Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Identified in 1921 by James Ewing
2nd most common bone tumor in children
Ewing’s Sarcoma Family of tumors:
Ewing’s sarcoma (Bone –87%)
Extraosseous Ewing’s sarcoma (8%)
Peripheral PNET(5%)
Askin’s tumor
Identified in 1921 by James Ewing
2nd most common bone tumor in children
Ewing’s Sarcoma Family of tumors:
Ewing’s sarcoma (Bone –87%)
Extraosseous Ewing’s sarcoma (8%)
Peripheral PNET(5%)
Askin’s tumor
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- 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
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 Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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
4. Epidemiology
• Testicular tumor -> 1- 2 % of malignancies in men
• Majority – GCTs - 90% originate in testis
- 10 % extragonadal
• Others – lymphoma, sarcoma
• GCTs
- Seminoma – 4th decade
- NSGCTs – 3rd decade
• Incidence of GCT doubled in past 30 yrs
• Common in young white men & less common in
african americans
5. Risk factors
• Cryptorchidism – 6 fold ↑ed risk
• Family H/O testicular ca
• Subfertility
• Testicular microlithiasis
• Prior testicular malignancy
• Heritability
- risk to son - 4- 6 times ↑ed
- risk to brother – 8 – 10 times ↑ed
• Other risk factors
- H/O testicular trauma
- ↑ed BMI
- Immunosuppression
- Prenatal factors
6. Pathology
• Seminoma arises from germinal epithelium of
seminiferous tubules
• GCTs
->60% - pure seminoma
->30% - NSGCTs
->10% - mixed tumors
• ITGCN
- precede all seminoma & NSGCTs
- 0.5% in impaired fertility
- 2.5% in cryptorchid & C/L testis of prior GCT
7. Seminoma - types
• Classic
• Atypical Seminoma
• Anaplastic seminoma
- ≥ 3 mitotic figures / HPF
• Spermatocytic Seminoma
- old men
- not ass. With IGCN
- do not express PLAP
- minimal metastatic
potential
- excellent prognosis
8. Pathways of spread
• Direct extension
- epididymis -> tunica
vaginalis -> spermatic cord ->
scrotum
• Lymphatic spread
- m.c. route
- Lt sided – para, pre aortic
& Lt common iliac LN
- Rt sided – interaorto
caval, pre, para caval & Rt c. iliac
- C/L LN mets – 15%
9. Pathways of spread – contd..
• Supra diaphragmatic spread
- via thoracic duct > post. Mediastinum > Lt S/c LN
• Pelvic & inguinal LN involvement rare (< 3%)
• Distant mets
- Lung > Liver > Brain > Bone > Kidney
10. Clinical features
• Painless testicular mass
• 45% of pts – testicular pain
• 10% of pts
- neck mass
- cough or dyspnoea
- anorexia, nausea, vomiting/haemorrhage
- lumbar backache
- bone pain
- U/L or B/L lower limb swelling
• 70 – 80% - stage I
• 15 – 20% - stage II
• 5 % - stage III
11. Work up
• History
• Physical examn
• Lab studies
- CBC, LFT, KFT, S. electrolytes, RBS
- Sr. LDH
- Sr. AFP
- Sr. β HCG
• Surgery
- Radical inguinal orchiectomy
• Diagnostic radiology
- CXR PAV & lat. View
- CT scan abdomen & pelvis
- CT scan Chest
- USG of C/L testis
• Semen analysis
USG of testicular swelling
14. Seminoma – risk classification
Any primary site
Any LDH
Any β HCG
Good Risk
No Non pulmonary
visceral mets
Intermediate Risk
Non pulmonary
visceral mets
15. General management
• Initial management
- Radical inguinal
orchiectomy
• Stage I
- surveillance
- adj. RT
- adj. CT
• Stage II A/B
- adj. RT
- adj. CT
• Stage II C / III
- sytemic CT
16. Stage wise Rx
• Stage I
1)Surveillance
- management strategy of choice
- Physical examn & CT scan
- 4 mthly assessment in 1st 2 years
- 6 mthly assessment in 3rd & 4th yr
- annual assessment in yrs 5 – 10
- Median time to relapse – 12 – 18 mths
- 76 – 94 % of relapses in retroperitoneum – Adj. RT
- 2nd relapse occur in 10 % of pts ( distant) - CT
17. Stage I – Rx (contd….)
• Warde et al, JCO 20:4448-4452, 2002 (pooled data from 4
major centers)
