The document discusses a case of hepatocellular carcinoma (HCC) in a 68-year-old male patient. Imaging revealed a solitary liver lesion with characteristics of HCC on CT scan. Given the patient's good performance status and the localized nature of the disease, he underwent a right posterior sectionectomy. Histopathology confirmed HCC. The patient recovered well post-operatively without major complications. Surgical resection can provide cure for select patients with HCC, especially when the tumor is localized and the patient's liver function is preserved.
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Kinds of Liver Cancers diagnosis and TreatementsSumit Roy
Wockhardt Hospitals has proved its medical one-upmanship yet again by successfully performing a major liver re-resection on a 58 year old man. In a case of a recurrent cancerous liver tumor which many hospitals worldwide would shirk from taking up for a second surgery, the expert team at Wockhardt Hospitals led by Dr S K Mathur took the challenge and skillfully excised the tumors in an arduous 11- hour surgical procedure
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Kinds of Liver Cancers diagnosis and TreatementsSumit Roy
Wockhardt Hospitals has proved its medical one-upmanship yet again by successfully performing a major liver re-resection on a 58 year old man. In a case of a recurrent cancerous liver tumor which many hospitals worldwide would shirk from taking up for a second surgery, the expert team at Wockhardt Hospitals led by Dr S K Mathur took the challenge and skillfully excised the tumors in an arduous 11- hour surgical procedure
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
Presentation on New Advances in the Treatment of Liver Tumors (Laparoscopic Resections) by Dr. Kimberly Moore Dalal, Surgical Oncology & General Surgery, Peninsula Medical Center.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
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- 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?
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- 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
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New Drug Discovery and Development .....NEHA GUPTA
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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3. Background
The incidence of hepatocellular carcinoma (HCC) has
continued to rise in recent years.
This increase has been attributed to alcohol-induced
liver diseases, metabolic syndrome, and the rising
number of hepatitis B and C viral infections.
Treatment options are evolving. With better
understanding of liver anatomy and physiology surgical
treatment emerges as the main curative option
4. Case Discussion
68 years old male, Diabetic/ hypertensive/ IHD ( on medical
management)
RUQ discomfort - 2-3 months
generalized weakness, fatigue, exertional breathlessness
No addictions, No H/O hepatitis infection.
GPE - pallor ++, BMI-35, otherwise normal, good performance
status
Abdomen examination– unremarkable
6. Investigations
UGI scopy – normal study of stomach
Colonoscopy – small Haemorrhoids. Occasional
uncomplicated left colonic diverticulae +
CT abdomen – for evaluation of bleeding
20. Further Evaluation ?
Tumour markers
AFP – 423 IU/dl
DCP/CEA/CA 19 9 - normal
?Biopsy
Decision on curative treatment
21. Biopsy – to do or not to do!!!!!
Risk of biopsy in liver tumors:
False negative – targetting error
Bleeding
Intrahepatic dissemination
Peritoneal dissemination
When to biopsy??
Resectable lesion – NO BIOPSY
Typical radiological features +/- raised AFP – NO BIOPSY
Atypical radiological features + raised AFP – NO BIOPSY
Atypical radiological features + normal AFP + nonresectable - BIOPSY
22. How to manage this case ?
Diagnosis conformed by Imaging and AFP
25. Which patients should undergo resection?
Performance status
Associated Medical Diseases
Stage of Disease
Size /Number of lesions
Extrahepatic disease
Portal vein status
Functional hepatic reserve
34. TOTAL LIVER VOLUME: 1256 CC
RESIDUAL LIVER VOLUME: 1256-
440CC = 816CC
PERCENTAGE
RESIDUAL LIVER
VOLUME = 64%
35. TOTAL LIVER VOLUME: 1256 CC
TUMOR VOLUME = 220 CC
TOTAL FUNCTIONAL LIVER VOLUME = 1256-220:
1036 CC
RESIDUAL LIVER VOLUME: 1036-440 = 596 CC.
PERCENTAGE RESIDUAL
LIVER VOLUME =
596 / 1036 : 57%
36. Assessment
Patient – Good performance status, fit for surgery; medical
factors well controlled
Disease related – Localised disease; no evidence of spread
Liver Status –rt Posterior sectionectomy, Segment 6,7; Good
residual volume
Facilities – Intraoperative USG; Dissecting tools – Waterjet;
Hemostatic tools – harmonic and Aquamantys
Surgeon and team
40. Post operative Course
No major morbidity
Discharged on Day 6
Follow up- doing well
41. FNAC OR BIOPSY FOR DIAGNOSIS?
Malignant tumours of liver can be confidently
diagnosed on FNAC. However, FNAC has limitations
and diagnostic challenges in benign lesions and well-differentiated
HCC.
Biopsy allows architectural, cellular and
immunohistochemical evaluation.
A combined approach of biopsy with clinical findings,
tumour markers and ancillary techniques is preferred.
43. Results of Biopsy in Suspected HCC
Sensitivity of FNA 67-100%
Specificity of FNA 80-100%
Risk of needle track seeding 2.7% overall, 0.9%/year
Median time for seeding: 17/12 (3-48/12)
Silva MA et al.Gut 2008;57:1592-1596
44. Pathology of HCC
Histopathology of this patient
Prognostic factors
45. Histology of HCC
Well-differentiated HCCs are those where the tumour
cells closely resemble hepatocytes.
Poorly differentiated HCC are those where the
hepatocellular nature of the tumour is not
very evident from the morphology.
46. CORE DATA ITEMS IN PATHOLOGY REPORT
Size
Number
Grade
Vascular invasion
Capsular invasion
Resection margin
Type (fibrolamellar variant better prognosis)
Background liver
Lymph node status
47. Outcome of Surgery
Good risk patient(Non Cirrhotic, Child A CLD)
Disease Status
Surgical expertise
Strict intra op measures – monitoring, less blood loss
Good residual liver volume
Complete resection with good margin
Favourable pathology
48. Take home messages
HCC - increasing diagnosis due to awareness
Should be evaluated by an experienced team –to select
the best treatment option for increased chance of cure
Do not needle all liver lesions!
Age and size of tumour really do not necessarily rule out
curative surgery
A meticulously planned surgery with intraoperative and
perioperative care results in excellent outcome
Treatment should be undertaken at center’s with
experience and facilities