Foreign Body Aspiration

Tracheobronchial aspiration of foreign body in the system, manifesting during childhood is a common cause of respiratory problems. The most frequently seen between 1-3 years. Foreign bodies in children aged 1-3 years aspirasyonlarının indicated that 7% of fatal accidents. Early diagnosis and treatment is essential in order to prevent serious complications. Weather roads settled foreign bodies, air obstruction can cause death as a result of the way full.


Aspirasyonlarının foreign body to see a higher incidence in children between 6 months-3 years of age, children's tendencies to bring the objects in their mouths, playing games, running, crying presence of objects in their mouth, swallowing and airway cleaning mechanisms that have immature neuromuscular, a complete lack of development of teeth and jaw, larynx, and epiglottisin Not to have been due to the anatomical shape of the adult.


Herbal and chemical pneumonia in children with aspirated material usually gives an early finding. Diagnosis can be delayed reaction açmadıklarından over metallic objects. School-age children, aspiration of plastic materials, beads, rubber parts, beads, plastic toys may be parts.

About Coronary Artery Disease

Coronary Artery Disease

Coronary artery disease, often early in life, coronary arterial fatty streaks and tied in bed later in the process of atherosclerosis in coronary blood flow and myocardial ischemia caused by a pathological process. CV is all over the world are known to be one of the most important causes of morbidity and mortality. CAD, the most important public health problem in developed countries, but in recent years, the frequency is increasing in developing countries. Official data and TARF (in Turkish adults and Risk Factors for Heart Disease) study data were evaluated with the time in our country 45% of all deaths from cardiovascular disease, heart disease, 36%, 32% were the result of coronary heart disease. The prevalence of coronary heart disease in our society, increasing with age and affects about 5% of people over the age of 60. The number of coronary artery disease in 2010, 3.4 million people in our country is expected to arrive. Coronary artery disease is the most important mechanisms underlying atherosclerosis.


A number of hypotheses have been proposed to explain how atherosclerosis occurs. Those which are most of them in the 'injury response' hypothesis. Normal arterial structure consists of three layers. Most of the inside of blood vessel wall with a semi-permeable barrier, the endocrine and paracrine function, as well as a single layer of the intima is lined by endothelial cells. Middle layer of the vessel elasticity

media, which creates a layer composed of smooth muscle. Adventisia located in the outermost layer. The most important step in the hypothesis of recurrent damage to endothelial damage response. Endothelium; vasoactive substances secretion and the regulation of vascular flat muscles contraction and relaxation, coagulation regulation, leukocyte adhesion, solid and liquid substances acts as a barrier. In addition, by inhibiting the adhesion of blood cells, by dilating blood vessels and vascular protective effect by inhibiting the proliferation of vascular smooth muscle. Developed in the presence of proatherogenic factors in this protective function is lost due to endothelial dysfunction and atherosclerosis begins. Endothelial dysfunction as a result of low-density lipoprotein (LDL) and oxidized to cross the endothelium-subintimal is a comfortable distance. Macrophages and oxidized LDL receptors are. Phagocytosis by macrophages and foam cells, composed of lipids. In the early stages of atherosclerosis, lipid, mostly as a cell within the foam cells. As you continue to proatherogenic factors, both circulating LDL is directly connected to the intimal proteoglycans, as well as foam cells mainly because of the fragmentation of the released cholesterol esters in lipid begins to accumulate outside the cell. As a result of the intimal layer of connective tissue, cholesterol and cell breakdown products of lipid-filled core. The age of the lesion progresses, the media layer of smooth muscle cells migration and proliferation of these cells and fibrous connective tissue proteins to produce a title with the atherosclerotic plaque covered above, consists of mature atherosclerotic plaque. Meanwhile, the central part of the plate are starved of oxygen and begins to develop necrosis. A plaque with focal or massive calcifications may occur. However, sometimes fibrous plaque build up in the title fissures and ulcers, and smooth muscle cells, blood circulation is in contact with oil. As a result, an intense thrombogenic reaction begins. Narrowing of the lumen and gradually increases as a result of repeated attacks. As a result of complete occlusion of the coronary artery, myocardial infarction and sudden death may occur if there is such a sufficient. As a result of rupture of the fibrous plaque next to the title of their lipid components in the circulation through the cholesterol plaque can cause embolisms.


