This document provides an outline for a presentation on lymphedema. It begins with an introduction that defines lymphedema as localized swelling caused by a compromised lymphatic system. The document then covers the embryology, anatomy, physiology and historical perspectives of the lymphatic system. It discusses the etiology, staging, diagnosis and various treatment approaches for lymphedema including medical, surgical and complete decongestive therapy. It also addresses complications, prevention strategies and advances in the field. The conclusion reiterates that lymphedema is a complex disorder that requires improved diagnostic and therapeutic methods.
Anatomy, physiology, pathophysiology of the lymphatic system, lymphedema definition, differential diagnosis and presentations, staging, contraindications and precautions for decongestive therapy (MLD/CDT)
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest. Lymphedema is incurable, but with the right treatment, it can be controlled.
Anatomy, physiology, pathophysiology of the lymphatic system, lymphedema definition, differential diagnosis and presentations, staging, contraindications and precautions for decongestive therapy (MLD/CDT)
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Lymphedema commonly affects one of the arms or legs. In some cases, both arms or both legs may be affected. Some patients might experience swelling in the head, genitals, or chest. Lymphedema is incurable, but with the right treatment, it can be controlled.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
A detailed ppt on lymphatic system and its diseases, along with clinical and applied common concepts for common lymphatic system diseases, final year MBBS students as well as surgery post graduate students. Includes practical tips for exams and a set of personal op photos.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
A detailed ppt on lymphatic system and its diseases, along with clinical and applied common concepts for common lymphatic system diseases, final year MBBS students as well as surgery post graduate students. Includes practical tips for exams and a set of personal op photos.
Fluid cytology in serous cavity effusionstashagarwal
The intrathoracic and intraperitoneal organs are covered by a single layer of mesothelial cells, which is continuous with the lining of the thoracic and peritoneal cavities. The potential space between the two layers of epithelium contains a small amount of lubricating fluid.
Serous fluid lies between the membranes lining the body cavities(parietal) and those covering the organs within the cavities(visceral).
Production and reabsorption are normally at a constant rate. They are influenced by
Changes in osmotic and hydrostatic pressure in the blood.
Concentration of chemical constituents in the plasma
Permeability of blood vessels and membranes.
An accumulation of fluid, called an effusion, results from an imbalance of fluid production and reabsorption. This fluid accumulation in the pleural, pericardial, and peritoneal cavities is known as serous effusion.
PHYSIOTHERAPY IN LYMPHOEDEMA CONDITION.pptxAneriPatwari
This power point will lighten up the anatomy, functions, components and flow of lymphatic system.
This will inform about causes, complications, types of lymphoedema.
This will give the knowledge of scales and severity of lymphoedema.
This will enhance the knowledge for difference in lymphoedema and oedema.
This will give detail physiotherapy assessment and management for lymphoedema.
Nephritis is a inflammation of kidney .
It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis.
Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus .
It is inflammation of lower urinary tract .
Management of Typhoid Intestinal Perforation which is a common and the most dreaded surgical complication of Typhoid fever.
This menace is still on the rise in low and medium income countries where we still battle with lack of potable water and open defecation.
This presentation is especially targeted at trainee surgeons in Nigeria and Medical Students also who may find it worthwhile.
Pars Planitis is a disease of the eye that is characterized by inflammation of the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. This may lead to blurred vision; dark, floating spots in the vision; and progressive vision loss.
Esophagoscopy continues to be a reliable diagnostic and therapeutic tool with a wide variety of applications, including biopsy, dilatation of strictures, repair of Zenker's diverticulum, placement of stents, and retrieval of foreign bodies.
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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
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
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!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
5. INTRODUCTION
• Lymphedema, also known as lymphoedema and
lymphatic edema;
• Is a condition of localized fluid retention and
tissue swelling.
• Caused by a compromised lymphatic system.
• The lymphatic system functions as a critical
portion of the body's immune system and returns
interstitial fluid to the bloodstream.
6. Definition
– Lymphedema is the accumulation of protein rich
interstitial fluid in the subcutaneous tissue and
skin of the extremity. which may be associated
with chronic inflammation and fibrosis or
hyperplasia.
Two broad types
– Medical
– Surgical
7. EMBRYOLOGY
• Closely related to blood vessel development to
understand concept
• Vasculogenesis; building blood vessels from
beginning and mostly completed in-utero (from stem
cells/ progenitors)
• Angiogenesis; new blood vessels grow from
extension or sprouting of existing vessels mostly post
natal
Wound healing
Menstrual cycle and pregnancy
Tumor formation
11. ANATOMY
• Blind-ended lymphatic capillaries arise within the
interstitial spaces of the dermal papillae.
• These unvalved, superficial dermal lymphatics
drain into interconnected subdermal channels,
which parallel the superficial venous system.
• These subsequently drain into the deeper,
epifascial system of valved trunks lined with
smooth muscle cells and located just above the
deep fascia of the extremity.
12. ANATOMY
• A deeper-valved subfascial system of lymphatics is
responsible for the drainage of lymph from the fascia,
muscles, joints, ligaments, periosteum, and bone. This
subfascial system parallels the deep venous system of the
extremity.
• In lymphedema some reversed flow through perforators
from the epifascial to the subfascial system may occur as a
mechanism of decompression of the epifascial system.
• However, the derangement in lymphedema is almost
always exclusive to the epifascial lymphatic system, with
the subfascial system being uninvolved. Thus, the surgical
approaches to lymphedema focus on the epifascial system
13. PHYSIOLOGY
– lymphatic fluid is an ultra filtrate of plasma.
