This document discusses laryngeal cancer, including:
- Types are mostly squamous cell carcinoma, with some other rare types. Glottic cancer is most common.
- Symptoms depend on location - glottic causes hoarseness, supraglottic causes throat pain and dysphagia, subglottic causes stridor.
- Staging involves examination, imaging, and considers tumor size and spread. Treatment options include radiation, surgery like laryngectomy, and rehabilitation techniques after total laryngectomy like oesophageal speech.
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Laryngeal malignancy is common in males than females especially due to smoking and drinking habits.
More than three weeks of hoarseness in an adult male who smokes or drinks alcohol should be suspicious of malignancy unless otherwise proven.
Commonest presentation of laryngeal carcinoma of supraglottic larynx is throat pain or discomfort and neck swelling, that of glottic is hoarseness and that of subglottic is stridor as this is the narrowest part of the larynx.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Laryngeal malignancy is common in males than females especially due to smoking and drinking habits.
More than three weeks of hoarseness in an adult male who smokes or drinks alcohol should be suspicious of malignancy unless otherwise proven.
Commonest presentation of laryngeal carcinoma of supraglottic larynx is throat pain or discomfort and neck swelling, that of glottic is hoarseness and that of subglottic is stridor as this is the narrowest part of the larynx.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
CA larynx Presentation - diag. & treatment
1. About 90-95% of laryngeal malignancies are squamous
cell carcinoma with various grades of differentiation
Squamous cell subtypes include keratinizing and
nonkeratinizing and well-differentiated to poorly
differentiated grade
The rest 5-10% of lesions include verrucous
carcinoma, spindle cell carcinoma, malignant salivary
gland tumor and sarcomas.
Glottic (59%)> Supraglottic (40%)> Subglottic
(1%)..
Widely prevalent in the Indian Sub-continent in
comparison to the west
2. The larynx is divided into the following three
anatomical regions:
The Supraglottic larynx includes the epiglottis, false
vocal cords, ventricles, aryepiglottic folds, and
arytenoids.
The Glottis includes the true vocal cords and the
anterior and posterior commissures.
The Subglottic region begins about 1 cm below the
true vocal cords and extends to the lower border of the
cricoid cartilage or the first tracheal ring.
Ref. American Cancer Society.: Cancer Facts and Figures
2012. Atlanta, Ga: American Cancer Society, 2012. Last
accessed January 5, 2012
3. Most common- 59%
Spread: Anteriorly- anterior commisure
Posteriorly- vocal process and arytenoid process
Upward- ventricle and false cord
Downward- Subglottic region
Symptoms:
Hoarseness of voice is an early sign bcoz lesions of cord
affect its vibratory capacity, stridor when growth
becomes larger in size.
4. There are few lymphatics in vocal cords and
nodal metastasis are never seen unless the
disease spreads beyond the region of
membranous cords.
Good Prognosis : Bcoz of early presentation
and late spread, it has good prognosis.
5. Picture of glottic squamous cell carcinoma of
the larynx. The tumor involves the anterior
half of the left vocal cord.
6.
7. Less frequent than glottic cancer
Majority of lesion are seen on epiglottis,false cord
followed by aryepiglottic fold, in that order
May spread locally and invade the adjoining areas
(vallecula, base of tounge and pyriform fossa)
Nodal metastases occur early(T1- 20%,T2-35%,T3-
50%,T4-65%)
Upper and middle jugular nodes are often involved
Bilateral metastases may be seen in cases of
epiglottic cancer.
8. Symptoms: Often silent, Hoarseness is a late
symptom. May present with throat pain, dysphagia
and referred pain in ear, mass of lymph node in the
neck.
Bad Prognosis : Due to early spread and late
presentation.
9. Preepiglottic space
involvement through
foramen in infrahyoid
epiglottis.
Paraglottic space
involvement through
mucosa of the
ventricle.
