By J. Cruz. Wright State University.

Monosaccharides and disaccharides are referred to as simple sugars or simple carbohydrates that our body can easily utilise order imodium 2mg on-line. For this reason discount imodium 2mg fast delivery, people with diabetes mellitus shouldn’t eat too many of these carbohydrates generic 2 mg imodium mastercard. Polysaccharides are called complex carbohydrates and they need to be broken down into simple sugars to be used by our body. Proteins are needed in our diets for growth (especially important for children, teens and pregnant women) and to improve immune functions. They also play an important role in making essential hormones and enzymes, in tissue repair, preserving lean muscle mass, and supplying energy in times when carbohydrates are not available. Pregnant women need protein to build their bodies and that of the babies and placentas, to make extra blood and for fat storage. All animal foods contain more protein than plants and are therefore usually better sources of body building foods. Fat is found in meat, chicken, milk products, butters, creams, avocado, cooking oils and fats, cheese, fish and ground nuts. The classification is important to enable you to advise your community about which fats can be consumed with less risk to people’s health. Eating too much saturated fat is not good for a person’s health, as it can cause heart and blood vessel problems. Examples include fats from fish, oil seeds (sesame and sunflower), maize oil and ground nut oil and breastmilk. As a general rule, plant sources of fats are better for a person’s health than the animal sources, because animal fats contain more saturated fats. Butter, meat fats and oils from animal sources are not good fats, because they have a high amount of saturated fats. People can live without solid food for a few weeks, but we cannot live without water for more than a few days. That is why giving drinks are so important when people lose a lot of water, such as when they have diarrhoea. For the body to make cells and fluids such as tears, digestive juices and breastmilk. For keeping the lining of the mouth, intestine, eyelids and lungs wet and healthy. Foods rich in fibre are ‘kocho’; vegetables like cabbage, ‘kosta’, carrots, cassava; fruits like banana and avocado; peas and beans; whole-grain cereals like wheat flour and refined maize or sorghum. Fibre makes food bulky or bigger — thiscanhelpapersonwhois overweight to eat less food. Fibre slows the absorption of nutrients, so it helps nutrients to enter the blood stream slowly. In this section you have learned about the macronutrients: carbohydrates, fats, proteins, water and fibre, and how they nourish the body. You are now going to learn more about vitamins and minerals, the important micronutrients. They are grouped together because, as their name implies, they are a vital factor in the diet. Classifications of vitamins Vitamins are classified into two groups: Fat soluble vitamins (vitamins A, D, E and K) are soluble in fats and fat solvents. Water soluble vitamins (vitamins B and C, and folic acid) are soluble in water and so they cannot be stored in the body. However, an adequate micronutrient intake can only be achieved through sufficient intake of a balanced diet that includes plenty of fruits and vegetables. Vitamins Function Food sources Vitamin A Night vision Breastmilk, tomatoes, cabbage, Epithelial cells form the thin layer Healing epithelial cells lettuce, pumpkins of tissue lining the gut, Normal development of teeth Mangoes, papaya, carrots respiratory and genitourinary and bones Liver, kidney, egg yolk, milk, systems. Vitamin K For blood clotting Green leafy vegetables Fruits, cereals, meat, dairy products B complex Metabolism of carbohydrates, Milk, egg yolk, liver, kidney proteins and fats and heart Whole grain cereals, meat, whole bread, fish, bananas Scurvy is a disease caused by Vitamin C Prevention of scurvy Fresh fruits (oranges, banana, vitamin C deficiency which leads mango, grapefruits, lemons, Aiding wound healing to sore skin, bleeding gums and potatoes) and vegetables internal bleeding. Examples of minerals include calcium, iron, iodine, fluorine, phosphorus, potassium, zinc, selenium, and sodium. Minerals Function Food sources Calcium Gives bones and teeth rigidity and Milk, cheese and dairy products strength Foods fortified with calcium, e. The vitamins and minerals that make up micronutrients have a crucial role in enabling the body to function properly. Your role as a Health Extension Practitioner is to advise people in your community to have a balanced diet that includes micronutrients. You will learn more about micronutrients in Study Session 7, in particular the impact of deficiencies in vitamin A, iron and iodine on individuals and communities. In this section we’ll discuss what a balanced diet is and the benefits of a balanced diet. It is important that you know enough to be able to recommend a balanced diet for the people in your community. Eating a balanced diet means choosing a wide variety of foods and drinks from all the food groups.

