Assurgent Techno

Archive for the ‘Radiology Markers’ Category

Treatment of cancer as a whole evolves from surgical oncology through radiation oncology and through medical oncology. Now it is the era of biological oncology. The future oncologist may not be a surgeon or a gist who manipulates the cells in the laboratory and then do the extension of treatment. That is the way the systems go. I am very happy to see that Ayurveda is coming up with plans to establish a medical oncology. Allopathy, Ayurveda and Homeo systems of medicine are not competitors, however those who can do best for a patient, should be able to execute the specialty whatever it may be.

Here are few areas, where we have thoroughly failed in management, like hepato-cellular carcinomas, pancreatic tumors, etc. I think these are the areas where the thrust should be given to all the incoming branches of medicines. In central part of Kerala, hepato-cellular carcinoma, pancreatic tumor etc are very common. The allopathic medicine cannot offer them much relief so they send them to palliative clinics. These are the areas where, other systems of medicines should be able to come up and try to do some thing. But all the experiments should be on scientific basics.

I am starting with some examples (case reports). A girl with acute lymphoblastic leukemia was treated in 1991-92, after treatment; she got married & is now well settled in Dubai. Unlike many other chronic diseases cancer patients can go back to their normal life after treatment. Another case, a lady with acute myeloid leukemia after treatment returned back to the normal life. There is another story of a mother, who had an acute lymphoblastic leukemia, when she was pregnant. The patient was not willing for an abortion and to take the medicines. The pregnancy continued & only chemotherapy was done. The child was born in the oncology ward of RCC & was named as ‘Medimon’ (because the child was born in the medical oncology ward). The mother & child are now doing well. This is the example of the advancement of oncology where we can select the drugs, which are less toxic.

You should know what cancer is or what actually happens in the body?

Basically in cancer the cells are reasonably immortal. If the cells of the body become immortal, the state of cancer occurs in two ways

1. Uncontrolled multiplication of cells or
2. The cells once attained maturity, but not getting killed.

The natural mechanism of programmed cell death is called Apoptosis. If Apoptosis does not happen, the cells go on multiplying with out any interruption. There will be uncontrolled multiplication of cells, which is the basic problem in a malignancy.

Basics

Let us consider the skin as a model. If injury occurs, there will be a recovery phenomenon. After the repair of the injury, there will be a negative feed back & there is no more repair work that has to be done in a well-balanced state. In malignancy, the cells migrate and they go for an uncontrollable proliferation.

Increased numbers of cells are called hyperplasia, not malignant. But when there is a small change in the nature, (cells doesn’t look alike or the arrangement is different), then they are called dysplastic cells. Again, they are not malignant but can progress to a malignancy; but hyperplasia will never progress to a malignancy.

Next we can consider about carcinoma in situ. The cells are showing the features of malignancy, they are still maintained within the basement membrane. When the cells are out of the basement membrane, and shed out, then they are invasive cancer, carcinoma invasive.
Dysplasia can reverse to a normal state also. Once they progress in to carcinoma in situ, they can never reverse. They go for a invasive carcinoma.

Problem is not in the local site alone. The cells remain the state for some times is then multiplies and starts then to migration.

Ways of migration:

1. Invasion of the blood vessels or lymphatic – migration
2. Spread by other routes like CSF, implantation and trans coelomic spread.

Terminology:

Cancer is not a single disease. With lot of etiologies and characters cancer exists. That’s the problem in identifying the plan of action of cancers. Cancers can occur in anywhere on the body including hair follicles. No area, sex, age, is excluded. Depending of the type of tumors terminology varies. (Lymphoma on the lymph nodes, sarcoma on the connective tissues etc.) The epithelial tumors are called carcinoma; connective tissue tumors are called sarcoma.

Cancers detection & diagnosis:

No patient should be seen or treated as cancers only with a histopathological diagnosis.
Basic diagnosis criteria, including fine needle aspiration, biopsy, operative specimen on which we are doing histopathological study etc should be there. But the pathologists should give in black & white, and say that this is a malignancy before you enter into treatment. This should be done in all cases, except in brain tumor, where tumor is in a very vulnerable site. In there cases, you are justified in treating with out a biopsy, but we should have evidence on radiology to say that there is a tumor which is malignant. There are many non-malignant tumors which may mimic malignancy has to be excluded before you treat them as a malignancy.

Features of malignancy.

