This document discusses undescended testes (UDT), beginning with the normal embryological descent of the testes from the abdomen into the scrotum. UDT occurs when this descent is halted and can result in increased risks of malignancy, infertility, torsion and hernia. Clinical presentation of UDT varies depending on whether the testes are palpable or impalpable. Management involves hormonal therapy, imaging, and surgical orchidopexy before age 2 to minimize risks. Complications of UDT include increased risks of testicular cancer, torsion, hernia, and infertility.
1. Undescended Testis : Along the normal path, but not reached scrotum.
2. Retractile Testis : Hyperreflexic Cremaster
3. Ectopic Testis : Deviation from normal path of descent
Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
this presentation covers anatomy of the testis, embryological development, causes, clinical features, complications, differences between various types, investigations, and management of undescended testis.
1. Undescended Testis : Along the normal path, but not reached scrotum.
2. Retractile Testis : Hyperreflexic Cremaster
3. Ectopic Testis : Deviation from normal path of descent
Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
this presentation covers anatomy of the testis, embryological development, causes, clinical features, complications, differences between various types, investigations, and management of undescended testis.
seminar (Undescended testes)
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes Majmaah University
Commonest cause for empty scrotum is undescended testis. Proper education of physicians and parents regarding timing of surgery is mandatory to avoid serious consequences.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
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.
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
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.
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.
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. Introduction
UDT also known as cryptorchism
Failure of the testis to descend normally from the
abdominal cavity into the scrotum
UDT is associated with a variety of potential
consequences:
Malignancy, infertility, torsion of testis, and inguinal
hernia.
Treatment of UDT is aimed at minimising these risks.
4. EMBRYOLOGY
NORMAL DESCENT OF TESTES
Germ cells migrate from yolk sac to genital ridges at
6 weeks
The gonads acquire male or female morphological
in the 7th week of development
By the 8th week of gestation, Leydig cells begin
production of testosterone and sexual
differentiation begins
6. embryology
DESCENT OF TESTES
By the end of 8th week the testes have acquired two
attachments
The caudal genital ligament and the gubernaculum
Descent is believe to be achieved by:
Abdominal descent by the out growth of the extra abdominal
gubernaculum
Inguinal descent by the raising intra abdominal pressure
Regression of the extra abdominal gubernaculum facilitates
descent to the scrotum
7. embryology
FEATURES OF TESTICULAR DESCENCE
The testes will reach the internal ring by 12
weeks, pass through the inguinal canal by 28
weeks and finally in the scrotum by 33 weeks
Endocrine factors probably play a major role in
descent
– Testosterone induces testis descent in humans
– Androgens affect the nuclei of the genitofemoral
nerve to release modulating factors for gubernacular
development
8. embryology
FEATURES OF TESTICULAR DESCENCE
Blood supply from the aorta is maintained with testicular
arteries arising from the lumber region
The testes emerge from the abdominal cavity carrying
with it the abdominal coverings and peritoneum
Peritoneum makes the processus vaginalis
Canal portion of processus obliterates, testicular portion
persists as tunica vaginalis
Gubernaculum atrophies
11. CLINICAL PRESENTATION
UDT occurs in 3% of term male infants and in up
to 33% of premature male infants.
A true UDT has had its descent halted
somewhere along the path of normal descent.
The ectopic UDT has deviated from the path of
normal descent and can be found in the inguinal
region, perineum, femoral canal, penopubic
area, or even the contralateral hemiscrotum.
12. Clinical presentation
A retractile testis is a normally descended testis
that retracts into the inguinal canal as a result of
cremaster muscle contraction.
It can be manipulated down into the scrotum on
examination without tension and will remain in
place
Acquired UDT refers to a testis that was
previously descended on examination and can
no longer be brought down into the scrotum.
14. Clinical presentation
Most common dilemma is distinguishing retractile testis
from one that may or may not descend spontaneously
Maneuvers used: 1. examine boy in crosslegged position,
2. soaping the examiner’s fingers
3. examining in a warm bath
Physical exam is very important to evaluate retractile
testes
– Non-palpable testis is intraabdominal, intracanalicular,
absent
15. To locate the testis is to walk the fingers gently down
the inguinal canal from the internal ring toward the
scrotum, trying to push subcutaneous structures
toward the scrotum.
16. Bilateral UDT requires hormonal evaluation and
challenge
– Elevated gonadotropins (FSH) suggest
bilateral anorchia
– Normal serum gonadotropins=>hCG
challenge (2000 IU x 3days)
– No testosterone response indicates bilateral
anorchia
17. Imaging
Herniography-poor sensitivity and specificity
U/S-good for inguinal testes, not reliable if higher
CT-may be helpful for bilateral impalpable testes
– Difficult to perform in young children
MRI-least invasive, most expensive
– Difficult to perform in young children
18. Imaging
Venography-invasive, pampiniform plexus
present=>testis present
– Non-visualized plexus or blindending does not
eliminate testis
Angiography-difficult to perform, high complications
Overall accuracy of radiologic imaging for UDT = 44%
– PE is 53% - 84%
19. Hormonal Treatment
hCG is given to stimulate Leydig cells to produce
testosterone=>descent of testes
GnRH is given if basal LH is low and abnormality
in GnRH secretion is suspected
20. Surgical Treatment
Basic principles of orchidopexy are: localization,
mobilization, cord dissection, isolation of processus,
tension-free relocation to scrotum
Pexation does not reduce risk of cancer
Orchidopexy should be performed before 2 y.o.
Orchidectomy is an option for post-pubertal males and
dysgenetic testes
21. Standard Orchidopexy
Transverse inguinal incision, watch for testis
Identify testis and divide gubernaculum
Open tunics and evaluate testis
Open external oblique fascia, avoid nerve
Mobilize spermatic cord
Finger dissection to enlarge scrotal cavity medially
Incise scrotal skin, create dartos pouch
22. Standard Orchidopexy contn
Pass clamp through pouch into inguinal area and
bring testis into pouch by gubernaculum or
tunica
Pex testis with 4-0 vicryl sutures
Complications: atrophy, retraction, torsion,
hematoma, nerve or vas injury
24. Complications
Neoplasm and UDT
– 10% of testis CA are in UDT
– UDT is 35-48x more likely to have malignancy
– Abdominal UDT is 4x more likely than inguinal testis to
develop CA
– UDT tumors typically occur around puberty
– CIS occurs in 1.7% of UTD
– Orchiopexy should be performed between 1-1.5 years old
– 1/5 of testis CA in patients w/ hx of UDT occurs in contralateral
testis
– Seminoma is most common CA in UDT
25. Complications contn
Torsion and UDT
– Increased risk for torsion in UDT due to anatomic
abnormality between testis and mesentery
– Incidence is greatest after puberty with increased
testis size
– Be aware of abdominal pain and empty
hemiscrotum=> torsed intra-abdominal UDT
26. Complications contn
Hernia and UDT
Processus vaginalis should obliterate between the 8th
month of gestation and 1st month of life
UDT results in patent processus vaginalis
Hernias are found in 90% of patients w/ UDT
27. Complications contn
Infertility and UDT
Spermatogenesis is retarded by maldescent
Bilateral UDT => poor fertility
Higher UDT => more damage to seminiferous tubules
Earlier orchidopexy may improve chances for recovery
of spermatogenesis
Sperm counts in unilateral UDT are much lower than
normal
– Contralateral testis may also be defective