Malignant bone tumors are classified into primary bone sarcomas (osteosarcoma, Ewing's sarcoma, chondrosarcoma) and metastatic bone disease, with staging essential before any invasive procedure to determine prognosis and guide treatment. The Enneking classification grades tumors from A (low-grade, intracompartmental, no metastases) to D (high-grade, extracompartmental, with metastases), while the JCC classification uses tumor size and compartmental involvement. Treatment involves neoadjuvant chemotherapy (especially for osteosarcoma and Ewing's sarcoma), surgery with wide margins (2-3 cm), and adjuvant therapy, with radiotherapy reserved for radiosensitive tumors like Ewing's sarcoma.
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ORTOP-Talks: Highlights de Tumores Ósseos MalignosAdded:
which you will watch later. Send a hug For everyone.
Hey everyone at Top Review, welcome!
Here's another live stream from us. Now We're going to talk a little bit about malignant tumors. I am Felipe, I think you all probably already know me.
of the oncological orthopedics modules, but also some slightly more... complicated pediatric cases. Pediatrics, is How are you, Giovan? Uh, medicine based on Evidence, right? Things get a little complicated.
there. Basically, Felipe, Sorry to interrupt you, it's like this, look, we I'm too tired to do another class.
That's difficult, we send it to Felipe, he Solve it for us really quickly. Then, Someone has to sort this out, but Come on, that's what we're here for. AND Today we're going to talk a little about... malignant tumors, uh, my specializing in oncological orthopedics, is a topic that is super relevant, that will falling on your test, regardless of that.
What year are you going to make this theorem?
What year are you listening to us in?
In our podcast, something will fall that We're going to talk about this in this live stream... you in the test. Good one, Felipão. Guys, Today, in fact, they came out.
Information from the 2027 Teot exam.
So, if you haven't caught on yet, Stay tuned. January 10th first phase of Teote and the final week of February, the second phase.
God willing, everyone will be there.
Hey Vittor, tell me, we were just... It was a bit of a distant place yesterday, wasn't it?
Good. That's it, guys. First of all, good night. Thank you for being here.
you. It's a pleasure to have you here today.
with us. One more, one more chat.
here about super important topics in Test it and see it in your practice. Today talking about malignant tumors. Uh, no Don't be surprised here, okay? Me and Giovani with the They look worn out, but we did a It's crazy to do a day trip there.
Teresina in a flash. Yeah, but it's always a It's a pleasure to be near you, to be able to have this.
socializing, uh, arriving, you know, at the places then more, well, more spread out there of this Brazil of ours, so that we can, uh, ending up meeting you, you Getting to know us too, right, Joan?
because we end up surprising ourselves.
How come there are people out there who have never ever We heard about it and, well, we're taking it there.
A little bit of the top review for each one.
It was a really cool event, okay? We have it there two classes, it's in the... we managed Combining two services, in fact, worked well.
Interesting, it was a really cool exchange.
federal, state, there in Piauí, and it was a very good experience. The problem is that we returned in the early morning, already amended care, surgery, they are It's kind of finished here, but we're here with Let's talk a little more today, to bring a little more knowledge, beauty? Then That's it, folks. So you guys there... Teresina, which we told you about.
They can join today so they can discuss malignant tumors. A hug for you. Who knows, maybe we'll be back soon.
And the next one is Recife, right, Vitor? Guys From Recife, on June 10th, we There will be several services there with you.
together there, more than 40 residents for Let's do a roadside workshop. But Let's get down to business, shall we, Felipe?
Today we'll discuss the topic of malignant tumors.
You made that pretty picture there.
Did you like it there? It turned out great, right, man?
It was left. What did you use there, yeah yeah, little girl?
Classic, right? To show them. See?
Hey, look? That's the bad guy from the group over there, look.
Everyone's angry. It is important understand that this is no joke, right? We're talking about tumors that... a high mortality rate and that is a disease that that normal orthopedist He doesn't even like to deal with it, does he? Orthopedist He's the guy who doesn't want to talk about illness.
That kills, right? The guy wants to talk about disease that he will do a little medicine, he's going to have surgery, the Dude, it'll be okay, things will get back to normal.
As quickly as possible. But it exists some pathologies that we have to to talk a little about some predictions of mortality that quequera quer não h it goes through, right, the training of general orthopedist to graduate in Esbot, right? And here is our table that I like to emphasize. We still have I still need to update that with Teó.
2026. I promise that by the end of the year We'll have that up to date.
A table with Taro will also be available.
This year, okay? So what do we have to do?
The most common ones, right, are the tumors... Evil, right? Of course, it's by hitting, right, sticking a stick.
a pau 31 with 30%, sarcoma being the theme more second most recurring theme and soon as the most recurring theme: metastases Bones, right? And then there are many questions of metastases. It's very funny that it is if the People, grab the most recent ones, Giovani, the SAR is much more common than metastasis.
because we have a lot of old issues, right, from the old citharas that it had Those are the maxims of epidemiology, right?
Which metastasis is most common? (below) of the knee, batidinha, those classic batidinhas It was very common. Nowadays, more and more But the theorist has been raising issues that are more clinical cases, which require a a slightly better reasoning and a A greater understanding of pathologies.
Let's start by chatting a little bit.
about that.
Well, this is just a general overview.
guys. you. We're here live, right? So, we're making adjustments there.
screen, you'll be able to see it soon.
That's really cool, how's our screen looking?
But enjoy it while we're gone.
Adjusting things here, and then you can send it.
