This document summarizes a case of adrenocortical carcinoma in an 18-year-old male. Laboratory and imaging findings confirmed the diagnosis of metastatic adrenocortical carcinoma. The patient was discharged on palliative chemotherapy with ketoconazole. Adrenocortical carcinoma is a rare and aggressive cancer with poor survival outcomes. Surgical resection offers the only chance of cure but recurrence is common. Palliative treatments provide limited benefits.
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
62 years old female patient presented for nausea, vomiting , palpitation, dizziness and abdominal bloating with unspecific epigastric pain.
diagnosed to have giant pheochromocytoma
treated with laparoscopic approach
62 years old female patient presented for nausea, vomiting , palpitation, dizziness and abdominal bloating with unspecific epigastric pain.
diagnosed to have giant pheochromocytoma
treated with laparoscopic approach
Evaluation and management of Stage III Non-Small Cell Carcinoma Lung including Radiotherapy planning. On a Radiation Oncologist Perspective. MD Radiotherapy discussion - CMC, Vellore
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Laparoscopic adrenalectomy in patients with subclinical cushing syndrome | γι...Γιώργος Ζωγράφος
Abstract:
Background Subclinical Cushing syndrome in patients with adrenal incidentalomas has been associated with an increased prevalence of the metabolic syndrome and car- diovascular risk. The management of these patients, be it conservative or surgical, is still debated, but there is accumulating evidence that surgery is best and that lapa- roscopic adrenalectomy, when possible, is the most pre- ferred procedure. Here we present the short- and long-term results of laparoscopic adrenalectomy for subclinical Cushing syndrome and determine the effect of this proce- dure on components of the metabolic syndrome.
Methods Twenty-nine patients, 8 men and 21 women with adrenal incidentalomas and subclinical Cushing syn- drome who underwent laparoscopic adrenalectomy, were studied retrospectively. They had undergone postoperative follow-up for improvement or worsening of their arterial blood pressure, body weight, and fasting glucose level for a mean period of 77 months.
Results:
Preoperatively, 17 patients (58.6 %) had arterial hypertension, 14 (48.3%) had a body mass index exceeding 27 kg/m2, and 12 (41.4 %) had diabetes melli- tus. Postoperatively, a decrease in mean arterial pressure was found in 12 patients (70.6 %), a decrease in body mass index in 6 patients (42.9 %), and an improvement in gly- cemic control in 5 patients (41.7 %).
Conclusions Laparoscopic adrenalectomy is beneficial in many patients with subclinical Cushing syndrome because it reduces arterial blood pressure, body weight, and fasting glucose levels. Prospective randomized studies are needed to compare laparoscopic adrenalectomy with a conserva- tive approach and to confirm these results.
Dr. Sharfuddin Chowdhury: Tranexamic Acid administration in traumaShakila Rifat
Time since injury is the major factor in preventing Tranexamic Acid (TXA) use in the trauma setting: An observational cohort study from a major trauma centre in a middle income country.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
2. Mr. KS, 18 y.o. male referred from NSH with
features of cushing’s syndrome
He presented with 6/12 hx of cutaneous striae,
hirsutism (excessive hair growth) truncal obesity,
puffy face, weight gain +/-30kg, fatigue
4. CT scan revealed a large lobulated and enhancing lesion originating from the
right adrenal gland with involvement of retrohepatic IVC & liver and atleast 2 lung
metasteses noted
5. Its appearance, coupled with the patient history, physical
exam, and laboratory data strongly suggested an
unresectable metastatic adrenocortical carcinoma
Patient discharged with palliative chemotherapy-
ketoconazole
6. Mrs. DW, fit 87 y. o. female presented to private with symptomatic
anaemia with unexplained bleeding in about March/ April last year.
She had 4 Gastroscopies, 2 Colonoscopies, a barium follow-through
and a nuclear scan study was suggestive of bleeding from terminal
ileum.
She then had a resection of the terminal ileum but has continued
bleeding.
