Interhospital Pediatric Chest Conference Queen Sirikit National Institute of Child Health 4/10/2007
|
|
- Tabitha Fleming
- 5 years ago
- Views:
Transcription
1 Interhospital Pediatric Chest Conference Queen Sirikit National Institute of Child Health 4/10/2007 Patient profile เด กหญ ง อาย 3 เด อน ภ ม ล าเนา จ.แพร Chief complaint ไข ไอ หอบ 2 ว น Present illness 2 เด อนก อน ม ต มหนองท ท ายทอยขวา ได ยาปฏ ช วนะทาจากคล น ก 1 เด อนก อน มาตรวจท ร.พ.เด กด วยป ญหาต มหนองท ท ายทอยขวาไม ด ข น ได ร บการร กษาโดยการท า I&D และยา dicloxacillin 4 ว นต อมาเด กเร มไอม เสมหะ ไข ไม ส ง น าม กใส ไม หอบเหน อย มาร.พ.ได erythromycin,bromhexine,paracetamol อาการด ข น 2 ส ปดาห ก อน ม ไอเป นช ดๆ ไข ไม ส ง หอบหล งไอ ส าล กนมบ อย ไม เข ยว 2 ว นก อนไข ไอ หายใจหอบเหน อย ถ ายเหลว 2-3 คร งต อว น จ งมาตรวจท ร.พ.เด ก Past history บ ตร 2/2 มารดาผลเล อดปกต คลอดครบก าหนดท ร.พ.วช ระ B.W 3,050 gm. ไม เคยหอบมาก อน, ว คซ นครบตามน ด Development ปกต Nutrition breast feeding Family history มารดา 19 ป แม บ าน ส ขภาพแข งแรง บ ดา 26 ป ร บจ างก อสร าง ส ขภาพแข งแรง ตาเป นโรคปอดเม อ 10 ป ก อนได ร บการร กษาท ร.พ.ร ฐบาล แต ย งม อาการ ไอบ อย ระหว างน ร บการร กษาท ร.พ.ร ฐบาล อ กแห งหน ง บอกเป นโรคปอดเร อร ง ไม ได ใช ยาประจ า ตาส บบ หร จ ด Physical examination GA A Thai girl, alert, tachypnea and dyspnea, no cyanosis V/S T 38 C, PR 130/min, RR 60/min BW 4.2 kg (< P3) HEENT AF 2x2 cm, abscess Ø 1.5 cm. at Rt. Occipital area CVS Normal heart sound, no murmur Lung Subcostal retraction, rhonchi and wheezing both lungs Abdomen Soft, mild distension, liver 3 cm. below RCM (span 7 cm.), Spleen not palpable LN Not enlarged
2 Problem list 1. Fever for 2 wk 2. RTI with Respiratory distress 3. Questionable Tbc contact 4. Hx of chronic skin infection 5. Poor weight gain Investigation CBC Hct 31.7 %, Hb 10.3 g/dl, WBC 19,600 /mm3.(n 47%, L40%, Mo11%, ATL2%) Plt. 633,000 UA Sp.gr , ph 6.0, pro 1+, ket 1+, WBC 3-5, RBC 0-1 ABG ( O2 Box 10 LPM) ph 7.463, Pco mmhg, Po mmhg, HCO mmol/l, BE 0.5 mmol/l LFT TP 4.48 g/dl, Alb 2.72 g/dl, Glo 1.76 g/dl, Alk 91 U/L,Chol 103 mg/dl, TB 0.4/ DB0.18 mg/dl, AST 49/ALT 27 U/L LDH 946 U/L ( ) Gastric wash for AFB x 3 day negative Tuberculin test 0 mm. PCR for TB negative Anti- HIV negative Ig level normal Ig G subclasses normal T and B cell function normal DHR negative TS for modified AFB negative TS for viral study negative for Influenza A/B,Parainfluenza 1/2/3, Adenovirus, RSV TS for fungus negative TS for PCP negative Melioid titer negative (titer 1:20) Bone marrow biopsy unsatisfactory for evaluation Bone marrow aspiration normal cellularity, normal megakaryocyte M:E:L = 68:23:5, EO 4 %
3 CXR
4 CT Chest
5
6 Hospital course 17-4 On O2 box 10 LPM, Start Cefuroxime 18-4 On ETT, Ventilator เปล ยน ATB :Bactrim (R/O PCP) + Ceftriaxone 19-4 Add Amikin 22-4 Off Ceftriaxone, Amikin Start Meropenem 24-4 Off Bactrim 26-4 Add Vancomycin 27-4 CT Chest Off Meropenem, Vancomycin Start Sulperazone 28-4 CXR: พบ massive Rt pneumothorax, on ICD On HFOV 3-5 Median sternotomy Excision tumor, thymectomy and lung biopsy Operation : Total thymectomy size 5.5 x 3.5 x 1.8 cm. Excision of anterior mediastinal tumor: brownish cystic mass size 5 x 4.6 x 3.1 cm. with gelatinous-like content Lung biopsy of LUL and RLL Pathological report : The immunohistochemical studies show tumor cells reactive for CD1a, S100. The CD20, CD15 and CD3 are non-reactive Thymus gland: Histiocytosis-X involving the thymus gland. Mild thymic hyperplasia seen. Final diagnosis is Histiocytosis-X 5-5 Add Amikin 16-5 Off HFOV, on SIMV mode BMA, BM biopsy Start VCR+Prednisolone 18-5 Off ETT, On O2 Box 10 LPM Off Sulperazon (ได ยา 20 ว น)
7 Off Amikin (ได ยา 14 ว น) 24-5 Film bone survey : no definite bone lesion 30-5 CT chest (2nd) 2-6 D/C F/U Hemato Clinic ได Chemotherapy: Vinblastine, prednisolone, VP-16, 6-MP F/U Chest Clinic เด กย งม หายใจเร วบ าง ไม หอบ ไม ม ไข P.E. lungs:clear CXR พ.ค.49 CT Chest พ.ค. 49 CXR ต.ค. 49 CT Chest ต.ค. 49
8 CXR ส.ค. 50 CT Chest ส.ค. 50
9 Pulmonary Langerhans cell histiocytosis (PLCH) Occurs predominantly in adult cigarette smokers PLCH as spectrum of Langerhans cell histiocytosis (uncontrolled proliferation and infiltration of various organs by Langerhans cell) Organ systems involved by LCH may include skin, bone, pituitary gland, lymph nodes and lungs LCH ~ 3 times more common in children than adults Pulmonary involvement much more common in adults with LCH, lungs affected in 50% of children who have multisystem disease Rare cause of ILD in children Epidemiologic features Occurs principally in young adults ages of years, can present in other age groups but rare in children younger than 15 years Sex distribution of PLCH varies among studies Large surgical lung biopsy series of patients with interstitial lung disease identified PLCH in 5% of specimens Principal epidemiologic factor associated with cigarette smoking Smoking also may precipitate recurrence of disease in transplanted lungs of patients with PLCH, conversely, smoking cessation may result in objective improvement of disease Although the epidemiologic association between smoking and PLCH is strong, some patients with biopsy proven PLCH have no history of active, past or second-hand smoking Other potential role for PLCH are genetic factors and viral pathogens Pathogenesis
