Pancreatitis

Pancreatitis
Presentation lecture by:Brad Brough, DO

Acute pancreatitis
* Pathophys- insult leads to leakage of pancreatic enzymes into pancreatic and peripancreatic tissue leading to acute inflammatory reaction
* Etiologies
o Idiopathic
o Gallstones (or other obstructive lesions)
o EtOH
o Trauma
o Steroids
o Mumps (& other viruses: CMV, EBV)
o Autoimmune (SLE, polyarteritis nodosa)
o Scorpion sting
o Hyper Ca, TG
o ERCP (5-10% of pts undergoing procedure)
o Drugs (thiazides, sulfonamides, ACE-I, NSAIDS, azathioprine)

“Less Common” causes
* Pancreas divisum
* Chinese liver fluke
* Ischemia (bypass surgery)
* Cystic fibrosis

Trivia
Signs & Symptoms
* Grey Turner sign
* Cullen’s sign
Differential
* Not all inclusive, but may include:
o Biliary disease
o Intestinal obstruction
o Mesenteric Ischemia
o MI (inferior)
o AAA
o Distal aortic dissection
o PUD
Evaluation

* amylase…Nonspecific
* lipase
* Other inflammatory markers will be elevated
* Depending on severity may see:

Radiographic Evaluation

* AXR - “sentinel loop” or small bowel ileus
* US or CT may show enlarged pancreas with stranding, abscess, fluid collections, hemorrhage, necrosis or pseudocyst
* MRI/MRCP newest “fad”
o Decreased nephrotoxicity from gadolinium
o Better visualization of fluid collections
o MRCP allows visualization of bile ducts for stones
# Does not allow stone extraction or stent insertion
* Endoscopic US (even newer but used less)
o Useful in obese patients

CT Scan of acute pancreatitis
Gall stone pancreatitis by ERCP
Prognosis
Ranson Criteria
CT Severity Index
* CT Grade
* Necrosis score)
* TOTAL SCORE
Therapy
Complications
Prognosis
Chronic pancreatitis
* Pathophys - irreversible parenchymal destruction leading to pancreatic dysfunction
* Persistent, recurrent episodes of severe pain
* Anorexia, nausea
* Constipation, flatulence
* Steatorrhea
* Diabetes

Evaluation
CT - chronic pancreatitis
Complications
Conclusion
References

Pancreatitis.ppt

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Neurology & NeuroSurgery Grand Rounds 2005 videos

