Cephalic vein [Key Facts You Should Know About It]

After reading the name of the topic you got an idea of the article what it’s gonna be about. Yes, it’s about vein, cephalic vein. Did you ever hear about the cephalic vein? For medical students, YES! They have heard due to their anatomy course. For the layman, they might be heard or might not. The layman should understand some basics about the cephalic vein. This article will give a chunk of information for you guys to better understand the cephalic vein.

If you have read our article about the basilic vein you have an idea about the cephalic vein because we have discussed some facts about the cephalic vein as well. But here, in this article, we will give you a valid description of this topic including its anatomy, course, drainage, and location, etc. 

Let’s give a short glimpse at the venous system of the upper limb. So, the venous system of the upper limb clears out deoxygenated blood from the arm, forearm, and hand. It can be subdivided into the peripheral system and the deep system. Let’s move towards the cephalic vein. 

What is a Cephalic vein? 

The most main outermost veins of the upper limb are the cephalic and basilic veins. They are found within the hypodermic (subcutaneous) tissue of the upper limb. The cephalic vein is a superficial vein of the upper limb and it’s one of the two chief veins of the arm. The cephalic vein also begins from the dorsal venous plexus of the hand. It rises the anterolateral phase of the upper limb. The cephalic vein moving preliminary at the elbow. 

The superficial venous network is the main source of blood for most blood tests and is the tranquil place to obtain venous blood.

Cephalic vs Basilic Vein

The basilic vein begins from the dorsal venous network of the hand and ascends the medial phase of the upper limb and the cephalic vein also originates from the dorsal venous plexus of the hand. It ascends the anterolateral phase of the upper limb. The cephalic vein passes preliminary at the elbow. 

Anatomy of A Cephalic Vein

The cephalic vein begins in the anatomical snuffbox from the radial plane (wrist) of the superficial venous network of the dorsum of the hand. The cephalic vein is the outermost (superficial) part of the arm, hand, and forearm. There is a valve between the superficial and deep vein that probably reduces the backflow from the deep venous system. 

Course:

The cephalic vein courses from the radial side of the superficial venous network. The vein curves throughout the radial aspect of the forearm to the course within the anterolateral forearm. The cephalic vein later meets with the basilic vein at the cubital fossa through the median cubital vein. It then reaches upwards across the anterior elbow region and arises into the anterolateral brachium lateral to the biceps muscle which is in the deltopectoral groove. 

The deltopectoral groove is made by the close edges of the deltoid and pectoralis major muscles. The cephalic vein resumes rising in a channel between the pectoralis major and deltoid muscles.

Branches of A Cephalic Vein:

The cephalic vein is one of the most superficial veins that drain into the upper limb. The two branches of the cephalic vein are; 

• The median cubital vein: is a very common site of venipuncture. The median cubital vein joins the basilic vein to the cephalic vein in the anterior point of the cubital fossa.
• Accessory cephalic vein: Accessory cephalic veins can begin from either one side like a venous plexus on the dorsum of the forearm or the medial side of the dorsal venous network of the hands.

Termination:

The cephalic vein ends by removing into the foremost part of the axillary vein at the Clavipectoral region. 

Drainage:

It passes the Clavipectoral fascia and axillary artery to clear out into the axillary vein under the clavicle. The cephalic vein drains the lateral surface of the superficial venous network of the dorsum. It then drains the blood from the palm. After that, the cephalic vein clears out blood from the lateral region of the upper limbs through small superficial veins. 

Conclusion

The most main outermost veins of the upper limb are the cephalic and basilic veins. They are found within the hypodermic (subcutaneous) tissue of the upper limb. It rises the anterolateral phase of the upper limb. The cephalic vein moving preliminary at the elbow. There are two branches of cephalic vein-like; the median cubital vein and accessory cephalic veins. The cephalic veins end in the axillary vein.

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.

Brachiocephalic Vein: Amazing Key Points You Should Know About 

Did you ever hear about the brachiocephalic vein?. As in our previous articles were about cephalic vein and basilic vein, if you have read our previous article then you guys have an idea about this. But if not so don’t worry we will give an amazing article for you on this platform. This article will let you know about the anatomy of the brachiocephalic veins, courses, termination, and drainage, etc. 

We agree that medical students have known about brachiocephalic vein, it might be difficult for the layman to understand more rapidly as compared to medical students but it’s not impossible for you. If you are interested in the anatomy of your body then this article is for you. 

What is a Brachiocephalic Vein?

The brachiocephalic vein is also called the innominate vein and is a paired vein of the superior mediastinum that removes the venous blood from the head and neck, upper limbs, and thorax. The left and right brachiocephalic veins combine to appear the superior vena cava on the right view of the upper chest. The left vein is usually longer than the right one. 

The Function of A Brachiocephalic Vein:

The brachiocephalic veins are made by the convergence of the subclavian vein and internal jugular vein on the right and left. These vessels are valveless. These vessels are a vital element of the circulatory system which helps in the drainage of deoxygenated blood from the head and upper limbs. The right brachiocephalic vein length is about 2 to 3 cm, while the left measures approximately 6 cm. 

