This document discusses soft tissue sarcomas. It begins by listing various histologic diagnoses of soft tissue sarcomas categorized by tissue of origin. It then discusses imaging with MRI and CT to evaluate tumors. Key points regarding surgery include performing limb-sparing over amputation when possible and obtaining negative margins of at least 2cm if no post-op radiation is planned. Adjuvant radiation improves local control but not necessarily survival. Pre-op radiation may increase wound complications compared to post-op.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
IORT uses a high single-fraction radiation dose (10-30 Gy) is delivered during surgery to a surgically-exposed tumour bed, immediately after a chunk of the tumour has been surgically excised. This slide includes topics like APBI, IOERT, IOHDR.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
IORT uses a high single-fraction radiation dose (10-30 Gy) is delivered during surgery to a surgically-exposed tumour bed, immediately after a chunk of the tumour has been surgically excised. This slide includes topics like APBI, IOERT, IOHDR.
Radiotherapy in the Treatment of Sarcomas in Adolescents and Young AdultsMethodist HealthcareSA
Daniel Indelicato, MD, University of Florida, Jacksonville, FL
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference, Methodist Healthcare-San Antonio
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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.
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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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.
Dehradun #ℂall #gIRLS Oyo Hotel 9719300533 #ℂall #gIRL in Dehradun
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
1. Dr. Kanhu Charan Patro
M.D,D.N.B[RT],P.D.C.R,C.E.P.C
[EX – TATA MEMORIAL HOSPITAL]
Consultant- Radiation Oncology
MAHATMA GANDHI CANCER HOSPITAL
VISAKHAPATNAM
Email-drkcpatro@gmail.com ,M-09160470564
2. No one denies the importance of evidence.
It is a sine qua non of professional practice. But
often, there are no simple answers to
apparently simple questions: there is a role for
judgement and decision-making
3. Levels of evidence
Level-I=large double blind RCTs, or, metaanalysis of
smaller RCTs , with clinically relevant outcomes
I a=evidence from meta-analysis of RCT
I b=evidence from at least 1 RCT
Level-II=small RCTs, non-blinded RCTs
IIa=evidence from one well designed non-RCT
IIb=evidence from one well-designed quasi-
experimental study
Level-III=observational [cohort ] studies ,case-
control studies , non-RCTs
Level-IV=opinion of expert committees, or
respected authorities
Level -V=expert opinion 3
12. GOALS
High dose to tumor tissue-Tumor control
Normal tissue sparing
Minimize long and short term toxicities
Better Quality of life
10/20/12 01:12 PM 12
13. Evolution of Treatment Techniques
CONVENTIONAL RT
Collimator shapes Beam
Rectangular Treatment Field
Shaped Treatment Field
1970s and earlier
10/20/12 01:12 PM 13
18. Biopsy should be regarded as the
final diagnostic procedure, and not
a shortcut to diagnosis.
History
Imaging
Investgtn.
19. Biopsy should be regarded as the
final diagnostic procedure, and not
a shortcut to diagnosis.
“The gross anatomy, as evidenced by X-rays is a
safer guide to a correct clinical conception of the
disease than the variable and uncertain structure of
the small piece of tissue sent for microscopy”
Dr. James Ewing -1922
History
Imaging
Investgtn.
20. The biopsy should be performed by the
surgeon who will be doing the definitive
surgery
24. Needle Biopsy
OPD procedure, LA
Can be image guided or CT guided
Practically no infection
Very little tissue contamination
Much smaller risk of causing fracture
Cores from depth of the tumor
Minimally invasive, much less traumatic
25. May not yield adequate tissue
May be difficult to make a diagnosis
Experienced pathologist required to
be able to give a diagnosis on small
quantity of tissue
Needle Biopsy
28. Typical treatment
pathways in
osteosarcoma and
Ewing’s sarcoma,
illustrating their
similarities and
differences from
diagnosis to
follow-up
PAEDIATRICS AND CHILD HEALTH 20:3
33. Information helps decide
Post op radiotherapy
Radiotherapy indicated for patients with
positive margins and considered for those with
residual viable tumor
Radiation dose adjusted depending upon the
percentage necrosis of tumor and margins of
resection
36. 10/20/12 36
Osteosarcoma lesions can be purely osteolytic
(30%), purely osteoblastic (45%), or a mixture of
both. (Kesselring 1982).
