Chapter 4: Normal and Anomalous Coronary Arteries in Humans. Part 1
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Lung Pathology: Embryologic Abnormalities
Chapter2C Lung Pathology: Embryologic Abnormalities Content and Objectives Pulmonary Sequestration 2C-3 Chest X-ray Findings in Arteriovenous Malformation of the Great Vein of Galen 2C-7 Situs Inversus Totalis 2C-10 Congenital Cystic Adenomatoid Malformation of the Lung 2C-14 VATER Association 2C-20 Extralobar Sequestration with Congenital Diaphragmatic Hernia: A Complicated Case Study 2C-24 Congenital Chylothorax: A Case Study 2C-37 Continuing Nursing Education Test CNE-1 Objectives: 1. Explain how the diagnosis of pulmonary sequestration is made. 2. Discuss the types of imaging studies used to diagnose AVM of the great vein of Galen. 3. Describe how imaging studies are used to treat AVM. 4. Explain how situs inversus totalis is diagnosed. 5. Discuss the differential diagnosis of congenital cystic adenomatoid malformation. (continued) Neonatal Radiology Basics Lung Pathology: Embryologic Abnormalities 2C-1 6. Describe the diagnosis work-up for VATER association. 7. Explain the three classifications of pulmonary sequestration. 8. Discuss the diagnostic procedures for congenital chylothorax. 2C-2 Lung Pathology: Embryologic Abnormalities Neonatal Radiology Basics Chapter2C Lung Pathology: Embryologic Abnormalities EDITOR Carol Trotter, PhD, RN, NNP-BC Pulmonary Sequestration pulmonary sequestrations is cited as the 1902 theory of Eppinger and Schauenstein.4 The two postulated an accessory he clinician frequently cares for infants who present foregut tracheobronchia budding distal to the normal buds, Twith respiratory distress and/or abnormal chest x-ray with caudal migration giving rise to the sequestered tissue. The findings of undetermined etiology. One of the essential com- type of sequestration, intralobar or extralobar, would depend ponents in the process of patient evaluation is consideration on the timing of the accessory foregut budding (Figure 2C-1). -
Distance Learning Program Anatomy of the Human Heart/Pig Heart Dissection Middle School/ High School
Distance Learning Program Anatomy of the Human Heart/Pig Heart Dissection Middle School/ High School This guide is for middle and high school students participating in AIMS Anatomy of the Human Heart and Pig Heart Dissections. Programs will be presented by an AIMS Anatomy Specialist. In this activity students will become more familiar with the anatomical structures of the human heart by observing, studying, and examining human specimens. The primary focus is on the anatomy and flow of blood through the heart. Those students participating in Pig Heart Dissections will have the opportunity to dissect and compare anatomical structures. At the end of this document, you will find anatomical diagrams, vocabulary review, and pre/post tests for your students. National Science Education (NSES) Content Standards for grades 9-12 • Content Standard:K-12 Unifying Concepts and Processes :Systems order and organization; Evidence, models and explanation; Form and function • Content Standard F, Science in Personal and Social Perspectives: Personal and community health • Content Standard C, Life Science: Matter, energy and organization of living systems • Content Standard A Science as Inquiry National Science Education (NSES) Content Standards for grades 5-8 • Content Standard A Science as Inquiry • Content Standard C, Life Science: Structure and function in living systems; Diversity and adaptations of organisms • Content Standard F, Science in Personal and Social Perspectives: Personal Health Show Me Standards (Science and Health/Physical Education) • Science 3. Characteristics and interactions of living organisms • Health/Physical Education 1. Structures of, functions of and relationships among human body systems Objectives: The student will be able to: 1. -
Extralobar Pulmonary Sequestration Infected with Mycobacterium Gordonae
