Abdominal Aortic Aneurysm
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An Abdominal Aortic Aneurysm(AAA) is abnormal focal dilatation of the aorta, the main blood vessel that delivers blood to the body, at the level of abdomen
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Abdomianl Aortic Aneurysm (AAA)
An abdominal aortic aneurysm (AAA) is a focal dilation of the abdominal aorta greater than 1.5 times its normal diameter. AAAs are classified as either true or false aneurysms. Risk factors include smoking, hypertension, and family history. Rupture of an AAA leads to exsanguination and death and is among the top 10 causes of death in men over 65 years old. Treatment options include open surgical repair or endovascular aneurysm repair (EVAR) with a stent graft, with EVAR being less invasive but requiring more follow-up. Early diagnosis and elective repair can significantly reduce mortality from AAAs.
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Y menu difficult tumours of the liver jfim hanoi 2015
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The document discusses various liver lesions that can be difficult to diagnose. It begins by listing common and rare liver masses and discusses which ones typically require treatment. It then presents several case studies of patients with liver lesions found on imaging. This includes a case of hepatocholangiocarcinoma mimicking HCC and a case of peripheral cholangiocarcinoma in a cirrhotic patient. Other cases discuss rare neuroendocrine tumors and angiosarcoma of the liver. Throughout, the document emphasizes adapting diagnoses based on imaging characteristics, patient history, and recognizing atypical presentations of common lesions.Adrenal mass
This document discusses the evaluation and diagnosis of an adrenal mass found on imaging. It describes the different types of adrenal masses including benign non-functioning adenomas, hyperfunctioning tumors like pheochromocytomas, metastatic cancers, and adrenal hypofunction. Imaging features on CT and MRI are provided to characterize masses and distinguish benign from malignant lesions based on size, enhancement pattern, chemical shift, and washout characteristics. The majority of incidentally detected adrenal masses are benign non-functioning adenomas.
Acute Limb Ischemia
1. Acute limb ischemia occurs due to a sudden decrease in blood flow to a limb, threatening the viability of the extremity. It requires prompt diagnosis and treatment to determine if the limb is viable, threatened, or irreversibly ischemic.
2. Initial management involves analgesia, oxygen, intravenous heparin, and urgent referral to a vascular specialist. Further imaging and either surgical or endovascular revascularization may be needed depending on the classification of ischemia.
3. The prognosis depends on factors like etiology and severity of ischemia. With timely treatment, limb salvage is possible in the majority of patients.
Anterior circulation aneurysms and surgical considerations 2011
1) Anterior circulation aneurysms are the most common type, accounting for 86.5% of all intracranial aneurysms. They often present with subarachnoid hemorrhage and have high rates of mortality.
2) CT, CTA, MRA and DSA are important diagnostic tools to detect aneurysms and plan treatment. The ISAT trial showed coiling to be as effective and safer than clipping for ruptured aneurysms.
3) Common anterior circulation aneurysm locations include the ACOM, PCOM, and MCA bifurcations. Surgical approaches depend on the specific location and include pterional craniotomy and lateral trans-sylvian approaches.
Varicous Vain
Varicous Vain,
During General Surgery course, KFU, 2012
hope you will find it helpful
Regards, Fahad Al Hulaibi
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Aortic Aneurysm: Diagnosis, Management, Exercise Testing, And Training
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Y menu difficult tumours of the liver jfim hanoi 2015
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Anterior circulation aneurysms and surgical considerations 2011
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More from Dr. Amritha Anilkumar
Urethritis by Dr.K.AmrithaAnilkumar
URETHRITIS - inflammation of urethra
CAUSES
Gonococcal urethritis.
Nongonococcal urethritis:
Trichomonal urethritis.
Lymphogranuloma venereum (LGV).
Mycoplasma.
Ureaplasma urealyticum.
Candida.
Trauma
Catheters
Cystoscopes
stones.
Chemical urethritis.
Reiter’s disease: Arthritis, conjunctivitis, urethritis.
Allergy.
Stricture urethra by Dr.K.AmrithaAnilkumar
STRICTURE URETHRA
CLASSIICATION -I
I: Aetiologically.
2. Congenital.
3. Inflammatory:
Post-gonococcal
is most common
Gonococcal stricture occurs one year after infection.
Retention develops only 10–15 years later.
