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Case study on Non-Hodgkins Lymphoma

lumbar spine fixation
by

Reem M. Alkaabi

on 27 June 2015

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Transcript of Case study on Non-Hodgkins Lymphoma

Part 2
Matrix Partners preso!
Harvard Business Review
How to lower the cost of enterprise sales?
chest x-ray pre-OP
Lymphatic system
_ _ _ _ _ _ _ _ _ _
(General Portable X-ray)
Stage 4 Non-Hodgkins lymphoma situated in the Chest resulting in pleural effusion
Pathology
Understanding the Problem
Case study on
Profits on a 25,000 software license
What to do?
Anatomy
Lymphatic System Components
?
Ancillary pain, discomfort in the spine and limbs caused by increasing neurological dysfunction.
Highest likelihood of poor survival.
•Having a disseminated tumor (stage IV)
•Disease has spread to more than one site beyond the lymph nodes
poor patient's functional ability
Elevated levels of the lactate dehydrogenase (LDH) protein
permanent decrease in anterior height
PART 4
Prognosis
Part 6
Reference

Emotional Problems:
Anxiety and depresssion
somatic symptoms -> fatigue, pain and ache.
Don't forget to call your Mom!
Jive
Spend on M&S
Revenues
Clients
2010
2011
$65M
$46M
676
560
$45M
$29M
Diff
$19M
77
$16M
Year 1 cost of sales!
85%
T
H
N
A
K
Y
O
U
P
R
E
Z
I
Part 5
Conclusion:
Why
What
How
Gap is too big to close with traditional SaaS sales.
Year 1
Year 2
Year 3
Risk with SaaS is way higher
Perpetual
SaaS
Introduction:
A 52 years old male was admitted in the Emergency Department, bed ridden, complaining of short of breathness. According to the clinical information, patient was going through chemotherapy. He was requested for a chest x-ray to see the progression and the severity of his bilateral Pleural effusion that he developed on 16-10-12 as a complication of his Pre-diagnosed Stage 4 non-hodgkin lymphoma in the chest.
(reference of Information)
1. Merrill’s Atlas of Radiographic Positioning and Processing.Chapter 10 and 9 Bony thorax + thoracic viscera
2.http://www.umm.edu/patiented/articles/what_general_guidelines_staging_classifying_treating_lymphomas_000084_6.htm
3. Patient Operation record and discharge summary.
4.Patient report by the physician at dubai Hospital

Video Reference
Lung Anatomy

Images Reference:
Img.5 & 6 - http://www.wikiradiography.com/page/Lumbar+Spine+Radiographic+Anatomy
Img .7 & 8 - http://emedicine.medscape.com/article/1899053-overview#aw2aab6b3
10-14 : Dubai hospital, Impact system.
Figures References:
Fig.1 : http://images.yourdictionary.com/chest
Fig.2 : http://www.medicalnewstoday.com/articles/146136.php
Fig.3 : http://www.fpnotebook.com/_media/LumbarSpineAnatomyVertebra.gif
Fig.4 : http://emedicine.medscape.com/article/1899053-overview#aw2aab6b3
Bony Thorax
Formed by:
*Sternum
Thoracic Cavity
Bounded by thoracic aperature
Superior
Inferior
Physiology
supprts the walls of plueral cavity and diaphragm
volume can varied during respiration
Protects heart and lung
Bony thorax
Thoracic cavity:
_ _ _ _ _ _ _ _