• The primary function of the brachiocephalic veins is to help in carrying deoxygenated blood from the circulation back to the right side of the heart. 
• Blood from the head drains through the internal jugular veins.
• Blood from the upper extremities clears out by the subclavian veins.

Anatomy of The Brachiocephalic Vein 

Origin and Course of the Vein:

The internal jugular and subclavian veins merge to form the brachiocephalic veins behind the medial points of the clavicles in the neck root. The left and right brachiocephalic veins originate posteriorly to the particular left and right sternoclavicular joints.

Left Brachiocephalic Vein:

The left brachiocephalic vein is approximately 6 cm long including ways a deep oblique course to the right via the superior mediastinum anterior to the tributaries of the aortic arch to combine with the right brachiocephalic vein posterior to the primary sternocostal joint to make the superior vena cava. The left brachiocephalic vein initially courses near to the medial surface of the apex of the left lung and is converged by the right pleura close to its end.

Right Brachiocephalic Vein:

The branches of the left brachiocephalic vein are the left vertebral, internal thoracic, inferior thyroid, and superior intercostal veins. It runs a vertical course anterior to the brachiocephalic trunk and vagus nerve. It shifts the superior vena cava as it is connected from the left by the left brachiocephalic vein which drains into the right atrium of the heart. The right brachiocephalic vein is formed at the anterior to the right pleura, phrenic nerve, and internal thoracic artery. 

Branches of Left Brachiocephalic Vein:

The left and right brachiocephalic veins collect many branches. Brachiocephalic veins receive venous blood from the head, neck, upper limb, and the upper part of the thorax by certain branches. 

The branches of the right brachiocephalic vein are:

• right vertebral vein
• right inferior thyroid vein
• right internal thoracic vein
• right supreme intercostal vein

The branches of the left brachiocephalic vein are:

• left vertebral vein
• left inferior thyroid vein
• left internal thoracic vein
• left supreme intercostal vein
• left superior intercostal vein
• thymic veins
• pericardiophrenic veins

Layers & Relation of A Brachiocephalic Vein:

The vein consists of many coverings:

• An outer layer called adventitia is formed by connective tissue
• The middle layer called tunica media which is made up of smooth muscle cells
• The inner layer called tunica intima is made with endothelial cells

The right brachiocephalic vein has a relationship with the following;

• The cartilage of the first rib
• The infrahyoid muscles (sternothyroid)
• The phrenic nerve 
• The cranial nerve vagus
• Parietal pleura
• Brachiocephalic arterial trunk

The left brachiocephalic vein has a relationship with the following; 

• The medial epiphysis of the clavicle
• The infrahyoid muscles (sternothyroid and sternohyoid)
• Retrosternal fat

Conclusion:

The brachiocephalic vein is also called the innominate vein and is a paired vein of the superior mediastinum that removes the venous blood from the head and neck, upper limbs, and thorax. The drainage area of the brachiocephalic vein is the head, neck, upper limb, and upper thorax. The brachiocephalic vein drains into the superior vena cava. The left and right brachiocephalic veins collect many branches which are mentioned above. So we have mentioned the anatomy of the brachiocephalic vein in this article. 

If you have any further queries related to this article, Kindly Comment below and Our team members will respond to them very soon!

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.

BASILIC VEIN [Key facts You Should Know About it]

After reading the name of the topic you got an idea of the article what it’s gonna be about. Yes, it’s about vein, basilic vein. Did you ever hear about the basilic vein?. For medical students, YES! They have heard due to their anatomy course. For the layman, they might be heard or might not. The layman should understand some basics about the basilic vein. In this article, we will give a chunk of information for you guys to understand better about the basilic vein. 

Let’s give a short glimpse at the venous system of the upper limb. So, the venous system of the upper limb clears out deoxygenated blood from the arm, forearm, and hand. It can be subdivided into the peripheral system and the deep system. Let’s move towards the basilic vein. 

What is a Basilic Vein?

The most main outermost veins of the upper limb are the cephalic and basilic veins. They are found within the hypodermic (subcutaneous) tissue of the upper limb. The upper limb is highly flexible and well developed. The accurate functioning of the upper limb is facilitated by vascular supply and venous drainage. The basilic vein begins from the dorsal venous network of the hand and ascends the medial phase of the upper limb. 

Basilic Vein VS Cephalic vein

The basilic vein begins from the dorsal venous network of the hand and ascends the medial phase of the upper limb and the cephalic vein also originates from the dorsal venous plexus of the hand. It ascends the anterolateral phase of the upper limb. The cephalic vein passing preliminary at the elbow. 

Anatomy of a Basilic Vein

Origin of a Basilic Vein:

The basilic vein originates from the ulnar side of the superficial venous network of the dorsum of the hand. 

Course:

The basilic vein ascends posteromedially in the forearm towards the anterior elbow section to move anterior to the medial epicondyle of the humerus from the ulnar aspect of the superficial venous network. 

