osteochondroma is a common bone growth which has varied presentations. It can be easily diagnosed with the help of Xrays and MRI. The presentation is a brief overview of the condition however its uncommon variants are not included...
A classification of bone tumours. Modified after Revised WHO Classification –Schajowicz (1994)
Osteoblastoma
Are larger: > 2 cm.
Periosteal reaction may be more prominent than encountered in osteoid osteomas
osteochondroma is a common bone growth which has varied presentations. It can be easily diagnosed with the help of Xrays and MRI. The presentation is a brief overview of the condition however its uncommon variants are not included...
A classification of bone tumours. Modified after Revised WHO Classification –Schajowicz (1994)
Osteoblastoma
Are larger: > 2 cm.
Periosteal reaction may be more prominent than encountered in osteoid osteomas
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.
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
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
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.
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
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
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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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
2. DEFINITION
• An aneurysmal bone cyst is a benign, expansile
lesion with blood filled cavities separated by septa
of trabecular bone or fibrous tissue containing
osteoclast giant cells.
• The term derived from its
macroscopic
aneurysmal is
appearance – sponge like tumour
containing numerous giant cells.
3. EPIDEMIOLOGY
•75% of patients are < 20 yrs.
•Anatomic location
o 75% of patients are < 20 yrs.
o 15% in spine
o >60% in long bones (Femur and tibia being most common)
o 51% occured in the lower extremities, 22.5% in upper extremities
o usually in metaphysis
o metatarsal and calcaneus are the most common locations in the foot
o posterior elements of pelvis
4. ETIOLOGY
The true etiology of ABCs is unknown.
primary ABC is driven by upregulation of the ubiquitin-specific
protease USP6 (Tre2) gene on 17p13 when combined by a translocation with a
promoter pairing
most commonly described translocation t(16;17)(q22;p13) leading to juxtaposition
of promoter region CDH11 on 16q22
5. INCIDENCE AND
DEMOGRAPHICS
ABCis found at anyage
Around 75%:before 20 yearsand rareafter 30 years
Female: Male = 2 : 1
Site - can be found in any bone in the body. The
most common location is the metaphysisof long
bones of lower extremity.
About 12-30% of the ABCs involve the spine that
represents only 1.4 % of primary vertebral column
tumors.
6. Spine:
Most common in the thoracolumbar region
The cervical spine is involved in 30-41 %.
As with most benign osseous lesions, 60% of
spinal aneurysmal bone cysts occur in the
posterior elements.
Half of the casesinvolving more than one
vertebra.
7. PRESENTATI
ON
Patients usually present with pain, a mass, a pathologic fracture, or
combination of these symptoms in the affected area.
Neurologic symptoms may develop when involving the nerve, typically in the
spine.
Other findings may include the following:
• Deformity
• Decreased movement, weakness, or stiffness
• Occasionally, bruit over the affected area
• Warmth over the affected area
8. HISTOLOGY
Aneurysmal bone cyst consists of blood-filled spaces of
variable size that are separated by connective tissue
containing trabeculae of bone or osteoid tissue and
osteoclast giant cells.
They are not lined by endothelium.
9. DEVELOPMENT OF ABC
It follows 3 stages-
Stage Description
I Initial phase Osteolysis without peculiar findings.
II Growth phase •Rapid increase in size of osseous erosion.
•Enlargement of involved bone.
•Formation of shell around central part of lesion.
III Stabilization phase Fully developed radiological pattern.
11. X-RAYAPPEARANCE
• ABC is normally placed in the metaphysis and appears as a
osteolytic lesion. The periosteum is elevated and the cortex is
eroded to a thin margin.
• The expansile nature of the lesion is often reflected by a
"blown-out" or "soap bubble" appearance.
• The lesion rarely penetrates the articular surface or growth
plate.
12. COMPUTED
TOMOGRAPHY
• Cross-sectional CT is the most useful imaging examination, because
it can demonstrate the intraosseous and extraosseous extents of the
lesion.
