg /kg body weight+ pyrodoxine10-20 mg daily
◼ Streptomycin 0.75-1gm daily
◼ Pyrazinamide 30 mg/kg body weight or 45- 50 mg /kg body
weight twice weekly
◼ Ethambutol 1200 mg /kg
11. Leprosy
◼ This is a chronic granulomatous disease caused by M. Leprae
◼ Types of leprosy:
◼ Tuberculoid leprosy: are solitary lesions involvement of one or more
sensory or motor nerves
◼ Paralysis of muscles
◼ Skin lesions may extend up to the nasal vestibule
◼ Lepromatous leprosy:
◼ In this type of leprosy there is diffuse infiltration of skin, nerves and
mucosal surfaces by the bacteria
◼ Cutaneous infiltration is more common over the edges of
pinna, chin, nose and eyebrows
◼ crust formation, nasal obstruction and Serosanguinous discharge.
◼ Nasal bridge collapse is commonly seen in these patients
12. .
◼ Diagnosis can always be confirmed by the scrapings of nasal
mucosa. They demonstrate the typical cigar pattern Lepra bacilli.
◼ Commonly positive scrapings can be obtained from the anterior end of
inferior turbinate
◼ Borderline leprosy:
◼ These patients have poor immunological resistance
◼ In pure borderline lesions involvement of nasal mucosa is not seen
13. .
Treatment
◼ Triple therapy:
1. Rifampicin – 600mg on first two days of a month taken before
breakfast
2. Clofazimine – 100mg on alternate days for three times a week
3. Dapsone – 100 mg a day
◼ These drugs are continued for 3 months after which Rifampicin
is stopped. Other two drugs are continued till 9 months are
completed.
◼ Nasal douching with saline help in removal of crusts.
14. .
Syphilis:
◼ Nasal syphilis can affect any age group.
◼ Histopathology:
◼ Diagnosis is purely histopathological. It is characterized by
oedema,stromal infiltration with lymphocytes, plasma cells and
endothelial cells. Perivascular cuffing and endarteritis will cause a
reduction in the lumen of blood vessels causing necrosis and ulceration.
◼ Nasal syphilis can be classified into:
1. Primary syphilis: (chancre)
◼ Hard, non tender ulcerated papule always associated with enlarged,
rubbery, and non tender lymphadenopathy.
15. .
◼ Diagnosis is based upon:
1. Cultures from the surface of the lesion will always be negative
2. Smears when examined under dark ground illumination will
show the spirochete Treponema palladium
3. Serological tests for syphilis is positive – VDRL,FTA-ABS
4. A biopsy from suspicious lesion may confirm the diagnosis.
◼ Secondary syphilis:
This is the most infectious of all the three stages of syphilis.
Symptoms usually appear 6-10 weeks after inoculation.
The symptoms include:
◼ Simple catarrhal rhinitis (persistent)
◼ Crusting & fissuring of nasal vestibule
◼ Other secondary lesions like mucous patches in the pharynx.
◼ Papular skin rashes
◼ Enlarged non tender lymph nodes
◼
16. .
Tertiary syphilis:
◼ This stage is commonly encountered in the nose. The lesion is
also known as gumma.
◼ This lesion invades the mucous membrane, periosteum and bone. The
bony portion of the nasal septum is frequently affected causing septal
perforation.
◼ Rarely the following portions of the nose can also be involved:
1. Lateral nasal wall
2. Frontal sinus
3. Nasal bones
4. Floor of the nose
17. /
Symptoms include:
1. Pain / headache (worse during night)
2. Swelling / obstruction of nose - swelling may be diffuse /
localized associated with offensive discharge, bleeding and
crusting of the nose
3. Olfactory acuity diminishes
4. septal perforation
5. There may also be associated secondary atrophic rhinitis
6. The lesion is usually unilateral, but if septum is involved then
swelling may be present in both sides of the nasal cavity.
