This document provides information about grossing nephrectomy and prostatectomy specimens. It describes the surgical anatomy of the kidney and prostate. For nephrectomy specimens, it outlines the steps for grossing radical and partial nephrectomy specimens, including describing the tumor, examining lymph nodes, and determining sections to submit. For prostatectomy specimens, it discusses transurethral resection of the prostate, radical prostatectomy, and steps for grossing including describing any tumors, sections of the seminal vesicles and lymph nodes to submit.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
The Kidney cancer also called renal cancer. It's a disease in which kidney cells become malignant and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubules in the kidney. This type of kidney cancer is called renal cell carcinoma.
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
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.
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
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In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
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2. KIDNEY:INTRODUCTION
Nephrectomy specimens are most important in
view of Renal cell carcinoma which is most
common primary malignant tumour of kidney.
Classification of kidney neoplasms is based on
combination of histological,genetic and
immunohistochemical features.
3. Surgical Anatomy:
Kidneys are paired abdominal organs situated on each
flanks retroperitoneally.
Normal adult kidney measurements:
10 to 13cm long
5 to 7.5 cm wide
150grams weight
#Each kidney enclosed in transparent membrane called
RENAL CAPSULE.
One side of kidney is convex and other side is concave
indented,giving it a bean shape appearance.
4.
5. On cutting,kidney Is divided into two main areas:
Renal cortex-lighter outer area
Renal medulla- Darker inner area
Within medulla there are cone shape sections known as RENAL
PYRAMIDS.
Area between renal pyramids called RENAL COLUMNS.
Collecting system of is comprised of minor and major calyces
which finally joins to form PELVIS which continues as URETER.
RENAL SINUS: concave cavity within kidneyoccupied by renal
pelvis,renal calyces,blood vessels,nerves and fat.
10. RADICAL NEPHRECTOMY
Radical nephrectomy consists of Kidney,most of
the Ureter,Renal vein and artery,perinephric fat
and Gerota’s fascia.
Adrenal gland may or may not present.
11.
12. PARTIAL NEPHRECTOMY
Partial nephrectomy is
usually performed for
clinical stage T1a tumour
Vascular and ureteral
structures generally do
not accompany partial
nephrectomy specimens.
Perinephric soft tissue will
also usually not be
included.
16. STEPS IN GROSSING:
Firstly establish the
size,location and
completeness of
resection of tumour
with respect to 3
regions:
Kidney
Renal Hilum
Perinephric tissue
17. RADICAL NEPHRECTOMY
1# Weigh measure entire specimen.
2# Don’t strip off perinephric tissue and renal capsule until their
relation to tumour is determined.
3# Ureter is used to orient the specimen.
4# Ureter arises from medial aspect of kidney and point inferiorly in
continuity with Renal Pelvis at HILUM-anterior to posterior: Renal
Vein, Renal Artery, Renal Pelvis.
5# Shave the ureter,renal vein and artery and submit these sections.
6# Record if any tumour emboli seen at renal vein cut margin.
7# Open ureter,vessels and bivalve the kidney.
18.
19. 8# Describe the tumour as:
Measure size.
Location in terms of upper pole lower pole
Arise from CORTEX or MEDULLA.
Tumour colour.
Any area of haemorrhage and necrosis.
Mension gross capsular invasion:submit section from area of
suspected PERINEPHRIC FAT invasion.
Note and sample area with a homogenous,tan buldging
surface so called FISH FLESH QUALITY,which represent
sarcomatoid dedifferentiation.
20.
21. 9# Describe the hilum:vessel patency,number and
size,color,and lymph nodes.
10# Describe perinephric fat,look for involvement of
ADRENAL GLAND.
11# Serially section the sinus fat at 5mm intervals,and
2 section from interface between the tumour and
sinus tissues.
12# Dissect out perihilar and hilar lymph nodes.
22. SECTIONS TO BE SUBMITTED:
1) Tumour with area of
haemorrhage,necrosis and adjoining renal
parenchyma.
2) Tumour showing FISH FLESH area.
3) Tumour with pelvicalyceal system and
hilar structures.
4) Tumour with renal capsule and if
infiltrated-with perinephric fat.
5) Radial margin of external inked surface.
6) Renal vein section if involved.
26. INRODUCTION:
PROSTATE are resected for tumours-RADICAL
PROSTATECTOMY
less commonly for BENIGN HYPERPLASIA-SUPRAPUBIC
PROSTATECTOMY
Transurethral resection of prostate(TURP) are performed to
relieve urinary obstruction,generally for benign disease.
Prostate adenocarcinoma is one of the most frequently
diagnosed carcinoma in men.
Occurs at an increasing rate with advancing age.
