High Resolution Manometry Introduction2dubeczattila
High-resolution manometry uses a catheter with 36 solid-state pressure sensors spaced 1 cm apart to measure esophageal motility. It provides 2D and 3D spatial-temporal plots of pressure data along the esophagus. Classic achalasia shows no peristalsis and impaired lower esophageal sphincter relaxation, while other primary motility disorders like jackhammer esophagus have high amplitude contractions over 180 mmHg with double peaks and prolonged contractions over 6 seconds. HRM allows diagnosis of different motility disorders based on patterns of peristalsis, LES relaxation, and contraction amplitudes.
This document discusses the management of gastric polyps. It begins with an introduction to gastric polyps and their classification. It then discusses the epidemiology and histological classification of various polyp subtypes. General management principles are outlined, including biopsying polyps, checking for H. pylori infection, and surveillance based on polyp type and characteristics. Specific guidelines are provided for managing common polyp types such as hyperplastic, fundic gland, adenomatous and carcinoid polyps. The document concludes with recommendations that gastric polyps should be fully characterized, the stomach evaluated for atrophy or H. pylori, and management individualized based on polyp features and histology.
This document summarizes the management of rectal cancer. It discusses various imaging modalities used for clinical staging such as transrectal ultrasound, CT scan, and MRI. It then covers staging, prognostic factors, principles of pathologic review, and various treatment options including surgery (local excision, transabdominal resection, low anterior resection), total mesorectal excision, laparoscopic resection, and the role of combined modality therapy with chemotherapy and radiotherapy.
This document discusses treatment approaches for rectal cancer. It notes that rectal cancer is best treated through a multidisciplinary team approach. Surgery remains the primary treatment but neoadjuvant chemoradiation is preferred to postoperative chemoradiation for stages II and III disease due to improved outcomes and toxicity profiles. Fluoropyrimidine chemotherapy forms the backbone of treatment regimens and can be given orally. Long course radiation therapy is the standard approach. Achieving a pathologic complete response through neoadjuvant therapy leads to significantly better outcomes. Further research is still needed.
Gastric polyps & tumors by Dr. Karan AroraKaran Arora
Gastric polyps and tumors can be benign or malignant. Benign polyps include hyperplastic, fundic gland, and juvenile polyps. Rare polyp syndromes like Peutz-Jeghers syndrome and familial adenomatous polyposis can increase cancer risk. Gastric adenomas have a risk of malignancy depending on size and histology. Gastric carcinomas are usually adenocarcinomas and can be intestinal or diffuse type. Early detection of gastric cancer improves prognosis. Precancerous conditions include chronic gastritis and intestinal metaplasia.
The document discusses gastric carcinoma (stomach cancer). It provides details on risk factors, clinical presentation, diagnostic testing including endoscopy, staging, treatment options including surgery, chemotherapy and radiation, complications, and prognostic factors. The highest rates of gastric cancer are seen in Japan, and it is more common in males and older individuals. Infection with H. pylori is a significant risk factor. Endoscopy with biopsy is the gold standard for diagnosis. Treatment depends on staging but may include surgery such as total or subtotal gastrectomy. Prognosis depends on depth of invasion and lymph node involvement.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
High Resolution Manometry Introduction2dubeczattila
High-resolution manometry uses a catheter with 36 solid-state pressure sensors spaced 1 cm apart to measure esophageal motility. It provides 2D and 3D spatial-temporal plots of pressure data along the esophagus. Classic achalasia shows no peristalsis and impaired lower esophageal sphincter relaxation, while other primary motility disorders like jackhammer esophagus have high amplitude contractions over 180 mmHg with double peaks and prolonged contractions over 6 seconds. HRM allows diagnosis of different motility disorders based on patterns of peristalsis, LES relaxation, and contraction amplitudes.
This document discusses the management of gastric polyps. It begins with an introduction to gastric polyps and their classification. It then discusses the epidemiology and histological classification of various polyp subtypes. General management principles are outlined, including biopsying polyps, checking for H. pylori infection, and surveillance based on polyp type and characteristics. Specific guidelines are provided for managing common polyp types such as hyperplastic, fundic gland, adenomatous and carcinoid polyps. The document concludes with recommendations that gastric polyps should be fully characterized, the stomach evaluated for atrophy or H. pylori, and management individualized based on polyp features and histology.
This document summarizes the management of rectal cancer. It discusses various imaging modalities used for clinical staging such as transrectal ultrasound, CT scan, and MRI. It then covers staging, prognostic factors, principles of pathologic review, and various treatment options including surgery (local excision, transabdominal resection, low anterior resection), total mesorectal excision, laparoscopic resection, and the role of combined modality therapy with chemotherapy and radiotherapy.
This document discusses treatment approaches for rectal cancer. It notes that rectal cancer is best treated through a multidisciplinary team approach. Surgery remains the primary treatment but neoadjuvant chemoradiation is preferred to postoperative chemoradiation for stages II and III disease due to improved outcomes and toxicity profiles. Fluoropyrimidine chemotherapy forms the backbone of treatment regimens and can be given orally. Long course radiation therapy is the standard approach. Achieving a pathologic complete response through neoadjuvant therapy leads to significantly better outcomes. Further research is still needed.
