This document discusses Superior Vena Cava Syndrome (SVCS), which occurs when the Superior Vena Cava (SVC) is compressed, reducing blood flow from the head and upper body. The document covers the case presentation of a patient with SVCS, including symptoms, imaging findings, and treatment. It then provides details on the anatomy, etiologies, clinical features, imaging and classification of SVCS. Treatment options for malignant causes of SVCS such as radiation therapy, chemotherapy and stenting are described. A grading system and treatment algorithm for SVCS are also presented.
Oncologic emergencies are vital for many healthcare practitioners to note even if they do not take care of cancer patients alone. This slide deck covers malignant spinal cord compression, hypercalcemia of malignancy, and tumor lysis syndrome.
Oncologic emergencies are vital for many healthcare practitioners to note even if they do not take care of cancer patients alone. This slide deck covers malignant spinal cord compression, hypercalcemia of malignancy, and tumor lysis syndrome.
Venous Thromboembolism in the Cancer Patientlarriva
Cancer patients are at an increased risk of venous thromboembolism. There have been several guidelines published on the topic from the American College of Chest Physicians (ACCP), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN). Although they agree on some issues regarding prophylaxis and treatment there are several areas that vary. This presentation covers the varying recommendations and the areas of consensus (yellow boxes) among the guidelines while using a patient case to guide their interpretation.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
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.
Venous Thromboembolism in the Cancer Patientlarriva
Cancer patients are at an increased risk of venous thromboembolism. There have been several guidelines published on the topic from the American College of Chest Physicians (ACCP), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN). Although they agree on some issues regarding prophylaxis and treatment there are several areas that vary. This presentation covers the varying recommendations and the areas of consensus (yellow boxes) among the guidelines while using a patient case to guide their interpretation.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
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.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Aortic Transection
• Hemothorax
• Innominate Artery Transection
• Dextrocardia
• Situs Inversus
• Pneumonia
• Complete Lung Consolidation
• Septic Pulmonary Emboli
• Pulmonary Metastases
• Pneumothorax
Endovascular and surgical treatment of pulmonary embolism 26.11.17Ivo Petrov
Interventional treatment (thrombus fragmentation and supraselective fibrinolysis) of high and intermediate risk patients with pulmonary embolism.
Protocols of intervention, results, clinical cases provided
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: January CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. Lauren Ramsey, PA-C works with the Sanger Heart & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Atrial Myxoma
- Cardiac Lymphoma
- Small Cell Lung Cancer
- Metastatic Cervical Squamous Carcinoma
- Spontaneous Pneumothorax
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
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!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
- 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
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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.
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
2. Case Presentation
58 yo female presented with cough productive of yellow sputum, sore
throat and fever with chills for 1 week.
She was seen earlier in clinic with similar complaints and given a course of
Zithromax.
She was using her Albuterol pump more often.
PMHx:
-HIV dx 2007: CD4 284 in 8/2012, VL undetectable in
8/2012, Bactrim, Zithromax ppx dced 6/2012 as CD4 consistently elevated.
-Asthma since childhood, never intubated, non steroid dependent
-Thyrotoxicosis with crisis in 2008, Multinodular goitre-bx benign in 9/2008
-Parotid cyst and masses 9/2008
-Seizure disorder
-Migraine, Chronic Low back pain, Severe OA of knees
-Anxiety, Depression with Psychosis
4. Case Presentation
Family Hx: Mother with heart disease, Breast ca-died of breast ca, father
with DM, died of complications
Social Hx: lives by herself in Harlem in apt with elevator, has HHA, smokes
2 cigarettes/day ( previously ½ PPD X 20 years), No ETOH, no drugs
VS in the ER: T 98.9 F HR 110 BP 129/74 RR 20 Sat 94-97% RA, Wt 115
kg( Baseline)
Physical Exam:
Gen:Obese, AAF, not in acute distress, alert and oriented X3
HEENT: Icteric sclera, No thrush
Neck: +symmetrical fullness at base of neck, bilateral cervical and
supraclavicular LAD
Lymph: mildly tender submandibular LAD
Cardiac: Normal
Pulm: Symmetrically reduced breath sounds b/l, no wheezes/rales/rhonchi
Abd: soft, non tender, no organomegaly, BS+
Skin: Normal
Extr:1+ B/l pitting edema.