Brief Communications Extralobar pulmonary sequestration infected with Mycobacterium gordonae Yukio Umeda, MD, PhD,a Yukihiro Matsuno, MD, PhD,a Matsuhisa Imaizumi, MD, PhD,a Yoshio Mori, MD, PhD,a Hitoshi Iwata, MD, PhD,b and Hiroshi Takiya, MD, PhD,a Gifu, Japan Pulmonary sequestration is a malformation composed of lung was found except around the left lower pulmonary dysplastic lung tissue without normal communication with vein. We diagnosed it as extralobar sequestration and the tracheobronchial tree and with an anomalous systemic planned a simple excision of the sequestrated lung. We di- arterial supply.1 Few cases of pulmonary sequestration in- vided the aberrant artery and drainage vein and excised the fected with tuberculous or nontuberculous mycobacterium sequestrated lung using a linear stapler. The postoperative have been reported.2-4 However, all of those reports were course was uneventful. of intralobar pulmonary sequestrations. In the present article, Histopathologic study revealed destruction of alveolar we describe the first case of extralobar sequestration infected and reconstruction of respiratory epithelium within its own with Mycobacterium gordonae. pleura. The alveolar spaces were filled by mucoid or mono- nuclear cells. Caseating epithelioid granulomas and Lan- ghans’ giant cells were also observed (Figure 2). The CLINICAL SUMMARY diagnosis was of an extralobar pulmonary sequestration in- In August of 2005, a 72-year-old woman was referred to fected with Mycobacterium. M. gordonae was identified the Gifu Prefectural General Medical Center for abnormal from the culture of preoperatively collected sputum and sur- shadow on chest x-ray. Contrast media-enhanced com- gical specimen by the DNA–DNA hybridization method. -
Recurrent Pneumonia (Recurrent Lower Respiratory Tract Infections)
Recurrent Pneumonia (Recurrent lower respiratory tract infections) Guideline developed by Gulnur Com, MD, and Jeanne Velasco, MD in collaboration with the ANGELS team. Last reviewed by Jeanne Velasco, MD, on May 15, 2017. Key Points A single episode of uncomplicated pneumonia in an otherwise healthy child does not require investigation. Recurrent pneumonia is not an uncommon presenting symptom in general pediatric practice and one of the most common reasons for referral to pediatric pulmonologists. Recurrent pneumonia is usually defined as ≥2 episodes of pneumonia in a year or ≥3 in life.1 Many children with recurrent pneumonia do not need a full diagnostic work up, either because pneumonia episodes are not frequent or severe enough or because eventually children become asymptomatic. Evaluation of children with recurrent pneumonias begins by taking a careful history, an examination while the child is sick, and confirmation that the child is truly experiencing recurrent pneumonia. The majority of recurrent pneumonia causes in children have predictable risk factors (e.g., psychomotor retardation with feeding problems). Extensive investigations may not identify an underlying cause in up to 30% of children with recurrent pneumonia.1 The initial step in evaluating a child with recurrent respiratory symptoms includes distinguishing between recurrent wheezing versus recurrent infections. Studies show that asthma is being over diagnosed in children with recurrent respiratory symptoms. Patients with atypical asthma that does not respond to therapy should be investigated further. The evaluation of children with recurrent pneumonia should not be focused only on the respiratory tract. 1 Investigation for other organ system involvement may help for ultimate diagnosis (e.g., cystic fibrosis). -
Blood Vessels
BLOOD VESSELS Blood vessels are how blood travels through the body. Whole blood is a fluid made up of red blood cells (erythrocytes), white blood cells (leukocytes), platelets (thrombocytes), and plasma. It supplies the body with oxygen. SUPERIOR AORTA (AORTIC ARCH) VEINS & VENA CAVA ARTERIES There are two basic types of blood vessels: veins and arteries. Veins carry blood back to the heart and arteries carry blood from the heart out to the rest of the body. Factoid! The smallest blood vessel is five micrometers wide. To put into perspective how small that is, a strand of hair is 17 micrometers wide! 2 BASIC (ARTERY) BLOOD VESSEL TUNICA EXTERNA TUNICA MEDIA (ELASTIC MEMBRANE) STRUCTURE TUNICA MEDIA (SMOOTH MUSCLE) Blood vessels have walls composed of TUNICA INTIMA three layers. (SUBENDOTHELIAL LAYER) The tunica externa is the outermost layer, primarily composed of stretchy collagen fibers. It also contains nerves. The tunica media is the middle layer. It contains smooth muscle and elastic fiber. TUNICA INTIMA (ELASTIC The tunica intima is the innermost layer. MEMBRANE) It contains endothelial cells, which TUNICA INTIMA manage substances passing in and out (ENDOTHELIUM) of the bloodstream. 3 VEINS Blood carries CO2 and waste into venules (super tiny veins). The venules empty into larger veins and these eventually empty into the heart. The walls of veins are not as thick as those of arteries. Some veins have flaps of tissue called valves in order to prevent backflow. Factoid! Valves are found mainly in veins of the limbs where gravity and blood pressure VALVE combine to make venous return more 4 difficult. -
