The document describes a case of a 79-year-old female patient who fell down the stairs after suddenly losing consciousness. She has a history of diabetes and hypertension. Upon examination, her left radial pulse was weak and there was a 20 mmHg difference in blood pressure between the left and right arms, suggesting subclavian steal syndrome. Further tests such as CT angiography would be needed to confirm.
1) The document describes lung ultrasound findings for various lung conditions. Lung ultrasound can detect pneumothorax by the absence of lung sliding and evaluate interstitial syndrome by the presence of multiple B-lines.
2) It then discusses a study comparing the diagnoses of 301 ICU patients to their lung ultrasound findings using a standardized protocol. Common lung ultrasound findings and their sensitivity and specificity for different lung diseases are presented.
3) In summary, the document outlines the use of lung ultrasound to evaluate lung abnormalities and validate it as a diagnostic tool by comparing its findings to patient diagnoses in the ICU. Lung ultrasound can rapidly detect conditions like pneumothorax and interstitial syndrome.
1) The document describes lung ultrasound findings for various lung conditions. Lung ultrasound can detect pneumothorax by the absence of lung sliding and evaluate interstitial syndrome by the presence of multiple B-lines.
2) It then discusses a study comparing the diagnoses of 301 ICU patients to their lung ultrasound findings using a standardized protocol. Common lung ultrasound findings and their sensitivity and specificity for different lung diseases are presented.
3) In summary, the document outlines the use of lung ultrasound to evaluate lung abnormalities and validate it as a diagnostic tool by comparing its findings to patient diagnoses in the ICU. Lung ultrasound can rapidly detect conditions like pneumothorax and interstitial syndrome.
不定期開催のEMCNAカンファレンスです。EMCNAとは「Emergency Medicine Clinics of North America」の略で、救急外来や集中治療室、麻酔領域において遭遇する症候・疾患についての総説をまとめた、年4回発行の良著です。
初回のテーマは「Severe ARDSの初期治療(Emerg Med Clin N Am 34 (2016) 1–14 )」救急外来および集中治療室でしばしば遭遇するARDS, その基本的対応を再確認しました。
This document discusses immunoglobulin free light chains (FLC) and the κ/λ ratio. It contains the following key points:
1) FLC are produced in excess of heavy chains by plasma cells and any unbound light chains are known as free light chains.
2) An abnormal κ/λ ratio can indicate a clonal plasma cell disorder like multiple myeloma where either κ or λ chains are predominantly increased.
3) Measurement of FLC and the κ/λ ratio can aid in early diagnosis and monitoring of multiple myeloma and monoclonal gammopathy of unknown significance. It provides better sensitivity than traditional M-protein detection methods.
- Whipple's disease is a rare infection caused by the bacterium Tropheryma whipplei. It was first reported in 1907 but the bacterium was not identified until 1991 and not cultured until 2000.
- Classic symptoms include weight loss, diarrhea, arthralgia or arthritis. Neurological involvement occurs in 10-40% of cases and can include cognitive changes, supranuclear ophthalmoplegia, and altered consciousness.
- T. whipplei can also cause heart infections in 17-55% of cases, with infiltration of the pericardium, myocardium, and endocardium. Endocarditis from T. whipplei is a potential cause of sudden
This document discusses subclavian steal phenomenon, which occurs when there is stenosis or occlusion of the subclavian artery causing blood to flow in reverse from the vertebral artery to supply the arm. It classifies subclavian steal based on which arteries are involved and lists common causes as atherosclerosis, cervical ribs, and congenital issues. Clinical presentations include weak pulses, blood pressure differences, and neurological symptoms. Diagnosis involves Doppler ultrasound, CT angiography, or angiogram. Treatment options are balloon angioplasty, endarterectomy, bypass surgery, or follow up. The incidence increases with age and is more common in males and on the left side.
不定期開催のEMCNAカンファレンスです。EMCNAとは「Emergency Medicine Clinics of North America」の略で、救急外来や集中治療室、麻酔領域において遭遇する症候・疾患についての総説をまとめた、年4回発行の良著です。
初回のテーマは「Severe ARDSの初期治療(Emerg Med Clin N Am 34 (2016) 1–14 )」救急外来および集中治療室でしばしば遭遇するARDS, その基本的対応を再確認しました。
This document discusses immunoglobulin free light chains (FLC) and the κ/λ ratio. It contains the following key points:
1) FLC are produced in excess of heavy chains by plasma cells and any unbound light chains are known as free light chains.
