The document discusses surgical margins in head and neck cancers. It reports that studies have defined an adequate margin as >=5mm and found higher recurrence and lower survival rates with margins <5mm. Mucosal tissue can shrink by 20-25% after resection. While clear margins are >5mm, close margins are generally defined as <=5mm. Even with margins of 5-7mm, patients without adjuvant therapy require close follow-up due to genetic changes that may remain in histologically normal margins.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
8 th edition TNM classification and significance of depth of invasionishita1994
Diagnosis of oral cancer is completed for:
Initial diagnosis
Staging
Treatment planning
A complete history, and clinical examination is first completed, then a wedge of tissue is cut from the suspicious lesion for tissue diagnosis. In this procedure, the surgeon cuts all, or a piece of the tissue, to have it examined under a microscope by a pathologist.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
8 th edition TNM classification and significance of depth of invasionishita1994
Diagnosis of oral cancer is completed for:
Initial diagnosis
Staging
Treatment planning
A complete history, and clinical examination is first completed, then a wedge of tissue is cut from the suspicious lesion for tissue diagnosis. In this procedure, the surgeon cuts all, or a piece of the tissue, to have it examined under a microscope by a pathologist.
Objective: To determine the local incidence and clinical consequences of myoma following intraperitoneal dissemination via morcellation.
Materials and Method: An electronic search for laparoscopic myomectomies from the computer data base of a tertiary hospital and a separate search for sarcoma or myomata with atypical features on National Cancer Registry were carried out for the 10-year study period. The identified cases have their medical records traced, their data extracted and studied in details
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
Minimizing locoregional recurrences in colorectal cancer surgeryApollo Hospitals
Colorectal cancer is a major cause of morbidity and mortality worldwide. The Indian scenario also shows a similar trend, and this has been attributed to the changing dietary patterns. Recurrence in colorectal cancer is associated with many factors, some related to the tumor itself and some to the surgical principles applied. Understanding these factors and application of sound surgical principles can go a long way in decreasing the incidence of colorectal cancer. Here, we highlight the main biological and technical factors implicated in the recurrence of colorectal cancer.
Colon cancer epidemiology, risk factors, and etiology, pathology, screening, diagnosis, workup, staging, treatment, chemotherapy and follow-up.
These slides are selections from the major references in surgery, oncology, and internal medicine. I have tried to gather the information from valid and recently-updated references such as NCCN guidelines and Cancer statistics. I hope it helps!
Objective: To determine the local incidence and clinical consequences of myoma following intraperitoneal dissemination via morcellation.
Materials and Method: An electronic search for laparoscopic myomectomies from the computer data base of a tertiary hospital and a separate search for sarcoma or myomata with atypical features on National Cancer Registry were carried out for the 10-year study period. The identified cases have their medical records traced, their data extracted and studied in details
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
Minimizing locoregional recurrences in colorectal cancer surgeryApollo Hospitals
Colorectal cancer is a major cause of morbidity and mortality worldwide. The Indian scenario also shows a similar trend, and this has been attributed to the changing dietary patterns. Recurrence in colorectal cancer is associated with many factors, some related to the tumor itself and some to the surgical principles applied. Understanding these factors and application of sound surgical principles can go a long way in decreasing the incidence of colorectal cancer. Here, we highlight the main biological and technical factors implicated in the recurrence of colorectal cancer.
Colon cancer epidemiology, risk factors, and etiology, pathology, screening, diagnosis, workup, staging, treatment, chemotherapy and follow-up.
These slides are selections from the major references in surgery, oncology, and internal medicine. I have tried to gather the information from valid and recently-updated references such as NCCN guidelines and Cancer statistics. I hope it helps!
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Cut margins in head and neck cancers.pptx
1. Cut margins in head and neck cancers
• Most studies that specifically define margin
distance use a somewhat arbitrary definition of
=>5 mm to define margin adequacy.
• Chen et al4 reported on 270 consecutive patients
with carcinoma of the oral cavity, oropharynx,
hypopharynx, and larynx, using a defined 5- mm
margin standard. Locoregional recurrence and 5-
year disease-free survival rates were 55% and 7%,
versus 17% and 39%, for patients with
inadequate versus adequate margins,
respectively
2. • Gallo et al27 reported on 253 patients treated
by supracricoid partial laryngectomy, which
included 42 patients with supraglottic cancers.
Here, they defined "positive margins" as
cancer or dysplasia <5 mm, although they
did not further clarify the degree of dysplasia.
3. • Canine studies have demonstrated that
tongue mucosa contracts more than deep
tongue muscle after resection (24.8% vs
20.9%).
