Chylothorax and Superior Vena Cava Syndrome Case Study

Chylothorax and Superior Vena Cava Syndrome Case Study Title: Chylothorax and Superior Vena Cava Syndrome as the Initial Presentation of Non small Cell Lung Cancer, which was Successfully Resolved by Systemic Chemotherapy We define a case report of 35 year old male presented with shortness of breath, dyspnea, heaviness of left chest wall, engorgement of vein in left side chest wall and upper left neck, swelling in left side of the neck, chest pain and cough. At the time of admission, an abnormal round opacity presented in left upper lung lobe and histology shows non-small cell carcinoma with superior vena cava syndrome was diagnosed. MSCT scan report heterogeneous enhancing large soft tissue density mass lesion of size approximately 96 100 mm seen in left upper lobe extending in to whole mediastinum encasing all major vessel including arch of aorta, descending aorta, trachea, esophagus, pulmonary trunk,M PA and all major neck vessels origin. Lesion causing significant luminal narrowing of left main bronchus. Lesion causing obliteration of left brachio-cephalic.Left moderate pleural effusion seen. Heterogeneous attenuated right lung field is seen due to mosaic perfusion. Left sided thoracocentesis done milky white fluid drained from pleural cavity. Ultrasonography guided FNAC left lung done is suggestive of non-small cell carcinoma. Superior vena cava syndrome associated with lung carcinoma with massive chylothorax. Patient received cisplatin and gemcitabine chemotherapy. After chemotherapy taken chylothorax resolution almost completely. Key words: Lung cancer; squamous cell carcinoma; chylothorax; superior vena cava syndrome INTRODUCTION Lung cancer in India commonly accounts 80-85% of non-small cell carcinoma. In Acharya tulsi regional cancer treatment and research institute Bikaner hospital squamous cell carcinoma interpretation for 15% of all cases of NSCLC according to registry. In advanced lung cancer chemotherapy play main role in quality of life and survival. Chylothorax initial symptom of NSCLC is rare but pleural effusion is commonly seen. Chylothorax is mostly seen after complication of lung surgery. But in this case chylothorax is initial presentation with NSCLC with SVC. Incidence of chylothorax is .3-2.4%.[3-5]. Few report of this disorder in current year[2]. We report this case of NSCLC with initial appearance with SVC and chylothorax which resolved almost entirely with chemotherapy CASE REPORT A case report of 35 year old male presented with shortness of breath, dyspnea, heaviness of left chest wall, engorgement of vein in left side chest wall and upper left neck, swelling in left side of the neck, chest pain and cough. He is heavy smoker for 13 year and also chronic alcohol drinker. Patient vital signs at the time of admission pulse rate is 88 per minute, respiratory rate is 26 per minute, BP is 128/84 and temperature in normal limit. On auscultation breathe sound decreased in left side of chest. At the time of admission, an abnormal round opacity presented in left upper lung lobe and histology shows non-small cell carcinoma with superior vena cava syndrome was diagnosed. MSCT scan report heterogeneous enhancing large soft tissue density mass lesion of size approximately 96 100 mm seen in left upper lobe extending in to whole mediastinum encasing all major vessel including arch of aorta,descending aorta, trachea, esophagus, pulmonary trunk,M PA and all major neck vessels origin. Lesion causing significant luminal narrowing of left main bronchus. Lesion causing obliteration of left brachio-cephalic. Left moderate pleural effusion seen.Heterogeneous attenuated right lung field is seen due to mosaic perfusion. Multiple para-esophageal,perigastric, supra-clavicular,superior mediastinum, pre, paratracheal, subcarinal AP window lymphadenopathy are seen,larger measuring approx. 18 mm size. Left sided thoracocentesis done milky white fluid drained from pleural cavity. Ultrasonography guided FNAC left lung done is suggestive of non-small cell carcinoma. Superior vena cava syndrome associated with lung carcinoma with massive chylothorax. Patient received cisplatin and paclitaxil chemotherapy. cisplatin given D1 and D2 schedule. After two cycle chemotherapy taken chylothorax resolve almost completely.Laboratory investigation shows serum creatinine e 1.1 mg /dl, albumin 3.2 mg/dl, total cholesterol 193 mg/dl, serum; triglyceride, 93 mg/dl, LDH is 425 IU/l. thoracocentesis done and 2000 ml milky white coloured fluid drained. Milky fluid biochemistry done and shows triglyceride, 867 mg/dl; l actate dehydrogenase, 332 IU/l; and carcinoembryonic antigen, 6.16 ng/ml.The cytological analysis of fluid revealed no malignant cells. Intercostal tube inserted and fluid is drained and symptom is improved. The clinical stage was T3N2aM0 stage IIIb. Therefore, SCC of the lung complicated by chylothorax and