This document discusses recent advances in the treatment of rectal cancer. It notes that multimodal therapy for rectal cancer has improved sphincter-saving procedures from 15% to 50% while also increasing 5-year survival from 30% to 60%. Advances include improved staging with ERUS and MRI, use of neoadjuvant chemoradiotherapy, and total mesorectal excision surgery. However, late presentation, lack of neoadjuvants, and inadequate supervision remain challenges for rectal cancer treatment in Africa. The document emphasizes the importance of early diagnosis and accurate staging to optimize outcomes for rectal cancer patients.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. PROFESSOR PANKAJ G. JANI. M.MED., FRCS.
DEPT. OF SURGERY, UNIVERSITY OF NAIROBI. KENYATTA
NATIONAL HOSPITAL
CHAIR. EXAMINATIONS AND CREDENTIALS COMMITTEE
COSECSA
INT. ONCOLOGY CONF. NAIROBI, OCTOBER
2011
3. RECTAL CANCER
Progress in MULTIMODAL
THERAPY of Rectal Cancer is one
of the BEST examples of success of
Clinical Research in the last 2
decades.
4.
5. RECTAL CARCINOMA – RECENT
ADVANCES -- OVERALL
1.SPHINCTER SAVING PROCEDURES – UP
FROM 15% TO 50% -- NO COLOSTOMY
(IMPROVED QOL)
2. OVERALL FIVE YR SURVIVAL – UP FROM
30% TO 60%
3. DEPTH OF INVASION – DECREASED BY
40%-60% WITH ADJUVANT Rx
4. LYMPH NODE STATUS AND REC. FREE
SURVIVAL - SAME
7. MOLECULAR BIOLOGY
DNA CHIP TECH. – DNA SEQUENCE
CHECKED
-- APC GENE – FAP
-- MISMATCH REPAIR GENES – HNPCC
SUCH PTS.(5%) PUT ON A
SURVEILLANCE PROG. --PROPHYLACTIC
SURGERY
8. MOLECULAR BIOLOGY
DNA SEQUENCE OF MICROSATELLITE
INSTABILITY
-- GOOD RESPONSE WITH 5 FU CHEMO.
P21 MARKER POSITIVE – RADIOSENSITIVE
9. MOLECULAR BIOLOGY
P53 PROTEIN MUTANT EXPRESSED --
RADIORESISTANT
KRAS, DCC, AND P53 -- IF +ve – POOR PROGNOSIS
MICROSATELLITE INSTABILITY OR LOW Cox2
EXPRESSION & P21 MARKER – IF +ve – GOOD
PROGNOSIS
25. II USE OF CH/RT
(NEOADJUVANT/ADJUVANT)
PTS WITH POOR HISTOLOGY
PTS WITH EXTRA MURAL SPREAD (MRI)
PTS WITH INVOLVED NODES (ERUS)
PTS WITH EMVI (MRI)
27. RADIOTHERAPY
EUROPEAN APPROACH
(25G/5CYCLES)
SHORT COURSE – LOW
DOSE – IMMEDIATE
SURGERY
NO CHANGE IN PATH
STAGING
LOWER COST
BETTER COMPLIANCE
DOSE EQUIVALENT TO
30-33G
EXPECT 66%
REDUCTION IN LOCAL
RECURRENCE
AMERICAN APPROACH
(45 – 54G/28 CYCLES)
PROLONGED COURSE –
HIGH DOSE – DELAYED
SURGERY
BETTER SURGICAL
TOLERANCE
MORE TUMOR
REGRESSION
EXPECT >80%
REDUCTION IN LOCAL
RECURRENCE
28.
29. III SURGICAL TECHNIQUE
TRADITIONAL
PROCTECTOMY PERFORMED
-- In the DARK
-- Using BLUNT Dissection
-- Without attention to ANATOMIC
Detail
RESULTED in
-- Bloody operation
-- Increased -- Autonomic Nerve injury
-- Local Rec.
30. SURGERY - TRADITIONAL
ANT. RESECTION – UPPER ⅓ RECTAL
CA
LOW ANT.RESCETION - MID ⅓
RECTAL CA
A.P.R. - LOWER ⅓ RECTAL
CA
ANY TUMOR 10cms FROM ANAL
VERGE -- APR
32. RECTAL CARCINOMA RECENT
ADVANCES
>100 YEARS SINCE MILES DESCRIBED
ABDOMINO-PERINEAL-RESECTION
>25 YEARS SINCE HEALD DESCRIBED
TOTAL MESORECTAL EXCISION
33. III SURGICAL TECHNIQUE
RECENT ADV.
TOTAL MESORECTAL EXISION
( EXICISION OF FASCIA
ENVELOPING THE FAT PAD
AROUND THE RECTUM.)
SAUSAGE APPEARANCE
34. SURGERY – RECENT ADVANCES
LOW-ANT RESECTION – UPTO ≏
6cms FROM ANAL VERGE
APR – ONLY IF SPHINCTOR
FUNCTION COMPROMISED
35. RECTAL CANCER – RECENT
ADVANCES
CAREFUL ASSESSMENT OF SxS
EARLY DIGNOSIS WITH
ACCURATE STAGING
CH/RT - FOR SELECTED PTS
- PROCTOSCOPY
- SIGMOIDOSCOPY
- DRE
- ERUS
- MRI