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ACETABULAR FRACTURES

ACETABULAR FRACTURES

In order to understanding the acetabular fractures it should be first known the anatomy of the acetabulum

Anatomy of the acetabulum

The acetabulum may be considered as an anterior column and wall and a posterior column and wall. The anterior column comprises the anterior part of the iliac wing extending down to include the anterior half of the acetabulum and anterior wall and around to the superior pubic ramus and pubic tubercle .the posterior column comprises the posterior half of the acetabulum the bone running back to the greater and lesser sciatic notch, and the bone running down to the ischium and the ischial tuberosity. The posterior wall abuts the centre of the posteriors column. these columns come together in an inverted Y with the dome of the acetabulum at the apex The classification of fractures is based on the extent involvement of the two columns and walls.

CAUSES AND TREATMENT OF PELVIC FRACTURES

CAUSES AND TREATMENT OF PELVIC FRACTURES

two hip bones

CAUSES AND TREATMENT OF PELVIC FRACTURES

To understanding the fractures of the pelvis first you should know the anatomy of the pelvic girdle

Anatomy of the pelvis

The pelvis is made up of

• innominate (hip) bones • the sacrum• the coccyx
These bones are bound to one another by strong ligaments

The hip bone or innominatum :This consists of three fused bones which are

• ilium• pubis• ischium

TIBIAL PLATEAU FRACTURES

TIBIAL PLATEAU FRACTURES

Introduction

TIBIAL PLATEAU FRACTURES

tibia and fibula

The tibia and fibula are the the bones of the leg which extended from the knee above to ankle below the tibia is more big than fibula the tibia is the medial bone but fibula is lateral one the tibia has shaft upper and lower end it is alone articulates with the femur at the knee joint the upper end has medial and lateral condyles the tuberosity of the tibia is at upper end of the anterior border of the shaft and gives attachment to the ligamentum patella the shaft of the tibia is lies subcutaneous so lacerations over it heal poorly because of lack of vascularity in the subcutaneous tissues as only the periosteum supports the skin the lower end of the tibia has the medial malleolus the

FRACTURES FEMUR

FRACTURES FEMUR

Introduction

The femur bone is the largest bone in the body which extended from hip joint above to the knew joint below it is divided into upper proximal part which contains the head neck greater and lesser trochanters shaft and distal or lower part which contains medial and lateral epicondyles

blood supply of femoral head

FRACTURES FEMUR

anatomy of the femur bone

this is from1- Retnacular branches from medial and lateral femoral circumflux arteries pass proximally within the joint capsule to anastamosis at junction of neck and articular surface which is the main source of supply the retinacular vessels are easily to disrupted in intracapsular fractures leading to avascular necrosis of the head 2- vessels travelling up the diaphysis 3- an artery in the ligamentum teres small contribution to no contribution in elderly

FRACTURES AND DISLOCATIONS OF THE UPPER LIMB IN CHILDREN

FRACTURES AND DISLOCATIONS OF THE UPPER LIMB IN CHILDREN

Introduction
Bony injuries in children are different from adult because their bone is different from adult as they have an epiphysis and they are still growing

Fractures and related childhood injuries you should be aware of the following 1- Epiphyseal injuries 2- Forearm bone fractures 3- Supracondylar fractures 4- Condylar fractures 5-Pulled elbow

CAUSES TYPES AND TREATMENT OF FRACTURES RADIUS AND ULNA

CAUSES TYPES AND TREATMENT OF FRACTURES RADIUS AND ULNA

Anatomy of the radius and ulna bones
the radius and ulna bones are formed the bone of the forearm which extend from elbow joint above to wrist joint below the radial bone is longer than the ulnar bone both bones run parallel to each other the radius articulated with the capitulum of the humerus bone by radial notch and head of the ulna and forming superior or proximal radioulnar joint the radius called that because it acts like radius(of a circle) the ulna acts as the

CAUSES TYPES AND TREATMENT OF FRACTURES RADIUS AND ULNA

anatomy of the radius and ulna

center point to the circle because when arm is rotated the ulna

CAUSES TYPES AND TREATMENT OF FRACTURE HUMERUS

CAUSES TYPES AND TREATMENT OF FRACTURE HUMERUS
Anatomy of the humeral bone

it is a long bone in the arm which connected the shoulder joint to elbow joint and run from scapula to the bone of the forearm (radius and ulna) the humeral bone consists of upper end which consists of rounded head and narrow neck and two short process called greater and lesser tuberosities which constriction below it called surgical neck which it is common site for

CAUSES TYPES AND TREATMENT OF SHOULDER DISLOCATIONS

CAUSES TYPES AND TREATMENT OF SHOULDER

DISLOCATIONS

In this section it will be also including fractures scapula and acromioclavicular joint injuries beside shoulder dislocation or subluxation what are the difference between dislocation and subluxation dislocation means complete separation while subluxation mean partial separation

shoulder dislocations can be divided into the following types 1- anterior dislocation 2- posterior dislocations 3- chronic dislocations 4- recurrent dislocations 5- inferior dislocations

CAUSES TYPES AND TREATMENT OF FRACTURES CLAVICLE

CAUSES TYPES AND TREATMENT OF FRACTURES CLAVICLE

Introduction

Fractures of the upper limb are very common injuries in all age groups. In adults, between the ages of 15-49 years, these injuries are more common in males and are usually due to high-energy mechanisms such as road traffic accidents. Between the ages of 65 and 89 years there is a considerable increase in the incidence of fractures, particularly in females. These are associated with osteoporosis and may follow minor trauma such as a fall from a standing height. Many of these injuries are relatively minor, for example clavicle fractures, which usually require no more than symptomatic treatment. Some injuries,

DISEASES OF ELBOW JOINT

DISEASES OF THE ELBOW JOINT
The aim is to understand the anatomy and physiology of the upper limb in relation to the problem that occur and their treatment and to explain the diagnosis and treatment of common problems the elbow with special fractures in children and also to appreciate the differences between adults and children in trauma involving the elbow joint

DISEASES OF SHOULDER JOINT

DISEASES OF SHOULDER JOINT

The aim is to understand the anatomy and function of shoulder joint and to be able to explain the diagnosis and treatment of common problems or diseases around the shoulder such as rotator cuff syndrome dislocation and fractures of shoulder joint and also to appreciate the differences between adults and children in trauma involving the shoulder and elbow joint

COMPLICATIONS OF LIMB INJURY

COMPLICATIONS OF LIMB INJURY

the complications of injuries can be divided into early and late, local and systemic, and those specific to certain methods of fixation either internal or external .