Lytic Sclerotic Mixed
38. 10/20/12 38
CT scanning
CT scanning of the chest is more sensitive than is
plain film radiography for assessing pulmonary
metastases.
MRI
MRI of the primary lesion is the best method to assess
the extent of intramedullary disease as well as
associated soft-tissue masses and skip lesions. (Estrada
1995)
Bone Scan
A bone scan should be obtained to look for skeletal
metastases or multi focal disease.
39. 10/20/12 39
Treatment
Current standard of care
1. Radiological staging
2. Biopsy to confirm diagnosis
3. Preoperative chemotherapy
4. Repeat radiological staging
(access chemo response, finalize surgical tx plan)
5. Surgical resection with wide margin
6. Reconstruction using one of many
techniques
7. Post op chemo based on preop response
41. 10/20/12 41
Chemotherapy
Before the era chemotherapy osteosarcoma was usually
treated with immediate wide or radical amputation on
diagnosis.
This usually treated the local disease adequately. However
80% of patients eventually died of micrometastatic
disease.
With the use of modern chemotherapy protocols, the
current 5-year survival rate for osteosarcoma is
approximately 70%.
42. 10/20/12 42
Surgery
The main goal of surgery is to safely and completely
remove the tumor.
Historically, most patients had an amputation. Over the
past 30 years, limb-sparing procedures have become the
standard, mainly due to advances in chemotherapy and
sophisticated imaging techniques (Scully 2002).
Limb salvage procedures now can provide rates of local
control and long-term survival equal to amputation.
44. 10/20/12 44
Radiotherapy
Radiation therapy has no major role in osteosarcoma
Radiation therapy may be useful in some cases where the
tumor cannot be completely removed by surgery. E.g. in
pelvic bones or in the bones of the face. In these
situations, As much tumor as possible is removed, and
then radiation is given to try to kill the remaining cancer
cells. Chemotherapy may be used after radiation.
Radiation can also be helpful in controlling symptoms like
pain and swelling if the cancer has come back or surgery is
not possible.
45. Ewings’ sarcoma
ESFTs 2nd
decade of life
Accounts for 4% of
childhood and
adolescent malignancies
One third of primary
bone tumours
Origin: Primordial neural
stem cell
Slight male
preponderance
“small round blue cell
tumors of childhood”
EFT
ETB 60% EOE PNET
48. Bx –preferably from soft tissue mass and
not from bone. If bone Bx reqd ,small
cortical window made.
Tissue for IHC ,RT-PCR.
B/L iliac for BMA and Bx.
IHC –Mic 2 [CD 99], membrane
expression,vimentin, NSE and
synaptophysin
Neural markers - neuron-specific
enolase, Leu-7, synaptophysin,
neurofilament, and S100.
49. Management
The primary goal of treatment is local control of the
disease while, if possible, achieving salvage of the
limb and its function
Limb-salvage procedures a valid alternative method
of treatment to amputation in 80-85% of patients
with primary bone sarcomas.
Wafa H et alExpert Rev Anticancer Ther. 2006 Feb;6(2):239-48.
50. Why anterior chemotherapy
Before the era of chemotherapy, fewer
than 10% of patients with Ewing’s
sarcoma survived despite
radiosensitivity
Why systemic therapy?
Mortality within 2 yrs with distant
metastasis
Jenkin RD, Clin Radiol1966;17:97–106
51. Rx Flow ChartInduction Chemotherapy
Sx Feasible
Sx Not Feasible
CT not Effective
W/E not possible
Amputation
Definitive RTPORT
Maintenance CT
52. Information helps decide
Post op radiotherapy
Radiotherapy indicated for patients with
positive margins and considered for those with
residual viable tumor
Radiation dose adjusted depending upon the
percentage necrosis of tumor and margins of
resection
53. Is surgery the best modality for local control at all sites ?
?