At time of diagnosis,prostate cancer may be organ
confined,locally advance or more commonly metastatic
disease.
27. SURGICAL ANATOMY
Prostate is a walnut size gland,located between bladder
and penis.
Prostate is just anterior to the rectum.
Apex is the inferior portion of prostate ,continues with
striated sphincter.
Base is the superior portion and continuous with bladder
neck.
It has 2 lateral surface on either side.
28.
29.
30.
31. Zones in Prostate: 3 zones
CENTRAL ZONE:1-5% of prostate cancers from this
zone
Cone shape region
surrounds ejaculatory ducts.
PERIPHERAL ZONE:70% prostate adenocarcinoma
arise from this zone
posterolateral prostate which
forms majority of prostatic glandular
tissue.
TRANSITIONAL ZONE:20% of prostatic cancers arise from TZ
TZ surrounds prostatic urethra proximal to
veru montanum.
32.
33.
34.
35. TYPES OF SPECIMEN
Radical Prostatectomy
Transurethral Resection of Prostate(TURP)
Suprapubic Prostatectomy or Retropubic Simple
Prostatectomy(Enucleation) for BPH
36. TRANSURETHRAL RESECTION OF PROSTATE
In this multiple fragments are curetted from central transition zone
of prostate in order to relieve obstruction.
For prostate cancer diagnosis,criteria for “Clinically Significant”
prostate cancer have included extent,gradeand age of patient but
no universally accepted definition.
A quarter to third of incidentally found prostate carcinoma will
progress if followed for 10 years.
Likelihood of finding carcinoma on TURP specimen depend on
amount of tissue from TURP.
In some studies limited sampling from prostate has been effective
in detecting all carcinomas defined to be clinically important.
37. CAP recommends examining specimens weighing 12
grams or less in their entirety.
For larger specimens,the first 12 grams should be
submitted (in 6 to 8 cassettes)
Then with one more cassette for each additional 5
grams of tissue.
If firm yellow or yellow orange chips are present,they
should be submitted,as these chips are more likely to
contain carcinoma.
38.
39.
40. Recommendations for submission of
entire specimen:
Patient <60 yrs age.(small low grade carcinoma is
significant in this age.)
Patient with elevated PSA.(may have centrally
located carcinoma.)
41. Steps in grossing:
Weigh the specimen.
Record the dimensions in aggregate.
Describe the fragments including colour(grey/tan-
normal,yellow-tumour),consistency(rubbery-normal,hard-
tumour) and all areas with different
appearance;necrosis,hemorrhage.
Ink the outer surface of specimen identifying surgical margins.
Submit the entire specimen if possible,upto 12 blocks.
For larger specimen follow the protocol.
If carcinoma is present on initial slides,and involves <5% of
tissues,all the remaining tissue is generally submitted.
42. Since the carcinoma tend to be near the capsule and
the clinician may take smaller slices to avoid going
through the capsule,
smaller fragments may be more likely to contain
carcinoma.
For cases with 1 to 2 cassettes,order 2 levels.for 3 or
more cassettes order one level
The proportion of prostatic tissue involve by
tumour(<5% or >5%) is reported.
The number of chips with tumour and total number
of chips also be reported.
44. RADICAL PROSTATECTOMY:
Steps in Grossing
Weigh and measure the prostate gland in 3D:also measure
seminal vesicles.
Orient the specimen and ink the outer aspect of prostate
identifying surgical margin prior to grossing.
After appropriate fixation and inking transect the distal apical
segment.
And serially section it perpendicular to inked surface.
The basal(bladder neck) aspect is commonly doughnut shape
and irregular.
Transect the base from main specimen and serially slice it.
46. Describe as per:
Any dominant/grossly seen tumour nodule.
Note their size no. and consistency.
If any tumour nodule buldges beyond the contours
of gland,note its location.
47. At the level of seminal vesicle base,includes sections of
prostate along with base of both the seminal vesicles to
look for any direct invasion.
As per grossing protocol entire specimen should be
submitted.
For partial or subtotal submission of specimen,a systematic
approach to include the posterolateral peripheral zone
should be used.
All lymph nodes accompanying the radical prostatectomy
should be submitted for histological analysis after noting
their number,size of LN and their appearance on cut
section.
48. SECTIONS TO BE SUBMITTED:
Apex:entire distal margin
of prostate is taken as a
thick section and then
devided perpendicular to
cut margin so as to look
for exact distance of
tumour(radial) 0n
microscopy.
49.
50. Beginning from apex,the entire prostate need to be
submitted.
Bilateral seminal vesicle.
Sections to include base of vesicle with prostate in
one section.
Base is submitted similar to apex.
Pelvic lymph nodes,right and left.