2) An abnormal κ/λ ratio can indicate a clonal plasma cell disorder like multiple myeloma where either κ or λ chains are predominantly increased.
3) Measurement of FLC and the κ/λ ratio can aid in early diagnosis and monitoring of multiple myeloma and monoclonal gammopathy of unknown significance. It provides better sensitivity than traditional M-protein detection methods.
- Whipple's disease is a rare infection caused by the bacterium Tropheryma whipplei. It was first reported in 1907 but the bacterium was not identified until 1991 and not cultured until 2000.
- Classic symptoms include weight loss, diarrhea, arthralgia or arthritis. Neurological involvement occurs in 10-40% of cases and can include cognitive changes, supranuclear ophthalmoplegia, and altered consciousness.
- T. whipplei can also cause heart infections in 17-55% of cases, with infiltration of the pericardium, myocardium, and endocardium. Endocarditis from T. whipplei is a potential cause of sudden
This document discusses subclavian steal phenomenon, which occurs when there is stenosis or occlusion of the subclavian artery causing blood to flow in reverse from the vertebral artery to supply the arm. It classifies subclavian steal based on which arteries are involved and lists common causes as atherosclerosis, cervical ribs, and congenital issues. Clinical presentations include weak pulses, blood pressure differences, and neurological symptoms. Diagnosis involves Doppler ultrasound, CT angiography, or angiogram. Treatment options are balloon angioplasty, endarterectomy, bypass surgery, or follow up. The incidence increases with age and is more common in males and on the left side.
Management of steal syndrome || Dr Ravi BansalAVATAR
This document discusses steal syndrome, which is arterial insufficiency caused by an arteriovenous dialysis access. It can cause hand pain, numbness, and tissue damage. The document describes methods for assessing and classifying steal syndrome severity. Treatment options aim to reverse ischemia while preserving access function, and include percutaneous and surgical interventions like angioplasty, stenting, banding, and distal revascularization-interval ligation. Risk factors include diabetes, peripheral vascular disease, and brachial accesses. Monitoring access flows can help prevent steal syndrome.
Hippocratic Sloth Presents: Subclavian Steal for the USMLEH. Sloth
Subclavian steal syndrome is caused by occlusion of the proximal subclavian artery, which causes reversal of blood flow in the vertebral artery and decreased blood flow to the posterior brain. It typically affects men over 55 years old and is usually caused by atherosclerosis. Symptoms include dizziness, visual disturbances, and arm weakness that is exacerbated by exercise of the affected arm. Diagnosis involves carotid ultrasound, MRI angiography, or aortography. Surgical management options include bypass procedures and percutaneous angioplasty with stenting.
This document discusses subclavian steal phenomenon, which occurs when there is stenosis or occlusion of the subclavian artery causing blood to flow in reverse from the vertebral artery to supply the arm. It classifies subclavian steal based on which arteries are involved in the reverse blood flow. Common causes include atherosclerosis and cervical ribs. Clinical presentations include weak pulse and blood pressure differences in the arms. Diagnosis involves Doppler ultrasound, CT angiography or angiogram. Treatment options are balloon angioplasty, endarterectomy or bypass surgery. The incidence increases with age and it is more common in males and affects the left side more often.
1. This 57-year-old male patient presented with numbness in both lower limbs for 18 months. Physical exam found reduced vibration and joint position sensation in both legs.
2. Blood tests found hemoglobin of 14.2 g/dL, MCV of 96 fl, and vitamin B12 level of 205 pg/mL. However, methylmalonic acid and homocysteine levels were significantly elevated at 3600 nmol/L and 49.1 μmol/L, respectively.
3. The abnormally high levels of methylmalonic acid and homocysteine, which are markers of vitamin B12 deficiency, suggest that vitamin B12 deficiency is a possible cause of the patient's numbness
1) Acute poststreptococcal glomerulonephritis (APSGN) is caused by previous infection with Group A streptococcus and is characterized by acute onset of hematuria, edema, and hypertension.