Early local complications
the key complication is the loss of circulation distal to the injury a second commonly missed problem is degloving of the skin and subcutaneous fat, which lose their blood supply as they are torn from the deeper tissues. This injury is easy to miss, but if a careful check is made for loss of sensation and capillary filling, and if the history suggests a high possibility of this type of injury, then appropriate action can be taken as all of the dead tissue needs to be "removed and skin cover is urgently needed

MANAGEMENT OF BONE FRACTURES

MANAGEMENT OF BONE FRACTURES

in order to understanding how fractures be healed and be management we should be first know the pathophysiology of fracture healing and known the methods of treatment of bone fractures by using external and internal fixation and their advantages and complications as follow

CLASSIFICATION OF FRACTURES AND DISLOCATIONS

CLASSIFICATION OF FRACTURES AND DISLOCATIONS

the aim

To know how to investigate a patient who may have a fracture or dislocation

• To be able to describe a fracture or dislocation concisely and correctly

• To understand the principles of reduction and holding a fracture or dislocation

• To know the common complications of fractures and dislocations, and how to check for them

• To understand the basic pathophysiology of fracture healing

MUSCLE STRUCTURE AND PHYSIOLOGY

MUSCLE STRUCTURE AND PHYSIOLOGY

All muscles share the following properties, which are interrelated and achieve movement

Contractility (ability to shorten in response to stimuli) Excitability (ability to react to stimulus

Extensibility (ability to undergo stretch

Elasticity (ability to return to original shape and size

JOINT STRUCTURE AND PHYSIOLOGY

JOINT STRUCTURE AND PHYSIOLOGY

A joint. or articulation, is the place where two bones come together. All bones except one - the hyoid - form a joint with another bone. joints hold bones together and allow the rigid skeleton to move.

Classification of joints

BONE PHYSIOLOGY AND STRUCTURE

BONE PHYSIOLOGY AND STRUCTURE

INTRODUCTION
Nicolas Andry coined the word from which the English word orthopaedics is derived when he wrote a book titled L'Orho'edie in
1741. Orthopaedics is derived from the two Greek words Andry chose: orthos, meaning straight or free from deformity, and pais, meaning child. Since that time orthopaedics has expanded to include the evaluation and treatment of all musculoskeletal injury and disorders. Until the later half of the twentieth century. orthopaedics was predominately the nonoperative treatment of fractures, treatment of musculoskeletal infections (often tuberculosis), and polio. As we enter the twenty-first century, orthopaedic surgery includes the replacement of

MUSCULOSKELETAL OR BONES IMAGING

MUSCULOSKELETAL OR BONES IMAGING

what are the aim of imaging of musculoskeletal system they are
To be able to list the advantages and risks of plain radiography, computerized tomography, magnetic resonance imaging, ultrasound and isotope scanning when imaging the musculoskeletal system

• To understand how to write a good imaging request card

• To know the law in relation to radiation

INTRODUCTION

Imaging is an intricate part of musculoskeletal diagnosis, and image-guided, minimally invasive techniques also play a major role in treatment. In broad terms, radiographs are the best method of looking for bony lesions or injuries. magnetic resonance imaging (MRI) shows bone marrow disease, muscle

Clinical examination in musculoskeletal disorders

Clinical examination in musculoskeletal disorders

what are the aims it is very important to know how you can examine the musculoskeletal system which include the whole bone joint skin soft tissue nerve and the tests done for it which will be discuss here also
To understand the three major types of history, their functions and the different ways in which they are obtained as

Hydrocephalus

Hydrocephalus

Hydrocephalus is defined as a disproportionate increase in the amount of CSF within the cranuum, usually in association with a rise in ICP

Physiology and circulation of cerebrospinal fluid

The normal volume of circulating CSF is in the region of 140 ml. The fluid both protects and supports the brain and spinal cord, as well as maintaining homeostasis by acting as a transport medium for transmitters and as a method of removing the end-products of metabolism. CSF is produced by an active process, 80% of it being derived from the choroid plexus and the rest from the parenchyma. The rate of production is between 0.2- 0.4 ml min with a daily production

Raised intracranial pressure

Raised intracranial pressure

Physiology of intracranial pressure

Pathophysiology The adult skull may be regarded as a rigid unyielding box containing brain, cerebrospinal fluid (CSF) and blood. At normal supine pressures of 0.67-2 kPa (5-15 mmHg, 6-18 cm H20). measured from the level of the foramen of Monro these three components maintain volumetric equilibrium. An increase in the volume of any of the components will result in an increase in intracranial pressure (ICP) unless there is a

Central Nerve System Infections

Central Nerve System Infections

Central nervous system infections of interest to neurosurgeons include those that cause focal neurologic deficit due to mass effect, require surgical aspiration or drainage because antibiotic therapy alone is insufficient, cause mechanical instability of the spine, or occur after neurosurgical procedures.

