Narrow band imaging (NBI) is an endoscopic imaging technique that enhances visualization of mucosal and vascular patterns. It uses narrow bandwidth illumination in the blue and green wavelengths, which penetrate the mucosa at different depths. This allows visualization of both surface patterns and blood vessels. NBI has been shown to improve detection of dysplasia and early cancer in a variety of gastrointestinal tissues compared to white light endoscopy. Several classification systems have been developed for NBI evaluation of tissues like the esophagus, stomach, and colon.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Management of medullary carcinoma of thyroid - based on latest NCCN and ATA g...Sana Sali
Flow charts with recommendations for Management of medullary carcinoma of thyroid based on latest NCCN guidelines and ATA guidelines. Recent Advances in management included.
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Management of medullary carcinoma of thyroid - based on latest NCCN and ATA g...Sana Sali
Flow charts with recommendations for Management of medullary carcinoma of thyroid based on latest NCCN guidelines and ATA guidelines. Recent Advances in management included.
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
Kudos To You: Learning your Kudo Pit Patterns and Paris Polyp ClassificationsPatricia Raymond
We've told patients that we won't know about their polyps until after the pathology report is back; turns out that's not precisely true. Today's excellence in optics provides an accurate instantaneous assessment of the histology of colon polyps which may help in decision making during colonoscopy.
Did you know that if a polyp has a type 5 Kudo pit pattern, 50% were invasive cancers to the submucosal layer? What is it about that scary polyp that raises your hackles? Join us in this highly interactive session where we'll learn Kudo pit patterns as well as Paris polyp classifications to elevate your GI procedure reporting and your patient care.
Describe the emerging evidence supporting the primary role of Kudo Pit Patterns in visual inspection of in situ polyps, and demonstrate your ability to identify the patterns
Authentication of Kudo Pits
Pits and their risks
Images of Kudo pits
Quiz of Kudo Pits
Discuss the potential and shortcomings of the Paris Polyp Classification, and demonstrate an ability to classify the polyp shape
Polyp shapes and and their risks (pedunculated, elevated, depressed)
Images of polyps for Paris classification
Polyps and their risks
Quiz of polyp shapes
Concerns regarding interobserver variability
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
Kudos To You: Learning your Kudo Pit Patterns and Paris Polyp ClassificationsPatricia Raymond
We've told patients that we won't know about their polyps until after the pathology report is back; turns out that's not precisely true. Today's excellence in optics provides an accurate instantaneous assessment of the histology of colon polyps which may help in decision making during colonoscopy.
Did you know that if a polyp has a type 5 Kudo pit pattern, 50% were invasive cancers to the submucosal layer? What is it about that scary polyp that raises your hackles? Join us in this highly interactive session where we'll learn Kudo pit patterns as well as Paris polyp classifications to elevate your GI procedure reporting and your patient care.
Describe the emerging evidence supporting the primary role of Kudo Pit Patterns in visual inspection of in situ polyps, and demonstrate your ability to identify the patterns
Authentication of Kudo Pits
Pits and their risks
Images of Kudo pits
Quiz of Kudo Pits
Discuss the potential and shortcomings of the Paris Polyp Classification, and demonstrate an ability to classify the polyp shape
Polyp shapes and and their risks (pedunculated, elevated, depressed)
Images of polyps for Paris classification
Polyps and their risks
Quiz of polyp shapes
Concerns regarding interobserver variability
Pancreatic cystic lesions are encountered quite commonly nowadays. How to appraoch them is important as some are bnign and some having malignant potential. EUS helps in characterising them complementing with the CT or MRI
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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
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
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
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Advanced endoscopic imaging
techniques (AEITs)
• Are imaging technologies embedded in gastrointestinal scopes
that allow changing the white-light (WL) image in order to
enhance visualization of the mucosal surface architecture and
microvascular pattern, potentially improving endoscopic
diagnosis.
East JE, Vleugels JL, Roelandt P, Bhandari P, Bisschops R, Dekker E, Hassan C, et al: Advanced endoscopic imaging:
European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2016; 48: 1029–1045.
11. WHITE LIGHT
MANY COLOURS
MANY WAVE LENGTH
MANY PENETRATION
MANY INFORMATION
DIFFICULT TO INTERPRET
NARROW BAND
FEW COLOURS
SHORT WAVELENTH
LIMITED PENETRATION
LIMITED VALUABLE
INFORMATION
LESS CONFUSION AND EASY TO INTERPERT
12. Summary of complex physics
• Two colours blue and green
• Two pattern vascular and surface mucosal
• Colour blind concept so you miss the thing that disturbs you
17. Summarising
.based on penetrating poer of light
.blue light (400 -430 nm) superficicial penetration thus highlights capillaries
Green light (525 – 555 nm ) penetrates deeper and thus provides surface clarity
At the end look for two things
.vascular patterns
.mucosal patterns
18. Oesophagus
NBI allows a better evaluation of mucosal and vascular patterns that
are associated with Barrett oesophagus (BE), dysplasia, and
oesophageal cancer.
19. Squamous Cell Carcinoma
• Useful in both the detection and the characterization of neoplastic
lesions.
• Have a better sensitivity for superficial oesophageal SCC when
compared with WL imaging (97 vs. 55%, p < 0.01)
Inoue H, Kaga M, Ikeda H, Sato C, Sato H, Minami H, Santi EG, et al: Magnification endoscopy in
esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop
classification. Ann Gastroenterol 2015; 28: 41–48.
