This document discusses non-surgical treatment options for hepatocellular carcinoma (HCC). It describes various local ablative therapies like radiofrequency ablation (RFA), microwave ablation, irreversible electroporation, cryotherapy, and ethanol injection. It also discusses regional therapies like hepatic artery embolization and chemoembolization. Systemic therapies mentioned include chemotherapy, targeted therapy, immunotherapy, and hormonal therapy. Specific treatment options like RFA, microwave ablation, stereotactic radiation therapy, and transarterial chemoembolization are described in further detail. The document emphasizes that treatment should be guided by the patient's liver function and cancer stage.
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...asclepiuspdfs
Purpose: Computed tomography (CT) guidance and general anesthesia have recently been recommended as the approach of choice for percutaneous ablation of small renal cell carcinoma (RCC), whereas ultrasound (US) guidance and conscious sedation have been tagged as inadequate. Aim of the study was to assess the safety and effectiveness of percutaneous thermal ablation of small RCC under ultrasound (US)-guidance and conscious sedation. Methods: The records of 74 patients with small RCC (≤5 cm), who underwent US-guided thermal ablation under conscious sedation were retrospectively reviewed. Conscious sedation was usually induced by means of intravenous bolus of midazolam 50–100 μg/kg plus continuous infusion of a 25 μg/mL solution of remifentanil at a rate of 0.05 μg/kg/min. Technical success, technical efficacy, local tumor progression (LTP), primary and secondary efficacy rates, complication rate, and 1-, 3-, and 5-year survival rates were analyzed.
Highlights in the treatment of Rectal cancer.pptxMona Quenawy
rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...asclepiuspdfs
Purpose: Computed tomography (CT) guidance and general anesthesia have recently been recommended as the approach of choice for percutaneous ablation of small renal cell carcinoma (RCC), whereas ultrasound (US) guidance and conscious sedation have been tagged as inadequate. Aim of the study was to assess the safety and effectiveness of percutaneous thermal ablation of small RCC under ultrasound (US)-guidance and conscious sedation. Methods: The records of 74 patients with small RCC (≤5 cm), who underwent US-guided thermal ablation under conscious sedation were retrospectively reviewed. Conscious sedation was usually induced by means of intravenous bolus of midazolam 50–100 μg/kg plus continuous infusion of a 25 μg/mL solution of remifentanil at a rate of 0.05 μg/kg/min. Technical success, technical efficacy, local tumor progression (LTP), primary and secondary efficacy rates, complication rate, and 1-, 3-, and 5-year survival rates were analyzed.
Highlights in the treatment of Rectal cancer.pptxMona Quenawy
rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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
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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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
- 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
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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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Couples presenting to the infertility clinic- Do they really have infertility...
NON SURGICAL MANAGEMENT OF HEPATOCELLULAR CARCINOMA1.pptx
1. NON SURGICAL MANAGEMENT OF
HEPATOCELLULAR CARCINOMA
Presenter- Dr. Abhishek raj
3rd year surgery PGT
2. • Hepatocellular carcinoma (HCC) represents a challenging malignancy of
global importance . It is the fifth most common solid tumor in terms of
incidence and the third leading cause of cancer-related death
worldwide.
3. • Its incidence mirrors that of chronic liver injury, which is
predominantly attributable to
• Viral hepatitis infection both hepatitis B and C
• Other etiologic factors that trigger chronic liver injury and cirrhosis
include alcohol; Alcoholic Liver Diseases
• Nonalcoholic steatohepatitis , commonly associated with morbid
obesity and diabetes;
• and other metabolic diseases, for instance, .hemochromatosis
4. • Fundamental challenge in HCC is the coexistence of underlying liver
injury and hepatic dysfunction as the premalignant environment in
the majority of patients.
• Both the underlying cirrhosis and the tumor itself impact the HCC
patient’s overall survival. Thus there is a need to evaluate the
cirrhosis status of patients with liver cancer to guide treatment
decisions.
