Gastric cancer is a major cause of mortality worldwide. The presentation outlined the epidemiology, risk factors, carcinogenesis, premalignant lesions, pathology, staging, gastric lymphoma, gastrointestinal stromal tumors (GIST), and gastric carcinoids of gastric cancer. Risk factors that increase risk include family history, diet, H. pylori infection, and premalignant conditions like atrophic gastritis and intestinal metaplasia. Gastric cancer is staged using the TNM system evaluating tumor invasion depth, lymph node involvement, and distant metastases. Other tumors of the stomach discussed included gastric lymphoma, GIST, and carcinoid tumors.
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Soft tissue sarcomas, treatment (surgical, radiation, chemotherapy)Joseph A. Di Como MD
A PowerPoint presentation for medical professionals regarding soft tissue sarcomas, likely most helpful to surgical residents and medical students. Gist tumors, liposarcomas, retroperitoneal sarcomas extremity, breast sarcoma and vascular sarcomas
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Soft tissue sarcomas, treatment (surgical, radiation, chemotherapy)Joseph A. Di Como MD
A PowerPoint presentation for medical professionals regarding soft tissue sarcomas, likely most helpful to surgical residents and medical students. Gist tumors, liposarcomas, retroperitoneal sarcomas extremity, breast sarcoma and vascular sarcomas
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
Gallbladder carcinoma is fifth most common gastrointestinal malignancy. Main indication for cholecystectomy is gallstone disease. Majority of gallbladder carcinomas are diagnosed during the course of histopathological evaluation of specimens obtained at cholecystectomy. Accomplishing radical cholecystectomy is advisable in these patients. Technically difficult gallbladder dissection during the course of laparoscopic surgery should raise a high suspicion of malignancy. Specimen retrieval bags should be used in all cases to avoid external spillage of bile giving rise to port side metastasis. A good outcome depends on prompt diagnosis and radical surgical resection. It is essential for a general surgeon to be aware of predisposing factors, pathology, patterns of presentation, and surgical options in gallbladder carcinoma.
Pancreatic cancer is sometimes called a "silent killer" because early pancreatic cancer often does not cause symptoms, and the later symptoms are usually nonspecific and varied. Therefore, pancreatic cancer is often not diagnosed until it is advanced.
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
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
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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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
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
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
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
1. Pathology of gastric cancer
B Y O L A N S O N R E G A S S A ( G S R 1 )
M O D E R A T O R D R . G E L E T A ( A . P R O F E S S O R O F
S U R G E R Y )
D E C 1 1 , 2 0 1 9
8/8/2020 1
3. Introduction
Major cause of mortality worldwide
Poor prognosis with cure rates 5-10%
Imminent curable disease if it detected earlier and
treated adequately
Resectional surgery is the only treatment modality
to cure
8/8/2020 3
12. Benign Gastric Ulcer
confounded by the inclusion of inadequately
biopsied ulcers s as “benign,” when, in fact, they
were malignant.
all should be viewed as malignant until proven
otherwise with adequate biopsy and follow-up.
8/8/2020 12
13. Gastric Remnant Cancer
Develop 10 years after initial operation
Near area of anastomosis
Bile or alkali reflux gastritis is precursor
Common after Billroth II procedure
8/8/2020 13
17. Early gastric cancer
• adenocarcinoma limited to the mucosa (T1a)
and submucosa (T1b)
• 10 %will have lymph node metastases
• 70% are well differentiated, and 30% are
poorly differentiated
• Cure rate is 95%
8/8/2020 17
20. Histology
• There are several histologic classifications of
gastric cancer. 1.WHO
• 2.lauren
• 3.japanese
4.Mings classification system
8/8/2020 20
24. Staging
• The most widespread system for staging of
gastric cancer is the tumor-node-metastasis
(TNM) staging system based :-on depth of
tumor invasion (T)
-extent of lymph node metastases(N),
-presence of distant metastases (M)
8/8/2020 24
27. Concerns of TNM staging
• 1. tumors of GE junction of stomach
•
8/8/2020 27
28. 2). R status Hermanek in 1994
• describe tumor status after resection
• is important for determining the adequacy of
surgery
• R0 microscopically margin negative resection
• R1 removal of all macroscopic disease, but
microscopic margins are positive for tumor
• R2 gross residual tumor
8/8/2020 28
30. GASTRIC LYMPHOMA
• Arise in stomach commonly
• (4%) of stomach tumors,
• nonHodgkin’s B-cell type
• The most characteristic histological feature is tumour
cell infiltration of the epithelium of gastric glands
• Submucosal and difficult for biopsy
8/8/2020 30
32. Pathogenesis : lymphoma
• MALT in the stomach is, in the great majority
of individuals, a reaction to H. pylori infection.
