Cervical Screening Program
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Cervical cancer screening is important. Dr. Mahmoud Meleis, who is the chairman of the gynecology department at Alex University, discusses the importance of cervical cancer screening. Regular screening can detect cervical cancer early when it is most treatable.
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2) While a radiation boost can help reduce recurrence risk for patients with positive margins, the absolute benefit is small and does not lower the risk to the level of patients with negative margins.
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This study evaluated the sensitivity of breast MRI for detecting breast cancers. Of 222 cancers, MRI correctly identified 213 but missed 9 cancers (sensitivity of 96.8%). The 7 true false-negatives included 4 DCIS lesions and 3 invasive cancers. False-negative lesions were often small or obscured by surrounding enhancing breast tissue. While MRI is highly sensitive for breast cancer, a small percentage of cancers can be missed, particularly DCIS and cancers in a background of diffuse parenchymal enhancement.
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- Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults and 3.0-8.0% of brain tumors in children, with most children presenting between ages 10-20 years old.
- MRI with gadolinium is used to evaluate pineal region lesions and assess characteristics like size, vascularity and borders, though tumor type cannot be determined reliably from imaging alone.
- Histopathological examination is needed for diagnosis, as germ cell tumors are the most common in children and include germinomas and other tumors derived from totipotential germ cells.
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- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
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Rhabdomyosarcoma is an aggressive and highly malignant form of cancer that develops from skeletal muscle cells that have failed to fully differentiate. It is generally considered to be a disease of childhood, as the vast majority of cases occur in those below the age of 18,with an annual incidence of 4.5 cases per 1 million children, making it the third most prevalent extracranial solid tumor of childhood after neuroblastoma and Wilms tumor.
The first line of treatment for rhabdomyosarcoma typically lasts between five and 12 months. We tailor our treatments to child’s risk group and type of disease. In general, patients in the low-risk group need less therapy than those in the high-risk group, and alveolar rhabdomyosarcoma may need more-intensive therapy than embryonal rhabdomyosarcoma.
Rhabdomyosarcoma treatment usually includes chemotherapy to shrink the tumor and prevent new tumors from forming. Radiation therapy usually begins several months after chemotherapy starts. It’s another effective way of shrinking the tumor. A few patients have surgery after chemotherapy to take out the entire tumor.
Often we do a PET scan after chemotherapy and radiation to see how the tumor responded to the treatments. Study shows that this practice can help predict the chance that the rhabdomyosarcoma will be permanently controlled by chemotherapy and radiation therapy.
We present a case of embryonal rhabdomyosarcoma of anterior mandible of a 11 months old child, with occasional bleeding for 45 days. Incisional biopsy and histopathology revealed it was a case of small round cell tumor with embryonal rhabdomyosarcoma. The pathological tissue was excised from the ant. mandible, the wound site was healing with good facial aesthetics.
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Menopause for the mrcog and beyond, second edition
This document discusses definitions related to menopause and controversies surrounding hormone replacement therapy (HRT). It defines key terms like menopause, perimenopause, and postmenopause. It also outlines the stages of reproductive aging. Two large studies, the Women's Health Initiative (WHI) and Million Women Study, found risks of HRT that led to controversies. The WHI was a randomized clinical trial of over 68,000 women aged 50-79 investigating HRT and other interventions. It found HRT increased risks of breast cancer, stroke, and heart disease and was stopped early.
A to zinc using dietary supplements wisely 3-5-2011
This document provides information on dietary supplements in the United States, including their regulation and safety considerations. It states that over 50% of US adults regularly take dietary supplements, which are most commonly multivitamins, vitamin C, calcium and fish oil. Supplements are less strictly regulated than drugs and manufacturers do not need to prove safety before marketing. Safety tips include checking for interactions, starting one supplement at a time, and being aware that "natural" does not always mean safe. Reliable sources for information on supplements are also provided.
Basic surgical skills final
The document discusses various topics related to surgical procedures including patient positioning, skin preparation, surgical incisions, suturing techniques, and types of sutures and needles. It provides details on different incision types for procedures like laparotomy and their advantages and disadvantages. It also describes characteristics of round-bodied needles, cutting needles, and factors to consider when choosing sutures and needles for procedures.
Uterine Fibroids on Ultrasound
Uterine fibroids, also known as leiomyomas, are benign tumors that grow from the muscular wall of the uterus. They are composed of fibrous tissue and smooth muscle and are the most common uterine tumors. Fibroids are classified based on their location in the uterus, such as submucosal, intramural, subserous, or cervical. Clinical findings of fibroids can include pain, abnormal uterine bleeding, pressure effects on nearby organs, infertility, and spontaneous abortions.