Gastric polyps & tumors by Dr. Karan AroraKaran Arora
Gastric polyps and tumors can be benign or malignant. Benign polyps include hyperplastic, fundic gland, and juvenile polyps. Rare polyp syndromes like Peutz-Jeghers syndrome and familial adenomatous polyposis can increase cancer risk. Gastric adenomas have a risk of malignancy depending on size and histology. Gastric carcinomas are usually adenocarcinomas and can be intestinal or diffuse type. Early detection of gastric cancer improves prognosis. Precancerous conditions include chronic gastritis and intestinal metaplasia.
The document discusses gastric carcinoma (stomach cancer). It provides details on risk factors, clinical presentation, diagnostic testing including endoscopy, staging, treatment options including surgery, chemotherapy and radiation, complications, and prognostic factors. The highest rates of gastric cancer are seen in Japan, and it is more common in males and older individuals. Infection with H. pylori is a significant risk factor. Endoscopy with biopsy is the gold standard for diagnosis. Treatment depends on staging but may include surgery such as total or subtotal gastrectomy. Prognosis depends on depth of invasion and lymph node involvement.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
The document discusses several studies by Dubecz et al. on trends in adenocarcinoma (adeno-CA) incidence and esophageal cancer (EC) cure and resection rates in the modern era. It notes increasing adeno-CA incidence rates over time, higher rates in white men, stage-by-stage incidence data, and modern cure rates for localized and regional EC from resection. Resection rates for non-metastatic EC in the US are presented from several data sources, along with median lymph nodes removed and percentage of patients with adequate lymph node dissection.
Stent Presentation at STS 2009 San franciscodubeczattila
This study evaluated the use of self-expanding metal stents, plastic stents, and hybrid stents to treat 133 patients with malignant and benign esophageal diseases over an 8-year period at a single institution. Stent placement was successful in relieving obstruction in 91% of patients with a median hospital stay of 1 day. Complications included migration in 9.7% of cases, impaction in 13% requiring endoscopic disimpaction, and tumor ingrowth in 5.2% of uncovered metal stents. Stent placement was found to be a generally safe, quick, and reliable procedure for palliating malignant esophageal obstructions.
High resolution manometry (HRM) can provide useful functional information for evaluating patients experiencing recurrent symptoms after failed fundoplication surgery. The study evaluated 28 patients with various symptoms using HRM and compared results to healthy controls. HRM revealed high residual lower esophageal sphincter pressures, low rates of LES relaxation, and high intrabolus pressures in the neo-high pressure zone for most patients experiencing post-fundoplication dysphagia. HRM allows detailed analysis of complex esophageal pathology to provide insight for clinical decision making.
This document provides an overview of essentials for manuscript review, including how to organize a manuscript, use statistics, identify types of studies and levels of evidence, address bias, interpret results, and write an abstract, introduction, methods, discussion, and conclusion. It discusses key aspects of each section and how to effectively review a submitted manuscript.
This document describes the steps of a surgical procedure involving the duodenum, pancreas, stomach, and other abdominal organs. Key steps include:
1) Kocherization to mobilize the duodenum and expose surrounding structures.
2) Bursectomy and dissection of surrounding tissues to further expose vessels.
3) Division of vessels including the right gastric and gastroduodenal arteries.
4) Transection of the duodenum and dissection of the pancreas and surrounding lymph nodes.
5) Distal pancreatectomy and esophagojejunostomy to reconstruct the digestive tract.
A 29-year-old woman had been chronically treated for Crohn's disease for years based on a biopsy suggesting a mild case. However, during a surgery, a retained surgical sponge was discovered in her small intestine that had been there since a previous surgery, causing her symptoms. A review of previous samples found threads from the sponge. It is believed the sponge had migrated through her intestines without causing an open wound. Her true diagnosis was misdiagnosed Crohn's disease due to the retained foreign body.
The document summarizes WHO's perspective on proposed reforms to Hungary's health insurance system. The WHO has two main concerns: 1) There is no logical link between the problems identified in Hungary's system and the solution of introducing competitive private health insurance. 2) Analyzing the system using labels like "Beveridge" and "Bismarck" is outdated and misleading. The WHO believes the reforms will greatly increase costs without clear benefits and that Hungary should learn from countries with similar systems rather than those proposed as models.
The document discusses several studies by Dubecz et al. on trends in adenocarcinoma (adeno-CA) incidence and esophageal cancer (EC) cure and resection rates in the modern era. It notes increasing adeno-CA incidence rates over time, higher rates in white men, stage-by-stage incidence data, and modern cure rates for localized and regional EC from resection. Resection rates for non-metastatic EC in the US are presented from several data sources, along with median lymph nodes removed and percentage of patients with adequate lymph node dissection.