It is smaller than the Cephalic vein and stops once it connects the brachial vein close to the elbow. It uninterrupted to rise anteromedially in the brachium until it sticks the brachial fascia at the basilic hiatus. The basilic vein then courses medially to the brachial artery until it connects with the brachial veins in the axilla to make the axillary vein. The axillary vein joins the cephalic vein.

Branches of a Basilic Vein:

Superficial veins of the upper limb are extremely mutable and hold various superficial branches which drain into them. Two such varying branches of the basilic vein include:

• The median cubital vein: is a very common site of venipuncture. The median cubital vein joins the basilic vein to the cephalic vein in the anterior point of the cubital fossa.
• Median antebrachial vein: The median antebrachial vein is a large superficial forearm vein that exudes the compositions of the anterior forearm, palmar surface of the hand, and antecubital region of the forearm. It ends in the basilic or median cubital veins.

Termination of The Basilic Vein:

It forms the axillary vein at the inferior border of the teres major muscle by combining the brachial veins. It terminates into a brachial vein. 

Drainage of The Basilic Vein:

The basilic vein drains into the brachial vein and then empties into the axillary vein once it goes through the inferior border of teres major. The axillary vein now meets the cephalic vein. The basilic vein drains the side of the superficial venous network of the hand and then it drains blood from the palm. 

Dissection of The Basilic Vein:

When the doctor dissects the superficial fascia he needs to be very careful and alert when giving the first incision by not damaging the vein. The veins have more thin walls than arteries so he needs to be well conscious while giving the incision. 

Conclusion

The most main outermost veins of the upper limb are the cephalic and basilic veins. They are found within the hypodermic (subcutaneous) tissue of the upper limb. The basilic vein begins from the dorsal venous network of the hand and ascends the medial phase of the upper limb. It originates from the dorsal venous network of the hand and drains into the brachial vein in the area of the hand and palm. Basilic veins have two branches; the median cubital vein and the median antebrachial vein. 

If you have any further queries related to this article, Kindly Comment below and Our team members will respond to them very soon!

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.

Application Of Statistics In The Medical Field

What is biostatistics?

The application of statistics in the medical field is specifically termed biostatistics. Biostatistics or biometry is the branch of science that deals with the statistical method and processes utilized for the analysis of biological phenomena. The discipline of biostatistics covers the study of biological experiments and reading the collection, summarization, and evaluation of data from those experiments. Biostatistics  also involves the formation  and application of the most suitable methods for the 

• Compilation of data.
•   Demonstration of the assembled data. 
•  Evaluation and perception of the results. 
•  Making judgments on the principle of such analysis

Biostatistics can also be defined as a sub-branch of statistics that assess in management of medical uncertainties and mainly concerned with mathematical facts and data related to biological events. Biostatistics covers contributions and applications not only from medicines, health, and nutrition but also from other fields like epidemiology, genetics, etc. Biostatistics usually comprise of following basics steps formation of a hypothesis, collection of data, and application of statistical analysis.

Role of biostatistics

The ultimate objective of biostatistics is to improve the health and quality of life of individuals within a community or population. The main role of biostatistics  are as follows:

• To diagnose the disease and treatment strategy with an estimation of its effects.
• To determine risk factors of disease
• Design, monitor, evaluate, interpret, and record the results of clinical studies.
• Measure, locate and explain the extent of disease.
• Develop statistical methods to give satisfactory answers to the questions that arise from public health data

Application of biostatistics in the medical field

Biostatistics has numerous applications as science specifically in the field of medicine. Its applications in medicines are briefly explained as follows

1. In physiology and anatomy

Biostatistics is used to find the ranges of normality in variables such as weight and pulse rate etc in a population. It also helps to define the correlation between two variables such as height and weight. 

2. In pharmacology

Biostatistics is used to compare the action of two different drugs or two successive dosages of the same drug. It is also utilized to assess the relative potency of a new drug with respect to standard drugs.

3. In medicine

Biostatistics has multiple uses in medicines such as compare the efficacy of a particular drug by assessing the percentage cured, dead, or alive in experiment and control groups. it is then compared and the difference is evaluated by applying statistical techniques. statistical methods are also applied to find an association between two attributes such as hypertension and diabetes.

4. In modern medicine

From analyzing data to determining the type and need of treatment during clinical trials, Biostatistics has played an integral role in modern medicine. Biostatistics helps to generate the facts and information on basis of statistical data like heart disease is one of the leading causes of death in America. Such types of outcomes are based on research-based statistical data and evaluations.

5. In clinical medicine

Biostatistics is used as a tool in clinical medicine for the documentation of the history of medical disease, designing, and planning of conduction of clinical trials, assessing the merits and demerits of different procedures and methodologies.

6. In preventive medicine

Biostatistics is involved to introduce and promote health legislation. Moreover, it helps to find out the actual reason underlying the reason and evaluate the success ate of health program introduced in the community.

Role of biostatistics in the evaluation and in health planning

Biostatistics mainly covers biological sciences specifically from the field of medicines and public health. Biostatistical methods are used for planning, conducting, and analyzing data that comes into being from branches of medicine and public health. It deals with the summarization and interpretation of data to get valid and reliable conclusions and also analyze the positive or negative outcomes positive or negative outcomes of health programs or policies in a community. 

