This document discusses pneumothorax, which is the presence of air in the pleural space outside the lung. It describes different types of pneumothorax including primary spontaneous, secondary spontaneous, closed, open, and tension pneumothorax. Risk factors, clinical features, diagnosis using chest x-ray, treatment options including chest tube insertion, and postoperative management of chest drains are covered. Surgical intervention is indicated for recurrent pneumothorax or when chest drainage fails.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
The goal of surgical therapy in pulmonary hydatid disease is to remove the cyst while preserving as much lung tissue as possible. The surgical method may be different in the intact (simple) and ruptured (complicated) cysts. The operation has two steps: a) removal of the germinative layer, b) management of the residual pulmonary cavity. Simple cysts are generally removed after needle aspiration or enucleation without needle aspiration.
General principles of the operationThe aim of surgery in pulmonary hydatid cyst is to remove the cyst completely while preserving the lung tissue as much as possible . Lung resection is performed only if there is an irreversible and disseminated pulmonary destruction. Careful manipulation of the cyst and adherence to the precaution to avoid the contamination of the operative field with the cyst content is the imperative part of the operation.
Acute respiratory distress syndrome (ARDS) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid resulting in severe dyspnoea, hypoxemia and diffuse pulmonary infiltrates.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
The goal of surgical therapy in pulmonary hydatid disease is to remove the cyst while preserving as much lung tissue as possible. The surgical method may be different in the intact (simple) and ruptured (complicated) cysts. The operation has two steps: a) removal of the germinative layer, b) management of the residual pulmonary cavity. Simple cysts are generally removed after needle aspiration or enucleation without needle aspiration.
General principles of the operationThe aim of surgery in pulmonary hydatid cyst is to remove the cyst completely while preserving the lung tissue as much as possible . Lung resection is performed only if there is an irreversible and disseminated pulmonary destruction. Careful manipulation of the cyst and adherence to the precaution to avoid the contamination of the operative field with the cyst content is the imperative part of the operation.
Acute respiratory distress syndrome (ARDS) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid resulting in severe dyspnoea, hypoxemia and diffuse pulmonary infiltrates.
- 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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
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.
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.
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.
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
5. Primary spontaneous pneumothorax
Common in young people from their mid-teens to late
20s.
About 75% of cases men are tall and have a family history.
It is due to leaks from small blebs, vesicles or bullae.
Typically occur at the apex of the upper lobe or on the
upper border of the lower or middle lobes.
6. Secondary spontaneous pneumothorax
When visceral pleura leaks due to underlying lung disease
Tuberculosis
Degenerative or cavitating lung disease
Emphysema
Necrosting tumours
7. Closed Pneumothorax
Communication between airway and the pleural space
seals off as the lung deflates.
Mean pleural pressure remains-negative.
Spontaneous reabsorption of air & re-expansion of lung
occur over a few days or weeks.
Infection uncommon.
8. Open Pneumothorax
Communication between pleura & bronchus doesn’t seals
off (Bronchopleural fistula).
Intra pleural pressure = atm. pressure.
Collapsed lung, no re-expansion.
Infection into the pleural space is common (empyema).
9. Tension Pneumothorax
Communication between the airway & the pleural space
acts as a one-way valve.
Air to enter the pleural space during inspiration but not to
escape on expiration.
Large amount of air accumulates progressively in the
pleural space.
Intrapleural pressure increases above atm pressure.
10. Tension Pneumothorax
Pressure causes mediastinal shift towards the opposite
side.
Compression of the opposite lung.
Impairment of systemic venous return &causing
cardiovascular compromise.
11. Risk factors for pneumothorax
Smoking. Risk increases with time and number of
cigarettes smoked.
Genetics.
Lung disease. chronic obstructive pulmonary disease
(COPD).
Mechanical ventilation.
Previous pneumothorax.
12. Clinical features
Sudden onset of unilateral pleuritic chest pain.
Breathlessness [In pts with a small pneumothorax,
physical examination may be normal].
General examination
Cyanosis
Rapid thready pulse.
Signs of peripheral circulatory failure in severe cases.
13. Inspection & palpation
Rapid respiratory rate.
Diminished chest movements.
Prominent accessory muscles of respiration.
Shift of trachea.
Shift apex beat.
Chest expansion diminished.
Increase in size of affected hemithorax.
Marked diminished vocal fremitus on affected side.
14. Percussion &Auscultation
Hyper-resonant on affected pneumothorax.
Right sided pneumothorax-liver dullness is obliterated
and cardiac. dullness is shifted to the opposite side.
Diminished to absent breath sounds.
Diminished vocal resonance.
16. Risk of recurrent pneumothorax
Patients who experience a first event, only about one
third experience recurrence.
Who have a second episode, about one-half go on to
experience a third episode.
Who have had three episodes will probably go on to have
repeated recurrences.
18. Treatment
Asymptomatic; careful observation.
Symptomatic patient; Intercostal chest drainage.
Tension pneumothorax; Percutaneous needle insertion
followed by chest drainage.
If intercostal drainage fails then
Surgery: Video assisted Thoracic Surgery (VATS) or
thoracotomy.
19. Indications for surgical intervention
●Second ipsilateral pneumothorax.
●First contralateral pneumothorax.
●Bilateral spontaneous pneumothorax.
●Pneumothorax fails to settle despite chest drainage.
●Spontaneous haemothorax: professions at risk (e.g.
pilots, divers).
●Pregnancy.
20. Inserting and management of chest drain
The safest site for insertion of a drain is in the triangle:
Anterior to the mid-axillary line.
Above the level of the nipple.
Below and lateral to the pectoralis major muscle.
Ideally find the fifth space.
21. Technique
Antiseptic cleaning & draping.
Adequate local anaesthesia.
Incision is made in the skin.
Blunt dissection with artery forceps down through the
muscle layers.
An oblique tract is created.
Drain pass over the upper edge of the rib.
22. Technique
Retaining stitch is secured.
Vertical mattress suture is inserted for later wound
closure.
Connect the drain to an underwater seal device which
functions as a one-way valve.
After completion, check chest radiograph is taken.
27. Management
DO
1. Keep the system closed and below chest level. Make
sure all connections are taped and the chest tube is
secured to the chest wall.
2. Ensure that the suction control chamber is filled with
sterile water to the 20-cm level or as prescribed.
3. Assess the amount, color, and consistency of drainage
in the drainage tubing and in the collection chamber.
28. Management
3. Encourage the patient to perform deep breathing,
coughing, and incentive spirometry.
4. Assess vital signs, breath sounds, SpO2, and insertion
site for subcutaneous emphysema.
5. When the chest tube is removed, immediately apply a
sterile occlusive petroleum gauze dressing over the site to
prevent air from entering the pleural space.
29. Management
DON’T
1. Don't let the drainage tubing kink, loop, or interfere
with the patient's movement.
2. Don't clamp a chest tube, except momentarily when
replacing the CDU, assessing for an air leak, or
assessing the patient's tolerance of chest tube removal,
and during chest tube removal.
3. Don't aggressively manipulate the chest tube; don't strip
or milk it.