Rupture of urethra by Dr.K.AmrithaAnilkumar
Rupture of the anterior urethra is usually caused by a fall astride a projecting object. Clinical features include blood in the urethra, a perineal hematoma, and retention of urine. Treatment involves gentle catheterization in the operating room. If catheterization is not possible, open surgical repair of the tear is performed through a perineal incision. Complications can include infection and stricture formation.
Renal calculus by Dr.K.AmrithaAnilkumar
RENAL CALCULUS AETIOLOGY
Males- radio-opaque gall stones
Females - Radiolucent gall stones
Diet:Vitamin A deficiency
it causes desquamation of epithelium
which acts as a nidus for stone formation.
Climate:
In hot climate urinary solutes will increase with decrease in colloids,
Paraphimosis by Dr.K.AmrithaAnilkumar
PARAPHIMOSIS
DEFINITION
Inability to place back (cover) the retracted prepucial skin over the glans is called as paraphimosis.
It causes ring like constriction proximal to the corona and prepuceal skin.
Hypospadias by Dr.K.AmrithaAnilkumar
HYPOSPADIAS
DEFINITION
It is the most common congenital malformation of urethra wherein external meatus is situated proximal than normal, over the ventral (under) aspect of the penis.
Hydronephrosis by Dr.K.AmrithaAnilkumar
HYDRONEPHROSIS (HN)
DEFINITION
It is an aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction to the outflow of urine.
AETIOLOGY
unilateral
bilateral.
Epispadias by Dr.K.AmrithaAnilkumar
EPISPADIAS
Here the urethra opens on the dorsum of the penis, proximal to the glans.
COMMON SITES
abdominopenile junction.
It is associated with a dorsal chordee, ectopia vesicae, urinary incontinence, separated pubic bones.
It is uncommon in females.
Beningn prostrate Hypertrophy (BPH) by Dr.K.AmrithaAnilkumar
This document discusses benign prostate hyperplasia (BPH), including its etiology, pathology, clinical features, diagnosis, and treatment. BPH is a non-cancerous enlargement of the prostate that occurs in older men due to an imbalance of hormones. It causes obstruction of the urethra and symptoms like frequent urination, weak urine stream, and retention. Diagnosis involves exams, urine and blood tests, and imaging of the prostate, kidneys, and bladder. Treatment depends on symptoms and complications but may include catheterization, surgery to remove part of the prostate like TURP, or other procedures to relieve blockage.
Bladder tumor by Dr.K.AmrithaAnilkumar
BLADDER TUMOURS
They are urothelial tumours.
They are commonly malignant.
Transitional cell carcinoma (TCC) is the most common.
Varicocele by Dr.K.AmrithaAnilkumar
Varicocele is dilatation and tortuosity of the veins within the scrotum that drain blood from the testicles. It is more common on the left side where the left testicular vein drains directly into the left renal vein. Varicocele can cause increased temperature in the scrotum and impair sperm production. Treatment involves surgical ligation of the affected veins to repair blood flow and potentially improve fertility.
Testicular tumors
TESTICULAR TUMOURS
PREVALANCE
99% of testicular tumours are malignant.
Life time prevalence of getting testicular tumour is 0.2%.
Very common in Scandinavia; least common inAfrica andAsia.
4 times common in whites than blacks.
Orchitis by Dr.K.AmrithaAnilkumar
ORCHITIS
AETIOLOGY
It is an inflammation of the testis.
It is commonly associated with inflammation ofthe epididymis. Hence, called as epididymo-orchitis.
Orchitis is due to infection through blood, lymphatics or epididymis.
Hydrocele by Dr.K.AmrithaAnilkumar
HYDROCELE
DEFINITION
It is the collection of fluid between the two layers of tunica vaginalis of testis.
Epididymitis by Dr.K.AmrithaAnilkumar
EPIDIDYMITIS,
CAUSES
Inflammation of epididymis is commonly associated with orchitis— epididymo-orchitis.
Nonspecific
viral like mumps.
Bacterial.
Filarial.
Tuberculosis
Perforated peptic ulcer by Dr.K.AmrithaAnilkumar
PERFORATED PEPTIC ULCER
PERFORATION
DEFINITION
It is the terminology used for perforation of duodenal ulcer or gastric ulcer or stomal ulcer.
