The document discusses the management of renal cell carcinomas (RCC) associated with genetic syndromes. It notes that for von Hippel-Lindau syndrome, smaller tumors less than 3 cm are observed while larger tumors greater than 3 cm are removed. For hereditary papillary RCC, surgery is emphasized to remove larger lesions and observe smaller ones due to the indolent nature of type 1 papillary RCC. For hereditary leiomyomatosis RCC, delayed intervention is not recommended due to the aggressive nature of the tumors, and wide local excision is recommended even for tumors under 3 cm. The document also discusses staging, treatment options including radical nephrectomy and minimally invasive approaches, management
diagnosis and outline of management of localized prostate cancer for non-urol...Dr Mayank Mohan Agarwal
a brief introduction of anatomy of prostate, screening of prostate cancer, measures to improve specificity of PSA screening, risk stratification of prostate cancer, treatment options - active surveillance, radical prostatectomy, radical radiotherapy
diagnosis and outline of management of localized prostate cancer for non-urol...Dr Mayank Mohan Agarwal
a brief introduction of anatomy of prostate, screening of prostate cancer, measures to improve specificity of PSA screening, risk stratification of prostate cancer, treatment options - active surveillance, radical prostatectomy, radical radiotherapy
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemiaguestd58ac53
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Juza Chen and Avi Bery
Director of Sexual Dysfunction Clinic
Department of Urology
Tel-Aviv Sourasky Medical Center
Sackler Faculty of Medicine Tel-Aviv University
Moscow 2010
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
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
Similar to Renal cell carcinoma: MAnagement guidelines (20)
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.
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
- 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
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
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.
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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.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
7. HEREDITARY KIDNEY CANCER SYNDROMES, GENETICS, AND
MOLECULAR BIOLOGY Management:
• Management of renal tumors in patients with VHL now includes surveillance of
smaller tumors (<3 cm) and resection of larger ones (>3 cm) by PN with the goal of
preventing metastases and optimizing renal function by “resetting the biologic clock”
through appropriately timed surgeries.
• The goal of complete tumor removal with wide negative surgical margins is less
appropriate for these patients, where management of localized lesions supplants cure.
8. HPRCC:
• As with VHL, management of renal tumors recognizes the need to remove larger
lesions and observe smaller ones.
• Although no size cutoff for intervention has been established, the biology of type 1
papillary RCC appears to be more indolent than ccRCC, suggesting the risk of death
from kidney cancer in these patients is low.
• Unfortunately, renal mass biopsy cannot reliably make a diagnosis of type 1 papillary
RCC, so surgery is sometimes required.
• As such, PN with renal preservation is emphasized despite the often encountered
diffuse micro- and macromultifocality of these lesions.
9. Hereditary Leiomyomatosis Renal Cell Carcinoma:
• Unlike other hereditary forms of RCC, AS with delayed intervention for small tumors
is not recommended due to the aggressive nature of these tumors. Although tumor
enucleation is recommended for most patients with hereditary tumors, renal lesions
associated with this syndrome tend to be infiltrative, thus wide local excision is
recommended at initial diagnosis, even for tumors <3 cm.
20. • RN” as currently practiced may be better termed “total” nephrectomy, as it often omits
several of the components of the original, “radical” nephrectomy, which always included
extrafascial nephrectomy, adrenalectomy, and extended lymphadenectomy (LND) from
the crus of the diaphragm to the aortic bifurcation.
• Perifascial dissection is still routinely practiced for larger tumors, as ≥25% of these
tumors extend into the perinephric fat.
• Removal of the ipsilateral adrenal gland is no longer recommended, unless there is
suspicion of direct invasion of the gland by tumor or a radiographically or clinically
suspicious adrenal tumor because of the similar propensity of RCC to metastasize to the
ipsilateral or contralateral adrenal gland.
21. • Finally, extended LND has been shown to be of no therapeutic benefit for patients with clinically
localized RCC as the risks of clinically negative nodes being pathologically involved is <5%.46
The role of LND in high-risk (>pT2 N+ M+) renal tumors remains controversial.
• RN is still a preferred option for some patients with localized RCC, such as those with very large
tumors (most clinical T2 tumors) or the relatively limited subgroup of patients with clinical T1
tumors that are not amenable to nephron-sparing approaches.
• According to the 2017 AUA guidelines, physicians should consider RN for patients with a solid
or Bosniak 3/4 complex cystic renal mass where increased oncologic potential is suggested by
tumor size, renal mass biopsy, and/or imaging characteristics and in whom active treatment is
planned.
22. • In this setting, RN is preferred if all of the following criteria are met:
• (1) high tumor complexity and PN would be challenging even in experienced hands;
• (2) no preexisting chronic kidney disease (CKD) or proteinuria; and
• (3) normal contralateral kidney and new baseline estimated glomerular filtration rate (eGFR)
will likely be >45 mL/min/1.73 m2
• The surgical approach for RN depends on the size and location of the tumor as well as the
patient’s habitus and medical/surgical history. For locally advanced disease and/or bulky
lymphadenopathy, an open surgical approach using either an extended subcostal, midline, or
thoracoabdominal incision is generally used.
23. • Current minimally invasive approaches allow all of the essential steps of RN to be
performed, with the associated benefits of shorter convalescence and reduced morbidity.
• Laparoscopic RN is now established as a preferred approach for moderate to large
volume tumors (≤10 to 12 cm), without invasion of adjacent organs, with limited (or no)
venous involvement, and having manageable (or no) lymphadenopathy.
• Robotic RN may further extend the indications for minimally invasive radical
nephrectomy (MIRN), to include some patients with features previously thought to
mandate open RN as vascular control and suturing is facilitated with this approach.
29. Opinion from UpToDate:
Is there a role for adjuvant therapy? — For patients with localized clear cell renal
carcinoma treated with nephrectomy, adjuvant pembrolizumab improved disease-free
survival (DFS) and was well tolerated in a phase III trial. These data are promising, and
we await regulatory approval and/or introduction into consensus guidelines prior to
incorporating adjuvant immunotherapy into routine clinical practice.
We also do not suggest the use of adjuvant sunitinib. Although adjuvant sunitinib
improved DFS in select patients with high-risk disease in one clinical trial, it confers no
clear overall survival (OS) benefit and increases toxicity.
30. Other trials evaluating sunitinib and sorafenib (ASSURE and SORCE), pazopanib
(PROTECT), and axitinib (ATLAS) have failed to demonstrate a recurrence-free or OS
benefit in the adjuvant setting.
●
Everolimus – A randomized clinical trial (EVEREST) is ongoing evaluating mechanistic
(mammalian) target of rapamycin (mTOR) inhibitor everolimus as adjuvant therapy
(NCT01120249).