Ultrasonography Doppler is useful in differentiating carotid occlusion from near-occlusion. Near-occlusion is defined as severe stenosis at the bulb followed by collapse of the distal ICA (string sign). Total occlusion is characterized by absence of any flow in the extracranial ICA, while near-occlusion may show variable flow patterns. Doppler criteria for stenosis grading do not apply in near-occlusion/occlusion. CT or MR angiography can help confirm ultrasound findings of total versus near occlusion. Optimizing Doppler parameters is crucial to avoid false positive occlusion diagnoses.
introduction, causes, risk factors, symptoms, examination, investigations and management of peripheral arterial disease.
how to assess the patient and what will be the complications of PAD, physiotherapy treatment for PAD
atherosclerosis is one of most common cause of aortic ds,screening of abdominal aorta in vulnerable population is very useful for prevention and early detection of future omplication.
introduction, causes, risk factors, symptoms, examination, investigations and management of peripheral arterial disease.
how to assess the patient and what will be the complications of PAD, physiotherapy treatment for PAD
atherosclerosis is one of most common cause of aortic ds,screening of abdominal aorta in vulnerable population is very useful for prevention and early detection of future omplication.
A refresher course on imaging in peripheral arterial disease (PAD). The session also includes talk on clinical exam in PAD, MRA in PAD and interventional radiology treatment of PAD.
A refresher course on imaging in peripheral arterial disease (PAD). The session also includes talk on clinical exam in PAD, MRA in PAD and interventional radiology treatment of PAD.
Sudden Cardiac Death and Aborted SCD in Patients with Anomalous Aortic Origin...Hunain Shiwani
Delivered at the American Congress of Cardiology 2018 - Orlando, FL. Sudden Cardiac Death and Aborted SCD in Patients with Anomalous Aortic Origin of a Coronary Artery (AAOCA): A Comprehensive Review of the Literature
Anomalous coronary arteries: Challenges in Access and InterventionGhazi Muheeb
This is a ppt i presented during my residency at GB Pant hospital, 2019-2022. I have included many angiogram videos but unfortunately they are not playable on slideshare. I hope this will cardio residents and consultants during their day to day practice.
Dr. Ghazi Muheeb
Senior resident (DM),
GB Pant Hospital and MAMC, New Delhi.
Diagnosticul si tratamentul TVP nu sunt intotdeauna usor de realizat. Din constelatia de antitrombotice, alegerea schemei si dozajului terapeutic pentru liza trombusului si/sau preventia secundara, pune serioase probleme in practica medicala
Colangiografie percutana transhepatica si drenaj biliar extern ALEXANDRU ANDRITOIU
colangiografie percutana transhepatica combinata cu drenaj biliar extern si drenaj peritoneal la un pacient cu ciroza hepatica atrofica, colangiocarcinom centrohilar si ascita refractara complicat a 5-a zi post-intervnetie cu colangita (angiocolita) si exitus
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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1. Ultrasonografia Doppler inUltrasonografia Doppler in
diferentierea ocluziei carotidienediferentierea ocluziei carotidiene
de preocluziede preocluzie
Alexandru Andritoiu, MD, MPh
Spitalul Clinic de Urgenta Militar
Craiova
Doppler Ultrasound in theDoppler Ultrasound in the
differentiation of carotid occlusiondifferentiation of carotid occlusion
from near-occlusionfrom near-occlusion
2. TermeniTermeni
• Ocluzie
• Falsa ocluzie
• Subocluzie
• Ocluzie incompleta
• Stenoza preocluziva
• Preocluzie
Se adreseaza cel mai adesea ACI, dar si ACC sau ACE pot fi afectate
3. DefinitiiDefinitii
• Ocluzia carotidiana: absenta oricarui
flux pe traiectul ACI extracraniene
• Preocluzia carotidiana: stenoza severa
la nivelul bulbului urmata de colaps al
ACI distale (string-sign)
Thanvi B, Robertson T. Postgrad Med J 2007;83:95–99.
Simptomatica vs. Asimptomatica
4. Importanta clinicaImportanta clinica
• Relatia cu patologia
neuro-vasculara
• AIT
• Stroke
• Sdr. ischemie
cronica oculara
• Stenoza ACI
simptomatica
• Stenoza ACI
asimptomatica
• Ocluzie ACI
• -acuta
• -cronica
IMPORTANTA TERAPEUTICA
5. Importanta terapeuticaImportanta terapeutica
• Stenoza simptomatica 70%: endarterectomie-stent
• Stenoza asimptomatica: tratament farma
• Preocluzia
• Riscul operator sau interventional depasesc riscul de
stroke (meta analiza NASCET/ECST)
Exceptie: Preocluzia simptomatica cu colaps al ACI
distale: indicatie de endarterectomie (stent)-riscul de
recidiva a stroke-ului este de peste 40%
• Ocluzia acuta: tromboliza pe cateter urmata de
tratament endovascular (angioplastie si stent) sau
endarterectomie
• Ocluzia cronica: by-pass extra-intracranian (a.