2) Histologically, APSGN typically shows diffuse proliferative glomerulonephritis with neutrophil infiltration, C3 deposition along the glomerular capillaries, and subepithelial humps on electron microscopy.
3) The differential diagnosis of APSGN includes other causes of postinfectious glomerulonephritis, lupus nephritis, and IgA nephropathy. Distinguishing features include clinical presentation and serological
This document discusses important considerations for drug administration in elderly patients. It notes that elderly patients often have multiple chronic conditions and take many medications. Their drug metabolism can change with age due to decreases in organ function. Specifically, absorption may decrease or increase depending on digestive changes, distribution volumes decrease for hydrophilic drugs and increase for lipophilic drugs, metabolism decreases due to liver changes, and excretion decreases due to kidney function decline. Close monitoring is needed when prescribing certain drugs that carry higher risks for adverse effects in elderly patients like benzodiazepines, digoxin, and anticoagulants. Dosage adjustment may be required based on an individual's physical characteristics.
This document discusses urinalysis and provides information on various aspects of analyzing urine samples. Some key points include:
- Urinalysis is a convenient, inexpensive test that provides a lot of information.
- Midstream urine samples are typically collected, and samples should be tested within 2 hours for accurate results.
- Visual inspection of urine color, clarity, odor and other physical properties can provide diagnostic clues.
- Dipstick testing is simple but can have false positives or negatives depending on factors like medication use, concentration, and pH level.
- Specific gravity and pH measurements provide additional information about urine concentration and acid-base status.
- Microscopic hematuria is found in a percentage of
Acs0605 Pulseless Extremity And Atheroembolismmedbookonline
This document discusses the evaluation and management of acute limb ischemia (ALI), also known as a pulseless extremity. It begins with an overview of ALI and the goals of managing it, which are limb salvage, minimizing morbidity, and preventing death. It then describes the clinical evaluation of a patient presenting with ALI, including obtaining a detailed history and performing a physical exam to assess limb viability. It outlines investigative studies such as Doppler pressures, angiography, and lab tests that can further evaluate the patient. The document categorizes ALI into 3 categories based on the severity of ischemia and threat to the limb. It provides algorithms for managing ALI depending on the category and findings during evaluation and revascularization attempts.
This document provides an overview of spinal arteriovenous malformations (AVMs). It discusses the classification, anatomy, presentation, diagnosis and treatment of different types of spinal AVMs. The main types discussed are:
1. Dural AVFs, the most common type which are slow flow fistulas between dural arteries and veins.
2. Intramedullary AVMs, which resemble brain AVMs and can cause hemorrhage or progressive myelopathy.
3. Juvenile/metameric AVMs, an extremely rare congenital lesion involving skin, vertebrae and spinal cord with multiple arterial feeders.
4. Conus medullaris AVMs, which are location-specific
Cavernous malformations were considered rare before modern imaging technology. The introduction of MRI in the 1980s revolutionized understanding of these lesions by allowing for accurate diagnosis based on MRI characteristics alone. The widespread availability of MRI has increased recognition of cavernous malformations in symptomatic and asymptomatic patients. Management requires understanding the epidemiology and natural history of these lesions, which are characterized by hemorrhage that can cause seizures, neurological deficits, and mass effect in the brain.
This document introduces arrhythmogenic cardiomyopathy (ACM), a genetic heart condition characterized by replacement of heart muscle with fatty or fibrotic tissue. It discusses two main types - arrhythmogenic right ventricular cardiomyopathy (ARVC) and the more recently described arrhythmogenic left ventricular cardiomyopathy (ALVC). The document summarizes the clinical presentation, diagnostic criteria including ECG findings, imaging like echocardiogram and cardiac MRI, genetic causes, and management of ACM.
Ventricular septal rupture (VSR) is a rare but serious complication of myocardial infarction where a tear forms in the ventricular septum, creating a left-to-right shunt. It typically occurs 2-8 days after MI. Diagnosis is made through echocardiography which demonstrates the shunt. Urgent surgical repair is the treatment of choice to close the defect before hemodynamic deterioration, though supportive medical management may be used to stabilize the patient pre-operatively. Surgical techniques involve infarct removal and patch reconstruction of the septum. Prognosis depends on factors like presence of cardiogenic shock, with posterior defects associated with higher mortality.