Primary tumors confined to the lung and >2 cm distal to carina generic imodium 2 mg fast delivery, with metastases to peribronchial or ipsilateral hilar lymph nodes b buy imodium 2mg otc. And/or metastases confined to the ipsilateral mediastinal of subcarinal lymph nodes (N2) Surgical Treatment of T3 (Chest Wall Invasion) Non-Small Cell Lung Carcinoma (exclusive of superior sulcus tumors) 1 buy discount imodium 2 mg line. Includes pulmonary resection with contiguous soft tissue and rib resection and chest wall reconstruction b. When peripheral tumors is attached to parietal pleura, extrapleural resection can be attempted with good success or en bloc resection will be required c. Most important prognostic factor is whether a complete resection can be performed Surgical Treatment of T3 (Proximity to carina) Non-Small Cell Lung Cancer 1. Most important diagnostic procedure is bronchoscopy in order to determine proximity of the tumor to the carina 2. Indication is for bulky tumors in proximity to or involving the carina or tracheobronchial angle v. Number of nodes affected survival, upper paratracheal nodes affected survival with an overall 5 year survival of 20% i. Found that post-operative radiotherapy significantly decreased local recurrence but no affect on survival iii. Chemotherapy and found increased disease free survival in those patients that received chemotherapy a. If left untreated the pain becomes unremitting and spreads medially to the scapula, extends along the ulnar nerve distribution of the arm to involve the elbow, forearm and hand. Other involved structures include the cervical sympathetics (Horner’s syndrome), vagus and phrenic nerves, carotid artery, and the vertebral bodies. Small cell is rare Location All are T3 since they invade the chest wall; classified as T4 when mediastinal and/or cervical invasion has taken place. Posterior—stellate ganglion, posterior ribs, brachial plexus (upward extension), and vertebral bodies (medial extension) Anterior—1st rib, scalene muscle, subclavian vessels, phrenic nerve Resection possible even with brachial plexus, stellate ganglion, rib, transverse process, subclavian artery (adventitia), vertebral body (<25%). It is not effective for tumors that invade the posterior aspects of the ribs and their transverse processes, the stellate ganglion and sympathetic chain, and the vertebral bodies. Pathogenesis · The lung is the first capillary bed draining most primary sites, with tumor cells usually depositing in the periphery · 10-20% of patients with pulmonary metastases have disease confined to the lungs (especially with sarcomas) 2. Patient Selection · There are four criteria which should be met prior to resection of pulmonary metastases: 1. Prognostic Factors · Histologic cell type affects the pattern of metastasis as well as outcome · Tumors with longer doubling time have better survival · The number of metastases, the disease-free interval, and unilateral vs. Operative Technique · Wedge resections should be performed wherever possible to preserve parenchymal tissue · Manual exploration is preferred to thoracoscopic examination to identify all nodules · Bilateral disease may be treated either by staged bilateral thoracotomy or median sternotomy for a single operation 6. Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: Results of a prospective trial. This important article reports five-year survival of 37% for resection of a solitary metastasis and 30% after a second resection for recurrent metastasis. This series of 33 patients shows an increased survival for resection (36% vs 11%) over medical therapy. The authors suggest that resection be considered in patients without evidence of concomitant extrapulmonary disease. Chapters 25 and 28: Superior Sulcus Tumors and Indications for Resection of Pulmonary Metastases. Respiratory Tract Tissue examination Most lesions are peripheral Radiographic features- major diagnostic aid Calcification "Popcorn" type Well defined margins Lobulated Growth (? Epithelial tumors Mesodermal tumors Vascular tumors Bronchial tumors Neurogenic tumors Developmental or unknown origin tumors Inflammatory and other pseudo0tumors 3. Tumors of Epithelial origin Papilloma- 5 sib-classifications Solitary benign papilloma Multiple benign papillomas Combined bronchial mucous gland and surface papillary tumor In situ papillary bronchial carcinomas Bronchiolar papillomas Proximal Squamous, stalk Distal Clara cells One of few lesions that can be managed by bronchoscopic resection Recurrence is high Rare malignant transformation 4. Tumors of Mesodermal Origin Hemangioma Subglottic area of larynx or upper trachea of infants Airway obstuction Dx: Bronchoscopy Other vascular lesions of skin, mucous membranes Tx: Radiation therapy Lymphangioma Upper airway obstruction in infancy Associated with other lesions- cystic hygroma, hemangioma in the neck Tx: surgical excision 6. Hemangiopericytoma Solitary, encapsulated, asymptomatic Originates from pericytes associated with pulmonary capillaries Considered malignant Tx: Surgical resection for cure or radiation therapy for palliation 10. Fibroma Mostly tracheobronchial in origin Most common benign tumor of mesodermal origin in adult and pediatric age group Collagenous/ spindle cells- myxomatous/ adipose elements Tx: Bronchoscopic resection if stalk is present vs conservative pulmonary resection 11. Lipoma Rare, intrabronchial lesion; male predominance Slowly growing, avascular, obstructive, pedunculated Tx: Bronchoscopic removal for small lesions; bronchotomy for larger ones Arise in fat cells Associated with bronchiectasis (chronic obstruction) 13. Granular Cell Tumors (Myoblastoma) Previously thought to originate from myoblasts Originates from Schwann cells or histiocytes Arises from the tongue or skin 6% originate endobronchially Tx: Surgical removal with wide margins Bronchoscopic removal associated with recurrence < 8 mm 16. Developmental or Unknown Origin Hamartomas Most common benign tumor of the lung 8% of coin-shaped lesions 0. Thymoma Ectopic thymus tissue (rare) Intrapulmonary thymoma may be associated with Myasthenia Gravis 21. Pseudolymphoma Discrete localization Unilateral Resembles lymphoid interstitial pneumonitis Rare conversion to malignant lymphoma Tx: Lobectomy/ segmental resection with follow-up 23.

