This document discusses esophageal cancer, including:
- It remains the 6th most common malignancy and rates vary globally. Squamous cell carcinoma is most common.
- Risk factors include smoking, alcohol, hot liquids and micronutrient deficiencies. Barrett's esophagus increases adenocarcinoma risk.
- Symptoms depend on location and stage but include dysphagia, weight loss, pain and cough.
- Diagnostic tools include endoscopy, CT, PET, MRI and EUS to determine stage.
- Treatment involves chemotherapy, radiation, and surgery depending on location and stage. Surgical techniques include transhiatal, Ivor Lewis and minimally invasive approaches.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Carcinoma esophagus is the common cause for dysphagia for solids. These patients usually present too late to do any definitive curative surgical procedure.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
2. • It remains the sixth most common malignancy
• incidence of 160/100,000 in parts of South Africa and China
and 540/100,000 in Kazakhstan.
• India 8-20 / 100,000 , 6th most common in males
• Squamous cell carcinoma still accounts for most
esophageal cancers diagnosed.
• M:F – 3:1 (SCC) .. …..15:1 (adeno)
• Adeno – whites …..SCC – african american
3. Epithelial:
• Squamous Cell Ca.
• Adeno Ca.
• Mucoepidermoid Ca.
• Adenoid Cystic Ca.
• Small Cell Ca.
• Undifferentiated Ca.
Non – Epithelial:
• Leiomyosarcoma.
• Malignant Melanoma.
• Rhabdomyosarcoma.
• Malignant Lymphoma
4. • Squamous cell carcinomas arise from the squamous
mucosa - native to the esophagus - 70% - upper and
middle thirds
• Most common type of esophageal ca in India (90%)
• Smoking and alcohol are common eitiologic factors (5
fold increase in risk)
• Combined increase risk from 25 - 100 folds
5. Dietary
• Nitrosamines (pickled foods , smoked food)
• long term ingestion of hot liquids
• Micronutrient deficiency (Vit. A, B12, C, E).
• Trace Element deficiency (Cobalt, Copper & Selenium).
Acquired
• Cigarette smoking. Alcohol.
• Chronic esophagitis.
• Chronic Dysphagia
• Caustic ingestion
• Radiation exposure
7. • almost 70 % - United States and Western countries.
Etiology :
• Increasing incidence of GERD
• Western diet
• Increased use of acid-suppression medications
Histologically it is from :
• Submucosal glands of the esophagus
• Heterotopic islands of columnar epithelium
• Malignant degeneration of metaplastic columnar epithelium
(Barrett’s esophagus) – 40 fold incresed risk
8. BARRETS OESOPHAGUS :
• Traditionally - the presence of columnar mucosa extending at
least 3 cm into the esophagus.
• Recently - the specialized, intestinal-type epithelium
(presence of goblet cells) found in the Barrett’s mucosa is
the only tissue predisposed to malignant degeneration - the
diagnosis of BE is presently made given any length of
endoscopically identifiable columnar mucosa that proves, on
biopsy
• 10 % of GERD pts develop – BARRETS
• Approx 1 in every 100 patient years of followup of barrets
develop ADENOCARCINOMA (40 fold increased risk)
9. • Early - asymptomatic – mimic GERD
• Dysphagia.
• Weight Loss most common symptoms
• > 2/3rds of lumen has to be obstructed (lack of serosa)
• Vomiting/Regurgitation
• Pain.
• Cough , choking , asp.pneumonia (TEF)
• Hoarseness.(lt.RLN , vocal cords)
• Dyspnoea
10. • In high-incidence areas where screening is practice,the
most prominent early symptom is pain on swallowing
rough or dry food
• Systemic disease – jaundice ,excessive pain ,bone pain,
respiratory symptoms
12. Esophagoscopy :
• Good 1st test – dysphagia &
suspecting ca esophagus
Can differentiate intra luminal
From intramural &
intrinsic from extrinsic
Apple core
appearance
13. Endoscopy :
• Dx of esophageal ca is best made by endoscopic biopsy
Critical points :
• Location of lesion
• Nature of lesion (polypoid etc)
• Extent & relationship
to cricophayngeus ,GEJ
14. CT :
• Imp for staging.