This document discusses the syndrome of right ventricular infarction. Some key points:
- RV infarction commonly occurs with inferior MI involving the inferior wall of the LV. It can complicate 30-50% of inferior MIs.
- Diagnosis is important as RV infarction requires distinct management from LV infarction. Signs include hypotension, elevated JVP, clear lung fields on exam. EKG often shows ST elevation in right-sided leads.
- RV has greater ability to recover function than LV due to its smaller muscle mass and dual blood supply. Proximal RCA occlusion is more likely to cause larger infarcts and RV involvement compared to distal occlusion.
Two cases of an extremely rare accessory coronary artery are reported. In both cases, the accessory artery arose from the left coronary cusp and traveled parallel to the left main coronary artery and left anterior descending artery. While one case showed an ostial lesion, the accessory arteries did not seem to be clinically significant. The authors propose naming this previously unreported anomaly the "Khan-Malek anomaly" due to its discovery.
This document discusses coronary artery disease and the abnormalities seen on echocardiography. It covers the pathophysiology of coronary syndromes and describes techniques for detecting wall motion abnormalities. It then details various complications that can occur with acute myocardial infarction such as pericardial effusions, infarct expansion, ventricular thrombi, and mitral regurgitation. Chronic complications of coronary artery disease discussed include left ventricular aneurysms, mural thrombi, and remodeling.
Persistent Left SVC- Can it be Used for Dialysis?semualkaira
Persistent left sided Superior vena cava (PLSVC) is encountered
in 0.3% of healthy population and majority of times gets incidentally detected during a left sided internal jugular catheter insertion
or during electrophysiological studies. There are couple of reports
where after its accidental cannulation, dialysis has been continued
for a variable period of time.
Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart condition characterized by thickened heart muscle and reduced space in the left ventricular outflow tract. It is caused by mutations in sarcomere proteins. Symptoms include chest pain, dizziness, and heart failure. Diagnosis is made through echocardiogram showing septal hypertrophy and left ventricular outflow tract obstruction. Septal myectomy surgery aims to relieve outflow tract obstruction by removing hypertrophic septal tissue. While early mortality risk is high, long term survival is good for most patients after surgery. Residual systolic anterior motion of the mitral valve and gradients remain issues.
This document discusses procedures for revascularization of the upper extremities. It focuses on brachial embolectomy for acute arm ischemia, which accounts for one-fifth of acute limb ischemia cases. The brachial artery is the most common site of emboli. Selection of patients includes all with acute-onset arm ischemia, except those who are terminally ill or unfit for surgery. The procedure involves exposing the brachial, ulnar, and radial arteries through a lazy-S incision and removing any clots via an arteriotomy. Outcomes are generally good, with 95% of patients symptom-free after successful embolectomy, though operative mortality may be as high as 12%.
The document summarizes arrhythmogenic right ventricular dysplasia (ARVD), a condition where the right ventricle of the heart is replaced by fat and fibrous tissue. It affects mostly young males and can cause sudden cardiac death. Genetic factors are involved in many cases. The condition starts with fatty infiltration of the right ventricle and progresses to include fibrosis, thinning of the ventricular wall, and later involvement of the left ventricle. Diagnosis involves criteria related to structural changes, electrocardiogram abnormalities, arrhythmias, and family history.
This document discusses the anatomy, pathophysiology, clinical presentations, investigations, and management of various spinal cord vascular syndromes. It begins by describing the vascular supply and drainage of the spinal cord from segmental and radiculomedullary arteries. It then discusses various etiologies that can lead to spinal cord ischemia or hemorrhage including arterial occlusion, venous drainage abnormalities, vascular malformations, trauma, and surgery. Clinical syndromes are described based on the vascular territory involved. Imaging findings and treatment options are also summarized.
Congenitally corrected transposition of great arteriesDheeraj Sharma
This document provides an overview of congenitally corrected transposition of the great arteries (CCTGA). Key points include:
- CCTGA is a rare congenital heart defect where the ventricles are transposed but the atria are connected to the physically opposite ventricles, resulting in circulatory pathways in series.
