Date
March 22-23, 2023 | 10:00 AM GMT
Location
London,
London,
As a consultant nephrologist, Dr. Simon Gibson provided his services close to people’s homes, traveling and providing his specialist renal services to four hospitals, tending to the needs of patients with kidney problems. He has also been on the receiving end of life-saving treatment. With "Tales of a Meandering Medic" he shares the lessons he learned from these experiences, providing a medical textbook made in a way that readers with no prior knowledge of medicine can grasp the concepts within its pages.
This book describes my journey through my working life as a Doctor. It also describes my experiences as 8 patients, and the wonderful life saving care I received from the NHS. There are also a few lines on my earlier life, as a Medical Student and how that impacted on my life as a Hospital Consultant Physician and Nephrologist (kidney specialist). The book consists of a series of vignettes describing episodes that have lingered in my memory.
This is well illustrated by the vignette “A Legacy of 5pina bifida”. In this, I describe a courageous lady with spina bifida. Illustrations come mainly from Bing Pictures, although some are of my own creation. There is a detailed Glossary at the start of the book explaining abbreviations commonly used in Medicine, for example LP is the abbreviation for Lumbar Puncture, used in the vignette describing my own lumbar puncture. Towards the end of the book I describe my interaction with the Driving and Vehicle Licensing Authority (Aittocracy), and the General Medical Council (Gang of Mealymouthed Charlatans). Hopefully the book will entertain and educate. The intended reader is an average member of the public and no prior medical knowledge is required. Some over inflated egos may be punctured. So Reader, enjoy 'Tales of a Meandering Medic” Any profits will be donated to Oxfam. 1 have been a donor to Oxfam since my undergraduate days at Oxford.
Hillary L. Copp is a pediatric urologist who treats abnormalities of the urinary tract and genitals, including urinary tract infections, disorders of sex development and spina bifida. She treats patients ranging from infants to teens. Copp uses multiple surgical techniques, including open, endoscopic, laparoscopic and robot-assisted laparoscopic surgery.
In children and adolescents underweight is a significant risk factor for infection especially in developing countries, probably reflecting malnutrition and poor hygienic standards. Data from industrialized countries suggest that infection rate is also increased in obese children and adolescents. Similarly, several studies suggest a U-shaped increased infection rate in both underweight and obese adults. In the latter, infections of the skin and respiratory tract as well as surgical-site infections have consistently been reported to be more common than in normal-weight participants. Paradoxically, mortality of critically ill patients was reduced in obesity in some studies.
Nouman Khan has completed his MBBS from Khyber Medical College Peshawar and Fellowship in Urology from the College of Physicians and Surgeon Pakistan (FCPS-Urology) in December 2015. He worked as Registrar Urology at North West General Hospital Peshawar for one year and later moved to Lahore city for fellowship in Urological Oncology at Shaukat Khanum Cancer Hospital Lahore. He is currently working as assistant consultant urology at King Faisal Specialist Hospital & Research Centre, Saudi Arabia. He has published 12 papers in Pakistan and international journals. Three articles are ready for publication.
Background
Testicular cancer is the most common solid tumor in young men aged between 20 and 35 years old.
Many of patient with nonseminomatus germ cell tumor will require further management. Retroperitoneal Lymph Node Dissection (RPLND) remains an integral component in the ultimate care of such patients, either alone or in combination of chemotherapy. Literature regarding long-term oncologic outcome of nonseminomatus germ cell tumor after retroperitoneal dissection surgery is deficient in the Saudi Arabia population.
Objectives
The main objective of this research was to determine the long-term surgical and oncological outcomes of NSGCT after retroperitoneal lymph nodes dissection and to determine the clinical and pathological factors associated with long-term survival.
Methods
This study is a retrospective case series, we included all the seven adult patients who underwent Retroperitoneal Lymph Node dissection for nonseminomatus germ cell tumor in our hospital, from January 2010 to April 2021.
The data using HIS power chart in the form of history, demography, labs and radiological findings, staging of the disease, chemotherapy and radiotherapy status, surgery procedure details and surgery related per OP, post op acute and chronic complications, surgery related morbidity and mortality, follow up Labs and radiological findings, disease recurrence in months and overall survival in months. The data was analysed in SPSS 23 for overall and disease free survivals in months using life table and Kaplan Mires curve.
Results
9 patient underwent RPLND for NSGCT during the study period, Mean age was 28. years ( ± 5.4 SD ). . Yolk sac and embryonal cell carcinoma was the most common variant in testicular biopsies. Using AJCC 8th Edition NSCT staging classification, three patients had 3A stage, 3 patients had 3B stage while one patient had 3C, one 1S stage and one 2B stage. All patients received NeoAdjuvant chemotherapy with reduction in retroperitoneal nodes size in 4 patients, no response noted in 4 patients and 1 patient had progression of nodes size post chemotherapy. No morbidity or mortality noted post RPLND, mean hospital stay was 8 days. All patients needed intervention in form of blood transfusion or IV antibiotics hence making the Calvin Dindo score of 2 in all the patients. 66.7% of the RPLN resected harboured cancer, all of them had teratoma as major component with one patient had yolk sac tumor and 1 had choriocarcinoma in combination with teratoma, on histopathology reports. Post treatment the median overall survival was 26 months and disease free survival was 21 months. The 1 year overall survival was 86% and 5 years survival was 66.7% using Kaplan Myers survival chart. Embryonal cell carcinoma had good prognosis over yolk sac tumor, the 3 years overall survival for the two variant were 66% vs 50% respectively.
Conclusion
Retroperitoneal lymph nodes dissection is safe procedure with very low morbidity, mortality and post OP complications. It achieves reasonable oncological results with good overall and disease free survival.
Rome, Italy - Jun 21, 2023
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