Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
The prognosis of most peritoneal surface malignancies were previously dismal. However, with the incorporation of HIPEC to standard of care, we have been seeing doubling of survival for select malignancies. Appropriate patient selection is crucial.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
The prognosis of most peritoneal surface malignancies were previously dismal. However, with the incorporation of HIPEC to standard of care, we have been seeing doubling of survival for select malignancies. Appropriate patient selection is crucial.
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Artery first approach For Pancreatic Head tumours by Dr Harsh Shah (www.gastr...Dr Harsh Shah
Artery first approach to Pancreatic head tumour. There are various approaches as described in this presentation. Pros & Cons of all approaches are discussed.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Artery first approach For Pancreatic Head tumours by Dr Harsh Shah (www.gastr...Dr Harsh Shah
Artery first approach to Pancreatic head tumour. There are various approaches as described in this presentation. Pros & Cons of all approaches are discussed.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Chemotherapy Combined with Intraperitoneal Perfusion Chemotherapy for Gastric...Ross Finesmith M.D.
Gastric cancer is a common cancer with relatively poor survival rates. Early detection improves survivability, but clinical symptoms often do not present until late stages of the disease. Gastric resection and intravenous chemotherapy are the current accepted standard treatment. Intraperitoneal chemotherapy has been utilized in other abdominal cancers with moderate success. This systematic meta-analysis included randomized control studies that compared gastric cancer outcome data between post-operative subjects that received intravenous chemotherapy alone vs those that received intravenous plus intraperitoneal chemotherapy.
Cette présentation faite le 27 Avril 2017 à l'Hôpital Saint Joseph organisée par le Dr Vincent de Parades fait le point sur les nouvelles approches multidisciplinaires dans la prise en charge des cancers colorectaux en insistant sur la prise en charge de la maladie métastatique hépatique et de la carcinome péritonéale pour terminer sur les nouvelles approches par immunothérapie. Cette EPU a connu un large succès d'audience avec plus de 60 participants. Merci à toutes et tous.
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
Assessing the efficacy of targeted therapy using circulating epithelial tumor...Peter Pachmann
Abstract
Purpose In malignant tumors, predictive markers have been developed with respect to targeted therapies. One of the Wrst targeted therapies was the hormone-blocking treatment of tumors of the male and female reproductive system. A typical therapy in breast cancer is the use of the selective estrogen receptor modulator, tamoxifen. However, only some of the patients, positive for the target molecules, respond to the selected therapy. It would, therefore, be highly desirable to have a tool to promptly assess the therapeutic eYcacy of the applied agent in the individual patient.
Methods Longitudinal observation of CETC provides a unique tool for monitoring therapy response. About 178 patients with breast cancer were followed prospectively during hormone therapy, requiring only 1 ml of peripheral blood, using a Xuorochrome-labeled antibody against surface- epithelial antigen. Image analysis allowed CETC numbers to be calculated in relation to blood volume and monitoring over the entire course of treatment. Results A more than tenfold increase in CETC during therapy was a strong indicator of looming relapse (P = 0.0001 hazard ratio 5.5; 95% conWdence interval 1,297–23,626), and a Cox regression analysis of age, tumor size, receptor expression, nodal status and previous treatment resulted in a regression model, in which CETC behavior was the parameter with the highest independent correlation to relapse-free survival. Conclusions The change in the number of CETC (increase or decrease) may, in the future, be used to guide therapy in order to change to other available treatment options in good time.
Breast surgery for Metastatic Breast Cancer : Cochrane Analysis Kundan Singh
Breast surgery plus systemic treatment may improve local PFS when compared to systemic treatment alone (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; I2 = 43%; low quality evidence)
The group receiving breast surgery plus systemic treatment probably had a shorter time
to distant PFS compared to the group receiving systemic treatment alone (HR 1.42, 95%CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence)
Advantages of Cervicofial flaps :
Operative time is short.
It causes minimum deviations in relations to important structures around cheek.
reduce surgical risk in high risk patients like old age, diabetic patients, un-controlled hypertension
It can provide excellent skin colour and texture match.
Study of the distribution and determinants of
health-related states or events in specified populations and the application of this study to control health problems.
John M. Last, Dictionary of Epidemiology
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Evaluation of POSSUM scoring system in patients with perforation peritonitis ...Kundan Singh
Background: Continuous audit of clinical practice is an essential part of making improvements in medicine and
enhancing patient care. Recently, physiological and operative severity score for the enumeration of mortality and
morbidity (POSSUM) scores has been developed, which would help to identify those patients who are at increased
risk of developing complications and deaths. This scoring system is based on 12 physiological characteristics of
patient and 6 characteristics of the surgery performed.
Methods: This study was done in Department of surgery at Patna medical college, Patna, Bihar, India from April
2014 to October 2015 on 100 patients. Physiological variables were collected prior to induction of anesthesia and
operative variable collected during operation chi-square test was used for expected and actual mortality differences.
Results: In present study 100 patients of peritonitis due to different cause of intestinal perforation were studied.
Comparison of observed and POSSUM predicted mortality and morbidity rates were done. Observed to expect
mortality and morbidity ratio was 1.005 and 1.001 respectively and there was no statistically significant difference
between the predicted and observed values.
Conclusions: This study confirms and validates the findings of previous work that POSSUM is an accurate and
reliable tool for estimating in-hospital mortality.
multilobed spleen : A case report
The spleen plays multiple supporting roles in the body. It is a vital organ for the functioning
of immune system. It acts as a filter for blood as part of the immune system. Old red blood
cells are recycled in the spleen, and platelets and white blood cells are stored there. It can
have a wide range of congenital anomalies including its shape, location, number, and size.