- Patients may be asymptomatic for years but eventually develop right ventricular failure or left ventricular outflow tract obstruction. Diagnosis is made through physical exam, chest x-ray, and electrocardiogram showing right ventricular hypertrophy.
- Associated anomalies include ventricular septal defects, pulmonary stenosis, Ebstein's anomaly of the tricuspid valve, and heart block. Surgical
The document provides information on inferior wall myocardial infarction (MI), including:
1. Definitions, epidemiology, etiology, clinical features, diagnosis, treatment and complications of inferior wall MI are discussed. Worldwide over 7 million people experience STEMIs or NSTEMIs annually.
2. Diagnosis involves ECG, cardiac imaging, cardiac biomarkers like troponin and CK-MB. Reperfusion therapy within 6 hours includes PCI or thrombolysis. General treatment measures include aspirin, clopidogrel, anticoagulants, analgesics, beta-blockers, nitrates and oxygen.
3. The history of pioneers in cardiology and development of techniques like echocardi
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
- Highlighted causes of pruritus in older patients include dry skin due to reduced skin barrier function with age, age-related decline in immunity, and neuropathy.
- Evaluation of pruritus involves assessing severity, location, modifying factors, medications, and performing physical exam to check for signs of dry skin, scabies, or rashes.
- Management depends on identified cause, beginning with treating dry skin, checking for scabies, and using topical steroids or potassium hydroxide if a rash is present. If no rash, further workup and treatment for potential metabolic, endocrine, or neurological causes is warranted.
(1) Cardiac syndrome X refers to chest pain and ST segment depression during exertion despite normal coronary arteries and no other heart disease.
(2) It is thought to be caused by microvascular dysfunction in the coronary arteries. Various factors like diabetes, hypertension, inflammation and estrogen deficiency are associated with endothelial dysfunction and impaired vasodilation.
(3) Diagnosis involves typical angina, evidence of myocardial ischemia on tests like stress electrocardiogram or scintigraphy, and normal coronary arteries on angiography with no other heart condition.
Cryoglobulinemia is a condition where proteins in the blood called cryoglobulins precipitate or clump together at low temperatures. There are three main types of cryoglobulins:
Type I consists of a single monoclonal immunoglobulin. Type II contains monoclonal rheumatoid factors along with polyclonal immunoglobulins. Type III contains only polyclonal immunoglobulins.
The most common cause of cryoglobulinemia is hepatitis C virus infection, which is associated with type II cryoglobulinemia. Other causes include other infections, autoimmune diseases like Sjögren's syndrome, hematological cancers, and essential/idiopathic cryoglobulinemia.
Ceftriaxone: 1 g IM once
C16,47
Lavage of the infected eye
C16
Treatment to cover chlamydia is indicated
C16,50
Dual therapy
C16
1) Conjunctivitis is inflammation of the conjunctiva that covers the sclera and inside of the eyelids.
2) Causes of conjunctivitis include viral (most common), bacterial, allergic, toxic, autoimmune, and tumoral. The most common viruses are adenoviruses.
3) Treatment depends on the cause but may include antibiotics, antivirals, cold compresses
1) Fulminant type 1 diabetes is a subtype of type 1 diabetes that accounts for around 20% of acute-onset type 1 diabetes cases in Japan. It is characterized by a very rapid onset typically within 1 week and associated with diabetic ketoacidosis.
2) Genetic factors like certain HLA genotypes are associated with increased risk of developing fulminant type 1 diabetes. Viral infections also seem to trigger onset in many cases.
3) Affected individuals tend to be adults with a mean age of around 40 years. Fulminant type 1 diabetes results in almost complete loss of insulin secretion and pancreatic beta cell mass within a short period.
Scleroderma Renal Crisis (SRC) is a malignant hypertension and acute renal failure that can occur in scleroderma patients. It typically affects 5% of scleroderma patients, mainly those with the diffuse type. Pathology shows thickened endothelial cells in blood vessels resembling onion skin. SRC is triggered by factors that further reduce renal blood flow in patients who already have renal hypoperfusion. Early diagnosis and treatment with ACE inhibitors has greatly improved prognosis for SRC. Risk factors include diffuse skin involvement, rapid skin progression, disease duration less than 4 years, recent cardiac events, steroid use over 15mg/day.