Messages for us. We're seeing it.
Here's your screen, the YouTube chat.
Say hi, tell me where you're from first.
You're talking, right? Where are you from?
They're watching with us and they can Send us your questions and we'll read them.
Here for you live, here for the Felipe, is everything alright? So this prevalence So, Felipe, who falls more often?
Malignant or benign in the test?
So it's stick stick, but I think that's how it is.
The big question of whether something is evil, I think.
a more important topic, relevant to Sometimes more so than the benign, it is the malignant.
probably the clinical cases and then the What will sometimes be charged is the second one.
phase, which is like a phase that is super It's frightening, imagine it's a matter of A tumor for someone in the second stage, no.
They had malignant tumors, right? Then The benign one will be the more severe case.
simple, that easier question to deal with and very overdue, charged, as We talked about this in the previous live stream.
to syndromes, right, genetic syndromes associated with tumors and syndromes Tumors have been increasingly charged.
I brought that slide over there, We brought that cool slide over there.
who saved your good gang, we She talked a little about him in the last live stream.
For those who haven't seen it, it's definitely worth watching.
Go back and watch the live stream we did.
Benign tumors, you know, guys? Very It's important that you add to it.
These two classes are essential.
to settle all questions.
Good.
So let's go. There is the concept of "pediology." That Here I also like another slide which is It's important that we revisit one more time.
time. So the most common type of tumor is lactic acid. THE People have a diagnostic question regarding... fibronocifying and ostrochondroma. THE The field places the most common chondroma. But the fibronocifying agent often in our orthopedic oncology books It is considered more common because it does not It is diagnosed. I have osteochondrome many Sometimes it is the tumor that it is most Symptomatic, right? Can you feel it?
It's palpable, it will cause tendinitis.
associated there, bursitis associated with Exasto, right, on the spot. When the movie Harmful if you don't get an X-ray.
due to trauma, he often It goes unnoticed and sometimes he Some, right, those cortical effects.
smaller fibrous tissue, it disappears completely.
in adulthood. So maybe he is more common than even cyclondroma.
Well, in the most common type of bone cancer, we... It has metastases, right? We're going to talk about... Not much more on that. So it's important not to Don't mess that up, guys. So, a tube malignant, no matter what it is, bone The most common type is carcinoma. Carcinoma metastatic. Sarcomas, which are primary bone tumors of parts moles, which is what we treat, they They are very uncommon, representing 1% of all tumors. When are we going?
Speaking thanks to God, much more Difficult to deal with, isn't it? But also bad for us who are ecologists, they say that the There aren't many patients in that area.
of general sarcasm and many more halves to People have it, okay? Then, it turned primary malignant bone tumor, most common, my multiple loma because the spinal cord Bone marrow comes from the blood, right? The medulla occult blood is from Tough, huh? So, bone marrow, folks.
produces all blood cells It comes from the bone. So much more common than primary bone tumors sarcomatous comoos sarcoma, quosarcoma, sarcoma in vem meloma múltiplos, tá? And then, yes, the most common primary bone sarcoma or often sometimes he likes to Ask about the primary malignant bone tumor.
non-hematological, non-hematogenic, but That's common, but it's definitely a sarcoma, okay guys?
Below the age of 10, the same question is... The most common primary sarcoma of Okay, it's chondrosarcoma, right? That one normally the order. And what if we Speaking of a general order, it would be sarcoma, sarcoma of one and against sarcoma. What if it is In older patients, of course.
when sarcoma will be more common than Ien, right? So it's much more common.
patients under 20 years of age age.
Okay folks, we're not there yet.
successfully displaying the slides on the screen, But rest assured, these slides then we can share it with You guys in the group, right? That we put together there at this event so you can so they can see all of this nicely Slide, okay? So don't worry about Regarding that, we'll move on later.
for you. Perfect. So here's a That's just how you are, Felipão, right, of the of the of the Malignant tumors are on the test.
Yes, and classical epidemiology here is... A classic test, guys. That's it.
Charged directly. That's how it is, if you fall on this question, you get it wrong, you You have to redo a lot of questions or get them wrong.
This is a question that will come up and I will I'll ask you. Beauty? And now what?
We didn't talk about that in our live stream.
by Tomas Benigues, now that the time has come To speak is to speak a little of staging. So that thing classic and very important to talk about, especially in the oral exam, I see a bone injury. And then we commented on... initial live stream, right, from the most local places.
common injuries, right? If it's more... metaphyseal, if it is more epiphyseal, if it is more diaphyseal, the most common lesions of each thing. Sometimes the injury you have aggressive characteristics, what is that?
It's important for me to do this when I see it.
Injury? It's time to treat it, it's time to give it diagnosis. No, not even before, even Instead of doing a biopsy, I'll do... a business called staging. And the What is staging? Parking, Basically, guys, it's about me understanding in At what stage is this disease?
Because it depends on the point that... The disease is present, I will change so much my patient's prognosis and changing the His prognosis depends on... his prognosis for survival global and member survival, I will to have different treatment options for he and options for different approaches to that I'm going to have to do. So, the importance of taking care to do a staging, one before I do any invasive approach. And when I I speak of invasive procedures, even bone biopsy, a biopsy of some other tissue. Then What is this staging process? To understand that where is this tumor located and that It depends on which tumor we're talking about.
right? So, as you can see in the staging process, It's a little different for each one.
of the lesions that are suggestive.
