ACCT- 3. 50 ADVANCED COST ACCOUNTING Syllabus. This course addresses cost and management accounting topics relating to the implementation and control of management decisions. Final Comprehensive Exam - 2. Unit Tests - -- -- -- -- -- -- -- -- -- -- -- -- - 3. Quizzes - -- -- -- -- -- -- -- -- -- -- -- -- -- -- 2. Homework Assignments - -- -- - 2. Participation - -- -- -- -- -- -- -- -- -- -- -- 0. TOTAL - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- - 1. Final comprehensive exam will be administered in two class periods. Each unit test weighs 1. A missed unit test grade is a zero. Four class quizzes will be given. Each class quiz weighs 5%. Ten homework assignments will weigh 2% each. Class participation will be based on the students' class attendance and contribution to class discussions. The faculty member may schedule a make- up for other equally. There are no make- ups on any homework assignments, tests, quizzes, projects, or the final comprehensive exam except with a written, valid excuse. Any make- up work assigned, upon review of valid excuse, is required to be completed within one week from the original date. All students are required to complete each homework assignment, quiz, unit test, and final comprehensive exam by the appointed time. No extra time will be allowed. Group participation, including during group quizzes and unit tests, if any, is encouraged for items selected by the instructor. Selected accounting applications, presentations, and assignments necessitate researching through the required resources, recommended readings, the internet, and library resources. Please do retain your required resources for possible future use. A swipe- card terminal in each classroom is used to record attendance electronically. No. partial credit may be given. You are welcome to my class. Transrectal Ultrasonography of the Prostate: Background, Indications, Contraindications. Prostate cancer is the most common cancer in males. It is estimated that about 6. In active surveillance, patients are followed by their urologist by means of periodic physical exams, prostate- specific antigen (PSA) testing, digital rectal exam (DRE), and/or periodic repeat prostate biopsies. Neetha Shetty is an Indian television actress. She has starred in the TV series Ghar Ki Lakshmi Betiyann as one of Laxmi's sisters, and in Kahiin to Hoga as Dr. The decision regarding whether one can pursue active surveillance depends on the biopsy results, PSA levels, and the clinical stage of the cancer. The American Urological Association (AUA) deems active surveillance an option in prostate cancer patients who have a low PSA level, clinical stage, and Gleason score, making accurate biopsy results extremely important in considering patients for this option. TRUS has become an extension of the urologist. The evolution of end- firing probes has further enhanced urologists.
In medicine, the initial use of ultrasound was in the detection of brain tumors. In urology, ultrasound was first used to detect renal stones during surgery. The early applications of ultrasonography in medicine involved sound- wave generators, cathode- ray tubes, Polaroid photography, or 3. However, the invention of the silicone microchip gave birth to the modern ultrasonography revolution. Early investigators in prostatic ultrasonography conducted experiments with ultrasound probes and recording devices. One of the earliest devices was a chair- type apparatus with a probe mounted in the center of the chair. The Department of Classical Studies offers students the opportunity to study the languages, cultures, and histories of ancient Greece and Rome. Ice Princess - Un sogno sul ghiaccio (Ice Princess) Everything about Sindhis, Culture,Language,MusicFree Sindhi Music MP3 songs for listening and download. Sindhi Music Artists, Sindhi Music Streaming, Sindhi Radio. The patient sat on the probe, which was guided into the rectum. Improvements in gray- scale ultrasound display and multiplanar scanning have resulted in user- friendly hand- held probes. Earlier studies concentrated on the ultrasonographic appearances of prostate abnormalities such as benign prostatic hyperplasia (BPH), carcinoma of the prostate (CAP), prostatitis, prostatic abscess, and prostatic calculi. Since the introduction of the PSA screening test and early detection of prostate cancer, the role of TRUS has changed; it is mainly used to visualize the prostate (see the image below) and to aid in guided needle biopsy. Real- time prostate biopsy has emerged as a potential replacement for conventional systematic biopsy in an effort to improve quality, reduce the number of clinically insignificant cancer diagnoses, and improve targeting of high- grade and clinically significant tumors. PSA guidelines. The AUA has published updated guidelines for the early detection of prostate cancer (CAP) to guide urologists in the screening of asymptomatic men. Men younger than 5. CAP (family history or African American race) should discuss an individualized approach to prostate cancer screening with their urologists. Men aged 5. 5 to 6. For men in this age group, the panel strongly recommended shared decision- making regarding PSA screening and proceeding at 2- year intervals depending on the individual. PSA screening is not recommended for men older than 7. Several investigators have demonstrated that the addition of color Doppler improved the specificity of prostate biopsy findings. However, differentiating a focus of prostatitis from cancer was difficult. The addition of power Doppler was not advantageous. Contrast- enhanced prostate biopsy. The use of microbubble contrast agents can enhance gray- scale imaging and Doppler imaging. Newer agents that remain in the vascular compartment have been used for prostate imaging. Currently available agents include the following. Perflenapent emulsion (Echo. Gen). Galactose. Ragde et al used Echo. Gen to study 1. 