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- Risk factors include deficiencies in vitamins, alcohol/tobacco, Barrett's esophagus, and tylosis.
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Short and brief description of adrenal gland and its disorder.
it involves the basic anatomy, physiology and metabolism of adrenal hormones.
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esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
Adrenal Gland and its Disorders with surgical management.Manish Shetty
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.Adrenal gland tumor like adrenal cortical tumor phaechromocytoma, incidentalaoma are mentioned in this PPT.
it explains the clinical symptoms, investigation and desired management of adrenal gland disorders.
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
Biological screening of herbal drugs: Introduction and Need for
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
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Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2. Introduction
• 6th most common cancer in the world
• Very poor survival rate
• Common in China , South Africa & Asian Countries
• India - Karnataka & Orissa
• Less common - American and European countries
8. Direct Spread
• More favorable - Lack of serosal layer
• Upper third - Spreads to muscular layer
• Adheres to left main bronchi, trachea , recurrent
laryngeal nerve , aorta
• May perforate and cause mediastinhtis
• May adhere to pleura also
9. Lymphatic Spread
• Spread by lymphatic permeation & lymphatic
embolisation
• Can cause satellite nodules
• Neck - Supra clavicular lymph nodes
• Abdomen - Coeliac Lymph nodes
• Blood Spread - Liver , Lungs, Brain, Bones
11. • Recent onset of dysphagia
• Regurgitation
• Anorexia, severe loss of weight, cachexia
• Substernal pain, abdominal pain
• Liver secondaries ,ascites
• Bronchopneumonia,melaena
12. • Features of bronchoesophageal fistula in carcinoma of upper 3rd esophagus
• Left supra clavicular lymph nodes may be palpable
• Hoarseness of voice due to involvement of recurrent laryngeal nerve
• Hiccough due to phrenic nerve involvement
• backpain
13. TNM staging & histological grading
• T 0 – NO primary tumour
• T 1a -invasion into lamina propria,muscularis mucosa
• T 1b-submucosa
• T 2-muscularis propria
• T 3-paraesophageal tissues(adventitia)
• T 4a-resectable adjacent structures(pleura,pericardium,diaphragm)
14. • T4b-unresectable adjacent structures(aorta,vertebral body,trachea)
• N STATUS-NODES
• N 0-no regional lymph node metastasis
• N 1- 1 to 2 positive regional lymph nodes
• N 2-3 to 6 positive regional lymph nodes
• N 3-7 or more positive regional lymph nodes
15. M STATUS
• M O-no distant metastases
• M I-distant metastases
• HISTOLOGICAL GRADING
• G1 –well differentiated
• G 2- moderately differentiated
• G3 –poorly differentiated
• G4-undifferentiated
17. INVESTIGATIONS
BARIUM SWALLOW – Irregular filling defect
- Rat tail lesion on
flouroscopy is typical.
OESOPHAGOSCOPY - To see the lesion, extent
and type
BIOPSY – For histological type and confirmation
CHEST X-RAY - To look for aspiration pneumonia
18. • CT – SCAN - To look for local extension
• BRONCHOSCOPY - To see invasion in upper 1/3rd carcinoma of oesophagus
• LARYNGOSCOPY - To identify vocal cord palsy
• OESOPHAGEAL ENDOSONOGRAPHY - To look for involvement of layers of oesophagus, nodes, cardia
and left lobe of liver
19. • ULTRASOUND ABDOMEN – To look for liver and lymph nodes state in abdomen
• ENDOSCOPIC OESOPHAGEAL STAINING – WITH LABELLED IODINE
RESULTS : Normal mucosa – Brown
In carcinoma – Remains pale
(Mucosa in carcinoma doesn’t take up the iodine)
20. • BLOOD TESTS - Haematocrit, ESR, LFT
• LAPROSCOPY - Used to see peritoneal spread
liver and nodal spread
• VIDEO- ASSISTED THORACOSCOPIC APPROACH – To stage the carcinoma of oesophagus and to identify
the operability and nodal status
• ENDOSCOPIC MUCOSAL RESECTION (EMR) – It’s a diagnostic biopsy tool
21. • CHROMOENDOSCOPY MAGNIFICATION ENDOSCOPIES ( NEWER METHODS) – local topical application of
different stains will improve the tumor localisation, features and diagnosis
STAINS USED:-
1) Absorptive – LUGOLS
METHYLENE BLUE
absorbed by specific cell membrane
22. 2) Contrast – INDIGOCARMINE - permeate into mucosal crevices showing irregularity
3) Reactive – CONGO RED
-PHENYL RED
Show color change due to reaction with cell chemicals
• NEWER MODALITIES OF EVALUATION :
*Flow cytometry
*P53 immunohistochemistry
*Optic coherance tomography
*Spectroscopy
23. TREATMENT
20% Oesophagel cancers are early and
curable
THOSE CONFIRMED:
🡪 With absence of Nodal spread -
RADICAL OESOPHAGECTOMY
*Proximal extent: 10cms above
macroscopic tumor
24. * Distal extent : 5cm from macroscopic
tumor
* Proximal stomach is removed:
especially in the lower 1/3rds of the
tumor
�If nodes are involved-
MULTIMODAL APPROACH
*Curative resection
* Radiotherapy
* Chemotherapy
25. �If >5% lymph nodes are involved:-
POOR PROGNOSIS
🡪If 5/<5% lymph nodes are involved:-
CURATIVE RESECTION
❖NEO ADJUVANT THERAPY-
Chemotherapy and radiotherapy prior to
surgery may improve the survival
26. ❖AGGRESSIVE CHEMORADIATION-
Curative therapy
In some patients especially with upper
1/3rd growths and in patients who are
unfit for surgery
In remaining 80% PALLIATION is the main
modality of treatment
27. • Approaches for different level tumors:
1)POST CRICOID TUMOR
* Treated by radiotherapy- radical
radiotherapy with 5000-6000 rads.
�Often pharyngectomy is done along
with gastric and colonic transposition.
�Complications are more in this
procedure.
28. 2) UPPER THIRD GROWTH
Treated by radiotherapy
�If it is early and operable,
Mc Keown 3 phased oesophagectomy and
anastamosis is done in the neck
*initially laparotomy- to mobilise stomach
* then thoracotomy- to mobilise
oesophagus
* anastamosis between pharynx and
stomach is done in the neck
30. Laparotomy 🡪 pyloroplasty 🡪 thoracotomy
🡪 growth with tumor is mobilised 🡪
partial oesophagectomy and
oesophagogastric anastamosis in thorax
🡪 Intercostal tube drainage is placed
during closure
• Right gastroepiploic vessels should be
retained
• Azygous vein should be ligated securely
• Mediastinal nodes should be dissected
• Thoracic duct ligated if needed
31. COMPLICATIONS
Complications in this operation are
Pulmonary-broncho pneumonia
-emphyema
Anastomotic leak
Mediastinitis
Oesophagitis
Sepsis
If growth is inoperable-palliative
radiotherapy
32. 4)LOWER THIRD GROWTH:
• Partial oesophago gastrectomy is done
with oesophago gastric anastomosis
Approach-left thoraco abdominal
• Orringer approach:
palliative surgery
i.e,transhiatal blind total oesophagectomy
with anastamosis in the left side of the
neck