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Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in diagnosis of hepatic focal lesions.
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Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in diagnosis of hepatic focal lesions.
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...daranisaha
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely,
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...semualkaira
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
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Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
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Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely, T-lymphoblastic lymphoma(T-LBL) or B-acute...
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Epithelioid hemangioendothelioma is a rare type of angiogenic tumor composed of Epithelioid endothelial cells, which is characterized by potentially malignancy and metastasis potential. It is mainly seen in adults, while very rare in children. Tumor can be found in soft tissue or other parts,such as liver and lung, however it is rare in the kidneys.
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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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Literature and a Case Presentation
1. Clinics of Oncology
ISSN: 2640-1037
Review Article
Critical Role of PET-Scan in Unravelling the Dual Pathology-
Review of Literature and a Case Presentation
Islam MS*
Department of Hematology, Consultant Hematologist, Guy’s Hospital and Queen Elizabeth Hospital, Stadium Road, London, UK
Volume 2 Issue 3- 2019
Received Date: 30 Nov 2019
Accepted Date: 16 Dec 2019
Published Date: 24 Dec 2019
2. Keywords:
Myeloma; Lymphoma; DLBCL;
PET/CT scan; Biopsy
1. Abstract
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare.
Adequate and optimal diagnostic steps including various imaging techniques and histopathological
biopsies are required unpin the exact diagnoses to be able to deliver the best management
strategies. Positron Emission Tomography/Computerised Tomography scan (PET/CT) can be
used to determine the sites of disease with the highest Standardized Uptake Value (SUV) and
hence, the preferred site of biopsy.
3. Introduction
The simultaneous occurrence of two lymphatic malignancies in
one patient is extremely rare with an incidence rate of 1.4–6.5
cases/1,000,000 individuals [8]. Co-existence of MM and other
lymphoid malignancies like Chronic Lymphocytic Leukemia (CLL)
[9], MM and Hodgkin’s Disease (HD) [10], MM and Lympho
Plasmacytic Lymphoma (LPL) [11] has been reported. However,
there are less than 5 reported cases in PubMed of simultaneous
presentation of DLBCL and MM [12].
Diffuse Large B-cell Lymphoma (DLBCL) is the most common
type of Non-Hodgkin Lymphoma (NHL), comprising about 24%
of new cases of NHL [1, 2]. DLBCL is an aggressive NHL which
usually present with rapidly enlarging lymph nodes. Positron
Emission Tomography/Computerised Tomography scan (PET/
CT) can be used to determine the sites of disease with the highest
Standardized Uptake Value (SUV) and hence, the preferred site of
biopsy.
Multiple Myeloma (MM), a plasma cell neoplasm involving
clonal proliferation of terminally differentiated plasma cells and
MM is the second most common hematologic cancer [3]. Unlike
other metastatic bone malignancies, multiple myeloma related
osteolyticbone lesions exhibit no new bone formation [4]. Myeloma
relatedbone disease is one of the main causes of morbidity and
this can be detected on skeletal radiographs, low-dose Whole
Body Computed Tomography (WB-CT), Magnetic Resonance
Imaging (MRI) or PET/CT [5,6]. About 1% to 2% of MM patients
presents with Extrame Dullary Disease (EMD) and an accurate
differentiation of this finding from nodal lymphoma is very crucial
as treatments are very different for these two haematological
cancers [7].
Positron Emission Tomography (PET) scan is a functional
imaging developed in the late 1950s. Radio-labelled glucose
analogue Fluorine-18 Fluorodeoxy-Glucose (F-18 FDG) is the
most frequently used PET tracer and it allows visualization of the
cellular uptake of glucose, which is often up regulated in malignant
neoplasms. FDG-PET has replaced Gallium-67 scintigraphy,
which was previously used to assess the extent and viability of
lymphoma [13, 14]. A major advantage of FDG-PET is the ability
to quantify the level of FDG uptake from PET images and resulting
in a Standardized Uptake Value (SUV). The combined PET and
CT isan important evolution of imaging technique and the CT
component of PET/CT provides anatomical information and PET
component provides tissue metabolic activity. Combined PET/CT
results in a reduced incidence of false-positive and false-negative
PET findings.