A mere sampling of the renal hilar lymph nodes is insufficient for pathologic staging discount imodium 2 mg mastercard. For right sided tumor imodium 2mg on-line, paracaval and interaortocaval lymph nodes and for left sided tumor para-aortic and interaortocaval lymph nodes should be removed from the crus of the diaphragm to the common iliac artery generic 2mg imodium otc. Socio-economic and facility issues – Advanced – • staging tools • surgical facility • follow up facility • socio-economic support may not be available everywhere. A substantial improvement in progression-free survival and overall survival has been 54 achieved in large randomized controlled trials, when compared to Interferon-α. Sarcomatoid variant is associated with poor prognosis, and a modest response with doxorubicin & gemcitabine is observed. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. Lymph Node Dissection at the Time of Radical Nephrectomy for High-Risk Clear Cell Renal Cell Carcinoma: Indications and Recommendations for Surgical Templates. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. Invasive bladder cancer: Bladder cancer that histologically invades the muscularis propria. This may be partially attributed due to better detection and improved health care. Detailed evaluation of all patients with gross hematuria and elderly patients (>40 years) with microscopic hematuria and associated risk factors like smoking 15. Prompt referral of men with advanced bladder cancer to higher centers for further evaluation V. Diagnosis –The diagnosis mainly depends on the cystoscopic examination of the bladder, biopsy, and urine cytology. The management algorithm is based on the diagnosis of invasion of muscularis propria or not. Biopsy of the apical prostatic urethra when there is a bladder neck tumour or when abnormalities of prostatic urethra are visible. Pelvic examination (Bimanual examination) under anaesthesia: Helpful in assessment of local staging in muscle invasive bladder cancer and advanced cases. Bone scan –Indicated in patients with raised alkaline phosphatase and with bone pain. Stage T1 tumours originate from the urothelium but penetrate the basement membrane which separates the urothelium from the deeper layers. T1 tumours invade into the lamina propria, but are not so deep that they reach the detrusor muscle. Carcinoma in situ (Tis) is a high-grade (anaplastic) carcinoma confined to the urothelium, but with a flat non-papillary configuration. Unlike a papillary tumour, Tis appears as reddened and velvety mucosa and is slightly elevated but sometimes not visible. Three types of Tis are distinguishable;  Primary Tis (no previous or concurrent papillary tumours);  Secondary Tis (with a history of papillary tumours);  Concurrent Tis (in the presence of papillary tumours). Predicting recurrence and progression of tumours [15,16]: TaT1 tumours The pattern of recurrence and progression depends on the following clinical and pathological factors: 1. Larger tumours should be resected in fractions, which include the exophytic part, the underlying bladder wall and the edges of resection area. An immediate single post-operative instillation with a chemotherapeutic agent (drug optional – Mitomycin C preferred). Maintenance therapy for at least 1 year (monthly once) is necessary [22,23] although the optimal maintenance scheme has not yet been determined. The major issue in the management of intermediate risk tumours is to prevent recurrence and progression, of which recurrence is clinically the most frequent. Adjuvant intravesical chemotherapy (drug optional), schedule: optional although the duration of treatment should not exceed 1 year. Maintenance therapy for at least 1 year (monthly once) is necessary although the optimal maintenance schedule has not yet been determined. Early radical cystectomy at the time of diagnosis provides excellent disease-free survival, but over-treatment occurs in up to 50% of patients. Muscle invasive bladder cancer: Neo-adjuvant chemotherapy: Neo-adjuvant cisplatin-containing combination chemotherapy improves overall survival by 5-7% at 5 years. Radical Surgery and Urinary Diversion Cystectomy is the preferred curative treatment for localized muscle invasive bladder cancer.