Congenital Anomalies of Central Nerve System

Congenital Anomalies of Central Nerve System

Dysraphism

Dysraphism describes defects of fusion of the neural tube involving the neural tube itself, or overlying bone or skin. Dysraphism may occur in the spine or the head. Neural tube defects are among the most common congenital abnormalities.

Spinal Cord Tumours

Spinal Cord Tumours

A wide variety of tumors affect the spine. Approximately 20% of CNS tumors occur in the spine. The majority of spinal tumors are histologically benign, unlike cranial tumors. Understanding the two major spinal concepts facilitates understanding of the effects of spinal tumors. The two concepts are spinal stability and neural compression. Destruction of bones or ligaments can cause spinal instability, and lead to deformities such as kyphosis or subluxation and possible subsequent neural compression. Tumor growth in the spinal canal or neural foramina can cause direct compression of the spinal cord or nerve roots and cause loss of function. Anatomic categorization provides the most logical approach to these tumors. The various tumors present in characteristic locations. An understanding of the anatomy leads to an understanding of the clinical presentation and possible therapeutic options

Cerebrovascular Disease

Cerebrovascular Disease

these are including the following important disease like as Ishaemic disease .Thrombotic disease ,Embolic disease ,Haemorrhagic disease
Cerebrovascular disease is the most frequent.causes of new rapid onset, non traumatic neurologic deficit It is a far more common etiology than seizures.or tumors. Vascular structures are subject to a variety of chronic pathologic processes which compromise vessel wall integrity. Diabetes, high cholesterol, high blood pressure, and smoking are risk factors for vascular disease. These conditions can lead to vascular damage by such mechanisms as atheroma deposition

Peripheral Nerve Trauma or Injury

Peripheral Nerve Trauma

The peripheral nervous system extends throughout the body and is subject to injury from a wide variety of traumas. Peripheral nerves transmit motor and sensory information between the CNS and the body. An individual nerve may have pure motor. pure sensory. or mixed motor and sensory functions. The key information-carrying structure of the nerve is the axon. The axon transmits information from the neuronal cell body and may measure from less than1 mm to greater than I m in length. Axons that travel a significant distance are often covered with myelin. which is a lipid-rich. electrically-insulating sheath formed by Schwann cells. Myelinated axons transmit signal much more rapidly than unmyelinated axons, because the voltage shifts and currents that define action potentials effectively jump from gap to gap over the insulated lengths of the axon.

Spinal Cord Trauma

Spinal Cord Trauma

The spine is a complex biomechanic and neural structure. The spine provides structural support for the body as the principal component of the axial skeleton, while protecting the passing spinal cord and nerve roots. Trauma may fracture bones or cause ligamentous disruption. Often bone and ligament damage occur together. Damage to these elements reduces the strength of the spine and may cause the spine to be unstable. This compromises both its structural support function and its ability to protect neural elements. Spine trauma may occur with or

Brain Death

Brain Death

Brain death occurs when there is an absence of signs of brain stem function or motor response to deep central pain in the absence of pharmacologic or systemic medical conditions that could impair brain function.

For as long as medical practice has existed, the layperson has required of medical practitioners that they be knowledgeable
about death. For cenrunes, lay people and doctors alike have accepted cessation of respiration and heart beat as the classical signs of death. Advances in cardiopulmonary resuscitation and modern mechanical ventilation have made obsolete the traditional clinical definition of death with a small but significant harvest of irreversibly brain-damaged patients. The worst form of such damage led to the concept of (coma depasse), first defined by Mollaret and Goulon in 1959. As the number of patients with artificially maintained ventilation and circulation increased. they became to be regarded as a potential source of donor organs. These two developments occurred parallel to but independently of each other, and the diagnosis of brain death did not arise because of the need for donor organs.

Traumatic Intracranial Haematoma

Traumatic Intracranial Haematoma

Types of intracranial haematoma can be classified into

Intracerebral or intraparenchymal which are hypodense on CT scan and small ones may enlarge and may need evacuation-1

2- Extradural or Epidural haematoma

3- Acute subdural haematoma

4- Chronic subdural haematoma

Head Trauma Scalp injury Skull fractures Closed head injury

Head Trauma Scalp injury Skull fractures Closed head injury

Head Trauma

Trauma is the leading cause of death in children and young adults; however. incidences of death and disability from trauma have been slowly decreasing. This is partly attributable to increased awareness of the importance of using seat belts and bicycle and motorcycle helmets. However, trauma remains a major cause of morbidity and mortality, and can affect every major organ system in the body. The three main areas of neurosurgic interest in trauma are TBI, spine and spinal cord injury (SCI), and peripheral nerve injury.

Neurological and Neurosurgical emergencies

Neurological and Neurosurgical emergencies

these including the following items

1-Raised intracranial pressure

2-Brain stem compression

3-Cerebral Stroke

4- Seizure

5- Trauma as Head Trauma

Raised Intracranial Pressure ICP

ICP normally varies between 4 and 14 mm Hg. Sustained ICP levels above 20 mrn Hg can injure the brain. The Monro-Kellie doctrine states that the cranial vault is a rigid structure, and therefore the total volume of the contents determines ICP.The three normal contents of the cranial vault are brain, blood, and CSF. The brain's contents can expand due to swelling from traumatic brain injury . stroke or reactive edema. Blood volume can increase by extravasation to form a hematoma, or by reactive vasodilation in a hypoventilating, hypercarbic patient. CSF volume increases in the setting of hydrocepbalus. . Addition of a fourth element, such as a tumor or abscess, will also increase ICP

Neurological examination and diagnostic methods

Neurological examination and diagnostic method

NEUROLOGIC EXAMINATION

The neurologic examination is divided into several components and is generally done from head to toe. First assess mental status. A patient may be awake, lethargic (will follow commands and answer questions, but then returns to sleep), stuporou (difficult to arouse at all), or comatose (no purposeful response to voice or pain). Cranial nerves may be thoroughly tested in the awake patient, but pupil reactivity, eye movement, facial symmetry, and gag are the most relevant when mental status is impaired. Motor testing is based on maximal effort of major muscle groups in those able to follow commands, while assessing for amplitude and symmetry of movement to deep