Normal cells, if any variation in size and shape, you can describe them in two ways.

1. The benign tumors are described as the ‘Convert girl appearance’ and white or blue & white- Well disciplined going of cells.
2. 2nd type – malignant cells (‘College girl appearance’ No uniformity) Totally disordered arrangement.

Pathology – Description

1. Morphology- the pattern of cells, low they look like etc.
2. Peoulioe marks- characteristics of certain cells. E.g.:- leukemia, where the cytoplasm on the nucleus can be stained using some special stains. Thus they can be easily diagnosed.
3. Immunized chemistry. The cells do expulse antigens, which can be identified with the use of immunized chemistry. Once the cells are identified, we can label them.
4. Cytogenetics:- There are certain cytogenetic abnormalities, which are specific to some tumors. Thus we can identify the type of tumors.

Combination of these tests helps a clinician to arrive at a correct diagnosis.
The pathology, after diagnosing the type of tumors, should predict about the chances of progress of the tumors. The doctor should understand the chances of survival.
The chances of survival depends on

1. General condition of the patient
2. Site of tumors.
3. Grade of tumors (Grade 1 tumors – cells have the features almost like normal cells

Grade 2 tumors – in between the G1 and G2xG3.

Grade 3 and 4 tumors – very poorly differentiated.

They don’t have the feature of the primary cells).

As a broad statement, poorly differentiated tumors or fast growing tumors have high chance of metastasis and will respond to the chemotherapy and radiotherapy well. But relapse also will be there. Where as the well differentiated & slowly growing tumors have low chance of metastasis. Their response to chemotherapy & radiotherapy is not much effective.

Tumors.

You should do investigations to understand whether metastasis has happened or not. If metastasis occurred, the prognosis is bad. Before doing all the investigations, you should take the natural history of the diseases & then decide the staging. Natural history is the basic study of the oncology. Tumors have got an affinity to certain areas. In each tumor, there is a specific federacy of metastasis to a specific area. The doctors should know that.

Stage I, Stage II, Stage III, Stage IV ? Stages
Stage I – well localized
Stage II – regional lymph nodes are involved
Stage III – Much more lymph nods are involved
Stage IV – Distort metastasis

TNM classification is the fundamental classification. Idea of cancer detection is to identify the cancer in the 1st stage itself.

Blood tests to diagnose malignancy: –
Tumor markers are certain biochemical products available in the blood, which is secreted by the tumors which when identified, helps in diagnosis.. There is some specificity e.g. if there is prostate cancers the PSA (Prostate specific antigen) will be high in blood. That doesn’t mean that, all patients with PSA will have prostate cancers. But there is one tumor marker, by which we can be sure about the diagnosis in the serum. Beta SEG is detected in the clinical set up in gestational trophoblastic tumors. You can go for treatment without doing the histological test.
What causes cancer: -

Unknown Postulations

1. Heredity
2. Radiations to a certain extend
3. Chemicals
4. Infections

Concept: – cancers do not develop over night; it is a slowly advancing process, which can be reverted at different stages of progression, by intervention. But it can progress if not intervened. Each part has to contribute in the cancer formation.
Molecular aspects: -

Normal cell Gene regulates the cell growth.

When the genes are mutated (in a cancers cell), over activity of the genes (oncogenes) occur. These genes affect the cell growth. The growth is accelerated. Over acceleration of the oncogenes is one cause.

Certain genes can prevent the cancers (Anti oncogenes). Balance between the oncogenes and anti oncogenes maintains the correct growth of the cells. Failure of the working of the anti oncogenes leads to over growth of the cells.

What happens at the cellular level: -

You have got receptors in the cells. The growth factor goes and attach to the receptors. Signal, called transudation signals message to the molecules. Getting the genes activated, out put counting from the genes maintain the cycle. The cell multiplies as a result and uncontrolled proliferation occurs.

Doubling process:-

Time taken for a cell to get doubled is the doubling time. Doubling time will be short for rapidly multiplying tumors. If doubling time remains normal, the curve (combustion growth curve) will be linear. But this doesn’t happen. The initial part, multiplication will be slow process; but at the end part the multiplication will be fast process. Till a point, i.e. 109 no of cells are available in the body; it is sub clinical & is not able to detect the cancers grown with any available investigations. By the time, 109 to 1010 no of cell multiplication happen, the patient will be no more.

Importance of early detection in malignancy.