Although most of these anomalies are congenital, there are also acquired types. Multilobed
spleen is one of such condition. It is most commonly detected during abdominal surgeries.
Since they are bigger in size than the normal spleen, they are more pre disposed to trauma. In
this case report we have presented such a case of multi lobed spleen, which was detected
incidentally during exploratory laprotomy for blunt trauma abdomen with hemoperitoneum
A retrospective study of outcome of intraoperative gallbladder perforation du...Kundan Singh
Abstract:
Background: During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently while gallbladder is being dissected from liver bed or while extracting it through the port site. In this retrospective study we have studied the case files of the patients who underwent laproscopic cholecystectomy and had intraoperative gallbladder perforation and had studied its effect on outcome of the surgery.
Material & method: This is a retrospective done at patna medical college and hospital in January 2016 in which the patients records of 310 patients of laproscopic cholecystectomy from January 2015 to December 2015 were studied. The incidence of perforation, duration of operation and the post-operative complications were noted and the data obtained was analysed
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
3. • The earliest known use of hyperthermia to
treat cancerous tissue was by the Ancient
Greeks, Romans, and Egyptians around 2000
BC.
• Presently, hyperthermia is divided into the
following three categories: local,regional/part-
body, and whole body.
• However, clinical results by HT alone have not
always been satisfactory.
4. • The most striking cellular changes in response
to HT are the disruptions of cytoskeletal
structures.
• Exposure of cells to heat stress leads to
protein denaturation and aggregation in the
cells, assuming that the accumulation of
unfolding proteins is the signal which initiates
the heat-shock response.
5.
6.
7. • Hyperthermia produced an increased number of
lysosomes and lysosomal enzyme activity in malignant
cells, resulting in enhanced cancer cell destruction.
• HIPEC had following advantages
1) direct impairment against cancer cells
2) enhancement of the cytotoxicity of chemotherapy
3) inhibition of angiogenesis
4) improvement in denaturation of proteins
5) great tolerance without additional adverse effect
8.
9. • Systemic chemotherapy has little effect on PM
because the blood-peritoneal barrier (BPB)
impedes the penetration of drugs from the
systemic circulation into the peritoneal cavity.
• Intraperitoneal (IP) chemotherapy
concentrates drugs locoregionally in the
peritoneal cavity to a greater extent than does
systemic chemotherapy.
10.
11.
12.
13. • Gynaecologic Oncology Group-
debulking to zero residual disease (RD0);
optimal debulking (0-10mm, RD1);
suboptimal debulking (>10mm, RD2).
14. Table : PCI cutoff levels and 5-year survival rates in patients with peritoneal metastases, treated at
Peritoneal Surface Malignancy Treatment Centers belonging to Japanese NPO to support peritoneal
surface malignancy treatment
Source : Y. Yonemura et al. Hyperthermic Oncology from Bench to Bedside
15.
16. • Epithelial ovarian cancer has a marked
propensity for peritoneal spread, which makes
it suitable for aggressive loco-regional
therapies.
• 5-year survival rate of less than 30%
17.
18. For CRS alone, the DESKTOP OVAR Trial showed that macroscopically
completely resected tumours showed significantly longer overall
survival compared to patients who had any visible residual tumour.
[median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence
interval (CI) 2.27-6.05; P < .0001]
19.
20. • Survival of ovarian cancer patients treated with cytoreductive
surgery and perioperative intraperitoneal chemotherapy
21. Morbidity, hospital stay and mortality for patients with ovarian cancer treated with
cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy
22.
23. • 429 patients who underwent randomization, 415 were
eligible.
• Grade 3 and 4 pain, fatigue, and hematologic,
gastrointestinal, metabolic, and neurologic toxic effects
were more common in the intraperitoneal-therapy group
than in the intravenous- therapy group (P ≤ 0.001).
• The median PFS in the intravenous-therapy and
intraperitoneal-therapy groups was 18.3 and 23.8 months,
respectively (P = 0.05 by the log-rank test).
• The median duration of OS in the intravenous-therapy and
intraperitonealtherapy groups was 49.7 and 65.6 months,
respectively (P = 0.03 by the log-rank test).
24.
25.
26. • In this meta-analysis, comparative clinical
trials were included.
• Experimental group - patients who were
treated with CRS + hyperthermic
intraperitoneal chemotherapy (HIPEC),
• Control group - the patients treated with
traditional treatment without HIPEC
27.
28.
29. Pooled data demonstrated that there was an improvement in OS HIPEC groups
compared with the groups without HIPEC treatment in all population (HR = 0.54,95%
CI:0.45 to 0.66,)
32. • The current meta-analysis demonstrated that
the HIPEC not only improved OS significantly
but also prolonged the PFS in all population.
• Subgroup analysis indicated that HIPEC was
associated with better clinical outcome
whether primary or recurrent patients. Even
stage III or IV ovarian cancer patients could
benefit from HIPEC.
33. • In conclusion, there is an emerging body of
evidence that supports the use of HIPEC with CRS
and systemic chemotherapy for primary and
recurrent EOC compared to CRS and
chemotherapy alone.
• Maximal cytoreduction remains essential for
overall survival rates, even when HIPEC is used.
• In both primary and recurrent EOC treated with
HIPEC+CRS, the importance of complete
cytoreduction remains vital for long-term survival
outcomes.