*Corresponding Author (s): Md Serajul Islam, Department of Hematology, Consultant He-
matologist, Guy’s Hospital and Queen Elizabeth Hospital, Stadium Road, London, UK, SE18
4QH, E-mail: serajul@doctors.org.uk
Citation: Islam MS Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of
Literature and a Case Presentation Clinics of Oncology. 2019; 2(3): 1-6
clinicsofoncology.com
3. for the coexisting malignancies but studiesusing immunoglobulin
light and heavy chain isotype analysis or genotypic studies
have demonstrated disparate clonal evolutions in concomitant
malignancies. The separate clonal origins indicate DLBCL and
MM evolve independently and not from transformation of a B-cell
clone [19].
Until the early 2000s, lymphoma staging was based mainly on CT
scan as the main imaging modality along with results from clinical
examination and bone marrow biopsy [20]. Since then studies
have shown that combined FDG-PET/CT is superior to FDG-
PET or contrast-enhanced CT as separate imaging procedures
in the staging of lymphoma [21-26]. The 2014 International
Myeloma Working Group (IMWG) criteria for the diagnosis of
MM highlighted the importance of new imaging techniques for
the management of MM in order to early detection of bone disease
as a symptomatic MM criterion requiring treatment even when
asymptomatic[27].Studiesconductedoverrecentyearshaveshown
better performance using low-dose whole-body CT and MRI scans
than standard skeletal radiographs [28, 29]. However PET/CT scan
may be better imaging technique as it can simultaneously show the
functionality of neoplastic cells as well as show their anatomical
position.
A more recent study suggests that PET/CT scan is a reliable
imaging for initial staging, therapeutic monitoring and relapse
workup in MM, especially because of its prognostic potential [30].
PET/CT scan is very useful in evaluating metabolic activity in
malignant tumor. For MM staging PET-FDG allows whole-body
exploration and has 90% sensitivity for the detection of medullary
disease and 70-100% specificity [31-33]. PET scans are shown to
have prognostic importance in myeloma patients as the presence
of at least 3 Focal Lesions (FL) and EMD predicted inferior Overall
Survival (OS) as well as Progression Free Survival (PFS) [34, 35].
The PET scan identifies the location of lymphoma uptake and
distinguishesitfromphysiologicuptakeorothercausesofincreased
FDG uptake i.e. infection, inflammation or any second malignancy
as in our case according to distribution and characteristics of FDG
uptake. PET/CT appears to be very sensitive and highly specific
for detecting NHL in nodal and extra-nodal siteshowever, the
reliability of detection lymphoma in bone marrow involvement is
no consistent [36-39].
However, PET scan findings are usually different between MM
and high grade lymphoma as the latter group shows more intense
FDG uptake than neoplastic cell of MM [40-45]. Moreover, MM
does not usually present with lymphadenopathy. Our patient
had lymphadenopathy as well as there was a differential FDG
uptake between para-spinal mass and the groin lymph nodes
which prompted further investigation in our patient. In this case,
the patient was found to have a second malignancy in the form
of DLBCL which is potentially curable versus myeloma which at
present time is an incurable malignancy. Therapeutic decision
making was complicated by the fact that for these two different
malignancies patients usually receive very different treatment
regimens. However, our patient was treated with a regimen based
on the ReMODL-B trial with excellent response for both MM and
Volume 2 Issue 3 -2019 Review Article
clinicsofoncology.com 3
Figure 1:
Figure: 2
4. NHL [46].
6. Conclusion
PET/CT is an invaluable diagnostic tool that should be
integrated in evaluating lymphoid malignancies, during initial
diagnosis and as subsequent response assessment. The specific
mechanisms underlying the simultaneous presentation of two
B-cell malignancies have yet to be established. Hence, there are
no consistent treatment guidelines. Due to the lack of specific
guidelines management of such should be based on available
evidence and the doctor’s experience, the characteristics of the
patient’s illness and the performance status.
7. Acknowledgement:
Talhah S Bin-Islam for helping with the typing and editing the
manuscript.
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