Neurosurgery Introduction and Anatomy

Neurosurgery

This chapter will be including the following items which will be discuss separately and these items are

Introduction
Anatomy of the scalp skull brain spinal cord
Diagnostic methods
Neurologic and Neutologic emergencies
Trauma eg.Head .Spinal .Peripheral nerve trauma
Cerebrovascular disease eg Ishemis Thrombotic Embolic, Haemorrhagic Disease
Tumours of the central nervous system eg Intracranial , Metastatic ,Glial ,Neural Crest .Miscellaneous ,Emryologic and Spinal Tumours

CANCER PREVENTION

CANCER PREVENTION

The old axiom "an ounce of prevention is worth a pound of cure" is being increasingly recognized in oncology. Cancer prevention can be divided into three categories: (I) primary prevention (i.e., preventing initial cancers in healthy individuals); (2) secondary prevention (i.e., preventing cancer in individuals with premalignant conditions); and (3) tertiary prevention (i.e., preventing second primary cancers in patients cured of their initial disease

Gene therapy of cancer

Gene therapy of cancer

Gene therapy is being pursued as a possible approach to modifying
the genetic program of cancer cells as well as for treatment of
metabolic diseases. The field of cancer gene therapy utilizes a variety of strategies, ranging from replacement of mutated or deleted tumor suppressor genes to enhancement of immune responses to cancer cells Indeed. in preclinical models. approaches such

Immunotherapy of cancer

Immunotherapy of cancer

The aim of immunotherapy is to induce or potentiate inherent anti tumor immunity that can destroy cancer cells. Central to the process of antitumor immunity is the ability of the immune system to recognize tumor-associated antigens present on human cancers and to direct cytotoxic responses through humoral or T-cell-mediated immunity. Overall, T-cell-mediated immunity appears to have the greater potential of the two for eradicating tumor cells. T cells recognize antigens on the surfaces of target cells as small peptides presented by class I and class 11major histocompatibility complex (MHC) molecules

Biologic therapy or management of cancer

Biologic therapy or management of cancer

Over the past decade, increasing understanding of cancer biology has fostered the emerging field of
molecular therapeutics. The basic principle of molecular therapeutics is to exploit the molecular differences
between normal cells and cancer cells to develop targeted therapies. The ideal molecular target would be

Hormonal therapy or management of cancer

Hormonal therapy or management of cancer

HORMONAL THERAPY
it has been found that up to 15%of tumors may have responsive elements

Some tumors, most notably breast and prostate cancers. originate from tissues whose growth is under hormonal control. The first attempts at hormonal therapy were through surgical ablation of the organ producing the hormones of interest, such as oophorectomy for breast cancer. Currently, hormonal manipulation is accomplished by several different modes .

Cancer management by Radiotherapy

Cancer management by Radiotherapy or Radiation therapy

Radiotherapy

Radiation may be particulate or electromagnetic
Radiotherapy kills tumour cells by generating high energy molecular movement Tumour susceptibility is related to tumour oxygenation and radiosensitivity of the individual cells
Radiotherapy may be used as a primary, neoadjuvant, adjuvant or palliative therapy to causes damage to normal as well as tumour cells resulting in local and systemic complications
.This is the therapeutic use of ionising radiation for the treatment of malignant conditions

CANCER MANAGEMENT BY CHEMOTHERAPY

Cancer management by chemotherapy

Definition

Chemotherpeutics are drugs that are used to treat cancer that inhibit the mechanisms of cell proliferation. They are therefore toxic to normally proliferating cells (ie bone marrow gastro intestinal eipithelium hair follicles

they may be used as primary neoadjuvant or adjuvant therapies

They can be

Cycle-specific: effective throughout the cell cycle

Phase-specific: effective during part of the cell cycle

, tumors susceptibility depends on the concentration of drug delivered, on cell sensitivity, cycling of tumour. Drugs are less effective in large solid tumours because of

• Fall in the growth fraction

• Poor drug penetrance into the centre

Surgical management of cancer distant metastasis

Surgical management of cancer distant metastasis

as mentioned before surgical management of cancer included three groups

1

surgical management of primary tumour

2

surgical management of Regional lymph nodes basin

3

Surgical management of Distant metastasis which will be discussed here

The treatment of a patient with distant metastases depends on the number and sites of metastases, the cancer type, the rate of tumor growth, the previous treatments delivered and the responses to these treatments, and the patient's age, physical condition. under desires.

SURGICAL MANAGEMENT OF CANCER LYMPH NODES

Surgical management or treatment of cancer

as mentioned before it divided into three groups

1- surgical management of the primary tumor

2- surgical management of the regional lymph nodes basin

3- surgical management of distant metastasis

2- Surgical management of the Regional lymph nodes basin which will be discuss

Most neoplasms metastasize via the lymphatics

Therefore, most onocologic operations have been designed to remove the primary tumor and drainage lymphatic en bloc

This type of operative approach is usually undertaken when the lymph nodes draining the primary tumor lie adjacent to the tumor bed, as is the case for colorectal cancer and gastric cancers

For tumors where the regional lymph node basin is not immediately adjacent to the tumor eg,melanomas lymph node surgery can be performed through
separate incision

SURGICAL MANAGEMENT OF CANCER

SURGICAL MANAGEMENT OF CANCER

Can be divided into

surgical treatment of primary tumour

surgical treatment of the regional lymph node basin

surgical treatment of distant metastasis

Although surgery is the most effective therapy for most solid tumors most patients die of metastatic diseases

