1. The document discusses the clinical use of a portable head CT scanner called CereTom that can scan patients at their bedside. Between 2006-2009, 3421 portable CT scans were performed, with 95.8% in the neuroscience ICU.
2. Scans were used to guide treatment for conditions like traumatic brain injury, hemorrhage, and stroke. Quantitative CBF data from scans helped guide decisions around blood pressure management and other physiological variables.
3. Portable CT allowed scanning of critically ill patients without the risks of moving them, and provided rapid anatomical and physiological data to guide critical care decisions at the patient's bedside.
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerve...InsideScientific
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerventions
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ON DEMAND
Experts discuss how PET/CT imaging can be used to enable image-guided neurointerventions and to study targeted delivery and clearance of therapeutic agents.
WATCH WEBINAR
Mice are by far the most frequently used animal for modeling disease and developing therapeutic strategies including neurointerventions. However, due to its anatomical and physiological barriers, the brain is a difficult target for delivery of therapeutic agents. Systemic administration is plagued with marginal brain accumulation and high risk of off-target side effects.
In this webinar sponsored by Scintica Instrumentation, Dr. Piotr Walczak, Dr. Mirosław Janowski and Dr. Wojciech Lesniak address this challenge and discuss why advanced imaging is essential to perform image-guided neurointerventions.
First, Dr. Janowski provides rationale as to how imaging can be used to better understand how therapeutic agents are delivered to the brain and subsequently cleared. Next, Dr. Walczak reviews methodological and technological advances for improving precision and reproducibility of brain targeting in mice based on MRI and two-photon microscopy. Finally, Dr. Lesniak presents recently-published results using ARGUS PET/CT to quantify intra-artrial delivery of antibodies, nanobodies and poly(amidoamine) dendrimers.
Key Learning Objectives Include:
- Why advanced imaging is essential to perform image-guided neurointerventions
- Why we need to visualize not only penetration of therapeutic agents to the brain, but also their clearance
- How image-guided procedures can be used to visualize and optimize delivery of therapeutic agents to the brain
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerve...InsideScientific
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerventions
Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Email (Opens in new window)
ON DEMAND
Experts discuss how PET/CT imaging can be used to enable image-guided neurointerventions and to study targeted delivery and clearance of therapeutic agents.
WATCH WEBINAR
Mice are by far the most frequently used animal for modeling disease and developing therapeutic strategies including neurointerventions. However, due to its anatomical and physiological barriers, the brain is a difficult target for delivery of therapeutic agents. Systemic administration is plagued with marginal brain accumulation and high risk of off-target side effects.
In this webinar sponsored by Scintica Instrumentation, Dr. Piotr Walczak, Dr. Mirosław Janowski and Dr. Wojciech Lesniak address this challenge and discuss why advanced imaging is essential to perform image-guided neurointerventions.
First, Dr. Janowski provides rationale as to how imaging can be used to better understand how therapeutic agents are delivered to the brain and subsequently cleared. Next, Dr. Walczak reviews methodological and technological advances for improving precision and reproducibility of brain targeting in mice based on MRI and two-photon microscopy. Finally, Dr. Lesniak presents recently-published results using ARGUS PET/CT to quantify intra-artrial delivery of antibodies, nanobodies and poly(amidoamine) dendrimers.
Key Learning Objectives Include:
- Why advanced imaging is essential to perform image-guided neurointerventions
- Why we need to visualize not only penetration of therapeutic agents to the brain, but also their clearance
- How image-guided procedures can be used to visualize and optimize delivery of therapeutic agents to the brain
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
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
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
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Yonas, Howard
1. DISCLOSURES BASED ON EARLY CONSULTATION WITH COMPANY ON DESIGN OF TECHNOLOGY RECEIVED A MINOR STOCK POSITION WITH NEUROLOGICA INC, MAKER OF CERETOM. XENON/CT CBF NOT FDA APPROVED.. XENON/CT CBF INTEGRATED WITHIN CERETM SCANNER BUT AVAILABLE ONLY UNDER AN INVESTIGATIVE PROTOCOL… REAPPROACHING FDA IN 2011…
