Medical Videos ppt and Lecture Notes: May 17, 2009

22 May 2009

Intra Cytoplasmic Sperm Injection (ICSI) Procedure

Intra Cytoplasmic Sperm Injection (ICSI) Procedure
Intracytoplasmic Sperm Injection procedure

The indications for ICSI and a video of the process

Chinese Fertilty Massage video

Chinese Fertilty Massage video

Massage techniques for blocked fallopian tubes, endometriosis, female fertility and fibroids.

Infertility - Advances in Treatment video(Part 2)

Infertility - Advances in Treatment video(Part 2)

Overview:
Infertility affects thousands of couples. In this interview, Dr. Howard McClamrock discusses advances in understanding and treating infertility.

Part Two:
How in-vitro fertilization works
Who can benefit most
Egg retrieval
Pre-implantation testing
Intracytoplasmic sperm injection
GIFT and ZIFT procedures
Acupuncture and IVF
Frozen eggs

Guest:
Dr. Howard McClamrock, director of the Center for Assisted Reproductive Technologies at the University of Maryland Medical Center. Dr. McClamrock is also an associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.

Parkinson's Disease Guidelines video(Part 2)

Parkinson's Disease Guidelines video(Part 2)

Overview:
Experts in Parkinson's disease have revised the guidelines for diagnosing and treating the disease in order to help people receive the best care. In this program, the Parkinson's disease specialist who was lead author of the guidelines explains what changes were made and why, along with the latest information about Parkinson's disease.

Part Two:
Deep brain stimulation
Complementary therapies
Benefits of exercise
Physical / speech therapy
Emotional effects of Parkinson's disease
Depression / anxiety
Mental / cognitive changes
Clinical trials
Future research - stem cells

Guest:
Dr. William Weiner, chief of neurology at the University of Maryland Medical Center where he directs the Parkinson's Disease and Movement Disorders Center. Dr. Weiner is also professor and chairman of Neurology at the University of Maryland School of Medicine.

Parkinson's Disease Guidelines video(Part 1)

Parkinson's Disease Guidelines video(Part 1)

Overview:
Experts in Parkinson's disease have revised the guidelines for diagnosing and treating the disease in order to help people receive the best care. In this program, the Parkinson's disease specialist who was lead author of the guidelines explains what changes were made and why, along with the latest information about Parkinson's disease.

Part One:
Parkinson's symptoms
Diagnosing Parkinson's disease
Progression of Parkinson's disease
Medications - Levodopa
Drugs for motor fluctuations

Hearing Loss, Vertigo and Facial Nerve Problems video (Part 2)

Hearing Loss, Vertigo and Facial Nerve Problems (Part 2)

Overview: Our ears play an important role in our lives, not just for hearing, but also for regulating our balance. This interview covers some major health issues involving our ears, including hearing loss and vertigo, as well as facial paralysis.

Guest: Dr. David Eisenman, an ear, nose and throat expert at the University of Maryland Medical Center and an assistant professor of otorhinolaryngology, head and neck surgery at the University of Maryland School of Medicine.

Hearing Loss, Vertigo and Facial Nerve Problems video(Part 1)

Hearing Loss, Vertigo and Facial Nerve Problems video(Part 1)

Overview: Our ears play an important role in our lives, not just for hearing, but also for regulating our balance. This interview covers some major health issues involving

our ears, including hearing loss and vertigo, as well as facial paralysis.

Part One:
How our ears work
Causes of hearing loss
Hearing tests
Medications for hearing loss
Hearing aids
Cochlear implants

Surgery for Lung Cancer video (Part 2)

Surgery for Lung Cancer (Part 2)

Overview:
More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part Two:
Diagnosing lung cancer
Types of lung cancer
Lung cancer symptoms
Staging
Lobectomy
Recurrence Rate

view

Surgery for Lung Cancer Video (Part 1)

Surgery for Lung Cancer (Part 1)

Overview:
More than 85 percent of lung cancer cases are smoking-related. In this interview, we hear from a chest surgeon who specializes in treating lung and esophageal cancer about the trends in smoking in the United States. The interview also covers lung cancer, including how it develops and how it is treated.