10. Radiofrequency Ablation(RFA)
• Radiofrequency ablation involves the application of high frequency
(375-480 kHz) alternating current to the target tissue by using a
needle like applicator, with cell death resulting from frictional heating.
• Active tissue heating occurs only within a few millimeters of the
exposed tines of the applicator, and larger-volume tissue destruction
mainly relies on conductive heating.
• RFA probes are usually placed under ultrasound or computed
tomography (CT) guidance either directly to or iteratively around the
tumor to create a confluent ablation zone.
11. • Tumors adjacent to larger (>3 mm) blood vessels may be
undertreated due to the thermal sink effect.
• In patients with Child-Pugh class A cirrhosis, data suggest thermal
ablation can rival surgery when tumors are solitary and smaller .They
are more suitable for central and deep lesions
12. Microwave Ablation
• Microwave Ablation Like RFA, microwave (MW) ablation (MWA) uses
electromagnetic waves to produce heating.
• Unlike RFA, the MW energy is not an electrical current and is in a
much higher frequency range that extends from 300 MHz to 300 GHz.
• The broader deposition of MW energy creates a much larger zone of
active heating. MW applicators available for clinical use generally
operate in the 900 to 2,450 MHz range.
13. • The rapidly alternating electric field of the MW antenna causes water
molecules to spin rapidly in an attempt to align with electromagnetic
charges of opposite polarity. MW tissue heating occurs because of the
induction of kinetic energy in surrounding water molecules.
• Microwave ablation (MWA) appears to have potential to improve the
rate of complete ablation achieved with RFA in tumors that are larger
than 2 to 3 cm or multiple. Device specific safety and efficacy data,
including predictability and reproducibility, are warranted.
14. • MWA seems to have potential to overcome the limitations of RFA in
the treatment of tumors in perivascular location as it is less
influenced by heat sink effect.
15. IRREVERSIBLE ELECTROPORATION
• Irreversible electroporation (IRE) is a novel, non–thermal injury, ablative
technology that uses multiple short pulses (pulse length, 70-90 µsec) at
high voltage (2250-3000 volts) of electrical energy to induce permanent
electroporation of the tissue.
• IRE is a dynamic phenomenon by which cell membrane integrity is
compromised by inducing permanent nanopores using transmembrane
electrical distortion.
• Using an electrical field of 2500 V/cm3 , it is postulated that IRE creates
nano-sized pores (0.08-0.5 µm) in the cell membrane that are unable to
reseal, because the electrical pulse strength and duration surpass the cell
membrane threshold, permanently damaging the plasma membrane.
16. • The clinical indication for IRE of liver tumors must be made based on
• (1) tumor biology,
• (2) tumor size less than 4 cm,
• (3) tumor location within 5 mm or less of a vital structure that needs
to be spared.
17. Cryotherapy
• Cryotherapy causes cell death by a variety of physical and chemical
mechanisms, depending on the rate of cooling, absolute depth of
hypothermia, rate of thawing, number of freeze-thaw cycles used,
and delayed effects of post thaw ischemia. When a cryoprobe is
inserted into the liver, three overlapping zones of injury develop
within the ice ball.
• The dynamics of the freezing process cause different mechanisms of
injury in these three idealized zones
18. • The rate at which tissue cools affects the proportion of cells killed by
a single freeze cycle.
• Maximal cell death is achieved at slow and rapid cooling rates
(although through different mechanisms), whereas greatest cell
survival is seen with intermediate cooling rates.
• Cellular dehydration causes lethal injury at slow cooling rates,
whereas rapidly cooled cells are destroyed by the mechanical action
of ice crystallization and expansion
19. • There is approximately a 60% (range, 40%-82%) reduction in AFP
levels after cryotherapy in patients with elevated preoperative AFP.
• Reduction of AFP serum levels after cryotherapy does not clearly
translate into a survival benefit.
• For primary liver cancer patients treated with cryotherapy alone, the
5-year actuarial survival is approximately 30%.