2. WHAT IS THE ICU STAFF ASKING THEMSELVES?? WHAT DID WE DO WITHOUT A PORTABLE SCANNER?
3. MULTIPLE TRAUMA WITH SEVERE TBI PHYSIOLOGICALLY UNSTABLE WITH ALL THE MONITORS WE KNOW HOW TO PLACE. VENTILATION STATUS MARGINAL…. THIS IS SOMEONE WE DO NOT WANT TO SEE TAKING A “ROAD TRIP”.. WE WERE FORCED TO PROVIDE CARE WITHOUT VITAL ANATOMIC AND PHYSIOLOGICAL DATA
4. BRING HE TECHNOLOGY TO THE PATIENT… DO NOT HAVE TO BE A “ROCKET SCIENTIST ” TO FIGURE THIS OUT….
5. PAST BARRIERS TOMO M (PHILLIPS) -- 1990’S TOO LARGE, TOO HEAVY, TOO UNRELIABLE, TOO DIFFICULT TO USE. CERETOM (NEUROLOGICA)-- 2004+ SMALLER, LIGHTER, MORE RELIABLE, USER FRIENDLY
6. WHY DO WE NEED A PORTABLE SCANNER? BECAUSE MOVEMENT OF MARGINALLY STABLE ICU PATIENTS OUT OF THE UNIT IS DANGEROUS 25% OF HIGH RISK PATIENTS HAVE A COMPLICATION DUE TO TRANSPORT.. COMPROMISES CARE OF PATIENTS REMAINING IN UNIT REDUCES PRODUCTIVITY OF LARGER FIXED SCANNERS
7. WHY A PORTABLE SCANNER BETTER FOR THE PATIENT BETTER FOR OTHER PATIENTS BETTER FOR STAFF (NURSING, INHALATION THERAPY AND MEDICAL) BETTER FOR HOSPITAL LOW COST OF ACQUISITION (1/3 COST OF FIXED SCANNER)
8. WHY NOT IMAGING NOT EQUAL TO FIXED BASED SCANNERS IF NOT EQUAL….VERY CLOSE NOT ENOUGH TECHNICAL SUPPORT MAY NEED MORE CT TECH SUPPORT PERCEIVED LOSS OF CONTROL OF IMAGING TECHNOLOGY BY RADIOLOGY UNIQUE TO EACH HOSPITAL
9. Head Computed Tomography Scanner Technology and Applications: Experience with 3421 Scans Andrew P. Carlson, MD, Howard Yonas, MD From the Department of Neurosurgery, University of New Mexico, Albuquerque, NM. METHODS We describe the clinical use of a portable head CT scanner (CereTom: NeuroLogica: Danvers, MA) that can be brought to the patient’s bedside or to other locations such as the operating room or angiography suite.
10. RESULTS Between June of 2006 and December of 2009, a total of 3421 portable CTs were performed. A total of 3278 (95.8%) were performed in the neuroscience intensive care unit (ICU) for an average of 2.6 neuroscience ICU CT scans per day. Other locations where CTs were performed included other ICUs (n = 97), the operating room (n = 53), the emergency department (n = 1), and the angiography suite (n = 2). Most studies were non-contrasted head CT, though other modalities including xenon/CT, contrasted CT, and CT angiography were performed. CONCLUSION Portable head CT can reliably and consistently be performed at the patient’s bedside. This should lead to decreased transportation-related morbidity and improved rapid decision making in the ICU, OR, and other locations.
11. -STORED IN HALL -BATTERY POWERED -CHARGE MAINTAINED WITH 120 V WALL PLUG -ONE AVERAGE TECH CAN ROLE TO PATIENT -PATIENT HEAD IS STILL AND SCANNER MOVES
15. CERETOM CT (Non Enhanced) Acquisition method Axial Acquired in 1.25mm slices Reconstruction On the scanner In real time 1.25mm, 2.5mm, 5mm & 10mm DICOM SOFT WARE IMPROVEMENTS HAVE STEADILY IMPROVED IMAGE QUALITY..