– Has the same electrolyte and some plasma
protein content of the plasma.
– Lymphatic capillaries (Zonal drainage)
– Primary lymph vessels valveless
– Secondary lymph vessels valved
– Sentinel nodes
14. PHYSIOLOGY
– Regional lymph nodes (arranged anatomically) in upper and
lower exteremities
– Watershed area of Sapey
– No communication between deep and superficial lymphatics
except at 2 points in the extremity
– also are aided by skeletal muscle contractions and pulsatile
movements of surrounding blood vessels to assist with lymph
flow
15. HISTORICAL PERSPECTIVE
• The 17th century saw several emerging and almost
simultaneous discoveries in the field of lymphology
by Asselli, Pecquet, Bartholin and possibly Joliffe.
• Lymphatic system was first described by Erasistratus
in Alexandra > 2000yrs ago
• Williams Hunter in 18th century was 1st to describe
the functions of the lymphatics
• Olof Rudbeck (1630-1708) was probably the first
anatomist to consider correctly the lymphatic
circulation as an integrated system of the whole body
16. EPIDEMIOLOGY
• Worldwide, the most common cause of
lymphedema is filariasis infection. More than 100
million people are affected in endemic areas
worldwide
• Prevalence is about 0.13 – 2% globally
• At birth 1 in 60,000 people
• Females account for 70-80% of cases of
congenital lymphedema.
• Apart from its symptoms, it is also a frequent
source of emotional and psychological distress
17. STATEMENT OF SURGICAL IMPORTANCE
• It's important that lymphedema is identified
and treated as soon as possible. If it isn't
treated, it can get worse.
30. •Address of the patient
•Differentiate between unilateral and
bilateral Lymphedema
•Age of the patient
•Duration of swelling
•History of ulcers/Lymphangitis
•Effects of Posture
•How fast did the swelling develop
/progress
•What is the underlying medical
disease
•Previous Surgery
•Family History
•Drug History -Adalat
HISTORY
31. PHYSICAL EXAMINATION
INSPECTION
•Compare the 2 limbs
•Extend of lymphedema with
measurement
•Old scar
•Current Lymphangitis
•Any skin changes
•Collateral veins
•Scars and/or Radiation skin
•Ulcers
•Papillomas
33. PHYSICAL EXAMINATION Circumference
• Most commonly used
method to assess limb
volume
• Measurements taken at
various points of arm or
leg
• Time-consuming
• Requires considerable
experience
39. What types of compression are available ?
• Compression stocking
• can be used for treatment and maintenance
• 2 pairs are appropriate to maximize hygiene
• last from 4 to 6 months
• can be difficult to don or doff and keep in position
• Compressive wrapping
• better flexibility for specific problem areas and for
specific patients
• patients and families can learn technique
• allow greater activity level than pumps
• can be time consuming to don
COMPLETE DECONGESTIVE THERAPY
40. Surgery
• Indications
– Failed conservative therapy
– Impaired function
– Gross extremity size and weight
– Recurrent lymphangitis (>3/yr)
– Severe skin changes
42. Complications
• Of lymphedema
– Recurrent cellulitis and/or lymphangitis
– Bacterial and fungal infections
– Lymphangio-adenitis
– DVT
– Severe functional impairment
– Cosmetic embarrassment
– Necessitating amputation
• Of Surgery
– Partial wound separation
– Seroma
– Hematoma
– Skin necrosis
– Exacerbation of edema
– Lymphangiosarcoma
43. Follow up
• Wear compressive garments
• With improvement, do routine limb elevation
and compression therapy
• Document circumferential measurements
44. Prevention
• Avoid extreme temperature changes
• Wear rubber gloves when doing chores
• Always put on shoes even at home
• When traveling by air, patients with lymphedema or those at
risk must wear a compression sleeve or stocking
• Use only electric razors
• Avoid trauma (bruising, cuts, sunburn, insect bites, cat
scratches etc.) to affected area
• Call physician at first sign of infection
• Treat all skin infections aggressively
45. Advances
• Use of silicon tubes
• Stem cell therapy
• VEGF-C therapy
47. CONCLUSION
• Lymphedema is a common, complex and
debilitating disorder whose biology is still
incompletely understood.
• Increased interest in, and comprehension of, this
disorder have led to enhanced methods of
diagnostic evaluation and therapeutic
intervention.
• It is anticipated that further investigation into the
cellular mechanisms of lymphedema will lead to
ever more elegant refinements in the ability to
control this disease.
49. REFERENCES
• Greenlee R, Hoyme H, Witte M, Crowe P, Witte C. Developmental
disorders of the lymphatic system.Lymphology1993;26(4): 156–68.2
• Cambria RA, Gloviczki P, Naessens JM, Wahner HW. Noninvasive
evaluation of the lymphatic system with lymphoscintigraphy: a pro-
spective, semi quantitative analysis in 386 extremities.J Vasc
Surg1993;18(5): 773–82.3
• BeckerC,VasileJV,LevineJL,etal.Microlymphaticsurgeryforthetreatmentofiat
rogeniclymph- edema. Clin Plast Surg 39:385-398, 2012.
• Partsch H. Assessment of abnormal lymph drainage for the diagnosis of
lymphedema by isotopic lymphangiography and by indirect lym-
phography.Clin Dermatol1995;13: 445–50.4
• Ter SE, Alavi A, Kim CK, Merli G. Lymphoscintigraphy. A reliabletest for the
diagnosis of lymphedema.Clin Nucl Med1993;18(8):646–54.5