Ctg interpretation and mangment
CTG interpretation involves analyzing fetal heart rate patterns during labor and delivery to monitor fetal well-being. Abnormal or suspicious CTG tracings require closer monitoring and may necessitate changes to the delivery plan or emergency intervention to address fetal distress. Experts recommend additional training and standardized guidelines to improve consistency and accuracy in CTG interpretation.
Iugr update
Intrauterine growth restriction (IUGR) refers to fetal growth that falls below what is expected based on gestational age. It can be symmetric, affecting all body parts equally, or asymmetric, affecting some body parts more than others. Infants with IUGR are at higher risk for perinatal problems like hypoglycemia and hypothermia. The causes of IUGR include maternal, fetal, and placental factors. Evaluation involves physical exam, labs, and imaging to identify the underlying etiology. Management focuses on monitoring postnatal growth and addressing any metabolic complications. Outcomes depend on the specific cause, but IUGR infants may be at risk for neurodevelopmental issues.
Endometriosis by Ultrasound
Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity, which is commonly caused by retrograde menstruation or hormonal imbalances. Common sites of endometrial growth include the ovaries, cul-de-sac, and ligaments near the uterus. Symptoms include painful periods, pain with bowel movements and urination, infertility, and menstrual disturbances. Sonography can detect rounded masses with homogeneous internal echoes and increased through transmission, appearing as endometriomas that may be cystic or solid. Surgical removal is more effective for treatment than hormonal therapy alone.
Sonohysterography
Sonohysterography (SIS) involves inserting a catheter into the uterus and using saline solution to distend the uterine cavity during an ultrasound exam. It allows visualization of the endometrial cavity and identification of polyps, submucous fibroids, and other causes of abnormal uterine bleeding. Studies show SIS has high sensitivity and specificity compared to hysteroscopy and avoids an unnecessary invasive procedure for many patients. SIS is recommended as the next test after an inconclusive transvaginal ultrasound for evaluating abnormal uterine bleeding.
Palm coein clasification
The document discusses the new FIGO classification system for abnormal uterine bleeding (AUB). It introduces the PALM-COEIN system which provides a standardized terminology and classification. The system categorizes AUB into structural causes (polyps, adenomyosis, leiomyoma, malignancy) and non-structural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified). It provides guidelines for evaluation and outlines the notation system for documenting multiple contributing factors to a patient's AUB. The standardized classification aims to improve management of AUB internationally through a unified terminology and focus on appropriate treatment concepts.
Diagnosis and management of endometriosis pathophysiology to practice
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Understand the history and pathophysiology of endometriosis
Understand the critical need for timely diagnosis and effective intervention
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postgraduate tutorial describing the clinical, pathological and treatment aspects of endometriosis involving extragenital organs
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This document discusses postpartum hemorrhage (PPH), defined as blood loss of 500 ml or more after childbirth. It outlines the main risk factors for PPH as the "four Ts" - tone (issues with the uterus), tissue (retained products of conception), trauma (lacerations), and thrombin (coagulation disorders). The document provides guidelines for preventing PPH through routine oxytocin administration after delivery and controlled cord traction. It also describes a stepwise approach for managing PPH, beginning with initial resuscitation and treatment of any atonic uterus or lacerations, and progressing to more invasive local control measures, surgery, or embolization if bleeding remains uncontrolled.
Colposcopy nstrumentation and principles on how to do 22
This document discusses the principles and procedures of colposcopy examinations. It begins by defining a colposcope and its main uses. The most common reason for referral is abnormal cervical screening tests indicating possible precancerous lesions. During the exam, the cervix is examined under magnification with saline, acetic acid, and Lugol's iodine to identify any abnormal white lesions that could indicate precancer or cancer. The document outlines the proper colposcopy instrumentation, examination steps including the principles behind using acetic acid and Lugol's iodine, how to interpret the results, and the importance of thoroughly documenting findings.
Colposcopy technique
This document describes the Modified Reid Colposcopic Index (RCI) scoring system for evaluating cervical lesions seen during colposcopy. The RCI considers 4 criteria: color, margin, blood vessels, and iodine testing response of the lesion. Lesions are given a score of 0-2 for each criterion and the total RCI score helps determine the likely grade of cervical intraepithelial neoplasia, with lower scores indicating CIN1 and higher scores indicating CIN2-3. Examples of different types and grades of cervical lesions seen during colposcopy are also shown.