16. Image Comparison Portable CT image Fixed CT image Same patient scanned 24 hours apart on the CereTom and fixed scanner
17. Comparison: Coronal Sinus Images 4 months apart, Same Patient, Same Dose, Same recon settings CereTom GE Lightspeed
19. CERETOM GOES ELSEWHERE OPERATING ROOM PLACEMENT OF VENTRICULAR CATHETERS EXTENT OF TUMOR REMOVAL– MOST TUMORS ARE EVIDENT WITH CONTRAST PEDIATRIC ICU ANGIO SUITE EVALUATE HEMORRHAGE CBF
20. REMOVE RETRACTOR SYSTEM AND ALL METAL OVER HEAD. 10-15 MINUTES FROM START TO REVIEW OF IMAGES. Intra Operative Scanning
23. REMAINING AVM CAN HIDE --- (DIFFICULT TO DO INTRA OPERATIVE ANGIO IN PRONE POSITION)
24. PEDIATRIC ICU SINGLE ROTATION OF SCANNER CAN IMAGE WITH VERY LOW RADIATION EXPOSURE
25. XENON/CT CBF INTEGRATED WITHIN CERETOM WHY HAVE WE CONTINUED TO PURSUE? ONLY MEANS OF OBTAINING QUANTITATIVE CBF AT BEDSIDE. 24,000 CALCULATIONS PER CT IMAGE X 4 IMAGES SAFEST CONTRAST AGENT WITH VERY RAPID WASHIN AND WASHOUT STUDIES REPEATABLE WITHIN 10 MINUTES
26. BEEN AT THIS FOR A LONG TIME (1978---) ⏎ -REBREATHER- 8 LITERS XE/STUDY -CALCULATION IN 10 SECONDS SEPARATE COMPUTER ---------I HAD SOME HAIR -33% XENON FILLED BAG 20 LITERS/STUDY -GE SCANNER INTEGRATION -CALCULALTION 1 HOUR PER LEVEL ------I HAD LOTS OF HAIR
27. 2009 A NEW XE/CT CBF -INTEGRATED WITH CERETOM -CALCULATION 10 SECONDS IMMEDIATE DISPLAY -REBREATHER (8 LITERS 23% XENON/STUDY) ---- I HAVE MUCH LESS HAIR FINALLY: -RIGHT PLACE -RIGHT TIMING -WITH THE RIGHT STUFF
28. WHY PERSIST?? BECAUSE REAL TOMOGRPAHIC HIGH RESOLUTION CBF IS IMPORTANT! PROBABILITY OF INFARCTION 20 40 cc/100gms/min JOVIN, STROKE 03
29.
30. ENDOVASCULAR REPERFUSION ASSOCIATED WITH HEMORRHAGIC COMPLICATION. GUPTA, 2006 HERNIATION IF INVOLVES MOST OF MCA. FIRLIK, 1999 FAILED REPERFUSION HOUR 48 HOUR 2 HOUR 24
31. NEED REAL NUMBERS TO DECIDE ON VESSEL SACIFICEALL QUALITATIVE METHODS FAIL 50% OF TIME..
33. WHY TOMOGRAPHIC DATA BECAUSE INJURY IS RARELY HOMOGENEOUS, ESPECIALLY IN THE WORLD OF HEAD TRAUMA.. CT DAY 1
34. WHY TOMOGRAPHIC DATA BECAUSE INJURY IS RARELY HOMOGENEOUS, ESPECIALLY IN THE WORLD OF HEAD TRAUMA.. CT DAY 1 CBF
35. WHY TOMOGRAPHIC DATA BECAUSE INJURY IS RARELY HOMOGENEOUS, ESPECIALLY IN THE WORLD OF HEAD TRAUMA. CBF DATA CAN TELL YOU WHERE TO PLACE PROBE AND IMPORTANTLY, HOW TO INTERPRET .. CT DAY ONE CBF CT DAY 2 LICOX PROBE
36. TEST RE TEST XE/CT CBF ALLOWS FOR A RAPID AND DIRECT MEASUREMENT OF RESULT OF PHYSIOLOGICAL CHANGE. SHOULD WE RAISE OR LOWER THE BLOOD PRESSURE??
37. 5 DAYS POST ICA ANEURYSM RUPTURE, NEW LEFT HEMIPARESIS DESPITE BLOOD PRESSURE ELEVATION TO 170 MMHG SYSTOLIC STILL HEMIPARETIC, APHASIC AND ISCHEMIC MCA FLOW 18 CC/100GMS/MIN 170/110 on Dopamine SHOULD BP BE HIGHER AND IF SO HOW HIGH??