10 Pathologic finding The lungs contain yellow or grey nodules and subpleural cysts, predominantly in upper lobes, size from 1mm-1.5cm Nodules contain mainly atypical histiocytes (Langerhans cells) and eosinophils with few lymphocytes Infiltrate mainly peribronchiolar but also present in alveolar wall and around small vessels/capillaries EM allows definitive identification of LCH through demonstration of specific intracytoplasmic organelles called Birbeck granules LCH typically identified by staining for the S-100 protein and the CD-1a antigen Birbeck granules S-100 CD-1a
11 Clinical features Commonly present with non-specific respiratory symptoms (cough, exertional dyspnea) 25% of patients are asymptomatic at the time of presentation or have a mild smokers cough, spontaneous pneumothorax is the presenting symptom ~10-15% of patients, constitutional symptoms found upto 1/3 of patients In children presented with FTT,breathlessness Auscultation of the lungs frequently normal, digital clubbing is unusual In advanced stage of the disease, decrease breath sounds and prolonged expiration Pleural effusion(exudative) very uncommon Radiologic features Lung volumes may be either normal or increased Hilar lymphadenopathy is unusual Fine or coarse reticular or nodular infiltrates in the upper and midzones with sparing costophrenic angles If disease progress small cysts or bullae appear and eventually fibrosis and honeycombing HRCT : nodules and cysts that predominantly upper lung zones with relative sparing of lung bases cyst often bizarre shaped, variable in size and typically have a thin wall ( 1 mm.) advanced stage, confluent cysts may be form, difficult to distinguish from emphysema PFT, V/Q scan and DLCO PFT finding depend on when the test is performed during the course of the disease(variable pattern) v./q. scan : not specific(ventilation more impaired than perfusion) DLCO : reduced is likely to be the consequence of involvement of the pulmonary vascular compartment and parenchymal disease Bronchoscopy Bronchoscopy with transbronchoscopic lung biopsy has low diagnostic yield 10-40% (because of the patchy distribution of nodular lesions in PLCH and the small amounts of tissue obtained) Analysis of BAL fluid also has a small, but appreciable diagnostic yield An increase in BAL CD1a cells > 5% occurs almost exclusively in PLCH Lung biopsy Surgical lung biopsy (either by thoracotomy or thoracoscopic lung biopsy) remains the gold standard method with the greatest diagnosis yield because of the large portion of tissue obtained
12 Management Patients with persistent pulmonary or constitutional symptoms or patients who demonstrates progressive decline in lung function, corticosteroid therapy is often used (Prednisolone 0.5mg/kg) Screening echocardiography for pulmonary HT should be considered in all dyspneic patients Various chemotherapeutic agents, such as 2-chlorodeoxyadenosine, vinblastine, MTX, cyclophosphamide, etoposide and etanercept have been tried in patients with progressive PLCH or multisystem LCH that is unresponse to corticosteroid therapy Prognosis and long term outcome Asymptomatics or minimally symptomatic patients have a relatively good prognosis with stabilization or spontaneous improvement, especially with cessation of cigarette smoking Currently, no good clinical marker to identify patients who are at risk for progressive disease Variable prognosis ranging from excellent (spontaneous remission) to lethal in children Retrospective studies have identified various factors associated with adverse clinical outcome -extremes of age -multisystem involvement -prolonged constitutional disturbance -extensive cysts and honeycombing on chest radiograph -markedly reduced DLCO -low FEV1/FVC ratio -corticosteroid therapy at time of F/U -high RV/TLC ratio Serial PFT every 3 months in the first year after diagnosis to identify patients who are likely to develop progressive disease Adult patients with PLCH seem to have an increased risk of developing malignant neoplasms (lymphoma, MDS, and various epithelial cancers)
Imp. Empyema thoracis with pneumothorax Lt.