Biotechnology is one of the most important domains covered by biostatistics. From genetic modification of plants and animals to gene therapy, reproductive theraphy, medicine, and drug manufacturing, and even energy production. In all situations, analysis is carried out by generating something and assessing whether or not it includes the desired operation, and determining performance involves statistical analysis of results.

Applications of biostatistics in community medicine and public health

The role of biostatistics in community medicine and public health can be highlighted and summarized in the following key points.

• To assess the potency of antibodies and vaccines in the field.  
• In demographical and epidemiological studies, the position of original factors is statistically verified. 
•  To test whether the variation between two populations is true or a chance incident.
•  To survey the interrelationship between traces in the same population.  
• To measure morbidity and fatality. 
•  To evaluate performances of public health programs.  
• To establish priorities in public health programs. 
•  To help develop health regulation and initiate administrative measures for oral health.
• It cooperates in the collection of data, drawing conclusions, and generating orders for graduates of medicine/dentistry
•  By reviewing the structures in biostatistics a student learns to seriously evaluate articles reported in therapeutic and dental journals or papers read in medical and dental conferences.  
• To understand the essential methods of measurement in clinical practice and research.

Applications of biostatistics in environmental sciences

Biostatistics in  Environmental science involves a lot of types of investigation. It gives baseline studies to record and document the existing state of a surrounding to present background in the situation of unexplained variations in the future. It enables the researchers to perform targeted studies to illustrate the likely impact of changes being designed or of unexpected occurrences and ultimately leads to regular monitoring to pursue to identify changes in the environment.

Applications of biostatistics in nutrition

Biostatistics, which can be described as the handling of establishing scientific inferences from data that contain uncertainty, becomes historically played an intrinsic role in developing nutritional systems. in the age of systems, biology statistics has become a progressively powerful weapon to quantitatively analyze information about biomolecules.

 Over the preceding 2 decades, there have been revolutionary advancements in history science technologies represented by high throughput, significant efficiency, and fast calculation.  Nutritionists now have good opportunities and leading techniques for the judgment of DNA, RNA, amino acid, protein, low- molecular-weight metabolites, as well as an approach to bioinformatics databases.

Appropriate statistical evaluations are supposed to produce an effective input to dealing with major nutrition-linked complications in individuals and beasts

•  Obesity
•  Diabetes
• Cardiovascular diseases
• Cancer
• Ageing
•  Intrauterine growth retardation).

Applications of biostatistics in genetics

In Genetics  Statistics and Human Genetics are twin studies, including spread with the century together, and there are many correlations between the two. Some major aspects in specific the approach of Analysis of Fluctuation, first derived in Human Genetics, while demographic and statistical methods are now fundamental to many situations of analysis of challenges in human genetics

The most prevalent fields where one can notice large functions of statistical practices in human genetics is 

•  Human Genome Project 
•  Linkage Analysis 
•  Sequencing

Applications of biostatistics in dental sciences

In dental sciences, biostatistics has its own dominant role that proves it to be an essential tool in overall medical science. It serves to detect the statistical distinction between the means of the two groups. Ex: Mean dental sensitivity scores of two groups. . It helps to assess the state of oral health in the community and to decide the opportunity and application of dental care facilities. Biostatistics tends to express the necessary aspects ruling the state of oral health by recognizing the community and uncover solutions to such problems. It helps to make decisions about the accomplishment or collapse of unique oral health care programs or to figure out the program operation. Moreover, it leads to improving oral health constitution and in shaping administrative standards for oral health care distribution.

Application of biostatistics in the medical field

As we mentioned previously that biostatistics or statics in medical fields stands for the same meanings. Both terms are interchangeable so don’t get confused between these terms. In this article, we mainly focused on applications of statistics in the medical field. Its applications varying from biomedical lab analysis to clinical medicine to health promotion, to social and universal policies of health care to medicine and the health sciences, involving clinical research, forensic medicine, epidemiology, and public health.

1. In health care system

In the healthcare system, researchers used the scientific method to collect data on samples of the human population. This data was used by healthcare organizations to get knowledge about the variety of phenomena such as the most prevailing diseases in a particular society or mortality rate due to any particular disease. Moreover, biostatistics enables healthcare organizations to know about consumer market characteristics such as sex, age, income, and disabilities. Biostatistics is utilized to predict the type of services used by people and determine the level of care affordable to them. 

2. Resource issuance

Resource issuance is another important application of statistics in the medical field. Valid Statistical information helps in resource allocation by determining several key facts about resources  and reduce the risk of healthcare trade-offs, such as 

• Which type of resources are utilized to produce goods and services?
• What is the most appropriate combination of goods and services that need to produce?
• What type of community, it should be served?