Part One:
Cancer death rates
Trends in smoking
Lung cancer
Pack years
Second hand smoke

view

Crohn’s Disease Presentations

Crohn’s Disease Presentations
University of Maryland Inflammatory Bowel Disease Symposium 2006

Management Dilemmas in Ulcerative Colitis
By:Stephen Bickston, M.D.
Assistant Professor of Medicine, University of Virginia

http://www.umm.edu/ibd/ppt/dilemmas_uc_bickston.ppt
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Management Dilemmas in Crohn's Disease
By:Raymond Cross, M.D.
Assistant Professor of Medicine
Director, IBD Program
Division of Gastroenterology and Hepatology, University of Maryland

Inflammatory Bowel Disease Symposium 2007 Presentations

University of Maryland Inflammatory Bowel Disease (IBD)Symposium 2007 Presentations

Colorectal Dysplasia/Cancer in IBD
by:David Rubin, M.D.
Associate Professor of Medicine
Co-Director, Inflammatory Bowel Disease Center, University of Chicago Medical Center

http://www.umm.edu/ibd/ppt/prevent_colorectal_cancer_ibd.ppt
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Issues in the Care of Pediatric and Adolescent IBD
By:Marla Dubinsky, M.D.
Assistant Professor of Medicine and Director of the Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, California

http://www.umm.edu/ibd/ppt/care_teens_ibd.ppt
-----
Hepatic Complications in IBD
By:Preeti Reshamwala, M.D.
Assistant Professor of Medicine
Medical Director, Transplant Hepatology
University of Maryland Medical Center

http://www.umm.edu/ibd/ppt/care_teens_ibd.ppt
-----
Use of Psychotropic Agents in the Treatment of IBS
By:Arnold Wald, M.D.
Associate Professor of Medicine Section of Gastroenterology and Hepatology
University of Wisconsin School of Medicine and Public Health Madison, Wisconsin

Dealing with infertility Video

20 May 2009

Behavioral Approaches to Early Intervention with Autism

Behavioral Approaches to Early Intervention with Autism
Presentation by:WAYNE W. FISHER
Munroe-Meyer Institute at the
University of Nebraska Medical Center

Autism and Childhood Schizophrenia
Definition of Autism
Autism Spectrum Disorders
Prevalence of Autism
NIH Research Dollars Devoted to Autism
Autism
Juvenile Diabetes
Muscular Dystrophy
Leukemia
Cystic Fibrosis
Prevalence of Autism and Other Conditions
Demographics of Autism
Assessment and Diagnosis of Autism
Identifying the Genetic Bases of Autism Spectrum Disorders
Early Screening for Autism (NICHD)
Early Screening for Autism (CHAT)
Associated Disorders
Autism ASD
Associated Etiologic Diagnoses
* Fragile-X syndrome
* Tuberous Sclerosis
* Williams syndrome
* Landau-Kleffner syndrome
* Congenital Rubella
* Smith-Magenis syndrome
* Neurofibromatosis

Genetics and Twin Studies

ADHD and Mental Retardation

ADHD and Mental Retardation
By:Daniel M. Bagner, M.S.

Mental Retardation
* Sub average intelligence (IQ < 70: DSM-IV; <75: AAMR)
* Associated adaptive deficits in at least two areas:
o Communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work
* Occurrence of deficits before age 18
Classification of MR
Pervasive Profound/custodial
Extensive
Severe/trainable
Intermittent
Educable
Mild
IQ range
Support required
Educational Classification
Level of MR
Etiology of MR
ADHD in MR
ADHD in Genetic Etiologies of MR

* Down Syndrome
* Fragile X syndrome

Underdiagnosis of ADHD in MR

Genetic Diseases

Genetic Diseases
Presentation by:Amrik Sahota
Dept Path & Lab Med
UMDNJ - RWJMS

What’s the Nature of This Talk?

* Review
* Preview
* Overview

Major Topics
* Mutations
* Single gene disorders
* Chromosomal disorders
* Multifactorial disorders
* Molecular diagnostics
* Pediatric disorders (not discussed)

DNA RFLPs
HLA antigens
Serum proteins
Blood groups
Structural changes
Chromosomes
Marker
Polymorphic Markers
Microsatellite markers
Single Nucleotide Polymorphisms
Causes of Mutation
* Spontaneous mutations
o Arise naturally during DNA replication
* Induced mutations
o Ionizing radiation (X-rays)
o Non-ionizing radiation (UV)
o Chemical mutagens

