This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
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
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.
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.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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.
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
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
3. Types of GTDTypes of GTD
BenignBenign
• Hydatidiform mole/molar pregnancyHydatidiform mole/molar pregnancy
(complete or incomplete)(complete or incomplete)
malignantmalignant
• Invasive moleInvasive mole
• Choriocarcinoma (chorioepithelioma)Choriocarcinoma (chorioepithelioma)
• Placental site trophoblastic tumorPlacental site trophoblastic tumor
4. The termThe term Gestational TrophoblasticGestational Trophoblastic
TumorsTumors has been applied the latterhas been applied the latter
three conditionsthree conditions
Arise from the trophoblastic elementsArise from the trophoblastic elements
Retain the invasive tendencies of theRetain the invasive tendencies of the
normal placenta or metastasisnormal placenta or metastasis
Keep secretion of the human chorionicKeep secretion of the human chorionic
gonadotropin (hCG)gonadotropin (hCG)
Types of GTDTypes of GTD
7. Definition and EtiologyDefinition and Etiology
Hydatidiform mole is a pregnancyHydatidiform mole is a pregnancy
characterized by vesicular swelling ofcharacterized by vesicular swelling of
placental villi and usually the absence ofplacental villi and usually the absence of
an intact fetus.an intact fetus.
The etiology of hydatidiform moleThe etiology of hydatidiform mole
remains unclear, but it appears to be dueremains unclear, but it appears to be due
to abnormal gametogenesis andto abnormal gametogenesis and
fertilizationfertilization
8. In aIn a ‘‘complete molecomplete mole’’ the mass ofthe mass of
tissue is completely made up oftissue is completely made up of
abnormal cellsabnormal cells
There is no fetus and nothing canThere is no fetus and nothing can
be found at the time of the firstbe found at the time of the first
scan.scan.
Definition and EtiologyDefinition and Etiology
9. In aIn a ‘‘partial molepartial mole’’, the mass may, the mass may
contain both these abnormal cellscontain both these abnormal cells
and often a fetus that has severeand often a fetus that has severe
defects.defects.
In this case the fetus will beIn this case the fetus will be
consumed ( destroyed) by theconsumed ( destroyed) by the
growing abnormal mass verygrowing abnormal mass very
quickly.quickly. (shrink)(shrink)
Definition and EtiologyDefinition and Etiology
10. IncidenceIncidence
• 1 out of 1500-2000 pregnancies in the1 out of 1500-2000 pregnancies in the
U.S. and EuropeU.S. and Europe
• 1 out of 500-600 (another report 1%)1 out of 500-600 (another report 1%)
pregnancies in some Asian countries.pregnancies in some Asian countries.
• Complete > incompleteComplete > incomplete
11. Repeat hydatidiform moles occure inRepeat hydatidiform moles occure in
0.5-2.6% of patients, and these0.5-2.6% of patients, and these
patiens have a subsequent greaterpatiens have a subsequent greater
risk of developing invasive mole orrisk of developing invasive mole or
choriocarcinomachoriocarcinoma
There is an increased risk of molarThere is an increased risk of molar
pregnancy for women over the age 40pregnancy for women over the age 40
IncidenceIncidence
12. Approximately 10-17% of hydatidiformApproximately 10-17% of hydatidiform
moles will result in invasive molemoles will result in invasive mole
Approximately 2-3% of hydatidiformApproximately 2-3% of hydatidiform
moles progress to choriocarcinomamoles progress to choriocarcinoma
( most of them are curable)( most of them are curable)
IncidenceIncidence
Not definitely benign disease ,Not definitely benign disease ,
has a tight relationship with GTThas a tight relationship with GTT
13.
14. Clinical risk factors for molarClinical risk factors for molar
pregnancypregnancy
Age (extremes of reproductive years)Age (extremes of reproductive years)
<15<15
>40>40
Reproductive historyReproductive history
prior hydatidiform moleprior hydatidiform mole
prior spontaneous abortionprior spontaneous abortion
DietDiet
Vitamin A deficiencyVitamin A deficiency
BirthplaceBirthplace
Outside North America( occasionally hasOutside North America( occasionally has
this disease)this disease)
15. CytogeneticsCytogenetics
Complete molar pregnancyComplete molar pregnancy
Chromosomes are paternal , diploidChromosomes are paternal , diploid
46,XX in 90% cases46,XX in 90% cases
46,XY in a small part46,XY in a small part
Partial molar pregnancyPartial molar pregnancy
Chromosomes are paternal and maternal, triploid.Chromosomes are paternal and maternal, triploid.