Cancer prevention:-

1. Early displacing cells can have a chance of revision back to normal and we can try to prevent the multiplication process.
2. National cancers convert program (NCKP) In which the thrust be on the tobacco, which is a well established, well-identified cancer causing agent. Even a passive smoker of tobacco has got a 15% higher incidence in developing lung cancers. Smoking in public places should be totally banned.
3. Diet Breast cancers Diet (linked with diet) High fat, high diet- fatty females are the candidates who are more prone to develop breast cancer.

Control measure – Avoid high fatty diets, burn the fat by doing exercises. Vegetables (preferably green leafy vegetables) have anti oxidant property that can reverse the malignant property of the cells. Lot of vegetables should be taken as a part of diet.

Unfortunately there is no one-method-fits-all technique to writing a quality college essay, every topic requires a different approach. However, that being said if you follow this top 10 checklist you can make the process a little easier.

Understand what is being asked. Read the question two or three times, make sure you understand exactly what is being asked. One of the biggest mistakes students make is writing what they think others want to hear, rather than the issue being asked. Plan. Once you have read the question a few times and you are confident that you understand what is being asked, ask yourself “what do I need to do to answer the question?” Begin jotting down ideas on paper – anything that pops to mind. Start to formulate a ruff plan, then slowly an overall plan for each section will start to emerge. Tell a story. As you make your plan, try to tell a story, set the scene, and introduce the reader with some background info. Take the reader on a journey that ends with a conclusion – a conclusion that answers the question. Ask yourself “so what?” Does your story have a point? As you write your essay, after each section, ask yourself “so what?” Does this paragraph have a point, is it helping to tell the story I am trying to sell? Do something different. Take a risk. Don’t write the essay that everyone else is writing. Imagine you are the marker – after reading 30 essays, the novelty will wear off. A bit of creativity, taking a slightly different angle on even the most boring topic, may be that extra push your essay requires. Remember, even seemingly boring essay topics can sound interesting if creatively approached. “The danger lies not in writing bad essays but in writing common essays-the one that admission officers are going to read dozens of” – Scott Anderson, associate director of college counselling at Mercersburg Academy (PA). Big words do not make good essays. Many students think big words make good essays. Big words are fine, but only if they are used in the appropriate contexts. Grab interest from the beginning. Expect your marker to spend just a few minutes reading your essay. You must use your introduction to grab their interest from the outset. Your introduction needs to do two things; firstly create mystery and Intrigue. It is not necessary or recommended that your first paragraph give away the entire essay. Raise questions in the minds of the reader so that they will want to read on. Appeal to their emotions so that the reader forms a personal connection with your essay. Secondly do not summarize the entire contents of your college essay in your Introduction, if you summarise the entire paper, the marker need not read the rest of your essay! The body is the story. The introduction sets the scene for the rest of the essay so make sure the body of your essay is consistent with the points raised in your introduction and make sure you tell that story. Research. Take the time to research all the information that is required for your college essay. Use a variety of sources – local libraries, teachers/tutors, and friends. With the internet at your finger tips you have access to over 5 billion web pages. Use search engines such as Google to search for information, try a variety of queries, ranging from broad keywords on the discipline to specific queries on the subject matter. Use websites such as Wikipedia and Answers.com. If you get stuck, you can find custom research for your college essay from a number of reputable websites, when using these websites; remember not to plagiarize. For guidelines of what constitutes plagiarism, visit ipassoc.org The conclusion is crucial. It is the logical ending to your essay. Students can quite often find the conclusion to be the most difficult part of an essay to write, because they feel that they have nothing left to say – hang in there, it is important to keep in mind that the conclusion is often what your marker will remember most, your conclusion should be the best part of your paper. A good conclusion should complete the essay and emphasize the importance of the thesis statement outlined at the beginning.

If you follow the above tips, you’re already half way to writing your essay. Before we finish remember that you do not need to write this masterpiece on your first attempt. It’s not possible, and all that pressure is likely to give you writer’s block. For your first draft, write anything that comes to mind. Don’t worry too much about grammar or spelling. Just get it down on paper (or computer screen). If time permits, it is also a good idea to spend a little time (a few days or a week) away from your draft to not only refresh your ideas and thoughts but also decide if you still consider your approach correct.

Digital recordings have many advantages over analogue tape recordings. These advantages impact not only on the quality of the final recording, but also result in reduced transcription time which, in turn, reduces costs. The recent spate of postal strikes has proved the last straw for some analogue transcription clients and has prompted them to make the switch to digital.

