- Microinvasive breast cancer (MIBC) has a low but measurable risk of lymph node metastasis. Several studies found positive lymph nodes in 3.7-7.5% of MIBC patients who underwent sentinel lymph node biopsy (SLNB).
- Factors like lymphatic invasion and positive estrogen receptor status predict higher risk of lymph node metastases in MIBC. However, routine SLNB is not warranted for all MIBC patients. Careful selection based on risk factors is needed to avoid overtreatment.
- Studies of patients with DCIS found lymph node micrometastases in 21-34% of those undergoing SLNB for high-risk features like palpable mass or suspicious imaging. However, the clinical significance
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
Radiation Oncology in 21st Century - Changing the ParadigmsApollo Hospitals
Since its inception radiation therapy has been used as one of
the essential treatment options in the management of malignant and some benign tumors. With better understanding of tumor biology many new molecules have been added to the armamentarium of an oncologist. There is continuous improvement in surgical techniques with more emphasis on minimally invasive, organ- and function-preserving techniques. Neoadjuvant chemotherapy with or without addition of radiation therapy has helped surgeon downsizing the tumor and obtaining clearer margins.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
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.
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
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.
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
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.
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
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
- 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
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
The role of sentinel lymph node in microinvasive DCIS
1. The role of sentinel lymph node in microinvasive DCIS
Dr . Mutaz al makhamrah
Surgical oncology fellow
KHCC
Surgical oncology department
2. Background
The status of the regional lymph nodes is the single most important predictor of disease-free
and overall survival in breast cancer patients
DCIS is a disease devoid of invasive behaviour and thus without potential for spread to the
axillary lymph nodes.
Current practice is to perform sentinel lymph node biopsy (SLNB) only in selected patients
with DCIS when there is
substantial risk of upgrade of the lesion at final pathology,
such as a mass lesion highly suggestive of invasive cancer at imaging and physical
examination,
patients with a large area of DCIS at imaging (5 cm or greater), or
when mastectomy is indicated
3. Microinvasive breast cancer is an uncommon pathological entity, approximately 1 per
cent of all breast cancers.
The definition:
Extension of cancer cells beyond the basement membrane into the adjacent tissue with
no focus more than 1mm in greatest dimension, ( AJCC )
As a result, the term ‘T1mic’ has now been added to the TNM staging system.
According to the international treatment guidelines, MIBC falls into the group of T1
cancer subset, and it should be treated as such.
This includes axillary staging via sentinel lymph node biopsy (SLNB).(NCCN2018)
4.
5. 613 cases of DCIS and microinvasive carcinoma that were consecutively resected
from 2003 to 2014 and analysed
clinicopathological variables, expression of standard biomarkers such as
the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth
factor receptor 2 (HER2), p53, and Ki-67, and tumor recurrence.
6.
7.
8.
9.
10.
11.
12. conclusion
axillary staging is performed for patients with microinvasive carcinoma, lymph node metastasis is a
rare event for such patients.
observed axillary nodal metastases in only four (3.7%) of 110 patients with microinvasive carcinoma
who underwent axillary staging surgery.
microinvasive carcinoma is different from pure DCIS with respect to pathological features and
biomarker expressions but is similar to DCIS with respect to clinical outcomes.
The triple-negative subtype is the only factor associated with tumor recurrence.
These results suggest that microinvasive carcinomas can be treated and followed up as pure DCIS,
although axillary staging surgery is necessary.
This study also indicates that patients with triple-negative DCIS or microinvasive carcinoma need
close follow-up because such cancers are associated with tumor recurrence, especially invasive
recurrence.
13.
14. Between July 1989 and December 2008,
9635 patients had operation on invasive breast cancer in Asan Medical Center. Among these
patients,
319 patients had MIC.
The research conducted on the 293 patients (excluded were 26 who did not receive axillary
lymph node dissection or SLN biopsy).
retrospectively checked clinical and pathologic variables.
15.
16.
17. Conclusion
There were 22 cases of ALN metastases identified in this group of patients (7.5%).
the incidence of ALN metastases is low in MIC patients;
Lymphatic invasion (P<.001)
positive estrogen receptor status (P =. 03) were independent significant predictors of axillary
metastases.
studies of predictors of SLN metastases indicate that selective SLN node evaluation is
warranted in such patients, whereas routine SLNB is not indicated in all patients with MIC.
