This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
An IVU (Intravenous Urography) is an x-ray of your urinary tract (consisting of kidneys, ureters and bladder) following an injection of a clear dye called contrast into a vein in your arm.
The pictures produced are called intravenous urograms (IVU) or intravenous pyelograms (IVP).
A series of x-rays are taken of the abdomen at various time intervals. This usually takes up to an hour, but occasionally it may be necessary to take additional delayed images, which may continue for several hours.
Routine IVP[edit]
This procedure is most common for patients who have unexplained microscopic or macroscopic hematuria. It is used to ascertain the presence of a tumour or similar anatomy-altering disorders. The sequence of images is roughly as follows:
plain or Control KUB image;
immediate X-ray of just the renal area;
5 minute X-ray of just the renal area.
15 minute X-ray of just the renal area.
At this point, compression may or may not be applied (this is contraindicated in cases of obstruction).
In pyelography, compression involves pressing on the lower abdominal area, which results in distension of the upper urinary tract.[1]
If compression is applied: a 10 minutes post-injection X-ray of the renal area is taken, followed by a KUB on release of the compression.
If compression is not given: a standard KUB is taken to show the ureters emptying. This may sometimes be done with the patient lying in a prone position.
A post-micturition X-ray is taken afterwards. This is usually a coned bladder view.
Image Assessment[edit]
An IVU (Intravenous Urography) is an x-ray of your urinary tract (consisting of kidneys, ureters and bladder) following an injection of a clear dye called contrast into a vein in your arm.
The pictures produced are called intravenous urograms (IVU) or intravenous pyelograms (IVP).
A series of x-rays are taken of the abdomen at various time intervals. This usually takes up to an hour, but occasionally it may be necessary to take additional delayed images, which may continue for several hours.
Routine IVP[edit]
This procedure is most common for patients who have unexplained microscopic or macroscopic hematuria. It is used to ascertain the presence of a tumour or similar anatomy-altering disorders. The sequence of images is roughly as follows:
plain or Control KUB image;
immediate X-ray of just the renal area;
5 minute X-ray of just the renal area.
15 minute X-ray of just the renal area.
At this point, compression may or may not be applied (this is contraindicated in cases of obstruction).
In pyelography, compression involves pressing on the lower abdominal area, which results in distension of the upper urinary tract.[1]
If compression is applied: a 10 minutes post-injection X-ray of the renal area is taken, followed by a KUB on release of the compression.
If compression is not given: a standard KUB is taken to show the ureters emptying. This may sometimes be done with the patient lying in a prone position.
A post-micturition X-ray is taken afterwards. This is usually a coned bladder view.
Image Assessment[edit]
Presentations about Democracy of Thailand as summarized from WIn Lyowarin's book, Democracy Shaken & Stirred. This presentation is made by gathering almost every information from cited sources. No copyright restricted, you are free to use as long as you cite me. Also, you are not able to alter the contents directly, and republish the altered version in either your name(s), my name(s), or Win's name. I am not related to this book, Democracy Shaken & Stirred's author.
Fracture interpretation for medical studentsejheffernan
An introduction to the approach to fracture interpretation on radiographs, aimed at medical students. From the medical student radiology teaching website, svuhradiology.ie.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
A radiological insight into various musculoskeletal complications in patients suffering from AIDS and how it'll affect the management of the patient. A must know for all Radiologists.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
2. INTRODUCTION
Percutaneous abscess drainage (PAD) has evolved from revolutionary to routine,
replacing open surgical abscess drainage in all but the most difficult or
inaccessible cases.
Originally only patients with simple fluid collections were candidates for PAD;
however, researchers have convincingly demonstrated that both septated and
viscous fluid collections may be successfully treated percutaneously, particularly
with the adjunctive use of lytic agents.
An aggressive practical approach with relatively simple devices and techniques
may yield a high success rate with few complications.