5. Case Presentation
Labs:
Initial: WBC 9.5, H/H 8.4/24.8 (<- 12/35.3 in 8/2012 baseline), PLT 277
BMP: K 3, CO2 29, BUN/Creat 9/0.8
LFT: ALP 141( elevated since8/2012), T Bili 3.2, D Bili 1.1
Pro BNP 43.3
INR 1.18
Troponins negative
CDX: new RML opacification, left hilar fullness, widened mediastinum
EKG: Sinus tachycardia, No ST-T wave changes
CT PE Protocol :RUL segmental arterial filling defects c/w PE, main PA
normal, heterogenous enhancing mass in right side of thyroid extending
into the mediastinum: multinodular goitre vs malignancy, bulky mediastinal
and Left hilar LAD.
Positive for PE: patient started on heparin drip
CT abdomen non-contrast: cholelithiasis, rest normal
6. Case Presentation
Further Hospital Course:
Patient responded to antibiotic treatment with Ceftriaxone. Since the CT
showed bilateral cervical LAD, she underwent Biopsy of the left cervical
anterior LN. She was then later swtiched to Arixtra and discharged home
after 10 days of IV antibiotics to follow up as outpatient for results of the
biopsy.
She however returned 2 weeks later with persistent symptoms of cough
with yellowish sputum production and worsening sob. She also reported
significant weight loss unintentional 10 pounds along with night sweats.
Repeat Chest CT showed worsening clot burden in the previous areas of
PE and new PE in the left upper lobe. Also noted was interval increase in
the left hilar mass and mediastinal LAD.
She received an IVC filter and was continued on anticoagulation.
7. Case Presentation
Results of the Left Cervical LN FNA were consistent with poorly
differentiated metastatic ca. She later underwent Left Cervical LN excision
biopsy which confirmed the previous finding. The repeat CT also showed
worsening infiltrates in both lungs and patient was then treated for HCAP.
In view of her HIV status, she was also started on Bactrim for suspected
PCP and Zithromax to cover for atypicals. These were later discontinued
due to negative workup.
Patient then had worsening sob, became increasingly dyspnoeic and
orthopnoiec when she was transferred to MHC for further management.
On initial evaluation, patient was noted with facial edema, b/l UE edema
R> L and collateral veins on upper chest. No stridor.
Repeat Chest and Neck CT were done, however in view of AKI, without
contrast. It showed: b/l cervical and supraclavicular LAD with necrotic
nodes left hilar mass and left hilar LAD with marked narrowing of theleft
upper and lower lobe bronchi, bulky right hilar and mediastinal LAD
causing significant narrowing of the trachea,b/l retropectoral and axillary
LAD,enlarged Pulmonary arteries, moderate pleural effusions.
Patient was taken to Lincoln Hospital for RT. Received 1 session. However
expired next day. Patient not resuscitated as she was DNR/DNI.
8. Introduction
SVC Syndrome : A medical entity where compression of SVC by various causes
brings clinical symptoms and signs of facial, upper body edema, formation of
collateral circulations, and causes cyanosis and dyspnea.
Affects 15,000 people in the US every year.
Symptoms develop over a period of 2 weeks in approx. a third of patients, and
over longer periods in other cases.
15. CT Diagnosis of Superior Vena
Cava Syndrome: Importance of
Collateral Vessels
It was believed at that time that CT diagnosis of obstruction of the superior
vena cava (SVC) or its major tributaries required at least two findings:
One was lack of (or decreased) opacification of central venous structures
distal to the site of obstruction.
(This may be associated with a visible, obstructing lesion or intraluminal
filling defects.)
The other CT finding was opacification of collateral venous vessels. The
fulfillment of either criterion alone was insufficient for an accurate CT
diagnosis of venous obstruction.
Results of their study: The presence of collateral vessels, regardless of
the number and location of the vessels shown on CT scans, was highly
accurate as a predictor of superior vena cave syndrome, with a
sensitivity of 96% and a specificity of 92%.
The most common site of venous obstruction seen on CT scans was
the SVC (n = 41), followed by the brachiocephalic vein (n = 20) and the
jugular vein (n = 2).
KIM ET AL. AJA:161, September1993
16. CT Diagnosis of Superior Vena
Cava Syndrome: Importance of
Collateral Vessels-Contd.
KIM ET AL. AJA:161, September1993
17. Clinical and Radiological Grading of
Superior Vena Cava Obstruction
Respiration 2008;76:69–75Plekker et al
18. Clinical and Radiological Grading of
Superior Vena Cava Obstruction-Contd.
Respiration 2008;76:69–75Plekker et al
19. Clinical and Radiological Grading of
Superior Vena Cava Obstruction-
Contd.
