Comprehensive review of Isolated Axillary lymph nodal metastasis of unknown origin- Clinically unknown primary axilla which includes detailed approach and management of inguinal lymph nodal metastasis also
Comprehensive review of Isolated Axillary lymph nodal metastasis of unknown origin- Clinically unknown primary axilla which includes detailed approach and management of inguinal lymph nodal metastasis also
Common: 200 000 TC/an, 12 000 death
Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury
CT: first-line of imaging
MR imaging being recommended in specific settings
MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms
However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
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.
- 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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Sophie Taieb How to avoid Errors in uterine imaging ? Jfim Buenos-Aires 2017
1. How to avoid Errors in uterine imaging ?
Anatomopathological correlations.
S. Taïeb, M. Ben Haj Amor, A.S. Lemaire,
E. Leblanc, L. Ceugnart
2. How to shoot one self in the foot ?
Not enough knowledge about pathology and treatment
Bad choice of technique / pathology : US / CT / MRI ?
Pitfalls in technique
Mistakes when reading
Omissions in report
5. Patients related limitation
US :
Anatomical, inadequate cycle
Limited US access (size, pain, virgo)
Disease specific problems : air, calcium, posterior localization
MRI
Contraindications : heart pacemaker, metallic foreign body,
claustrophobia (severe !)
Motions or metallic device : artefacts
6. Uterine pathology = US, MRI
Referred for clinical symptoms : Pain, Bleeding, Mass US
Diagnosis : STOP
Diagnosis ? : if uterus or unknown origin MRI
7. Uterine pathology = US, MRI
Referred for clinical symptoms : Pain, Bleeding, Mass US
Diagnosis : STOP
Diagnosis ? : if uterus or unknown origin MRI
Referred for known carcinoma of cervix or endometrium MRI
SFR, ESUR, ESMO, ESGO, ACR
8. Uterine pathology = US, MRI
Referred for clinical symptoms : Pain, Bleeding, Mass US
Diagnosis : STOP
Diagnosis ? : if uterus or unknown origin MRI
Referred for known carcinoma of cervix or endometrium MRI
SFR, ESUR, ESMO, ESGO, ACR
Referred before specific treatment symptomatic uterine fibroids
SARCOMA ? MRI
hysterectomy, myomectomy, uterine artery embolization, Magnetic resonance-
guided focused US, Radiofrequency volumetric thermal ablation
9. Uterine pathology = US, MRI
Referred for clinical symptoms : Pain, Bleeding, Mass US
Diagnosis : STOP
Diagnosis ? : if uterus MRI
Referred for known carcinoma of cervix or corpus MRI
Referred before specific treatment symptomatic uterine fibroids
SARCOMA ? MRI
10. Cervix lesion
Prognosis and Treatment planning according on :
Lesion size
Extension
Lymph node
American College of Radiology 2016 :
Early stage :
- MRI with contrast : Rating 8 (6 if without contrast)
- FDG-PET/CT : Rating 8 (with MRI)
Late stage :
- MRI with contrast : Rating 9 (6 if without contrast)
- FDG-PET/CT : Rating 9 (with MRI)
https://www.guideline.gov/summaries/summary/49923
11. Pitfalls in cervix lesion
Prognosis and Treatment planning according on :
Lesion size : MRI
Extension : MRI
Lymph node : Lymphadenectomy > PET-CT > MRI = CT
American College of Radiology 2016 :
Early stage :
- MRI with contrast : Rating 8 (6 if without contrast)
- FDG-PET/CT : Rating 8 (with MRI)
Late stage :
- MRI with contrast : Rating 9 (6 if without contrast)
- FDG-PET/CT : Rating 9 (with MRI)
https://www.guideline.gov/summaries/summary/49923