The Muppets Take the Mcu
THE MUPPETS TAKE THE MCU by Nathan Alderman 100% unauthorized. Written for fun, not money. Please don't sue. 1. THE MUPPET STUDIOS LOGO A parody of Marvel Studios' intro. As the fanfare -- whistled, as if by Walter -- crescendos, we hear STATLER (V.O.) Well, we can go home now. WALDORF (V.O.) But the movie's just starting! STATLER (V.O.) Yeah, but we've already seen the best part! WALDORF (V.O.) I thought the best part was the end credits! They CHORTLE as the credits FADE TO BLACK A familiar voice -- one we've heard many times before, and will hear again later in the movie... MR. EXCELSIOR (V.O.) And lo, there came a day like no other, when the unlikeliest of heroes united to face a challenge greater than they could possibly imagine... STATLER (V.O.) Being entertaining? WALDORF (V.O.) Keeping us awake? MR. EXCELSIOR (V.O.) Look, do you guys mind? I'm foreshadowing here. Ahem. Greater than they could possibly imagine... CUT TO: 2. THE MUPPET SHOW COMIC BOOK By Roger Langridge. WALTER reads it, whistling the Marvel Studios theme to himself, until KERMIT All right, is everybody ready for the big pitch meeting? INT. MUPPET STUDIOS The shout startles Walter, who tips over backwards in his chair out of frame, revealing KERMIT THE FROG, emerging from his office into the central space of Muppet Studios. The offices are dated, a little shabby, but they've been thoroughly Muppetized into a wacky, cozy, creative space. SCOOTER appears at Kermit's side, and we follow them through the office. -
Captain Suffers Sudden Cardiac Death During Physical Fitness Evaluation - Alabama
2007 Death in the 15 Fire Fighter Fatality Investigation and Prevention Program line of duty… A summary of a NIOSH fire fighter fatality investigation January 30, 2008 Captain Suffers Sudden Cardiac Death During Physical Fitness Evaluation - Alabama SUMMARY • Incorporate exercise stress tests into the Fire Department’s medical On April 25, 2007, a 56-year-old male career evaluation program. Captain was participating in the Fire Department’s annual “Fit Check” (physical • Provide fire fighters with medical fitness) evaluation. The Captain successfully evaluations and clearance to wear completed the bench press, sit-ups, and sit self-contained breathing apparatus and-reach portions of the evaluation within the (SCBA). allotted time. During the aerobic capacity (3 mile walk) portion of the evaluation, he • Provide exercise equipment in all fire completed 6 of 12 laps around the ¼-mile stations. track, when he suddenly collapsed. Crew members on the scene responded and found • Ensure that all members participate in him unresponsive, not breathing, and with a the Fire Department’s mandatory weak pulse that stopped shortly thereafter. wellness/fitness program. Approximately 29 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support administered on-scene INTRODUCTION and METHODS and at the hospital, the Captain died. The death certificate and the autopsy, completed by the On April 25, 2007, a 56-year-old male Captain County Medical Examiner, listed lost consciousness while participating in the “complications of atherosclerotic Fire Department annual physical fitness cardiovascular disease” as the immediate evaluation. Despite CPR and advanced life cause of death with “cardiomegaly” as a significant condition. The Fire Fighter Fatality Investigation and Prevention NIOSH investigators offer the following Program is conducted by the National Institute for recommendations to address general safety Occupational Safety and Health (NIOSH). -
Coronary Artery Ectasia: an Interventional Cardiologist’S Dilemma Matthew Schmidt and Timothy E Paterick*
