This document summarizes a study on the clinical outcomes of patients who underwent extracorporeal shock wave lithotripsy (ESWL) to treat renal stones. The study included 150 patients between 18-73 years old with renal stones measuring 0.5-2.5cm who received ESWL. Most patients were male, with stones composed primarily of calcium oxalate. Following ESWL, 98% of patients became asymptomatic after 3 months, though larger stones required more treatment sessions. Complications included hematuria and loin pain in about 20-30% of patients respectively. The study concludes ESWL is an effective treatment for renal stones, with outcomes dependent on stone size, location and composition.
Bariatric surgery, especially malabsorptive procedures like Roux-en-Y gastric bypass, significantly increases the risk of kidney stones compared to obese controls. The risk is highest with malabsorptive procedures and correlates with the degree of fat malabsorption and enteric hyperoxaluria. However, bariatric surgery does not appear to increase the risk of chronic kidney disease. Further research is still needed to fully understand the mechanisms by which bariatric surgery leads to hyperoxaluria and kidney stone formation.
Ureteric colic, also known as renal colic, is characterized by severe pain in the flank and groin caused by a kidney stone obstructing the ureter. Calcium oxalate stones are the most common type. Symptoms include acute, colicky flank pain that radiates to the groin, as well as nausea and vomiting. Diagnosis involves urinalysis, kidney-ureter-bladder x-ray, ultrasound or CT scan to detect stones. Conservative treatment with NSAIDs, calcium channel blockers or alpha-blockers is usually attempted first to aid stone passage, with surgical intervention if conservative measures fail.
Ureteric colic is defined as a medical condition characterized by the presence of a urinary stone, leading to a severe urinary system pain. An excruciating pain that can strike without a warning, ureteric colic or renal colic is caused by dilation, stretching and spasm of the ureter.
Australasian Laparoscopic Colon Cancer Studyensteve
- ALCCaS is a multi-center randomized controlled trial comparing laparoscopic and open surgery for colon cancer in Australia and New Zealand that recruited 600 patients between 1999-2008.
- The primary aims are to compare 5-year mortality and tumor recurrence rates between the two surgical methods. Secondary aims look at short-term outcomes like complications, recovery time, and costs.
- Over the study period, 592 patients were recruited across 7 centers by 34 surgeons. Data collection is now complete and results will be analyzed to determine if laparoscopic surgery is as safe and effective as open surgery for colon cancer.
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
Oesophageal surgery- Is there light at the end of the tunnel? Professor Neil ...SMACC Conference
The 105 years since the first successful thoracic oesophagectomy was performed saw initially slow progress in terms of operative mortality, morbidity and oncological outcomes. Even until the late 1990’s, operative mortality figures of 15-20% were commonplace and long term survival was poor, as low as 12%1. The last 20 years has seen a major change in these outcomes both within Australia and overseas. These improvements have been based on the bed rocks of improved surgical techniques, improved peri operative care, changes in the distribution of the pathophysiology of the disease, improved patient selection through better staging, Development of endoscopic techniques for early tumours, development of effective neo adjuvant regimes and the development of “high” volume centres have all contributed to the current figures of 4% preoperative mortality and overall 5 year survivals in the post surgical patient of 40%. Better understanding of the nutritional issues involved has led to an emphasis on better quality of life issues in both the curative and palliative settings. This talk outlines the forces that have brought about the changes including outlining the modern treatment algorithm and discussing the volume effects of surgery in the Australian context
1. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;67: 381-90
Lessons learnt from management of PUB in ICU by Professor Lars LundellSMACC Conference
Peptic ulcer bleeding (PUB) carries a 10% risk of death within 30 days and accounts for 36–46% of emergency upper gastrointestinal bleedings (UGIBs). The annual incidence of hospitalization due to PUB is 19–57 per 100,000 persons. Most of these patients undergo esophago-gastro-duodenoscopy (EGD), estimated to 2000 patients in Denmark alone every year. The poor prognosis in PUB is partly due to the clinical condition itself, and partly due to the high prevalence of medical comorbidities. Hence, optimizing pre-, intra-, and post-endoscopic patient management are likely to be important in order to minimize the risk of death and improve outcome. Although duodenal ulcer (DU) and gastric ulcer (GU) seem to be identical diseases with a considerable overlap in both risk-factor profile and clinical manifestations, ulcer site could potentially affect outcome. However, the prognostic importance of ulcer site has not been extensively evaluated, and existing knowledge is ambiguous. Two systematic reviews of predictors of re-bleeding after endoscopic treatment reported that posterior DUs and ulcers on the lesser gastric curvature more often were associated with haemostatic failure. A recent cohort study reported that bleeding DU was associated with poorer outcome than bleeding GU in terms of mortality, need for surgery and readmission. However, another large cohort from Hong Kong did not find that DU site was associated with increased mortality. Limited data exist on the prognostic importance of ulcer site in patients with PPU. In a nationwide cohort study comprising more than 24,000 Danish patients with complicated PUD, a significantly higher 30- and 90-d all-cause mortality rates were found, and more re-interventions in patients with bleeding DU compared with patients with bleeding GU, suggesting that ulcer site is an important predictor for poor outcome in patients with PUB. In patients with PPU, no significant association was seen between ulcer site and mortality or re-intervention. Finally, the proportion of GU increased slightly over time. Critically ill patients in the intensive care unit (ICU) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. However, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. The aims of some recent trial have been to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the ICU. It has been hypothesized that stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding, but increases rates of nosocomial infections and myocardial ischaemia. The overall effect on mortality seems to be unpredictable.