20. Two ME-NBI classifications are available to estimate
invasion depth in SCC.
•IPCL pattern classification (Inoue classification) and
•Novel classification
21. IPCL classification
• Type I corresponds to normal mucosa
• Type II to inflammation,
• Type III to borderline lesions, i.e., atrophic mucosa or
low-grade intraepithelial neoplasia,
• Type IV to high-grade intraepithelial neoplasia, and
• Type V to invasive carcinoma
25. Novel classification
• Group 1 (nonneoplastic: IPCL types I and II),
• Group 2 (borderline: IPCL types III and IV),
and
• Group 3 (cancer: IPCL type V)
26. Barrett’s oesophagus
• NBI with targeted biopsies improves the diagnosis of
dysplasia when compared to HDWL examination with the
Seattle protocol.
Sharma P, Hawes RH, Bansal A, Gupta N, Curvers W, Rastogi A, Singh M, et al:
Standard endoscopy with random biopsies versus narrow band imaging targeted
biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled
trial. Gut 2013; 62: 15–21.
27. For ME-NBI in BE, four classification systems have
been proposed
• Kansas
• Amsterdam
• Nottingham
• Barrett’s International NBI Group (BING)
28. BING system
• Nondysplastic BE has a circular, tubular, or villous mucosal pattern with
regular vessels,
• Dysplasia is characterized by an irregular or absent mucosal pattern and
vessels not following the normal glandular architecture
Validation studies of this classification
using MENBI showed that the BING
classification can predict the presence or
absence of dysplasia with a high level of
accuracy (> 90%) and very high
interobserver agreement.
Sharma P, Bergman JJ, Goda K, Kato M, Messmann H, Alsop BR,
Gupta N, et al: Development and validation of a classification system
to identify high-grade dysplasia and esophageal adenocarcinoma in
Barrett’s esophagus using narrow-band imaging. Gastroenterology
2016; 150: 591–598.
29. Stomach
• Evaluation of the gastric mucosa with WL correlates poorly with
histological findings, while NBI can improve the correlation with
histology.
• Normal gastric body and antral mucosa have a slightly different
appearance with NBI.
30. Antrum Body
Normal antral mucosa has a coil shaped
appearance of a subepithelial capillary
network
The normal gastric body shows a regular
arrangement of small round pits, surrounded
by a regular capillary network with a
honeycomb appearance
31. Gastric Intestinal Metaplasia, Dysplasia, and Early
Gastric Cancer
For the evaluation of gastric lesions with NBI, three
classifications were proposed
• Simplified classification
• Vessels plus Surface Classification
• Classification of gastric lesions proposed by Li.
32. The simplified NBI classification
• Three different patterns: pattern A is related to normal mucosa, and is
further subdivided into Aa (normal antrum) and Ab (normal gastric
body); pattern B corresponds to intestinal metaplasia; and pattern C
is associated with dysplasia/cancer
• An additional pattern of Hp can be included. If it is positive, a plus
sign is added to the pattern (e.g., pattern Aa+ for Hp gastritis in
normal antral mucosa, pattern B+ for intestinal metaplasia and Hp
infection)
34. • This simplified NBI classification demonstrated to be an
efficient technique for the diagnosis of gastric intestinal
metaplasia and dysplasia (with an accuracy of 83% for
normal histology [pattern A], of 84% for intestinal metaplasia
[pattern B], and of 95% for dysplasia [pattern C])
Pimentel-Nunes P, Libânio D, Lage J, Abrantes D, Coimbra M, Esposito G, Hormozdi D, et al: A multicenter prospective study of
the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions. Endoscopy 2016;
48: 723–730.
35. Vessels plus Surface Classification
Clear border between the suspicious lesion and the
background mucosa (demarcation line)
• if absent, it excludes cancer;
• if present, microvascular and microsurface patterns should be
evaluated.
Kaise M: Advanced endoscopic imaging for early gastric cancer. Best Pract Res Clin Gastroenterol 2015; 29:
575–587.
36.
37. Conclusion
• NBI (with and without magnification) is accurate in the diagnosis of
gastric intestinal metaplasia ,dysplasia, and diagnosis of early gastric
cancer.
Editor's Notes
White light is broad band with primary color and its mixtures
Where as in narrow band imaging only two color is used with narrow range of their wave length
Green colour displayed as red
Blue colour displayed as green and blue
When light enters biological tissue, some reflects off the
surface and some diffuses within the body. Multiple scattering
occurs among light and small particles such as cell nuclei, cell
organelles, and nuclei in the tissue.
The propagation of light is
determined by its wavelength.
While red light diffuses widely and deeply because of its long wavelength, blue light, having a short wavelength, diffuses with a smaller range.
Hb has high affinity for blue and green light
So their use can gives us near to perfect idea on surface mucosal and vascular pattern.
Same concept is used in agriculture where they use NBI to determine ripening of fruits based on chorophyll
Missing signals in traffic lands up in emergency department but here missing unwanted things land up in diagnosis
Rt shows the first ever taken NBI of human toungue
Had problem with brightness
The brightness was improved using high intensity discharge lamp
guide
therapy: group 1 lesions require no treatment, group 2 requires
careful follow-up or therapy, and group 3 definitely
demands therapy.
