Starting with the Definition, Coverage of field, Seldinger technique, Instruments used in IR we move forward into the embolization Techniques and applications, IR procedures in hepatobiliary system, Portal hypertension, Varicose veins
and lastly RFA for bone tumors like ostoid osteoma
Ductography is a special type of contrast
enhanced mammography used for imaging the
breast ducts.
•
Ductography can aid in diagnosing the cause of
an abnormal nipple discharge and is valuable in
diagnosing intraductal papillomas and other
conditions.
•
It is also called as Galactography or
Ductogalactography
Starting with the Definition, Coverage of field, Seldinger technique, Instruments used in IR we move forward into the embolization Techniques and applications, IR procedures in hepatobiliary system, Portal hypertension, Varicose veins
and lastly RFA for bone tumors like ostoid osteoma
Ductography is a special type of contrast
enhanced mammography used for imaging the
breast ducts.
•
Ductography can aid in diagnosing the cause of
an abnormal nipple discharge and is valuable in
diagnosing intraductal papillomas and other
conditions.
•
It is also called as Galactography or
Ductogalactography
Foreign Body Obstruction - Esophagus.pptxVaibhavRamesh
Foreign Body Obstruction of Esophagus - this presentation covers the key aspects of the condition where a foreign body (anything ranging from a blade to a stone) is stuck on the esophagus or the food pipe causing an obstruction of it.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
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
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.
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
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
3. What is fistula?
• A fistula is an abnormal pathway between two
anatomic spaces or a pathway that leads from an
internal cavity or organ to the surface of the body.
• Is an abnormal connection between two hollow
spaces(such as blood vessels, intestines)
• Can develop in various parts of body
• Is caused by injury or surgery but can result from
infection or inflammation
4. Types of fistula on the basis of location
• Internal fistula
(connection between lumen of one vicious and another)
for eg :-vesicovaginal fistula, enterorectal, rectovaginal,
etc.
• External fistula
(connection between one hollow vicious to the exterior)
for eg :- enterocutaneous fistula
• Fistula joining two vessels
for eg :- arteriovenous fistula
5. Types of fistula on the basis of openings
1. Blind fistula
with only one open end could be a sinus tract
2. Complete fistula
with both external and internal openings
3. Incomplete fistula
fistula with external skin opening which doesn’t
connect to any internal organs
6. Common fistulas
Fistulas Abnormal connection between:-
1. Perilymph fistula Air filled middle ear and fluid filled inner
ear
2. Vesicovaginal fistula Urinary bladder and vagina
3. Rectovaginal fistula Lower part of large intestine/rectum and
vagina
4.Anorectal fistula End of bowel/rectum and anus
5. Enterorectal fistula Small intestine and rectum
6.Enterocutaneous
fistula
Intestinal tract and stomach and skin
7. Rectovesical fistula Rectum and urinary bladder
7. Cause of fistula
1. Congenital (fistula present due to birth defect)
2. Acquired (fistula developed in later stage of life)
• Traumatic
• Inflamatory
• Post medcal treatment
• Malignancy
• Diseases
• Iatrogenic
8. Some common congenital fistulas
1. Branchial fistula(developed in the upper part of neck
anterior to sternocleidomastoid to skin surface)
2. Tracheo-esophageal (between trachea nad
oesophagus)
3. Congenital AV fistula (between artery and vein)
4. Thyroglossal fistula(formed by the rupture of the
thyroglossal duct)
9. Common acquired traumatic fistulas
• Head trauma can lead to perilymph fistulas,
• trauma to other parts of the body can cause
arteriovenous fistulas.
• Obstructed labor can lead to vesicovaginal and
rectovaginal fistulas.
• An obstetric fistula develops when blood supply to the
tissues of the vagina and the bladder (and/or rectum) is
cut off during prolonged obstructed labor.
• Vesicovaginal and rectovaginal fistulas may also be
caused by rape, in particular gang rape, and rape with
foreign objects,
10. Common acquired fistulas
1. Post medical treatment
(Complications from gallbladder surgery can lead to
biliary fistula. Radiation therapy can lead to
vesicovaginal fistula.)
2. Diseases
(Inflammatory bowel disease, more often in the form
of Crohn's disease than ulcerative colitis, is the leading
cause of anorectal, enteroenteral, and enterocutaneous
fistulas.)
11. Cond……
3. Inflammatory
caused by inflammation for eg:-enterovesical hernia
4. Malignancy
when growth of one organ penetrates into the nearby
organ. e.g., Rectovesical fistula in carcinoma rectum
4.iatrogenic (caused by the health care provider)
• Cimino fistula - AVF for hemodialysis
• ECK fistula - to treat esophageal varices in portal HTN
12.
13. Sinus
• A sinus tract is an abnormal channel that originates or
ends in one opening.