- The document discusses various studies and data related to peptic ulcer bleeding (PUB), including trends in incidence rates of gastric and duodenal ulcers over time, endoscopic findings associated with rebleeding risk, mortality rates, causes of death, and comparisons of treatments.
- Key findings include declining rates of peptic ulcers but no major decline in bleeding, higher mortality associated with rebleeding or presentation for other reasons, and comparisons showing similar effectiveness of different endoscopic hemostasis methods but better outcomes with combination therapies.
Bariatric surgery, especially malabsorptive procedures like Roux-en-Y gastric bypass, significantly increases the risk of kidney stones compared to obese controls. The risk is highest with malabsorptive procedures and correlates with the degree of fat malabsorption and enteric hyperoxaluria. However, bariatric surgery does not appear to increase the risk of chronic kidney disease. Further research is still needed to fully understand the mechanisms by which bariatric surgery leads to hyperoxaluria and kidney stone formation.
Ureteric colic, also known as renal colic, is characterized by severe pain in the flank and groin caused by a kidney stone obstructing the ureter. Calcium oxalate stones are the most common type. Symptoms include acute, colicky flank pain that radiates to the groin, as well as nausea and vomiting. Diagnosis involves urinalysis, kidney-ureter-bladder x-ray, ultrasound or CT scan to detect stones. Conservative treatment with NSAIDs, calcium channel blockers or alpha-blockers is usually attempted first to aid stone passage, with surgical intervention if conservative measures fail.
Ureteric colic is defined as a medical condition characterized by the presence of a urinary stone, leading to a severe urinary system pain. An excruciating pain that can strike without a warning, ureteric colic or renal colic is caused by dilation, stretching and spasm of the ureter.
Australasian Laparoscopic Colon Cancer Studyensteve
- ALCCaS is a multi-center randomized controlled trial comparing laparoscopic and open surgery for colon cancer in Australia and New Zealand that recruited 600 patients between 1999-2008.
- The primary aims are to compare 5-year mortality and tumor recurrence rates between the two surgical methods. Secondary aims look at short-term outcomes like complications, recovery time, and costs.
- Over the study period, 592 patients were recruited across 7 centers by 34 surgeons. Data collection is now complete and results will be analyzed to determine if laparoscopic surgery is as safe and effective as open surgery for colon cancer.