7. Tenderness over the bridge of the nose is a characteristic sign
18. .
◼ Diagnosis is based upon
1. The swollen nasal mucosa does not shrink when
vasoconstrictors are used.
2. Radiographs show rarefaction of bone.
3. Serological tests for syphilis are positive
4.Biopsy from the lesion is diagnostic.
19. Treatment
◼ The first-choice treatment for uncomplicated syphilis remains a
single dose of intramuscular penicillin .
◼ Doxycycline and tetracycline are alternative choice; however, it
cannot be used in pregnant women
◼ Antibiotic resistance has developed to a number of drugs
including macrolides, clindamycin,and rifampin.
◼ Ceftriaxone is also effective.
20. .
Nasal complications of gumma:
1. Secondary infections with pyogenic organisms
2. Sequestration
3. Perforation of bony portion of nasal septum, palate or nasal
walls
4. Collapse of bridge of nose with deformity of nose
5. Scarring / stenosis of nasal passages
6. Atrophic rhinitis
7. Intracranial complications due to involvement of meninges
21. .
Yaws
◼ This condition is also known as “Framboesia”. This disease
closely resembles syphilis in its pathology.
◼ Seen mostly in central Africa, Jamaica
◼ Causative organism: Treponema Pertenue.
◼ Transmission: Is by direct extra genital contact.
22. .
Clinical features:
◼ Primary, secondary and tertiary stages occur as in syphilis. Yaws
characteristically affects the skin.
◼ Mucous membrane are usually spared .
◼ Advance nasal lesions are associated with extensive destruction
of the nose, palate etc.
◼ Destruction also may involve the whole of the maxilla, face and
pharynx
23. .
Rhinoscleroma: “Scleroma”
◼ This is a progressive granulomatous lesion beginning in the nose
and eventually extending into the Nasopharynx and oropharynx.
Rarely larynx, trachea and lower airway may also be involved.
◼ Scleroma may occur at any age.
◼ Both sexes may equally be affected
24. .
◼ Pathology: Organism Klebsiella Rhinoscleromatis.
◼ Granulomatous tissue infiltrates the submucosa and is
characterized by the presence of accumulation of plasma cells,
lymphocytes and eosinophils among which are scattered
large foam cells (Mikulicz cells). These foam cells have a central
nucleus.
◼ Russell bodies have also been demonstrated.
Investigations:
◼ Levin test: This is a complement fixation test.
◼ Serum with suspensions of K. Rhinoscleromatis.
◼ High titres of antibodies against K. Rhinoscleromatis has been
demonstrated. This indicates humoral immunity to be intact in these
patients
25. .
◼ Clinical features:
Three different stages have been documented:
1. Atrophic stage: In this stage changes appear in the nasal mucous
membrane.These changes resemble that of atrophic rhinitis. Foul smelling
crusts are seen.
2. Granulation / nodular stage: Nodules are non ulcerative in nature. Initially
these
nodules are bluish red and rubbery. Later these nodes become a little paler
and harder.
◼ 3. Cicatrizing stage: Adhesions and stenosis distort the normal nasal anatomy.
The shape and contour of the nose changes causing a condition known as
“Tapir’snose”. The disease may extend to involve the maxillary sinus, naso
lacrimal duct, Nasopharynx, trachea and bronchi. Lymphatic spread is
uncommon becauseof extensive fibrous tissue deposition. This deposition
blocks the lymphatics
26. .
◼ Diagnosis is confirmed by biopsy.
◼ Bactericidal antibiotics should be administered
in large doses. It should be administered atleast
for a period of 4-6 weeks.
Surgical debridement should be considered
when extensive cicatrization is present.
27. Non specific granulomas
Sarcoidosis
◼ This granulomatous lesion is a systemic condition of unknown
etiology.
◼ This may affect any part of the body
◼ Sarcoidosis affect young adults,commonly between their 3rd and
5th decades of life. Females/males by a ratioof 2:1.