Neurology & NeuroSurgery Grand Rounds videos - 2005
from University of Arizona

December 16, 2005 NEUROLOGY	Benefits & Risks of Immunomodulation in Multiple Sclerosis Therapy Olaf Stüve, MD Assistant Professor Department of Neurology, University of Texas, Southwest Medical Center at Dallas Disclosure: Nothing to disclose.
December 9, 2005 NEUROLOGY	GRAND ROUNDS NOT AVAILABLE AT REQUEST OF PRESENTER Amir Akhter , MD, Assistant Professor, Clinical Neurology, VA Hospital
December 2, 2005 NEUROSURGERY	Management of Malignant Skull Base Tumors Involving the Carotid Artery Iman Feiz-Erfan, MD Neurosurgery Resident, Barrow Neurological Institute, St Joseph's Hospital and Medical Center Phoenix, Az Disclosure: Nothing to disclose.
October 21, 2005 NEUROLOGY	Lysosomal Storage Disorders Tim Miller, M.D. Neurosurgery Resident UA College of Medicine, Dept. of Neurosurgery Disclosure: Presenter is a consultant for Genzyone.
October 14, 2005 NEUROLOGY	Neurotube 2005 A. Lee Dellon, MD, Professor of Plastic Surgery and Neurosurgery, John Hopkins University Baltimore, Maryland, The University of Arizona Disclosure: Presenter has relationship with commercial products or devices included in discussion.
October 7, 2005 NEUROSURGERY	Surgical Treatment of the Peripheral Entrapment Neuropathy of the Lower Extremities: 158 consecutive surgical cases Juan Valdivia-Valdivia, M.D. Neurosurgery Resident UA College of Medicine, Dept. of Neurosurgery Disclosure: Nothing to disclose.
September 30, 2005 NEUROLOGY	Drug-Induced Movement Disorders Holly Shill, M.D. Director, Muhammad Ali Parkinson Research Center, Barrow Neurological Institute Disclosure: Presentation will include discussion of unlabeled/investigational drug use.
September 23, 2005 NEUROLOGY	Telemedicine and it's use in Acute Stroke: The Stroke DOC Clinical Trial Brett Meyer, M.D. Assistant Professor, Neurology; USCD Stroke Center San Diego, CA Disclosure: Nothing to disclose.
September 16, 2005 NEUROLOGY	Neurologic Treatment of Status Epilepticus Yu-Tze Ng, MD, FRACP; UA Asst. Professor, Clinical Pediatrics & Neurology; Pediatric Neurologist/Epileptologist, Division of Child Neurology, Children's Health Center, Barrow Neurologic Institute Disclosure: Presenter in on the speakers bureau for Novartis, GSK, Ortho-McNeil, and Cyberonics
September 9, 2005 NEUROLOGY	Tourette Syndrome: An Integrative Approach SLIDES Evan S. Trost, MD; Troon Family and Preventative Care, PLLC Disclosure: Nothing to disclose.
September 2, 2005 NEUROSURGERY	Stereotactic Radiotherapy of Central Nervous System and Head and Neck Lesions using a Conformal Intensity Modulated Radiotherapy System: The PEACOCK System Mario Ammirati, MD Adjunct Professor, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA Disclosure: Nothing to disclose.
August 26, 2005 NEUROLOGY	The Search for Neuroprotection in Parkinson's Disease Richard B. Dewey, Jr., MD Associate of Professor of Neurology, Department of Neurology The University of Texas Southwestern Medical Center at Dallas Disclosure: Nothing to disclose.
August 19, 2005 NEUROLOGY	Physicians, Stress and Optimal Performance: How to Perform Optimally in Today's Healthcare Environment Larry G. Oñate, M.D. House Staff Counselor,The University of Arizona College of Medicine, Chair, UMC Physician Well-being Committee Disclosure: Nothing to disclose.
August 12, 2005 NEUROLOGY	Health Consequences of Sleep Disordered Breathing Stuart F. Quan, M.D. Professor, Medicine, Anesthesiology, Public Health; Director, Sleep Disorders Center, The University of Arizona Disclosure: Nothing to disclose.
August 5, 2005 NEUROSURGERY	Lower Extremity Nerve Pathology Jerome K. Steck, D.P.M UA Clinical Assist. Professor, Surgery Institute for Plastic Surgery and Peripheral Nerve Surgery, Foot & Ankle Institute of Arizona. Disclosure: Nothing to disclose.
July 29, 2005 NEUROLOGY	Epilepsy and Depression David M. Labiner, M.D. Professor of Neurology, Pharmacy Practice & Science. Disclosure: Nothing to disclose.
July 22, 2005 NEUROLOGY	Temporolimbic Epilepsy and Behavior SLIDES Geoffrey L. Ahern, M.D., PhD Professor of Neurology, Psychology, and Psychiatry. Director, Behavioral Neuroscience & Alzheimer's Clinic, The University of Arizona Health Sciences Center Disclosure: Nothing to disclose.
July 15, 2005 NEUROLOGY	The Hospitalists in Neurology SLIDES Marc Malkoff, M.D. Director Neurocritical and Neurovascular Service, Barrow Neurological Institute Disclosure: Nothing to disclose.
July 8, 2005 NEUROSURGERY	Safety and Effectiveness of Cortical Stimulation in Patients with Hemiparetic Stroke, The Baker Study Martin E. Weinand, M.D. Disclosure: Nothing to disclose.
July 1, 2005 NEUROLOGY	Systemic Thrombolysis for Stroke Andrei V. Alexandrov , M.D. Assoc. Professor, Director, Cerebrovascular Ultrasound, Dept. of Neurology, University of Texas, Houston Disclosure: Presenter recieves grant/research support. Presenter is a consultant for IMARX and is on the speakers' bureau for Genentech.
June 24, 2005 NEUROLOGY	Neuronal Migration Disorders Dinesh Talwar , M.D. Pediatric Neurology Associates Disclosure: Nothing to disclose.
June 17, 2005 NEUROLOGY	Does Prolonged Status Epilepticus Produce a Model of Temporal Lobe Epilepsy with Hippocampal Sclerosis? Hemant Kudrimoti, M.D., Ph.D. Assistant Professor, Department of Neurology, The University of Arizona Disclosure: Nothing to disclose.
June 10, 2005 NEUROLOGY	Disturbing Sleep: Dreams, Violence and REM Behavior Disorder Pedram Navab, D.O. Neurology Resident, The University of Arizona Disclosure: Nothing to disclose.
June 3, 2005 NEUROSURGERY	Not available due to privacy concerns
May 27, 2005 NEUROLOGY	Technical Advances in the Treatment of Brain Tumors Baldassarre 'Dino' Stea, M.D., Ph.D. Disclosure: Nothing to disclose
May 20, 2005 NEUROLOGY	Cortico-Hippocampal Interactions and Memory Consolidation: Insights From Neural Ensemble Recording and Immediate-Early Gene Activation Studies Bruce L. McNaughton Ph.D. Disclosure: Nothing to disclose
May 13, 2005 NEUROLOGY	Cancelled
May 6, 2005 NEUROSURGERY	Hyperglycemia During Acute Cerebral Infarction: Does it Matter?/New Concept in the Neurovascular Unit Askiel Bruno, M.D./ Gregory del Zoppo, M.D.
April 29, 2005 NEUROLOGY	A Deadly Cross-Talk Between Mitochondria and Nuclei in Neuronal Apoptosis & Neurogeneration Seong-Woon Yu, Ph.D. Disclosure: Nothing to disclose
April 22, 2005 NEUROLOGY	Dr. Alzheimer Goes Molecular: Recent Developments in Diagnosis and Treatment Earl Zimmerman, M.D. Disclsoure: Presenter recieves grant/research support from Pfizer, General Electric. He is on the speakers bureau for Pfizer, Forest Labs and Novartis
April 8, 2005 NEUROLOGY	The Physiology of Emotion: A Non-Human Primitive Model Katalin Gothard, M.D. Disclosure: Nothing to disclose
April 1, 2005 NEUROSURGERY	Dynamic Cerebral Blood Flow Phillip Carter, M.D. Disclosure: Presenter has relationship with commercial products or devices included in discussion.
March 18, 2005 NEUROLOGY	Automatic Tracking of Body Movement, Gait & Gestures Jay Nunamaker, M.D. Disclosure: Nothing to disclose.
March 4, 2005 NEUROSURGERY	Advances in Endovascular Neurosurgery Eric Eskioglu, M.D. Disclosure: Presentation includes discussion of unlabeled or investigational drug use.
February 25, 2005 NEUROLOGY	Genetic Disorders and Epilepsy David King-Stephans, M.D. Disclosure: Presenter is on the speakers bureau for UCB Pharma, Novartis , and GlaxoSmithKline
February 11, 2005 NEUROLOGY	Recent Advances in Vestibular Testing Terry D. Fife, M.D. Disclosure: Presenter has a financial interest, arrangement or affiliation with GlaxoSmithKline.
February 4, 2005 NEUROSURGERY	Localizing and False Localizing Signs in Neurosurgery Patients Charles W. Needham, M.D. Disclosure: Nothing to disclose
January 21, 2005 NEUROLOGY	Treatment of Ischemic Stroke Adhan Qureshi, M.D. Disclosure: Presenter has a financial interest, arrangement or affiliation with corporate organizations.
December 3, 2004 NEUROSURGERY	Arachnoid Cysts: To Treat or Not to Treat and How to Treat When Treating David H. Shafron, M.D. Disclosure: Nothing to disclose.