Therefore to improve patient survival rates a multimodality approach with systemic therapy
and radiation therapy is key for most tumors. It is important
that surgeons involved in cancer care know not only how to perform a cancer operation but also the alternatives to surgery and he well versed in reconstructive options

CANCER RISK ASSESSMENT

CANCER RISK ASSESSMENT

.cancer risk assessment is an important part of the initial evaluation of
a patient .A patient's cancer risk is not only an important determinant
of cancer screening recommendations but also may alter how
.aggressively an in determinant finding will be pursued for diagnosis.
;a probably benign mammographic lesion. for example. defined as with less than a 2% probability of malignancy • is usually managed with a 6-month
follow up mammogram in a patient at baseline cancer risk.but
obtaining a tissue diagnosis may be preferable in a patient at high
risk for breast cancer

Tumour markers

Tumour markers

Definition:Tumour markers are substances that can be detected in higher than normal amounts in the blood or serum urine nipple aspirate fluid or stool tissues of patients with certain types of cancer

How it is produced

Tumors markers are produced either by the cancer cells themselves or by the body as a response to the cancer
What are the aim of tumour markers
tumour markers are useful in diagnosis staging treatment and detection of recurrence of cancers

Over the past decade, there has been an especially large

Tumour Typing Grading and Staging

Tumour typing grading and staging

What these are mean and what the benefits from its

Typing, grading and staging are important for

Planning of treatment

Type and degree of surgical excision

Consideration of pre-operative radiotherapy or chemotherapy to downsize

To provide accurate prognostic information

For the patient

For the physician

CLINICAL CANCER DIAGNOSIS

CLINICAL CANCER DIAGNOSIS

Cancer diagnosis as mentioned before cancer diagnosis can be done by laboratory and clinical features or pictures of the cancers now

what are the clinical features of malignancy
It can be divided into three groups as

Local features of the tumours
Distant clinical features
Systemic or general clinical features

Local features of the neoplasm or tumours

Including either mass, pain ,changes in organ function obstruction in a hollow viscus ,bleeding or infarction

Mass

• May be palpable

• May be a primary tumour or secondary lymphadenopathy

• May be painful or more commonly, painless (eg breast lump, testicular lump

Cancer Diagnosis

Cancer diagnosis

Can be divided into laboratory diagnosis and clinical features of the neoplasm or by it is clinically important effects into

Local clinical features
Distant clinical features
Systemic features of the tumour

Laboratory diagnosis

The definitive diagnosis of solid tumors is usually obtained with a biopsy of the lesion

Causes of cancer viral carcinogens

Viral Carcinogens

One of the first observations that cancer may be caused by transmissiblcell-free extracts from sarcomas in chickens could transmit sarcomas to other animals injected with these extracts e agents was by Peyton Rous in 1911 when he
demonstrated that
This was subsequently discovered to represent viral transmission of cancer by the Rous sarcoma virus RSV

At present, several human viruses are known to have oncogenic properties, and several have been causally linked to human cancers it is estimated that 15% of all human tumors worldwide are caused by viruses&

CAUSES OF CANCER PHYSICAL CARCINOGENS

Physical carcinogens or physical causes of cancer

Physical carcinogenesis can occur through induction of inflammation and cell proliferation over a period of time or through exposure to physical agents that induce DNA damage. Foreign bodies can cause chronic irritation that can expose cells to carcinogenesis by alter environmental agents

In humans it is associated with chronic irritation and inflammation such as

CAUSES OF CANCER GENETIC AND CHEMICAL CARCINOGENS

CAUSES OF CANCER GENETIC AND CHEMICAL CARCINOGENS

Aetiology or causes of cancer
The aetiology of cancers can be classified into four main categories

Genetic causes or carcinogens

Chemical causes or carcinogens

Physical causes or carcinogens

Viral causes or carcinogens

Genetic causes or cancer

One widely held opinion is that cancer is a genetic disease that arises from an accumulation of mutations that leads to the selection of cells with increasingly aggressive behavior. These mutations may lead either to a gain of function by oncogenes or to a loss of function by tumor suppressor genes. Most mutations in cancer are somatic and are found only in the cancer cells. Most of our information on human cancer genes has been gained from hereditary cancers. In the case of hereditary cancers, the individual carries a particular germline mutation in every cell. In the past decade, more than 30 genes for autosomal dominant hereditary cancers have been identified A few of these hereditary cancer genes are oncogenes, but most are tumor suppressor genes, Though hereditary cancer

CANCER METASTASIS

Cancer biology or molecular basis of cancer include

Cancer metastasis

To explain how cancer tumour becomes spreading to surrounding structures or nearby organ (local spread) or

Direct extension eg direct invasion of bladder from adenocarcinoma of the sigmoid colon

Blood or haematogenous spread eg bone metastasis from follicular cell carcinoma of the thyroid

Lymphatic spread eg axillary nodes from carcinoma of the breast or by

Transcoelomic spread eg ovary or implantation spread

Spillage of tumour cells during surgery

CANCER INVASION

CANCER INVASION

cancer biology or molecular basis of cancer include the following item Cancer Invasion

first what are the tumour or neoplasm progression means

Neoplastic progression is a term that refers to the generation of sub-clone the tumour. These sub-clones occur by accumulation of further genetic mutations and have an increasingly aggressive phenotype, allowing invasion and metastasis to distant sites
Neoplastic or cancer invasion
The ability to invade and spread determines the difference between a benign and a
malignant phenotype
Invasion is due to
Changes in adhesion molecules by the following methods
1- Cell-to-cell interactions
2- Cell-to-matrix interactions
Proteolysis , Migration and chemotaxis
Changes in adhesion by
Loss of cell-to-cell adhesion
E-cadherin is the major cell adhesion molecule in epithelia; these cell adhesion
are down-regulated in several carcinomas