◼ Etiology: Etiology is unknown. Various theories have been
proposed.
◼ Infective agents (? Viral)
◼ Chemical (Beryllium & Zirconium)
◼ Pine pollen
◼ Pea nut dust
28. .
◼ Immunology in patients with Sarcoidosis:
1. Type IV delayed hypersensitivity is depressed
2. Cell mediated immunity is normal
3. Type I humeral immunity is normal
4. Total plasma protein levels are raised
5. There is an increase in the amount of circulating immune
complexes
29. .
Histology:
◼ Sarcoid granuloma is characterized by epitheloid cells
surrounded by lymphocytes and fibrocytes, but there is no
caseation.
◼ Crystalline / calcified inclusion bodies are seen. These bodies are
known as Schaumann bodies.
30. .
Clinical features:
1. Nasal stuffiness / obstruction
2. Crusting
3. Blood stained discharge
4. Purulent discharge
5. Facial pain
6. Mucoid discharge
7. Anosmia
◼ Nasal cavity mucosa has a characteristic granular appearance
(strawberry skin).
◼ The anterior portion of the nasal septum may perforate,
especially if traumatized for example during surgery
◼ Adenoid enlargement may lead to middle ear effusion
31. /
◼ Diagnosis: Is by a combination of histology, imaging,
hematology and clinical acumen.
◼ 1. Kveim test: This is a skin test which helps in the diagnosis of
Sarcoidosis.
This test is performed by intradermal injection of a filtered
extract of spleen from a patient with sarcoid. Six weeks later a
skin biopsy is taken. The test is positive when the histology
shows features of Sarcoidosis.
◼ 2. Angiotensin converting enzyme is found to be elevated in
patients during acute phase of the disease
3. ESR levels are raised
4. X-ray chest will identify pulmonary lesions
32. .
Treatment:
◼ Some patients may be lucky enough to have the benefit of
spontaneous resolution.
Majority of the patients are treated with a combination of oral
steroids, methotrexate and hydroxychloroquine.
◼ The treatment modality depends on the severity of the disease.
Nasal douching may be needed to remove the crusts.
Endoscopic sinus surgery may be needed to treat secondary
bacterial infection
33. Churg Strauss Syndrome
◼ Defined as eosinophil-rich and granulomatous inflammation
involving the respiratory tract and necrotizing affecting small to
medium sized vessels associated with asthma & eosinophillia.
◼ Lesion show necrotising giant cell vasculitis,granuloma
formation and eosinophillic pulmonary infiltrates.
◼ There may be nasal crusting & septal perforation
◼ Treatment includes :
◼ Oral steroids
◼ Surgical resection of the polyp.
34. Eosinophilic granuloma
◼ Proliferation of langerhans cells associated with inflammatory
infiltrates of eosinophillia, histocytes, plasma cells and
neutrophils.
◼ Males more affected than females.
◼ Clinical features include
◼ Painful sweeling of the bone (temporal ,frontal ,parietal)
◼ Cervical lymphadenopathy
◼ Mandibular lesion produce toothache, gum ulceration, loose teeth.
◼ Histology :langerhans cells are mixed with eosinophils, plasma
cells, neutrophils.
◼ During healing phase stoma becomes hard.
35. ◼ Treatment includes:
◼ In unifocal disease curettage and excision is done.
◼ Chemotherpy regime include etoposide and steroids given over a
period of 12 months
◼ Recently alpha interferon and bone marrow transplantation is
done.
36. Giant cell granuloma
◼ Benign condition generally seen in young adults.
◼ Clinical features include:
◼ Pain and seliing
◼ Diplopia
◼ Maxilla and mandible are most commonly affected.followed
by sphenoid and temporal bones.
◼ Histology : cellular fibroblastic stoma containing giant cells
◼ Treatment: curettage and excision.
37. .
◼ Cholesterol granulation
◼ Cholesterol precipitated in the tissue resulting in
haemorrhage or trauma.