69,XXY 80%69,XXY 80%
69,XXX or 69,XYY 10-20%69,XXX or 69,XYY 10-20%
Wrong life message , so can not develop normally
16. Comparative Pathologic Features ofComparative Pathologic Features of
Complete and Partial HydatidiformComplete and Partial Hydatidiform
MoleMole
FeatureFeature Complete MoleComplete Mole Partial MolePartial Mole
KaryotypeKaryotype Usually diploid 46XXUsually diploid 46XX Usually triploidy 69XXX mostUsually triploidy 69XXX most
common.common.
VilliVilli All villi hydropin; noAll villi hydropin; no
normal adjacent villinormal adjacent villi
Normal adjacent villi may beNormal adjacent villi may be
presentpresent
vesselsvessels present they contain nopresent they contain no
fetal blood cellsfetal blood cells
blood cellsblood cells
Fetal tissueFetal tissue None presentNone present Usually presentUsually present
TrophoblastTrophoblast Hyperplasia usuallyHyperplasia usually
present to variablepresent to variable
degreesdegrees
Hyperplasia mild and focalHyperplasia mild and focal
23. Color Dopplor facilitates visualization of the enlarged spiral
arteriesclose proximity to the “ snow storm” appearance
24. Color Doppler image of a hydatidiform mole and surrounding
vessels. The uterine artery is easily identified from its anatomical
location.
25.
26. Dopplor waveform analysis demonstrates low vascular resistance(RI=0.29) in
the spiral arteries, much lower than that obtained in normal early pregnancy
30. Here is a partial mole in a case of triploidy. Note the
scattered grape-like masses with intervening normal-
appearing placental tissue.
31. Large bilateral theca lutein cysts resembling ovarian germ cell
tumors. With resolution of the human chorionic gonadotropin(HCG)
stimulation, they return to normal-appearing ovaries.
32. Signs and Symptoms of CompleteSigns and Symptoms of Complete
Hydatidiform MoleHydatidiform Mole
• Vaginal bleedingVaginal bleeding
• Hyperemesis ( severe vomit)Hyperemesis ( severe vomit)
• Size inconsistent with gestationalSize inconsistent with gestational
age( with no fetal heart beating andage( with no fetal heart beating and
fetal movement)fetal movement)
• PreeclampsiaPreeclampsia
• Theca lutein ovarian cystsTheca lutein ovarian cysts
33. Signs and Symptoms of PartialSigns and Symptoms of Partial
Hydatidiform MoleHydatidiform Mole
• Vaginal bleedingVaginal bleeding
• Absence of fetal heart tonesAbsence of fetal heart tones
• Uterine enlargement andUterine enlargement and
preeclampsia is reported in only 3%preeclampsia is reported in only 3%
of patients.of patients.
• Theca lutein cysts, hyperemesis isTheca lutein cysts, hyperemesis is
rare.rare.
34. Diagnosis of hydatidiformDiagnosis of hydatidiform
molemole
Quantitative beta-HCGQuantitative beta-HCG
Ultrasound is the criterion standard forUltrasound is the criterion standard for
identifying both complete and partialidentifying both complete and partial
molar pregnancies. The classic imagemolar pregnancies. The classic image
is of ais of a ““snowstormsnowstorm”” patternpattern
35. The most common symptom of a mole isThe most common symptom of a mole is
vaginal bleeding during the first trimestervaginal bleeding during the first trimester
however very often no signs of a problemhowever very often no signs of a problem
appear and the mole can only be diagnosed byappear and the mole can only be diagnosed by
use of ultrasound scanning. (rutting check)use of ultrasound scanning. (rutting check)
Occasionally, a uterus that is too large for theOccasionally, a uterus that is too large for the
stage of the pregnancy can be an indication.stage of the pregnancy can be an indication.
NOTE: Vaginal bleeding does not alwaysNOTE: Vaginal bleeding does not always
indicate a problem!indicate a problem!
DiagnosisDiagnosis
37. TreatmentTreatment
Suction dilation and curettageSuction dilation and curettage :to:to
remove benign hydatidiform molesremove benign hydatidiform moles
When the diagnosis of hydatidiform mole isWhen the diagnosis of hydatidiform mole is
established, the molar pregnancy should beestablished, the molar pregnancy should be
evacuated.evacuated.
An oxytocic agent should be infusedAn oxytocic agent should be infused
intravenously after the start of evacuationintravenously after the start of evacuation
and continued for several hours to enhanceand continued for several hours to enhance
uterine contractilityuterine contractility
38. • Removal of the uterus (hysterectomy)Removal of the uterus (hysterectomy)
: used rarely to treat hydatidiform moles if: used rarely to treat hydatidiform moles if
future pregnancy is no longer desired.future pregnancy is no longer desired.