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Oocyte pick up and Embryo transfer
This document discusses oocyte pick up and embryo transfer procedures. It describes the equipment, techniques, tips, and potential complications for oocyte pick up, which involves using ultrasound-guided needles to aspirate follicles and retrieve oocytes. It also outlines the timing, catheters, techniques, ultrasound guidance, and factors considered for embryo transfer, which involves placing embryos into the uterine cavity. Mock embryo transfers are recommended to practice catheter placement before the real procedure.
Optimal endometrial preparation for frozen embryo transfer cycles
This document discusses optimal endometrial preparation for frozen embryo transfer (FET) cycles. It describes different preparation protocols including natural, modified natural, and programmed artificial cycles. Programmed cycles use estrogen and progesterone supplementation to prepare the endometrium. The document emphasizes identifying the receptive implantation window and the importance of progesterone support. Personalizing FET timing based on endometrial development and reducing uterine contractions with progesterone can improve pregnancy rates. With advances in cryopreservation, FET cycles now often match or exceed the success of fresh cycles.
Stimulation Protocols
This document describes various ovarian stimulation protocols for infertility treatment, including oral medications, injectable medications, and monitoring techniques. It summarizes protocols for natural cycles, mild stimulation, conventional stimulation, antagonist protocols, and protocols for poor responders. Key points include the use of clomiphene citrate, gonadotropins like hMG and rFSH, protocols with and without downregulation, monitoring with ultrasound and hormones, and tailoring the protocol based on ovarian reserve and previous response. The goal is to recruit multiple follicles for retrieval while avoiding overstimulation and maintaining endometrial receptivity.
A failed icsi trial, who is responsib
This document discusses potential causes of failed ICSI trials and responsibilities of different parties. It identifies things the patient, clinician and lab may be responsible for, such as proper medication use, embryo transfer technique, and lab procedures/conditions. The lab sections cover cleanliness, quality control measures, staff roles and responsibilities, and metrics for evaluating IVF/ICSI outcomes. Maintaining proper temperatures, equipment calibration, cleaning, and following protocols are emphasized as important lab responsibilities in achieving successful fertilization and pregnancy.
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This document provides guidelines for obtaining good quality 3D and 4D ultrasound images. It discusses factors such as gestational age, fetal position, amniotic fluid levels, and lack of fetal coverage that can affect image quality. It also outlines how to optimize 2D image parameters before capturing 3D/4D images and adjust 3D/4D parameters like rendering mode, voxel of interest size, angle, threshold, and others. The key is to prepare the 2D image properly and adjust the 3D/4D parameters to focus on the desired region of the fetus with clear boundaries and low noise.
Overian induction protocols for ifc candidates
This document describes various ovarian stimulation protocols for infertility treatment, including oral medications, injectable medications, and monitoring approaches. It discusses:
1) Oral medication protocols using clomiphene citrate or tamoxifen to stimulate follicle growth over 5-7 days.
2) Injectable medication protocols using FSH alone or with LH activity administered via injections over 8-10 days to stimulate multiple follicle growth, monitored by ultrasound and blood tests.
3) "Down regulation" protocols using GnRH agonists or antagonists to prevent premature ovulation, along with FSH injections to stimulate several mature follicles for procedures like IUI, IVF, or ICSI.
Integrated approach to infertility work up
This document outlines an integrated approach to infertility workup. It discusses evaluating the male partner, ovarian function, tubal function, and the uterus. For the male partner, a history, examination, and semen analysis are recommended. Ovarian function is assessed through menstrual history, ultrasound, and hormone levels. Tubal function can be evaluated with HSG, laparoscopy, or hysteroscopy. The uterus is examined with imaging like HSG, ultrasound, or hysteroscopy and potentially endometrial biopsy. A complete workup considers factors from both the male and female partners.
Icsi preparation
This document summarizes evidence-based guidelines for preparing patients for ICSI (intracytoplasmic sperm injection). It discusses evaluating patients' ovarian reserve, investigating uterine cavities, assessing endometrial receptivity, screening for infections, and optimizing lifestyle factors like smoking, alcohol, and weight. Key recommendations include testing ovarian reserve with day 3 FSH and estradiol levels and antral follicle counts, treating any uterine abnormalities found on hysteroscopy or ultrasound, and advising patients to quit smoking and limit alcohol and caffeine intake to improve ICSI success rates.
