Computed Tomography Angiography in Chronic Pulmonary ThromboembolismApollo Hospitals
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
Computed Tomography Angiography in Chronic Pulmonary ThromboembolismApollo Hospitals
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
An Educational material showing Chest Imaging and describing NORMAL IMAGING-VOLUME LOSS-LOSS OF PARENCHYMA-ALVEOLAR PROCESSES-BRONCHIECTASIS
PLEURAL ABNORMALITIES
NODULES AND MASSES
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
An Educational material showing Chest Imaging and describing NORMAL IMAGING-VOLUME LOSS-LOSS OF PARENCHYMA-ALVEOLAR PROCESSES-BRONCHIECTASIS
PLEURAL ABNORMALITIES
NODULES AND MASSES
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
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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2. Anatomy
Azygous Vein- Runs on the right side and drains into the SVC
Thoracic duct- Originates around L1/L2 goes through AORTIC hiatus crosses
towards left side at T4/T5 drains into the Left Subclavian (IJ junction)
Phrenic Nerve- Anterior to hilum
Vagus Nerve- Posterior to hilum
Main resp muscles- diaphragm (80%) and intercostals (20%). When with increased
work of breathing employ SCM, levators, serratus, scalenes.
Sup-Inferior change in volume
3. Anatomy Continued
Right Lung has 3 lobes and accounts for 55% of the volume
Left Lung has 2 lobes and accounts for 45% of the volume
(lingual)
Left Lung has 2 lobes and accounts for 45% of the volume
(lingual)
Type 1- gas exchange
Type 2- surfactant production
There are an equal amount of type 1 and type 2
pneumocytes, although there are more type 1 pneumocytes
on the air exchange surface
4. Post-Op
FEV1>0.8 OR >40% of predicted post op
Use VQ scan if close. Best predictor of pulmonary complications
DLCO>10 (oxygen exchange. Hgb also plays a role in this)
No resection if:
PCO2>50; PO2<60; VO2 max <10-12ml/min/kg
Segmentectomy- Persistent Air Leak
Lobectomy- Atelectasis
Pneumonectomy- Arrythmias
5. Lung Cancer
Lung Cancer:
Asymptomatic, cough, hemoptysis, pain, weight loss
MCC of cancer death
*prognostic factor indicator: nodal involvement
Mets: Brain (1), other lung, bone, liver, adrenals
5 yr survival: ~30 w/ resection. ~10 otherwise
6. Lung Cancer Types
Types:
Non-small cell:
MOST COMMON lung cancer (80% of lung cancer)
Squamous, central, smoking
PTHrP (hypercalcemia)
Adenocarcinoma, peripheral (MOST COMMON NON SMALL CELL)
TX: Resection, Carboplatin, Taxol, XRT
Small cell:
Neuroendocrine. Poor prognosis. Even stage 1 disease: 50% 5 yr survival.
ACTH (MC paraneoplastic syndrome), ADH
TX: Chemo-rads most typical given late presentation; Cisplatin; Etoposide
Mesothelioma:
Asbestos exposure. Ship builder, old houses/buildings. Aggressive local invasion, nodal
invasion, and distant mets
Aggressive
7. Lung Cancer Types Continued
Bronchoealveolar CA:
alveolar walls; multifocal; pneumonia
Carcinoid:
Neuroendocrine. Central. Coughing, flushing, diarrhea, hemoptysis
Typical 90% 5 yr; Atypical 60% 5yr
RF for recurrence: >3cm; + nodes
TX: resection
Mets:
Can be resectable IF no other mets. Colon, Renal, Sarcoma, Melanoma, Ovarian, Endometrial
mets to lung
8. Work Up
Imaging: CT- T & N; PET- M
Mediastinoscopy: For central tumors. CANNOT reach aorto-pulm nodes
If positive, unresectable
Structures
Left- RLN, esophagus, aorta, PA
Right- Azygous, SVC
Anterior- innominate
Chamberlain: though 2nd rib space. Anterior/ Parasternal thoracotomy.