Otherwise all clinical features and management are similar.
Perforation is common in duodenal ulcer
Mortality is more in gastric ulcer perforation and perforation in elderly
Gastric ulcer by Dr.K.AmrithaAnilkumar
GASTRIC ULCER
AETIOLOGY
It occurs due to imbalance between protective and damaging factors of gastric mucosa.
Atrophic gastritis
duodenogastric bile reflux
gastric stasis
abnormalities in acid and pepsin secretion.
Acid becomes ulcerogenic even to normal gastric mucosa.
Curling ulcer by Dr.K.AmrithaAnilkumar
CURLING ULCER
DEFINITION
They are acute ulcers which develop after major burns, presenting as pain in epigastric region, vomiting or haematemesis.
Curling’s ulcer occurs when burn injury is more than 35%.
It is observed in the body and fundus not in antrum and duodenum
Congenital (infantile) hypertrophic pyloric stenosis by Dr.K.AmrithaAnilkumar
CONGENITAL (INFANTILE) HYPERTROPHIC PYLORIC STENOSIS
DEFINITION
It is hypertrophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax.
Duodenum is normal.
Carcinoma stomach by Dr.K.AmrithaAnilkumar
CARCINOMA STOMACH
INCIDENCE
‘It is the captain of men of death’.
It is more common in Japan—70 per 1,00,000 population.
It is more common in males 2:1.
Decrease incidence in western world
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This guideline is directed principally toward new Molecular Entities that are
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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PGx Analysis in VarSeq: A User’s Perspective
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The purpose of this webcast is to:
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Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
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Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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Abdominal Aortic Aneurysm
- 1. en love da Homoeopathy ABDOMINAL AORTIC ANEURYSM
- 3. ABDOMINALAORTIC ANEURYSM(AAA) DEFINITION An enlargement of the aorta, the mainblood vessel that delivers blood to the body , at the level of abdomen CAUSES • Atherosclerosis (as degenerative process) • Familial aorticaneurysm - more females • Cysticmedial necrosis • associationwith Chlamydiapneumoniae
- 4. • Others: • Syphilis • Dissection • Trauma • collagen diseases • Infection • Arteritis CLASSIFICATON • ClassificationI • Infrarenal—most common • Suprarenal—5%. (associatedwiththoracic and or infrarenal types. ) • Isolated
- 5. • ClassificationII • Asymptomatic. • Symptomatic. • Symptomaticruptured ASYMPTAMATICTYPE • It is foundincidentally either on clinical examinationor on angiography or on ultrasound. • Repair is requiredif diameter is over 5.5 cm on ultrasound. • It is identifiedduring routine abdominal palpation or while assessing or operating for some other abdominal conditions.
- 6. SYMPTAMATIC • Backpain, • Abdominal pain • Mass abdomenwhichis smooth, soft, nonmobile, • not moving withrespiration, • vertically placed abovethe umbilical level, • pulsatile both in supine as well as kneeelbowposition with • same intensity • Resonant on percussion.
- 7. • Common in males • commonin smokers. • GIT • urinary, venous symptoms can also occur • Hypertension • Diabetes • Cardiac problems • In infrarenal type upper border is clearlyfelt. • Lower limb ischaemia • embolicepisodes can occur.
- 8. • Being a retroperitoneal mass back painis common - due to retroperitoneal stretching, nerve irritation or vertebral erosion. • inflammatoryaneurysm adherent to ureters • Aortocaval fistula- presenting as GI bleed, malaena, shock. • highoutput cardiacfailure withcontinuous bruitin abdomen • severe lower limb ischaemia • (steal phenomenon).
- 9. INVESTIGATION • Blood urea, • serumCeratinine • CT angiogram • MR angiogram. • Blood sugar • lipid profile • other • ECG • Echocardiography • Cardiac and pulmonary assessment
- 10. COMPLICATION • Rupture • infection • Thrombosis • embolism • Distal ischaemia/gangrene • Aortocaval fistula formation • Aortoenteric fistula • Erosion of vertebra • Spinal cord ischaemia when thrombosis develops
- 11. REFERENCE 1. SRB's Manual of Surgery by SriramBhat M 2. A Manual on Clinical Surgeryby Das 3. A Concise textbookof Surgeryby Das
- 12. A Special Thanks To A Very Special Doctor