This document discusses pulmonary sequestration and congenital lobar emphysema. It defines pulmonary sequestration as dysplastic lung tissue that receives blood supply from the systemic circulation and does not communicate with the tracheobronchial tree. There are two main types: intralobar, contained within the normal visceral pleura, and extralobar, contained in its own pleural covering. Congenital lobar emphysema is characterized by overinflation of a lung lobe due to a check valve mechanism, most often affecting the left upper lobe. Both conditions may cause respiratory distress and are typically treated with lobectomy.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
4. Pulmonary sequestration
• Pulmonary sequestration is defined as a
dysplastic pulmonary tissue that does not
communicate with the tracheobronchial
tree
It receives its blood supply from the
systemic circulation usually from aorta.
5. Pulmonary sequestration
The anomalous blood supply can result in
• high-output cardiac failure because of
substantial arteriovenous shunting
through the BPS
• or bleeding with massive hemoptysis or
hemothorax.
6. Pulmonary sequestration
• The term “sequestration,” was first
used in the medical literature by
Pryce in 1946.
• Represents 0.15- 6% of all
pulmonary malformations.
7. Pulmonary sequestration
• Originates from accessory lung bud inferior
to the normal lung bud.
• Another explanation is that a portion of the
developing lung bud is mechanically
separated from the rest of the lung by
– compression from cardiovascular
structures
– traction by aberrant systemic vessels, or
– inadequate pulmonary blood flow
8. Pulmonary sequestration
There are 2 distinctive forms of pulmonary sequestration:
intralobar sequestration 75%
Extralobar sequestration
9. Pulmonary sequestration
• An extralobar sequestration may reside in
the chest, within the diaphragm, or in a
sub-diaphragmatic location.
• Intralobar and extralobar sequestrations can
occur simultaneously.
• An entire lung can be sequestered.
• Bilateral sequestrations have been reported
but are very rare.
10. Intralobar pulmonary sequestration
• The intralobar variety accounts for 75
percent of all sequestrations
• Intralobar sequestration is contained
within the normal visceral pleura.
• It is usually located in the posterior basal
segments of the lower left lobe.
11. Intralobar sequestration ILS
• The arterial supply is from the descending thoracic aorta
through inferior pulmonary ligament in 90% of cases
• Other arterial sources could be the
» intercostal artery,
» subclavian arteries,
» internal thoracic arteries and
» sometimes coronary arterial
• Venous drainage is via the pulmonary veins into left
atrium.
12. Intralobar sequestration ILS
• Intralobar sequestration is rarely
symptomatic
• When present symptoms are nonspecific
» chest pain
» pleuritic pain
» shortness of breath
» Wheezing and
» recurrent infection
13. Intralobar sequestration ILS
• Presents in childhood to adult as
recurrent pneumonias.
• Males and females are equally affected
with ILS
• The recurrent localization of the
pathology in the lower lobe suggests the
diagnosis
14. Extralobar pulmonary Sequestration
• It is a mass of abnormal lung tissue invested in
its own pleural covering.
• Three times less frequent than the intralobar
type (25%).
• usually is associated with other congenital
anomalies
» congenital diaphragmatic hernia
» Pectus excavatum
» vertebral anomalies.
15. Extralobar pulmonary Sequestration ELS
• It is located usually in the left costophrenic
groove.
• About one-sixth are located below the
diaphragm.
• The arterial supply is in most of the cases
arises directly from the thoracic or
abdominal aorta.
16. ELS
• Venous drainage is almost always in the
Azygos
Hemiazygos veins.
Rarely venous drainage is in the
pulmonary veins
17. ELS
• Extralobar sequestration has a male
predominance (80%).
• ELS is usually asymptomatic and
discovered incidentally on a routine X-
ray.
• ELS may cause severe respiratory distress
in newborn OR feeding difficulties
18. ELS
»Older infants and children may present
with
• congestive heart failure
• mitral regurgitation.
»In some particularly uncommon cases the
sequestration can produce even frank
hemoptysis
19. Feature Intralobar sequestration Extralobar sequestration
Age at diagnosis Child to adult Neonate
Sex distribution Equal 80% male
Location Posterior basal left
segment
Independent of lung
Associated anomalies Uncommon Common
Venous drainage Pulmonary Systemic
Bronchial
communications
Present none
20. Diagnosis
Prenatal ultrasound:
– Homogeneous, echogenic, well defined
mass in a paraspinal location, most often
the left lower thorax.