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
Oesophageal surgery- Is there light at the end of the tunnel? Professor Neil ...SMACC Conference
The 105 years since the first successful thoracic oesophagectomy was performed saw initially slow progress in terms of operative mortality, morbidity and oncological outcomes. Even until the late 1990’s, operative mortality figures of 15-20% were commonplace and long term survival was poor, as low as 12%1. The last 20 years has seen a major change in these outcomes both within Australia and overseas. These improvements have been based on the bed rocks of improved surgical techniques, improved peri operative care, changes in the distribution of the pathophysiology of the disease, improved patient selection through better staging, Development of endoscopic techniques for early tumours, development of effective neo adjuvant regimes and the development of “high” volume centres have all contributed to the current figures of 4% preoperative mortality and overall 5 year survivals in the post surgical patient of 40%. Better understanding of the nutritional issues involved has led to an emphasis on better quality of life issues in both the curative and palliative settings. This talk outlines the forces that have brought about the changes including outlining the modern treatment algorithm and discussing the volume effects of surgery in the Australian context
1. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;67: 381-90
Lessons learnt from management of PUB in ICU by Professor Lars LundellSMACC Conference
Peptic ulcer bleeding (PUB) carries a 10% risk of death within 30 days and accounts for 36–46% of emergency upper gastrointestinal bleedings (UGIBs). The annual incidence of hospitalization due to PUB is 19–57 per 100,000 persons. Most of these patients undergo esophago-gastro-duodenoscopy (EGD), estimated to 2000 patients in Denmark alone every year. The poor prognosis in PUB is partly due to the clinical condition itself, and partly due to the high prevalence of medical comorbidities. Hence, optimizing pre-, intra-, and post-endoscopic patient management are likely to be important in order to minimize the risk of death and improve outcome. Although duodenal ulcer (DU) and gastric ulcer (GU) seem to be identical diseases with a considerable overlap in both risk-factor profile and clinical manifestations, ulcer site could potentially affect outcome. However, the prognostic importance of ulcer site has not been extensively evaluated, and existing knowledge is ambiguous. Two systematic reviews of predictors of re-bleeding after endoscopic treatment reported that posterior DUs and ulcers on the lesser gastric curvature more often were associated with haemostatic failure. A recent cohort study reported that bleeding DU was associated with poorer outcome than bleeding GU in terms of mortality, need for surgery and readmission. However, another large cohort from Hong Kong did not find that DU site was associated with increased mortality. Limited data exist on the prognostic importance of ulcer site in patients with PPU. In a nationwide cohort study comprising more than 24,000 Danish patients with complicated PUD, a significantly higher 30- and 90-d all-cause mortality rates were found, and more re-interventions in patients with bleeding DU compared with patients with bleeding GU, suggesting that ulcer site is an important predictor for poor outcome in patients with PUB. In patients with PPU, no significant association was seen between ulcer site and mortality or re-intervention. Finally, the proportion of GU increased slightly over time. Critically ill patients in the intensive care unit (ICU) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. However, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. The aims of some recent trial have been to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the ICU. It has been hypothesized that stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding, but increases rates of nosocomial infections and myocardial ischaemia. The overall effect on mortality seems to be unpredictable.
- The document discusses various studies and data related to peptic ulcer bleeding (PUB), including trends in incidence rates of gastric and duodenal ulcers over time, endoscopic findings associated with rebleeding risk, mortality rates, causes of death, and comparisons of treatments.
- Key findings include declining rates of peptic ulcers but no major decline in bleeding, higher mortality associated with rebleeding or presentation for other reasons, and comparisons showing similar effectiveness of different endoscopic hemostasis methods but better outcomes with combination therapies.
Inductive Study of ESWL Outcomes for Proximal and Distal Ureteric StonesIRJET Journal
This study evaluated the success rates of extracorporeal shock wave lithotripsy (ESWL) for proximal and distal ureteric stones. 275 patients treated between 2015-2016 were analyzed. Stone-free rates were 85.26% for proximal ureteric stones, 87.20% for middle ureteric stones, and 75.53% for distal ureteric stones. Overall success rate was 82.54%. Success rates were higher for stones <15mm (90.41%) compared to >15mm (46.42%). There was a statistically significant relationship between stone location, age, and ESWL success. ESWL is concluded to be an effective treatment for u
Gastrointestinal-Pancreatic NET managementChandan K Das
1. The document discusses the management of neuroendocrine tumors (NETs), including their definition, classification, diagnostic evaluation, and treatment approaches.
2. NETs are defined and classified based on their histology, grade, and biomarkers like Ki-67 index. Higher grades (G2/G3) have worse survival outcomes than lower grades (G1).
3. Diagnostic evaluation involves biomarkers, imaging modalities, and pathology. Treatment focuses on controlling symptoms, tumor growth, and improving survival through surgery, liver-directed therapies, and somatostatin analogs like octreotide which has been shown to prolong time to progression in midgut NETs.
The document discusses guidelines for endoscopy in patients with inflammatory bowel disease (IBD). It recommends screening beginning at 8-10 years after symptom onset, then risk-stratified surveillance. Chromoendoscopy, using dyes to enhance mucosal features, detects more dysplasia than standard white light endoscopy and is superior for surveillance. Advanced imaging techniques like narrow-band imaging and autofluorescence have potential but no method is clearly better than chromoendoscopy currently. The goal is optimizing endoscopic detection of dysplasia to reduce colorectal cancer risk in IBD patients.
A Cytological Study of Osteolytic Bone Lesions with Intact Cortexiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, on Cancer Control in Australia - Institute of Cancer Research 12 July 2010
Using linked medical records, this study explored outcomes for people with mental illness discharged from inpatient care over several decades. Some key findings include:
- There is significant risk of death within the first year of discharge, especially from natural causes.