It is important because it classifies the tumor. So we have some classifications that are the classic TNM that we have there for classification of tumors that the street uses and then there are the variations of the TNM which is the classification NK and JCC are the ones we're going to talk about.
a little further ahead after these classifications. Guide our treatment and facilitates communication even with other colleagues, right? Because this Speaking of, oh, I'm talking about the opposite.
metastatic sarcoma or am I talking about isolated non-metastatic chondroma of bone. These are diseases that are two completely different diseases that they have Different prognoses and approaches. That This helps in our identification of these.
Such rare diseases, right? So let's go.
Maligno ospo. So I have an injury, Guys, she's a suspect there, guys, Anyone who speaks is suspicious, remember? AND Antibiopsy, I'm not sure. Then I have an injury that is aggressive to the bone.
It must definitely be a malignant bone disease.
right? It has sun rays, cortical tussing, soft tissue mass, transition zone It's wide, isn't it? I can't define the zone of transition. I'll have to do one.
a survey that involves a scan bone. And then we have typists as That's a possibility, PETCT, right? tomography of prositon emission together there with some marker for glycolysis that is much more specific for neoplasms of What style!
positive, for trauma Astromelite gives a positive result. Now the PETCT, how does it capture the amount of glucose that the fabric is consuming, it is much more specific, he is quantitative. It's a business that has Here's the SUV, if you've ever heard of it, SUV is the amount of data collected.
isotope that that tissue is having, In other words, how much glucose is in it?
destroying, how much of that isotope of He's consuming fluoxoglucose.
Complex, yes.
AND. And the taller this SUV is, the greater the chance that that fabric is a fabric malignant neoplastic and help us often in relapses. It's too much.
CT foot is important. And one of the events What's new is what we have, which is becoming more and more each day.
More and more formalized, is the resonance of Totally corrupt, which is very interesting.
young patients, in childhood, a whole-body resonance, of the whole body. So, It's for what purpose, to try to find meta for Try to find common ground. from p CT, he is with more or less a body restaurant It's complete, but it has a big problem.
It's a CT scan, it involves radiation.
So imagine the patient who has a genetic disease with risk of neoplasia, that he will have to stay like this for the rest of his life.
making pets and pets accumulating radiation and It keeps accumulating tumors. So the idea of The rest of the entire body is in this patient that I'll have to stay like this for the rest of my life.
having to undergo several tests periodicals to be able to investigate tumors.
Uh-huh.
I'm going to have an exam that involves radiation.
virtually zero. The resonance Magnetic resonance imaging is an examination that uses waves.
electromagnetic, it does not use radiation.
Ionizing, right? So it's very protective.
different.
So the big question is that we still cost uh don't see that it can be It's an expensive exam, so the health insurance companies still... There is no release yet and there is no specific protocols for Ronante COP total. Right here in São Paulo we There are few corners that do that. Basically GRAC does it, Fleuri does it.
Uh-huh.
Okay. Sorry about the copyright issue if... If people are talking about companies like that Specific, right? no it doesn't have total it has P CT And what happens is that it's something that... We don't have any studies yet.
Enough, it's under study for us.
to be able to define that he is superior or equal to or not less than PETCT in carcinomas in general. we're in Studies can prove this, and it has been showing that.
There are diffusion studies. In remaining coral, you use a protocol of diffusion, it doesn't have a marker like the Glucose fluoride that accumulates glucose, but are you really using the a I forgot the word, didn't I? O o contrast Contrast of resonance, gadolinium.
So the diffusion, the diffusion that the Gadolinium makes a deal happen.
Weird, right? It's something the guy uses.
a specific resonance protocol, a It's mathematical, right? the reach that it has in how much it passes, the speed that he passes it over the fabric, speaks in favor of or It's not about being evil or not. It's a business Very strange, it's different.
Very, very specific, and it always comes from that.
That's going to be something that in the future go Sometimes during the test, bringing it up here For the resident's context, it's to cite, right?
I think that already shows that the guy It's already there, the guy is... The guy is flying, so the guy is Speaking of whole body rations, this Dude, you know it exists, right? That's all to provide context. I think it's good.
In these live streams here we talk about... a little bit of these contexts a little bit different, a little bit that isn't Much is written in books, In books, right? It's a thing of life, isn't it?
So, uh, and the toxic tomography scan, the Most important of all, okay, guys?
Because, you see, if I have one bone sarcoma, a chondrosarcoma, tumor primary bone malignancy, the main site of betages is lung, because the Metastatic tumors are hematogenous. That's it.
It was also a test question, it came up.
recently. So, metastasis of bone tumor, so the bone doesn't have lymphatic system.
Uh-huh. So, most tumors carcinomatous, prostate, breast, thyroid, they metastasize via lymphatic, right? So, the lymph nodes Regional areas end up having an accumulation of tumors.
and this tumor continues to spread through body through the lonos everything that I I have that lymph node research from Sentinel, of the breast, right? Patients They do this to control this metastasis.
lymphatic. Now, the bone doesn't have eh well-established lymphatic system, so bone metastasis is much more hematogenous metastasis, right, than what?
lymphatic. So you see, when I I enter the hematogenous system, then it It's going to go straight into your veins, right? To the Veins will join together next to the oat shell. THE vena cava there to the right ventricle right and stop at the first corner Where?
Lung. So it's the main place where They'll have to go back there, scared.
That's because that's the case. So the first singing passes through the lungs, so imagine the lung gain filter and that's it something, if I have a metastasis, if I I have a tumor that has not metastasized.
It's in the lung, but it has metastasized outside of it.
lung, This means that he went beyond the gain of filter, caramb.