12. Advanced stages : > IB2,
or N+
RCC
[Green JA et al. Lancet 01]
Cervix carcinoma – FIGO 2009
STAGE DESCRIPTION
STAGE 0 Carcinoma in situ
STAGE I
IA
IA1
IA2
IB
IB1
IB2
Extension deeper into the cervix
Micro invasion
< 3mm deep ; < 7mm extension
>3mm et < 5mm deep et < 7mm extension
Clinically visible > Stage IA limited into the cervix
< 4cm in greatest dimension (MRI)
> 4 cm in greatest dimension
STAGE II
IIA
IIA1
IIA2
IIB
Extension limited beyond the uterus
Vagina (< 2/3 supérieur) but not parametrial
Clinically visible lesion < 4 cm
Clinically visible > 4 cm
Parametrial invasion
STAGE III
IIIA
IIIB
Large extension
Lower one third of the vagina
Pelvic wall, hydronephrosis, nonfunctioning kidney
STADE IV
IVA
IVB
Pelvic or extra pelvic extension
Bladder or rectum (biopsy proved)
Metastasis
Early stages : < IB1, N-
Surgery
+/- Brachyttt (2-4 cm)
13. Pitfalls in cervix lesion – Lesion size
IS, IA1 < 5mm : not seen
IA2 – IB1 : > 5mm
14. Pitfalls in cervix lesion – Lesion size
64 y-o. TSE T2
15 x 14 x 17 mm, N-, no extension
15. Pitfalls in cervix lesion – Lesion size
46 y-o. TSE T2
15 x 14 x 17 mm, N-, no extension
Post contrast : 1mn15, 2mn30 , 6mn
16. Pitfalls in cervix lesion – Lesion size
• 41 y-o. Conization : lesion 15mm, non in sano
• IRM 6 weeks later : TSE T2, DWI, ADC
17. Pitfalls in cervix lesion – Lesion size
• 41 y-o. Conization : lesion 15mm, non in sano
• IRM 6 weeks later : TSE T2, DWI, ADC
Post contrast : 30 sec, 1 mn 30 – Residual lesion 10mm
18. > IB2
47 x 34 x 43 = Concomitent RTCT
Pitfalls in cervix lesion – Lesion size
39. Cervix Lesion
Take home messages
TSE T2 : Sagittal, Axial, coronal : bigger axis of lesion – ! fast T2
DCE-MRI : help in small and big lesion not an option
DWI MRI : help if enough big lesion
Don’t forget to describe items may impact treatment
• anatomical vascular (or other) variations
• Specific extension
40. Endometrium carcinoma – FIGO 2009
Stage Description
Stage I
I A
I B
Tumor confined to the uterus
< 50 % Invasion of the myometrium
> 50% Invasion of the myometrium
Stage II Tumor invades cervical stroma
not beyond the uterus
Stage III
III A
III B
III C
Local or regional spread of tumor
Serosal or adnexal invasion
Vaginal or parametrial involvement
Pelvic Lymph nodes (C1)
Paraaortic Lymph nodes (C2)
Stage IV
IV A
IV B
Extension beyond the uterus
serosa
Bladder or bowel mucosa
Metastases, inguinal lymph nodes
American College of Radiology 2013 :
Assessing the depth of myometrial invasion
MRI with or without contrast : Rating 9
Assessing endocervical tumor extent
MRI with or without contrast : Rating 9
https://www.guideline.gov/summaries/summary
/47687
41. Endometrium carcinoma
Prognosis and Treatment planning according on :
Myometrium extension : MRI
Cervical stroma extension : MRI
Lymph nodes : surgery > PET > MRI = CT
Lesion grade, type of lesion : pathology
42. Endometrium carcinoma
Type II
Non Oestrogen dependant
> 66 y-o
10-23 %
Serous, clear cells
Type I
Oestrogen dependant
50-59 y-o
77-80%
Endometrioid carcinoma
43. Treatment according to risk
90% diagnosis early stage : I or II
ESMO 2009
Total hysterectomy with bilateral salpingo-oophorectomy
No lymphadenectomy
STOP
No lymphadenectomy
(or for staging)
Vagina brachytherapy
Pelvic Lymphadenectomy
If + : Aortic Lymphadenectomy
Vagina Brachyttt + ERT
Low risk : Type 1
Stage IA, grade 1 or 2
Intermediate risk : Type 1
Stage IA, grade 3
Stage 1B, grade 1 or 2
High risk
Stage IB, grade 3, Type 1
Type 2 (all stages)
Stage II (cervix)
Vascular embols