- Mortality rates within 30 days of discharge have markedly decreased over time, especially from natural causes.
- Admission rates for those over 65 with mental illness have significantly decreased while rates of community-based care have increased.
- Working with encrypted medical records presents challenges for outcomes research but record linkage is still advantageous for studying mental health outcomes over long periods.
This document discusses the gastrointestinal (GI) and cardiovascular (CV) risks associated with nonsteroidal anti-inflammatory drug (NSAID) use. It outlines the mechanisms by which NSAIDs can cause GI adverse effects like gastric ulcers and bleeding. It also notes that NSAIDs are associated with increased CV risks. The document recommends prevention strategies for NSAID use based on assessing individual patient's GI and CV risk factors.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
POUR AANS 1226 presentation A. Bashee[1]Azam Basheer
This document reports on a study examining the incidence and risk factors of postoperative urinary retention (POUR) in neurosurgical patients. The study found that the overall incidence of POUR was 39.4% in a cohort of 137 neurosurgical patients. Male patients, those over 60 years old, and those undergoing spine surgery were at highest risk. Patients who developed POUR had longer hospital stays. The results suggest POUR is common in neurosurgery and identifying risk factors could help reduce its occurrence and negative impacts.
This document reviews interventional endoscopic ultrasound (EUS) procedures, including EUS-guided fine needle aspiration (FNA). EUS-FNA is a safe and accurate procedure used to diagnose lesions in the esophagus, pancreas, lymph nodes, liver, lungs and other organs. It has a diagnostic accuracy of 64-94% for pancreatic masses. EUS also guides drainage of pancreatic pseudocysts and bile ducts when conventional endoscopy fails. Emerging applications include EUS-guided celiac plexus neurolysis for pain relief, fiducial placement for tumor localization, and ablation techniques for treating pancreatic cysts and tumors. In summary, the document outlines the various diagnostic and therapeutic applications of
Corrosive injury review article and management.pptxAsthaAmeta2
This document discusses corrosive injury to the gastrointestinal tract. It begins with an overview of the epidemiology, noting it is a global health problem with a bimodal age distribution. It then covers the pathophysiology of acid versus alkali injuries, clinical presentation, diagnostic modalities such as endoscopy and radiology, management including conservative approaches and surgery, and late sequelae including strictures and carcinoma. Key points include the coagulative necrosis caused by acids versus liquefactive necrosis from alkalis, predictors of injury severity and complications, the utility of endoscopy for grading injuries and predicting outcomes, and challenges with managing corrosive strictures through serial dilatation.
CT urography (CTU) is highly accurate for detecting bladder cancer in high-risk patients. A retrospective study of 45 high-risk patients found that CTU had a 97% sensitivity and 80% specificity for bladder cancer detection compared to flexible cystoscopy. Multivariate analysis showed that positive CTU findings were highly significant predictors of bladder cancer diagnosis. The study suggests that in high-risk patients with positive CTU findings, flexible cystoscopy could be omitted and patients referred directly for rigid cystoscopy and potential biopsy or resection. However, the study had some limitations due to the small sample size.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
Evaluation Of Aetiology Of Upper Gastro Intestinal Bleeding &Management In Th...iosrjce
Upper GI Bleeding is defined as Bleeding from GIT starting from oral cavity upto Ligamentum of
trietz .,it may be either a hematemesis, malena or both. Upper GI bleed is a quiet common problem seen in
day to day Gastroenterology OPD., & a detailed 5yrs study was made to assess the etiological factors for UGI
bleeding in the period from 2009-2014, in the department of Gastroenterology ,GGH/Guntur Medical college,
Guntur,AP.
Background: The spectrum of pathological bone lesions ranges from inflammatory to neoplastic conditions. Bone tumours are comparatively uncommon among wide array of lesions. The roentgenogram helps in defining exact location of lesion but becomes difficult to differentiate them. They often pose diagnostic problem as they constitute a small portion of diagnostic experience among pathologist.
Objective: To study histopathological spectrum of bone lesions & correlate them with age, gender and site of occurrence.
Results: All bone biopsies from January 2011 to December 2015 received at department of pathology, S.Nijalingappa Medical College, India. Total 121 cases of bone biopsies were analysed. They were decalcified & processed routinely. Out of 121 bone biopsies, 35 (28.9%) cases are non- neoplastic, 77 (63.6%) are neoplastic and 9 (7.4%) were inadequate for evaluation. The incidence of benign lesions are more than malignant with 51(66.2%) and 26(33.7%) cases respectively. Chronic osteomyelitis is the most common non-neoplastic lesion. Giant cell tumor and osteosarcoma are common benign and malignant lesions respectively. Femur is the common bone involved and metaphysis, the commonest site. The maximum numbers of cases are in the age group between 11-30 years with male preponderance.