TreatmentTreatment
39. Chemotherapy with aChemotherapy with a
single-agent drugsingle-agent drug
Prophylactic (for prevention)Prophylactic (for prevention)
chemotherapy at the time ofchemotherapy at the time of
or immediately followingor immediately following
molar evacuation may bemolar evacuation may be
considered for the high-riskconsidered for the high-risk
patients( to prevent spread ofpatients( to prevent spread of
disease )disease )
TreatmentTreatment
40. High-risk postmolarHigh-risk postmolar
trophoblastic tumortrophoblastic tumor
1.1. Pre-evacuation uterine size larger than expectedPre-evacuation uterine size larger than expected
for gestational durationfor gestational duration
2.2. Bilateral ovarian enlargement (> 9 cm theca luteinBilateral ovarian enlargement (> 9 cm theca lutein
cysts)cysts)
3.3. Age greater than 40 yearsAge greater than 40 years
4.4. Very high hCG levels(>100,000 m IU/ml)Very high hCG levels(>100,000 m IU/ml)
5.5. Medical complications of molar pregnancy suchMedical complications of molar pregnancy such
as toxemia, hyperthyrodism and trophoblasticas toxemia, hyperthyrodism and trophoblastic
embolization (villi come out of placenta )embolization (villi come out of placenta )
6.6. repeat hydatidiform molerepeat hydatidiform mole
41. Patients with hudatidiform mole arePatients with hudatidiform mole are
curative over 80% by treatment ofcurative over 80% by treatment of
evacuation.evacuation.
The follow-up after evacuation is keyThe follow-up after evacuation is key
necessarynecessary
uterine involution, ovarian cystuterine involution, ovarian cyst
regression and cessation of bleedingregression and cessation of bleeding
Follow-upFollow-up
42. Quantitative serum hCG levels shouldQuantitative serum hCG levels should
be obtained every 1-2 weeks untilbe obtained every 1-2 weeks until
negative for three consecutivenegative for three consecutive
determinations,determinations,
Followed by every 3 months for 1Followed by every 3 months for 1
years.years.
Contraception should be practicedContraception should be practiced
during this follow-up periodduring this follow-up period
Follow-upFollow-up
44. DefinitionDefinition
This term is applied to a molarThis term is applied to a molar
pregnancy in which molar villi growpregnancy in which molar villi grow
into the myometrium or its bloodinto the myometrium or its blood
vessels, and may extend into thevessels, and may extend into the
broad ligament and metastasize to thebroad ligament and metastasize to the
lungs, the vagina or the vulva.lungs, the vagina or the vulva.
45. Invasive mole: the tissue invades into the myometrial layer.
No obvious borderline, with obvious bleeding.
47. A case of invasive mole: inside the uterine cavity the typicalA case of invasive mole: inside the uterine cavity the typical
““snow stormsnow storm”” appearance can be detected, The location ofappearance can be detected, The location of
blood flow suggest an invasive mole.blood flow suggest an invasive mole.
48. The same patient owing to the myometrial invasion.The same patient owing to the myometrial invasion.
Reduced vascular resistance is detected in the uterine artery.Reduced vascular resistance is detected in the uterine artery.
49. Transvaginal color Doppler scan of a patient with invasive mole Following
uterine curettage, Persistent color signals within the myometeriun
55. DefinitionDefinition
A malignant form of GTD which canA malignant form of GTD which can
develop from a hydatidiform mole ordevelop from a hydatidiform mole or
from placental trophoblast cellsfrom placental trophoblast cells
associated with a healthy fetus ,anassociated with a healthy fetus ,an
abortion or an ectopic pregnancy.abortion or an ectopic pregnancy.