ISSN: 2643-3966 Schmidt and Paterick. Int Arch Cardiovasc Dis 2018, 2:007 Volume 2 | Issue 1 Open Access International Archives of Cardiovascular Diseases CaSE REPoRT Coronary Artery Ectasia: An Interventional Cardiologist’s Dilemma Matthew Schmidt and Timothy E Paterick* Check for Bay Care Medical Group, Green Bay, Wisconsin, USA updates *Corresponding author: Timothy E Paterick, MD, JD. MBA, Bay Care Clinic, 4950 Founders Terrace, Hobart, Wisconsin 55145, USA, E-mail: [email protected] The term ‘ectasia’ refers to diffuse dilation of a cor- Abstract onary artery, while focal coronary dilation is called ‘a Coronary artery ectasia is defined as a localized, or diffuse coronary aneurysm’ [2]. The exact pathophysiology of dilation of a coronary artery lumen. Coronary artery ecta- sia is well recognized, but a rare finding encountered dur- CAE is unknown. CAE is an anatomical variant and a ing diagnostic coronary angiography. Coronary artery ec- phenotypic expression of coronary artery disease that tasia represents a form of atherosclerotic coronary artery may present with myocardial ischemia or coronary syn- disease, seen in 1.4-4.9% of patients undergoing coronary drome. The incidence varies between 1.2-4.9% [3]. The angiography. It may be an isolated finding, or in combination CASS registry found CAE in 4.9% of coronary angiograms with stenotic lesions. [3]. Our group classifies CAE as small (vessel size < 5 The classification of coronary artery ectasia is divided into mm), medium (vessels size 5-8 mm) and giant (vessel four groups: Type 1: Diffuse ectasia of two or three vessels, Type 2: Diffuse ectasia in one vessel and localized disease size > 8 m). -
Cardiology Self Learning Package
Cardiology Self Learning Package Module 1: Anatomy and Physiology of the Module 1: Anatomy and Physiology of the Heart Heart. Page 1 Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology (October 2011) CONTENT Introduction…………………………………………………………………………………Page 3 How to use the ECG Self Learning package………………………………………….Page 4 Overview of the Heart…………………………………………………...…………..…….Page 5 Location, Size and Shape of the Heart…………………………………………………Page 5 The Chambers of the Heart…………….………………………………………..……….Page 7 The Circulation System……………………………………….………………..…………Page 8 The Heart Valve Anatomy………………………….…………………………..…………Page 9 Coronary Arteries…………………………………………….……………………..……Page 10 Coronary Veins…………………………………………………………………..……….Page 11 Cardiac Muscle Tissue……………………………………………………………..……Page 12 The Conduction System………………………………………………………………...Page 13 Cardiac Cycle……………………………………………………………………………..Page 15 References…………………………………………………………………………………Page 18 Module Questions………………………………………………………………………..Page 19 Module Evaluation Form………………………………………………………………..Page 22 [Module 1: Anatomy and Physiology of the Heart Page 2 Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology (October 2011) INTRODUCTION Welcome to Module 1: Anatomy and Physiology of the Heart. This self leaning package is designed to as tool to assist nurse in understanding the hearts structure and how the heart works. The goal of this module is to review: Location , size and shape of the heart The chambers of the heart The circulation system of the heart The heart’s valve anatomy Coronary arteries and veins Cardiac muscle tissue The conduction system The cardiac cycle This module will form the foundation of your cardiac knowledge and enable you to understand workings of the heart that will assist you in completing other modules. Learning outcomes form this module are: To state the position of the heart, the size and shape. -
Myocardial Bridges a Forgotten Condition: a Review Martín Ibarrola, MD*
ISSN: 2474-3682 Ibarrola. Clin Med Img Lib 2021, 7:162 DOI: 10.23937/2474-3682/1510162 Volume 7 | Issue 1 Clinical Medical Image Library Open Access IMAGE ARTICLE Myocardial Bridges a Forgotten Condition: A Review Martín Ibarrola, MD* Centro Cardiovascular BV, General Cardiology, Argentina Check for updates *Corresponding author: Martín Ibarrola, MD, Centro Cardiovascular BV, General Cardiology, Argentina Abstract Introduction Myocardial Bridging (MB) is a congenital anomaly in which The first reference of MB was Reymann, H, the an- a segment of a coronary artery takes a “tunneled” intramus- atomically description Published in the Dissertationem cular course under a “bridge” of overlying myocardium. The inauguralem De Vasis Cordis Propriis, written in Latin, first reference of MB in coronary arteries, the association with angina and anatomically as referred by Reyman in described anatomically the presence of MB in a descrip- 1737. Considered a “benign” finding since the myocardi- tion and their relationship with angina in 1937. When al bridge causes coronary artery narrowing during systole noted this anatomy in human heart. Described was a therefore myocardial bridges should not compromise blood congenital variant of a coronary artery in which a por- supply to the musculature during diastole. The Left Anterior Descending coronary (LAD) is the most frequently affected tion of an epicardial coronary artery (most frequently vessel (70% in an autopsy series) and in some cases hearts the middle segment of the LAD takes an intramuscular contain more than one bridge, affecting the same vessel or course [1]. The relation of MB in coronary arteries and different coronaries. presence of angina was described by Black S in 1796 [2]. -