Types of Mutation
* Single gene mutations
o Minor structural alterations (single base changes, deletions, insertions, etc)
* Chromosomal mutations
o Major structural alterations (deletions, insertions, inversions, translocations, etc)
o Loss or gain of whole chromosomes (monosomies, trisomies, etc)

Single Gene Mutations
* Structural gene mutations
* Regulatory region mutations
* Dynamic mutations

Point Mutation (Sickle Cell)
Single Base Deletion (ABO)
Three-base Deletion (Cystic Fibrosis)
Premature Chain Termination (Beta Thalassemia)
Four-base Insertion in Hexosaminidase A Gene (Tay-Sachs)
Summary of Single Gene Mutations
Type Effect Example
Deletion Null Cystic fibrosis
Insertion Null Tay-Sachs
Inversion Null Hemophilia A
Missense Null Sickle cell
Nonsense Null Beta-globin
Frameshift Null Cystic fibrosis
Splicing Null Beta-globin
Regulatory Low exp. Beta-globin

Molecular Consequences of Single Gene Mutations
* Loss of function
* Haploinsufficiency
* Dominant negative mutation
* Gain of function

Loss of Function Mutations
Adenine Phosphoribosyltransferase (APRT) Deficiency
Adenine
DHA
Crystals in kidney
Stones in kidney
Renal injury
XDH
Precipitation/crystallization

Variations in Chromosome Number and Arrangement

Variations in Chromosome Number and Arrangement

* Chromosomal mutations or aberrations
o Abnormal chromosomal number
o Gene deletion or duplication
o Chromosome rearrangements
* Aberrant chromosomes passed on in a Mendelian fashion

Terminology
* Euploid – chromosomes present in complete haploid units
o Haploid
o Diploid
o Triploid
o Tetraploid
* Aneuploid – loss or gain of one or more chromosomes
* Alloploid – multiples of different genomes

Aneuploidy
* Commonly results from nondisjunction during meiosis
o Monosomy, trisomy, tetrasomy, etc.
o Klinefelter and Turner syndromes are examples involving human sex chromosomes

Nondisjunction
Monosomy
Cri-du-Chat Syndrome
* Autosomal monosomy in humans not reported beyond birth (die quickly)
* Partial autosomal monosomy may survive
* “Cry of cat” syndrome

Trisomy
* Trisomy (2n + 1)
* Meiotic issues

Trisomy Meiosis

Reasons for Referral to Genetics

Reasons for Referral to Genetics

Prenatal or preconceptional patient who is or will be:
* Age 35 years or older at the time of delivery (for a singleton pregnancy)
* Age 33 years or older at the time of delivery (for a twin pregnancy)
* A close blood relative of her partner (consanguineous union)

Prenatal or preconceptional patient who has:
* An abnormal first or second trimester maternal serum nuchal translucency screening test
* Exposure to a teratogen or potentially teratogenic agent during gestation such as radiation, high-risk infections (cytomegalovirus, toxoplasmosis, rubella), drugs, medications, alcohol, etc.
* A fetal anomaly or multiple anomalies identified on ultrasound and/or through echocardiography
* A personal or family history of pregnancy complications known to be associated with genetic factors such as acute fatty liver of pregnancy

Either member of the couple with:
* A positive carrier screening test for a genetic condition such as cystic fibrosis, thalassemia, sickle cell anemia, Tay-Sachs, etc.
* A personal history of stillbirths, previous child with hydrops, recurrent pregnancy losses (more than two), or a child with sudden infant death syndrome (SIDS)
* A progressive neurologic condition known to be genetically determined such as a peripheral neuropathy, unexplained myopathy, progressive ataxia, early onset dementia, or a familial movement disorder
* A statin-induced myopathy

Either member of the couple with a family or personal history of:
* A birth defect such as a cleft lip palate, spina bifida, or a congenital heart defect
* A chromosomal abnormality such as a translocation, marker chromosome, or chromosomal mosaicism
* Significant hearing or vision loss thought to be genetically determined
* Mental retardation or autism

Rates of Autism in Fragile X syndrome

Rates of Autism in Fragile X syndrome (FXS)

FXS OVERVIEW
* Fragile X syndrome (FXS), also called Martin-Bell syndrome, is the most common type of inherited intellectual disability
* An inherited condition that is passed down from parents to child, due to a single gene mutation. The abnormal gene is located in the X chromosome.
* About one out of 4,000 males and one out of 8,000 females are born with FXS each year in the United States.
* Mothers with the mutation have 50% chance of passing the gene to their children of both sexes, whereas fathers can only pass it to their daughters.
* Severity of the condition depends on the number of gene repetition.
* patients with FXS experience some combination of symptoms that affect their mental, physical, social, and sensory characteristics. Females with FXS often experience milder symptoms than males.