So he has a worse prognosis, right?
Hmm. If you have metastasis, that It is extrapulmonary, an etasse in another bone. He has to pass the lung.
Skip skip meta skip on the same bone. Node same bone.
But I have metastasis, oh. It tastes good.
like in fem and I discover metastasis in hand.
Oh there.
On the radio.
This is a worse prognosis than pulmonary metastasis, because he wants to to say that he managed to get this tumor to overcome the great filter, It went into his lung and now he's... spread throughout the entire body. I am unable to define that it is not spread in whole body. Thoracic tomography super important and the resonance with lesion of the lesion with contrast. When the People are talking about the injury, guys, it's from entire compartment. There's no point in doing it.
a knee MRI scan I have osteosarcoma or I suspect I have it.
ost sarcoma in distal smoke type proximal, okay? Yes, the idea is to make a Whole-body resonance, okay?
Thank you, Vitor. Uh, sorry, from entire compartment exactly what the Vitor said, discard metastasis team, because I could get injured there and in the I smoke near my nose and change my treatment.
place that performs femoral endoprosthesis This refers to a total femoral endoprosthesis, right?
for this patient.
Chelipão, there are R1s here who have never seen one.
tumor case. Quickly explain what which is a skip metastasis for that crowd. So, guys, it's the skip.
metastatic of the Portuguese term that we usa is metastatic and bouncy, right, for people use Brazilian-style language to describe the situation. Good, Basically, it's like this: if I I have an injury, let's see, look at that We talk about the injury, she's... Located there, she doesn't normally catch the bone as a whole, right, when we speaks of evil bones. So, the injury that It is located there in the distal region of female. And then during the investigation I discover another separate injury, there is the a bone segment that is normal, that does not have alteration in the proximal region of the femus.
These injuries, they are part of from the same compartment and therefore are called skip metastases, that is, it a metastasis that still involves the same bony compartment, but there is a zone healthy tissue between an injury And another thing, okay? They are a very good thing.
questionable. And then he went into that thing about the question of theotras who said that the prognosis script metastasis of metastasis equal.
Uh-huh.
But we know that this is very... questioned in the literature because theoretically writing metastasis means that the metastasis is within the same compartment. It may have been a a a I already have local pulmonary dissemination.
It is definitely extralocal dissemination.
So much so that the JCC ranking divides JCC makes it clear that metal equipment People are going to say it's grade three and a half.
The pulmonary condition is already grade four, meaning it has... That's the worst possible prognosis, okay?
Good, good.
If you take a soft tissue lesion, then... a little different. We're going to do it.
basically a chest CT scan and the resonance, right, of the compartment like a whole. It is not mandatory to Do a bone scan, okay?
crowd? He took part more rarely some specific cases. So there is the lipoaccommodoid that it metastasizes a lot retroperitoneal and then a CT scan of The contrast of the abdomen and pelvis is worth it.
It's a shame it had to be done. This has already been charged.
question, okay? So I'm saying this because It was charged, It's already happened, it's already fallen on that spot. So it is It's important for you to know this.
There are exceptions, but basically you Doing this, saying this on the test, is already... enough. And then when metastasis occurs from an unknown place, then I discover initially an aggressive bone injury, 60-year-old patient whom I do not I know what the origin is. Then, probably from an unknown location, there I'll have to investigate, it doesn't look like it.
of sarcoma, it doesn't look like when sarcoma, it's probably from another [type of sarcoma].
thing. Then I'll have to do one.
a much more thorough investigation and then Yes, laboratory testing is indicated.
In the other tumors, no laboratory tests were conducted.
There is a clear indication that it should be done.
for study. That's the one. Then I'll go.
to have thyroid tests, you can check if there are any markers suggestive of there. I'm going to get a PSA test, I'm going to do it.
To check if it's not melon, try electrophoresis.
I'm going to have functional tests done as well.
of other diseases that it can mimic A tumor, right? Yes. Make sure it's not possible.
It could be a brown tumor, if it can't be... PTH, see if it could be something else.
thing. X-ray, right, of the affected limb.
or magnetic resonance imaging, if possible to be done, X-ray or CT scan of chest, right?
And then you also have to investigate how a all chest, abdomen, and pelvis CT scans why? Thorax v lung, abdomen pelv, kidney, which is a large area, prostate, right? Which is a great place, column is the large place that can have this type of tumors, okay good? Beauty. Oh, just give a hug over there, oh, For Dr. Eduardo. No, no, you can speak.
he can talk, advance the slide and do not biopsy before... That's the end of the evaluation, okay, guys?
Oh yes. Good.
That's right, guys, it's a matter that has to Listen, man, you can't mess that up, okay?
Good it cannot Not doing a biopsy before the end, right? Then, For example, Joe, because if you do, to say that you're going to do a biopsy, oh, I'm in a huge hurry, I want to talk about it right away.
biopsy, perform the biopsy and then you forget to say something Currently, you're making a big mistake there.
You change. You perform a biopsy before I might be able to have an MRI.
hindering my resonance of to understand how this tumor is doing, to to finish a is to generate an artifact in that injury, generate a difficulty of to understand how it's going to be my edges around that perfect tumor.
Good, good, everyone. So, look, give it a A big hug to Dr. Eduardo Hank over there.
Valença, Rio de Janeiro. Beauty, Guilherme Pouso, I think that's it. Ruma to Teote. Tell me where you're from, William. And Gabriel Nunes, good evening.
Good evening, Gabriel. Let's go. Let's go, then. Let's go. Let's go.