Conclusion: Though bone lesions are less common, if viewed in perspective of clinico-radiology and histopathology, correct diagnosis can be reached.
Key-words- Bone lesions, Chronic osteomyelitis, Osteosarcoma, Giant cell tumor, Histopathology
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
This document discusses sterilization and disinfection procedures. It begins with definitions of sterilization and disinfection. It then covers the historical perspective of sterilization practices. The Spaulding classification system for medical devices is introduced. The main methods of sterilization discussed are heat sterilization including steam sterilization and dry heat, along with radiation, hydrogen peroxide gas plasma, and chemical sterilization methods. Key steps in the sterilization process like cleaning, packaging, and loading are outlined. Monitoring of sterilization is also summarized.
This document summarizes the surgical treatment of malignant melanoma. It discusses the different subtypes of melanoma including superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. It covers the staging and prognostic factors in melanoma as well as the surgical procedures for treatment including wide local excision, sentinel lymph node biopsy, lymph node dissection, and treatment of distant metastases. The goal of surgical treatment is complete resection of the primary tumor and regional lymph nodes to prevent recurrence and spread of the cancer.
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Inductive Study of ESWL Outcomes for Proximal and Distal Ureteric StonesIRJET Journal
This study evaluated the success rates of extracorporeal shock wave lithotripsy (ESWL) for proximal and distal ureteric stones. 275 patients treated between 2015-2016 were analyzed. Stone-free rates were 85.26% for proximal ureteric stones, 87.20% for middle ureteric stones, and 75.53% for distal ureteric stones. Overall success rate was 82.54%. Success rates were higher for stones <15mm (90.41%) compared to >15mm (46.42%). There was a statistically significant relationship between stone location, age, and ESWL success. ESWL is concluded to be an effective treatment for u
Gastrointestinal-Pancreatic NET managementChandan K Das
1. The document discusses the management of neuroendocrine tumors (NETs), including their definition, classification, diagnostic evaluation, and treatment approaches.
2. NETs are defined and classified based on their histology, grade, and biomarkers like Ki-67 index. Higher grades (G2/G3) have worse survival outcomes than lower grades (G1).
3. Diagnostic evaluation involves biomarkers, imaging modalities, and pathology. Treatment focuses on controlling symptoms, tumor growth, and improving survival through surgery, liver-directed therapies, and somatostatin analogs like octreotide which has been shown to prolong time to progression in midgut NETs.
The document discusses guidelines for endoscopy in patients with inflammatory bowel disease (IBD). It recommends screening beginning at 8-10 years after symptom onset, then risk-stratified surveillance. Chromoendoscopy, using dyes to enhance mucosal features, detects more dysplasia than standard white light endoscopy and is superior for surveillance. Advanced imaging techniques like narrow-band imaging and autofluorescence have potential but no method is clearly better than chromoendoscopy currently. The goal is optimizing endoscopic detection of dysplasia to reduce colorectal cancer risk in IBD patients.
A Cytological Study of Osteolytic Bone Lesions with Intact Cortexiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, on Cancer Control in Australia - Institute of Cancer Research 12 July 2010
Using linked medical records, this study explored outcomes for people with mental illness discharged from inpatient care over several decades. Some key findings include:
- There is significant risk of death within the first year of discharge, especially from natural causes.
- Mortality rates within 30 days of discharge have markedly decreased over time, especially from natural causes.
- Admission rates for those over 65 with mental illness have significantly decreased while rates of community-based care have increased.
- Working with encrypted medical records presents challenges for outcomes research but record linkage is still advantageous for studying mental health outcomes over long periods.
This document discusses the gastrointestinal (GI) and cardiovascular (CV) risks associated with nonsteroidal anti-inflammatory drug (NSAID) use. It outlines the mechanisms by which NSAIDs can cause GI adverse effects like gastric ulcers and bleeding. It also notes that NSAIDs are associated with increased CV risks. The document recommends prevention strategies for NSAID use based on assessing individual patient's GI and CV risk factors.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
POUR AANS 1226 presentation A. Bashee[1]Azam Basheer
This document reports on a study examining the incidence and risk factors of postoperative urinary retention (POUR) in neurosurgical patients. The study found that the overall incidence of POUR was 39.4% in a cohort of 137 neurosurgical patients. Male patients, those over 60 years old, and those undergoing spine surgery were at highest risk. Patients who developed POUR had longer hospital stays. The results suggest POUR is common in neurosurgery and identifying risk factors could help reduce its occurrence and negative impacts.