(http://www.wellness.com/reference/conditions/fragile-x-syndrome-fxs/symptoms-and-causes)

GUILTY GENE
* One in 250 females and 1 in 500 males carries the FMRl gene in a pre-mutation state.
* Located on the long arm of chromosome X, in the q 27.3 region.

CHARACTERISTICS OF FRAGILE X SYNDROME
* FXS has different effects on males and females. Males tend to be more affected than females.
* Intellectual disabilities. ranging from mild to severe. Low IQ score (40-75 for males). Female’s intellectual abilities is considered mild to moderate ,to a relatively normal mental development .
* Physical characteristics:
* elongated face or jaw
* larger ears,
* short stature
* Physical characteristics are usually normal for infants and young children.
* They become noticeable around the 11th year, and become clearly distinct during puberty.
* http://www.wellness.com/reference/conditions/fragile-x-syndrome-fxs/symptoms-and-causes

CHARACTERISTICS OF FRAGILE X SYNDROME

Fragile X Syndrome

Fragile X Syndrome
By: Mary Beth Oliver, Megan Lawrence, Kayla Sink

An inherited disorder caused by a defective gene on the X-chromosome and causing mental retardation, enlarged testes, and facial abnormalities in males and mild or no effects in heterozygous females.

Cause/Origin
* In a normal cell there are 23 pairs of chromosomes.
* The first 22 pairs are the same in both males and females.
* The 23rd pair is what makes a person a boy or girl
* X and Y make a person a male and two X chromosomes make a person a female
* On the X chromosome is a gene that is known as FMR-1, this is where the mutation occurs and causes Fragile X
* The FMR-1 gene is thought to play an important role in the development of the brain
Video:
http://www.youtube.com/watch?v=wGdH1M5lCVY

Prevalence
* affects both males and females from all races and backgrounds
* more men are affected and tend to have more severe traits than the women
* more than 80% of males with Fragile X have an IQ of 75 or below
* women often have less severe impairments than men

Characteristics
* most common characteristics are mental impairments and learning disabilities
* long face and large ears
* problems with sensation, emotion, and behavior
* developmental delay and mental retardation
* speech delay and excessive tiredness
* autism or autistic-like behavior
* delayed motor development

Educational Implications
Calming techniques
* beanbag chair
* watching a video

Fragile X syndrome

Fragile X syndrome

Defenition: A genetic disorder which can cause cognitive impairment and a number of other physical and behavioural characteristics. Some of these behaviours, such as poor eye contact, hand flapping, and poor social skills, also occur in children with autism. While most children with Fragile X Syndrome do not have all the characteristics of autism, about 15% to 33% are diagnosed as autistic. Individuals can be tested for "Fragile X" by having a blood test and having their chromosomes examined by a geneticist.

Presentation by: Michael Garrett Logan

What is Fragile X Syndrome?

* According to the National Fragile X foundation, “fragile X syndrome is the most common cause of mental impairment”
* Impairments range from learning disabilities to severe cognitive disabilities to intellectual disabilities.
* Fragile X is the most common known cause of autism and autism like behaviors.

http://www.fragilex.org

What causes Fragile X Syndrome
* Fragile X syndrome is a genetic disorder passed from parent to offspring through DNA.
* It is caused by mutation of the FMR1 gene (Fragile X mental retardation 1) on the X chromosome.
* This mutation is the result of a trinucleotide repeat disorder.
* A section of the FMR1 DNA usually repeats a sequence known as CGG (cytosine, guanine & guanine) 30-55 times. For someone with Fragile X syndrome, this section repeats itself 200-800 times.
* This causes the FMR1 gene not to produce the FMRP (Fragile X mental retardation protein).

PubMed Search Engines Resource Guide

PubMed Search Engines Resource Guide

This information is provided by Margaret Henderson, Librarian VCU Libraries

There is more than one way to search the medical literature (PubMed) stored at the National Library of Medicine. Entrez is the search engine created by NLM to search PubMed, but just like there are multiple search engines to search the Internet (Google, Netscape, etc.) there are multiple engines that can be used to search PubMed. As different groups and people have needed different things from the literature, they have created front-ends or 3rd party tools to search the medical literature. Some of these PubMed interfaces are useful if your specific needs correspond to those of the search tool.