temporala superf. si ACM)
6. Evolutia stenozei catre ocluzie
• Risc adesea supaestimat
Cauze
• Stenoza stransa
• Absenta stenozei semnificative
Alti factori
• placa ulcerata
• disectia
• embolia
• post-endarterectomie
J. David Spence JAMA Neurology Nov 2015
7. • Pionier al masurarii placii carotidiene (planimetrie,
volum 3D)-relatia cu RCV
• In preventia stroke-ului, tinta trebuie sa fie placa
arteriala si nu FRCV (LDL-Col)
• Doar 5% dintre pts. cu stenoza ACI ar beneficia de
revascularizare-Doar cei cu microembolizari
documentate la TCD!
• Doar prin masuri farmacologice intensive s-a observat
reducerea riscului de stroke si IMA de la 8% la 1%
• Critica excesul de stentare carotidiana din SUA pe
care-l echivaleaza cu malpraxisul!
Robarts Research Institute
Canada
8. Tehnici de diagnosticTehnici de diagnostic
• Angiografia standard
• CT-Angio
• RMN-Angio
• US
USUS
• 2D/3D (gray-scale)
• CDI
• PWD
• Slow-flow sensitivity
• Power-angio
• Photopic
• B-flow
• Sie-Flow
• CEUS
• IVUS
10. Corelatia MVRatio-%Sten ACICorelatia MVRatio-%Sten ACI
• Corelatia MVR cu stenoza ACI
masurata angiografic dupa criteriile
NASCET
• Corelatia MVR cu stenoza ACI masurata
dupa criteriile ECST.
Ranke S et al. – Stroke 1999
MVR (raportul velocitatilor medii)
Raportul intre Velocitatea medie masurata la nivelul stenozei si Velocitatea medie masurata distal de
stenoza
13. PreocluziaPreocluzia
(1-10% din stenozele stranse)(1-10% din stenozele stranse)
• a). Rezultatul unei stenoze progresive
care devine subocluziva
• b). Rezultatul unei recanalizeri postr-
trombotice
• !!!Velocitatile sunt mari in preocluzia fara
colaps distal si pot fi mari sau f. joase in
preocluzia cu colaps complet.
• In cazul preocluziei nu se aplica grade de
severitate (%Sten)
Johansson E. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke.J Intern Med 2015
El-Saden SM. Imaging of the internal carotid artery: the dilemma of total versus near total occlusion. Radiology 2001
14. Carotid Artery Stenosis: Gray-Scale and Doppler US
Diagnosis Society of Radiologists in Ultrasound
Consensus Conference
• In cases of near occlusion of the ICA, the velocity
parameters may not apply, since velocities may be high,
low, or undetectable. This diagnosis is established
primarily by demonstrating a markedly narrowed lumen at
color or power Doppler US.
• Total occlusion of the ICA should be suspected when
there is no detectable patent lumen at gray-scale US and
no flow with spectral, power, and color Doppler US.
Magnetic resonance (MR) angiography, computed
tomographic (CT) angiography, or conventional
angiography may be used for confirmation in this setting.
EG Grant, Radiology 2003
16. Criteriile angiografice
Near-Occlusion
• Termen folosit de Gabrielsen (1981) ptr. a
descrie o stenoza stransa cu colaps distal.
• Near-occlusion with full collapse (string sign)
• Near-occlusion without colapse (nu poate fi diferentiata
de o stenoza stransa)
18. • …the near occlusion prognosis with full collapse
(higher risk) differs from that without full collapse
(lower risk). Patients with near-occlusion with full
collapse show compromised cerebral
hemodynamics.
• Sonography, common as the first and often only
carotid imaging, cannot distinguish near-occlusion
without full collapse from conventional stenosis with
peak systolic velocity analyzed.
AJNR Am J Neuroradiol 2016
19. Ocluzia CAR
Ocluzia acuta
• simptomatologie neurologica zgomotoasa
• urgenta neurologica-masuri complexe (unitati de
stroke)
• US-material anecogen endoluminal si absenta
semnalului Doppler
Ocluzia cronica
• bine tolerata neurologic prin instalarea mecanismelor
de autoreglare circulatorie cerebrala
• US-material ecogen (eventual placi hiperecogene) si
absenta semnalului Doppler
23. Fluxul in ACE ipsilateralaFluxul in ACE ipsilaterala
a) Flux inversat
b) Flux internalizat
24. Echocontrast-Enhanced Ultrasound ofEchocontrast-Enhanced Ultrasound of
Extracranial Internal Carotid Artery High-Extracranial Internal Carotid Artery High-
Grade Stenosis and OcclusionGrade Stenosis and Occlusion
• Echocontrast helps to
obtain Doppler
signals, especially in
the distal parts of the
ICA.