10. Lesions rare( 1 - 2%)
Spread: Anterior wall, to the opposite side or
downwards to the trachea
May invade cricothyroid membrane, thyroid
gland and muscles of neck
Paratracheal LN involved
Symptoms: Stridor is the
Earliest presentation.
11. Hoarseness is a late symptom as upward spread
to the vocal cords is late.
Hoarseness of voice indicates :
Spread of disease to undersurface of vocal cords.
Infiltration of thyroarytenoid muscle.
Involvement of recurrent laryngeal nerve.
12. 1. History :
Symptomatology of glottic, subglottic, supraglottic is
different as explained earlier.
2. Indirect Laryngoscopy :
It is done to see the-
A) Appearance of lesion- which vary according to the
site of origin.
B) Vocal Cord Mobility – Fixation of vocal cords
indicate deeper infiltration.
13. C) Extent of the disease.
3. Direct Laryngoscopy :
It is done to see the-
a) Hidden areas of larynx
b) Extent of disease.
4. Examination Of Neck :
It is done to find the-
a) Extralaryngeal spread of the disease.
b) Nodal metastasis.
14. 5. Radiography :
Chest X Ray – Essential for co-existent lung
diseases,pulmonary metastasis and mediastinal
nodes.
CT Scan – Useful investigation to find the
extent of the tumour,invasion of pre and para
epiglottic space,destruction of cartilage and
lymph node involvement.
Laryngograms using dionosil are obsolete.
15. 6. Microlaryngoscopy:
For smaller lesions, laryngoscopy is done
under microscope for better visualisation.
7. Supravital staining and biopsy:
Toluidine blue is applied to the laryngeal
lesion and then washed and examined. CIS and
superficial carcinomas take up dye while
leukoplakia does not and thus helping in
selecting the area for biopsy.
16. The staging system for laryngeal cancer is
clinical and based on the best possible estimate
of the extent of disease before treatment.
Staging of disease is very important
it influences the choice of therapy and
helps in predicting the overall prognosis,
it provides confirmity amongst clinicians thereby
helping in comparing the efficacy of various forms of
therapy.
17. Tx - Primary tumor cannot be assessed.
T0 - No evidence of primary tumor.
Tis - Carcinoma in situ.
Supraglottis
T1 Tumor limited to one subsite of supraglottis with normal vocal
cord mobility.
T2 Tumor invades mucosa of more than one adjacent subsite of
supraglottis or glottis or region outside the supraglottis
(e.g., mucosa of base of tongue, vallecula, medial wall of pyriform
sinus) without fixation of the larynx.
T3 Tumor limited to larynx with vocal cord fixation and/or invades
any of the following: postcricoid area, pre-epiglottic
space, paraglottic space, and/or inner cortex of thyroid cartilage.
18. T4a Moderately advanced local disease.Tumor invades through the
thyroid cartilage and/or invades tissues beyond the larynx (e.g.,
trachea, soft tissues of neck including deep extrinsic muscle of the
tongue, strap muscles, thyroid, or esophagus).
T4b Very advanced local disease.Tumor invades prevertebral space,
encases carotid artery, or invades mediastinal structures
GLOTTIS
T1 Tumor limited to the vocal cord(s) (may involve anterior
or posterior commissure) with normal mobility.
T1a Tumor limited to one vocal cord.
T1b Tumor involves both vocal cords.
19. T2 Tumor extends to supraglottis and/or subglottis and/or with
impaired vocal cord mobility.
T3 Tumor limited to the larynx with vocal cord fixation and/or
invasion of paraglottic space and/or inner cortex of the thyroid
cartilage.
T4a Moderately advanced local disease.Tumor invades through the
outer cortex of the thyroid cartilage and/or invades tissues beyond
the larynx (e.g., trachea, soft tissues of neck including deep
extrinsic muscle of the tongue, strap muscles, thyroid, or
esophagus).
T4b Very advanced local disease.Tumor invades prevertebral
space, encases carotid artery, or invades mediastinal structures.