Full details here

19 May 2009

Pharmacology Basics

Pharmacology Basics

First rule of thumb:
NEVER EVER ADMINISTER A DRUG YOU ARE UNFAMILIAR WITH
* Ancient vs. Modern Pharmacology
o Pharmekos-study of medicine/drug
o Ology-study
* Studies effects of drugs/how they exert their effects

Therapeutic Purposes of Medications
* Prevent disease
* Diagnose disease
* Cure disease
* Relief of symptoms

Drugs
* A drug may be defined as:
o Any substance taken by mouth; injected into a muscle, blood vessel, or cavity of the body; inhaled, or applied topically to treat or prevent a disease or condition.
* Drug- any substance that alters physiologic function w/potential for affecting health
* Drug interaction
* Adverse drug reaction-undesirable drug effect

Sources of Drugs
* Plants
* Animals
* Minerals or mineral products
* Synthetic chemical compounds
* Biotechnology

Drug Nomenclature
Drug Classification Indicates
Forms or Preparations of Drugs
* Liquid (solution, elixir, emulsion, spirit, syrup, suspension)
* Solid (tablet, capsule, powder, granules)
* Suppository (rectal, vaginal)
* Creams or lotions
* Aerosol
Sources of Drug Information
* Pharmacology textbook
* Pharmacists
* Internet sources
* Journal articles
* Drug reference books

Drug Standards Ensure

Antiretroviral Therapy

Antiretroviral Therapy: Adherence, Drug Interactions, and Safety Among Women
Presentation by: Melissa D. Johnson, PharmD, MHS

Objectives
* Identify adherence barriers and motivators specific to women
* Discuss several drug-drug interactions of particular interest among women with HIV
* Describe mechanisms of gender differences antiretroviral pharmacokinetics and the potential implications of this on toxicity

Factors contributing to poor adherence among women
HIV-infected women have higher incidence of:
o Depression
o Emotional stress
o Fatigue and anxiety
o Physical and sexual abuse
o Stigma, rejection, and isolation
o Hiding diagnosis

Barriers to adherence among HIV-infected women
Factors influencing adherence
* Treatment experiences
* Support from provider and others
* Health care environment and material factors
* Informational resources

Factors influencing adherence
Beliefs, attitudes and behaviors regarding adherence among women
Motivators of adherence
o Physician
o Quasi-scientific rationale

Food/Drug Interactions

Food/Drug Interactions
Presentation by:M. Burns, PhD, RD

Drug therapy
* Long-term care
* Numerous drugs
* Therapeutic side effects
* Alters nutritional status

JCAHO
* Joint
* Commission
* Accreditation
* Healthcare
* Organizations

Drug-induced malnutrition
* Numerous meds at one time
* Sudden increased need
* Genetics
* Body composition

High-risk Groups

Biogenic Amines in Foods & MAOI Drugs

Biogenic Amines in Foods & MAOI Drugs
A Crossroads Where Medicine, Nutrition, Pharmacy, and Food Industry Converge
Authors
* Beverly J. McCabe-Sellers, PhD, RD, LD
* Cathleen Staggs, MS
* Margaret L. Bogle, PhD, RD, LD
* Lower Mississippi Delta Nutrition Intervention Research Initiative
* Little Rock, AR 72211

Biogenic Amines in Foods
* What are Biogenic Amines (BAs)?
* What are MAOI drugs?
* Why be concerned?
* What are the problems in establishing BA content of foods?
* Why is interdisciplinary collaboration essential?

Biogenic Amines
* Organic bases usually produced by decarboxylation of amino acids or by amination and transamination of aldehydes and ketones.
* Vasoactive or psychoactive amines.
Decarboxylation Reactions: Free Amino Acid to Biogenic Amine

* Histidine
* Arginine
* Phenylalanine
* Tyrosine
* Tryptophan
* Histamine
* Putrescine
* 1-phenylethylamine &
* Tyramine
* Tryptamine
Vasoactive Pressor Amines
* Tyramine
* Tryptamine
* phenylethylamine

Tyramine:Physiological Effects

Grapefruit Juice: Interactions with Prescription Drugs

Grapefruit “Juicy” Details on Health Benefits and Drug Interactions
Presentation by:Elaine Turner & Gail Rampersaud, FSHN
University of Florida

Grapefruit Juice: Interactions with Prescription Drugs
Grapefruit Juice: What’s the Story?