SVCS was diagnosed. . Chemotherapy with paclitaxel (175 mg/m2) and cisplatin (75 mg/m2) was administered on days 1, and cisplatin give in two days in divided dose respectively of six cycle repeat 21-day. The dyspnea and shortness of breath improved after two cycle of chemotherapy and amount of milky fluid drained is gradually tapered in intercostal tube after chemotherapy given. After five cycles chemotherapy patient symptoms improved and neck swelling is disappear and intercostal drained is 230 ml/day so intercostal tube come out and remaining one cycles is given. After 6 cycle complete again CECT chest revealed tumor size significantly decreases and also pleural fluid almost di sappear but superior vena cava symptoms is minimally improved . Then subsequently, the patient put another chemotherapy with gemcitabine and carboplatin, and radiotherapy is given to chest wall 30 gy 300cGy per fraction total 10 fraction in 2 weeks, but the tumor eventually progressed. Discussion The relationship between lung cancer and chylothorax may occur after compression of tumor to thoracic duct so increase pressure to duct and ruptured [6]. Secondly in obstruction in superior vena cava so venous pressure is increased significantly so leakage of chyle from thoracic duct to pleural cavity [7-9]. Another Couse of chylothorax is side effect of radiotherapy because after radiotherapy fibrosis is there and diminishing of lymph circulation [10-13]. This complication of radiation treatment is also observed in many disease like Hodgkin lymphoma (mantle field technique), squamous cell carcinoma in esophagus, breast carcinoma and also lung carcinoma[ 10,11, 12, 13, ]. With out lung surgery chylothorax is rare but this case present chylothorax without surgery. In current year 3 case reported with non small cell carcinoma[2,10,14-16].table 1 shows patient have chylothorax with clinical manifestation and resolve after management. In this table include our case report. The three case report series have 2 male and one female and median age af all three case was 47 yrs. All case non small cell carcinoma sub group is squamous cell carcinoma. Dahlbalk et al.[17] shows squamous cell carcinoma of lung cancer present with thorasic duct fluid in pleural cavity and nodular depositation. All case presented with right side lung carcinoma. Pleural fluid cytology present wih malignant cell. Main dominant feature in case is chylothorax and its present in mainly right pleural space. Treatment of chylothorax is mainly frequently repeated aspiration of pleural fluid, low fatty diet, intercostal tube drainage, and pleurodesis with chemical substance. [6,18] surgical management of chylothorax is thorasic duct ligation and pieuroperitonial shunt are mainly used in when milky coulred fluid is more than 550 ml or more then continues 14 days. In Dahlbalk et al study mainly two case successfully treated with chemical pleurodesis. One patient any intervention not done because general condition is very poor give only paliiative treatment. If chylothorax associated with cloot in brachiocephalic vein or subclavian and jugular vein is treated with anticoagulant therapy. Beghetti et al[8]. studied resistant case of chylothorax associated with superior vena cava syndrome manage with chemotherapy. Our case usual taken four cycle chemotherapy and mostly resoved chylothorax . Thrombus in superior vena cava are correct with treatment of underlying couse. Symptoms of superior vena cava syndrome is extremlly improved with two cycle chemotherapy. It is revealing of a promising response to chemotherapy Table 1 three patients of non-small cell lung cancer presented with Chylothorax Abbreviations: SCC=squamous cell carcinoma; ; RML=right middle lung; RT= radiotherapy; C/T=chemotherapy; NA=not available

In Electricity Generation, an Electric Generator Is a Device

Electric generator In  electricity generation, an  electric generator  is a device that converts  mechanical energy  to  electrical energy. A generator forces  electric charge  (usually carried by  electrons) to flow through an external  electrical circuit. It is analogous to a  water pump, which causes water to flow (but does not create water). The  source of mechanical energy  may be a reciprocating or turbine  steam engine, water falling through a  turbine or waterwheel, an  internal combustion engine, a  wind turbine, a hand  crank,  compressed air  or any other source of mechanical energy.The reverse conversion of electrical energy into mechanical energy is done by an  electric motor, and motors and generators have many similarities. In fact many motors can be mechanically driven to generate electricity, and very frequently make acceptable generators. ———-Historical developments Before the connection between  magne tism  and  electricity  was discovered,  electrostatic generators  were invented that used  electrostaticprinciples. These generated very high  