• Chest and abdomen –
Length , thickness, LN
Liver and lung mets , T4
• Accuracy 57% T
74% N , 83% M
• Many unresectable tumors by
CT scan are deemed resectable at the
time of surgery.
15.
16. PET :
• FDG –PET
• Evaluates
Primary mass
LN
Mets
• Sensitivity and specificity
slightly greater than CT
• Not reliable as single Dx tool]
• Value in evaluating response to chemo and RT
17. Figure Distant lymph node metastases of esophageal cancer detected by integrated CT PET. A,
Integrated CT PET demonstrates para-aortic lymph node metastases showing increased FDG
uptake (arrowheads). B, Corresponding CT image shows lymph nodes (arrowheads) measuring 5
to 8 mm in diameter. Based on size criteria, these lymph nodes may be considered benign on CT
scan
18. MRI
• Not done routinely
• To identify involvement of vascular & neural
• Accurately detects T4 and mets
• Overstages T & N status
19. EUS :
can identify
• depth and length of the tumor
• degree of luminal compromise
• status of regional LN &involvement of adjacent structures.
• In addition, biopsy samples - mass and lymph nodes in the
paratracheal, subcarinal, paraesophageal, celiac, lesser
curvature
20.
21. EMR :
• double-channel endoscope with a soft plastic cap at its tip.
The cap is placed over the top of the lesion, suction is applied,
and a snare is brought down over the top of the lesion
• A biopsy specimen of 1 to 1.5 cm will contain mucosa and
submucosa
22. • may also be used as a therapeutic modality for
premalignant and early malignant conditions
23. • Minimal invasive surgical modalities :
• Includes bronchoscopy ,Thoracoscopy and Laparoscopy.
• Highly accurate in evaluating N & M Status.
• Right sided thoracoscopy is usually done.
30. • Tumors confined to
• epithelial layer have no associated LN.
• lamina propria and muscularis mucosae - 5% and 18%
• Superficial and deep submucosal lesions - 50% and 55%
lymph node involvement.
31.
32.
33.
34.
35. • depth of tumor penetration (T stage) affects lymph node
involvement (LNI)
• Intramucosal T1 lesions (18% LNI)
• submucosal T1 lesions (55% LNI)
• T2 lesions (60% LNI)
• T3 lesions (80% LNI)
• Chance if LN <50% - conservative eso resection and limited
lymph node dissection
• LN>50% - neoadjuvant therapy followed by resection
37. • Unlike other malignancies chemo in esophageal and
gastric ca is poorly able to control local and distant
disease
• The best complete response rate for adenocarcinomas is
25% when chemotherapy is given in combination with
radiation.
• Squamous cell cancers respond more favorably
38. • Cisplatin – as single agent - 25 -30 % response rate
• Combination with 5FU – 50% response rate
• Administered once a week for 2 to 10 weeks, up to 8
cycles of chemotherapy are infused.
• The addition of a third agent- mitomycin C, etoposide,
paclitaxel - resulted in some improvement in locoregional
control and short-term survival
39. • A neoadjuvant regimen – induction with cisplatin and
paclitaxel followed by combination chemoradiotherapy with
5-fluorouracil, cisplatin, and paclitaxel and 4500 cGy of
external beam radiation.
• < 4500 cGy are used in neoadjuvant therapy (reduce bleeds
in radiation tissue during surgery)
40. • Factors affecting surgical decision –
1.Location of the tumor
2.Surgical approach
3.Location of the anastomosis
4.Anastomotic technique
5.Type of replacement conduit
6.Position of the conduit
41. • APPROACH TO CERVICAL TUMORS:
• Above the level of carina – scc
• surgery is initiated with endoscopy, bronchoscopy and
cervical exploration
• Non invasion to trachea, spine, larynx, or vessels are
resected primarily
• Tumors near to cricopharyngeus muscle/larynx- 2 to 3cycles
of chemotherapy and RT before resection
• Extension into the thoracic inlet – near total esophageal
resection - transhiatal or transthoracic approach to ensure a
safe and complete resection.