7. She then had a capsule endoscopy study which was unsatisfactory but did show
some blood in the stomach. some telangiectatic spots were noted and it was
thought that these may be the cause of the bleeding.
Since then she has required regular blood transfusions every month.
She usually presents with melaena without any acute haemodynamic event.
She had a previous left adrenocortical carcinoma which was operated in 1991 in
private.
8. CT Abdomen:
revealed a 6.5 cm relatively vascular mass arising anterior to the upper pole
of the left kidney infiltrating the posterior wall of the stomach just distal to the
OG junction highly suggestive of recurrence of adrenal carcinoma.
CT Guided Biopsy: inadequate
9.
10. Estimated incidence of 0.5-2 per 106 patients per
year
Peaks of age distribution at age <10 and in the 4 th
and 5th decades
Scattered reports of gene associations, but rarity of
lesion precludes clear associations
11. 60-65% are functional and produce hormone excess related symptoms
> rapidly progressive cushing syndrome
> mixed cushing syndrome and an androgenital disorder
> 75%are locally aggressive at the time of diagnosis, median survival of 18
months following diagnosis. Tumor grade important for survival
35-40% are non functional tumors ( or asymptomatic functioning tumors)
> abdominal pain / mass, weight loss, fatigue, nausea
12. Hormonal studies can be a first diagnostic test which
confirms ectopic steroid hormone secretion, leading to an
imaging and tissue diagnosis.
13. 24 hour urinary cortisol exrection
> More than 90% of Cushinoid patients have free cortisol levels greater than
200mcg/ 24 hours. 97% of normals have levels less than 100mcg/ 24 hours
ACTH measured with serum cortisol will demonstrate
ACTH independent nature of hypercortisolism.
14. Other steroids are elevated:
androstenediol and adrosetenedione
DHEA and DHEA-S
11- deoxycortisol
urinary 17- ketosteroids
aldosterone
Many intermediate enzymes are defective or
dysregulated, leading to inefficient steroid production
and precursor buildup
15. Serum Testosterone
Serum DHEA and DHEA-S
24 hour urinary ketosteroids
Plasma estradiol and/ or estrone
Plasma aldosterone/ renin
Urinary catecholamines/ metanephrines in all
patients
16. CT detects 98% of adrenal carcinomas
MRI scanning can also provide vascular invasion/
tumor thrombosis information.
Also provides many incidentalomas
Malignant lesions tend to be > 5cm, have irregular
shapes/ blurred margins, and be heterogeneously
enhancing.
17. Stage I — Disease confined to the adrenal gland and
<5 cm in diameter (approx 20%)
Stage II — Disease confined to the adrenal gland and
>5 cm in diameter (approx 20%)
Stage III — Local invasion that does not involve
adjacent organs or regional lymph nodes(approx20%)
Stage IV — Distant metastases or invasion into adjacent
organs plus regional lymph nodes (approx 40%)
21. Unresectable tumors include those that invade the
celiac plexus/ vascular structures/ SMA/ aorta
22. In a case review of 46 patients at MSKCC, 3 histologic
factors correlated with survival:
tumor> 12cm
6 or more mitotic figures/ 10hpf
presence of histologic evidence of intratumoral
hemorrhage
5 year survivals:
▪ 0 factors: 83%
▪ 1 factor: 42%
▪ 2 factors: 33%
23. There are scattered case reports demonstrating
improved pain when palliative XRT used for
localized lesions
24. Review of the literature reveals case reports,
retrospective treatment data, and reviews.
A few phase II trials do exist from some
cooperative or national groups
No true modern- design controlled phase III trials
exist
25. 1,1- dichloro-2-(o-chlorophenyl) ethane (o,p-DDD).