Present illness On ICD : pus 200 ml. + air Imp. Empyema thoracis with pneumothorax Lt. จ งrefer จงrefer รพ. จ งหว ด จงหวด Present illness รพ. จ งหว ด CBC : Hb 9.5 g/dl, Hct 27 % WBC 10,400 cells/mm 3 (N
More informationObesity Hypoventilation Syndrome
Obesity Hypoventilation Syndrome Teeradej Kuptanon, MD Division of Pediatric Pulmonology, Ramathibodi Hospital, Mahidol University PP; เด กหญ งไทย อาย 8 ป กทม. ประว ต จาก มารดา CC หายใจหอบเหน อยตอนกลางค
More informationPthaigastro.org. Pediatric Gastrointestinal Interhospital Conference 27 มกราคม 2555
Pediatric Gastrointestinal Interhospital Conference 27 มกราคม 2555 ทารกเพศหญ งอาย 8 เด อน ภ ม ลาเนากร งเทพมหานคร ผ นาเสนอ พญ.ศ วพร แสงโสมแจ ม ผ ควบค ม อ.พญ.น ยะดา ว ทยาศ ย อ.พญ.ศ ร ล กษณ เจนน ว ตร สถาบ
More informationFinancial disclosure COMMON DIAGNOSES IN HRCT. High Res Chest HRCT. HRCT Pre test. I have no financial relationships to disclose. Anatomy Nomenclature
Financial disclosure I have no financial relationships to disclose. Douglas Johnson D.O. Cardiothoracic Imaging Gaston Radiology COMMON DIAGNOSES IN HRCT High Res Chest Anatomy Nomenclature HRCT Sampling
More informationClinical Radiological Pathological Conference
Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion
More informationLangerhans Cell Histiocytosis with Anterior Mediastinum, Pulmonary and Liver Involvement: CT Demonstration
Chin J Radiol 2002; 27: 191-195 191 Langerhans Cell Histiocytosis with Anterior Mediastinum, Pulmonary and Liver Involvement: CT Demonstration SIU-CHEUNG CHAN 1 MUN-CHING WONG 1 SHIU-FENG HUANG 2 WAN-CHAK
More informationPULMONARY MEDICINE BOARD REVIEW. Financial Conflicts of Interest. Question #1: Question #1 (Cont.): None. Christopher H. Fanta, M.D.