18.
19. From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk
DCIS (n 5 76) or DCISM (n 5 31) were enrolled prospectively in database.
Patients with DCIS were considered high risk and were selected for sentinel lymph node biopsy if there
was concern that an invasive component would be identified in the specimen obtained during the
definitive surgery.
Patients underwent intraoperative mapping that used both blue dye and radionuclide.
Excised sentinel nodes were serially sectioned and were examined by hematoxylin and eosin and by
immunohistochemistry.
21. • reviewed the 76 high-risk DCIS patients,
found that they each had at least one of the following
characteristics:
palpable mass (21%) presence
histology
suspicious but
not
diagnostic for
microinvasion
(24%) multicentric
disease
that required
mastectomy
(53%)
histologically high
nuclear grade or non-high
nuclear grade with necrosis
(72%).
mammograph
ic
mass
(34%) Axilla clinically (0%)
Type of
surgery :
Mastectomy+
SLNBX
(53%) BCS (47%)
22.
23.
24.
25. conclusion
This study documents a high incidence of lymph node micrometastases as
detected,by sentinel node biopsy in patients with high-risk DCIS and DCISM.
Although the biological significance of breast cancer micrometastases remains
unclear at this time,
these findings suggest that sentinel node biopsy should be considered in patients
with high-risk DCIS and DCISM.
26.
27. Institutional Review Board–approved chart review identified 322 patients with DCIS or DCISM on
final pathology who underwent SNB from 1997 to 2003.
28. Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of
local or distant recurrence.
Other features of DCIS and DCISM may be important in predicting recurrence risk
29.
30.
31.
32.
33.
34. Conclusion
This study demonstrates a low incidence of SN macrometastase (< 4%) in patients with MIBC.
The odds of SN metastases were almost a threefold higher in patients with a HER2+ status and nearly
a fivefold higher in patients under the age of 50.
If SN macrometastases are detected, a considerable proportion (22%) has further metastatic spread
to non-SN and might need axillary treatment.
to avoid overtreatment, advise against the routine use of axillary staging in MIBC patients above 50
years of age with a HER2− status.
axillary staging should be confined to
younger HER2+
MIBC patients without staging at primary surgery.
35.
36. Retrospective review of our pathology database was performed (1994–2012).
Of 7000 patients surgically treated for invasive breast carcinoma, 99 (1%) were classified as
microinvasive carcinoma.
Axillary staging was performed in 81 patients (64, sentinel lymph node biopsy; 17, axillary
lymph node excision).
37.
38.
39. results demonstrate a very low incidence of sentinel lymphe node metastases in microinvasive
carcinoma patients,
exclusively limited to isolated tumor cells.
This study highlights that many of the so-called ‘positive’ sentinel lymph nodes are falsely
positive
secondary to iatrogenic transport of displaced epithelial cells.
Careful pathologic evaluation of sentinel lymph nodes and the surgical breast specimen is
required to avoid false positives and subsequent unwarranted axillary surgery or adjuvant
treatment.
recommend reassessment of the routine surgical practice of sentinel lymph node biopsy in
patients with microinvasive carcinoma.
Alternative procedures to sentinel lymph node biopsy such as preoperative ultrasound and
ultrasound-guided fine-needle aspiration of axilla should be explored.
40.
41. A database was analysed to identify patients with microinvasive ductal carcinoma in situ
(DCIS) who had surgery for invasive breast cancer at the European Institute of Oncology,
Milan, between 1998 and 2010.
Women who had undergone axillary staging by sentinel lymph node biopsy were included
in the study.
257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy
(SLNB),
226 (87⋅9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs.
Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had
macrometastases in sentinel nodes.
Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs.
median follow-up of 11 years.
42.
43.
44.
45.
46. conclusion
The present findings, of low positive SLN rates in women with good DFS and OS, and the
lack of influence on selection of adjuvant treatment, are in line with other studies showing
that SLNB in microinvasive DCIS may not be useful.
This study supports the evidence that less surgery, combined with adequate presurgical
clinical/histological information allowing the planning of a correct, personalized, clinical
pathway for each patient,
may provide the same level of OS with better patient quality of life.