Some pills become too potent when you drink grapefruit juice Grapefruit juice and drugs don’t mix
Forbidden Fruit? Grapefruit Juice-Medicine Interaction Studied Grapefruit Takes the Defense Sex, drugs, and grapefruit

Food/Drug Interactions
Food can affect:
* absorption
* utilization
* excretion
Influence can be:
* positive
* negative

Effects of Grapefruit Juice Enhances Absorption
* inhibits an intestinal enzyme
* less metabolism in GI tract
* like giving larger dose

Nutrient-drug interaction

Nutrient-drug interaction
Presentation by:Dr. Wassef
Department of Food Science

Definition of drug
* Medicine that helps recover from illness
* Illegal substance that leads to bodily harm and addiction
* Any substance that modifies one or more body functions

Multiple effects of drugs
* For example, Aspirin….
* Limits production of prostaglandins
* Prostaglandins help to produce fevers, sensitize pain receptors, cause contractions of the uterus, stimulate digestive tract motility, control nerve impulse, regulate blood pressure, promote blood clotting, cause inflammation.
* By interfering with prostaglandin actions, aspirin may have multiple effects!
* Nutrient-drug interaction can lead to nutrient imbalance or it can interfere with drug effectiveness
* Adverse interactions occur most likely if drugs are taken over long periods, if several drugs are taken or if nutrition status is poor
* Elderly people with chronic diseases are most vulnerable

Action of a Drug

o Dissolve in stomach
o Absorbed in blood and moves to where needed
o Has a reaction
o Eliminated

Action of a Food/Nutrients
o Digestion in stomach
o Absorbed in blood and moves to where needed
o Has a reaction/stored
o Not needed is Eliminated

Type of interactions
* Drugs can alter food intake, absorption, metabolism and excretion of nutrients
* Foods and nutrients can alter absorption, metabolism and excretion of drugs

Mix Food, Drink and Drugs Carefully
* Ask doctor questions
* Talk to pharmacist
* Read medicine labels
* Read printed material from pharmacy
* Read inserts provided by manufacturers

Nutrient-Drug Interactions
KNOW YOUR DRUG
Don’t mix a drug directly into a food or drink
Know Whether the Drug Should Be Taken on a Full or Empty Stomach
A New Concern - Grapefruit
* Can cause more of a drug to be absorbed from intestine – even toxic levels
* Interfere with the activity of a specific enzyme in the intestine – cytochrome

Drugs may not work when dairy products are consumed
* Tetracycline (also no iron supplements)
* Antifungal medicines
o Examples Diflucan and Nizoral
Drugs may require dairy products to work
* Progesterone supplementation

High Blood Pressure Medicine
* May need more or less potassium in your diet depending on the medicine
* Examples of high potassium foods – bananas, oranges, potatoes, leafy green vegetables, tomatoes

Coumadin and Vitamin K structural analog

Food-Drug Interactions

Food-Drug Interactions

Definition of Terms
* Drug-nutrient interaction: the result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone
* Food-drug interaction: a broad term that includes drug-nutrient interactions and the effect of a medication on nutritional status

Food-Drug Interaction
* For example, a drug that causes chronic nausea or mouth pain may result in poor intake and weight loss
Key Terms
* Bioavailability: degree to which a drug or other substance reaches the circulation and becomes available to the target organ or tissue
* Half-life: amount of time it takes for the blood concentration of a drug to decrease by one half of its steady state level
* Side effect: adverse effect/reaction or any undesirable effect of a drug

Other Terms
* Bioavailability: % free to function
* Absorption rate: % absorbed and time for absorption
* Transported: amount in blood (free or bound)
* Metabolized: altered by enzymes in tissues
* Mixed-function oxidase system (MFOS): enzyme system that metabolizes drugs, carcinogens, compounds in foods, etc.