PULMONARY MEDICINE BOARD REVIEW Christopher H. Fanta, M.D. Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Financial Conflicts of Interest
More informationBRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION
BRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION GRAND ROUND WARD 7C DATE: 25 TH MARCH 2015 PRESENTER: DR E. SAYO FACILITATOR: DR J MECHA DEMOGRAPHIC DATA NAME : CM AGE: 69 YEARS ADDRESS : KIAMBU OCCUPATION:
More informationINTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018
INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial
More informationManish Powari Regional Training Day 10/12/2014
Manish Powari Regional Training Day 10/12/2014 Large number of different types of Interstitial Lung Disease (ILD). Most are very rare Most patients present with one of a smaller number of commoner diseases
More information4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs
Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation
More informationCase approach in Asthma and COPD. Assoc.Prof.Sunee Lertsinudom BSc.Grad.Diplo.BCP. Department of Clinical pharmacy Khonkaen University
Case approach in Asthma and COPD Assoc.Prof.Sunee Lertsinudom BSc.Grad.Diplo.BCP. Department of Clinical pharmacy Khonkaen University Asthma Diagnosis History and patterns of symptoms Physical examination
More informationพรช ย ก งว ฒนก ล ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร จ ฬาลงกรณ มหาว ทยาล ย
พรช ย ก งว ฒนก ล ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร จ ฬาลงกรณ มหาว ทยาล ย We are detectives. Frame of thought Clinical or Lab Medical vs. Surgical Supportive care only? Refer? Frame of thought Onset Clinical
More informationCase Discussion 17/7/2017 Int1.ธนาภรณ โชต เอ ยม
Case Discussion 17/7/2017 Int1.ธนาภรณ โชต เอ ยม Objectives Approach to Acute RLQ pain in female Diagnosis of Acute appendicitis Treatment of Acute Pelvic inflammatory disease Patient identification ผ ป
More informationObservational study II
Observational study II (QUANTITATIVE METHOD IV) หล กส ตรเวชศาสตร ช มชน RACM 302 1 AIMS Observational study and analytic study designs : Case-control study Cross-sectional study Ecological study Calculate
More informationPrimary Research Study Methodology II
Primary Research Study Methodology II Patompong Ungprasert, MD, MS Clinical Epidemiology Unit, Department of Research and Development Faculty of Medicine Siriraj Hospital, Mahidol University Patompong.Unp@Mahidol.ac.th
More informationAn Introduction to Radiology for TB Nurses
An Introduction to Radiology for TB Nurses Garold O. Minns, MD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Garold O. Minns, MD has the following disclosures
More informationPHYSIOLOGY AND MANAGEMENT OF HISTIOCYTIC DISEASE. Brant Ward, MD, PhD Division of Rheumatology, Allergy, and Immunology
PHYSIOLOGY AND MANAGEMENT OF HISTIOCYTIC DISEASE Brant Ward, MD, PhD Division of Rheumatology, Allergy, and Immunology What do histiocytes do? Apoptotic body removal Phagocytosis Antigen presentation Types
More informationCASE CONFERENCE GASTRIC VOLVULUS PIKOM, MD NONGLUK, MD; RADIOLOGIST
CASE CONFERENCE GASTRIC VOLVULUS PIKOM, MD NONGLUK, MD; RADIOLOGIST IDENTIFICATION DATA ผ ป วยเด กชายไทย อาย 13 ว น เช อชาต ไทย ส ญชาต ไทย ภ ม ล าเนา จ งหว ด อ ท ยธาน เข าร บการร กษาท รพ.มหาว ทยาล ยนเรศวรว
More informationInfluenza A (H1N1) Pandemic in Thailand Sopon Iamsirithaworn, MD, MPH, PhD Pasakorn Akarasewi, MD, MPH
Influenza A (H1N1) Pandemic in Thailand 2009 2010 Sopon Iamsirithaworn, MD, MPH, PhD Pasakorn Akarasewi, MD, MPH Kumnuan Ungchusak, MD, MPH Bureau of Epidemiology, Department of Disease Control, Ministry
More information* MILIARY MOTTLING --
* MILIARY MOTTLING -- RARE CAUSE DR ARATHI SRINIVASAN FELLOW IN PEDIATRIC HEMATO ONCOLOGY DR A ANDAL DEPARTMENT OF PEDIATRICS DR JULIUS XAVIER SCOTT DEPARTMENT OF PEDIATRIC HEMATO ONCOLOGY KANCHI KAMAKOTI
More informationOutline Definition of Terms: Lexicon. Traction Bronchiectasis
HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of
More informationExam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies
Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination
More information2 ส งหาคม 2559 เวลา น. รศ.พญ. วน ทปร ยา พงษ สามารถ ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล
Meet the Experts in TB, TB/HIV, DR TB: Childhood MDR-TB 2 ส งหาคม 2559 เวลา 10.30-12.00 น. รศ.พญ. วน ทปร ยา พงษ สามารถ ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล Case 1: A 12 Year- Old Boy with Admitted
More informationTB Radiology for Nurses Garold O. Minns, MD
TB Nurse Case Management Salina, Kansas March 31-April 1, 2010 TB Radiology for Nurses Garold O. Minns, MD April 1, 2010 TB Radiology for Nurses Highway Patrol Training Center Salina, KS April 1, 2010
More informationCase Presentations in ILD. Harold R. Collard, MD Department of Medicine University of California San Francisco
Case Presentations in ILD Harold R. Collard, MD Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Definition/Classification High-resolution CT scan Multidisciplinary
More informationAdam J. Hansen, MD UHC Thoracic Surgery
Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered
More informationAll I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis
All I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis Presenter Disclosure Faculty/Speaker: Dr. Brett Finney BSc MD CCFP Relationships with financial sponsors: Grants/Research
More informationThe Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 31 35
The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 31 35 Pulmonary Langerhans Cell Histiocytosis X Presented with Bilateral Pneumothorax: A Case Report College of Medicine, Taif University,
More informationComplicated echinococcal cyst to Biopsy or not to biopsy. V. Rusanov MR Kramer Pulmonary Institute, Rabin medical center
Complicated echinococcal cyst to Biopsy or not to biopsy V. Rusanov MR Kramer Pulmonary Institute, Rabin medical center Case 1 84 y.o. Male, Iraq descend, past smoker 40 PY Medical History- HTN, Rheumatoid
More informationProfessor Rob Miller
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Professor Rob Miller University College London Medical School COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Prof Rob Miller
More informationSmoking-related interstitial lung disease
Smoking-related interstitial lung disease Sergio Harari U.O. di Pneumologia UTIR Servizio di Fisiopatologia Respiratoria e Emodinamica Polmonare Ospedale S. Giuseppe MultiMedica Milano Milano, 7 Ottobre
More informationRestrictive Pulmonary Diseases
Restrictive Pulmonary Diseases Causes: Acute alveolo-capillary sysfunction Interstitial disease Pleural disorders Chest wall disorders Neuromuscular disease Resistance Pathophysiology Reduced compliance
More informationGeneral History. 林陳 珠 Female 69 years old 住院期間 : ~ Chief Complaint : sudden loss of conscious 5 minutes in the morning.