–Feeding artery originating from the
descending aorta can be seen on color
Doppler US
21. Prenatal ultrasound of a sequestration
A) Well defined hyperechoic lesion in the fetal thorax
B) Color Doppler image which shows the arterial supply of the lesion
22. Chest X-ray
–it is difficult to distinguish between ELPS
and ILPS on plain radiographs alone
– ELPS is usually found as
• well defined
• retro cardiac masses
• in the cardiophrenic angle
– Air bronchogram is absent
23. Chest X-ray
ELPS
–It may be found as a sub-diaphragmatic or
mediastinal mass lesion.
– It can be associated with opaque
ipsilateral hemithorax and pleural effusion
26. Chest X-ray
• ILPS is
– more heterogeneous and
– less well defined.
• Focal bronchiectasis, areas of
atelectasis, cavitaion, and cyst
formation may also be recognized.
29. CT
• CT scans have 90% accuracy in the diagnosis of
pulmonary sequestration.
• The most common appearance is homo- or
heterogeneous mass with cystic changes.
• Less frequent findings include a large cavitary
lesion with an air-fluid level
• Emphysematous changes at the margin of the
lesion are characteristic
30. CT
• CT-angiography techniques and 3-
dimensional images can help to show
aberrant arterial supply and anomalous
drainage.
• Helps in the surgical planning
38. Treatment
• The management of a pulmonary
sequestration diagnosed during
fetal life involve
– the conservative treatment and
ultrasound or MRI follow-up.
• Partial or complete regression
during pregnancy is possible.
39. Treatment
• Fetal intervention and excision of
the lesion during fetal life is
required only if
• signs of fetal distress,
• cardiac or vena caval compression
appears
40. Treatment
• After birth therapy will have to be
individualized depending on
• symptoms,
• the nature of the sequestration, and
• the presence of any associated
malformation.
41. Treatment
• Small Intralobar asymptomatic
lesions benefit in many cases of
conservative treatment with careful
long-term surveillance .
42. Treatment
• Other experts advocate that even asymptomatic
lesions should be surgically removed .
• Reasons for surgical excision of an asymptomatic
lesions
– risk of recurrent infections,
– an increase in the arterio-venous shunt,
– pressure effect on adjacent normal lung, airway
compression
43. Treatment
• Surgical treatment is required in symptomatic
lesions.
• Surgery usually involves lobectomy via thoracotomy
or Thoracoscopy.
• Special care must be taken when the vessels are
handled, because of their increased fragility.
• Care must be taken also during dissection not to
produce injury to the phrenic nerve.
46. Congenital lobar hyperinflation
• formerly called congenital lobar
emphysema, is characterized by
progressive over-inflation of a lobe
• results from a check-valve mechanism at
the bronchial level that causes
progressive hyperinflation of the lung.
47. Congenital lobar hyperinflation
• The collapsed airway can act as a one-way
valve, resulting in the air trapping.
• Affected lobe is unable to deflate normally
48. Congenital lobar hyperinflation
• It can either be congenital or acquired.
• The underlying cause can be secondary to
– intrinsic cartilaginous abnormality or
– extrinsic compression of an airway.
49. Congenital lobar hyperinflation
• Intrinsic narrowing can be produced
by the weakness or absence of
bronchial cartilage.
• There is air entry but collapse of the
narrow bronchial lumen during
expiration prevents deflation.
50. Congenital lobar hyperinflation
• Extrinsic compression may be by
• A large pulmonary artery,
• a prehilar bronchogenic cyst,
• an enlarged mediastinal node,
• an aneurysmal ductus arteriosus
• The affected cartilage rings become malformed,
soft, and collapsible
51. Congenital lobar hyperinflation
• muscular coat defect
• mucous membrane fold &
• Stenosis
• have also been implicated in the
development of CLE
52. Congenital lobar hyperinflation
Air trapping in the emphysematous lobe may be the
result of
• dysplastic bronchial cartilages creating a ball-valve effect
• endobronchial obstruction from inspissated mucus or
extensive mucosal proliferation
• extrinsic compression
• diffuse bronchial abnormalities
• Careful preoperative bronchoscopy may help
delineate an intrinsic obstructive lesion
53. Congenital lobar hyperinflation
• Polyalveolosis, or the polyalveolar lobe first
described by Hislop and Reid, has been
found in some cases of congenital lobar
emphysema.
• The total alveolar number is increased
several-fold in this condition,
54. Congenital lobar hyperinflation
• The polyalveolar lobe becomes hyperinflated and
hyperlucent on radiography
• Clinical presentation and imaging cannot
differentiate between true CLE and polyalveolar
lobe,
• Hence, the term “congenital lobar overinflation”
has been used to include both entities
55. Congenital lobar hyperinflation
• The most commonly affected lobe is
the left upper lobe.
• followed by the middle lobe and
the right upper lobe.