Histological, immunohistochemical, and electron microscopy methods, using extremely detailed morphological studies were performed on recordings. American Heart Association, the morphology of plaques dedicated to the 8 type:


Type 1 lesions: That intensive lipid-laden macrophages, the initial lesion.



Type 2 lesions: the number of macrophages was increased, and stratification. Other than macrophages, smooth muscle cells, as well as inside, outside the cell lipid droplets There. If the Type 2 lesion sensitive regions develops fast growing up (type 2a lesion), less-sensitive regions are formed more slowly than the development of Type 2 lesions (lesion Tip2b).


Type 3 lesions: The most important distinguishing feature of type 2 according to the lesion is small lipid deposits. Under this lipid macrophages and T cells, the lesion accumulates in the deepest place. Endothelial dysfunction begins to develop during this period.


Type 4 lesion: Classically defined as atherosclerotic plaque or atheroma. During this period, limited to the intimal intensive lipid available. This is called a lipid core. At this stage in order to protect the actual volume of artery lumen reconstruction begins. However, with the viewing of these lesions is difficult coronary angiography.


Type 5 lesions: the lesions are characterized by an increase of fibrous tissue covering the lipid core. Developing fibrous tissue, proliferating and secreting collagen and proteoglycans, matrix proteins, such as smooth muscle cells are generated. This so called fibroatheroma circuit or Type 5 lesions.


Type 6 lesions: the Type 4 and Type 5 lesions, fissures, hematoma, or thrombus formation occurs with. Clinical symptoms, mortality and morbidity in the most watched type. Type 6 is also called lesions, complicated lesions.


Type 7 lesions: lipid core, or any part of the lesion occurs with the development of calcification.


Lesion type 8: Lipid burden is less fibrotic plaques.

Coronary Artery Imaging Methods

Conventional Coronary Angiography

Usually the femoral artery access site of coronary arteries using the arterial catheter to send and display of various aspects of the coronary arteries under fluoroscopy with contrast medium is provided. It is accepted that the gold standard method of assessing coronary artery lumen. Also, if necessary, therapeutic interventions such as balloon dilation and stent placement can be made ​​of operations. Complication rate of about 0.08%, 0.15% mortality and morbidity rate of 1.5% is present in some complications may require emergency surgery. Interferential process in situations that require the patient's dose may be increased up to 3 times compared to angiography in diagnostic.


Intracoronary Ultrasound

Thanks to advancing technology by developing small-scale intravascular ultrasound transducers in clinical use has found. Ranging from 2.9 to 3.5 French in diameter, 20-40 MHz transducers with the lumen of the coronary arteries, artery wall, plaque size and morphology can be analyzed. High degree of invasiveness, cost of excess, the process and the need for coronary catheterization to evaluate only the proximal limits the availability of this method.


Electron Beam Tomography


Electron beam tomography (EBT) of hard X-ray source and detector fixed structure consists of tungsten. In 1979, was found by Boyd et al. Old IT equipment is one of the most important factors limiting the speed of the tube rotates around the patient, the rotation of the cables were connected to the tube and detectors. Unlike other IT devices in EDT have mechanical moving parts. Produced under the tungsten targets in an electron beam directed at the patient. Fan-shaped x-rays through the patient's body, the patient placed on a 210 ° angle, more than 3,000 collected by the detector. EBT in a period of 40-60 units from 1.5 to 3 mm to 100 milliseconds, it is possible to take cross-sections. All transactions are made ​​during breath-holding only one patient. In addition, motion artifact can be minimized by using EBT with the ECG trigger. The earliest CT evaluation of the coronary artery was done with the 1980 EBT