Chemical relative to DDT
It produces selective adrenocortical necrosis in both the adrenal tumor and
metastases
Reported in 1960 by Bergenstal
Subsequent NCI study in 1966 in 138 patients
Noted “reduced symptoms” in about half the patients
Another study (Haak, Netherlands) retrospectively looked at a series of 96
patients treated from 1959- 92
62 patients were treated with mitotane during their course
Of the 30 who achieved serum levels >14mg/L, they had a greater survival
27. Italian series showed no
survival difference
between two groups of
completely resected
patients
Effect of adjuvant mitotane (n = 11) compared with no treatment (n = 15) on the
disease-free interval in patients with localized or regional adrenocortical carcinoma.
28. Of 19 patients treated at MD Anderson cancer center, 8
patients received it adjuvantly, 5 patients received it
transiently, 6 patients did not receive any.
Disease free interval was actually shortest in the adjuvant
group
29. Various systemic cytotoxics have been used for
advanced disease, usually for those failing
mitotane.
Most studied have been Etoposide, cisplatin,
and adriamycin.
Paclitaxel and Temozolamide have recently
demonstrated antitumor activity in vitro
30. Original studies utilized Cisplatin and Doxorubicin with
Cyclophosphamide or 5-FU. Response Rate was 20%
Cisplatin/ Etoposide reported to have an 11% response
rate
Phase II studies with varying reported efficacy exist
31.
32. Italian study
28 patients enrolled
Etoposide (100mg/ m2) d5-7; Doxorubicin (20mg/ m2) d1,8; Cisplatin
(40mg/ m2) d1,9 every 4 weeks
Concomitant mitotane up to 4g/ day
Complete Response in 2 patients
Partial Response in 13 patients
Overall response of 54%
Stable disease in 8, progessive in 5
33. Recurrences that are amenable to re- operation
may be resected for long term survival
5 year survivals compare from 57% in those
amenable to resection to 0% for those who are not
34. Italian registry: 140 resections
Recurrences in 52 (37%)
▪ Locally in 13
▪ Distant in 25
▪ Local + Distant in 14
20 patients underwent re- resection
▪ 5 yr survival of 50% in those resected
▪ 5 yr survival of 8% in those not resected
35. MSKCC: 47 patients with recurrent/ metastatic disease
Patients who had a complete second resection had a
median survival of 74 months (5-year survival, 57%),
whereas those with incomplete second resection had a
median survival of 16 months (5-year survival, 0%).
MSKCC: Memorial Sloan Kettering Cancer Centre
36. Adrenocortical carcinoma is a rare disease that often
presents late
Primary curative therapy is surgical
No role for adjuvant chemotherapy has been demonstrated
to date
Palliative therapy with mitotane may be useful; its palliative
effect may be entirely due to adrenolytic effect
37. Reoperation appears to be the only long term curative
option in recurrent cases
Cytotoxic chemotherapy in the advanced/ metastatic
setting has not been definitively demonstrated to be useful
in controlled trials
EDP-M may be useful in metastatic settings; more
evaluation is needed
Editor's Notes
Barzon L, Fallo F, Sonino N, Daniele O, Boscaro M. Comment--Is there a role for low doses of mitotane (o,p'-DDD) as adjuvant therapy in adrenocortical carcinoma? J Clin Endocrinol Metab. 1999 Apr;84(4):1488-9. The role of mitotane as adjuvant treatment for adrenocortical carcinoma is controversial (1, 2, 3, 4, 5, 6, 7, 8). Our experience with adjuvant mitotane (8), as that of others (3, 4, 5, 6), indicates that it is not beneficial in terms of either disease freedom or survival. We expanded our observation, and, of 59 consecutive patients (36 females, 23 males) with adrenocortical carcinoma (34 functioning and 25 nonfunctioning), 26 (44%) with localized or regional disease (median tumor size, 8.0 cm; range, 4.6–25.0 cm) underwent complete resection of the tumoral mass. Of these, 11 patients (group 1: 7 females and 4 males) received mitotane (o,p'-DDD, Lysodren, Bristol-Myers Squibb) postoperatively at doses of 4–8 g daily, whereas 15 patients (group 2: 9 females and 6 males) were given no medical treatment. The two groups were similar with regard to sex, age, tumor size, functional status, and tumor staging at diagnosis. Six patients of group 1 were free of disease at last follow-up (range: 6–82 months after surgery), and 5 developed metastases or recurrences (disease free-intervals of 4–29 months); 3 of them died of the disease 24–40 months after diagnosis. Of group 2, 6 were free of disease at last follow-up (range, 14–74 months after surgery), and 9 developed metastases (disease free-intervals of 8–60 months), 8 of them died during follow-up (survival: 15–104 months). Cumulative disease-free interval and survival rates, estimated with the Kaplan-Meyer method and compared with the log-rank test, were not significantly different between the two groups (2 = 0.26, df = 1, P NS; and 2 = 1.15, df = 1, P NS, respectively; Fig. 1). Owing to these disappointing results and the side-effects of mitotane, which significantly worsen quality of life of patients, we would not advocate mitotane as adjuvant treatment of adrenocortical carcinoma. However, prospective studies are needed to evaluate the real efficacy of this compound.