voltages  and low  currents.They operated by using moving  electrically charged  belts, plates and disks to carry charge to a high potential electrode. The charge was generated using either of two mechanisms: * Electrostatic induction * The  triboelectric effect, where the contact between two insulators leaves them charged. Because of their inefficiency and the difficulty of  insulating  machines producing very high voltages, electrostatic generators had low power ratings and were never used for generation of commercially significant quantities of electric power.The  Wimshurst machine  and  Van de Graaff generator  are examples of these machines that have survived. Faraday's disk In the years of 1831–1832,  Michael Faraday  discovered the operating principle of electromagnetic generators. The pr inciple, later calledFaraday's law, is that an  electromotive force  is generated in an electrical conductor that encircles a varying  magnetic flux. He also built the first electromagnetic generator, called the  Faraday disk, a type of  homopolar generator, using a  copper  disc rotating between the poles of a horseshoe  magnet. It produced a small DC voltage.This design was inefficient due to self-cancelling counterflows of current in regions not under the influence of the magnetic field. While current was induced directly underneath the magnet, the current would circulate backwards in regions outside the influence of the magnetic field. This counterflow limits the power output to the pickup wires and induces waste heating of the copper disc. Later homopolar generators would solve this problem by using an array of magnets arranged around the disc perimeter to maintain a steady field effect in one current-flow direction.Another disadvantage was that the output volta ge was very low, due to the single current path through the magnetic flux. Experimenters found that using multiple turns of wire in a coil could produce higher more useful voltages. Since the output voltage is proportional to the number of turns, generators could be easily designed to produce any desired voltage by varying the number of turns. Wire windings became a basic feature of all subsequent generator designs. Dynamo The  dynamo  was the first electrical generator capable of delivering power for industry.The dynamo uses  electromagnetic  principles to convert mechanical rotation intopulsed DC  through the use of a  commutator. The first dynamo was built by  Hippolyte Pixii  in 1832. Through a series of accidental discoveries, the dynamo became the source of many later inventions, including the DC  electric motor, the AC  alternator, the AC  synchronous motor, and the  rotary converter. A dynamo machine consists of a stationary structure, which provides a constant magnetic field, and a set of rotating windings which turn within that field.On small machines the constant magnetic field may be provided by one or more permanent magnets; larger machines have the constant magnetic field provided by one or more electromagnets, which are usually called field coils. Large power generation dynamos are now rarely seen due to the now nearly universal use of  alternating current  for power distribution and  solid state  electronic AC to DC power conversion. But before the principles of AC were discovered, very large direct-current dynamos were the only means of power generation and distribution.Now power generation dynamos are mostly a curiosity. Alternator Without a  commutator, a dynamo becomes an  alternator, which is a  synchronous singly fed generator. When used to feed anelectric power grid, an alternator must always operate at a constant speed that is precisely synchronized to the electrical frequency of the power grid. A D C generator can operate at any speed within mechanical limits, but always outputs direct current. Typical alternators use a rotating field winding excited with direct current, and a stationary (stator) winding that produces alternating current.Since the rotor field only requires a tiny fraction of the power generated by the machine, the brushes for the field contact can be relatively small. In the case of a brushless exciter, no brushes are used at all and the rotor shaft carries rectifiers to excite the main field winding. MHD generator Main article:  MHD generator A magnetohydrodynamic generator directly extracts electric power from moving hot gases through a magnetic field, without the use of rotating electromagnetic machinery. MHD generators were originally developed because the output of a plasma MHD generator is a flame, well able to heat the boilers of a  steam  power plant.The first practical design was the AVCO Mk. 25, developed in 1965. The U. S. government funded su bstantial development, culminating in a 25 MW demonstration plant in 1987. In the  Soviet Union  from 1972 until the late 1980s, the MHD plant U 25 was in regular commercial operation on the Moscow power