• CT can be used to determine the nature of the matrix of the tumor,
especially when tumors are in complex locations, such as the facial
skeleton, spine, thoracic cage, and pelvis.
• Spinal CT can demonstrate stenosis of the spinal canal due to
involvement of the posterior elements.
13. FLUID - FLUID LEVEL (NON
SPECIFIC)
FFLresults from separation of 2 fluids of different densities within a cavernousspace
Mnemonic
•
•
•
•
•
•
•
•
G:giant celltumour
O: osteoblastoma
A: aneurysmal bone cyst
T
:telangiectatic osteosarcoma
S: sarcomas
C: chondroblastoma
S: solitary bone cyst
F: fibroxanthoma
14. NUCLEAR
IMAGING
• Demonstration of a solitary lesion on bone scintigraphy helps
distinguish an aneurysmal bone cyst from other bone tumors,
a hemophilic pseudo tumor, etc.
• Radioisotope uptake is increased.
• The common pattern is the accumulation of the tracer in the
periphery of the lesion, with little intensity in the center; this
finding is present in about 65% of cases.
17. ANGIOGRAPH
Y
• On angiograms, ABCsare hypervascular lesions .
• This feature is contrary to that of other malignant lesions, such
as osteosarcoma and chondrosarcoma, which have gross
hyper vascularity.
• Hyper vascular regions in aneurysmal bone cysts may affect
the prognosis, because the number and size of the lesions are
positively correlated with the likelihood of lesional recurrence
after treatment.
18. Angiography examination of ABCof a 13-year-old male showed an expansile
lesion involving the left inferior pubic ramus and ischium.
19. DIFFERENTIAL
DIAGNOSIS
• Simple bone cyst
- central location, before epiphyseal fusion
- absence of expansion
- lack of cortical discontinuity
• Giant cell tumor of bone
- occurs in patients over age 20 -40 year
- expansile, eccentric, wide zone of transition
- begin in epiphysis with extension into metaphysis
- involves joints or adjacent bone or soft tissue
• Osteoblastoma
- may have a “soap bubble” expansile appearance
- no fluid level on CT/MR
• Fibrous dysplasia
- ground-glass opacities: 56%
- homogeneously sclerotic: 23%
- well circumscribed lesions
- no periosteal reaction
• Chondroblastoma
- arising eccentrically in the epiphysis of long bone
- internal calcifications can be seen in 40-60% cases
- Sizeranges from 1-10 cm, most are 3-4 cm at diagnosis
• Chondromyxoid fibroma
• - knee joint (2/3)
- well defined radiolucent, eccentric in metaphysis
- marginal sclerosis
20. TREATMEN
T
• Preoperative embolization
• Curettage & bonegrafting
• Complete resection with bone graft
• Radiotherapy
• Steroids & Calcitonin
• The treatment of choice for aneurysmal bone cysts
is gross total resection, which is curative when
feasible.
21. EMBOLIZATIO
N
• Embolization can be used as first-line and the sole
therapy for ABCs.
• Several successful cures after embolization of ABCs
have been reported.
• In addition, embolization is used preoperatively to
decrease intraoperative blood loss and morbidity.
22. SURGER
Y
• Surgically, complete excision of the tumor is the goal
• Aggressive curettage with adjuvant and bone grafting is
prefereable
• Incomplete tumor excision may be associated with
significant rates of tumor recurrence.
23. RADIOTHERAP
Y
• Radiotherapy can be considered in patients with
residual or recurrent tumor.
• ABCs are sensitive to radiation, but the recurrence
rate remains significant despite adjuvant
radiotherapy.
• Usually 26 to 30 Gy are used.
24. PROGNOSI
S
Recurrence rate 20-30%
Partial resection or curettage has been
associated with recurrence rates as high as 71%.
Despite high recurrence rates, cases of
spontaneous regression of ABCs have also been
reported