1) Radiotherapy is an important treatment option for cancers of the larynx, especially early stage cancers of the vocal cords and glottis.
2) For early vocal cord cancers, radiotherapy alone or supracricoid laryngectomy are options. For moderately advanced vocal cord cancers, radiotherapy is preferred if favorable or total laryngectomy if unfavorable.
3) For advanced vocal cord or supraglottic cancers, total laryngectomy with neck dissection and radiotherapy is recommended for T3/T4 N0 cancers, and total laryngectomy with neck dissection and chemoradiotherapy for advanced supraglottic cancers.
This slide explains the radiotherapy contouring guidelines for carcinoma esophagus. It has detailed explanations in a quite simple way, so that you need not go anywhere else for esophageal contouring guidelines.
This slide explains the radiotherapy contouring guidelines for carcinoma esophagus. It has detailed explanations in a quite simple way, so that you need not go anywhere else for esophageal contouring guidelines.
presentation of cancer larynx lecture by Dr Ibrahim Habib Barakat ..E-mail: salamatuall@yahoo.com
Tel: 00966500072975
(Please vote for this lecture if you see it is good)
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
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
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- 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
- 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
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
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New Drug Discovery and Development .....NEHA GUPTA
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6. Subsites in Larynx
1. Ca Supraglottis
Epiglottis, False vocal cord, Ventricles
Aryepiglottic fold, Arytenoids
2. Ca Glottis
True VC , Ant. and post. Commissure
3. Ca Subglottis
7. Lymphatics
• Supraglottic larynx -superior deep cervical
nodes
• Glottis-No lymphatics
• Subglottis-Inferior deep cervical nodes, pre- or
para-tracheal nodes (level VI)
9. Vocal Cord and Lymph node
T1 : 0
T2: <2%
T3 and T4 :20-30%
If Supraglottic invasion –Level 3, 2
If Subglottic invasion –Level 6
DOI: 10.1200/JCO.2001.19.20.4029 Journal of Clinical Oncology 19, no. 20 (October 2001) 4029-
4036. T1-T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Radiation Therapy
William M. Mendenhall, Robert J. Amdur, Christopher G. Morris, Russell W. Hinerman
10. Goal of Treatment
• Best functional result with least risk of serious
complication
1. Loco regional Control
2. Larynx preservation
11. Management of CIS
• Stripping of the cord
• Excision using CO2 laser
• RT
LC and Larynx preservation-91%
12. Early Vocal Cord Carcinoma
• Radiotherapy
• Supracricoid
Laryngectomy
• Hemilaryngectomy
• Cordectomy
• Verrucous Ca- Partial
Larngectomy>RT>Total
Laryngectomy
Recurrent lesions after
treatment are always
agressive
13. Moderately Advanced Vocal Cord
Carcinoma
Favourable
• Extensive bilateral or
compromised airway-
Mangement as per
advanced group
Unfavourable
• Radiotherapy
14. Advanced Vocal Cord Cancer
T3,T4 N0
• Total laryngectomy+ RT
• Total Laryngectomy+Lateral
neck dissection+RT
T3,T4 N1
• Total Laryngectomy+Lateral
neck dissection+RT
• MC sites of
recurrence post
surgery
1. Tracheal stoma
2. Base of tongue
3. Neck nodes
4. Soft tissues of neck
15. Indication of Post op RT
1. Positive margin
2. Significant suglottic
extension
3. Cartilage invasion
4. PNI
5. Extension of primary to
soft tissues f neck
6. Multiple positive neck
nodes
7. ECE
8. Dose 60-70Gy/30-35# with
5 fractions per week over
6-7 weeks depending on
margins.
Indication of Pre op RT
1. Fixed nodes
2. Energency tracheostomy
through tumour
3. Extension of tumour
involving skin
16. Early and Moderately Advanced
Supraglottic Lesions
1. Radiotherapy
2. Supraglottic Laryngectomy+
RT
Advanced Supraglottic Lesions
1. Total Laryngectgomy
2. Concomitant
Chemoradiotherapy
19. Ca Larynx Early Glottic Cancer(T1–2 )
• Superior: Sup border thyroid
cartilage
• Inferior: Inferior border of
cricoid cartilage
• Anterior: 0.5–1 cm fall-off to
skin
• Posterior: in front of vertebral
bodies
• 4x4- 6x6 fields
• Dose-66-70Gy/33-35# with 5
fractions per week over 6-7
weeks
23. • Two anterior oblique
fields for treatment of
early glottic carcinoma
24.
25.
26.
27.
28.
29.
30.
31.
32.
33. Ca Larynx Early Glottic Cancer(T1–2 )
2 opposed lateral wedged
fields for T1 glottic tumor
2 anterior oblique fields for
early glottic cancer
34. T3–4 Glottic and Supraglottic
Laryngeal Cancer
• Superior: superior to mandibular angle
• Inferior: bottom of cricoid cartilage •Subglottic
extension (+), shoulders should be pulled down
as much as possible.
• If patient is operated, 1.5 cm superior to stoma
(stoma is treated in supraclavicular field)
Anterior: 0.5–1 cm skin fall-off to neck and one-
third of mandible Posterior: usually spinous
processes
35. Follow up
• 1st year – 4-6 weeks
• 2nd year – 6-8weeks
• 3rd year- Every 3 months
• 4th and 5th -Every 6
months
• Thereafter annually
• LN examination,IDL ,TFT
• Challenges
1. Distinguish between
edema and recurrence
• Progressive edema
• Persistent throat pain
• Fixation of previous
mobile vocal cord
Larynx extends from the tip of epiglottis at the level of C3 to C6 vertebra below
Vocal cord 3-5mm thick , post attachment with vocal process . Thyrohyoid, cricothyroid- sup laryngeal n (bowing mobile VC and hoarseness), cricotracheal, hyoepiglotticthyroepiglottic, cricovovocal lig, pre epiglottic and para glot=LN mets
Fixation of VC – Destruction of VC muscle, Invasion of cricoarytenoid muscle or invasion of RLN
Cricothyroid
Between vestibular and vocal fold is ventricle,
SG:Glottis 3:1
Superior level 3 and 2
Inf level 4,3
Extensive supraglottic or subglottic extension, bilateral glottic involvement, invasion of thyroid, cricoid, arytenoid invasion,compromidsed airway
Note hot spot 101% outside target volume c= True VC SC is Spinal cord