TUMOUR ANGIOGENESIS

TUMOUR ANGIOGENESIS

molecular basis or cancer biology abnormalities in neoplastic cell behaviour tumour angiogenesis

What angiogenesis means

Angiogenesis is the establishment of new blood vessels from a pre-existing vascular bed. This neovasculariztion is essential for tumor growth and metastasis. Tumors develop an angiogenic phenotype a. as a result of accumulated genetic alterations and in response to local selection pressures such as hypoxia. Many of the common oncogenes and tumor suppressor genes have been shown to play a role in inducing angiogenesis. including ras, myc. HER2/neu. and mutations in p53
In response to the angiogenic switch. pericytes retract and the endothelium secretes several growth factors such as basic fibroblast growth factor (FGF), platelet-derived growth factor (pDGF). and insulin-like growth factor (FGF). The basement membrane and stroma around the capillary are proteolytically degraded, which is mediated in most part by uPA. The endothelium then migrates through the degraded matrix, initially as a solid cord, then forming lumina. Finally. sprouting tips anastomose to form a vascular network surrounded by a basement membrane

Disucssion of Tumours abnormalities

Discussion of Tumours abnormalities

molecular basis or biology of cancers include the abnormalities in neoplastic cell behaviour which means the neoplastic cells exhibit different behaviour to normal cells in terms of

Proliferation

Differentiation

Immortality

Apoptosis

Karotype and progression

Stimulate angiogenesis

First tumour cell proliferation

the rate of cell proliferation within any population of cells depends on three things
the rate of tumour cell division: tumour cells can be pushed into the cell cycle more

GENES INVOLVED IN CARCINOGENESIS

GENES INVOLVED IN CARCINOGENESIS

Genes involved in carcinogenesis there are four classes of genes can be affected to produce a neoplasm

ONCOGENES

TUMOUR SUPPRESSOR GENES

ANTI-APOPTOTIC GENES

DNA MISMATCH REPAIR GENES
Oncogenes which means normal cellular genes that contribute to cancer when abnormal are called oncogenes .the normal counterpart of such a gene is called Proto-oncogenes which they are normal genes involved in cell division ,oncogenes are usually designated by three - letter abbreviations such as MYC or RAS .oncogenes are further designated by the prefix of (v-)for virus or (c-)for cell or chromosome
some. corresponding to the origin of the oncogene when it was first detected. Proto-oncogenes can be activated (have increased activity) or over expressed (expressed at increased protein levels) by translocation (e.g., abl). promoter insertion (e.g.c-myc), mutations (e.g . ras), or amplification (e.g .HER2/neu). More than 100 oncogenes have been identified

CARCINOGENESIS

BIOLOGY OR MOLECULAR BASIS OF CANCER DISCUSS

CARCINOGENIS

What we means by carcinogenesis a tumour or neoplasm is an overgrowth of tissue formed by a clone of cells bearing cumulative genetic injuries confers an additional growth advantage to the clone that possesses it these mutations can be 1- congenital :already present in the genome heritable cancers 2- acquired mutations brought about by exposure to a carcinogen (sporadic cancers)what are the stage process of carcinogenesis

NORMAL CELL GROWTH

NORMAL CELL GROWTH

Cell growth first what tumour mean the tumour literally means swelling is either physiological or pathological ,physiological swelling eg. pregnant uterus pathological swelling eg. neoplastic or non neoplastic eg abscess inflammatory and bony callus what neoplasia means is an abnormal mass of the tissue , the growth of which is uncoordinated exceeds that of the normal tissue and persists in the same manner after cessation of the stimuli that evoked the change

Normal cell growth

Cells fall into several different categories according to their propensity to divide and
their degree of differentiations into three types of cells as

labile cells: which are constantly renewed cells (eg stratified squamous epithelium of the skin

Stable cells: usually quiescent cells but can be stimulated to divide eg hepatocytes

Permanent cells: do not undergo mitosis in post-natal life (eg neurones, skeletal muscle tissue , glomeruli . Cells divide as they progress through the cell cycle

There are many regulatory points inherent in the cycle, and disruption of these genes

INCIDENCE OF COMMON CANCERS

Incidence of common cancers

Cancer is a common disease affecting a third of the population
in their life time There are 250 000 new cases diagnosed per year65% of cancer affects the> 65 age group Common cancers are different for different age groups (adults, teenagers children) Smoking and diet are the main environmental etiological factors (thought to be responsible for a third of cancer cases each

Cancer incidence by age and gender

Common cancers in adult 50% of adult cancer involves the big four: breast, prostate, lung, large bowel.Remember that the incidence of a cancer is not the same as the death rate cancer

CANCER SCREENING

CANCER SCREENING -3

first of all there are criteria for screening programmes and for the screening test which they are used Screening programmes -1what are the Criteria for screening programmes
A screening programme needs to fulfil certain criteria (defined by the WHO in 1966 these criteria are
• The condition is an important health problem
• Its natural history is well understood
• It's recognisable at an early stage
• Treatment is better at an early stage
• A suitable test exists
• An acceptable test exists
• Adequate facilities exist to cope with the abnormalities detected Screening is done at repeated intervals when the onset is insidious • The chance of harm is less than the chance of benefit• The cost is balanced against benefit

2-criteria for screening tests

oncology malignancies cancers tumours

oncology malignancies cancers tumours

first of all what is definition of oncology this word can be divided into two part first onco which mean mass or tumour or swelling or bulk and second logy which means study so oncology means it is the branch or the science which deal with everything about the tumours or cancers