Complex regional pain syndrome (CRPS) is characterized by persistent pain that occurs after trauma and is disproportionate to the inciting event. It involves pain, swelling, sweating changes, and motor dysfunction localized to limbs, often impairing social reintegration. CRPS is diagnosed clinically based on symptoms in 3 of 4 categories (sensory, vasomotor, sudomotor/edema, motor/trophic) and signs in 2 categories. While diagnostic criteria lack sensitivity and specificity, the Budapest criteria improved accuracy with 2 symptom and 2 sign categories required. CRPS may involve 3 stages defined by increasing pain, dysfunction and trophic changes, though distinct stages are not validated.
Polycythemia vera (PV) and essential thrombocythemia (ET) are types of myeloproliferative neoplasms characterized by increased red blood cells in PV and increased platelets in ET. Both can involve increased white blood cells and risk of thrombosis, spleen enlargement, itching, and progression to acute myeloid leukemia or myelofibrosis. PV and ET involve an acquired abnormal clone with mutations in genes like JAK2 and MPL. The document discusses diagnostic criteria and distinguishing PV and ET from secondary causes of increased red blood cells or platelets. Bone marrow testing is often not required if criteria are met.
1) Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by early postural instability and vertical gaze palsy.
2) It is more common than previously thought and often misdiagnosed initially as Parkinson's disease or other conditions.
3) Diagnosis relies on clinical features including early falls, slowed vertical eye movements, and a characteristic stare known as the "Mona Lisa" gaze.
This document discusses pyogenic liver abscess, including epidemiology, risk factors, pathogenesis, microbiology, and relationships to hepatocellular carcinoma and colorectal cancer. Some key points:
- Klebsiella pneumoniae is the most common causative organism, especially in Asia.
- Risk factors include diabetes, liver cirrhosis, hepatitis B/C infection, and older age.
- Pathogenesis can involve biliary tract infection, hematogenous spread, or direct invasion.
- In some cases, liver abscess may be an initial manifestation of underlying hepatocellular carcinoma or metastasis from colorectal cancer.
Immune Thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet count due to increased platelet destruction and impaired production. The bone marrow findings in ITP show increased immature megakaryocytes with scant cytoplasm and absent lobulation in the nucleus. Dysplastic megakaryocytes with separated nuclei and micromegakaryocytes are also seen. Megakaryocytes in ITP frequently show emperipolesis of lymphocytes or lymphocytes and nucleated red blood cells within the cytoplasm. These bone marrow findings are sensitive and specific for diagnosing ITP.
Normal pressure hydrocephalus (NPH) is a potentially reversible cause of dementia. It is characterized by a triad of gait disturbance, urinary incontinence, and cognitive impairment. Gait disturbance is the most common and responsive to treatment, making "treatable gait disorder" a more accurate description. Diagnosis requires imaging evidence of ventricle enlargement without obstruction and presence of at least two of the three clinical symptoms. Compared to Alzheimer's disease and vascular dementia, NPH shows more prominent enlargement of the lateral and third ventricles, aqueduct, and fourth ventricle on MRI. Lumbar puncture typically shows normal opening pressure. Shunt surgery can improve symptoms if performed early.
Multiple system atrophy (MSA) is a rare, rapidly progressive neurodegenerative disease characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia. MSA is pathologically classified into MSA-P and MSA-C subtypes based on predominant symptoms. Diagnostic criteria require autonomic dysfunction with either parkinsonism or cerebellar ataxia, along with supportive MRI or neuroimaging findings. Compared to Parkinson's disease, MSA has a poorer prognosis with average survival of 7-9 years after onset.
This document summarizes causes of eosinophilia, including:
1) It classifies causes of eosinophilia as primary (clonal, idiopathic) or secondary. Secondary causes include infections, tissue invasion by parasites, drugs, allergies, autoimmune diseases, and malignancies.
2) Common primary causes include hypereosinophilic syndrome (HES), chronic eosinophilic leukemia (CEL), and myeloproliferative neoplasms associated with eosinophilia such as those involving FIP1L1-PDGFRA, PDGFRB, FGFR1, and KIT mutations.