I'm following the classification here of a people talked about that classification of Genetics of benign bacteria, right? The ENEM, great father of orthopedic oncology there in world, right? He also did the classification for evil mores. That It falls much more than the other one, okay? That Here, guys, is the slide. There is one tumor classification that you have to Decorate for the test. Decorate, yes, if you already I'm watching this live stream right now.
Guys, it's almost 2027, remember this.
The ranking is what matters.
There's a good chance she'll fail the test.
You guys, okay? So basically, he's going to divide into low-grade and high-grade tumors degree. And then it's one for a lower degree, two for a high degree. And what if he is intracompartmental or intercompartmental. And look, it's a ranking that goes from best A prediction for the worst-case scenario, okay?
So that's the idea behind Enate.
To give our patient a prognosis for us to be able to see what we're going to do treatment for him. So an A below Intracompartmental grade without metastases.
A B is a low extracompartmental degree.
and then yes, a much more... An aggressive approach will have to be taken, but without metastasis. 2A is a high grade.
Intracompartmental as well. Hey, remember?
which are typically high-grade tumors, Of course, there are exceptions, there is one.
tendency to undergo more treatment systemic, such as chemotherapy, low We don't do that kind of thing; it's very rare.
to undergo chemotherapy for low-grade, That's why it's about differentiation.
Eh, 2B, high extracompartmental grade, which is the worst-case scenario without metastasis. And there Any metastasis doesn't matter, man. THE The guy is there telling the whole story. Ah, the Aggressive tumor in the thigh Extracartimemental, so many centimeters.
He mentioned metastasis, that's it, you can now... Mark three and go on with life peacefully.
without stress, save time on the test.
Yeah, it's about saving time on the test, you know? Go soon we'll see if it has halves or not, because That's a tip we always give... classification is that, as a rule, uh, the The most common type of cancer that falls off is sarcoma.
Yes. And as a rule, it's, uh, it's already been high degree. Then, said showsarcoma, Sometimes he may not specify in Proof of yours, but showsarcoma spoke, You assume it's a high-risk tumor.
Okay, degree?
Very good. That's very important.
so that if he does not replace the a subtype of sarcoma that is increasingly seen as We'll talk about that too, huh?
you have to believe that he should be one conventional and conventional is high degree equal to the ilwin. iwin is high grade.
Fução talking about unlike a chondrosarcoma, by For example, it could be a tumor of low grade, understand?
That's even when it's conventional, even when conventionally we divide it into Grais, né? It's well divided and that This is part of the practice of dividing it into Grais, okay? We have another one.
classification, okay? which is less used instead of the one from JCC. He lost one.
a little bit here in our formatting, Okay? So basically, it can fix it.
So, let's try it, let's go.
Hey guys, JCC hasn't changed, okay? Node New Field. I already checked, I already saw, she It remains the same, but she had, she There are some changes in the red that the Field You didn't use it, did you? It's just like rock, right, Vitor?
Rock has changed. Yeah, it changed, but O, he continues using the old O. The same thing. Câ changed, he continues using it.
Old JCC, okay guys? Which is basically for bad bone ligation. So it's a lot similar to Eniken, and what changes is the the size of the tumor that he uses in place of Use it if it's a compartmental axis, okay?
So it's basically the same thing, only that instead of you using eh if it is if it is I intended you to use centimeters. Then smaller than 8 cm, larger than 8 cm. And then The big breakthrough this time is type three, which It's salty mettes. And that's what happened... times that JCC appeared on the exam was asking exactly that, if the type three was half bouncy and the type four is divided, if the goal is pulmonary, as we've already mentioned, right, that there is the better prognosis or if it is others goals. That's exactly it. And talk about This is also important for understanding.
this classification. Why does he Did you classify it like that?
Now that I understand this, you he explained. So the lung will be the first filter there of a cell tumoral. Yes.
and hematogenous dissemination.
If it's spread beyond the lungs, it's more serious, right?
Yes, probably yes, because then the tumolho is very much, it has a capacity of much wider spread. Probably He will be more difficult to treat.
It has the worst prognosis and therefore highest rating.
Good. Oh, Vitor already corrected it over there.
So now it's time to take down the video.
Take a picture, take a screenshot so... remember that classification there that It falls less, It's falling less, but it's still there. It's there, you can.
We know that Teó has been getting better and better.
more details charged there that It's so difficult to sit down.
differentiate. It's about differentiation.
So I think what stands out here, right, Type three, which is that bouncy goal.
and remember that instead of intracompartmental, this compartmental It's less or more than 8 cm, right?
injury.
Yes, I think that's easy to see. You Don't even bother decorating the 8 cm, that's all it will take.
Eight, right? That'll be there for you.
So basically it's about memorizing what you are.
More or less will help, but I think It's difficult for them to discover that detail like that.
Anyone who wants to help. Now this question The biopsy results were dropped in the second phase, right?
Do you think it will fall again or has it already?
because there was a teacher there and stuff, there was That's a rumor, isn't it?
So, I was there, we were They're even discussing it at orthopedic congresses.
Oncology, that's what fell this year and It's pretty well divided, isn't it? Some will say like this: "Wow, that's crazy, colonologist, It is not a general orthotist to want him to... He knows how to do a bi [something unclear - possibly a misinterpretation] fear of the guy leaving.
Dali said: "Boy, addicted to the world."
That's when the tumor guys lose ground.
There's not much left, is there? Enter that they Go get a job, kid. But it's going to be Just a bunch of crap.