◼ Males more affected than females
◼ Lesion may affect the maxilla , frontal sinus producing
expansion of the bone cosmetic deformity and
displacement of the adjacent structures.
◼ Histology shows apperance of granulation tissue containing
forgien body type giant cells created by cholestrol crystals.
◼ Treatment : excision
38. Wegener’s granulomatosis
◼ The condition was named after Dr. Friedrich Wegener
in 1936.
◼ It is a rare condition characterized by granulomatous
inflammation involving the respiratory tract and
necrotising vasculitis affecting small to medium sized
vessels.
◼ The disease is seen in 3rd decade of life.
◼ Males are more affected than females 4:1
39. .
◼ May attack the respiratory system, sinuses, nose,
kidney.
◼ Rarely seen affecting the central nervous system
40. Clinical features
◼ Rhinitis is the first sign in most of the patients.
◼ There may be associated symptoms like fever,
weight loss, anemia, joint pain, night sweats, fatigue.
◼ The disease may progress despite of antibiotic
treatment causing odema of the face, eyes,
proptosis, antroalveolar fistula or even saddle
deformity of the nose due to perforated septum.
41. .
◼ Ears : Conductive hearing loss due to auditory tube
dysfunction sometimes SSN.
◼ Oral cavity : gingivitis, bone destruction causing
loosing of teeth, nonspecific ulceration throughout
oral mucosa.
◼ One of the main feature is
vasculitis.
42. .
◼ Other affected organs:
◼ Lungs : may complain of pain, cough, haemoptysis.
◼ Bronchial stenosis is found in 20% of the cases
◼ Kidney : rapidly progressive glomerulonephritis seen in
75% of the cases leading to CRF.
◼ Trachea : may cause subglottic stenosis.
◼ Eyes : scleritis, conjuctivitis, episcleritis.
◼ Nervous system : occasionally sensory neuropathy (10%)
43. Pathophysiology
◼ It is widely presumed that ANCA’s are
responsible for inflammation of wegener’s.
ANCA’s Neutrophil Endothelium
damage to
endothelial cells
44. Histopathology
◼ Presence of multinucleated giant cells is helpful in
correct interpretation of the presenting lesion.
◼ The giant cells in Wegener granulomatosis resemble
those of tuberculosis (langhans type).
◼ The cytoplasm is more compact, homogenous and
eosinophilic.
◼ Necrotising arteritis is the essential feature of
microscopical picture.
45. .
◼ Vessel walls are infiltrated by acute inflammatory
cells and show a partial fibrinoid necrosis.
◼ Patchy necrosis is also the essential feature for
diagnosis.
46. Criteria for diagnosis
◼ In 1990 ACR accepted criteria for WG
◼ Two or more positive criteria have a senstivity of
88.2% and specificity of 99.2% of describing
Wegener’s Granulomatosis.
◼ Nasal or oral inflammation :
◼ Painful or painless oral ulcer.
◼ Purulent or bloody nasal discharge.
◼ Lungs :
◼ Nodules
◼ Infiltrates
◼ Cavities
47. .
◼ Kidney :
◼ Microhematuria
◼ Red cells casts
◼ Granulomatous inflammation within the arterial wall or in
the perivascular area.
48. .
◼ According to Chapel Hill conference on
nomenclature of systemic vasculitis diagnosis is
based:
◼ Granulomatous inflammation involving the respiratory
tract.
◼ Vasculitis of small to medium size vessels.
49. Diagnosis
◼ Wegener granuloma is suspected when the patient has
unexplained symptoms.
◼ Determination of ANCA’s be a useful aid in diagnosis
◼ Cytoplasmic staining ANCA react with enzyme proteinase-3
and are associated with wegener’s.
◼ If the patient has renal failure then biopsy should be sent.
◼ Urine test may detect protein, red blood cells and albumin.
50. .