Marked growth in last 20 years
All types of simple and complex collections drained in the chest,abdomen and
pelvis
Requires ability to assess CT and US images and familiarity with drainage
equipment
3. Collection Assessment-Imaging
Aim - shortest, safest route to site drain in the most dependent position
Avoid major vessels
Avoid transgressing bowel
Assessment of nature of fluid-echogenicity ; septations
4. IMAGING – US or CT
CT
good visualisation
opacified bowel
not limited by ileus or depth
US
real time
portable
operator dependent
Size+site of collection ; operator preference
5. Ultrasound guided percutaneous drainage is one form of image guided procedure,
allowing minimally invasive treatment of collections that are accessible by ultrasound
study.
It has several advantages and disadvantages over CT, which include:
Advantages
is a dynamic study, allowing greater precision to control needle insertion
not exposes patient to ionising radiation
does not require as wide a range of staff, compared to CT-guided procedures
Disadvantages
deeper targets may not be as well visualised on ultrasound (e.g. retroperitoneal
nodes)
bowel gas may obscure visualization
attenuation of the sound beam on larger patients
6. Indications
Indications for percutaneous drainage are broad: essentially any abnormal fluid collection in
the patient which can be accessible. Examples include:
complicated diverticular abscess
Crohn disease related abscess
complicated appendicitis with appendicular abscess
tuboovarian abscess
post-surgical fluid collections
hepatic abscess (e.g. amebic or post-operative)
renal abscess or retroperitoneal abscess.
splenic abscess
Contraindications
The only common contraindications are:
biopsy target is not accessible
patient has a bleeding diathesis
7. Laboratory parameters for a safe procedure
Interventional procedures like percutaneous drainage require special attention
to coagulation indices.There are widely divergent opinions about the safe
values of these indices for percutaneous biopsies.The values suggested below
were considered based on a literature review.
Complete blood count: Platelet > 50000/mm3 (Some institutions determine
other values between 50000-100000/mm3)
Coagulation profile:
international normalized ratio (INR) ≤1.5 1
normal prothrombin time (PT), partial thromboplastin time (PTT)
Some studies show that having a normal INR or prothrombin time is no
reassurance that the patient will not bleed after the procedure
8. Pre-procedure evaluation
Review other diagnostic studies first to clarify the collection that is
requested to be drained.
An ultrasound study should be done prior to biopsy to decide the access
angle and check the relationship of the collection to adjacent structures.
In general, the shortest possible route is preferred, as long as it does not
traversing other structures.
9. Equipment
Needle
Typical abscess fluid is readily aspirated through an 18-gauge needle
Viscous or debris-laden fluid is more likely to cause a false-negative aspirate
with a 21-gauge needle as only clear supernatant may return through the
needle.
An 18-gauge needle is easier to control and image and accepts a 0.038-inch
guidewire.
There is no clinically significant difference in needle trauma between the 18
and 22-gauge needles when a catheter is placed through the same tract.
The 21-gauge needle may be used to minimize trauma for a challenging
localization, low-probability fluid collection, or personal preference.
10.
11. Equipment (contd.)
Catheters
6F-24F catheters
Locking or non-locking-VIP at removal
Sump or non-sump-2nd lumen containing air which prevents cavity
collapsing around catheter tip
12.
13. Guidewire
A variety of guidewires are available for PAD with different properties and
prices. Guidewires should meet the following specifications:
Stiff enough to guide dilators and catheter into abscess
Not too stiff to prevent easy coiling of wire shaft within abscess
Floppy tipped enough to encourage wire to coil within the abscess and not
perforate the abscess wall
Short enough to make use convenient
14.
15. Localization Techniques
Any modality may be used to assist needle placement.
Prior to ready availability of CT fluoroscopy, patient assessment may be
performed with CT scanning, with the PAD procedure performed with US
localization.
Conventional fluoroscopy can be used as an adjunct to US.
US guidance allows real-time imaging and does not involve radiation
exposure.
