Testicular microlithiasis (TML) refers to small calcium deposits within the seminiferous tubules of the testes that are typically detected on ultrasound. While TML was once thought to increase the risk of testicular cancer, more recent evidence suggests it does not increase risk in the absence of other risk factors or a testicular mass. For patients at high risk, such as those with infertility or genetic disorders, surveillance with ultrasound or consideration of biopsy may be warranted to check for early signs of cancer. Overall, reassurance can be provided to most patients with isolated TML and no other risk factors, with education on self-exam the most important factor. Management depends on risk stratification based on presence of masses
Bosniak Classification and Renal Cystic Disease
" from both urological and radiological points of view "
historical point of view , uses and diagnostic significance , accuracy , all of these points and more in this presentation :)
Bosniak Classification and Renal Cystic Disease
" from both urological and radiological points of view "
historical point of view , uses and diagnostic significance , accuracy , all of these points and more in this presentation :)
Target audience : Oncology fellows and Oncologists.
Four challenging cases of Bladder cancer and managing decisions including latest management principles are discussed here.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
simple renal cyst lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bOP_UJuZl-dr6wJF6yv3reRw_uNqXGkt
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
Target audience : Oncology fellows and Oncologists.
Four challenging cases of Bladder cancer and managing decisions including latest management principles are discussed here.
Urethral strictures are more commonly seen in the anterior urethra. They are commonly seen secondary to gonococcal urethritis or trauma. The normal urethral lumen is 4mm or less in diameter and has small thin walls. A stricture appears as a segment of narrowed lumen with irregularity and thickening of the wall due to fibrosis and scarring.
simple renal cyst lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bOP_UJuZl-dr6wJF6yv3reRw_uNqXGkt
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
We know that mesothelioma patients would rather stay local when receiving treatment,rnso we will review options for private medical centers, surgical consultants, clinical trials,rnand match you up with friendly, local physicians wherever we can.
We know that mesothelioma patients would rather stay local when receiving treatment,rnso we will review options for private medical centers, surgical consultants, clinical trials,rnand match you up with friendly, local physicians wherever we can.
Similar to testicular microlithiasis simple.pptx (20)
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
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.
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
4. Testicular microlithiasis (TML) corresponds to concretions of
hydroxyapatite surrounded by fibrosis located in the seminiferous tubes.
The first sonographic identification ofTM was described by Doherty in 1987
They are due to the insufficient capacity of Sertoli cells to phagocyte the
degenerate cells present in the seminiferous tubules.
They are commonly discovered by ultrasound (US). They are not visible on
Magnetic Resonance Imaging (MRI).
5. They do not typically affect Leydig cells and the majority of the uninvolved
seminiferous tubules often have abnormal spermatogonia and reduced
luminal diameters.
Microliths can be seen in the testis as well as in extratesticular structures
such as the lungs and the central nervous system, with genetic factors also
thought to play a role in their development.
6. Definition
The presence of multiple microintratubular calcifications without any
acoustic shadow in the testicle and is often an incidental finding in US
examinations of the scrotum.
The microliths do not bring about pain or symptoms and are impalpable.
TM can be either unilateral or bilateral.
7. Grades
Three grades are distinguished according to the number ofTML
described by parenchyma per field of view
1. grade 1 (Limited ): 5 to 10
2. grade 2 (Classic ): 10 to 20
3. grade 3 (Diffuse ): with more than 20
Significance
A cluster (a few microliths per
field in a cluster) may be more worrying thanTM
scattered throughout the testis. It may indicate a dysgenic
area in the testis, in which carcinoma in situ
(CIS) may develop
8. Prevalence
The prevalence ofTM varied in the past data
In symptomatic adults, it range between 0.6% and 9.0%
In health population (adults without symptoms) from 2.4% to 5.6%.
In a group with genetic disorders, the prevalence of TM has been reported
much more higher. In men with Klinefelter syndrome is as high as 17.5%
and 36% in men with Down syndrome
9. The boys with Down syndrome had higher prevalence of
TML than the general healthy population.
No case of testicular cancer was recorded among 142 DS
men withTML.
Only one study found a testicular cancer (Leydig Cell
tumour) in an individual with DS andTML (1/54 = 1.9 %),
and the cancer was diagnosed during the fourth year of
follow-up.
TM and Down syndrome
10. A congenital disease characterised by
polyostotic fibrous dysplasia, caféau- lait
pigmentation and early puberty.
Two studies were included concerningTML
and MAS.
The prevalence ofTML in MAS males was
24.1 % and 62.5 % .
One testicular cancer (embryonal cell
tumour) was reported among 62 cases of
MAS.
TM and McCune–Albright syndrome
11. Both appear to have the highest frequencies of TML, ranging from 23 to
63 %.
The present analysis revealed that in these conditions there seemed to
be no relation between TML and development of testicular cancer.
This association between TML and chromosomal abnormalities may
indicate TML as part of a degenerative process of the testis.
Males with Down syndrome and McCune–Albright
syndrome Significance
12. Association of testicular microlithiasis with male
infertility
TM association with male infertility is still debated.
Incidence ofTM in a subfertile population is up to 20% .
Reduction in sperm count and sperm motility in a man with microliths is
attributable toTM-related obstruction of seminiferous tubules present in
30 to 60% of patients withTM .
Inflammation and calcification in the seminiferous tubules area bring
about deterioration in sperm quality and cause subinfertility [22].
13. Association of testicular microlithiasis with male
infertility
Thomas et al. reported a relationship between the degree of calcification
and poor sperm function.
TM is associated with worse semen parameters in adult men with infertility.
