Wednesday, April 22, 2009

53 - Testicular cancer (Germ cell tumor) staging and treatment

Stage Extent of Disease Seminoma Nonseminoma
IA Testis only, no vascular/lymphatic invasion (T1) Radiation therapy RPLND or observation
IB Testis only, with vascular/lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4) Radiation therapy RPLND
IIA Nodes < 2 cm Radiation therapy RPLND or chemotherapy often followed by RPLND
IIB Nodes 2–5 cm Radiation therapy RPLND +/– adjuvant chemotherapy or chemotherapy followed by RPLND
IIC Nodes > 5 cm Chemotherapy Chemotherapy, often followed by RPLND
III Distant metastases Chemotherapy Chemotherapy, often followed by surgery (biopsy or resection)

Thursday, April 2, 2009

52 - Pancreatitis - vascular complications mcqs

1q. Vascular complications of acute pancreatitis include the following except

(a) Splenic vein thrombosis
(b) Splenic artery aneurysm
(c) Gastroduodenal artery aneurysm
(d) Middle colic artery thrombosis

The following lines have been taken from
this article . the whole credit goes to the author .

The splenic artery, because of its contiguity with the pancreas, is the vessel most commonly involved in pancreatitis. However, virtually all of the pancreatic and peripancreatic vessels can be affected. 

The gastroduodenal and pancreatico-duodenal arteries are frequently involved, while the left gastric, hepatic and small intra-pancreatic branches are less often implicated.

Unlike arterial thrombosis, thrombosis of the splenic vein is much more common, being reported in .5-45% of patients with pancreatitis. Thrombosis involving the portal and superior mesenteric veins is rare and if present, should raise the suspicion of either a septic stage of severe necrotising pancreatitis or a pancreatic head malignancy.

The article states that embolisation of the middle colic artery infact is used in the management of the pancreatitis induced complications such as hemorrhage from pancreatic and peripancreatic vessels .

P.S : This question was asked in the UPSC CMS 2007 medical entrance paper . click here to view all the mcqs from that paper with answers . 

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