5 patients with rising PSA levels and previous negative biopsy findings and found that the addition of this contrast agent helped guide biopsies to appropriate sites. Intermittent ultrasonography increases the enhancement provided by the contrast agents. In harmonic imaging, the reverberations produced by the contrast agent are visualized at a different frequency than the insonating frequency, which can provide a better image. High- intensity focused ultrasound. With extracorporeal HIFU, temperatures higher than 6. The prostate can be easily treated with this modality via a transrectal probe. The size of the thermal lesion can be controlled by the power and the duration of the ultrasound pulse. Higher in situ intensities (> 3. W/cm. 2) create the cavitation phenomenon and bubble effect, which are difficult to monitor. The currently available HIFU devices use 3- 4 MHz transducers. Experimental studies have shown core temperatures of 7. Rectal cooling is employed to prevent rectal burns. Prostates smaller than 4. L or those with an anteroposterior diameter of less than 5 cm are best suited for this treatment. During the procedure, the whole gland is treated (in contrast to focal therapy). After the procedure, a suprapubic tube is left in place for 5- 7 days. In a multicenter trial of 4. HIFU, the median duration for catheter use was 5 days. Incontinence following HIFU was rare (0. Rectourethral fistula developed in 1. Complication rates are higher with salvage HIFU after radiation therapy, radical prostatectomy, or HIFU. Erectile function can be preserved in 2. HIFU. After a minimum follow- up period of 6 months, Thuroff et al reported negative biopsy results in 8. PSA level of 0. 4 ng/m. L after HIFU. Complication rates after salvage HIFU were higher: total incontinence developed in 6%, rectourethral fistula in 6%, and vesical neck contracture in 1. Prostate elastography. DRE, PSA testing, and color Doppler TRUS- guided systematic biopsy are the basis for the diagnosis of prostate cancer. As alluded to earlier, TRUS has not been proven as a reliable imaging technique for localizing cancer foci within the prostate. This line of thinking formed the basis for elastography, which was developed in the early 1. As elastography developed, it has been increasingly applied for prostate cancer imaging. There are 2 elastography techniques: quasi- static and shear- wave. This difference in deformation is used to estimate the tissue stiffness. Reduced deformation typically indicates neoplastic tissue; additionally, if this tissue appears hypoechoic, it is likely a malignancy. The shear- wave technique requires no compression of the rectal wall and is based on the measurement of shear- wave velocity propagating through the tissues. Elastic properties are typically provided in kilopascals (k. Pa), where neoplastic nodularity is suspicious at levels greater than 3. Pa. Further analysis showed that the best sensitivity and specificity were found in the apex region. Furthermore, elastography required fewer than half the number of biopsy cores. When evaluating elastography for the staging of prostate cancer, Salomon et al. MRI coregistration with ultrasound, commonly referred to as MR- US fusion, has been an area of increasing research and is a potential replacement for systematic biopsy moving forward. MR- US fusion allows MRI data to be used to obtain biopsies under ultrasound guidance. Cognitive fusion refers to the operator viewing lesions on MRI, allowing one to attempt biopsy of the visualized location from memory using real- time US. Obvious disadvantages include potential for human error and the steep learning curve and variability of results. In an effort to reduce this variability, several fusion devices have been developed and are now approved by the FDA. The Artemis device (Eigen) utilizes tracking of the TRUS probe by a directly attached robotic arm that translates the 2. D US into a 3. D model, which is fused with the preprocedure MRI and allows targeting of suspicious lesions. They also found that there was a clinically significant increase in the detection of significant cancers and a decreased detection of insignificant cancers, as compared to systematic biopsy. Disadvantages of using the Artemis device include the bulkiness of the device and difficulty with in- office use. The Uro. Nav device (Invivo) utilizes a sensor that attaches to the TRUS probe, and using a small electromagnetic field placed in close proximity to the patient, it fuses the MRI data. However, it has the disadvantage of an electromagnetic field, as opposed to the accuracy of the robot. Vourganti et al. The Urostation device (Koelis) utilizes real- time 3. D TRUS in a recreated model of the prostate to localize each biopsy site. This device has the advantage of a free- hand platform, though the inherent error in any free- hand technique still exists. Delongchamps et al. In their study of 3. The fusion MR- US devices did increase the detection of high- grade cancer with fewer cores, while decreasing the rate of micro focal cancer detection. Puech et al. The study found that targeted biopsy detected clinically significant cancer in more men than random biopsy; however, there was no significant difference in cancer detection between cognitive fusion and MR- US fusion software. MR- US coregistration has shown promise as a targeted method of sampling the prostate leading to more accurate identification of clinically significant prostate cancer. However, it remains unclear whether the biopsy results can be applied to the conventional risk- stratification systems that were designed for systematic and random biopsy. It is also unclear how exactly this will impact the practicing urologist. Long- term studies are certainly required. Nonetheless, it is an important advancement in the ongoing effort to improve the management of prostate cancer. The AUA and Society of Abdominal Radiology (SAR) has issued a consensus statement on the role of MRI in prostate biopsies. As a result, the organizations recommend that physicians strongly consider prostate MRI in patients with a prior negative biopsy who are undergoing repeat biopsy for clinically suspicious cancer. The authors state that the MRI should be reported in accordance with the Prostate Imaging r. Rporting and Data System (PI- RADS) version 2 (V2) guidelines.
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