CT fluoroscopy is increasingly available and facilitates "one-stop-shopping."
The diagnostic CT and PAD may now be performed readily in one setting.
16. PATIENT PREPARATION
IV access
Fasted for > 2 hours
Coagulopathy excluded
Informed consent
17. PROCEDURE
Ultrasound guided percutaenous drainage may be performed with a single or
multiple stage technique.
Consider conscious sedation
Clean skin
Anaesthetise skin
Skin incision large enough for passage of catheter
Consider tract dissection
18. TROCAR TECHNIQUE
Reference needle in collection
Catheter assembly advanced to the same depth ,in the same plane
Remove stylet and aspirate
Advance catheter over stationary stiffener
19. SELDINGER TECHNIQUE
18g needle in collection
Pass 0.035 wire into collection
Dilate tract
Pass catheter and stiffener over wire
When inside collection pass catheter alone
20. POST-INSERTION OF DRAIN
Aspirate fluid
Re-image:?need for 2nd drain
Secure drain-it is always more difficult to re-puncture a partially drained
collection
21. POST-PROCEDURE CARE
Post-procedure care
The patient's basic vital signs should be monitored for 4 hours post procedure (pulse,
blood pressure, SpO2), or as long as deemed necessary.
Aspirate 8hrly with a 50ml. Syringe
Irrigate with 10ml. of saline
Dependent position of bag
The patient should remain in bed for 2 hours. After this time period mobilization and oral
intake is permitted.
Removal-clinical improvement and drainage of <10ml. per day or collection resolved on
re-imaging
The entry site should be reviewed on a daily basis. If output from the collection ceases, it
may mean that the collection is no longer present or that the drain is clogged.
22. TIPS - INSERTION
Ensure adequate skin incision
Avoid kinking wire(no fluoroscopy)
Ideal wire-stiff enough to allow passage of dilators and catheter but will coil
within abscess and not perforate posterior wall
Cut thread flush with catheter hub
3-way tap
23. IF COLLECTION PERSISTS WITH LOW
FLOWS
Catheter displacement
Catheter/tubing blocked or kinked
Upsizing catheter
Septation/loculation
24. If Collection Persists with high flows
Expect to find a fistula
Can occur from bowel, bile and pancreatic duct, renal tract
Exclude distal obstruction ; underlying bowel disease ; proximal diversion ;
parenteral feeding
Bile leak postlap.chole.- drain plus cbd stent
25. IF THERE IS PRESENCE OF GROSS BLOOD
Place the catheter
Let the blood drain into the bag
Since blood is a potent irritant and toxic to omentum, it has to be drained
regardless to avoid fatal complications like peritonitis and adhesions
27. MINIMIZING COMPLICATIONS
Broad spectrum antibiotics
Correct coagulopathy
Adequate sedation + analgesia-beware the restless patient
Good bowel opacification at CT
Post procedure catheter management
Beware collections adjacent to implants-aspirate>drain
Discuss cases with clinical team
28. PITFALLS
The procedure was not indicated.
Failure to obtain informed consent
Failure to perform the procedure in a reasonable manner and deviation from
the standard of care.
Failure to promptly recognize and react to a complication.
Failure to adequately treat the complication according to an adequate
standard of care.
29. CONCLUSION
Assess pre-procedure imaging
Minimise complications related to PAD
Involvement in post procedure catheter management
Practical knowledge of needles, wires and catheters
30. References
Emedicine , percutaneous drainage of abscess and post operative collections
Radiopedia , USG guided percutaneous drainage
American College of Radiology. Percutaneous catheter drainage of infected
intra-abdominal fluid collections
Haaga JR,Weinstein AJ. CT-guided percutaneous aspiration and drainage of
abscesses.
Lang EK, Springer RM, Giorioso LW, Cammarata CA. Abdominal abscess
drainage under radiologic guidance: causes of failure.