46. Advantages :
• decreased anastomotic leak rate of 3%
• less morbid cervical leak if a leak does occur
• Less mortality when compared with TTE,EBE
• Reduced operative times
• less blood loss
• Cardiorespiratory complications
Disadvantages
• higher rate of postoperative strictures
• Injury to great vessels, airway structures -blind procedure
• inability to perform a complete lymph node dissection
47. TTE :
• 2 incisions –thoracic and abdominal
initiated through an upper midline laparotomy incision
the stomach esophagus are mobilized,
a feeding jejunostomy tube is placed
Patient is repositioned on the right side
48. A thoracotomy incision is made esophagus is mobilized.
The esophagus is transected at the level of the azygos vein
intrathoracic esophagogastric anastomosis is performed
49.
50. EN BLOC ESOPHAGECTOMY:
• most extensive of all esophageal resections -
• addition of a radical thoracic and abdominal
lymphadenectomy
• 3incisions—left neck, right chest, and abdomen
• Rt thoracotomy - esophagus is mobilized - azygos,
hemiazygos &intercostal veins are ligated and divided -
removed en bloc with the specimen
• All mediastinal lymph nodes , diaphragmatic lymph
nodes,lymphatic tissues associated with the thoracic duct are
removed
51. • An upper midline abdominal incision –
• stomach is mobilized.
• radical abdominal lymphadenectomy- includes removal of
paracardial, left gastric, portal, common hepatic, celiac,
splenic, and lesser and greater curvature lymph nodes.
• The gastric conduit is brought up through the posterior
mediastinal space and a cervical esophagogastric
anastomosis is performed – lt cervical incision
52. Advantages :
• Complete loco regional clearance
• increase in 5-year survival- early-stage disease who undergo
EBE as compared with THE
Disadvantages :
• mortality rate of 4.5% & a morbidity rate of 51%
• Most postoperative complications are pulmonary.
• The anastomotic leak rate of 8%
• Very less number of centres are practising
53. VAGAL-SPARING ESOPHAGECTOMY:
• technique varies from THE - without severing the vagus
nerves
• HSV is done and esophageal resection is done
• Results have shown improved gastric function over
esophageal resections that include a vagotomy
• Disadvantage - Incomplete resection of the esophagus
54. MINIMALLY INVASIVE ESOPHAGECTOMY :
• Thoracoscopy or transcervical mediastinoscopy are
substituted for a thoracotomy
• Comparable results
• Less pain and less hospital stay
• Longer learning curves and incomplete resection
55. • For any GI anastomosis - good blood supply and a tension-
free repair required
• Difficult in esophageal anastomosis – most of them –
diabetes,HTN,smokers – compromised blood supply
• The cervical anastomosis - necrosis of the tip of the
tubularized stomach- compromised blood flow - compression
of the conduit in the mediastinum
• An intrathoracic anastomosis has a slightly better chance of
healing when compared with the cervical
• Timing <48 hrs – inadequate arterial blood supply
• 7-9 days – consequence of venous compromise
56. • Conduit of choice – stomach (gastric pull-up)
• Free jejunal flap – microvascular anastamosis with internal
mammary artery
• For longer segments
1. a supercharged jejunal (pedicle flap with an additional
microvascular anastomosis)
2. colonic interposition
• Except in gastric pull-up, for all - additional enteroenteric
anastomosis - increases the risk for leaks
57. • who has no chance for cure or would not withstand surgery
• chemotherapy, radiation therapy, photodynamic therapy, laser
therapy, esophageal stenting, feeding gastrostomy or
jejunostomy, and esophagectomy
58. • The two cell types account for 98% of all malignancies of the
esophagus.
• 2% - unusual tumors
1. neuroendocrine tumors,
2. carcinosarcomas,
3. melanomas,
4. Sarcomas
• In general, epithelial tumors - mid and distal esophagus,
• tumors arising from the deeper layers - evenly distributed
throughout.
59. • These malignant tumors have the potential to spread through
one of four mechanisms:
1. Intraesophageal spread
2. Wall penetration with invasion of adjacent structures
3. Lymphatic spread to regional and distant
4. Hematogenous spread
• All have poor prognosis