This document reviews interventional endoscopic ultrasound (EUS) procedures, including EUS-guided fine needle aspiration (FNA). EUS-FNA is a safe and accurate procedure used to diagnose lesions in the esophagus, pancreas, lymph nodes, liver, lungs and other organs. It has a diagnostic accuracy of 64-94% for pancreatic masses. EUS also guides drainage of pancreatic pseudocysts and bile ducts when conventional endoscopy fails. Emerging applications include EUS-guided celiac plexus neurolysis for pain relief, fiducial placement for tumor localization, and ablation techniques for treating pancreatic cysts and tumors. In summary, the document outlines the various diagnostic and therapeutic applications of
Corrosive injury review article and management.pptxAsthaAmeta2
This document discusses corrosive injury to the gastrointestinal tract. It begins with an overview of the epidemiology, noting it is a global health problem with a bimodal age distribution. It then covers the pathophysiology of acid versus alkali injuries, clinical presentation, diagnostic modalities such as endoscopy and radiology, management including conservative approaches and surgery, and late sequelae including strictures and carcinoma. Key points include the coagulative necrosis caused by acids versus liquefactive necrosis from alkalis, predictors of injury severity and complications, the utility of endoscopy for grading injuries and predicting outcomes, and challenges with managing corrosive strictures through serial dilatation.
CT urography (CTU) is highly accurate for detecting bladder cancer in high-risk patients. A retrospective study of 45 high-risk patients found that CTU had a 97% sensitivity and 80% specificity for bladder cancer detection compared to flexible cystoscopy. Multivariate analysis showed that positive CTU findings were highly significant predictors of bladder cancer diagnosis. The study suggests that in high-risk patients with positive CTU findings, flexible cystoscopy could be omitted and patients referred directly for rigid cystoscopy and potential biopsy or resection. However, the study had some limitations due to the small sample size.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
Evaluation Of Aetiology Of Upper Gastro Intestinal Bleeding &Management In Th...iosrjce
Upper GI Bleeding is defined as Bleeding from GIT starting from oral cavity upto Ligamentum of
trietz .,it may be either a hematemesis, malena or both. Upper GI bleed is a quiet common problem seen in
day to day Gastroenterology OPD., & a detailed 5yrs study was made to assess the etiological factors for UGI
bleeding in the period from 2009-2014, in the department of Gastroenterology ,GGH/Guntur Medical college,
Guntur,AP.
Background: The spectrum of pathological bone lesions ranges from inflammatory to neoplastic conditions. Bone tumours are comparatively uncommon among wide array of lesions. The roentgenogram helps in defining exact location of lesion but becomes difficult to differentiate them. They often pose diagnostic problem as they constitute a small portion of diagnostic experience among pathologist.
Objective: To study histopathological spectrum of bone lesions & correlate them with age, gender and site of occurrence.
Results: All bone biopsies from January 2011 to December 2015 received at department of pathology, S.Nijalingappa Medical College, India. Total 121 cases of bone biopsies were analysed. They were decalcified & processed routinely. Out of 121 bone biopsies, 35 (28.9%) cases are non- neoplastic, 77 (63.6%) are neoplastic and 9 (7.4%) were inadequate for evaluation. The incidence of benign lesions are more than malignant with 51(66.2%) and 26(33.7%) cases respectively. Chronic osteomyelitis is the most common non-neoplastic lesion. Giant cell tumor and osteosarcoma are common benign and malignant lesions respectively. Femur is the common bone involved and metaphysis, the commonest site. The maximum numbers of cases are in the age group between 11-30 years with male preponderance.
Conclusion: Though bone lesions are less common, if viewed in perspective of clinico-radiology and histopathology, correct diagnosis can be reached.
Key-words- Bone lesions, Chronic osteomyelitis, Osteosarcoma, Giant cell tumor, Histopathology
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
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2. Urinary calculi are very common disease of urinary
tract
The incidence of urinary tract stone disease is
increasing*
*Epidemiological data of National Health and Nutrition Examination
Survey (USA)
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3. To study the clinical outcomes of patients who have
undergone ESWL for Renal stones
MATERIAL AND METHODS
This study was done in the Department of Urology, of a
tertiary care military hospital
Study design: Prospective observational study
Study group:
All patients diagnosed as having renal calculi (size0.5cm
to 2.5cm).
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4. Exclusion criteria
Radiolucent stones
Age <18 yrs
Stone size >2.5cm & Stone size< 0.5cm
Repeated presentation who undergone ESWL
All absolute contraindication for ESWL
Pregnancy.