20. • Subglottis
– T1: limited to subglottis
– T2: extends to vocal cord with
normal or impaired mobility
– T3: limited to larynx w/vocal
cord fixation
– T4a: invades cricoid or thyroid
cartilage, and/or invades tissues
beyond the larynx
– T4b: invades prevertebral
space, encases carotid artery, or
invades mediastinal structures
Staging
• Nodes
– Nx: regional LN can’t be
assessed
– N0: no regional node mets
– N1: single ipsilateral node, ≤ 3
cm
– N2a: single ipsilateral node, > 3
cm, ≤ 6 cm
– N2b: multiple ipsilateral
nodes, ≤ 6 cm
– N2c: bilateral or contralateral
nodes, ≤ 6 cm
– N3: node > 6 cm
• Mets
– Mx: unknown
– M0: no distant mets
– M1: distant mets
21. Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III
T3 N0 M0
T1-3 N1 M0
Stage IVA
T4a N0-1 M0
T1-4a N2 M0
Stage IVB
T4b any N M0
any T N3 M0
Stage IVC any T any N M1
Early
stage
Advanced
stage
22. Carcinoma in situ(Tis):if b/l staged procedure
/web formation
•Complete mucosal cord
stripping with co2 laser
•Quit smoking/no RT
•Vigilant follow up
Diffuse lesion
• Excision of leukoplakia with
microscissors/forceps
• Quit smoking/ no RT
• Vigilant f/u
Localised lesion
23. T1 Carcinoma
• RT or CO2 laser
• Laryngofissure
and cordectomy
T1 Carcinoma with
ext. to anterior
commissure
• RT
• Partial
frontolateral
laryngectomy
T1 with ext. to
arytenoid
• Endoscopic laser
resection
• Laryngofissure &
cordectomy
(surgery
preferred)
• RT
25. Transoral endoscopic CO2 laser cordectomy
Cure rates are uniformly above 90%
Quality of voice depents on extend of resection
Laryngofissure and cordectomy..
rarely used now
When endoscopic exposure is very poor
26. Tumor limited to the
glottis (T1/T2/early
T3)normal vocal cord
mobility
localised residual /recurrent
disease following failure of
RT for early cancer
debulking of tumour for
stridor
27. - Radiotherapy to the primary including radiation
to upper neck nodes.
If failure occurs, Conservative laryngectomy or
Total laryngectomy +/- neck dissection is done.
28. RT is avoided bcoz of the possibility of
developing perichondritis. Also impaired
mobility indicates deeper invasion and thus
poorer response to radiation.
- Conservative laryngectomy is done, if failure
occurs Total laryngectomy is done.
29. Best treated by total laryngectomy combined
with neck dissection if lymph nodes are
palpable.
Can also be combined with post operative RT.
30. Subglottic carcinoma
T1 & T2 are treated by RT.
T3 & T4 require total laryngectomy and post-op. RT
(radiation should also include superior mediastinum)
31. T1 lesions are treated by Rt or CO2 Laser.
T2 lesions require consideration of pulmonary function.
If pulmonary function is good, supraglottic laryngectomy is done.
If pulmonary function is poor, RT can be given with follow up.
T3 & T4 lesions require total laryngectomy with neck
dissection and post-op RT.
32. 1. Oesophageal Speech :
The patient is taught to swallow air in the oesophagus and to
release it slowlyfrom oesophagus to pharynx. Patient can speak
upto 6-10 understandable words.
2. Artificial Larynx :
a) Electrolarynx – It has a vibrating disc
which is held against the soft tissues of
the neck.
b) Transoral Pneumatic Device – Here
vibrations produced in a rubber diaphragm is carried by a
plastic tube into the back of oral cavity where sound is converted
to speech by modulators.
33. Tracheo-oesophageal Speech
Here attempt is made to carry air from trachea to oesophagus or
hypopharynx by the creation of skin lined fistula or nowdays,
prosthesis (Blom-Singer or Panje) are used which prevent the risk
of aspiration.
Thank You!!!