Stent Presentation at STS 2009 San franciscodubeczattila
This study evaluated the use of self-expanding metal stents, plastic stents, and hybrid stents to treat 133 patients with malignant and benign esophageal diseases over an 8-year period at a single institution. Stent placement was successful in relieving obstruction in 91% of patients with a median hospital stay of 1 day. Complications included migration in 9.7% of cases, impaction in 13% requiring endoscopic disimpaction, and tumor ingrowth in 5.2% of uncovered metal stents. Stent placement was found to be a generally safe, quick, and reliable procedure for palliating malignant esophageal obstructions.
High resolution manometry (HRM) can provide useful functional information for evaluating patients experiencing recurrent symptoms after failed fundoplication surgery. The study evaluated 28 patients with various symptoms using HRM and compared results to healthy controls. HRM revealed high residual lower esophageal sphincter pressures, low rates of LES relaxation, and high intrabolus pressures in the neo-high pressure zone for most patients experiencing post-fundoplication dysphagia. HRM allows detailed analysis of complex esophageal pathology to provide insight for clinical decision making.
This document provides an overview of essentials for manuscript review, including how to organize a manuscript, use statistics, identify types of studies and levels of evidence, address bias, interpret results, and write an abstract, introduction, methods, discussion, and conclusion. It discusses key aspects of each section and how to effectively review a submitted manuscript.
This document describes the steps of a surgical procedure involving the duodenum, pancreas, stomach, and other abdominal organs. Key steps include:
1) Kocherization to mobilize the duodenum and expose surrounding structures.
2) Bursectomy and dissection of surrounding tissues to further expose vessels.
3) Division of vessels including the right gastric and gastroduodenal arteries.
4) Transection of the duodenum and dissection of the pancreas and surrounding lymph nodes.
5) Distal pancreatectomy and esophagojejunostomy to reconstruct the digestive tract.
A 29-year-old woman had been chronically treated for Crohn's disease for years based on a biopsy suggesting a mild case. However, during a surgery, a retained surgical sponge was discovered in her small intestine that had been there since a previous surgery, causing her symptoms. A review of previous samples found threads from the sponge. It is believed the sponge had migrated through her intestines without causing an open wound. Her true diagnosis was misdiagnosed Crohn's disease due to the retained foreign body.
The document summarizes WHO's perspective on proposed reforms to Hungary's health insurance system. The WHO has two main concerns: 1) There is no logical link between the problems identified in Hungary's system and the solution of introducing competitive private health insurance. 2) Analyzing the system using labels like "Beveridge" and "Bismarck" is outdated and misleading. The WHO believes the reforms will greatly increase costs without clear benefits and that Hungary should learn from countries with similar systems rather than those proposed as models.
1. A BARRETT-NYELŐCSŐ DIAGNOSZTIKÁJA ÉS KEZELÉSE Magyar Sebész Társaság 58. Kongresszusa Budapest, 200 6 szeptember 5-9. dr. Máté Miklós dr. Dubecz Attila SE Sebészeti Tanszék – Fővárosi Önkormányzat Szent István Kórház Sebészeti Osztály
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4. Barrett-nyelőcső: Carcinogenesis Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A genetikai változások megelőzik a dysplasia kialakulását
5. Barrett-nyelőcső: Carcinogenesis Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. LG-dsyplasia metaplasia HG-dysplasia carcinoma Fenotípus Genetikai (DNS) abnormalitások akkumulálódnak
6. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
9. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. Onkogének: növekedési faktorok és receptorok
10. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
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13. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
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15. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A FAS-receptor indukálja az apoptosist
16. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A Barrett-sejt Fas-ligandot expresszál, elkerüli az apoptosist
17. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
18. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A normál sejtek Sejtöregedés Sejt- osztódások Teloméra Celluláris öregedés TELOMÉRA - a kromoszómavégeken található, ismétlődő részekből álló DNS-szakasz
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20. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. Sejt- osztódások Telomeráz nélkül Telomerázzal Sejtöregedés Halhatatlanság
21. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
22. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A rákos sejtekben folyamatos az angiogenesis
23. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. 3. Az apoptosis elkerülése 2. Az inhib. jelek elkerülése 1. Saját prolif. jelek szolgáltatása 4.Folyamatos replikáció 5. Folyamatos angiogenezis 6. Szöveti invázió és metastasis Barrett sejt Barrett carcinoma sejt A Barrett-sejt carcinomává alakulásának 6 útja
24. Barrett-nyelőcső: Genetika Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9. A cadherinek és ß-cateninek szerepe
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26. Barrett-nyelőcső: EMR Magyar Sebész Társaság 58. Kongresszusa – Budapest, 2006. szeptember 6-9.
Tisztelt hallgatóság, tisztelt hölgyeim és uraim! Előadásomban a barrett nyelőcső jelenleg új vagy vitatott kérdéseivel foglalkozom. Összefoglalom a Barrett carcinogenezis sebészek számára is fontos genetikai hátterét, ami a diagnosztikában lehet kulcsfontosságú, valamint a kezelés vitás kérdéseit.