This document summarizes the management of testicular tumors. It begins by stating that testicular tumors are relatively rare but most curable solid neoplasms. It then describes the lymphatic drainage patterns and WHO classification of different tumor types. The staging system and general management approaches are outlined, including radical orchidectomy surgery, surveillance, radiotherapy using external beam radiation, and chemotherapy regimens. Radiotherapy is indicated as adjuvant therapy for early stages, while chemotherapy is used for advanced stages. Close follow up after initial treatment is recommended to monitor for recurrence or side effects.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
It describes relationship between radiation dose and the fraction of cells that “survive” that dose.
This is mainly used to assess biological effectiveness of radiation.
To understand it better, we need to know about a few basic things e.g.
Cell Death
Estimation of Survival / Plating Efficiency
Nature of Cell killing etc.
A cell survival curve is the relationship between the fraction of cells retaining their reproductive integrity and absorbed dose.
Conventionally, surviving fraction on a logarithmic scale is plotted on the Y-axis, the dose is on the X-axis . The shape of the survival curve is important.
The cell-survival curve for densely ionizing radiations (α-particles and low-energy neutrons) is a straight line on a log-linear plot, that is survival is an exponential function of dose.
The cell-survival curve for sparsely ionizing radiations (X-rays, gamma-rays has an initial slope, followed by a shoulder after which it tends to straighten again at higher doses.
LET, Linear Energy Transfer, Relative Biologic Effectiveness, Oxygen enhancement ratio,
Dr. Vandana, KGMU, CSMMU, Lucknow, Radiation Oncology, Radiotherapy
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Similar to Part 1 management of testicular carcinoma - dr vandana (20)
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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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.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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2. Introduction
Relatively rare. 1-2 % of all male malignancies.
Malignancy in 20-34 yrs of age.
Most curable solid neoplasm.
90-95% of testicular tumors are germ cell tumors, either seminoma or
non-seminoma.
Improvement in diagnostic techniques, tumor markers, improved surgical
techniques, advanced radiotherapy machines and multidrug chemotherapy ,
decrease the mortality from 50% to <10%.
3. Lymphatic Drainage
Right testis: along the IVC inter-aortocaval region
pre-aortic & para-aortic lymph nodes, with possible cross-
over within the retroperitoneum
Left testis: Preaortic and para-aortic lymph nodes
around the left renal hilum inter-aortocaval nodes
mostly without cross-over
Retroperitoneal lymph nodes are located anterior to the
T11 to L4 vertebral bodies concentrated at the L1–L3
level
Nodal spread to iliac chain is ipsilaterally but
infrequent (~3%)
Scrotal skin: lymphatics drain into the inguinal and
external iliac nodes.
6. Royal Marsden staging system
STAGE
I Limited to testis
IIA Nodes <2 cm
IIB Nodes 2–5 cm
IIC Nodes 5–10 cm
IID Nodes >10 cm
III Nodes above and below diaphragm
IV Extralymphatic mets
7. Cont…
Regional lymph nodes (N) clinical
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis with a lymph node mass ≤2 cm in greatest dimension;
or multiple lymph nodes ≤2 cm in greatest dimension
N2 Metastasis with a lymph node mass > 2 cm but ≤5 cm in greatest
dimension; or multiple lymph nodes, any one mass > 2 cm but
≤5 cm in greatest dimension
N3 Metastasis with a lymph node mass > 5 cm in greatest dimension
11. GENERAL MANAGMENT
After obtaining serum AFP & B-Hcg levels in suspected case of malignant
germ cell tumour
Radical inguinal orchietectomy with high ligation of spermatic cord is
done, it is both diagnostic & therapeutic
Further management depends on, pathology & stage of disease.
Note: - Considering of sperm banking must be discussed with the patients
before undergoing any therapeutic intervention that may compromise
fertility including RT ,Surgery and CT.
12. Management of testicular tumor is combined modality
treatment.
Various treatment modalities are:
Surgery
Surveillance
Radiotherapy
Chemotherapy
14. Surgery
Radical orchidectomy:
all patients
done via an inguinal incision, with cross
clamping of spermatic cord vasculature and
delivery of testis into the surgical field.
Scrotal violation, increased local/regional
recurrence, but no difference in distant
recurrence rate or overall survival.
15. Retro peritoneal lymph node
dissection(RPLND):
Indication:
preferred treatment for low stage NSGCT
Include the precaval, retrocaval, paracaval,
interaortocaval, retroaortic, preaortic,
para-aortic, and common iliac lymph nodes
bilaterally.
Disadv.:
sympathetic nerve fibers are disrupted,
resulting in loss of seminal emission. A
modified RPLND developed that preserves
ejaculation in up to 90%.
17. Surveillance
An option, as potentially 80-85% of patients will not develop
recurrence
Rationale -With availability of highly effective salvage rt /ct for
relapse disease & low risk of occult disease in nodes in stage 1
pts.
Indications
Seminoma Stage I
NSGCT Stage I
Disadvantage
Costly and inconvenient
19. Radiation therapy
Indications
Adjuvant therapy for stages I–IIb diseases
Salvage of loco-regional failure after surgery or chemotherapy
Palliative treatment to loco-regional or distant metastatic sites
Techniques
EBRT to lymph nodes
High-energy radiation (6 – 18 MV)
Seminoma is extremely radiosensitive. Radiation therapy is often used for
adjuvant therapy for early-stage seminoma, and its use in non-seminoma
germ cell tumors (GCT) is limited.
20. Position and immobilization
Supine, arms placed by the pt. side and legs straight, with feet stabilized
with a foam wedge underneath the knees.
Position penis out of field
Shielding
Contra-lateral testis is shielded with a lead clamshell device.
Mean dose values to the contralateral testicle.
PA PA + IL iliac
Without shield 1.86 cGy 3.89 cGy
With shield 0.65 cGy 1.48 cGy
21. Stage I:
Field margins
Superior: T11–T12 interspace
Inferior: L5–S1 interspace
Lateral: transverse process
For left testis: cover renal hilum
Dose
20 Gy in 10# to para-aortic ±
pelivic lymph node by ap-pa field
Elective para-aortic field for stage I
seminoma
22. Stage II
Superior: T11–T12 interspace
Inferior: mid-obturator foramen
Lateral: transverse process down to
L5–S1 interspace then diagonally to the
lateral edge of the acetabulum, then
vertically downward to the median
border of the obturator foramen
For left testis: cover renal hilum
Paraaortic and ipsilateral inguinal field for
stage II left testicular seminoms, with
inclusion of the rental hilus.
23. Stage II a-
25Gy in 20 # by AP-PA
Stage II b & IIc
25 Gy in 20 #
10 Gy in 5 #
25. Chemotherapy
Indications
As an alternative to adjuvant RT for stages I–II seminoma
Adjuvant therapy for stages II–IV seminoma
Regimens
Single-agent carboplatin become an alternative for
stage I seminoma
Regimens including BEP, EP, PVB, and VIP for stages II–IV
diseases
26.
27. Conclusion
Most common curable malignancy of young adults.
Most common- germ cell tumors
Seminoma > nonseminoma
Nonseminoma occurs a decade earlier.
Surgery is the main modality of treartment followed by
Radiotherapy & or chemotherapy for seminoma and
chemotherapy & RPLND for nonseminoma.
Surveillance generally for patients who are compliant.
28. Radical inguinal orchiectomy with initial high ligation of the
spermatic cord is the standard procedure for diagnosis and
treatment. Biopsy prior to orchiectomy is usually not
recommended.
Follow-up is recommended to detect second primary tumors,
local or distant recurrences, and to monitor for potential long-
term side eff ects.