• The only study to address margin shrinkage in
patients with head and neck cancer appears to
have measured only mucosal contraction,
which was on the order of 20% to 25%.
4. • These figures providesome rough "rule of
thumb" for surgeons. Surgeons need to place
20% to 25% more tissue between the tumor
and "the blade" to achieve a particular margin
distance.
• Tissue formalin fixation and paraffin
embedding will also add to tissue shrinkage,
but to a lesser degree, on the order of 10%.
5. • Although what is a clear margin and what is an
involved one are intuitive, what lies between
involved and clear, commonly defined as
‘close’, is a concept that is much less clear.
• In general, the National Comprehensive
Cancer Network (NCCN) defines R close as B5
mm without distinction for any subsite in
HNSCC.
6. • Broder’s "grading system," on the basis of the degree
of tumor keratinization, was perhaps the first attempt
at microscopically predicting tumor behavior
• Tumor worst patterns of invasion (WPOI) can be
classified asaggressive if carcinomas contain either
small tumor islands (15 cells) that are separate from
but close to themain tumor mass (WPOI type 4), or
worse yet, if the tumor satellites are dispersed (WPOI
type 5). TheseWPOI have been validated as significant
prognosticators of outcome
7. • First described in 1953, this somewhat
controversial idea is that HNSCCs arise from a
"field" of genetically damaged or
"condemned" mucosa.
8. • The presence of morphologicallyintact but
genetically damaged cells would seem to explain
certain distressing patterns of HNSCC behavior
such as local tumor recurrence after
seemingly"complete" surgical resection with
"negative" margins. A growing lack of confidence
in the pathologist’s ability to recognize the
presence and extent of the neoplastic process in
patients at risk for HNSCC has accelerated a
search for novel biomarkers in the recognition
and treatment of HNSCC, particularly in the
evaluation of surgical margins.
9. • Liao et al. [9, 10] analyzed the survival in oral cavity squamous cell
carcinomas, in relation to pathological margins. They found that, in SCC of
the buccal mucosa, adequate pathological margins are deemed to play a
crucial role in ensuring satisfactory local control and they stated that the
presence of pathological margins B4 mm (close) is an independent
predictor of poor local control and should be treated with adjuvant RT. In
their experience, a close margin B4 mm was an independent risk factor for
local control both for patients treated with surgery alone and for those
treated with surgery plus adjuvant therapy [9]. However, in another article
published by the same authors, they concluded that the optimal
pathological margin for oral cavity squamous cell carcinomas should be[7
mm. Thus, despite a cut-off of 7 mm being the most reliable in their
experience, they concluded that in the case of margins of 4–5 mm,
patients must receive adjuvant therapy, and that for patients who did not
receive postoperative adjuvant therapy, even in the presence of
pathological margins of 5–7 mm, close follow-up examination is
recommended [
10. • Indeed, the presence of genetically altered
cells can be detected in histologically normal
mucosal margins with a variety of strategies
for detecting genetic alterations including
TP53 mutations, loss of heterozygosity,
promoter hypermethylation, eIF4E proto-
oncogene overexpression, and mitochondrial
DNA mutations.
11. • For carcinomas of the glottic larynx, narrow
margins of just 1 to 2 mm seem adequate.
Within the oral cavity 5 mm represents the
most commonly used margin standard.
12. • Based on the best literature evidence
currently available with regard to HNSCC, and
summarizing the data analyzed, the authors
conclude that, in vocal cord surgery, a close
margin could be considered as =<1 mm, in the
larynx as =<5 mm, in the oral cavity as =<4
mm and in the oropharynx as =<5 mm.
13. • Surgical margin affects locoregional control in
such a way that, narrower the surgical margin,
the greater the difference in locoregional control
after treatment. Patients with surgical margin ≤3
mm had a statistically significantly higher risk for
locoregional failure than those with surgical
margin more than 3mm . Recurrence rates for
patients with margins of 3 to 4 mm were identical
to those observed for patients with margins of
5mm . Acc. to Wong LS et al a margin of ≥5mm –
clear,1–5mm – close, <1mm – involved.
14. • Histologically normal margins may harbor underlying
genetic changes, which increase the risk of recurrence.
Genetic alterations identified in HNSCC included over-
expression of eIF4E , TP53 and CDKN2A/P16
proteins.Other alterations included promoter
hypermethylation of CDKN2A/P16 and TP53 mutations.
In addition, promoter hypermethylation of CDKN2A,
CCNAI and DCC was associated with decreased time to
head and neck cancer recurrence. A gene signature can
accurately predict which patients with OSCC are at a
higher risk of disease recurrence