56. Characterized by abnormalCharacterized by abnormal
trophoblastic hyperplasia andtrophoblastic hyperplasia and
anaplasia , absence of chorionic villianaplasia , absence of chorionic villi
DefinitionDefinition
62. Symptoms and signsSymptoms and signs
• BleedingBleeding
• InfectionInfection
• Abdominal swellingAbdominal swelling
• Vaginal massVaginal mass
• Lung symptomsLung symptoms
• Symptoms from other metastasesSymptoms from other metastases
63. WHO Prognostic Scoring SystemWHO Prognostic Scoring System
ScoreScore
Prognostic factorPrognostic factor 00 11 22 44
Age(years)Age(years) ≤≤3939 >39>39 —— ——
Pregnancy historyPregnancy history
HydatidiformHydatidiform
molemole
Abortion,Abortion,
ectopicectopic
TermTerm
pregnancypregnancy
——
Interval (months) ofInterval (months) of
treatmenttreatment
<4<4 4-64-6 7-127-12 >12>12
Initial hCG(mIU/ml)Initial hCG(mIU/ml) <10<1033
101033
-10-1044
101044
-10-1055
>10>1055
Largest tumor(cm)Largest tumor(cm) <3<3 3-53-5 >5>5 ——
Sites of metastasisSites of metastasis LungLung
Spleen,Spleen,
kidneykidney
GI tract, liverGI tract, liver BrainBrain
No. of metastasisNo. of metastasis —— 1-41-4 4-84-8 88
Previous (treatment)Previous (treatment) —— —— Single drugSingle drug 2 or more2 or more
0-4 low risk, 5-7 intermediate risk, >8 high risk for death
64. FIGO Staging System for GestationalFIGO Staging System for Gestational
Trophoblastic TumorsTrophoblastic Tumors
StageStage DescriptionDescription
ⅠⅠ Limited to uterine corpusLimited to uterine corpus
ⅡⅡ Extends to the adnexae, outside the uterus,Extends to the adnexae, outside the uterus,
but limited to the genital structuresbut limited to the genital structures
ⅢⅢ Extends to the lungs with or without genitalExtends to the lungs with or without genital
tracttract
ⅣⅣ All other metastatic sitesAll other metastatic sites
65. Substages assigned for each stage asSubstages assigned for each stage as
follows:follows:
A: No risk factors presentA: No risk factors present
B: One risk factorB: One risk factor
C: Both risk factorsC: Both risk factors
Risk factors used to assign substages:Risk factors used to assign substages:
1. Pretherapy serum hCG > 100,0001. Pretherapy serum hCG > 100,000
mlU/mlmlU/ml
2. Duration of disease >6 months2. Duration of disease >6 months
FIGO Staging System for GestationalFIGO Staging System for Gestational
Trophoblastic TumorsTrophoblastic Tumors
70. Diagnosis andDiagnosis and
evaluationevaluation
Gestational trophoblastic tumor isGestational trophoblastic tumor is
diagnosed by rising hCG followingdiagnosed by rising hCG following
evacuation of a molar pregnancy orevacuation of a molar pregnancy or
any pregnancy eventany pregnancy event
Once the diagnosis established theOnce the diagnosis established the
further examinations should be donefurther examinations should be done
to determine the extent of disease ( X-to determine the extent of disease ( X-
ray, CT, MRI)ray, CT, MRI)
72. Treatment of NonmetastaticTreatment of Nonmetastatic
GTDGTD
Hysterectomy is advisable as initial treatment inHysterectomy is advisable as initial treatment in
patients with nonmetastatic GTD who no longerpatients with nonmetastatic GTD who no longer
wish to preserve fertilitywish to preserve fertility
This choice can reduce the number of courseThis choice can reduce the number of course
and shorter duration of chemotherapy.and shorter duration of chemotherapy.
Adjusted single-agent chemotherapy at the timeAdjusted single-agent chemotherapy at the time
of operation is indicated to eradicate any occultof operation is indicated to eradicate any occult
metastases and reduce tumor dissemination.metastases and reduce tumor dissemination.
73. Single-agent chemotherapy is the treatment ofSingle-agent chemotherapy is the treatment of
choice for patients wishing to preserve theirchoice for patients wishing to preserve their
fertility.fertility.
Methotrexate(MTX) and Actinomycin-D areMethotrexate(MTX) and Actinomycin-D are
generally chemotherapy agentsgenerally chemotherapy agents
Treatment is continued until three consecutiveTreatment is continued until three consecutive
normal hCG levels have been obtained and twonormal hCG levels have been obtained and two
courses have been given after the first normalcourses have been given after the first normal
hCG level.hCG level.