3. Quality enhancer

Biostatistics plays a significant role in the medical field because it enables healthcare organizations to measure performance success or failure. Healthcare suppliers make efforts to develop effective goods and services.  Quality improvement managers can measure feature results by building standards of service excellence or by building benchmarks. Statistical data collected over time displays the overall growth and ability to show more growth of a healthcare organization or company  

4. Product development

Statistical analysis has a major role in the innovation and development of new pharmaceutical products. Innovations and modifications in medicines start and end with statistical analysis. In clinical trials of new technologies and treatments, data is collected and reported to analyze product benefits in comparison to its risks. Statistics tend to influence the pricing of products indirectly by defining consumers ’demand in the most appropriate units. 

5. Provide assessment

Statistical data provides assessment to public and private health care workers and organizations who are responsible to provide continuous care to a diverse population and compare the existing services to community needs.  A biostatistical analysis is a key factor in need assessment. Biostatistics plays a significant role in technological and pharmaceutical companies in establishing the product lines that meet the requirement of the community, they served.

6. In the research field

Biostatistics deals with human health and statistical data so it enables the researchers to analyze data from medical experiments, design studies, determine what data to collect, help illustrate the outcomes of the evaluations, and participate in creating essays to report the results of the medicinal investigation. Biostatistics helps analysts make understanding the data gathered to decide whether an operation is running or to get aspects that contribute to diseases. Medical statisticians plan and analyze examinations to diagnose the legitimate causes of health issues as recognizable from chance fluctuation.

Importance of biostatistics in medical and health science

Data collection is one of the most essential factors that help to determine the future of public health and health sciences. The collection of statistical data allows the medical practitioner and researchers to detect health problems, observe patterns and trends in health status, and assess the influence of health programs and policies. Statistical methods are developed and applied to

• Population growth
• Disease detection
• Treatment
• Genomics research
• Drug development
• Clinical trials
• Screening and prevention
• Assessment of rehabilitation
• Measure recovery time
• Determine the quality of life

Conclusion

The discipline of biostatistics covers the study of biological experiments and reading the collection, summarization, and evaluation of data from those experiments. Biostatistics covers contributions and applications not only from medicines, health, and nutrition but also from other fields like epidemiology, genetics, etc. Biostatistics usually comprise of following basics steps formation of a hypothesis, collection of data, and application of statistical analysis.

Bio-statistical approaches can guarantee that the results found in such an investigation are not simply because of chance.  In every event of our life, Statistics plays a crucial role in better income and valid results. A well-designed and properly controlled study is an underlying prerequisite to reach authentic conclusions.

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.

Everything You Should Know About PDL-1 Lung Cancer Testing

Before moving towards the PDL-1 lung cancer here we are giving a short overview of lung cancer so, Your lungs are two spongy organs in your thorax that bring in oxygen when you breathe and release carbon dioxide when you exhale. Lung cancer is the leading reason for cancer deaths worldwide. People who smoke have a substantial risk of lung cancer but it also developed in those people who have never smoked before. Here is a short overview of lung cancer. Let’s move towards PDL-1 lung cancer;

What is PDL-1? 

The full form of PDL-1 is Programmed death-ligand 1. The PDL1 testing is applied to observe if you have cancer that may good from immunotherapy. This test estimates the quantity of PDL1 on cancer cells. PDL1 is a protein that assists keep immune cells from invading nonharmful cells in the body. Our immune system is also known as the defence system of our body that fights against germs. Some cancer cells have great volumes of PDL1. 

PDL-1 function 

PDL-1 is sometimes also found in normal cells as well. When PD-L1 sticks to another protein called PD-1, it retains T cells from destroying the PD-L1-containing cells, including the cancer cells. Anticancer medications called immune checkpoint inhibitors to attach to PD-L1 and obstruct its binding to PD-1. This breaks the “hurdles” on the immune system and goes T cells free to kill cancer cells. If your cancers have a very high amount of PDL-1 so you might get benefit from immunotherapy. 

What is immunotherapy? 

Immunotherapy is a procedure that works with certain portions of a person’s immune system to fight conditions such as cancer. In the last few decades immunotherapy has become an essential part of managing any kind of cancer. Fresh immunotherapy approaches are being tested and confirmed.  Here is a big question like how it works? 

• Energizing or improving the natural defenses of your immune system so it performs quickly or smartly to detect and beat cancer cells. 

• Making bases in a lab that are quite like immune system components and using them to rebuild or boost the immune system that helps to fight the cells. 

PDL-1 lung cancer immunotherapy

The fresh confirmation of immunotherapy as a really hopeful way to Non-Small Cell Lung Cancer (NSCLC) therapy is one of the common exciting progress in the history of lung cancer therapy. This improvement of immunotherapy in cancer treatment can be broadly attributed to the evolution of novel immunotherapy drugs targeting specific immune regulatory checkpoints and intensifying the endogenous antitumor immune feedback. 

Why do I require a PDL-1 test? 

A protein found on T cells (a type of immune cell) that assists keep the body’s immune responses in check. If you have one of following cancer you may need PDL-1 testing. A high level of PDL-1 may need immunotherapy. PD-L1 testing is required before treatment with some drugs.