Pharmacokinetics
Movement of drugs through the body by
* Absorption
* Distribution
* Metabolism
* Excretion
Pharmacodynamics
Benefits of Minimizing Food Drug Interactions
* Medications achieve their intended effects
* Improved compliance with medications
* Less need for additional medication or higher dosages
* Fewer caloric or nutrient supplements are required
* Adverse side effects are avoided
* Optimal nutritional status is preserved
* Accidents and injuries are avoided
* Disease complications are minimized
* The cost of health care services is reduced
* There is less professional liability
* Licensing agency requirements are met

Therapeutic Importance
Patients at Risk for Food-Nutrient Interactions
* Patient with chronic disease
* Elderly
* Fetus
* Infant
* Pregnant woman
* Malnourished patient
* Allergies or intolerances

Food and Drug-Related Risk Factors

Laryngeal Mass

Laryngeal Mass
Presentation by:John F. McGuire, MD, MBA

Case Presentation
History
Exam
Differential Dx
Topic of this Presentation
OCT Today
OCT tomorrow???
Laryngeal Cancer
Clinical Pearls
Anatomy: Think Spaces

* Quadrangular membrane: Fibrous drape from epiglottis over arytenoids.
* Conus elasticus: See diagram.
* Anterior commissure tendon (Broyles ligament):
- No perichondrium.
* Hyoepiglottic ligament:
* Paraglottic space:
* Superior border : quadrangular membrane
* Inferior border: conus elasticus
* Lateral border: inner surface of the thyroid cartilage
* Medial border: ventricle

Management of Patients with Upper Respiratory Tract Disorders

Management of Patients with Upper Respiratory Tract Disorders

Rhinitis
Sinusitis
Pharyngitis
Tonsillitis
Peritonsillar Abscess
Laryngitis
Upper Airway Infections
Upper Airway Infections : Nursing Interventions
Obstructive Sleep Apnea
Epistaxis
Upper Airway Obstruction
Upper Airway Obstruction Inverventions

Laryngeal Cancer

Laryngeal Cancer
Presentation by:Anh Q. Truong
University of Washington, SOM

Anatomy
Anatomy – subdivision
Incidence by Site
Supraglottic
Glottic
Subglottic
Epidemiology
Risk Factors
* Signs and symptoms
Clinical Presentation

Speech Generation and Perception

Speech Generation and Perception

Schematic diagram of the human speech production
Organs of Speech :
* Lungs and trachea :
o source of air during speech.
o The vocal organs work by using compressed air; this is supplied by the lungs and delivered to the system by way of the trachea.
o These organs also control the loudness of the resulting speech.
o The trachea and lungs together constitute the pulmonary tract.
* The Larynx :
o This is a complicated system of cartilages and muscle containing and controlling the vocal cords. Principle parts are :
o The place where the vocal folds come together is called the glottis.
* The Vocal Tract :
o Laryngeal pharynx

Current Diagnosis and Treatment of Voice Disorders

Current Diagnosis and Treatment of Voice Disorders
Presentation by:Seth H. Dailey, MD
Assistant Professor
University of Wisconsin Hospital and Clinics
University of Wisconsin School of Medicine
Internal Medicine Grand Rounds:February 28th, 2007

Laryngeal Anatomy
* Three surrounding structures- pharynx, trachea and esophagus
* Three levels - supraglottis, glottis and subglottis
* Three fixed structures - hyoid, thyroid and cricoid
* Three mobile structures -epiglottis, false vocal cords and true vocal cords (folds)

Laryngeal Physiology
* Three main functions - airway, swallowing and voice
* Three criteria for voice- generator, vibrator resonator
* Three components for high quality glottic voice - closure, pliability and symmetry

Common disorders affect the “magic three”
* Closure - neuromuscular, joint, vocal fold
* Pliability - “golden layer” - mass, scar
* Symmetry - tension and viscoelasticity
* VOICE DISORDERS ARISE FROM A COMBINATION OF THESE ELEMENTS

Evaluation of Hoarseness
* History is paramount
* Projection - tired, breathy and low volume
* Quality - ”hoarse”, “gruff”, “raspy”
* Range - high, middle and low
* Physical Exam
* Speaking voice
* Range profile
* Fundamental Frequency – F0
* Maximum Phonation Time
* Standard Reading Passages

Paradoxical Vocal Cord Motion: Evaluation and Treatment

Paradoxical Vocal Cord Motion: Evaluation and Treatment
Presentation by:Starr M. Cookman, M.A., CCC-SLP
Speech Pathologist
Division of Otolaryngology, UCONN

Pseudonyms
* Episodic Laryngeal Dyskinesia
* Vocal Cord Dysfunction (VCD)
* Munchausen’s Stridor
* Emotional Laryngeal Wheezing
* Pseudo-asthma
* Fictitious Asthma

Definition of PVCM
Essential Features
Symptoms
* Stridor
* Difficulty with inspiratory phase
* Chest and/or throat tightening
* Dysphonia during/following an attack
* Abrupt onset and resolution
* Recalcitrant to medical treatment
* Seems to be related to stress and/or exercise.