General History 林陳 珠 Female 69 years old 住院期間 : 93.5.8~93.5.15 Chief Complaint : sudden loss of conscious for 2-52 5 minutes in the morning. General History DM under regular medical control for 10 years.
More informationBilateral Chest X-Ray Shadowing and Bilateral leg lesions - A case of Pulmonary Kaposi Sarcoma
Article ID: WMC005047 ISSN 2046-1690 Bilateral Chest X-Ray Shadowing and Bilateral leg lesions - A case of Pulmonary Kaposi Sarcoma Peer review status: No Corresponding Author: Dr. Mohammad Fawad Khattak,
More informationCLINICAL MANAGEMENT OF PATIENT WITH MERS. Weerawat Manosuthi, MD
CLINICAL MANAGEMENT OF PATIENT WITH MERS Weerawat Manosuthi, MD Outline Clinical course and case management of the first two MERS patients at Bamrasnaradura Data on clinical characteristic and management
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD II, Session XII, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION Session XII MHD II April 21, 2014 STUDENT COPY Helpful Resource: ACP Medicine online available through LUHS Library Infectious
More informationCase conference. Welcome Dr. Lawrence Tierney
Case conference Welcome Dr. Lawrence Tierney Case: 18 year-old male CC) hamatomesis, Fever and cough HPI) 1 st admission One month ago, he admitted to our hospital because of hematemesis. He had weight
More informationRehuka Khurana, MD, MPH has the following disclosures to make:
Case Presentation Steps to a Systematic Approach to Diagnosis of TB Case Presentation Steps to a Systematic Approach to Diagnosis of TB Renuka Khurana, MD, MPH March 13, 2015 TB for Pulmonologist March
More information11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.
The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated
More informationLecture Notes. Chapter 16: Bacterial Pneumonia
Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment
More informationResult of Ambulatory Diet Therapy in Gestational Diabetes Mellitus
Result of Ambulatory Diet Therapy in Gestational Diabetes Mellitus Prasert Sunsaneevithayakul MD*, Sujin Kanokpongsakdi MD*, Anuwat Sutanthavibul MD*, Pornpimol Ruangvutilert MD, PhD*, Dittakarn Boriboohirunsarn
More informationTB Intensive Houston, Texas. Childhood Tuberculosis Kim Connelly Smith. November 12, 2009
TB Intensive Houston, Texas November 10-12, 12 2009 Childhood Tuberculosis Kim Connelly Smith MD, MPH November 12, 2009 Childhood Tuberculosis Kim Connelly Smith MD, MPH November 12, 2009 1 OUTLINE Stages
More informationRadiologic Approach to Smoking Related Interstitial Lung Disease
Radiologic Approach to Smoking Related Interstitial Lung Disease Poster No.: C-1854 Congress: ECR 2013 Type: Educational Exhibit Authors: K.-N. Lee, J.-Y. Han, E.-J. Kang, J. Kang; Busan/KR Keywords: Toxicity,
More informationLung Injury after HCT
Lung Injury after HCT J. Douglas Rizzo, MD, MS Financial Disclosure None SCS06_1.ppt Background HCT an important therapeutic modality for malignant and non-malignant diseases Pulmonary Toxicity common
More informationCLINICAL FEATURES IN PULMONARY TUBERCULOSIS
CLINICAL FEATURES IN PULMONARY TUBERCULOSIS Dr. Amitesh Aggarwal Department of Medicine Tuberculosis Captain of all the Men of Death Great White Plague devastating effect on society 100 years ago one in
More informationCase Study #2. Case Study #1 cont 9/28/2011. CAPA 2011 Christy Wilson PA C. LH is 78 yowf with PMHx of metz breast CA presents
Case Study #1 CAPA 2011 Christy Wilson PA C 46 yo female presents with community acquired PNA (CAP). Her condition worsened and she was transferred to the ICU and placed on mechanical ventilation. Describe
More informationUndergraduate Teaching
Prof. James F Meaney Undergraduate Teaching Chest X-Ray Understanding the normal anatomical by reference to cross sectional imaging Radiology? It s FUN! Cryptic puzzle Sudoku (Minecraft?) It s completely
More informationTBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than
TBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than PAP) BAL is not required as a diagnostic tool in patients
More informationThe McMaster at night Pediatric Curriculum
The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives
More informationCase Report Langerhans Cell Histiocytosis Presenting as Uncontrolled Asthma
Case Reports in Medicine Volume 2013, Article ID 637232, 4 pages http://dx.doi.org/10.1155/2013/637232 Case Report Langerhans Cell Histiocytosis Presenting as Uncontrolled Asthma Frederic A. Rawlins III,
More informationCase Presentation. Rafid Asfar, MD
Case Presentation Rafid Asfar, MD Introduction ANCA associated vasculitis may be localized or systemic, and can involve the eyes Ocular manifestations can occur in the absence of systemic disease in persons
More informationBedside Diagnosis for Infectious Diseases
Bedside Diagnosis for Infectious Diseases Sasisopin Kiertiburanakul, MD, MHS Associate Professor Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol
More information10/17/2016. Nuts and Bolts of Thoracic Radiology. Objectives. Techniques
Nuts and Bolts of Thoracic Radiology October 20, 2016 Carleen Risaliti Objectives Understand the basics of chest radiograph Develop a system for interpreting chest radiographs Correctly identify thoracic
More informationCase presentation. Dr REESAUL R
Case presentation Dr REESAUL R Mr S. 25 years old Case 1 Ref on 06/ April /2006 to Chest Clinic from a private GP of Port Louis for : Cough + haemoptysis and dyspnoea Case 1(6/April/2006) Mr S Single 25
More informationIdiopathic Pulmonary of Care
Chapter 6.1 Living Medical etextbook A Digital Tool at the Point of Care From Projects In Knowledge Pulmonology Idiopathic Pulmonary Fibrosis @Point of Care IPF Case Study: Typical Presentation, Role of
More informationInterstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun
Interstitial Lung Diseases(ILD) By : Dr. Shaher M. Samrah Done by : Ibrahim M. sun. 26.11.11 Introduction Interstitial Lung Diseases (ILD) are group of diseases that affect the interstitium of the lungs,
More informationSeptember 2014 Imaging Case of the Month. Michael B. Gotway, MD. Department of Radiology Mayo Clinic Arizona Scottsdale, AZ
September 2014 Imaging Case of the Month Michael B. Gotway, MD Department of Radiology Mayo Clinic Arizona Scottsdale, AZ Clinical History: A 57-year-old non-smoking woman presented to her physician as
More informationChitsanu Pancharoen, MD Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
Hot Topics in Chitsanu Pancharoen, MD Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University Outline I I. Community acquired pediatric infectious diseases 1. Disease
More informationA Case of Pediatric Plasma Cell Granuloma
August 2001 A Case of Pediatric Plasma Cell Granuloma Nii Tetteh, Harvard Medical School Year IV Our Patient 8 year old male with history of recurrent left lower lobe and lingular pneumonias since 1994.
More informationHYPERSENSITIVITY PNEUMONITIS
HYPERSENSITIVITY PNEUMONITIS A preventable fibrosis MOSAVIR ANSARIE MB., FCCP INTERSTITIAL LUNG DISEASES A heterogeneous group of non infectious, non malignant diffuse parenchymal disorders of the lower
More informationCase study. Radiology Department, Srinakharinwirot University
Case study Radiology Department, Srinakharinwirot University Case ผ ป วยชายไทยอาย 46 ป ภ ม ล าเนา จ งหว ดปท มธาน Chief complaint : ถ กรถส บแปดล อชนท ายขณะท ข บรถยนต โดย ไม ได คาดเข มข ดน รภ ย 3 ว นก อนมาโรงพยาบาล
More informationChest Radiology Interpretation: Findings of Tuberculosis
Chest Radiology Interpretation: Findings of Tuberculosis Get out your laptops, smart phones or other devices pollev.com/chestradiology Case #1 1 Plombage Pneumonia Cancer 2 Reading the TB CXR Be systematic!