For clients who have traditionally recorded all their material on standard audio tapes, mini tapes or micro cassettes, the postal strikes have effectively brought any transcription work to a standstill, with a subsequent impact on their businesses. Even those clients who have switched to minidiscs to produce better quality recordings still rely on the post to deliver the discs to their transcribers. Clients have been forced to place extra burdens on their own in-house staff merely to complete regular work which their outsourced transcription company usually takes care of. Some clients have resorted to expensive courier deliveries simply in order to meet urgent deadlines.

There is one practical way round this impasse for analogue clients until the postal strikes ease. Some clients have been able to rerecord their analogue tapes on to digital sound files (with a bit of hand holding from their transcriber!). By using a sound editing software such as Goldwave, it’s fairly easy to rerecord tapes on to the PC as digital sound files. You simply need an inexpensive audio lead to connect the tape recorder headphone socket to the audio ‘in’ socket of the PC – transcription companies can usually provide a set of step by step instructions to help you through this. However, this will only work if the original tapes are clearly audible. If you try to rerecord a poor quality recording, you will only magnify any background noise or tape hiss, and the subsequent digital rerecording may well be inaudible and impossible to transcribe.

Assuming you’ve made a successful and clear digital recording of your analogue tapes, the next step is to transmit the digital files over the Internet to your transcriber using a secure FTP service. Digital sound files are very large, so you do need a fast Internet connection to make the transfer. Most transcription companies provide this FTP service at no extra cost to their clients. Sending digital files via an online service can be made on the same day from anywhere in the world, thus avoiding the delays experienced in sending tapes through the post. There are also no return postage costs to add to the final bill – digital files can simply be deleted when transcribed.

One permanent solution to any future postal problems is to ‘go digital’. While analogue clients have experienced extra hassle and expense because of the strikes, digital clients have been largely unaffected. The many advantages to digital are discussed in more depth in another article but briefly, digital recorders produce a superior quality recording which doesn’t deteriorate over time. There are no recording length restrictions as there are with tapes – digital recordings are as long as you need them to be. Sound files do not ‘physically’ break or become mangled and it’s easy to add additional material in the middle of a recording, for instance, for dictation. There are also fewer physical storage space issues with digital – back up recordings to CD take up less shelf space than tapes.

By eliminating the postal system entirely from the process, postage costs also disappear, along with the risk of losing precious original tapes. With digital recordings, you’re simply sending a copy of the digital file, while the original stays on your PC, as with any other document sent via email or online transfer. There’s also none of the usual deterioration experienced when copying tapes. The digital copy you send is just as clear as the original. Digital recordings can also be easily edited to cut out sections which don’t need to be transcribed. An added bonus of digital recordings is that audio time markers can be inserted to indicate precisely where inaudible or unclear words may be. Tape recorders and playback transcription equipment have different counters so audio time markers for analogue tapes are inaccurate.

Admittedly, digital recordings can’t entirely avoid all hiccoughs, such as Internet connection problems. However, there are usually ways round such difficulties. Using a nearby secretarial service or a library Internet facility will still allow you to send the digital audio files to the transcriber. A power failure over a wide area is about the only thing likely to scupper such plans, but then so does a prolonged, nationwide postal strike when trying to send tapes. Another plus point with digital is that, as most recordings are of superb quality, transcription companies can offer a fixed per audio minute price so that clients know in advance what their overall transcription costs will be. Tape quality is too variable to be able to do this, and is usually charged at an hourly rate.

As well as the current difficulties experienced with an interrupted postal service, analogue recordings have numerous other disadvantages. They produce inferior quality recordings which are more subject to tape hiss and background noise interference. All audio tapes have a limited life and if reused too many times can break or become chewed up. They’re very restrictive in terms of tape length and parts of the recording may be missed as the tape is turned over. It’s also impossible to add additional material to the middle of a recording without erasing something which follows. Even when the post is functioning normally, tapes can take time to reach the transcriber or can be lost in transit and postage costs are additional.

So next time the vagaries of the postal service threaten to interrupt the way you do business, consider a switch to digital recordings and ditch analogue. A transcription company will be able to advise on how to rerecord your audio tapes on to digital files. They’ll also be able to discuss the pros and cons of digital versus analogue recordings and open up a new, more efficient and cost effective way of working.