Coronary Magnetic Resonance Imaging


Coronary magnetic resonance imaging (MRI) in selected patient populations, the detection of coronary artery anomalies, and to be characterized, the evaluation of coronary artery aneurysms and bypass-graft patency in order to evaluate the clinical use today, has taken place. Long examination time, the disadvantages such as low spatial resolution, as well as the most important advantage is the absence of radiation. The sensitivity of MR imaging in detecting coronary stenosis 65-86%, the specificity ranged from 88-97%



MSCT Coronary Angiography


Computerized tomography (CT) is the first intellectual father Alan Cormack was the first clinical applications in 1967 by Hounsfield Godsfrey. Initial CT device, the elapsed time for 5 minutes going through the formation of a cross sectional view. Several generations of technology with the development of IT equipment is manufactured in the late 1980s by Kalender et al Spiral CT has been used clinically. Spiral CT gantry rotation rate, has been an important factor in the development of MSCT. IRs in the 1990s had been used in the first detector is a 2 in the years following the z-axis detector has been introduced more and more. MSCT with the z-axis, multi-detector system; more volume than thin slices can be scanned during a single gantry rotation, has been helping to deliver fast and high-quality images. Emerging technology, MSCT, CAD has been used for diagnostic purposes. With MSCT calcium scoring, CT angiography, and ventricular function analysis can be made. Coronary artery calcium scoring can be classified with the risk of coronary artery disease. In addition, the anatomy of the coronary artery, MSCT can be performed with the assessment of calcified plaques.

Coronary Artery Disease Risk Factors

Identify the risk factors and their treatment, prevention of CAD in asymptomatic individuals (primary prevention) and recurrent CHD events in people with established disease prevention (secondary prevention) is required for. The frequency of atherosclerosis in epidemiological studies in different countries of the world, the development and progression of age, gender, life styles, eating habits and heredity factors and has revealed that interest. Systematic studies on the study of risk factors in humans, approximately the middle of the last century began. A prospective, population-based Tramingham Heart Study ', hypercholesterolemia, hypertension and other cardiovascular risk factors has provided important evidence supporting a relationship between


Non-smoking


Non-use of the most important modifiable risk factor for CAD. Ischemic heart disease 35-to 40% of all smoking-related causes of deaths. Cigarette smoking is one of the most important risk factors and is of great importance due to the prevalence in our country. The risk of myocardial infarction and cardiac death in smokers than in non-smokers 2.7 times for men, women were 4.7 times more. Non-smoking, the most important preventable cause of mortality.


Diabetes Mellitus


Atherosclerosis in diabetic patients are more frequently and at an early age. Diabetes mellitus (DM), is an independent risk factor for CAD, men and women, respectively, two and four times increased risk of CAD. If artic summarized the effects of atherosclerosis in DM (46-48):

1. To lower HDL cholesterol, LDL cholesterol and raise triglycerides

2. Small, dense LDL cholesterol, upgrade, upgrade of lipoprotein-a is

3. Fibrinogen and increase platelet aggregation

4. Plasminogen activator inhibitor-1 upgrade

5. Impair endothelial function

6. Can be explained by hyperinsulinemia.


Obesity


By the AHA as a major risk factor for coronary heart disease identified. Obesity prevalence in many countries all over the world, and increasingly has become a health problem reaching epidemic proportions. Which is associated with increased morbidity and mortality, obesity is now recognized as a disease. There is in the early stages of obesity, metabolic and neuroendocrine changes. When left untreated metabolic changes in asymptomatic, hypertension, dyslipidemia, and diabetes, appears to clinical presentation. Obesity is the square of height criteria of body weight which is the ratio of body mass index (BMI) is used.

Right Coronary Artery (RCA)

The right coronary artery, pulmonary trunk and right atrium from the right sinus out of the posterior inter ventricular septum moves toward the right atrioventricular groove. Conus artery, usually the first branch of the right coronary artery. However, in some cases with conus artery may originate directly from the aorta. Sometimes it makes LAD anastomosis from the artery and the conus in a dalla 'Vieussens ring' is called. Sinoatrial node artery supplying the sinus node. Sinus node artery, proximal RCA 60%, 40% are divided into the proximal LCX 10. Artery supplying the atrioventricular node in 80% of the RCA and CX produces a variety of 20% has been reported to have originated from RCA, then the right ventricle, left anterior free wall of the feed branches. This branch, then the right ventricle, leaving the middle and distal RCA branch junction, called the acute marginal branch.