56. Congenital lobar hyperinflation
• The distribution of lobar involvement is
– 42.2% in the left upper lobe,
– 35.3% in the right middle lobe,
– 20.7% in the right upper lobe, and
– 0.9% in each lower lobe
57. Congenital lobar hyperinflation
• occurs in 1/20,000 to 1/30,000.
• The upper lobes tend to be the most
frequently involved.
• with the left side more common (40
to 50%) than the right (20%).
58. Congenital lobar hyperinflation
• More common in boys (Male to female ratio is about 3
to 1)
• Most patients become symptomatic during
the neonatal period with respiratory
distress.
• The remaining 50% develop symptoms in
the first 4 months.
59. Congenital lobar hyperinflation
• Myers described three clinical types
• symptomatic in infancy (type I),
• in older children (type II), or is an
incidental finding in
• asymptomatic patients (type III).
• Types II and III are rare
60. Congenital lobar hyperinflation
• In about 10% of patients associated
congenital anomalies are present,
primarily congenital heart disease.
61. Congenital lobar hyperinflation
• The typical postnatal presentation is that of
a new-born showing signs of progressive
respiratory distress
• Respiratory distress in varying severity is
present in 50% of the cases at birth.
63. Congenital lobar hyperinflation
• Physical examination shows:
asymmetry of chest
abdominal retractions on inspiration
hyper resonance and diminished or absent
breath sounds in the affected area
64. Congenital lobar hyperinflation
• The diagnosis is made on X-ray of
the chest showing a:
hyperlucent over expanded area.
compression of the remaining lung
on that side
65. X-ray chest
• It can also show
– widening of the ribs spaces,
– depression of the diaphragm,
– mediastinal shift.
– Compression of the contralateral
lung.
66. X-ray chest
• Chest radiograph:
expanded left lung with
mass effect
• (mediastinal shift to the
right
• and increased left
intercostal space)
67. X-ray chest
• The patient may also present with a
radio-opaque mass on X- ray chest.
• because of delayed clearance of lung
fluid of the affected lobe
68. X-ray chest
• As the fluid is absorbed, the affected segment
or lobe becomes hyperlucent
• Adjacent lobes and structures may be
compressed by the emphysematous lobe
• sometimes ipsilateral and contralateral
atelectasis may occur
69. X-ray chest
• The ipsilateral atelectatic lung is seen as a
small, triangular density in the apical or
supradiaphragmatic region
• the adjacent lobe collapses either caudad or
cephalad but not medial, towards the hilum
• lateral film may demonstrate posterior
displacement of the heart
70. X-ray chest
• Congenital lobar emphysema may
be confused with pneumothorax
or with a simple lung cyst or
acquired cyst.
• In congenital lobar emphysema,
there are bronchovascular
markings within the overdistended
lobe
71. CT
• Computed tomography scanning can
provide:
• More accurate information of the
overdistended lobe.
• its vascularity
• as well as information about the
remaining lung
72. CT
• A) Axial CT
image marked
hyperlucency
of the left
upper lobe,
compatible
with congenital
lobar
hyperinflation
74. Treatment
• Surgicalresection is not needed when
• infants have very mild symptoms that do
not progress,
• emphysematous lobe remains stable and
does not encroach on adjacent lung
75. Treatment
• Surgical intervention and resection of the
affected lobe is required when patient is
Symptomatic
• The surgical procedure in most of the cases
is lobectomy and sometimes
segmentectomy by open or thoracoscopic
approach
76. Treatment
• complete lobectomy instead of a wedge or
segmentectomy of the involved lobe is
preffered.
• Lobectomy favored because of the difficulty,
on a macroscopic level, of determining what
portion of the lung is involved and which is
not.
77. Treatment
• The increased difficulty and morbidity
associated with a partial resection does
not warrant the
• limited benefits of preserving a portion
of possibly diseased lung
78. Treatment
• segmentectomies is done
– In cases where more then one lobe appears to
be involved or there maybe bilateral disease.
– Or in cases where there are no clear anatomic
planes between the upper and lower lobe
lobes and segments of both are grossly
involved.
79. Treatment
• The symptomatic neonate needs to
be operated on immediately.
• In extreme cases an emergency
thoracotomy with decompression of
the chest cavity can be a life saving
intervention and an emergency
lobectomy is performed.
80. Treatment
• The timing of surgery remains somewhat
controversial but there is little evidence to
suggest that delayed resection benefits the
child in any significant way.
• In fact delayed surgery may increase the risk
of infection or respiratory compromise.
• Also early resection maximizes the
compensatory lung growth of the remaining
lobe
81. Treatment
• Many centers have recommended resection at
between 1 to 6 months of age to
• allow for some growth and to decrease the
risk of the anesthesia.