Sequel, only sequelae from others, right? Good, It's in the book, unfortunately that thing, If it's in the book, it's within the rules.
References, they can charge for them, I think.
That's just my opinion, Felipe, okay? This is the Felipe's opinion. No, who am I to to say whether it's good or not. I think they They charged that because it's easy.
It's very easy to charge. That's a lot, it's you.
Give it a needle.
No no. It's very easy to charge, did you understand? Jim is costly, cost-effectiveness. It's much, much more It's easy for them to grab a Janchin needle, Put it there and say, "Oh, go ahead, show it."
"How do you perform a biopsy?" What to have all that business of making a thorn of arthroscopy, prosthesis, arciroscopy. Wow, that's easy.
Ah, do you think it might fall again?
I don't think I'd ever fallen before.
He uncovered that hole. Saying no It could fall again. Yes, it would be like letting things slide.
The hole is over there, surrounded by a fence. It's done, it fell.
right?
AND. Now it's the same as here, the same as that time.
that fell, the prosthesis started to fall out and then The prosthesis turned and began to fall out.
arthroscopy and arthroscopy became standard. So now, the guys bring... an endoprosthesis, motorcycle, and the endop there I I think that's too much. I think that's too much. I think so.
craziness. Good.
What the resident needs to know Regarding biopsies? So, for theory and for practice. So, theoretically it fell a lot.
More in tarot than in theory. I think that I remember the theorist charging at some point.
those classic principles of biopsy, Tarot charges significantly more than theodic.
He charged, okay? So there are some details important things you need to understand in biopson. We're going to do it, right, like We already talked about it, after finishing the... complete investigation, the staging of this patient. He stayed as a Okay, I'll schedule a biopsy. And there Guys, the first point worth mentioning... You commenting on the test is super cool!
Comment on that. I'll forward this.
patient to referral center, if It is possible to have the biopsy done at the center.
Referral to the doctor who will Treat it, that's the best thing to do.
So R3 got it right there on the test, ideally.
It's that he doesn't do it in any exactly. So if you say that, You've already won, the guy's already going like that.
This guy understood that the business is complicated and he needs to forward it For a center that is a benchmark, right?
If he's not crazy, the guy is already going to win.
all. This guy here isn't crazy, no.
He's going to grab it and decide to do a biopsy on... Any help is already a huge advantage. Then Saying that was a real stretch at the PS, right? He does The X-ray produces a strange image.
Dude, grab a little field on the road.
little needle here before removing the thing, the. Send it over, come back in two weeks.
And I'm going to the PS and we'll see the result.
So, what happened? Okay? Okay, we're going to It's about typically making incisional lesions.
in major injuries. So, we say Basically, injuries smaller than 5 cm, you would be able to do a resection, an excisional biopsy. Biggest more than 5 cm, theoretically you have to To perform an incisional biopsy. Today Nowadays, the classic incisional biopsy is A needle biopsy, right? Thick needle, That's the classic jump needle, right?
that bone biopsy needle that comes with a chuck, which you will use to position it.
In position, remove the chuck, and continue doing... a rotating motion, pulls out a tube It's bony, right? You're coming back, right? Then I'll send you makes the cut, returns with the bone tube and normally sends around four fragments, depending on the quantity of The size of the injury could be even larger.
fragments, okay? It depends on the size of Injury, okay? A reconal, like we He commented, "Only minor injuries, then."
These bones are just unnecessary, right? Let's go. Head from the fibula, which is a bone that people It's normally not useful like that, it has Useful, right? Sorry to the guys from Knee, the foot gang. Sorry about that, it saw? But what could be a bone that is indispensable or is that the most important bone?
indispensable? It's difficult to talk about the head of Fibula, right? Basically, the head of the fibula.
It's more of a phalanx bone, perhaps personal.
The hand will kill. Exactly. It does not have way. The gang always goes.
to comment on us. Good, So, the procedure, guys, is... Next, I don't do it with a tourniquet, but It's described there. If you want, you you can make a tourniquet so you can reduce this patient's bleeding and Empty by lifting, never empty compressing the tumor. Imagine if you squeeze the tumor, A lot of parallel cells will come out.
Exactly. Theoretically you're spreading it.
The cell there has an infection, right?
Yeah, you're spreading cells over there to within. So, normally do longitudinal incisions. And why?
Longitudinal excisions? Why do I Can't I do a transversal [situation]? What is What a silly thing to do? So the route of The biopsy is contaminated. You can't consider that biopsy path He will stay with the patient. You, for This highlights the importance of the doctor who will... treat the patient, perform the biopsy, because he will know which way he will go to have the definitive surgery. Then he He's going to do a biopsy of the pathway right away.
what he's going to do and he's going to take that away path in definitive surgery and take for analysis because it may be This route is contaminated. I must to consider it contaminated. And I do longitudinal, because when I do a longitudinal incision, at the time I go resisting these routes is much more It's easy for me to carry, right? Our Oncological incisions are longitudinal.
No one makes a transverse incision to to undergo any cancer surgery of Prosthetics in orthopedics, right? Otherwise I will It's a very long incision and I can't... Close the skin afterwards, right? Ours The members are cylindrical. If I do a Cross-section, I need to remove the split.
I can't close it completely because that our half-cylinder, that it does not There will be space to be able to close it. He has to put a patch on it to close it.
So that's the idea, to achieve to preserve the skin, to ensure that The decision will come out more smoothly.
without major injuries for this patient.
That's where the tragedy began, right?