• Lung cancer 
• Bladder cancer
• Kidney cancer
• Breast cancer
• Melanoma
• Hodgkin lymphoma

Preparations for PDL-1 lung cancer testing

In several cases preparation is minimum. The procedure preparation usually depends on how the collection is being performed. Your health care practitioner gives you the instructions like how we will get the sample. A sample of cancer cells will be collected from a biopsy or surgical removal of cancerous tissue. 

Procedure of PDL-1 lung cancer testing

It is usually done in the form of biopsy so here are 3 types of biopsies; 

• Fine needle aspiration biopsy, which uses a very thin syringe to remove a specimen of cells or fluid
• Core needle biopsy, which uses a larger syringe to exclude a sample
• Surgical biopsy, which removes a sample in a lesser. It may perform in a surgical setup

Steps of fine needle and core needle biopsy

• You will put it down on your side or sit on an exam table.
• A health care provider will disinfect the biopsy site. 
• Might give anaesthesia to the procedure site so you won’t feel any pain during the procedure.
• Once the area is numb the health care provider will insert a fine aspiration needle or core biopsy needle into the biopsy place and eliminate a sample of tissue or fluid.
• You may feel a slight pressure when the sample is eliminated.
• Pressure will be implemented to the biopsy site until the bleeding ends.
• Your provider will apply a sterile dressing at the biopsy site.

Steps of surgical biopsy

A surgeon will make a small incision in your skin to remove all or part of a cancer site. A surgical biopsy is seldom performed if the site can’t be approached with a needle biopsy. It includes the following steps; 

• First, you have to shave the site if needed 
• After that asked patient to lie on the OT table 
• IV will be placed in your arm or hand 
• Sedative or relaxant medicine might be given
• You will given local or general anaesthesia so you won’t feel any kind of pain on the biopsy site
• General anaesthesia might be given by a health care provider and general is given by an anesthesiologist. 
• Once the site is numb or you are unconscious the surgeon makes an incision to the site to remove the cancerous tissues or fluid. 
• The incision is closed by stitches or bandages by the surgical technologist. 

Risks after PDL-lung cancer test

After the biopsy has been done and the sample is achieved. It might b possible to develop the infection after a PDL-lung cancer biopsy so your doctor may recommend you some antibiotics which can treat your infections. If you have to go through with surgical biopsy so you might suffer from deep pain and discomfort so your doctor might recommend you some pain killers and antibiotics to get feel better and relax. 

What does the PDL-1 lung cancer test show?

The result might show that PDL-1 is absent or present in tumor tissue or it may report the specific score for the test. If PD-L1 protein is being on the tumor tissue, then you may be a good candidate for the immunotherapy medication being considered. Not every person who has cancer with enhanced PD-L1 will react to the immunotherapy, however, and your response may modify over time. A negative result means that inadequate PD-L1 identified in the sample tested. The amount of PD-L1 can sometimes vary in different sections of the tumor. 

Is there any other type of test except biopsy?

No there is no other test approved yet other than biopsy. For the tumor or lung cancer diagnosis, you will need a tissue biopsy. Tissue cells from this biopsy are also required for PD-L1 examination.

Takeaway 

Lung cancer is the leading reason of cancer deaths worldwide. The PDL1 testing is applied to observe if you have cancer that may good from immunotherapy. If the PDL-1 is increased it means you are good for immunotherapy, it can be performed in labs and surgical setup. This test is performed by three types of biopsies. If you develop pain or infection after PDL-1 lung cancer biopsy so your doctor may recommend medication to make you feel comfortable and relax. 

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.

Kidney Stones; Symptoms, Causes, Types of Stones, Treatment, and Preventions

Nowadays kidney stones have become very common in every age group. It is of different sizes and causes acute and severe pain on the backside and radiates to the lower abdomen and groin while walking or sitting. When we jump on kidney stones it is better to know the basic anatomy and physiology of the urinary system.

The urinary system consists of two kidneys, ureters, urethra, and bladder. I think we all have studied the basic few points about our urinary system but if not so don’t worry before giving knowledge about kidney stones we will gonna provide you guys an overview of the urinary system. In this article, you will get all relevant information about kidney stones, types of kidney stones, sizes of kidney stones, symptoms, causes, etc. 

Our kidney filters the blood and removes the waste products so the waste products passed out through a liquid form called urine. The urine passes from the kidney through the ureters to the bladder. Urine stores in the bladder till you are ready to pass it. So here the basic overview of the kidneys. 

What are kidney stones?

Kidney stones, or renal calculi, are solid masses made of minerals salts. Kidney stones normally form in your kidneys. However, they can develop wherever in your urinary tract. Stones develop when the urine becomes concentrated, enabling crystals to crystallize and attach together. Stones can be formed from different sources like diet, obesity, supplements, medications, and specific medical conditions. 