PDA and PLV branches of the RCA distal to the right of movement is divided into the current. If the LAD artery that feeds the heart's apex is a small PDA, the anterior one-third of the inter ventricular septum can to feed the apex around branches. RCA, right ventricle and the front 2 / 3 of fame, the heart's right side, right atrium and the inter ventricular septum in the posterior 1 / 3 of feeds reputation.

Left Main Coronary Artery (LMA)

Left main coronary artery (LMA). Behind the left atrium from the pulmonary trunk and the left atrioventricular groove. Usually at the level of the atrioventricular groove in the LAD, LCX arteries are divided into two branches forming. In some cases, as a third branch of the ramus intermedius differs. Ramus intermedius branch, first diagonal branch of the LAD artery showed a similar pattern with the left ventricular anterior progresses. 0.41% of the cases' when the left main coronary artery is not available. In this case, the LAD and LCX arteries, the left coronary sinus with separate ostia is directly derived from the left sinus.


Drawing to the left anterior artery (LAD)


Pattern left anterior artery (LAD), the anterior inter ventricular groove ligaments. Cases in 1 / 3 third of the proceeds apex. LAD, left anterior free wall of the ventricle, inter ventricular septum and the anterior septal branches sends diagonal branches. These branches are called in order of output. LAD, the inter ventricular septum in the anterior 2 / 3 of fame, the anterior and lateral wall of the left ventricle, the anterolateral papillary muscle and right ventricle anteromediyal part 1 / 3 of 'fame feeds.


The left circumflex artery (LCX)


The left circumflex artery (LCX), left atrioventricular groove and left ventricular lateral watching wide-angle obtuse marginal (OM) sends branches. They are numbered according to the approximate order of the main branch. LCX, left ventricle and the anterolateral papillary muscle from the left edge of some of the feeds. In addition, the left atrium with atrial branch of the front, side and rear part of the feed. LCX's size varies according to whether or not dominant.

Breast Biopsy Procedures

Transactions of the breast biopsy


Imaging guided percutaneous needle biopsies:


1. Fine-needle aspiration biopsy (FNAB): FNAB cheap, practical, less complications, a method of high specificity and sensitivity. Diagnostic accuracy and evaluating the quality of the sampling rate varies between 50-95% according to experience. Pregnant and nursing women also reported to be successful.


2. Cyst aspiration for diagnosis and treatment.


3. Core biopsy: small pieces of breast tissue lesions and their histological examination of tissue samples taken. Mammography and U.S. guidance can be made. Failure rate was lower than histological diagnosis. Large-scale automated core breast biopsies have been reported successful applications. However, core biopsies applications has been noticed that some of the limitations. Done a lot of sampling, repeated blood samples decreased by increase in breast tissue specimens is not eliminated. In addition, calcified lesions, the diagnostic failure in cases of atypical ductal hyperplasia and DCIS can be seen.


4. Vacuum-assisted biopsies (BDD): increasing frequency in the diagnosis of suspicious breast lesions, biopsy is a new system. Larger than other systems with BDD percutaneous biopsy tissue samples are obtained and the lesions sometimes can be removed completely. Tri-cut biopsy technique through a single login to take more than the parts, histological diagnosis, the rate of failure is low, without causing a cosmetic defect, such as features of benign lesions can be removed completely or nearly completely, given BDD can be argued that excisional biopsy may be a good alternative. Percutaneous biopsy has some advantages over surgical biopsies: A cheaper and easier implementation, less than the complications of a biopsy, removal, and scar tissue that may interfere with routine follow-up evaluation include mamography. Percutaneous biopsies of patients benefiting the most to maximize the delay in diagnosis or follow-up patient compliance is very important to avoid the passage of malignancies. Although the reliability of diagnostic follow-up biopsies to determine the false negative results is also important to overkill extends