Best Varicose Veins Treatment in Jaipur
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Varicose veins are enlarged veins near the skin’s surface, often found in the legs due to increased pressure from standing and walking. For Best Varicose Veins Treatment in Jaipur, Dr. Manish Rajput provides advanced, personalized care using modern techniques to help you achieve healthier, smoother legs and a better quality of life.
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Ewing Sarcoma is a high-grade, undifferentiated small round cell tumor, primarily affecting children and young adults. In the 2020 WHO Classification of Soft Tissue and Bone Tumors, the term “Ewing Family of Tumors” has been retired. Instead, tumors are classified based on molecular alterations, specifically EWSR1/FUS::ETS fusion-positive sarcomas, primarily EWSR1::FLI1. Other tumors previously grouped under the ESFT umbrella (e.g., Ewing-like sarcomas with CIC or BCOR alterations) are now considered distinct entities due to their differing biology and clinical behavior.
Management of Ewing Sarcoma is stage-dependent and requires a multimodal strategy:
Localized Disease: Standard treatment begins with neoadjuvant chemotherapy, typically the VDC/IE regimen (vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide, etoposide). Following tumor shrinkage, local control is achieved through surgical resection when anatomically feasible, or radiotherapy if surgery poses significant morbidity. Adjuvant chemotherapy continues post-local therapy. With current strategies, 5-year survival exceeds 70% in localized cases.
Metastatic Disease: Prognosis is poorer, particularly with bone or combined lung and bone metastases. Treatment mirrors that for localized disease, but may include whole-lung irradiation (for isolated lung metastasis) or intensified systemic therapy. High-dose chemotherapy with autologous stem cell rescue may be considered in selected patients.
Recurrent Disease: Prognosis remains guarded. Salvage regimens include high-dose ifosfamide, topotecan/cyclophosphamide, or irinotecan/temozolomide. The rEECur trial supports high-dose ifosfamide as the preferred second-line agent. Molecularly targeted agents like cabozantinib and regorafenib have shown modest efficacy in phase II trials. Enrollment in clinical trials evaluating new modalities (e.g., PARP inhibitors, GD2-targeted therapies, immune checkpoint inhibitors) is encouraged.
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**Location*
* Located in the **anterior neck**, below the **larynx**.
* Lies over the **trachea**, from the level of **C5 to T1 vertebrae**.
*Structure**
Bilobed gland**: Right and left lobes connected by a thin bridge called the **isthmus**.
* Sometimes a pyramidal lobe is present (remnant of thyroglossal duct).
**Size & Weight**
* ~4-6 cm in length.
* Weighs about **15–25 grams** in adults.
**Capsules**
* **True capsule**: Thin fibrous capsule.
* **False capsule**: Formed by the pretracheal fascia.
*Blood Supply**
*Arterial supply**:
* **Superior thyroid artery** (from external carotid)
* **Inferior thyroid artery** (from thyrocervical trunk)
* Occasionally: **Thyroid ima artery** (from brachiocephalic trunk or aorta)
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* **Superior**, **middle**, and **inferior thyroid veins** → drain into internal jugular and brachiocephalic veins.
**Lymphatic Drainage**
* Prelaryngeal, pretracheal, and paratracheal lymph nodes → deep cervical nodes.
Nerve Supply**
Sympathetic**: Cervical sympathetic ganglia (vasomotor).
Parasympathetic**: From the vagus nerve** (via recurrent laryngeal and external laryngeal nerves).
* Recurrent laryngeal nerve runs close to the thyroid — important surgically.
**Development**
* Develops from a **midline endodermal outgrowth** of the **floor of the pharynx** (foramen cecum).
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In today’s fast-evolving pharmaceutical landscape, **Contract Research Organizations (CROs)** serve as the invisible backbone behind successful drug development and regulatory approval processes. This PowerPoint presentation offers a detailed, well-structured, and student-friendly overview of CROs—from their origin and purpose to their staff roles, key responsibilities, organizational structure, services offered, and real-world challenges.
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### 📖 What This PPT Covers:
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#### 3. **Objectives of CROs**
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* Biostatistics and data integrity
* Supervision in quality control
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---
### 🛠️ Services Provided by CROs
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