More informationThe Spectrum of Management of Pulmonary Ground Glass Nodules
The Spectrum of Management of Pulmonary Ground Glass Nodules Stanley S Siegelman CT Society 10/26/2011 No financial disclosures. Noguchi M et al. Cancer 75: 2844-2852, 1995. 236 surgically resected peripheral
More informationClinico-Pathologic Conferences Pulmonary Langerhans Cell Histiocytosis and Diabetes Insipidus in a Young Smoker
Canadian Respiratory Journal Volume 2016, Article ID 3740902, 5 pages http://dx.doi.org/10.1155/2016/3740902 Clinico-Pathologic Conferences Pulmonary Langerhans Cell Histiocytosis and Diabetes Insipidus
More informationSupplemental Figure 1. Gating strategies for flow cytometry and intracellular cytokinestaining
Supplemental Figure 1. Gating strategies for flow cytometry and intracellular cytokinestaining of PBMCs. Forward scatter area (FSC-A) versus side scatter area (SSC-A) was used to select lymphocytes followed
More informationCase 5 15-year-old male
Case 5 15-year-old male Present illness: Six months ago, abnormality of ECG was incidentally detected by annual health check. His blood level of γ-gtp, HbA1c and norepinephrine were elevated; however,
More informationSmoking-related Interstitial Lung Diseases: High-Resolution CT Findings
Smoking-related Interstitial Lung Diseases: High-Resolution CT Findings Poster No.: C-2358 Congress: ECR 2013 Type: Educational Exhibit Authors: V. Cuartero Revilla, M. Nogueras Carrasco, P. Olmedilla
More informationBPD. Neonatal/Pediatric Cardiopulmonary Care. Disease. Bronchopulmonary Dysplasia. Baby Jane
1 Neonatal/Pediatric Cardiopulmonary Care Disease 2 Bronchopulmonary Dysplasia 3 is a 33-day-old prematurely born girl who weighs 1420 g. At birth, her estimated gestational age was 28 weeks. Her initial
More informationLung Cancer - Suspected
Lung Cancer - Suspected Shared Decision Making Lung Cancer: http://www.enhertsccg.nhs.uk/ Patient presents with abnormal CXR Lung cancer - clinical presentation History and Examination Incidental finding
More informationLung Cancer-a primer. Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo
Lung Cancer-a primer Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo CLINICAL CATEGORIES THE SOLITARY PULMONARY NODULE MULTIPLE PULMONARY NODULES Differential Diagnosis Malignant
More informationPharmacist's Role in Medication Safety : What We Can Learn from Experiences in Ambulatory Clinic
Pharmacist's Role in Medication Safety : What We Can Learn from Experiences in Ambulatory Clinic ภญ. ธศ กานต แช มช อย ภญ. แอนน ไพศาลส ร ก ล กล มงานเภส ชกรรม โรงพยาบาลจ ฬาลงกรณ The median ADE incidence
More informationPatient Management. March 26, 2013 รศ.พญ. นฤมล เด นทร พย ส นทร
Patient Management March 26, 2013 พญ.น ชชนาฏ นชชนาฏ ธรรมเน ยมด ธรรมเนยมด รศ.พญ. นฤมล เด นทร พย ส นทร Case scenario เด กหญ งไทยอาย 2 ป โรคประจ าตว : Tetralogy of Fallot การผ าต ด การผาตด : Total repair
More informationOptimal Use of Blood Component
Optimal Use of Blood Component ว ชาการส ญจร โรงพยาบาลล าปาง ว นท ๑๖ มกราคม พ.ศ.๒๕๕๖ ย งยง ช นธรรมม ตร ภาคว ชาอาย รศาสตร คณะแพทยศาสตร ศ ร ราชพยาบาล ถ านห นล อชา รถม าล อล น เคร องป นล อนาม งามพระธาต ล อไกล
More informationRespiratory Diseases and Disorders
Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower
More informationPediatric Hemato-Oncology Interhospital Conference
Pediatric Hemato-Oncology Interhospital Conference Pallapa Bunjerdluk Division of Hemato-Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University 19-Dec-2017 Patient profile
More informationNew lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma
July 2016 New lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma Contributed by: Laurel Rose, MD, Resident Physician, Indiana University School of Medicine,
More information11/10/2014. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective Radiology Pathology Clinical 1 Role of HRCT Diagnosis Fibrosis vs. inflammation Next step in management Response to treatment
More informationNephrotic syndrome associated with Plasmodium malariae in infancy : A case report
รายงานผ ป วย Chula Med J Vol. 56 No. 5 September- October 2012 Nephrotic syndrome associated with Plasmodium malariae in infancy : A case report Tawatchai Deekajorndech* Savanuch Boonyasuwat* Ankanee Chanakul*
More informationPNEUMONIA IN CHILDREN. IAP UG Teaching slides
PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children
More informationLines and crackles. Making sense of ILD
Lines and crackles Making sense of ILD Case JM 65 year old male Gradual shortness of breath, going on over a year Some dry cough Ex-smoker, quit 10 years ago Crackles in the bases CXR presented Sent to
More informationPediatric TB Lisa Armitige, MD, PhD September 28, 2011
TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Pediatric TB Lisa Armitige, MD, PhD September 28, 2011 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interest.