TM was reported to be more prevalent in patients with spermatogenic
defects such as severe oligospermia and reduced testicular volume .
14. Association of testicular microlithiasis with male
Infertility andTumor
TML and infertility was associated with an approximated sevenfold higher
cancer risk compared to infertile men withoutTML (10.9 vs. 1.6 %)
confirming thatTML, infertility and testicular cancer seem to be
interlinked
TML may be an indicator of a “testicular dysgenesis syndrome”
consisting of infertility, cryptorchidism, CIS and testicular cancer
EUA 2022
The risk for infertility may be higher in patients with microlithiasis and if these patients have any
sign of infertility later, the risk of developing a tumour seems to be higher compared to patients
without microlithiasis and infertility
15. Association of testicular microlithiasis with
testicular cancer
In the past, there was concern that testicular microlithiasis may increase
the risk of testis cancer. However, more recent data indicates that
testicular microlithiasis does not increase the risk of testis cancer when
there is no solid testis mass and no other risk factors for testis cancer
16. Association of testicular microlithiasis with
testicular cancer According to EUA and AUA
Testicular microlithiasis without a concomitant solid testis mass
testicular microlithiasis in men
with no solid testis mass and no
risk factors for testis c.
testicular microlithiasis (but no solid testis
mass) and at least one risk for testis
cancer
annual follow-up with
Ultrasound is conterversal and monthly self-
examination should be
advised
does not require further
evaluation
Role of
testicular
biopsy
17. Role of testicular biopsy in patient withTM and risk factors
In patients at risk to develop testicular cancer, observation versus
testicular biopsy is debatable.
At present, testicular biopsy remains the gold standard to detect ITGCN
The early biopsy allows treating early these patients with radiotherapy
therefore avoiding orchiectomy and the risk of subsequent chemotherapy.
However, such an approach could alter definitively spermatogenesis and
has no impact on overall survival.
18. Role of testicular biopsy in patient withTM and risk factors
When biopsy is indicated for fertility purposes in patients with testicular
microlithiasis, a search for ITGCN should be systematically performed.
Observation versus testicular biopsy is also debatable in patients
previously treated by orchiectomy for a testicular cancer and harboring
microlithiasis in the contralateral testis
19. Role of testicular biopsy in patient withTM and risk factors
Due to the low incidence of a contralateral tumor, even in cases of
testicular microlithiasis, there is no indication for contralateral testicular
biopsy in prepubertal boys (EUA 2022).
While in Adult an individualized approach based on the age of the
patient,the presence of concurrent features of testicular dysgenesis
syndrome, the fertility of the couple, the desire of paternity and the
ultrasound pattern (bilateral and clusteredvs. unilateral and limited) is
recommended
20. A diagram explaining the link between different feature of dysgenetic testis and testicular
cancer.
21. A decision tree for patients having testicular microlithiasis.
22. Association of testicular microlithiasis with
testicular cancer
Testicular microlithiasis with a concomitant solid testis mass-these
patients are assumed to have testis malignancy
surgical exploration with testicular
biopsy or orchiectomy should be
considered An ultrasonography of a 16-year-old male
with testicular cancer and multiple
Classic testicular microlithiasis
and accompanying lobulated
seminoma .
23. Data in the literature are sparse, and cancer subtypes were inconsistently
reported.
Recently, it was suggested that there might be a positive association between
TML and seminoma, and a negative association betweenTML and embryonal
cell carcinoma.This was confirmed in our review, in which seminoma accounted
for 36 % of cancer cases reported withTML compared to 1 % for embryonal
carcinoma .
There appears to be no association betweenTML, age and tumour size
Association of testicular microlithiasis and cancer
subtypes
24. Summary and Our Recommendations When Testicular Microlithiasis
Is Noted
The management of TM detected on ultrasound can be divided into four
categories.
First,TM in the presence of a
mass is irrelevant.The mass
trumps all. “Most masses in
the testicle are assumed to
represent testicular cancer
until proven otherwise”
Second, the patient can be
reassured that if the patient is
at low risk forTC,
the risk ofTC developing in
the setting of isolatedTM,
although not precisely known,
is extremely small (with the
worst estimate of risk being 1
in 100 cases).
Third, and of most importance,
the patient should be educated
about the need for regular
monthly testicular self-
examination.
Finally, the risk of
TC should be stratified on the basis of
other
Risk factors , and follow-up ultrasound
examination should be reserved for high-
risk
patients.
25. Take-home massage
This association betweenTML and chromosomal abnormalities may indicateTML as part
of a degenerative process of the testis.
TML and infertility was associated with an approximated sevenfold higher cancer risk
compared to infertile men withoutTML (10.9 vs. 1.6 %).
In the absence of risk factors, the occurrence of testicular cancer in patients withTML is
similar to the risk of the general population.
TM at risk to develop testicular cancer, observation versus testicular biopsy is debatable.
Most masses in the testicle are assumed to represent testicular cancer until proven
otherwise”
26. 1. Winter, T. C., et al. (2016). "Testicular Microlithiasis: What Should You Recommend?"
AJR Am J Roentgenol 206(6): 1164-1169.
2. Leblanc, L., et al. (2018). "Testicular microlithiasis and testicular tumor: a review of
the literature." Basic Clin Androl 28: 8.
3. Pedersen, M. R., et al. (2019). "Association between risk factors and testicular
microlithiasis." Acta Radiol Open 8(9): 2058460119870297.
4. Aoun, F., et al. (2019). "Testicular microlithiasis: Systematic review and Clinical
guidelines." Prog Urol 29(10): 465-473.
5. EUA 2022
REFERENCE