54. Ewing’s pelvis L
8 year old girl
Involves ilium + upper acetabulum
64. Imaging
MRI
For extremity masses
Gives good delineation between muscle, tumor and
blood vessels
CT for abdominal and retroperitoneal
PET
May help determine high vs. low grade
May be helpful in recurrences
66. Relative risk for recurrence and survival
Age >50 years 1.6
Local recurrence at presentation 2.0
Microscopically positive margin 1.8
Size 5.0–10.0 cm 1.9
Size > 10.0 cm 1.5
High-grade 4.3
Deep location 2.5
Local recurrence 1.5
67. Surgery
Limb-sparing vs amputation
Comparison study with post-op radiation in limb sparing
showed no difference in survival
Amputation still may be indicated for
neurovascular or bone involvement
68. Resection
Arbitrary 2 cm margin if no plan for post-op
radiotherapy
Negative margins may be adequate for post-op
radiation therapy
Presence of positive margins increases local recurrence
by 10-15%
No need for lymph node dissection as only 2-3%
have nodal metastasis
69. Adjuvant radiotherapy
Small, low grade tumors resected with 2 cm
margins may not require radiation
Improves local control but not survival
Whether improved local control leads to
improved survival is controversial
70. Pre-op or post-op radiation?
Some avoid pre-op use because of increased
wound complications (although this is debatable)
RCT looking at wound complication rate pre-op vs post-
op radiation showed 35% vs 17%
Risk confined to lower extremity
Conclusions: pre-op may be better for upper extremity
and head & neck because of equal wound complication
risk and benefit of lower radiation doses to more vital
tissues
72. Chemotherapy
Can improve local control, but not survival
Doxorubicin and iFosfamide have response rates
of 20%
Use only in advanced disease
Combination with radiation or neoadjuvant
therapy are controversial
Hypothermic isolated limb perfusion may be used
for palliation
73. Treatment of Recurrence
20-30% of STS patients will recur
More common in retroperitoneal and head &
neck high grade tumors because hard to get clear
margins
38% for retroperitoneal
42% for head and neck
5-25% for extremity
After re-resection recurrence is 32% for extremity
and much higher for visceral
75. Retroperitoneal Sarcomas
15% of all sarcomas
Liposarcoma 42% and leiomyosarcoma 26%
CT scan can show cystic/solid/necrotic components and relation
to surroundings
CXR to r/o mets, chest CT if CXR abnormal
Biopsy not necessary unless suspect a lymphoma or germ cell
tumor or plan preop chemo or radiation
En bloc resection is standard treatment
bowel prep
assess bilateral kidney function
50-80% need organ resection
78% of primary lesions can be completely resected
77. Prognosis for retroperitoneal sarcomas
5 year survival after complete resection of 54-65%
Drops to 10-36% if incompletely resected
Recurrence occurs in 46-59% of completely
resected tumors
78. Radiation or chemotherapy for retroperitoneal
sarcomas
Radiation
GI and neuro toxicities limit delivery of sufficient
doses
May improve local control
Recommended for use only in clinical trials given
lack of data either way
Chemotherapy
Use for recurrent, unresectable or metastatic
disease
79. GIST
Separate subtype of sarcoma defined by expression of
c-Kit (CD117)
Surgery: complete resection without local or regional
lymphadenectomy
Very resistant to traditional chemotherapy
Gleevec (imantinib mesylate)
c-Kit is constitutively active tyrosine kinase receptor
Drug is tyrosine kinase inhibitor used in CML
Initial studies showed 54% response rates
Two RCTs currently looking at adjuvant treatment
114. CAUTION
C - Change in bowel or bladder habits
A - A sore that does not heal
U - Unusual bleeding or discharge
T - Thickening or lump in the breast or any part of the
body
I - Indigestion or difficulty swallowing
O - Obvious change in a wart or mole
N - Nagging cough or hoarseness
40. Breast Cancer: Stage IV
Stage IV, or metastatic, breast cancer is a lethal disease. The most common sites of metastases are soft tissue (skin or draining lymph nodes), bone, and viscera (eg, liver, lung).