How to save activity Step by Step
This document contains the steps recorded during a demonstration. The 10 steps show the user clicking and interacting with various windows and elements, such as clicking on links and menus. It cautions the reviewer to check that no private information like passwords were captured before sharing the recording. An additional details section provides technical information to identify the programs and interfaces used.
Prepubertal bleeding
This document defines pre-pubertal bleeding and outlines its causes and approaches to management. It discusses the developmental anatomy and physiology of the genital tract in infants/toddlers, preschoolers, and older children. Common causes of pre-pubertal bleeding include vulvovaginitis, urethral prolapse, lichen sclerosus, foreign bodies, trauma, precocious puberty, and rare tumors. A thorough history, physical exam, and investigations are needed to evaluate the bleeding and identify its cause, which is often a local genital tract lesion but could occasionally be a serious condition like cancer. Careful diagnosis is important for successful treatment.
Gynaecological oncology for the mrcog and beyond, 2e 2
This book provides a concise yet comprehensive overview of gynaecological oncology for those preparing for the MRCOG exam or seeking to further their knowledge. It has been updated from the first edition to reflect recent developments in multidisciplinary care and advanced training. The chapters cover the epidemiology, pathology, diagnosis and management of the main gynaecological cancers according to the latest evidence and standards of care. Additional chapters address related topics such as preinvasive disease, imaging, surgery, radiotherapy, chemotherapy, palliative care and complications. The book serves as a valuable resource for all clinicians involved in the care of women with gynaecological cancer.
Ctg interpretation and mangment
CTG interpretation involves analyzing fetal heart rate patterns during labor and delivery to monitor fetal well-being. Abnormal or suspicious CTG tracings require closer monitoring and may necessitate changes to the delivery plan or emergency intervention to assist the baby. Timely recognition of suspicious CTG patterns and an appropriate clinical response are crucial to avoiding adverse outcomes.
Ctg
This document discusses a CTG (cardiotocography) pattern and fetal heart rate tracing with late decelerations. It also covers the interpretation of the CTG pattern and the management of the case.
Intrauterine growth restriction
Intrauterine Growth Restriction (IUGR) refers to fetuses that are small for their gestational age and display signs of chronic hypoxia or failure to thrive. It occurs in approximately 3-5% of pregnancies and can be caused by fetal, placental or maternal factors that restrict the fetus's growth. Diagnosis involves measuring fetal growth via ultrasound and Doppler to assess blood flow. Management focuses on identifying and treating the underlying cause, optimizing maternal nutrition, and monitoring the fetus for signs of worsening condition or need for delivery. The risks of IUGR include complications for both mother and baby during pregnancy, birth, and long term health issues.
Ovulation induction
1. Clomiphene citrate is commonly used as the first line treatment for ovulation induction, working by depleting estrogen receptors in the brain and inducing a luteinizing hormone surge. It has a success rate of inducing ovulation in 60-80% but the live birth rate per cycle is only around 15%.
2. Aromatase inhibitors like letrozole are sometimes used as an alternative to clomiphene citrate for ovulation induction, working by inhibiting the conversion of androgens to estrogens. They have fewer side effects than clomiphene citrate and may reduce risks of multiple pregnancy and miscarriage.
3. When clomiphene citrate treatment fails, gonad
Malignancy reproduction
This document discusses cancer diagnosis and treatment during pregnancy. It notes that cancer during pregnancy is rare but may increase due to delayed childbearing. Data on outcomes after cancer treatment during pregnancy is limited due to low prevalence, high rates of pregnancy termination, and decisions not to treat during critical fetal periods. The most common cancers seen in pregnancy are breast, hematologic, skin, cervical, ovarian, and colorectal cancers. Radiographic and surgical procedures pose minimal risk after the first trimester. Chemotherapy also poses low risk after the first trimester, though some drugs like alkylating agents carry higher risk. Outcomes of cancer diagnosed and treated during pregnancy are generally similar to non-pregnant patients.
Benign dis of upper g tract
The document discusses benign diseases of the upper genital tract, focusing on fibroids. It defines fibroids as solid benign tumors of the uterus that are most common in women of reproductive age. The document covers the types, locations, and pathological features of fibroids, as well as their potential complications and clinical presentations. Common symptoms include abnormal uterine bleeding, pressure symptoms, and infertility. Secondary changes like degeneration, necrosis, and malignant transformation are also addressed.
Ctg
This document discusses a CTG (cardiotocography) pattern and fetal heart rate tracing with late decelerations. It also covers the interpretation of the CTG pattern and the management of the case.
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