Treatment of NonmetastaticTreatment of Nonmetastatic
GTDGTD
To prevent relapse or metastasisTo prevent relapse or metastasis
74. Single-agent chemotherapy with MTX or actinomycin-Single-agent chemotherapy with MTX or actinomycin-
D is the treatment for patients in this categoryD is the treatment for patients in this category
If resistance to sequential single-agent chemotherapyIf resistance to sequential single-agent chemotherapy
develops, combination chemotherapy would be takendevelops, combination chemotherapy would be taken
Approximately 10-15% of patients treated with single-Approximately 10-15% of patients treated with single-
agent chemotherapy will require combinationagent chemotherapy will require combination
chemotherapy with or without surgery to achievechemotherapy with or without surgery to achieve
remissionremission
Treatment of Low-RiskTreatment of Low-Risk
Metastatic GTDMetastatic GTD
75. Multiagent chemotherapy with or withoutMultiagent chemotherapy with or without
adjuvant radiotherapy or surgery should beadjuvant radiotherapy or surgery should be
the initial treatment for patients with high-ristthe initial treatment for patients with high-rist
metastatic GTDmetastatic GTD
EMA-CO regimen formula is good choice forEMA-CO regimen formula is good choice for
high-rist metastatic GTDhigh-rist metastatic GTD
Adjusted surgeries such as removing foci ofAdjusted surgeries such as removing foci of
chemotherapy-resistant disease, controllingchemotherapy-resistant disease, controlling
hemorrhage may be the one ofhemorrhage may be the one of treatmenttreatment
regimenregimen
Treatment of High-RiskTreatment of High-Risk
Metastatic GTDMetastatic GTD
76. EMA-CO Chemotherapy for poorEMA-CO Chemotherapy for poor
Prognostic DiseasePrognostic Disease
Etoposide(VP-16)Etoposide(VP-16) 100mg/M100mg/M22
IV daily×2 daysIV daily×2 days
(over 30-45(over 30-45
minutes)minutes)
MethotrexateMethotrexate 100mg/M100mg/M22
IV losding dose,IV losding dose,
then 200mg/M2 overthen 200mg/M2 over
12 hours day 112 hours day 1
Actinomycin DActinomycin D 0.5mg0.5mg IV daily×2 daysIV daily×2 days
Folinic acidFolinic acid 15mg IM or p.o. q 12 hours×4 starting 2415mg IM or p.o. q 12 hours×4 starting 24
hours after starting methotrexatehours after starting methotrexate
CyclophosphamideCyclophosphamide 600mg/M600mg/M22
IV on day8IV on day8
Oncovin (vincristine)Oncovin (vincristine) 1mg/M1mg/M22
IV on day8IV on day8
(Repeat every 15 days as toxicity permits)(Repeat every 15 days as toxicity permits)
77. PrognosisPrognosis
Cure rates should approach 100% inCure rates should approach 100% in
nonmetastatic and low-risk metastaticnonmetastatic and low-risk metastatic
GTDGTD
Intensive multimodality therapy hasIntensive multimodality therapy has
resulted in cure rates of 80-90% inresulted in cure rates of 80-90% in
patients with high-risk metastatic GTDpatients with high-risk metastatic GTD
78. Follow-up AfterFollow-up After
Successful TreatmentSuccessful Treatment
Quantitative serum hCG levels should beQuantitative serum hCG levels should be
obtained monthly for 6 months, every twoobtained monthly for 6 months, every two
months for remainder of the first year,months for remainder of the first year,
every 3 months during the second yearevery 3 months during the second year
Contraception should be maintained for atContraception should be maintained for at
least 1 year after the completion ofleast 1 year after the completion of
chemotherapy. Condom is the choice.chemotherapy. Condom is the choice.
80. Placenta Site Trophoblastic Tumor is anPlacenta Site Trophoblastic Tumor is an
extremely rare tumor that arised from theextremely rare tumor that arised from the
placental implantation siteplacental implantation site
Tumor cells infiltrate the myometrium andTumor cells infiltrate the myometrium and
grow between smooth-muscle cellsgrow between smooth-muscle cells
DefinitionDefinition
81.
82. Surum hCG levels are relatively lowSurum hCG levels are relatively low
compared to those seen withcompared to those seen with
choriocarcinoma.choriocarcinoma.
Several reports have noted a benignSeveral reports have noted a benign
behavior of this disease. They are relativelybehavior of this disease. They are relatively
chemotherapy-resistant, and deaths fromchemotherapy-resistant, and deaths from
metastasis have occurred.metastasis have occurred.
Surgery has been the mainstay of treatmentSurgery has been the mainstay of treatment
Dignosis and treatmentDignosis and treatment
Editor's Notes
Platlete bone marrow
because the diagnosis and decision to institute treatment are often undertaken without knowledge of the history
Triploid : has three set of chromsomes
This method does not answer the question of whether the mole is invasive ,or its potential malignancy
Scattered: some parts of them are
Polyhy’dramnios
Prophylactic (for prevention)
trophoblastic embolization (villi come out of placenta and locate in brain or lungs to block blood flow)
CT Conouted tomography
additional two courses should be given To make disease stable
Oral contraceptives may interfere with the accurate measurement of hCG