Respiration 2008;76:69–75Plekker et al
20. Clinical and Radiological Grading of
Superior Vena Cava Obstruction-
Contd.
Results of their study:
Thirty-four cases of SVCO were evaluated: 8 (23.5%) were
clinicallymild,16 (47%) moderate and 10 (29.5%) severe.
Lung cancer was the underlying histological diagnosis in 94% of
cases.
Radiologically,53% had complete SVCO. A well-developed collateral
system was found in 14 (41%).
A scoring system subtracting a ‘collateral score’ from an ‘obstruction
score’ showed a significant correlation with the clinical score (r =
0.75, p <0.01).
Conclusions:
Clinical severity of SVCO depends upon the degree of SVCO and is
ameliorated by collateral formation.
The novel clinical scoring system can predict the underlying CT
features in SVCO and may be valuable in the bedside assessment
of SVCO severity.
Respiration 2008;76:69–75Plekker et al
23. Radiation Therapy
Effective modality for malignancy related SVCO.
Relative Contraindications to RT:
Previous RT in same area
Certain Connective Tissue Disorders like Scleroderma
Known radioresistant tumor types eg Sarcoma
Response rates in literature clinical: Significant discordance with objective
response rates measured by imaging.
RT treatment can vary based on tumor histology and intent of treatment.
RT involves CT Based simulation for designing RT fields: should
encompass gross tumor volume and involved nodal regions and shield
normal organs particularly lungs and esophagus.
Field size may be altered during treatment course.
Monitor for progression of radioresistant tumors requiring alternative treatment.
Occasionally, symptom worsening may be due to thrombus.
24. Radiation Therapy-Contd.
As per a systematic review done by Rowell and Gleeson: RT provided relief
in ¾ ths of SVCO in SCLC and 2/3 rds of SVCO in NSCLC
Rapidity of response ranges from 7-15 days, may be seen as early as 72
hours.
Chemotherapy and radiotherapy are effective in relieving SVCO in a
proportion of patients whilst stent insertion may provide relief in a
higher proportion and more rapidly.
The effectiveness of steroids and the optimal timing of stent insertion
(whether at diagnosis or following failure of other modalities) remain
uncertain.
25. Radiation Therapy
In SCLC chemotherapy and/or radiotherapy relieved SVCO in 77%.
17% of those treated had a recurrence of SVCO.
In NSCLC, 60% had relief of SVCO following chemotherapy
and/or radiotherapy
19% of those treated had a recurrence of SVCO.
Insertion of an SVC stent relieved SVCO in 95%.
11% of those treated had further SVCO but recanalization was
possible in the majority resulting in a long-term patency rate of
92%.
Morbidity following stent insertion was greater if thrombolytics were
administered.
26. Chemotherapy
Lymphomas, SCLS, Germ Cell Tumors: Highly chemosensitive.
RT may be used but poorer long term results; used for failed
chemotherapy.
Chemotherapy can relieve SVCO symptoms in 80% of NHL and
77% of SCLC.
Response rates similar to RT: 7-15 days.
Addition of chemotherapy to RT: No significant benefit.
27. Endovascular Stenting
Relief may be immediate but most often between 24-72 hours.
Useful for:
○ Patients without a tissue diagnosis
○ Previously treated with RT
○ Known Chemotherapy and RT resistant tumors.
Stent placement needs to be followed up by other
treatment modalities.
Use of thrombolytics.
Prophylactic anticoagulation advocated.
Comparison of outcomes limited due to absence of randomized
controlled trials: Reasons for the same include:
○ One treatment more easily available than the other.
○ Clinical reason to favor one modality over another.
29. Benign SVC Syndrome
Most commonly due to chronic hemodialysis catheters and post
transvenous Pacemaker implantation.
Stenting for benign disease not recommended due to longer life
expectancy, lack of long term follow up and possibility of stent fracture,
migration or thrombosis.
Surgery is effective.
PTFE good prosthetic device with good short term patency rates: may be
related to intimal irregularity and stenosis making it prone to thrombosis.
Autogenous vein grafts have a higher patency rate.
Femoral, Subclavian and Jugular veins have been used: disadvantage of
impaired venous return at the site of harvesting.
Spiral vein graft created from saphenous vein to form a venous conduit is
the preferred graft now.
Disadvantages: long suture line: more thrombogenic, more time consuming
to construct.
Another autologous technique: Pericardial tube graft replacement.