Uncorrected bleeding diatheses.
Uncontrolled urinary tract infections.
Severe skeletal malformations and severe obesity
Arterial aneurysm in the vicinity of the stone treated.
Anatomical obstruction distal to the stone
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5. STATISTICAL METHODS
◦ SPSS version 19
◦ Chi square test, paired “t” test used for comparative
analysis
◦ ‘P’ value of 0.05 was taken as significant
Equipment
Electro Magnetic
Lithotripter
(Make- Dornier Compact Delta )
5
Dornier Compact Delta
Electro Magnetic Lithotripter
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6. Age ( years) Frequency %
16 - 25 15 10.00%
26 - 35 48 32.00%
36 - 45 32 21.33%
46 - 55 19 12.67%
56 - 65 26 17.33%
66 - 75 10 6.67%
Demographic data of the patients
Age distribution.
6
Description Age(yrs)
Mean(SD) 42.13(14.09)
Range 18 - 73
RESULTS
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7. Sex Frequency Percent Ratio
Female 41 27.33% 1
Male 109 72.67% 2.65
Gender description.
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8. Co morbidities Frequency %
Diabetes Mellitus 25 16.67%
Hypertension 22 14.67%
Parkinsonism 1 0.67%
IHD 1 0.67%
NIL 109 72.66%
Co-morbidity status
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9. Description Duration of Illness (weeks)
Mean 25.77(15.11)
Range 3 – 52
Description of duration.
Description of no of episodes
Number of Episodes Frequency %
1st 128 85.33%
2nd or more 22 14.67%
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10. Pain Frequency %
No 5 3.33%
Yes 145 96.67%
Description of chief complaints.
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18. Description Size of Stone
Mean(SD) 1.47(.43)
Range 0.80 - 2.50
Stone Size
Size description.
Location Frequency %
Lower 35 23.33%
Pelvis 3 2.66 %
Mid 74 49.33%
Upper 38 24.67%
Anatomical locations of stones.
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19. Stone size and number of sittings.
No of
sittings
n Mean S D Min Max P value
1 16 1.09 0.37 .80 2.20
<0.001
2 38 1.30 0.36 .80 2.30
3 48 1.47 0.33 .80 2.30
4 48 1.76 0.43 .80 2.50
total 150 1.48 0.44 .80 2.50
10.67%
25.33%
32.00%
32.00%
Number of Sittings
1.0
2.0
3.0
4.0
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20. Complications of ESWL
Complications Frequency %
Hematuria 30 20.00%
Loin pain 48 32.00%
UTI 7 4.67%
Dysuria 1 0.67%
Steinstrasse 5 3.33%
Total no of patients 91 60.66%
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23. Extra corporal shock wave lithotripsy was introduced
in 1983.
The clinical outcome of ESWL depends on
◦ size
◦ location
◦ chemical composition of the stone
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24. More common among male gender
◦ male and female was 1.7:1 as per a study done by Scale C
D et al [1]
Age group of 40 -60 yrs
◦ Strope SA et al showed the age group 40-60 yrs having highest
incidence of urolithiasis [2]
Calcium oxalate
◦ Bangash K et al, showed that calcium oxalate was the
commonest chemical type of stones (87.5%)[3]
Pain is the commonest symptom of renal stones
Pearle MS et al illustrated that 48.1% had pain , 25.9%
presented with gross haematuria, 14.3% had microscopic
hematuria and [6]
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25. E - Coli is the commonest
◦ E- coli were the commonest among patients with urinary tract
stones[4]
Larger stones required more number of sittings for
stone clearance
◦ Joshi HN et al in relation to size of the stone and respective
stone free rates were concluded as <1cm, 1-1.5 cm and > 1.5
cm was 97%, 97% and 90% [5]
Following ESWL 98% patients become
asymptomatic after three months time
◦ Joshi HN et al 95.4% within three months of follow up after
completion of ESWL [5]
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26. 26
Reference
1.Scales CD Jr, Curtis LH, Norris RD. Changing gender prevalence of
stone disease. J Urol. 2007; 177:979–82.
2. Strope SA, Wolf JS Jr, Hollenbeck BK. Changes in gender
distribution of urinary stone disease. Urology. 2010; 75:543-6.
3. Bangash K, Shigri F, Jamal A, and Anwar K. Spectrum of Renal
Stones Composition; Chemical Analysis of Renal Stones. International
Journal of Pathology. 2011; 9(2): 63-66
4. Mohammed A. Kadir, Majida N. Ibrahim ,Najeeba M. Salih.
prevalence of urinary tract infections in patients with renal stones. J.