In this section i will talk about these contents

Introduction for cancer

Cancer terminology and epidemiology

Cancer screening

Incidence of common cancers

Biology or molecular basis of cancer

Causes and types of Thalassaemias

Causes and types of Thalassaemias

thalassaemias are inherited disorders of defective synthesis of globin chains in haemoglobin they cause haemolysis anaemia and ineffective erythropoiesis they are found mainly in Africa the Orient Mediterranean ,Asia and the middle East
There are three types of thalassaemias 1- beta -thalassaemia major(homozygous)2- beta- thalassaemia minor (heterozygous) 3- alpha- thalassaemia
beta thalassaemia the most common of the thalassaemias beta thalassaemia minor is the heterozygous state it produces a symptmless microcytosis which may be accompanied by a mild anaemia

Sickle cell disease or anaemia

Sickle cell disease or anaemia

Definition
sickle cell disease is a genetic mutation commonly inherited causing changes in haemoglobin structure and altered oxygen binding it may be homozygous or heterozygous (sickle cell trait) the disease has predominance in Africa and is found in India and Middle east clinical problem include 1- haemolytic anaemia 2- vaso-occlusive crises

Thrombocytopenia from surgical view

Thrombocytopenia from surgical view

thrombocytopenia means a platelet number less than 150,000

Causes of thrombocytopenia
platelet production failure as in aplastic anaemia drugs like cytotoxics alcohol viral infections as EBV, CMV bone marrow infiltration as in leukaemia , myelofibrosis myeloma metastatic infiltration hereditary thrombocytopeniah
decreased platelet survival as in idiopathic thrombocytopenic purpura(ITP) drugs like heparin penicillamine gold .infections as in subacute bacterial endocarditis meningococcus , thromboletic

CAUSES AND TYPES OF ANAEMIA

CAUSES AND TYPES OF ANAEMIA

definition of anaemia

is the reduction in the concentration of circulating haemoglobin below the expected range for age and sex ,eg adult male:<13 g\dl adult female<11.5 g\dl it may be acute or chronic anaemia

mechanism of anaemia causes 1- decreases production as impaired erythrocyte formation or impaired erythrocyte function 2- increased loss as blood loss either acute or chronic and decreased erythrocyte lifespan eg. haemolysis nb. physiological anaemia occurs in pregnancy due to a relative increase in plasma volume . anaemia may be classified by cause or by the effects on cells when viewed as a blood film

CARCINOMA OF THE STOMACH OR GASTRIC CANCER

CARCINOMA OF THE STOMACH OR GASTRIC CANCER

Introduction

most of gastric cancer detected in the UK are advanced adenocarcinoma with an appalling overall 5- year survival rate 5-10%. in comparison , in japan , where the disease is commonest over 30%of all gastric cancers are detected early and overall 5- year survival rates exceed 50%.

demography : the incidence of gastric cancer has fallen dramatically in the western world over the past 30 years gastric cancer is twice as common in males peaks incidence between 55 and 65 years is associated with blood group A and Helicobacter pylori and occurs more frequently amongst the lower social classes . there is a genetic link as stomach cancer run in families but environmental factors such as diet and methods of food preservation are also important

Types of gastric cancer

It can be divided into intestinal and diffuse type these are recent classification . the intestinal type matches geographical area of increased incidence and is usually accompanied by an area of chronic gastritis . the diffuse type bears no such relationship

THYROGLOSSAL TRACT ANOMALIES

THYROGLOSSAL TRACT ANOMALIES

In order to understanding these anomalies it should be first known the development of thyroid gland

Development of thyroid gland

the thyroid gland develops from the thyroglossal duct (median bud of the pharynx) during the fourth embryonic week and passes ventrally from the foramen caecum at the back of the tongue to the pharynx just below the position of the developing hyoid cartilage . this line of descend is called the thyroglossal duct thus formed usually degenerates but it is incomplete regression results in the following

Congenital abnormalities

Benign prostatic hyperplasia

Benign prostatic hyperplasia

Benign prostatic hyperplasia BPH

IS INCREASINGLY COMMON WITH AGE AND IS PRESENT IN AN ESTIMATED 50%OF MEN OVER THE AGE OF 60 YERAS AND IN NEARLY 88% BY THE AGE OF 88 YEARS

THIS IS A HISTOLOGICAL DIAGNOSIS AND IS DUE TO THE HYPERPLASIA OF THE PERIURETHRAL GLAND IN THE TRANSITIONAL ZONE OF THE PROSTATE . THIS ENLARGEMENT CAUSES VARYIBG DEGREE OF OBSTRUCTION TO THE FLOW OF URINE AND LEADS TO

A GROUP OF SYMPTOMS CATEGORIZED

AS LOWER URINARY TRACT SYMPTOMS (LUTS) . THE EXTEND OF THE PROSTATIC ENLARGEMENT MAY NOT BE DIRECTLY PROPORTIONAL TO THE DEGREE OF BLADDER OUTFLOW NOR TO THE AMOUNT OF SYMPTOMS

THE CLINICAL DEFINITION OF BPH IS THEREFOR A COMBINATION OF LUTS , PALPABLE BENIGN PROSTATIC ENLARGEMENT AND URODYNAMIC EVIDENCE OF BLADDER OUTFLOW OBSTRUCTION

PRESENTATION

Patients may have no symptoms and are found to have a palpable bladder due to chronic retention of urine and occasionally in post renal obstructive renal failure LUTS can be divided into two groups

Obstructive symptoms

Associated with voiding which are hesitancy poor stream , straining , prolonged micturition postmicturition dribbling and a feeling of incomplete emptying and

Irritative symptoms

associated with filling which are frequency nocturia and urgency . patients may also present with acute retention haematuria and urinary tract infection

DYSPHAGIA

DYSPHAGIA

Dysphagia means difficulty in swallowing

What are the causes of dysphagia ?it can be divided into

Oral causes like

painful conditions as stomatitis , glossitis , ulcers mechanical factors as ankloglossia , cancer tongue cleft palate fracture or dislocation of the mandible