So, violating a compartment is super Importantly, as we mentioned, the bi The biopsy tract becomes contaminated, so I have to violate the minimum.
possible compartment. So, by For example, on the shoulder, it fell off recently, I will be performing a biopsy on my shoulder via the delta approach.
pectoral.
Uh-huh. or via transdelt.
Transdeltógico.
Transdeltó, guys, that's a only the pectoral compartment. You It's over for the patient, you're... contaminating both compartments of deltod as much as the compartment here of pectoral.
Uh-huh.
You're in compartment two.
compartments, just got contaminated two two things that you will sometimes having to undergo massive surgery to It's about resolving this recidivism. It didn't all work out.
I can only resolve the compartment issue. Then bring the solution, Okay? Eh, and the hole It has to be rounded or oval. Put what?
Because if I make the incision, which is... Angled, it is a point of weakness.
My bone could break, and then I could break it.
It might break.
That's why our bi- They're all round, right? Exactly. THE That's the positive side, they will make ovals that They reduced the risk of making one, both that when we are going to do a reaction more oncological in TGC, in colon sarcoma that we're going to do that, that to do that osteotomy, right, to to be able to remove the tumor, to enter inside the tumor and collect the cavity, the People always make oval shapes because of the risk of to weaken that bone. And then the Filling with PMMA, right, with bone cement, it's described there as option so that I can reduce the contamination, with three bleedings, right?
But it's not mandatory. I don't do it practical because I believe it doesn't change.
the issue of contamination is very important and It causes local bleeding and sometimes makes it difficult.
That's often my reaction, you know, after surgery. I think I prefer And even image-based assessment, right?
After the biopsy, you know, I'd rather not do it.
Okay? And there's something else important too.
That's compression, right? Apply compression Don't put it in the right place to prevent bleeding.
to keep contaminating that region by that's the cause of the tubal bleeding, right?
It was done.
Good. So guys, those are some tips.
legal both for the theoretical test that can to appear, especially this issue of It's a one-compartment system over there, right? Question of plan your incision, but it may appear also in your practical exam, as it came up last year in some stations of Hey guys.
Remember that there is a chapter on the field, That's all, right? And in the oral exam as well, J.
I think that's the big deal. You you Look, imagine you have 6 minutes to... talking about the tumor, sometimes you're not... Mastering so much chordoma, you're not... mastering those things so much that you will Regarding what you are a topic about, I'm not going to do it.
the biopsy and the biopsy I will do with You only earn about two trops there.
at the end of the investigation exactly.
You're already winning, you've been winning for a long time.
With his colleague there, the guy's already like, man, he Okay, he knows what he's talking about.
The guy next to me, if it's not the guy from... tumor, so he doesn't know what's wrong.
what's happening is something he doesn't know.
there. You're already winning by showing it.
Knowledge for this guy. Help Wow, that's something! So, radiotherapy, Guys, radiotherapy for bone tumors They are generally durable. And we We're talking about this because we're talking about it.
Adult patient, okay? So, basically Osteosarcoma and chondrosarcoma are radioresistant bone tumors. THE It's not sarcoma, okay? Sar de na que small round cell tumors and Blue, right? Like IL, like lymphoma, Like multiple myeloma, these are tumors that They are radiosensitive, and even IL, which... People will comment, a possibility of Local control is achieved with radiotherapy. Us In these cases, I don't have the option to to have an R0 surgery, right, on the spine, in the In this case, a pelvis that's in sacral comment.
Associate. So I don't have it, I can't Can I have R0 surgery?
radiotherapy as a treatment even of local control, but normally the Radiation therapy is an adjuvant treatment.
much more commonly used by patients with carcinomas, right, with lesions metastatic and in these patients with TOR Small cells, right? Uh, one the most common complication, as already proven, is the... Skin irritation, you know? So, do one one actinic dermatitis, no, actinic, which is the correct term there with Regarding this, but there are complications.
much more serious, and one of them has already been tested, which is the most complicated Of all of them, the second tumor is the... secondary neoplasms resulting from radiotherapy.
And we'll find out which are the most common ones.
These are sarcomas. J in chemotherapy that secondary neoplasms, Chemotherapy is more commonly done leukemias, lymphomas, hematological, radiotherapy, even for other diseases.
Breast radiography, radiotherapy of a Prostate cancer is phakomas, it's more common. And then there's the induced osteocoma, those radiotherapy-induced tumors sarcoma, high-grade sarcoma, they are of a much worse prognosis, They are usually much more aggressive.
much more serious, much more difficult to Treat it, okay? So I can receive these two points, radiotherapy, complications, skin. There are other things there, necrosis of feline head, bone necrosis, risk of fracture. Damn, I've had several cases like that.
fracture following radiotherapy. There is nothing The bone doesn't stick together. It doesn't stick, it doesn't stick, no.
Glue, no glue, no graft, no he wants. He died there, he died. So much so There are some discussions, some cases.
that you, for example, have a sarcoma.
very large thigh soft tissue and You're going to dry out that sarcon, dry it out.
periosteum and then, man, do I fix it before or not?
fixed to ensure that if it breaks, it's already fixed.
fixed.
I understood.
Did you understand? Question, It will become sensitive.
It looks like you're going to run the risk of him It will break because you're going to have radiotherapy.
if it's too extensive, it will cause necrosis in that bone, and if it... Breaking something can never be fixed.
I understood.
Nice. Nice.