◼ Blood tests may show increased ESR. (30 -60 mm/hr)
◼ CT scan of sinus may show bony erosion
51. Treatment
◼ Initially treatment is started with corticosteroids
1mg/kg/day and cyclophosphamide 2mg/kg/day.
◼ Occasionally cyclophosphamide can be given by I.V
route also.
◼ Monitoring of WBC is important in CYC therpy.
◼ Once remission is attained ( after 3-6 months )
treatment can be changed to azathioprine or
methotrexate which are less toxic drugs.
52. .
◼ Corticosteroids can be tappered to a low dose of
5-10 mg/day.
◼ Plasmapheresis may be benificial in severe cases or
pulmonary haemorrhage.
◼ In localized disease treatment with cotrimoxazole is
recommended.
◼ In CRF plasma exchange is benificial.
53. .
◼ Other drugs used are:
◼ Mycophenolate mofetil
◼ Antithymocyte globulin
◼ Rituximab
◼ Some patients with severe subglottic stenosis
tracheostomy is required to maintain airway.
54. Prognosis
◼ About 60% of the patients die within a year of
contacting the disease and 90% die within 2 years.
◼ 50% of the patients have been reported a have
relapse after proper medical management.
55. Idiopathic Midfacial Pleomorphic Granuloma
(Stewart’s Type)
◼ Most commonly seen in elderly people in 6th and 7th
decade of life.
◼ Seen more in white people.
◼ Males are more affected than females ( 4:1 )
56. ,
◼ Friedmann (1964) described pleomorphic granuloma
as a “ non healing or malignant granuloma of the
nose, an autoimmune disorder”.
◼ It is a multinating process that progressively destroy
the nose, paranasal sinus, palate.
57. Clinical features
◼ Clinical features can be described in to three stages:
◼ Prodomal stage of nasal stuffiness with serous
rhinorrhoea.
◼ Active stage with nasal obstruction caused by granulation
tissue covered with crusts.
◼ Terminal stage with wide spread invasion sometimes
toxemia and death.
58. .
◼ Ulceration can spread and destroy the soft tissue, cartilage
and bone.
◼ The ulcerated mucosa is covered by a sticky black or
brownish yellow crusts, removal of which reveals granulation
tissue.
◼ Exposure of bone may lead to formation of sequestra while
ulceration of the septum and turbinate may spread rapidly
through the nose involving the hard palate which may at
times perforate.
◼ Bacterial infection may lead to inflammatory odema of the
lips, cheek and subcutaneous abscess may follow.
59. .
◼ Extensive destruction may result in exposure of the roof of
the maxillary sinus, involvement of the orbit and loss of tooth.
◼ Similar destruction may involve the nasopharynx, oropharynx
and hypopharynx.
◼ Cachexia, haemorrhage and recurrent infection may lead to
death of the patient.
60. Histopathology
◼ Microscopic picture of polymorphic reticulosis is
seen
◼ Various pattern can be seen :
◼ Non specific pleomorphic cellular granulation tissue
containing waves of fibrous tissue.
◼ Non specific granulation tissue with histiocytes
predominating.
◼ Non specific granulation tissue with necrotising changes
predominating.
62. Investigation
◼ Biopsy is mandatory if the results are equivocal then
biopsy should be repeated.
◼ Radiographic examination of the skull shows bony
destruction and will demonstrate opacity of
paranasal sinus.
◼ Haematological examination shows
◼ Increased ESR
◼ Blood picture reveals
◼ Microcytic anemia.
◼ Eosinophilia.
◼ Chest x-ray shows periarteritis nodosa.
63. .
◼ Urinalysis may show presence of red blood cells
albumin, casts.
◼ Serum studies to exclude syphilis.
64. Treatment
◼ Radiotherpy is the choice of treatment.
◼ Surgery is required for biopsy and debridement if
required.
◼ Corticosteroids
◼ Prednisolone 60 mg .
◼ Dexamethasone 8mg in three divided doses.