• Lymphoid cells, initially attracted to the
mucosa by H. pylori, slowly accumulate
genetic changes and eventually develop into
an autonomously proliferating, monoclonal, B-
cell lymphoma.
8/8/2020 32
35. Gastrointestinal Stromal Tumors
• most common sarcomatous tumors of the GI tract
• derived from the interstitial cells of Cajal, an intestinal
pacemaker cell.
• usually found in the stomach (40% to 60%), small intestine
(30%), and colon (15%)
• Could present from small benign tumors to massive lesions
with necrosis, hemorrhage, and wide metastases
8/8/2020 35
36. GIST ; pathogenesis
• gain-of-function mutations of the gene
encoding the tyrosine kinase KIT, the receptor
for stem cell factor.(75-85%)
• 8% of GISTs have mutations that activate a
related tyrosine kinase, platelet-derived
growth factor receptor A (PDGFRA
8/8/2020 36
38. • Pathologically, GISTs
have smooth muscle
and
• neuroendocrine
features, consistent
with their origin from
the interstitial cells of
Cajal
• morphology
8/8/2020 38
39. Gastric carcinoid tumor
• Rare malignancy (0.48%)
• Arise from NE precursor cells (ECL)
• Most common site is GIT (60%)
• Stomach is 8% of all NETs
• Has 3 types type
Type I Associated with atrophic gastritis & p.
anemia
Type II associated with ZLE & MEN-1
Type III sporadic tumors , common in men
8/8/2020 39
40. • Pathogenesis :-Hypergasterenimia , low acid
states and NETs
• Classifications :- WHO
-low or intermediate
- high grade w/c resembles SCC lungs-
jejunum
8/8/2020 40
41. • Morphology :-
intramural or
submucosal masses
that create small
polypoid lesion
• elicit an intense
desmoplastic reaction
that may cause
kinking of the
bowel and
obstruction
8/8/2020 41
42. References
1. GLOBOCAN 2018
2. Baily & love short practice of surgery 27th edition
3. Muir's Textbook of Pathology, Fifteenth Edition -
Herrington, Simon C.Netter’s
4. Maingot’s abdominal operations 12th edition
5. Robbins Basic Pathology 10e Robbins
6. Sabiston Textbook of Surgery 20th ed The Biological
Basis of Modern Surgical Practice
7. Schwartz's Principles of Surgery,11th edition
8. Uptodate 2018
9. https://gut.bmj.com/content/45/5/784#F1
8/8/2020 42
it the fifth most frequently diagnosed cancer and the third leading cause of cancer death
9th most common cause of cancer in Ethiopia, 4th most common cause UGI cancer in Sudan
Prevalent in east Asia and south America
More common in males (60%) and elders
Adenocarcinoma accounts for 95%
2/3 rd. is almost distal gastric cancers
(MSI) is the condition of genetic hypermutability (predisposition to mutation) that results from impaired DNA mismatch repair (MMR). The presence of MSI represents phenotypic evidence that MMR is not functioning normally.
pernicious anemia 2-fold increased risk of noncardia gastric
adenocarcinoma and 11-fold increased risk of gastric carcinoid
autoimmune (involves the acid secreting proximal stomach),
hyper secretory (involving the distal stomach), and
environmental (involving multiple random areas at the junction of the oxyntic and antral mucosa)
In complete intestinal metaplasia, the glands and foveolar epithelium are replaced by small intestine type mucosa with goblet cells, eosinophilic enterocytes and a "brush border."
Incomplete type2&3.. Colon.. Gland wz irregular goblet cell
Rx of hpylori regrease metaplasia and chr gts
cell replication zone of the gastric
glands (i.e., the isthmus)
Low grade dysplasia, adenomatous type. (A) Large tubules
resembling colonic adenomas. (B) At higher magnification, the cells have
elongated, closely packed nuclei with dense chromatin. They are confined to
the basal half of the cells and retain their polarity.
Festooned =chained High grade type II (hyperplastic) dysplasia. (A) Closely
packed glands with mild luminal festooning. (B) At higher magnification,
the cells display oval/round open nuclei with prominent nucleoli and
frequent mitoses can be seen. The nuclei reach the apical region of the cells
and their polarity is partially lost.
intestinal type, comprising tubular or glandular formations of cohesive cells
diffuse-type,
composed of scattered clusters of non-cohesive cells which, in this example, contain a large clear mucin vacuole with compressed nuclei,
so-called signet ring cells (arrowed)
Macroscopically, MALT lymphomas are often poorly defined, but higher-grade present as solid ulcerated tumour masses
Te profound gastric acid suppression noted with PPIs has
resulted in hypergastrinemia and gastric NET formation in in
vivo animal studies
Desmoplastic reaction: A reaction that is associated with some tumors and is characterized by the pervasive growth of dense fibrous tissue around the tumor. The formation of scar tissue (adhesion) within the abdomen after abdominal surgery is another type of desmoplastic reaction.