3) Secondary causes discussed include parasitic infections, fungal infections, HIV, drugs
Pneumocystis carinii is a fungus that can cause pneumonia in immunocompromised patients. It exists in four forms - trophozoite, cyst, precyst, and sporozoite. The cyst form can be detected using stains like Giemsa, Papanicolaou, and Grocott staining under a microscope. Diagnosis is usually made by identifying the organism in samples obtained via bronchoscopy such as bronchoalveolar lavage fluid or transbronchial biopsy. Common symptoms include dry cough, fever, night sweats, and shortness of breath. Chest imaging may show diffuse ground glass opacities or nodules. Blood tests such as measuring beta-D-gluc
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
2. Med Sci Monit, 2012: 18(5): RA57-63
Subclavian Steal Syndrome
Review Article Med Sci Monit, 2012: 18(5): RA57-63
HISTORICAL BACKGROUND
Subclavian steal phenomenon occurs when a subclavian ar-
tery stenosis proximal to the vertebral origin causes retro-
grade flow in the ipsilateral vertebral artery. Contorni [1]
鎖骨下動脈 起始部の閉塞, 狭窄により
was the first to recognize and describe this retrograde flow
in 1960 using angiography in a patient who had an absent ra-
dial pulse. A year later, Reivich [2] associated this phenome-
non with transient ischemic attack (TIA) and hence became
椎骨動脈の逆流を生じ,
the first scientist to correlate it with neurological symptoms.
The term “subclavian steal”, however, was coined by Fisher
[3] in 1961. This was after he reviewed Reivich’s article and
observed that the anomaly caused the ipsilateral subclavian
椎骨-脳底動脈系の虚血を生じる病態
artery to receive retrograde flow from the contralateral circu-
lation at the expense of the vertebro-basilar circulation [3].
Subclavian steal syndrome (SSS) has since been defined
as a group of symptoms that arise from this reversed blood
flow in the ipsilateral vertebral artery. It is often a differen-
一過性の脳虚血やめまい, 失神,
tial diagnosis in any patient who presents with a pulse def-
icit or a systolic blood pressure difference of greater than
20 mmHg between the arms [4]. The subclavian steal, in
上肢の間欠性跛行を生じる.
the absence of other anatomical anomalies, is usually as-
ymptomatic and often an incidental finding. Rarely, how-
ever, some patients may provoke the syndrome with exer-
cise and present with transient ipsilateral arm claudication,
ataxia and/or angina. The latter is prominent in those un-
dergoing coronary artery bypass graft (CABG) surgery with
橈骨動脈の脈の欠損や減弱,
the left internal mammary artery (LIMA) as the graft [5].
Angiography was the initial test used to screen for subcla-
血圧の左右差(20mmHg以上)は
vian steal, with only high probability patients being inves-
tigated [6]. This selection bias in testing gave the false im-
pression that SSS was not only rare, but also symptomatic
[7]. However, with the emergence of noninvasive techniques
所見として認められることがある
such as ultrasound in 1970 and magnetic resonance angiog-
raphy (MRA) in 1992, a greater number of asymptomatic
patients have been identified, reflecting the more benign
nature of the condition [8,9]. The prevalence and natural
history of SSS has, nevertheless, only recently been recent-
ly reported [10].
3. Med Sci Monit, 2012: 18(5): RA57-63 Southern Medical Journal 2001;94:445-447
Review Article Med Sci Monit, 2012: 18(5): RA57-63
盗血現象は患側の上肢を運動させたり,
H B ISTORICAL ACKGROUND
Subclavian steal phenomenon occurs when a subclavian ar-
首を曲げる, 左右を向くといった運動, tery stenosis proximal to the vertebral origin causes retro-
grade flow in the ipsilateral vertebral artery. Contorni [1]
was the first to recognize and describe this retrograde flow
in 1960 using angiography in a patient who had an absent ra-
血圧が低下した際に増加. dial pulse. A year later, Reivich [2] associated this phenome-
non with transient ischemic attack (TIA) and hence became
the first scientist to correlate it with neurological symptoms.
The term “subclavian steal”, however, was coined by Fisher
>> 脳底動脈の循環不全を来す. [3] in 1961. This was after he reviewed Reivich’s article and
observed that the anomaly caused the ipsilateral subclavian
artery to receive retrograde flow from the contralateral circu-
lation at the expense of the vertebro-basilar circulation [3].