Symptoms of kidney stones

Kidney stones initially will not cause any symptoms until it goes around your kidney or reaches into the ureter. When kidney stones stick into the ureter it may obstruct the flow of urine and cause the kidney to swell and spasm of the ureter. Pain caused by kidney stones shifting to different positions as the stone moves through your urinary tract. You may suffer the following signs and symptoms includes; 

• Burning sensation while urinating 
• Severe pain below ribs
• Pink, red, or brown urine
• Cloudy or foul-smelling urine
• Urinating in small amounts
• Nausea and vomiting
• Fever and chills

Causes 

There is no particular or specific cause of kidney stones. Kidney stones caused by several different causes. Kidney stones develop when your urine holds more major crystal-forming substances such as calcium, oxalate, and uric acid. Anyone can get a kidney stone, but few persons are more prone than others to have them. Men get kidney stones more often as compared to women. Some known causes of kidney stones include; 

1.Low urine flow

constant low urine volume is the major risk for the kidney. When urine volume is low the urine becomes concentrated and dark in color. Concentrated urine actually means that there is more limited urine to keep salts dissolved. So you should improve water intake that will break down salts in urine. 

2. Diet

Diet may also enhance the chances of kidney stones. A high level of calcium in the urine is the most common cause of kidney stones. It is not due to how much calcium you consume. All you need to lower your calcium consumption in your diet or maybe your health care provider may limit or decrease your salt intake to lower your calcium level in your urine. Too much salt enhances the risk of increased calcium in the urine and causes kidney stones. Diet rich in animal protein raises the acid level in the urine. The breakdown of meat into uric acid also increases the risks of forming calcium and uric acid stones in the kidney. 

3. Bowel conditions

Certain bowel conditions that cause diarrhea may raise the risk of calcium oxalate kidney stones. Diarrhea is the condition in which loose or watery stools. It usually lasts a few days and frequently fades outwardly any treatment. Diarrhea can be acute or chronic. The body may absorb a large amount of oxalate from the intestines that causes more oxalate in your urine as well which develops different sizes of kidney stones. 

Some other causes are below:

• Previous history of kidney stones
• History of family have had kidney stones
• Don’t drink enough water.
• Obesity
• Polycystic kidney disease
• High levels of cystine, oxalate, uric acid or, calcium in urine
• Diuretics (water pills) or calcium-based antacids.

Types of kidney stones

Not all stones are made of the same minerals. There are different reasons and types as we mentioned above for kidney stones. Knowing the types of kidney stones is very important as it will give you a hint about the treatment and precautions that should be taken that save your kidney. Types of stones include:

1. Calcium Stones

Most kidney stones are calcium stones, that’s why it is called the most common type of kidney stones. They are present in the formation of calcium oxalate. Oxalate is a substance made every day by your liver or ingested from your diet. Consuming less oxalate-rich foods can lower your risk of producing this type of stone. High-oxalate foods are chocolate, peanuts, potato chips, nuts, and beets. Calcium stones may also take place in the form of calcium phosphate. This type of kidney stone is more popular in metabolic conditions, such as renal tubular acidosis.

2. Struvite Stones

Struvite stones can occur when you have specific kinds of urinary tract infections in which bacteria make ammonia that grows up in your urine. Struvite stones are made of magnesium, phosphate, and ammonia. Struvite stones can develop fastly and grow quite big, seldom with few symptoms. People with paralysis, spina Bifida, and multiple sclerosis at the highest risk of causing these stones. These stones can be big and create a urinary obstruction. 

3. Uric Acid Stones

Uric acid stones can occur in people who drop too much liquid because of chronic diarrhea or malabsorption, a high-protein diet, diabetes, or metabolic syndrome. They form when your urine is frequently too acidic. Uric acid can make stones by itself or with calcium. A food rich in purines can elevate urine’s acidic level

4. Cystine Stone

This type of stone is seen mostly in women with urinary tract infections (UTIs). These stones can be big and produce urinary obstruction. Cystine stones are quite unique and usually only seen in people with a genetic condition named cystinuria.

Diagnosis of kidney stones 

When your doctor observes symptoms and signs of kidney stones then he will recommend to you some diagnostic test that provides you specific results about the stones like where it is? The size of the stone etc. the following test are as follows;

1. Blood testing

Blood analyses may disclose too much calcium or uric acid in your blood. Blood test outcomes assist observe the health of your kidneys and may direct your doctor to examine for other diseases.

2. Urine testing

For this test, your physician may ask you to perform two urine samples over two consecutive days. The 24-hour urine collection test may reveal that you’re eliminating too numerous stone-forming minerals.

3. Imaging

Imaging tests may reveal kidney stones in your urinary tract. High-speed or dual energy computerized tomography (CT) may also reveal little stones. Simple abdominal X-rays are used less usually because this kind of imaging analysis can miss tiny kidney stones. The contrast stain used in the CT scan and the IVP can influence kidney function.

Sizes of kidney stones 

Kidney stones occur in different forms and sizes. They can be as little as a grain of dirt to several measures in diameter. The size and location of the stone determine how it affects you. Sizes are; 

1. Less than 5mm

the kidney stones less than 5mm can easily pass through the ureter without any pain and issues. Even it never shows any symptoms while passing out. This size of kidney stones don’t require any treatment and dissolves naturally by passing through urine. This takes an average of 45 days to dissolve completely. 