Droste DW et al.- Stroke 1999
25. CEUS is superior to conventional Doppler US and is similar to CTA
CLINICS 2015;70(1):1-6
27. The 4 patterns of collateral flow via the circle of Willis to the hemisphere ipsilateral to the
symptomatic ICA occlusion. PCoA indicates posterior communicating artery.
Pattern of flow via the OphA ipsilateral to the symptomatic occluded ICA in patients with a
symptomatic ICA occlusion 0 to 6 months, 6 to 12 months, and 12 to 18 months after
symptoms occurred. Left, Patients with a unilateral ICA occlusion (n=41). Right, Patients with
a bilateral ICA occlusion (n=21).
Rutgers D et al.- Stroke 2000
28. A. OftalmicaA. Oftalmica in ocluzia ACIin ocluzia ACI
Four types of retrobulbar circulation. A
modified classification previously reported by
Costa et al. Normal = normal circulation in
patients without ICAO; Type 1 = forward OA,
CRA, and SPCA flow; Type 2a = reverse OA
and forward CRA and SPCA flow; Type 2b =
reverse OA and undetectable CRA and SPCA
flow; Type 3 = undetectable OA, CRA, and
SPCA flow
CDI observations in the four types of
circulation. Normal = normal circulation in
patients without ICAO; Type 1 = forward OA,
CRA, and SPCA flow; Type 2a = reverse OA
and forward CRA and SPCA flow; Type 2b =
reverse OA and undetectable CRA and SPCA
flow; Type 3 = undetectable OA, CRA, and
SPCA flow.
38. Results
5000 cerebrovascular ultrasound records.
A total of 0.4% of the patients had common carotid artery occlusion (CCAO).
The mean age was 59.8 ± 14.2 years,
The male/female ratio was 2.33.
The most frequent risk factors were hypertension, ischaemic heart disease,
dyslipidemia, diabetes mellitus, and smoking.
39.
40.
41. Take home messageTake home message
• Ocluzia ACC este rara si se insoteste de obicei de infarct
cerebral intins la nivelul hemisferului ipsilateral
• Ocluzia ACC/ACI bilaterala este (teoretic) incompatibila
cu viata
• Rata anuala de stroke in ocluzia bilaterala ACI: 0-13%
• Cazul demonstreaza posibilitatea supravietuirii in absenta
unui stroke fatal, gratie rolului circulatiei colaterale
functionale
• Ocluzia carotidiana bilaterala-un stimul al preconditionarii
ischemice cerebrale in prevenirea leziunilor ischemice
focale
43. Ocluzia Tr.BCOcluzia Tr.BC
• o conditie rara
• simptome in teritorii vaste (circulatia cerbrala
anterioara, sistemul VB si membrul superior
drept)
• poate fi asimptomatica
• diagnostic US Doppler si angio CT (DSA) a.
subclavie dreapta, ACC dreapta si flux
retrograd in a. vertebrala ipsilaterala
Erdem Birgi et al. Subclavian steal-carotid recovery phenomenon due to innominate artery occlusion: Doppler ultrasound and
digital subtraction angiography findings and endovascular treatment. Turk Kardiyol Dern Ars. 2014; 42(4): 384-388
44. CONCLUZII
• If occlusion is confirmed by US, no further
imaging is necessary.
• US performed well in helping to differentiate
vessels with focal severe stenosis from those
with diffuse disease.
• MR-CT angiography added little in this group.
• Catheter angiography remains beneficial for
vessels with diffuse nonfocal narrowing.
El-Saden S et al. Radiology 2001
45. • CTA is suggested for current near-occlusion diagnosis.
• CTA is very accurate in separating near-occlusion from occlusion with
delayed imaging, and criteria exist to separate near-occlusion (with
and without full collapse) from conventional stenoses.
• For sonography, emphasis has often been on the separation of near-
occlusion and occlusion; possibly this can be further improved with
power Doppler and/or contrast enhancement. More important, it is
impossible to separate near-occlusion without full collapse from
conventional stenoses with sonography. This lack of sensitivity is a
relatively recent finding (from 2014).
• It seems appropriate to always perform CTA in addition because near-
occlusions can be missed with sonography.
• MRA with 2D TOF or contrast enhancement can separate some near-
occlusions from occlusion, but not all. It is uncertain whetherMRA can
consistently separate near-occlusion from conventional stenosis.
Am J Neuroradiol 2016
46. Cum putem evita diagnosticul
fals-pozitiv de ocluzie?
Optimizarea parametrilor Doppler este de o importanta
cruciala
• Transductor linear 7.5 MHz
• Obtine cele mai bune secvente ale ACI, atat in plan
transvers cat si longitudinal si cat mai distale
(retromandibular)
• Steering si color box adecvate
• Coboara PRF la cele mai mici valori posibile (sub 15
cm/sec) similar cu examinarea venoasa
• Utilizeaza Power-angio
• Creste esantionul de volum PWD la peste 2.5 mm
Utilizeaza CEUS si TCD