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Tourette Syndrome

Tourette Syndrome
Presentation by:Samuel H. Zinner, M.D.

Overview
Take Home Points:
* TS is not rare
* Tics are usually mild, not catastrophic
* In most people with TS, tics are one of many related complications
* Address main problems, often not tics

Who cares about Tourette syndrome?
* TS is:
o common
o under-diagnosed
o misunderstood
o ripe with opportunity for management (and mismanagement)& research

Tic Disorders: Characteristics
* Tic Definition
o motor or phonic
o involuntary (unvoluntary?)
o sudden and rapid
o recurrent
o non-rhythmic and stereotyped

Tourette’s Disorder
* DSM-IV-TRTM Criteria
o Multiple motor + 1 or more vocal
o Many times/day & at least 1 year
o Onset before 18 years
o Not due to substance or medical condition

Epidemiology
Etiology
Differential Diagnosis of tics
* Compulsions
* Habits
* Stereotypies
* Allergies
* Sydenham chorea
* Various involuntary neuromuscular
Genetics
Genetics barriers to identifying genes
* Diagnosis based on behaviors
* Defining the TS phenotypic spectrum
o “endophenotypes”
* Family pedigree problems
* Environmental influences
* Combinations of genes may be involved
* Symptoms decrease with age
* Transient tics

Differential Diagnosis of tics
* Sydenham’s chorea
* Compulsions
* Blepharospasm
* Other hyperkinetic disorders
* Stereotypies
* Allergies

Diagnostic Pitfalls 101
Diagnostic Pitfalls 102
Assessment: co-morbid conditions
Clinical Course
Quality of Life?
Management
Identification
Identification – comorbid conditions
KEY POINT!
Always assess for non-tic comorbidity
Identification – comorbid conditions
TRICHOTILLOMANIA: moth-eaten appearance to hair and scalp excoriations
Clinical Course
A common sense guide to complementary/alternative medicine
Integrative Medicine websites

National Center for Complementary and Alternative Medicine
http://nccam.nih.gov
Consortium of Academic Health Centers for Integrative Medicine
www.imconsortium.org
Management: Advocacy and Legal Rights
Pharmacotherapy for Comorbid Conditions
KEY POINT!
Target the most troubling symptoms
Pharmacotherapy
KEY POINTS!
Take Home Points: Clarifying Common Misconceptions

Tourette Syndrome.ppt

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