system with a rating of 25 MW, the largest MHD plant rating in the world at that time. [2]  MHD generators operated as a  topping cycle  are currently (2007) less efficient than combined-cycle  gas turbines. ————————————————- Terminology The two main parts of a generator or motor can be described in either echanical or electrical terms. Mechanical: * Rotor: The rotating part of an  electrical machine * Stator: The stationary part of an electrical machine Electrical: * Armature: The power-producing component of an electrical machine. In a generator, alternator, or dynamo the armature windings generate the electric current. The armature can be on either the rot or or the stator. * Field: The magnetic field component of an electrical machine. The magnetic field of the dynamo or alternator can be provided by either electromagnets or permanent magnets mounted on either the rotor or the stator.Because power transferred into the field circuit is much less than in the armature circuit, AC generators nearly always have the field winding on the rotor and the stator as the armature winding. Only a small amount of field current must be transferred to the moving rotor, using  slip rings. Direct current machines (dynamos) require a  commutator  on the rotating shaft to convert the  alternating current  produced by the armature to  direct current, so the armature winding is on the rotor of the machine. ————————————————- ExcitationAn electric generator or electric motor that uses field coils rather than permanent magnets requires a current to be present in the field coils for the device to be able to work. If the field coils are not powered, the rotor in a generator can spin without producing any usable electrical energy, while the rotor of a motor may not spin at all. Smaller generators are sometimes  self-excited, which means the field coils are powered by the current produced by the generator itself. The field coils are connected in series or parallel with the armature winding.When the generator first starts to turn, the small amount of  remanent magnetism  present in the iron core provides a magnetic field to get it started, generating a small current in the armature. This flows through the field coils, creating a larger magnetic field which generates a larger armature current. This â€Å"bootstrap† process continues until the magnetic field in the core levels off due to  saturation  and the generator reaches a steady state power output. Very large power station generators often utilize a separate smaller generator to excite the field coils of the larger.In the event of a severe widespread  power outage  where  islanding  of power stations has occurred, the stations may need to perform a  black start  to excite the fields of their largest generators, in order to restore customer power service. ————————————————- Equivalent circuit The equivalent circuit of a generator and load is shown in the diagram to the right. The generator's  VG  and  RG  parameters can be determined by measuring the winding resistance (corrected to operating temperature), and measuring the open-circuit and loaded voltage for a defined current load. ———————————————— [edit]Vehicle-mounted generators Early motor vehicles until about the 1960s tended to use D C generators with electromechanical regulators. These have now been replaced byalternators  with built-in  rectifier  circuits, which are less costly and lighter for equivalent output. Moreover, the power output of a DC generator is proportional to rotational speed, whereas the power output of an alternator is independent of rotational speed. As a result, the charging output of an alternator at engine idle speed can be much greater than that of a DC generator.Automotive alternators power the electrical systems on the vehicle and recharge the  battery  after starting. Rated output will typically be in the range 50-100 A at 12 V, depending on the designed electrical load within the vehicle. Some cars now have electrically powered  steering assistance  and  air conditioning, which places a high load on the electrical system. Large commercial vehicles are more likely to use 24 V to give sufficient power at the  starter motor  to turn over a largediesel engine.Vehicle alternators do not use permanent magnets and are typically only 50-60% efficient over a wide speed range. [4]Motorcycle alternators often use permanent magnet  stators  made with  rare earth  magnets, since they can be made smaller and lighter than other types. See also  hybrid vehicle. Some of the smallest generators commonly found power  bicycle lights. These tend to be 0. 