Encephaloceles are rare birth defects associated with skull defects characterized by partial lacking of bone fusion leaving a gap through which a portion of the brain sticks out (protrudes).
Encephaloceles are rare birth defects associated with skull defects characterized by partial lacking of bone fusion leaving a gap through which a portion of the brain sticks out (protrudes).
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
Effective treatment for hydrocephalus in Mindheal Homeopathy clinic ,Chembur...Shewta shetty
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The anatomy of the ventricular system, the physiology in production of CSF, the pathogenesis, and the different paediatric and adult forms of hydrocephalus.
- 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
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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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.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. Definition
Hydrocephalus is an abnormal enlargement of the ventricles
due to an excessive accumulation of CSF resulting from a
disturbance of its flow, absorption or, uncommonly,
secretion.
The normal volume of CSF is 140 ml. CSF is produced by
the choroid plexus in the ventricles at a rate of about 500 ml
in 24 hours.
4.
5. CSF circulation
The CSF flows from the lateral ventricles through
the foramen of Monro into the 3rd ventricle, via the
aqueduct of Sylvius into the 4th ventricle and then
through the foramina of Magendie and Luschka
into the subarachnoid space and basal cisterns.
It flows over the cerebral hemispheres and is
largely absorbed by the arachnoid villi of the dural
sinuses.
6.
7.
8.
9.
10. Classification
Obstructive hydrocephalus: when there is an
obstruction to the flow of CSF through the
ventricular system.
Communicating hydrocephalus: when there is no
obstruction to the flow of CSF within the ventricular
system but the hydrocephalus is due either to
obstruction to CSF flow outside the ventricular
system or to failure of absorption of CSF by the
arachnoid granulations.
11. Causes
1 Obstructive hydrocephalus:
lateral ventricle : thalamic glioma
3rd ventricule: gliomas or colloid cyst of the 3rd ventricle
aqueduct of Sylvius: primary stenosis or secondary to a tumour
4th ventricular: posterior fossa tumour: medulloblastoma, ependymoma, acoustic
neuroma.
2 Communicating hydrocephalus:
obstruction to flow of CSF through the basal cisterns
failure of absorption of CSF
The most common causes of communicating hydrocephalus are
infection (especially bacterial and tuberculous) and subarachnoid
haemorrhage (either spontaneous, traumatic or postoperative).
12.
13.
14.
15. Presenting features
Hydrocephalus in infants
3-4 per 1000 births ( congenital abnormalities).
The most common congenital cause is stenosis of the
aqueduct of Sylvius. This is a major cause of
hydrocephalus in children with spina bifida and
myelomeningocele who also have a Chiari
malformation. Congenital atresia of the foramen of
Luschka and Magendie (Dandy–Walker cyst) is a
rare cause.
The acquired forms of hydrocephalus occur most
frequently after intracranial bleeding, particularly in
premature infants, in meningitis and because of
tumours.
16. Hydrocephalus in infants
The major clinical features in infants are:
failure to thrive
increased skull circumference
tense anterior fontanelle
‘cracked pot’ sound on skull percussion
transillumination of cranial cavity with strong light
when severe, impaired conscious level and vomiting
‘setting sun’ appearance due to lid retraction and
impaired upward gaze from 3rd ventricular pressure on
the midbrain tectum
thin scalp with dilated veins.
17.
18.
19.
20.
21.
22. Adult hydrocephalus (either acute or gradual)
1. Acute-onset adult hydrocephalus
This type of presentation occurs particularly in patients
with tumours causing obstructive hydrocephalus. The
major presenting features are due to the signs and
symptoms of raised ICP as described earlier:
headache
vomiting
papilloedema
deterioration of conscious state.
Upgaze will often be impaired due to pressure of the dilated 3rd
ventricle on the superior colliculus of the tectum.
23. Adult hydrocephalus
2. Gradual-onset adult hydrocephalus
The symptoms of raised intracranial pressure are only
very gradually progressive and late diagnosis is
common.
Early features in the adolescent involve deteriorating
school performance as a result of headaches, failing
mental function, memory loss and behavioural
disturbances.
Endocrine abnormalities
Progressive visual failure will occur, secondary to
papilloedema and optic atrophy.
In elderly patients a chronic form of hydrocephalus is called
‘normal-pressure hydrocephalus’
24. Radiological investigation
If the lateral ventricles and 3rd ventricle are all very dilated,
and the 4th ventricle is small, it is likely that the obstruction is
at the level of the aqueduct of Sylvius. An enhanced CT scan
or MRI will help determine the cause, as it will better define
the presence of an obstructing tumour. In a communicating
hydrocephalus all the ventricles are dilated.
CT scan
Magnetic resonance imaging.
Ultrasonography.
Plain skull X-ray.
25.
26.
27.
28. Treatment
In general, the treatment of hydrocephalus is a CSF
shunt or a 3rd ventriculostomy. If there has been
rapid neurological deterioration this will need to be
performed as an emergency.
If the hydrocephalus is due to an obstructing tumour
that is surgically accessible, resection of the mass
may lead to resolution of the hydrocephalus and a
shunt might not be necessary.
29. Treatment
CSF shunt
The usual method of CSF diversion is a
ventriculoperitoneal shunt, in which a catheter is
placed into the lateral ventricle and is connected to
a subcutaneous unidirectional pressure-regulated
valve which is attached to a catheter threaded
subcutaneously down to the abdomen and inserted
into the peritoneal cavity.
Modern valves can have their draining pressures
adjusted percutaneously and shunts are being
developed allowing intracranial pressure to be
monitored percutaneously.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39. Treatment
Postoperative care
The postoperative management is similar for any
intracranial procedure. Initially the patient is
nursed flat, to avoid rapid decompression of the
ventricular system. Deterioration of neurological
state or failure to improve will require an urgent
CT scan to confirm that the catheter has been
placed accurately into the ventricular system and to
exclude the possibility of intracranial
complications such as intracerebral haematoma.
40. Complications of ventriculoperitoneal shunt
The major possible complications are:
• infection of the shunt
• obstruction of the shunt
• intracranial haemorrhage.
42. Treatment
Third ventriculostomy
Using an endoscopic technique, a ventriculoscope is
introduced into the lateral ventricle via a frontal burr hole
and advanced through the foramen of Monro. The floor of
the 3rd ventricle just anterior to the mamillary bodies is
then fenestrated, allowing CSF to bypass any obstruction in
the CSF pathway and be reabsorbed by the arachnoid villi.
43.
44. Arrested hydrocephalus
This is a state of chronic hydrocephalus in which
the CSF pressure has returned to normal and there
is no pressure gradient between the cerebral
ventricles and brain parenchyma. It is uncommon
and is most likely to occur in communicating
hydrocephalus.
The patients, often children and adolescents, should
be followed carefully. If there is any deterioration
of those parameters a shunt will be necessary.
45. Normal-pressure hydrocephalus
The gradually progressive classic clinical ‘triad’ consists
of:
1 Dementia.
2 Ataxia.
3 Incontinence.
The syndrome is progressive and the disturbance of
gait, which may be the first and most prominent
symptom, is more of an apraxia than a true gait ataxia.