Reaches AP space
Bronchoscopy: central tumors
Non-resectable: N2 (ipsilat nodes onwards)
11. Mediastinal Masses
Asymptomatic, cough, hemoptysis, dyspnea
If Neuroendocrine Typically posterior mediastinum
If asymptomatic 90% benign; symptomatic 50:50
MCC of adenopathy- lymphoma
Anterior: T’s- thymoma (#1 adults), thyroid, T cell, Teratoma, parathyroid
Middle: heart, trachea, ascending aorta bronchogenic cysts, pericardial cysts, enteric
cysts, lymphoma
Posterior: esophagus, neurogenic, lymphoma
12. Mediastinal Masses Continued
All thymomas require resection. 50% malig, 50% symp, 50% myasthenia gravis
Myasthenia Gravis- Antibody to anticholinesterase receptor. TX: Anticholinesterase
inhibitor, steroid, plasmapheresis. Thymus removal (even without mass can improve
symptoms)
Lambert-Eaton- autoimmune presynaptic regulation malfunction. Associated with small
cell. Gets better with time. TX: Guanidine Hydrochloride
13. Mediastinal Masses Continued
Germ cell tumor:
Teratoma- MC germline tumor. Resect because can be malignant. +/- chemo if malignant
Seminoma- MC MALIGNANT- NEGATIVE FOR AFP. Can have positive bHCG
XRT
Non Seminoma- elevated bHCG and AFP
Chemo: cisplatin, bleomycin, etoposide. Surgery for residual disease
Cyst:
Bronchiogenic resect; Pericardial can ;eave alone
Neurogenic Tumors:
painful, neuro symptoms/deficts
MC- neurolemmoma/schwannoma
Paraganglionoma VHL; catecholamine
14. Trachea
MC benign: Papilloma (adult); Hemangioma (children)
MC malignant: squamous cell (adult); carcinoid (children
After surgery:
Early edema reintubation, racemic epinephrine, steroids
Post-intubation stenosis:
Typically at cuff site for ET tube/stoma site
TX: serial dissection endoscopic resection/laser tracheal resection
Traheo-innominate fistula:
Bad problem to have. Herald bleed. Hemoptysis. To avoid, keep trach high (between
2nd and 3rd rings)
TX: Utley maneuver. Median sternotomy. Ligate and resect innominate artery
16. Other things in the lung
Lung abscess:
Necrotic area. Typically from aspiration. Typically in RLL. Think of Staph
TX: ABX drainage surgery if with complication (hemorrhage) or to rule out cancer
Empyema:
Pneumona/parapneumonic effusion
Pleuritic chest pain, fever, cough, SOB. High cells/proteins in fluid. + stain/culture
Exudative (1st week)- chest tube/abx
Fibroproliferative (2nd week)- above + VATs/decortication
Organized (3rd week onwards)- likely will need decortication. Adjuncts: intrapleural
tPA/Elpesser flap
17. Other things in the lung continued
Chylothorax:
high lymphocytes and Triglycerides (>110). Sudean red stain
Trauma, iatrogenic, lymphoma, infection.
T5 and above= left// T6 and below= right
TX: chest tube, octreotide, low fat diet ligate
If malignant: chemo/XRT
Hemoptysis:
Massive if >600 over 24hrs (likely from bronchial arteries)
MCC- infection
TX: bleeding side DOWN (keep visual field dry). Rigid bronch. May require resection/artery
embolization
Spontaneous Pneumo:
Recurrence increases the more episodes you have
Chest tube. PLeurodesis
18. Quick Hits
Endometriosis symptoms + difficulty breathing: pneumothorax (catamenial)
Residual hemothorax/ clotted hemothorax surgery
White out:
Shift away from white out effusion
Shift toward white out collapse
Tuberculosis:
lung apices. Caseating granuloma
Homeless, travel, hospital
TX: INH, rifampin, pyrazinamide
Sarcoidosis- non caseating granuloma
AVMs- embolize
Chest wall tumors- benign: osteochondroma; malignant: chondrosarcoma