• Blind track lined by granulation tissue leading from
epithelial surface down into the tissues
• Could be congenital or acquired
1. Congeninal = preauricular sinus
2. Acquired = TB sinus
Pilonidal sinus
Actinomycosis
Median mental sinus
14. • A pilonidal sinus (PNS) is a small hole or tunnel in the skin. It
may fill with fluid or pus, causing the formation of a cyst or
abscess. It occurs in the cleft at the top of the buttocks.
• Actinomycosis is a rare bacterial disease characterized by
abscess formation on mouth breast or GI tract. the abscess may
grow larger and penetrate the surrounding bone and muscle to
the skin, where they break open and leak large amounts of pus
forming sinus.
• Median mental sinus is the sinus on the chin can be the result
of a chronic apical abscess due to pulp necrosis of a mandibular
anterior tooth.
15. What is sinogram or fistulogram?
• A Sinogram or Fistulogram is an special x-ray
procedure that is perform to visualize any abnormal
passage (fistula/sinus) in the body, following the
injection of contrast media (x-ray dye) into the
opening between two or more organs.
• Is usually a painless procedure
• Is usually completed within half an hour
• The examination may be performed under fluroscopic
control and may include full size plain film
radiography
16. Indications
• Development of a sinus or a fistula
• Route or extent of the sinus or fistula
• In order to fig out which organs are involved
18. Equipments required
High power x-ray generator.
X-ray tube
Floating/tilting type of x-ray table
Fluoroscopic unit with II TV system
Resuscitative apparatus
19. Accessories and drugs required
• Iv cannula (18G, 20G, 22G)
• Dressing material (sterile towels, gauzes, cotton swabs,
scissors, gloves).
• Skin antiseptic solutions: povidone iodine, spirit,
savlon.
• Local anaesthetic injection: lignocaine
• A low osmolar contrast medium should be used.
• LOCM – 150-280 mgI/ml.
• Disposable syringe ( 10ml ,20 ml)
20. Patient preparations
There are no diet restrictions before the procedure.
The medical history and allergies should be checked.
It is better to check serology report prior to procedure
The procedure is explained to the patient
A consent form is signed.
The metallic objects is removed and patient is made to
change into a hospital gown
21. Technique
A preliminary film is taken of the fistula/sinus area to
exclude the presence of a radio-opaque foreign body.
The patient lies supine on the fluoroscopic table, with the
opening of the sinus or fistula uppermost, and is made as
comfortable as possible.
The skin surrounding the area is prepared using a suitable
antiseptic preparation and sterile towels are placed around
the opening.
22. • If there is discharge of pus or mucus from the opening,
then only the contrast is injected to the sinus if not the
whole procedure is avoided
• If a drainage tube is in situ, the control agent may be
introduced through it
• If not then, a cannula of the appropriate size is inserted into
the orifice of the sinus/fistula, a gauze pad is firmly placed
around the site of entry to discourage reflux.
• The sufficient quantity of a water soluble contrast agent is
injected under fluoroscopic control to outline the extent of
the lesion.
• Depending upon the departmental protocols and patient
situation, the spots films are taken.
23. Filming
• Generally, two images are normally taken at right angles to each
other.i.e.
1. AP or PA
2. Lateral
• Erect views using a horizontal beam may also be taken.
24. What to do after the procedure?
If the fistula/sinus is inside the back passage or
vagina, patient should go to the toilet to pass any left
over contrast.
If the fistula/sinus is outside the body, wound site will
be cleaned and dressed.
25. Aftercare
• There is no special things to care of after the procedure
still some things is needed to be taken in consideration
• If the patient experience headache, nausea, vomiting or
dyspnea or chest pain should immediately inform the
technologist
• We should take care of the sinus or fistula to avoid
bacterial infections and further complication of the
wound
26. Complications
• Common risks and complications include:
• Perforation of the fistula/sinus opening (minor pain)
• Bruising and/or infection from the tube insertion.
• May require treatment with antibiotics.
• Less common risks and complications include:
• Allergic reaction to the Contrast.
• Rash, hives, itching, nausea, fainting or shortness of
breath.
• Medication may be given to relieve this.
28. Tracheoesophageal fistula
• Note
• Thin barium is used
incase of TEF as the
ionic contrast if
inhaled in trachea can
cause chemotoxicity
i.e.
chemopneumonitis/
intractable chest
infections
37. References
Clark’s Special Procedures in Diagnostic Imaging,
A.S.Whitly et. all, 1st edition
A Guide to Radiological Procedures, S. Chapman & R.
Nikelny, 4 and 5th ediditon
Radiological Procedures: a guideline, Dr. B.N. Lakhar, 1st
edition
Various internet sites
38. Questions
1. Despite of having a sinus or fistula, in which
condition we don’t perform sinogram or
fistulogram?
2. Which contrast medium is used in case of suspected
TEF? Why?
3. Can ionic contrast media be given for fistulogram or
sinogram?
4. What is the filming pattern of sinogram or
fistulogram?
5. Explain about iatrogenic fistulas.