38. RAISING PRESSURE FURTHER ELEVATED CBF AND CLEARED DEFICITS. NO LONGER ISCHEMIC. NOW WHAT? ANGIOPLASTY 220/125 on more Dopamine 170/110 on Dopamine QUANTITATIVE INFORMATION PROVIDES NEEDED GUIDANCE
39. DAY 10 POST SAH FROM MCA ANEURYSM WITH SYMPTOMATIC VASOSPASM, ON PRESSORS. WHEN TO WITHDRAW PRESSORS? 168/90 ON NEO 145/80 OFF NEO ?
40. DAY 10 POST SAH FROM MCA ANEURYSM WITH SYMPTOMATIC VASOSPASM, ON PRESSORS. WHEN TO WITHDRAW PRESSORS? 168/90 ON NEO 145/80 OFF NEO TOO SOON!!!!!
41. INTRACEREBRAL BLEED 24 YEAR OLD WOMAN POST PARTUM 170 MMHG WE THINK WE KNOW: BP TOO HIGH, MUST LOWER BLUE < 20 CC/100GMS/MIN LAVENDER <8 CC/100GMS/MIN LEVEL BELOW
42. TOO LOW? 175 mm Hg 140 mm Hg 1 CM ABOVE L Basal Ganglia ICH LEVEL 4 GLOBAL REDUCTION OF FLOW WITH FOCAL INCREASE OF CORE AND PENUMBRA 1 CM BELOW
45. GSW- 18 YEAR OLD, ICP 35 MMGG. HOW LOW CAN YOU GO WITH CO2? Level 4 Level 1 Level 2 Level 3 BASELINE CT pCO2 = 38 FLOW LOOKS “NORMAL” DESPITE HIGH ICP
46. GSW- 18 YEAR OLD , ICP25 MMHG WITH PCO2 OF 27 MMHG, Level 4 Level 1 Level 2 Level 3 pCO2 = 38 pCO2 = 27 IMPROVED ICP BUT MADE BRAIN ISCHEMIC, WHAT IS THE GOAL?
48. HEAD TRAUMA 12 YEAR OLD, GCS 7 ICP 35 MMHG, PCO2 36 MMGH LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 BASELINE pCO2 = 36 CBF 70 CC/100GMS/MIN WITH LOW GCS, CLEARLY HYPEREMIC. HOW LOW SHOULD PCO2 GO??
49. HEAD TRAUMA 12 YEAR OLD, GCS 7 CO2 24 AND ICP 18 MMGH. WHAT IS OUR GOAL, ICP, CPP, PCO2 OR CBF??? LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 BASELINE pCO2 = 36 pCO2 = 24 mmHg NEED PATIENT SPECIFIC INFORMATION. LUMPING IS EASIER BUT UNDERSTANDING EACH PATIENT HAS TO BE THE GOAL.
50. CAN AN INITIAL XENON/CT CBF STUDY OBTAINED EARLY AFTER SEVERE TBI PREDICT OUTCOME? NIH GRANT PI: CLAUDIA ROBERTSON DAY ONEXENON/CT CBF STUDIES OBTAINED AND OUTCOMES ASSESSED AS PART OF A PROSPECTIVE TBI DRUG TRIAL.. RE ANALYSIS BY ED NEMOTO
51. TN= VOLUME CORTICAL MANTLE WITH FLOW > 30 CC/100GMS/MIN TC+P= VOLUME CORTICAL MANTLE < 30 CC/100GMS/MIN DAY ONE FLOW VALUES PREDICT OUT COME AT ONE AND 6 MONTHS I MO GOS 6 MO GOS
52. THE GOAL HAS TO BE BRINGING THE TECHNOLOGY TO THE PATIENT WITH BOTH FOCAL AND GLOBAL, EPISODIC AND CONTINUOUS MONITORS OF VITAL VARIABLES. QUANTITATIVE TOMOGRAPHIC CBF SHOULD BE PART OF THE GOAL… THANK YOU FOR ALLOWING ME TO SHARE SOME OF OUR EXPERIENCE AT THE UNIVERSITY OF NEW MEXICO..