2. Stone 5mm to 6mm

Kidney stones that are greater than 5 mm are often too large to pass through the ureter spontaneously. It requires some sort of treatment to completely dissolve the stones but 60% passes naturally. The complete duration to dissolve the stones is 45 days or more.

3. Greater than 6mm-9mm

This size of stones is very painful. It is never passing out through urine. The larger the stones, the greater time required to treat. Large stones are difficult to pass as it is like a popcorn type but the only treatment for this size of stones is surgical. It rarely passes without a surgical procedure.

Treatment for kidney stones

Treatment can be determined according to the size and type of stones. Drinking enough water can save you from the dehydration and risk of kidney stones. People having nausea and vomitings often require intravenous fluids. Treatments includes; 

1. Medication

If infection is present it requires antibiotics for the treatment for kidney stones. Medications are:

For pain; Ibuprofen (Advil), acetaminophen (Tylenol), naproxen sodium (Aleve) medication are given. 

• allopurinol (Zyloprim) for uric acid stones
• thiazide diuretics to inhibit calcium stones 
• sodium bicarbonate or sodium citrate for the making of the low amount of acidic urine 
• phosphorus solutions to stop calcium stones from forming.

2. Lithotripsy

Sometimes stones are small enough to split the body during urination without a person discerning. Large stones, though, can cause pain and prevent the flow of urine. If stones do not pass, they can harm the kidneys and urinary tract. When medications do not support so move towards the lithotripsy procedure can crush the stones broken into small parts so they can pass out in the urine. Sometimes, in very big stones, this needs to be done more than once. This treatment can be very efficient.

3. Percutaneous nephrolithotomy

If another treatment fails and does not affect positively so the last option will be surgery. In this surgery, the kidney stone is obtained by an incision in the patient’s back. Here are the following steps require while performing this surgical procedure:

Step 1: Patient positioning

After giving general anesthesia the patient is in the prone position, a circular packet is set below the pelvic bone and another under the upper abdomen and chest region to provide enough stretching throughout the flank region. The side to be operated should be taken at the side of the operating table.

Step 2: marking of the sites

Mark the sites according to the posterior axillary line as the lateral limit, the upper edge of the iliac top as a lower limit, the oblique edge of paraspinous muscle as the medial limit, the 11th and 12th rib margin as the upper limit. 

Step 3: Site of percutaneous puncture

The specific site of the hole depends primarily on the cause of hydronephrosis (HDN) including anatomic sites. Better envisioned space of dilated renal pelvis (in mild HDN) and both renal pelvis and calyx (in mild to firm HDN) is chosen and marked. The electronic dotted puncture position focused up that space and directed into the chosen calyx/pelvis. 

Step 4: Incision

The incision is given 1 cm to the flank area of the patient. A small incision is made with no. 11 surgical scalpels. 

Step 5: Guidewire insertion

Guidewire (0.038-inch diameter) is entered within the needle under fluoroscopy guidance, trying to adjust it into the ureter. When the dorsolumbar fascia is incised and the tract then is expanded up to 14 F by using a single step fascial dilator.

Step 6: Nephrostomy insertion

A small ureteral stent may be left draining the kidney to the bladder in addition to a nephrostomy tube removing the kidney to an external drainage pack at the end of the surgery. The duration of the surgery is generally 3-5 hours.

Prevention against kidney stones

• If you have a history of kidney stones so your doctor recommends you to drink as much water as you can and pass about 2.1 quarts (2 liters) of urine a day. If your urine is bright and clear, you’re likely sipping sufficient water intake. 
• If you had calcium oxalate stones or were willing to form in your kidney. Your doctor immediately stops the foods that are rich in calcium oxalate to reduce the risk of making calcium oxalate stones. Food includes; rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper, and soy products.
• Reduce your salt and sugar intake as well as animal protein. It is good to take vegetables as compared to the above-mentioned food. 
• If you are taking enough calcium through foods or calcium supplements. First, ask your doctor whether it’s safe to have this in your diet or not. You might reduce the risk by taking supplements with the meals. Your physician may prescribe medications to inhibit the formation of calcium and uric acid stones.

Why are kidney stones a problem?

Stones do not always remain in the kidney. Small stones move out through the ureter without any sign but large stones do to easily pass through the ureter to the bladder. The stones cause urine obstruction that causes severe infection. 

What are the risks that you may control?

Drinking too little water is the most common reason for kidney stones. First of all, if you develop the symptoms and back pain do first consult your doctor. Drink enough water, do not eat high animal protein. Control the diet and taking a sufficient amount of water can save you from kidney stones. 

What are the risks that you can’t control?

Certain medical conditions can raise the risk of kidney stones. If you have a family history of kidney stones you may not control the risk to form kidney stones in your kidney as well.

Takeaway

Kidney stones are very common and the most common cause of kidney stones is lack of drinking water. If you do not control your diet and taking enough salts may cause kidney stones of different sizes. It is very painful and sometimes causes urine obstruction and ureter spasms. Some stones can easily pass out without any sign and large stones need medications or surgery. You can only prevent it by drinking enough water and controlling your diet. 

Asbah Faisal

A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.