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New FIGO 2010 Staging for Carcinoma

Carcinoma of the Vulva

IA         Tumor confined to the vulva or perineum, ≤ 2cm in size with stromal invasion ≤ 1mm, negative nodes
IB         Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes
II          Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes
IIIA      Tumor of any size with positive inguino-femoral lymph nodes
            (i) 1 lymph node metastasis greater than or equal to 5 mm
            (ii) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB      (i) 2 or more lymph nodes metastases greater than or equal to 5 mm
          (ii) 3 or more lymph nodes metastases less than 5 mm
IIIC      Positive node(s) with extracapsular spread
IVA       (i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
            (ii) Fixed or ulcerated inguino-femoral lymph nodes
IVB       Any distant metastasis including pelvic lymph nodes

Carcinoma of the Cervix

IA1       Confined to the cervix, diagnosed only by microscopy with invasion of < 3 mm in depth and lateral spread < 7 mm
IA2       Confined to the cervix, diagnosed with microscopy with invasion of > 3 mm and < 5 mm with lateral spread < 7mm
IB1       Clinically visible lesion or greater than A2, < 4 cm in greatest dimension
IB2       Clinically visible lesion, > 4 cm in greatest dimension
IIA1      Involvement of the upper two-thirds of the vagina, without parametrial invasion, < 4 cm in greatest dimension
IIA2      > 4 cm in greatest dimension
IIB        With parametrial involvement
IIIA/B   Unchanged
IVA/B    Unchanged

Carcinoma of the Endometrium

IA         Tumor confined to the uterus, no or < ½ myometrial invasion
IB         Tumor confined to the uterus, > ½ myometrial invasion
II          Cervical stromal invasion, but not beyond uterus
IIIA      Tumor invades serosa or adnexa
IIIB      Vaginal and/or parametrial involvement
IIIC1    Pelvic node involvement
IIIC2    Para-aortic involvement
IVA       Tumor invasion bladder and/or bowel mucosa
IVB       Distant metastases including abdominal metastases and/or inguinal lymph nodes
Uterine sarcomas were staged previously as endometrial cancers, which did not reflect clinical behavior. Therefore, a new corpus sarcoma staging system was developed based on the criteria used in other soft tissue sarcomas.[2] This is described as a best guess staging system, so data will need to be collected and evaluated for further revision.

Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

IA         Tumor limited to uterus < 5 cm
IB         Tumor limited to uterus > 5 cm
IIA        Tumor extends to the pelvis, adnexal involvement
IIB        Tumor extends to extra-uterine pelvic tissue
IIIA      Tumor invades abdominal tissues, one site
IIIB      More than one site
IIIC      Metastasis to pelvic and/or para-aortic lymph nodes
IVA       Tumor invades bladder and/or rectum
IVB       Distant metastasis

Adenosarcoma Stage I Differs from Other Uterine Sarcomas

IA         Tumor limited to endometrium/endocervix
IB         Invasion to < ½ myometrium
IB         Invasion to > ½ myometrium

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Deadliest disease in the world

The following are the leading causes of death:
PUBLISHED in who website


No.CauseEstimated number of deaths (in millions)Percent of all deaths
1Ischaemic heart disease7.212.2
2Cerebrovascular disease5.79.7
3Lower respiratory infections4.27.1
4Chronic obstructive pulmonary disease3.05.1
5Diarrhoeal diseases2.23.7
6HIV/AIDS2.03.5
7Tuberculosis1.52.5
8Trachea, bronchus, lung cancers1.32.3
9Road traffic accidents1.32.2
10Prematurity and low birth weight1.22.0
11Neonatal infectionsa1.11.9
12Diabetes mellitus1.11.9
Source: Global Burden of Disease: 2004 update

common adverse effects of anti tubercular drugs and management

as given in DOTS_Plus_Guidelines_Jan2010.pdf 
AMINOGLYOCIDES :- KANAMYCIN
-ototoxicity
-nephrotoxicity
-vertigo
-electrolyte imbalance


QUINOLONES:- OFLOXACIN
-photosensitivity
-tendinopathies
-skin rash
-arthalgia
-cardiotoxicity
-diarrhoea


ETHAMBUTOL
-optic neuritis
leads to visual disturbances, colour blindness


PYRAZINAMIDE
-Arthralgia
Hyperuricaemia
• Hepatitis
• Pruritis with or without rash


ETHIONAMIDE

-Psychiatric: hallucination and depression
• Hepatitis
Hypothyroidism and goitre with prolonged administration
Gynaecomastia,menstrual disturbances, impotence, acne, headache, and peripheral neuropathy


CYCLOSERINE

-CNS: dizziness, slurred speech, convulsions, headache, tremor, and insomnia
• Psychiatric: confusion, depression, altered behaviour, and suicidal tendency
• Hypersensitivity reaction


PAS
-Gastro-intestinal: anorexia, nausea, vomiting, and abdominal discomfort
• Skin rash
• Hepatic dysfunction
Hypokalemia
Hypothyroidism and goitre with prolonged administration