More informationDiffuse Interstitial Lung Diseases: Is There Really Anything New?
: Is There Really Anything New? Sujal R. Desai, MBBS, MD ESTI SPEAKER SUNDAY Society of Thoracic Radiology San Antonio, Texas March 2014 Diffuse Interstitial Lung Disease The State of Play DILDs Is There
More informationUpdate in Emergency Medicine for Nurse
Update in Emergency Medicine for Nurse Dr. Udomsak Tangchaisuriya MD., B.Sc.(Public health), M.Sc.(Medical science), FTCEP Faculty of Medicine, Naresuan University Outline CPR 2015 & 2018 EKG quiz and
More information1 yr old girl presented with Fever on and off 3 months H/o frequent semisolid bulky stools 3 months Progressive abdominal distension 3 months Failure
Dr Rajasree S Dr Srinivas S, Dr Bagdi RK, Dr Satheesh C Apollo Childrens Hospital, Chennai 1 yr old girl presented with Fever on and off 3 months H/o frequent semisolid bulky stools 3 months Progressive
More informationReporting SPECT-VQ. Alp Notghi
Reporting SPECT-VQ Alp Notghi 20 year old female 24 weeks pregnant Clinical History : SOB and chest pain for past 3 days.?pe Doppler USS excluded DVT Case 4413041 Normal Case 4413041 CXR report: The heart
More informationCystic Lung Disease. Cristopher A. Meyer, MD
Cystic Lung Disease Cristopher A. Meyer, MD Air filled structure with definable wall typically less than 1 mm thick Cris A. Meyer, M.D. Professor of Radiology University of Wisconsin School of Medicine
More informationเช อมความข ดแย ง เพลง But เช อมความข ดแย งม อย หลายต ว เธอไม จ าเป นต องไปกล ว
ต วเข ต วเข ม ว ชาภาษาอ งกฤษ รายการท 5 Grammar ตอนท 5 หน า 14 เช อมความข ดแย ง เพลง But เช อมความข ดแย งม อย หลายต ว เธอไม จ าเป นต องไปกล ว แค ร องไปม วๆ ด าๆ ไปม วๆ เด ยวก ได เอง 1). But, Yet,, However,,,
More informationPulmonary Sarcoidosis - Radiological Evaluation
Original Research Article Pulmonary Sarcoidosis - Radiological Evaluation Jayesh Shah 1, Darshan Shah 2*, C. Raychaudhuri 3 1 Associate Professor, 2 1 st Year Resident, 3 Professor and HOD Radiology Department,
More informationSorasasak Lochindarat, M.D. Queen Sirikit National Institute of Child Health
Management of Severe Pneumonia in Children Sorasasak Lochindarat, M.D. Queen Sirikit National Institute of Child Health Epidemiology i Figure1: Distribution of 10.5 million deaths among children less than
More informationAugust 2018 Imaging Case of the Month: Dyspnea in a 55-Year-Old Smoker. Michael B. Gotway, MD
August 2018 Imaging Case of the Month: Dyspnea in a 55-Year-Old Smoker Michael B. Gotway, MD Department of Radiology Mayo Clinic Arizona Scottsdale, AZ USA Clinical History: A 55 year old woman presented
More informationTransfusion Medicine. Mar 3, 2018
Transfusion Medicine Mar 3, 2018 Objective ร จ ก blood product ใช blood product อย างเหมาะสม Management of complication Donor WB WB = Whole blood PRC = Pack Red Cell PRC PRP PRP = Platelet-rich plasma
More informationDr.kassim.m.sultan F.R.C.P
Dr.kassim.m.sultan F.R.C.P inflammatory disorder of the lung, involving alveolar walls and terminal airways, that is induced, in a susceptible host, by repeated inhalation of a variety of organic agents.
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationHypercalcemia of malignancy. Apirom Laocharoenkeat
Hypercalcemia of malignancy Apirom Laocharoenkeat ผ ป วยหญ งอาย 51ป เป นมะเร งเต านมชน ดแพร กระจาย CC : ม อาการ nausea /vomiting และ mental changes HPI:ได ร บ docetaxel cycle 4 เม อ 18 ว นก อน ญาต ผ ป
More informationPULMONARY EMERGENCIES
EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result
More informationCase 1: Question. 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule
HRCT WORK SHOP Case 1 Case 1: Question 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule Case 1: Question 1.2 What is the diagnosis? 1. Hypersensitivity
More informationOBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules.
Organ Imaging : September 25 2015 OBJECTIVES Case Based Discussion: State of the Art Management of Lung Nodules Dr. Elsie T. Nguyen Dr. Kazuhiro Yasufuku 1. To review guidelines for follow up and management
More informationMelanoma Case Scenario 1
Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5
More information