Functions the respiratory system and the cardiovascular system.
Movement
Non- hodgkins Lymphoma
---------------------
Lymphoma: is a type of cancer that begins in immune system cells called lymphocytes. It occurs when lymphocytes are in a state of uncontrolled cell growth and multiplication.
Types of Lymphoma:
Hodgkins
Non-Hodgkins
DO NOT! contain Reed-Sternberg cells and tend to develop in peripheral lymph nodes and spread throughout the body.
Symptoms:
Enlarged lymph nodes
Swollen abdomen (belly)
Feeling full after only a small amount of food
Chest pain or pressure
Shortness of breath or cough
Fever
Weight loss
Night sweats
Fatigue (extreme tiredness)
Examinations to confirm:
Physical examination
PET
X-ray
CT
MRI
Bone marrow aspiration and Biopsy
-------------------------
Treatment:
•Radiation therapy
•Chemotherapy
•Biologic therapy (immunotherapy)
•Stem cell or bone marrow transplantation
-------------------------
According to which Factors?!
•Stage (the extent of the tumor)
•Grade (the growth pattern of the tumor)
•Histologic type (cellular structure)
•Location of tumor
•blood levels of lactate dehydrogenase or patient's age and overall health status
Clinical Assessment:
Patient presented with a complaint of being short of Breath. On examination,
he was presented with fever and pain in movement , he was conscious and responsive to the instruction given.
Clinicians Assessment:
Stage 4 of Non- Hodgkin lymphoma with bilateral pleural effusion and bilateral interstitial shadowing.
Investigation Requested:
Abnormal results were found!
Result
Part 3
Medical Diagnotic Imaging:
a.MDI examination Procedure:
Patient preparation:
Check for Radio-opaque materials.
History of patient.
Evaluate co-operation ability range.
Exposure factor:
100 sID
35 x 43 cm ( x1)
Large focal spot
Kvp: 68 , mAs: 2
Patient in semi-supine position.
Fully Inspiration
Arms extended away, holding the side rail.
CR/CP- Perpendicular midway sternum
AP projection:
Complication:
There was no complications. Patient was very co-operative hence we have achieved a sub-optimum image.
Compications:
Due to patient being short of breath and in pain as well, movement was limited. Hence the rotation.
No positioning Aid.
Shielded Gonad
Radiologists Opinion:
Left sided pleural effusion is seen.
Right apical fibrotic strands are seen.
Diffuse bilateral interstitial shadowing is seen.
The cardiac shadow could not be commented upon.
The left dome of diaphragm is raised.
Physicians Diagnosis:
Bilateral pleural effusion with left lower lobe collapse
A 52 years old male was admitted in the Emergency Department, bed ridden, complaining of short of breathness. The patient according to clinical info was going through chemotherapy, he was requested for a chest x-ray on 5-3-2013 to see the progression of and the severity of his bilateral Pleural effusion that he developed on 16-10-12 as a complication of his Pre-diagnosed non-hodgkin lymphoma in the chest. Achieving poor outcomes, patient is deceased on 2-4-13.
(Img.5) AP chest x-ray
(Img.6) Axial CT image at the level of T7
Lab reports
AP Projection
(Img.10)PA chest showing left pleural effusion
(Img.11) PA chest showing pleural effusion
(Img.12)
AP portable chest x-ray
(Img.13)AP portable chest x-ray
Expansion and Contraction of the lung.
Effectivness of MDI investigation:
CT Scan well demonstrated the severity
Name: Reem M. Alkaabi
ID: U00025956
Course instructor: Mrs. Mawada
Supervisor Name: Wiam Alshami
Date: 27/11/12
(Fig.1) Diagram of the Bony thorax
(Fig.2) Lymphatic system anterior view
(Fig.3) Lymph drainage flow; lymphatic duct anatomy.
(Fig.4) Lymph capillaries in spaces. Blind-ended lymphatic capillaries arise within interstitial spaces of cells near arterioles and venules.
*Ribs
-costal cartilage made of hyaline cartilage.
- 12 ribs divided into true and false
-Floating ribs
-intercostal space
- rib nom. corresponds to the thoracic vertebrae.- - 1st to 9th rib the obliquity increases
- 10th to 12th rib obliquity decreases.
Consist:
Heart
lungs
Lymphatic system
inferior portion of esophagus
Thymus gland
cavity has 3 chambers:
Pericardial cavity
Right pleural cavity
Left pleural cavity
+Diaphragm
+Mediastinum
Consist of:
•Fluid -> lymph

•Vessels -> transport lymph

•Organs -> lymphoid tissue
Phsyiology:
FUNCTION OF THE LYMPHATIC SYSTEM IS SIMPLE!
Its a one way system that returns lymph fluid to the cardiovascular system ( via vessels) for eventual elimination of toxic by products of end organs.
R A D
estore
Interstitual fluid and and Protiens to blood
bsorb
fats and fat-soluble vitamins from the digestive system and transport of these elements to the venous circulation
EFENSE
against invading organs
1. Lymph

2. Lymphatic Vessels

3. Lymph Nodes

4. Thymus

5. Spleen
Normal Radiographic Anatomy
* CT, US and x-ray.
* Lab investigation: CBC, LDH
chest x-ray
1. Patient was semi supine
2. Midsagital plane is not perpendicular with the IR.
3. Inspiration
Medical Problems:
The radiation and chemo therapies used in treating NHL can have long-term effects on many organs in the body
Bilateral pleural effusion
Left lower lobe lung collapse
nodule enlargement
Pleural effusion: excess Accumilation of fluid between two pleural layers fluid-filled space that surrounds the lungs.

Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.
In non-hodgkin the tumor develops in lymphocytes
Where?!
STAGE 4
Widespread disease the lymphoma has spread (metastasized) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.
Full transcript