5 ampere, permanent-magnet alternators supplying 3-6 W at 6 V or 12 V. Being powered by the rider, efficiency is at a premium, so these may incorporate  rare-earth magnets  and are designed and manufactured with great precision.Nevertheless, the maximum efficiency is only around 80% for the best of these generators—60% is more typical—due in part to the rolling friction at the  tyre–generator  interface from poor alignment, the small size of the generator, bearing losses and cheap design. The use of permanent magnets means that efficiency falls even further at high speed s because the magnetic field strength cannot be controlled in any way. Hub dynamos  remedy many of these flaws since they are internal to the bicycle hub and do not require an interface between the generator and tyre. Until recently, these generators have been expensive and hard to find.Major bicycle component manufacturers like Shimano and SRAM have only just entered this market. However, significant gains can be expected in future as cycling becomes more mainstream transportation and LED technology allows brighter lighting at the reduced current these generators are capable of providing. Sailing yachts may use a water or wind powered generator to trickle-charge the batteries. A small  propeller,  wind turbine  or  impeller  is connected to a low-power alternator and rectifier to supply currents of up to 12 A at typical cruising speeds. Still smaller generators are used in  micropower  applications. ————————â⠂¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€ Engine-generator An  engine-generator  is the combination of an electrical generator and an  engine  (prime mover) mounted together to form a single piece of self-contained equipment. The engines used are usually piston engines, but gas turbines can also be used. Many different versions are available – ranging from very small portable  petrol  powered sets to large turbine installations. ————————————————- Human powered electrical generators A generator can also be driven by human muscle power (for instance, in field radio station equipment).Human powered direct current generators are commercially available, and have been the project of some  DIY  enthusiasts. Typically operated by means of pedal power, a converted bicycle trainer, or a foot pump, such generators can be practically used to charge batteries, and in some cases are designed with an integral inverter. The average adult could generate about 125-200 watts on a pedal powered generator, but at a power of 200 W, a typical healthy human will reach complete exhaustion and fail to produce any more power after approximately 1. 3 hours. 6]Portable radio receivers with a crank are made to reduce battery purchase requirements, see  clockwork radio. During the mid 20th century, pedal powered radios were used throughout the Australian outback, to provide schooling,(school of the air) medical and other needs in remote stations and towns. ————————————————- Linear electric generator In the simplest form of linear electric generator, a sliding  magnet  moves back and forth through a  solenoid  Ã¢â‚¬â€œ a spool of copper wire. Analternating current  is induced in the loops of wire by  Faraday's law o f induction  each time the magnet slides through.This type of generator is used in the  Faraday flashlight. Larger linear electricity generators are used in  wave power  schemes. ————————————————- Tachogenerator Tachogenerators are frequently used to power  tachometers  to measure the speeds of electric motors, engines, and the equipment they power. Generators generate voltage roughly proportional to shaft speed. With precise construction and design, generators can be built to produce very precise voltages for certain ranges of shaft speeds

Health Is Not A Singular Concept Essay - 1249 Words

With almost any visit to a doctor the question will come up, â€Å"Have you been eating healthy?† Everyone would like to think so or at least impress the doctor by saying so, but the term â€Å"health† may contradict the stereotypical simple answer of eating fruit and vegetables and working out. In fact, doctors may even have the wrong impressions on health when giving their patients advice. Over three articles, different authors have shared their views on health, what it means, and how it affects our society. From these, I comprised my own definition for health. Health is not a singular concept. Rather, it affects an entire society, allowing everyone to access food filled with the necessary nutrients to sustain life. This definition though has no use unless it is able to be shared with large populations. Therefore, education and ease of implementation are the most critical parts of the definition of health because they allow the American citizens to put the values of h ealth into practice. From the arguments, the authors vary in their abilities to make convincing arguments based on how well their health plans are defined. The first author, Michael Pollan, establishes health as a societal term. He desires to create a healthy, utopian society by changing the way food is produced. In his argument in the article â€Å"Farmer in Chief,† Michael Pollan points out that â€Å"the health of a nation’s food system is a critical issue of national security.