> 5 year OS – 97.7%
> 5 year CSS – 99.3%
> 5 / 10 year RFS – 82.3% / 78.7%
18. Stage I – Rx (contd….)
2)EBRT
> OS rates are 92-99%
> Cause-specific survival is nearly 100%
> Relapse rates are 0.5-5% in modern studies (mostly
supradiaphragmatic)
> Most relapses occur <2 years from treatment (median 18
mo. in PMH study)
> Chemotherapy is readily used in the setting of relapse
19. Stage I – EBRT (contd….)
• Historically Adj. RT to para aortic & I/L pelvic lymph nodes (
dog leg or hockey stick)
• Relapse rate – 1 – 5 % & disease specific survival – 100%
• Para aortic RT alone – higher failure in pelvic nodes
• Hence, a common approach using modified dog leg portal
where inf. Border placed at mid pelvic level is used
20. Stage I – Rx (contd….)
3)Adj. CT
- less toxic alternative to RT
- Oliver et al (Carboplatin without RT)
- 78 patients
- 53 with 2 courses of Carbo
- 25 with 1 course of Carbo
- 44 months of follow up with only 1 relapse
21. Stage I – RT vs CT
• The MRC (Oliver et at JCO, 29:957-962, 2011)
randomized:
• With a median of 6.5
years follow up
– Relapse rate was
5.3% with carboplatin
vs 4.0% with RT
885 patients got PA
or DL RT to between
20 and 30 Gy
560 patients got one
injection of carboplatin
22. Stage I - Rx Summary
• Treatment
– Inguinal Orchiectomy
• Active Surveillance with serial imaging
– ~85% RFS
– 70% relapses <2years, nearly all <5 years
• XRT
– 95% RFS
– Paraaortic equivalent with less toxicity than
PA/Pelvic (dog leg)
– 20 Gy equivalent with less toxicity than 30 Gy
• Carboplatin
– 95% RFS
– One cycle equivalent to two cycles
23. Stage II - Rx
• Stage IIA – RP node <2cm
• Stage IIB – RP node 2.1-5cm
• Stage IIC - >5 cm
• Few patients have stage II disease making randomized trials
difficult to perform
• Data hence stems from institutional experiences
• The greatest prognostic factor is bulk of nodal disease
(diameter of largest node)
25. Stage III - Rx
• Systemic CT
• 3 courses of BEP or 4 courses of EP
• 5 yr survival
> good prognosis group – 91%
> intermediate prognosis group – 80%
26. Residual Retroperitoneal Mass
• Presence of residual masses after definitive treatment
is common
• Most often represent fibrosis or necrosis
• Very few contain viable tumor
• Options
– Observation ( for mass ≤ 3 cm )
– Surgery
– RT (after chemo)
• PET is of little value in this setting
27. RT technique
• Cobalt – 60 or 6 – 18 MV linear
accelerator photons
• Parallel AP/PA fields
• Testicular shielding
• CT based planning
• IVU evaluation
• Target volume
- interaortocaval, pre & para
aortic,
- Lt renal hilar LN
- I/L int. & ext. iliac LN
28. RT technique
• Dog leg field
> upper – T9 & T10
> lower – top of obturator
foramen
• Modified dog leg
- upper – b/w T10 & T11
- lower – superior aspect of
acetabulam
- at para aortic region field
approx. 9 cm wide
- at renal hilum width – 11 –
12 cm
- field extended laterally at
mid L4 level to cover I/L external
iliac nodes
35. Follow up
Stage
H & P,
Sr. AFP, LDH, β HCG CXR CT Scan
IA, IB after RT
4 mthly for 1st 2 yrs
Then annually 3 –
10yrs
When clinically
indicated
CT pelvis annually
– 3 yrs only for PA
RT.
IA, IB after CT 3 mthly for 1st yr
4 mthly for 2nd yr
6 mthly for 3 rd yr &
annually thereafter
When clinically
indicated
CT abd/pelvis
annually for 3 yrs
IIA, IIB after RT 3 mthly for 1st yr
6 mthly for 2 – 5 yrs
Annually for 6 – 10 yrs
6 mthly for 2 yrs 6 mthly for 2 yrs,
Annually in 3rd yr
IIB, IIC & III after CT 2 mthly for 1st yr
3 mthly for 2nd yr
6 mthly for 3-4 yr
Annually upto 10 yr
2 mthly for 1st yr
3 mthly for 2nd yr
6 mthly for 3-4 yr
Annually upto 10 yr
When clinically
indicated
36. Results of therapy
• Stage I
– 96- 98% 10 yr DFS
- 99 – 100% cause specific survival
• Stage II A – 92% DFS, 96 – 100% CSS
• Stage IIB – 86% DFS, 96 – 100% CSS
• Stage III – overall progression free survival – 86%