Subclavian steal syndrome (SSS) has since been defined
椎骨動脈のみでは無く, as a group of symptoms that arise from this reversed blood
flow in the ipsilateral vertebral artery. It is often a differen-
tial diagnosis in any patient who presents with a pulse def-
icit or a systolic blood pressure difference of greater than
20 mmHg between the arms [4]. The subclavian steal, in
the absence of other anatomical anomalies, is usually as-
例えば内胸動脈からのCABG後の患者では ymptomatic and often an incidental finding. Rarely, how-
ever, some patients may provoke the syndrome with exer-
cise and present with transient ipsilateral arm claudication,
冠血流の盗血を来たし, 心筋虚血となる ataxia and/or angina. The latter is prominent in those un-
dergoing coronary artery bypass graft (CABG) surgery with
the left internal mammary artery (LIMA) as the graft [5].
Coronary subclavianAngiographysyndromeという subcla-
stealwith only high probability patients being inves-
vian steal,
was the initial test used to screen for
tigated [6]. This selection bias in testing gave the false im-
病態もある. pression that SSS was not only rare, but also symptomatic
[7]. However, with the emergence of noninvasive techniques
such as ultrasound in 1970 and magnetic resonance angiog-
raphy (MRA) in 1992, a greater number of asymptomatic
patients have been identified, reflecting the more benign
nature of the condition [8,9]. The prevalence and natural
history of SSS has, nevertheless, only recently been recent-
ly reported [10].
4. Figure 2. Schematic diagram showing the retrograde from the left
coronary artery through the mammary artery bypass
grafts in a patient with left subclavian artery Stenosis.
(Reproduced and modified with permission from Takach et
Coronary subclavian steal syndrome al., 2006).
Med Sci Monit, 2012: 18(5): RA57-63
7. Prevelance of grades subclavian steal Prevelance of symptoms and intervention for SSS
100 40
90 Absent % of symptomatic
Partial 35 % of requiring
80 Complete intervention
30
Presence of SSS patients
Precent of SSS patients
症状の有無も 70
60 25
50 20
血圧の左右差に比例 40 15
30
10
20
10 5
血圧差20-30mmHg程度では,
0 0
20–30 31–40 41–50 >50 20–30 31–40 41–50 >50
症候性となる例は少ない(1.38%).
Arm blood pressure differential (mmHg) Arm blood pressure differential (mmHg)
Figure 4. Prevalence of grades of subclavian steal with increasing arm Figure 5. Prevalence of symptoms and interventions in patients with
BP differential. Grade 1: BP differential 20–30 mmHg; Grade SSS with increasing arm Blood Pressure (BP) differential.
血圧差>50mmHgでは38.5%が症候性 (Reproduced and modified with permission from
2: BP differential 31–40 mmHg; Grade 3: BP differential
41–50 mmHg, Grade 4: BP differential >50. (Reproduced Labropoulos et al., 2010).
and modified with permission from Labropoulos et al., 2010).
pathway for the affected arm [31]. Significant ischemia of
CLASSIFICATION the arm is therefore rare, even in patients who have com-
plete occlusion of the proximal subclavian artery [16,32].
The subclavian steal phenomenon has been characterized Some authors have suggested that the patients who develop
either by the territory from which the blood is “stolen” [28] symptoms from this phenomenon usually have additional
or the severity of hemodynamic disturbances in the verte- vascular pathology involving either the intracranial or ex-
bral artery [29]. Territories are classified as vertebral-verte- tra-cranial vessels [33]. However, while there is some log-
bral, carotid-basilar, external carotid-basilar, or carotid-sub- ic to this assertion, cases of patients who had no significant
clavian. A case has also been reported of a patient who had stenosis in any other cervical or intracranial artery yet still
partial bilateral (carotid – carotid and carotid – vertebral) suffered from chronic posterior circulation ischemia as a
subclavian steal syndrome, with blood supply to both arms result of SSS has also been reported [34].
somewhat maintained by collateral vessels [30].
Med Sci Monit, 2012: 18(5): RA57-63 Recent studies have shown a linear correlation between in-