Adult Outcome of Congenital Lower Respiratory Tract Malformations M S Zach, E Eber
500 Arch Dis Child: first published as 10.1136/adc.87.6.500 on 1 December 2002. Downloaded from PAEDIATRIC ORIGINS OF ADULT LUNG DISEASES Series editors: P Sly, S Stick Adult outcome of congenital lower respiratory tract malformations M S Zach, E Eber ............................................................................................................................. Arch Dis Child 2002;87:500–505 ongenital malformations of the lower respiratory tract relevant studies have shown absence of the normal peristaltic are usually diagnosed and managed in the newborn wave, atonia, and pooling of oesophageal contents.89 Cperiod, in infancy, or in childhood. To what extent The clinical course in the first years after repair of TOF is should the adult pulmonologist be experienced in this often characterised by a high incidence of chronic respiratory predominantly paediatric field? symptoms.910 The most typical of these is a brassy, seal-like There are three ways in which an adult physician may be cough that stems from the residual tracheomalacia. While this confronted with this spectrum of disorders. The most frequent “TOF cough” is both impressive and harmless per se, recurrent type of encounter will be a former paediatric patient, now bronchitis and pneumonitis are also frequently observed.711In reaching adulthood, with the history of a surgically treated rare cases, however, tracheomalacia can be severe enough to respiratory malformation; in some of these patients the early cause life threatening apnoeic spells.712 These respiratory loss of lung tissue raises questions of residual damage and symptoms tend to decrease in both frequency and severity compensatory growth. Secondly, there is an increasing with age, and most patients have few or no respiratory number of children in whom paediatric pulmonologists treat complaints by the time they reach adulthood.13 14 respiratory malformations expectantly; these patients eventu- The entire spectrum of residual respiratory morbidity after ally become adults with their malformation still in place. -
Insight Into Coronary Artery Ectasia
Abstract Background: Coronary artery ectasia (CAE) is defined as a diffuse dilatation of the epicardial coronary arteries exceeding 1.5 folds the diameter of the normal adjacent arterial segment and/ or the remaining non-dilated part of the same artery [1]. The incidence of CAE has been variably reported between different nations and ranges between 1.4 -10 % [2-5]. This wide range of variability is related to many factors including diverse definition of CAE, geographical distribution, association with other conditions (i.e. inflammatory, congenital or atherosclerosis) hence the existent uncertainty of disease burden and prevalence [6]. The main pathophysiology of CAE is initially understood to be part of atherosclerosis [3], yet others reported the non-atherosclerotic nature of the disease [2, 7]. The exact disease pathophysiology, prognosis and clinical outcome are not well studied; particularly the isolated, non-atherosclerotic form of the disease has not been fully determined or well identified. Methods: In paper one, we examined the clinical presentation, prevalence and cardiovascular risk profile of the CAE patients in acute myocardial infarction (MI). We investigated the inflammatory response and short-term outcome in CAE patients of 3,321 acute consecutive MI patients who underwent primary Percutaneous Coronary Intervention (PPCI) in two different centres in the United Kingdom (Royal Free Hospital, London and Norfolk and Norwich University Hospital) between January 2009 and August 2012. In paper two, we studied the personalised lipid profile in 16 CAE patients from two different western European centres; Umea in Sweden and Letterkenny in Ireland (mean age 64.9 ± 7.3 years, 6 female).