• RFA has replaced cryoablation as preferred ablation therapy.
20. ETHANOL INJECTION(PEI)
• This technique consists of injecting 95% ethanol in liver tumors
through a needle to induce coagulative necrosis and a fibrous
reaction. In general, multiple sessions of the procedure are needed to
achieve adequate responses.
• Among ablative techniques, PEI was the first percutaneous treatment
introduced in clinical practice
21. • RFA appears to be superior to PEI in regard to local recurrence rates,
overall survival, and event-free survival.
• Despite higher long-term recurrence rates and inferior overall survival, PEI
has specific indications. Lesions in the liver hilum and close to major
vessels are adequate sites for this procedure, where chemical injection can
be performed more safely than thermal ablation.
• Another modest benefit is that the cost of ethanol injection is
approximately 100 times less than for RFA
22. Conformal radiation therapy(RT)
• RT for liver tumors has been limited by the tolerance of the liver and
the surrounding normal organs to even relatively low doses of
radiation.
• Techniques typically consist of innovations designed to minimize
normal hepatic irradiation and enhance target conformality, such as
intensity-modulated radiotherapy (IMRT), image-guided radiotherapy
(IGRT), and the use of motion management.
23. • Intensity-modulated RT is a more sophisticated approach to the
planning and delivery of RT that uses computer software to define
high-dose regions for the tumor and subclinical disease and to
constrain the dose to normal organs.
• The introduction of IMRT more than a decade ago was made possible
by the use of computed tomography (CT) or magnetic resonance
imaging (MRI)
• Core beam CT (CBCT), has been developed to allow real-time
assessment of tumor positioning on the linear accelerator while the
patient is on the table before treatment delivery
24. • Early on, researchers determined that low doses of whole-liver
irradiation were ineffective in controlling gross hepatocellular
carcinoma (HCC) disease, and that higher doses resulted in high rates
of radiation hepatitis or radiation-induced liver disease (RILD)
• . The underlying mechanism of RILD has not been fully elucidated, but
it may be a combination of radiation-induced damage to both
hepatocytes and endothelial cells. The resulting clinical syndrome is
characterized by anicteric hepatomegaly, ascites, and elevated liver
enzymes, occurring up to 3 months after liver RT
25. • Stereotactic body RT (SBRT), which allows for the precise delivery of
high-dose radiation to a conformal target within the body
(extracranial), using either a single dose or a small number of
fractions .
• The ability to deliver high doses of RT is based on the more focal
treatment fields afforded by the use of IMRT and the more accurate
localization of tumors based on diagnostic-quality imaging techniques
on the linear accelerators, such as CBCT.
• Unlike the conventional RT fractionation schedule of 1.8 to 2 Gy/day,
delivered 5 days a week over 5 to 6 weeks, SBRT can deliver a very
high ablative dose of 18 to 30 Gy in 1 day or 30 to 60 Gy in 1 to 5
fractions over 1 to 2 weeks.
26. Hepatic artery embolization and
chemoembolization of liver tumors
• In the absence of effective systemic therapy, much effort has been
put into developing and testing transarterial liver-directed therapies
for local tumor control. Transarterial chemoembolization (TACE) has
been the most commonly used procedure to palliate symptoms and
to prolong survival in patients with liver tumors
• TACE should be distinguished from transarterial embolization, which
uses only embolic material, and hepatic arterial infusion
chemotherapy, which uses only antitumoral chemoagents.
27. • The basic physiologic principle that makes hepatic artery
embolotherapy feasible in patients with liver tumors is the dual blood
supply to the liver. The portal vein provides more than 75% of the
blood flow to the normal hepatic parenchyma and is the primary
trophic blood supply.
• Conversely, most of the blood supply (90% to 100%) to liver tumors
comes from the hepatic artery; thus embolization of tumor-feeding
hepatic artery leads to selective ischemic damage of the tumor while
sparing the normal liver parenchyma, which is mainly supplied by the
portal vein.