Ayub Med. Coll. Abbottabad ; 2010: 20: 60-62
5. Joshi HN, Karmacharya RM, Shrestha R, Shrestha B, de Jong IJ,
Shrestha RK. Outcomes of extra corporeal shock wave lithotripsy in
renal and ureteral calculi. Kathmandu Univ Med J (KUMJ). 2014 Jan-
Mar;12(45):51-4.
Pearle MS, Calhoun EA, Curhan GC. Urologic Diseases in America
project: urolithiasis. J Urol. 2005; 173:848–57
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Editor's Notes
Statistical methods:
SPSS version 19 was used for evaluation of results. Chi square test, paired “t” test used for comparative analysis and a ‘P’ value of 0.05 was taken as significant
Age Distribution
Mean age of the patients of this study group was 42.13 yrs (18-73 yrs). The maximum number of patients was in the age group between 26-35 yrs (32%) (Table 1&2).
Out of 150 patients, 41(27.33%) were females and 109(72.67%) were males. Male to female ratio was 2.65: 1 (Table 3).
Out of 150 patients 25(16.67%) had diabetes mellitus, 22(14.67%) had hypertension 1(0.67%) had parkinsonism, 1(0.67%) had ischemic heart disease(IHD) and 109(72.66%) patients were free of comorbidities (Table 4).
1.Mean duration of the presenting complain as per the history was 25.77 weeks (3 – 52) (Table 5 )
2. Out of 150 patients 128(85.33%) patients presented as fresh cases and 22(14.67) presented with past history of stone diseases (Table 6).
Main presenting complaint of the study group was pain. Out of 150 patients, 145 (96.67%) had pain of various clinical grades. Only 5(3.33%) patients did not complaint pain and renal stones were incidental findings in those cases (Table 6).
Chemical composition of Stones
In this study group 77 patients underwent chemical analysis of voided stone particles. Calcium Oxalate (CaC2O4) stones were found among 48(62.33%) patients, 10(12.98%) patients had mixed stones, 7(9.09%)patients had Struvite (MgNH4PO4.6H2O) stones, 4(5.19%) patients had Calcium Phosphate(Ca3(PO4)2)stones, 2(2.59%) patients had Calcium Carbonate (CaCO3) and 6(7.79%) patients had uric acid stones
Pain in relation to size of the renal stones
Mean size of the renal stones of patients who presented with pain was 1.48cm and without pain was 1.44 cm. There was no statistical significance between stone size and pain as presenting complaint, p value was 0.894 (Table 9).
There was no statistical significance between location of stone and pain as a presenting complaint, p value was 0.742 (Table 10).
Haematuria was a common presentation which 53(35.33%) showed microscopically and 2(1.33%) patient presented with gross haematuria. However 95(63.33%) patient did not have haematuria (Table 11
There was no statistically significant relationship with stone size and haematuria P value was 0.238 (Table 13).
There was no statistically significant association with location of stones and haematuria, P value was 0.299 (Table 14).
Associated Urinary tract infection (UTI)
In this study group 37(24.66%) patients had concomitant UTI and 113(75.36%) had sterile culture. Urinary culture of UTI patients showed the growth of E. coli 20(54.05%), Proteus 12(32.43%), Klebsiella 3(8%) and Enterococcus Sp 2(5.4%) (Table 15
Anatomical locations of stones
Middle zone of the caliceal system (CS) of the kidney was found to be the commonest anatomical location of stones 74(48%). Upper CS stones were
found in 38(24.67%) patients, Lower CS stones among 35(23.33%) patients and pelvic stones in 3(4%) patients
Number of sittings and size of the stones
Mean stone size of the group which achieved complete stone clearance with single sitting was 1.09 cm
mean stone size of the group which required 2 sittings for complete stone clearance was 1.3cm
group which required 3 sittings the mean stone size was 1.47
mean size of the stone which patients required four sittings was 1.76cm
Total 428 sittings of ESWL being given for 150 numbre of patients in which 91(60.66%) patients developed complications. Commonest complication was loin pain which 48(32%) presented with, hematuria was observed among 30(20%) patients, UTI 7(4.67%), steinstrasse 5(3.33%) and dysuria (culture sterile) 1(0.67%). Most of the complications are self limited or managed with OPD basis and fully recovered by subsequent visits (Table 49).
Protocol follow up was done in one month and three months after completion of treatment
mixed stones, MgNH4PO4 (struvite)stones, Ca3(PO4)2 stones, and uric acid stones are the different chemical composition in descending order of frequency