Vassilopoulou-Sellin R, Guinee VF, Klein MJ, et al.: Impact of adjuvant mitotane on the clinical course of patients with adrenocortical cancer. Cancer 71 (10): 3119-23, 1993. [PUBMED Abstract] BACKGROUND. Adrenocortical carcinoma is a rare and aggressive disease with a poor prognosis. Adjuvant mitotane administration has been suggested as a strategy that might improve the outcome of patients with localized disease. METHODS. The authors analyzed the clinical outcome of patients with localized or regional adrenocortical cancer. The study included 19 patients who were registered at M.D. Anderson Cancer Center during a 3-year period and who had localized or regional disease at the time of surgery. Of these, eight patients received mitotane postoperatively and continued the drug until their last contact or recurrence (Group A, adjuvant); five patients began taking mitotane after surgery but discontinued it after 2-12 months for reasons unrelated to the disease (Group P, postoperative); and six patients did not receive mitotane (Group N, no mitotane). All patients have been followed for at least 12 months. RESULTS. The treatment groups differed significantly in their time to recurrence; the disease-free interval was shortest in Group A (P = 0.0055, by log-rank test). There was no statistical difference in survival among the groups, but the profile remained unfavorable for Group A. The 2-year survival rate was 100% for Groups N and P but only 43% for Group A. Of the potentially confounding factors, gender, age, steroid hypersecretion, and tumor size, none had any influence on recurrence or survival rates. CONCLUSIONS. These findings do not support the conclusion that adjuvant mitotane is beneficial in patients with localized or regional adrenocortical cancer. Neither the disease-free interval nor survival was improved by the drug. The authors suggest that alternative therapeutic strategies be explored for the management of these patients.
Jensen JC, Pass HI, Sindelar WF, et al.: Recurrent or metastatic disease in select patients with adrenocortical carcinoma. Aggressive resection vs chemotherapy. Arch Surg 126 (4): 457-61, 1991. In a retrospective, nonrandomized comparison of patients with first recurrence of adrenocortical cancer, 18 patients were treated with chemotherapy (primarily mitotane) and 15 patients were treated with surgical resection plus similar chemotherapy. Surgical resection of recurrent adrenocortical cancer was often extensive, with morbidity in 20% of patients and no mortality. Mitotane therapy was ineffective at controlling tumor growth. Median survival from the time of diagnosis for all patients was only 23 months and no patient was cured. Disease-free interval greater than 12 months was associated with prolonged survival, but it only occurred in six patients (18%), with a similar frequency in both treatment groups. Surgical resection of recurrent disease was associated with prolonged survival from the time of first recurrence. The potential benefit of this resection was evident in the 5 patients (33%) who were able to live greater than 5 years from the time of first recurrence with improvement in symptoms and signs of hypercortisolism. Although no patient with recurrent adrenal cancer could be cured, resection of recurrent disease was associated with a slight prolongation of survival and good palliation of Cushing's syndrome.