28. • The pharmacokinetic advantage of locoregional drug administration
enhances the theoretical benefit. For example, hepatic drug exposure
has been estimated to be double for doxorubicin, 7 times greater for
cisplatin, 8 times greater for mitomycin C, and 10 times greater for 5-
fluorouracil (5-FU) when these were given through the hepatic artery
rather than through the systemic veins.
• The chemotherapeutic drug is dissolved in water or water-soluble
contrast agent. The drug is then mixed with Lipiodol and administered
as a water-in-oil–type emulsion
29. • In the BCLC staging system, TACE is recommended as first-line therapy
for intermediate stage HCC (multinodular, asymptomatic tumors
without vascular invasion or extrahepatic spread).
TACE can be considered as an alternative treatment with curative
intent in patients with early stage HCC who are not eligible for hepatic
resection or ablation therapy due to systemic comorbidities or
anatomic problems.
TACE induces a significant tumor necrosis without negative influence
on liver function in patients with preserved liver function. The extent of
tumor necrosis has been reported to range from 60% to 100%.
30. • Although the concept of delivering high-dose chemotherapy to the
tumor is sound, no evidence-based findings support the routine use
of conventional TACE (cTACE). Bland embolization with spherical
embolic agents or microspheres has been shown to be as effective as
cTACE in treatment of hypervascular primary and metastatic liver
tumors; it can be used instead of cTACE, thereby avoiding the added
expense and potential systemic toxicity of chemotherapy.
• Drug-eluting beads (DEBs) are specifically designed microspheres
that load a specific chemotherapeutic drug and release the drug
locally within the target tissue during an extended period. DEBs can
enhance therapeutic efficacy, and at the same time, they reduce
toxicity because of minimum systemic exposure.
31. Radioembolization
• Radioisotopes linked to either glass or resin microspheres are injected
into the HA. This outpatient treatment is typically delivered through
either the right or the left HA, although with favorable anatomy, it can
be delivered more selectively.
• Whole liver treatment is usually reserved for metastases rather than
HCC due to the risk of liver injury.
• The most common isotope is 90Y, a pure β emitter, with an effective
path length of 5 mm and a half-life of 65 hours. A total of 90% of the
energy is deposited within 5 mm of the sphere; therefore, side effects
are quite localized.
32. • The limited availability of donor organs for Orthotopic liver transplant
OLT and the dropout of patients as a result of tumor progression
limits the number of patients who are able to undergo OLT.
• Thermal ablation (radiofrequency ablation) has a limited role because
of the risk of tract seeding and the size and location of tumor.
• Radioembolization has been shown to limit progression of the
disease, which allows the patient more time to wait for donor organs
and thus increases their chance of undergoing OLT .Thus
radioembolization has a role in bridging patients to OLT.
33. • This stage includes patients presenting with vascular invasion or
extrahepatic spread who are still relatively fit, as reflected by
performance status at staging work-up, and who have preserved liver
function.
• BCLC-C patients should be evaluated for systemic therapy.
• The combination of atezolizumab with bevacizumab (Atezo-Bev) is
currently the first-choice first-line treatment, as it confers a superior
survival benefit compared to sorafenib
• The combination of cabozantinib and atezolizumab showed a
significant benefit in progression-free survival in recent
34. • Almost every class of chemotherapy has been investigated in
advanced HCC .Doxorubicin is one of the most common drug studied
for this indication.
• IFN, doxorubicin, and 5-fluorouracil (5-FU), which became commonly
known as PIAF . PIAF was subsequently modified and studied in the
outpatient setting
35. • Resection and liver transplantation represent the potentially curative
options with the longest track record. For small tumors, ablation and
radiotherapy (RT) are quite effective and may also be curative.
• Only 20% to 30% of patients are candidates for curative surgical
treatment, including hepatic resection and liver transplantation .In
addition, the disease recurs after curative resection in 50% to 70% of
patients at 5 years.