† This shows how seriously he takes America’sShow MoreRelatedCultural Competency And Awareness, Organization, And Skills1605 Words   |  7 Pages It is important to first define cultural competency, as the ability for health professionals to work in situations where their personal culture may not be identical to that of the patient they are interacting with (Blackburn, 2015). Unfortunately, there is no definitive definition utilized across professions (Suarez-Balcazar et al., 2011). This can make it difficult to pursue in both teaching it and evaluating it. In fact, this study will only touch on one method of evaluating cultural competenceRead MoreCrisis Management Communication Plan1291 Words   |  6 Pages(Roberts, 2005 ). Effective communication vitally important in health care setting. 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Famous Quotations About Education

What is the role and importance of education? The word education comes from the Latin verb  educatus  Ã‚  meaning bring up (children), to train, or bring up, rear, educate. Throughout history, the purpose of education has been to pass to younger members of a society the values and accumulated knowledge of a society and to prepare these younger members for their roles as adults. As societies became more complex, the transmission of values and knowledge were delivered by an expert or teacher. In both the Ancient and Modern World, the ability of a society to deliver education became a measure of success. Great thinkers have reflected on and recorded their opinions about education and its value to the individual and society. The following selected quotes are from individuals past and present, representing their thoughts on the importance of education: Plato: The purpose of education is to give to the body and to the soul all the beauty and all the perfection of which they are capable.Herbert Spencer: Education is preparation to live completely.John Milton: A complete and generous education fits a man to perform justly, skillfully, and magnanimously all the offices, both public and private, of peace and war.Sully: Education seeks, by social stimulus, guidance, and control, to develop the natural powers of the child, so as to render him able and disposed to lead a healthy, happy, and morally worthy life.W. T. Harris: Education is the preparation of the individual for reciprocal union with society; the preparation of the individual so that he can help his fellow-men and in return receive and appreciate their help.Malcolm Forbes: Educations purpose is to replace an empty mind with an open one.T. S. Eliot: It is, in fact, a part of the function of education to help us escape, not from our own time — for we are bound by that â₠¬â€ but from the intellectual and emotional limitations of our time.G. K. Chesterton: Education is simply the soul of a society as it passes from one generation to another.George Washington Carver: Education is the key to unlock the golden door of freedom.Jules Simon: Education is the process by which one mind forms another mind, and one heart, another heart.Thomas Hill: A complete education ought to preserve the pupils bodily health and strength, and give him command over his mental and muscular powers, increase his quickness and sharpness of perception, form in him the habit of prompt and accurate judgment, lead to delicacy and depth in every right feeling, and make him inflexible in his conscientious and steadfast devotion to all his duties.Robert Frost: Education is the ability to listen to almost anything without losing your temper or your self-confidence.Robert M. Hutchins: The object of education is to prepare the young to educate themselves throughout their lives.Robert M. Hutchins: Education is not to reform students or amuse them or to make them expert technicians. It is to unsettle their minds, widen their horizons, inflame their intellects, teach them to think straight, if possible.Martin Luther King, Jr.: Education must enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction.Martin Luther King, Jr.: We must remember that intelligence is not enough. Intelligence plus character—that is the goal of true education. The complete education gives one not only power of concentration, but worthy objectives upon which to concentrate.Horace Mann: Education then, beyond all other devices of human origin, is the great equalizer of the conditions of men, the balance-wheel of the social machinery.Anatole France: An education isnt how much you have committed to memory, or even how much you know. Its being able to differentiate between what you do know and what you dont.Victor Hugo : He who opens a school door closes a prison.Alvin Toffler: The illiterate of the future will not be the person who cannot read. It will be the person who does not know how to learn.Aristotle: Education is an ornament in prosperity and a refuge in adversity.