Various Etiologies
* Laryngopharyngeal reflux
Vocal Fold Edema
Lx Erythema
Interarytenoid Edema
* Allergic rhinitis
* Conversion disorder
* Respiratory-type laryngeal dystonia
* Drug-induced laryngeal dystonic reactions
* Asthma-associated laryngeal dysfunction
* Brainstem abnormalities
* Chronic laryngeal instability & tension

Vocal Cord Visualization

Vocal Cord Visualization
Presentation Team:Erik Joseph Birkeneder, Kevin Ryan Kinney, Eric Jordan Miller, Christopher Carlin Valley
Vocal Cord Visualization

Overview
* Procedure
* Problem Statement
* Background
* Current Prototype
* New Design Alternatives
* The Matrix
* Final Design and Future Work

Claude Shannon’s Alias Frequency Principle
Prototype – LED Stroboscope
Advantages
Limitations
New Design Alternatives
Design 1 – Foot pedal frequency control
Design 2 – Microprocessor
Design 3 – Microprocessor with LCD Vocal Cord Display
Design Matrix
Manufacturing Simplicity

Exercise Induced Paradoxical Vocal Cord Dysfunction

Exercise Induced Paradoxical Vocal Cord Dysfunction
(EI-PVCD)
Presentation lecture by:Dale R. Gregore, M.S., CCC-SLP
Speech Language Pathologist, Clinical Rehabilitation Specialist - Voice

NORMAL Respiration 101
* On inhalation, the vocal cords (folds) ABduct allowing air to flow into the trachea, bronchial tubes, lungs
* On exhalation, the vocal folds may close slightly, however should and do remain ABducted

Normal Larynx
Vocal fold ABDUCTION occurs during respiration
Vocal fold ADDUCTION Occurs during swallowing, coughing, etc…
Strobe exam
Paradoxical Vocal Fold Movement (PVFM)
* The cord function is reversed in that the vocal folds ADDuct on inspiration versus ABduct
* Leads to tightness or spasm in the larynx
* Inspiratory wheeze evident

Definition of EI-VCD
Pseudonyms
* Vocal Cord Dysfunction (VCD)
* Munchausen’s Stridor
* Emotional Laryngeal Wheezing
* Pseudo-asthma
* Fictitious Asthma
* Episodic Laryngeal Dyskinesia

Patient description of VCD episodes

Vocal Cord Paralysis

Vocal Cord Paralysis
Medialization Laryngoplasty
Shashidhar S. Reddy, MD, MPH
Faculty Sponsor: Anna Pou, MD
University of Texas Medical Branch

Overview
* Anatomy of the Larynx
* Function of the Larynx
* Causes of Vocal Cord Paralysis
* Evaluation of Vocal Cord Paralysis
* Anterior TVC Medialization
* Posterior TVC Medialization
* Overview of Treatment for Bilateral Vocal Cord Paralysis
* Conclusion (Key Points)

Anatomy of the Larynx - Cartilages
Anatomy of Larynx - Muscles
Anatomy of Larynx - Muscles
Anatomy of Larynx - Nerves
Anatomy of Larynx - Motion
Anatomy of the Larynx - Motion
* Adductors of the Vocal Folds
Anatomy of the Larynx - Motion
* Abductor of Larynx
Anatomy of Larynx - Histology
Function of Larynx

* Passage for Respiration
* Prevents Aspiration
* Allows Phonation
* Allows Stabilization of Thorax

Respiration
Phonation
Vocal Cord Paralysis
Etiology, Preoperative Evaluation, Treatment
Etiology
* Causes of Vocal Cord Paralysis in Adults
Neurologic
Intubation
Malignancy
Idiopathic
Surgery
Bilateral %
Unilateral %
Cause
Evaluation – Patient History
* Alcohol and Tobacco Usage
* Voice Abuse
* URI and Allergic Rhinitis
* Reflux
* Neurologic Disorders
* History of Trauma or Surgery
* Systemic Illness – Rheumatoid
* Duration – Affects Prognosis

Evaluation – Physical Examination