Pharyngeal causes as

painful conditions like pharngitis , tonsillitis , paratonsillar abscess mechanical factors as foreign body , retropharyngeal abscess , diverticulm , tumours , pharyngeal pouch ,

plummer vinson syndrome

hysterical causes

oesophageal causes

as 1- in the lumen like foreign body 2- in the wall as stricture tumours , oesophagitis , scleroderma , achalasia 3- compression from outside as cancer thyroid or goitre and mediastinal syndrome

Cardio-oesophageal causes

as 1- achalsia 2- hiatus hernia 3- cancer cardia or lower thrid of the oesohpagus 4- reflux oesophagitis and peptic ulcer of the lower end of the oesophagus

Discussion of commonest causes of dysphagia

Achalasia of the oeosphagus

Which affect female more than male and most patient are in the third and fourth decades the onset is insidious with intermittent dysphagia often more marked with fluid than solids . regurgitation of food more several hours after meals and is often mistaken by the patient for vomiting , there may be retrosternal discomfort rarely amounting to pain . in advanced cases the nutrition suffers and loss of weight occurs

P lummer -Venson syndrome

Occurs in women around 40 years of age . there is long standing dysphagia due to achalasia of the circopharyngeus muscle and chronic inflammation of the mucous

TREATMENT OF BREAST CANCER

TREATMENT OF BREAST CANCER

Treatment of breast cancer include the following methods

Control of local disease by

Surgery

In patients without systemic disease local surgery may be curative but most patients have occult micrometastases . a mobile tumour with or without axillary lymph nodes is generally operable . prospective trials indicate no difference in 5-10 year survival rate of patients undergoing mastectomy or breast conservation (lumpectomy , wide local excision , quadrantectomy) and radiotherapy , but the local recurrence rate in the latter group is slightly higher

. Mastectomy with axillary clearance results in 5 year recurrence rate of 4%and 8% in node- negative and node - positive patients respectively

It is not yet clear if there are difference in long term survival (10-25)years between radical surgery and conservation

Subcutaneous mastectomy is indicated for prophylactic mastectomy in women at high risk of breast cancer

palliative mastectomy with or without local adjuvant treatment may be necessary to control advanced local disease anxiety and depression accompany ,mastectomy in many women but breast conservation does not protect against this many women fearing the possibility of residual or recurrent disease

BREAST CANCER

BREAST CANCER

Breast cancer this is the commonest amongest women affecting 1 in 13 and resulting in 25000 new cases and 15000 deaths per year in the UK . the incidence rises rapidly to 200|100000 women per year by age 45 and continues to rise into old age . one per cent of breast cancers occur in men . the severity of the problem in the UK has led to a government directive that all women suspected of having breast cancer must offered an outpatient appointment within 2 weeks of referral nulliparous women in developed countries are increased risk of breast cancer whereas women who have their first child young and breast feed are protected . modern low dose oral contraception does not seem to increase the incidence of breast cancer . predisposing factors include oestrogen exposure unopposed by progesterone , hyperoestrogenism family history of premenopausal breast cancer , saturated dietary fats and previous benign a typical hyperplasia two important breast genes (BRCA1- chromosome11 and BRCA2- chromosome17)are associated with inherited breast cancer which accounts for about 5% of cases but environmental factors seem more important

Pheochromocytoma

Pheochromocytoma

Definition

Pheochromocytoma are tumours arising from neuroectodermal cells of the adrenal medulla or extra adrenal sites they are found increased frequency in patients with hypertension MEN2a and MEN2b syndrome and von recklimghausen,s nerurofibromatosis

TREATMENT OF CROHN,S DISEASE

TREATMENT OF CROHN,S DISEASE

Medical treatment or Surgical treatment

Medical treatment

as 1- 5- aminosalicylic acid - containing preparations may be of benefit , colitis responds better than small bowel disease however there are no proven benefits in reducing recurrence following resection 2- antibiotics particularly metronidazole and ciprofloxacin are effective though three months may need to be given 3- steroids are used in acute episodes though there is little to suggest that maintenance

CROHN,S DISEASE

CROHN,S DISEASE

Definition

This is a chronic granulomatous inflammatory condition that

can involve any part of the gastrointestinal tract . it may occur at any age and the sex distribution is equal the most common site affected is the terminal ileum . this is involved in 70% of patients , giving rise to the soubriquet of (terminal ileitis) or (regional ileitis) the colon may also be involved and crohn,s colitis is the only manifestation of the disease in 20%of cases . multiple sites are common . crohn,s disease occurs in a discontinuous pattern within the bowel such that affected areas may be separated by quite normal bowel . these affected areas are termed skip-lesions
Pathology

,Macroscopically the bowel wall becomes grossly thickened and enveloped in mesenteric fat (fat wrapping). the histological hallmark is non - caseating granuloma . this may not be found in up to 40%of specimens however . there is transmural chronic inflammation of the affected bowel with local lymphadenopathy . various aetiological theories exist , including genetic autoimmune viral and mycobacterial infections though a complex polygenic aetiology is the most likely . there appears to be strong relationship with smoking

MANAGEMENT OF ACUTE PANCREATITIS

MANAGEMENT OF ACUTE PANCREATITIS

non- operative management

repeated and careful clinical assessment of all patients during the first 25 hours is essential as the course of the disease is unpredictable during this time . a chest radiography is mandatory as is estimation of arterial blood gases daily for the first 48 hours and oxygen should be administered by mask if there is hypoxaemia . plain abdominal radiographs may show a sentinel loop, pancreatic calcification or calcified gall stones . vital signs and urine output should be monitored hourly . the severely affected patient should be managed on the intensive care unit . oral intake is withheld so adequate fluid replacement , especially of colloid is necessary . energetic fluid replacement is the single most important therapeutic measure since a large volume of protein rich fluid is sequestered in the