And the chemo So, chemotherapy, okay guys? Then Basically, we have chemotherapy, right?
adjuvant and forward. And then for R1 that He forgot all about medicine and now he's... Entering the field of orthopedics, do you think counting He still remembers something.
You think you don't have to remember anything else.
So, aduvansia is something that will help the helper, will help the helper. And this could be it.
The assistant may be new, meaning he will to start with this first thing, which will be done, or it could be the helper who's coming.
after surgery, which is theoretically Surgery in oncology has always been the flagship product.
Uh-huh. Ground zero.
It was ground zero. Oed when it started to medical residency and it was oncology, He believed surgery was the business that It resolved the tumors, okay? After that I saw chemotherapy, then the one that I saw radiotherapy. So these are the helpers of surgery.
Yes.
So when the helper comes before the flagship surgery, he is a neoadjuvant, which is pre-operative aquatherapy, that it can be used to reduce the tumor. And more than just reducing the tumor, I think which is the better term, is control of local spread. Because what's the idea?
That's why our chemotherapy... How is that super important? Because if I have the surgery before having chemotherapy in the patient, at the time I have the surgery, I can be spreading a lot of cells in that tumor. So if I did therapy in Diving, I kind of controlled that local spread, decreased in size of the tumor, it reduces that spread I can do the location of that tumor.
a surgery at the surgical moment will to be a much more effective control.
It makes surgery easier, right?
It facilitates surgery.
Sometimes it even sets limits better.
That's much more than that. Can I use scoma? He It rarely decreases. It decreases much more.
with chemotherapy because small cells decrease significantly or is it sacasombó de high graphics, none of them decrease The novel doesn't diminish as much with the chemotherapy, but it has this function of control of local spread, Okay? Preoperative.
So Ewing's disease is a small tumor.
cells, it will be chemotherapy and radiotherapy will be good for very good. And man, chemotherapy in the I is an impressive business, which sometimes You get an MRI scan.
pre-chemo and then you get an idea of tumor, then you do MRI scan.
Post-chemo, and there is no tumor.
Damn, he finished.
And there, but sometimes it doesn't work.
So that's a discussion.
gigantic. What if the tumor disappears?
completely? What if he had a tumor?
neurovascular bundle involvement, It's gone now. Do I have to cooperate based on that resonance before surgery, before chemotherapy or post-chemotherapy?
He doesn't know, but he tends to come back after... to. So, normally we do a adjuvant chemotherapy after systemic treatment, of the treatment definitive, right, that could be Radiotherapy for Ian may be the surgery, there is chemotherapy adjuvant. You will complete the cycle of with chemotherapy, there is a risk of recurrence.
local, it exists, but the controls v They showed that you have to do the control.
In this place, you can't not do it. Ah, maybe.
radiotherapy with local control.
It disappeared. Sometimes I have, already I see, we have some cases of A disappearing collarbone. It completely disappeared.
We will perform local radiotherapy on his collarbone and let it go.
The worst that can happen is messing up the PLXO, right?
Then, But surgery is very difficult, because Oh man, I'm going to have my collarbone removed without There's no tumor, nothing there, there's no more tumor.
there.
Yes, it's complicated.
Complicated. Sometimes we have to What to do, even if it's a board decision, Right, for the reason, with the oncologist. r Therapy with the group, right? Very It's important that this decision be made. And there There's the adventance, right, which is post- Chemotherapy, and that's where its importance also lies.
to reduce it by half and control the disease.
as a whole, okay? Well, theoretically in That's important, right? Like, having this idea, right, that the new supporting role She will take steps to reduce the tumor there.
To make your surgery easier. Then you it operates and the second stage, digression, it It will serve to avoid the goal, because the People may not see it, but it could be... that there are cells there in the lung, in big filter and all that, that after a The period develops. So the guy thinks who is cured, had the surgery, from now on Not much of a fart, a goal in the lungs, right? Then I think the idea of adjvance is That's exactly it, right?
So it's funny, that one.
chemotherapy. So, at the beginning, People used to treat it only with surgery, and then... Survival rates were very low, so it crashed.
around 30%, then chemotherapy And that's when this questioning started, and then I... I move forward, I only move forward, operate the first and then it was shown first if start doing it after surgery, remember? Surgery is the mainstay of already Survival rates improved, and that's when it became clear... Here in the sticks that you used to make neoadivante and then completed with advancing and further improving survival. So, the surgery will be done.
in the context of chemotherapy, the Chemotherapy has all these effects of Systemic control of the disease.
This is in the field, okay? In fact, this That report you mentioned is there in field.
It's there, that's historic. Super This account of the... is important.
Well, and what's most important about Kimio?
what That's what comes up on tests, right? What is it?
Grape classification, right? Classically known as clção de uvos aala, né?
Formerly known as such, which basically it was invented for olacoma, right? He assessed initially tumor necrosis two Sacoma post-chimerapia, but it is extrapolated.
para is extrapolated to these others tumors that you do chemotherapy for of adductant. So basically he It was classified as stomatopathological, okay guys?
You take the surgical specimen and take it there and you'll see field by field how much of I have necrosis in this tumor. If I don't I have no necrosis, the tumor is completely viable, it is ineffective, Bad prognosis. If he has more than 50% cross-section, better prognosis, degree Two, but still not as good. What I I want at least a grade three and Ideally, level 4, which is more than 90%.
of necrosis, that's where I have an idea of that chemotherapy had an effect on this patient, but 90% of the tumor is necrotic.
Basically, there is no viable tumor. You The chiropractic therapy at Advante was great.
effective. This is a very predictable prognosis.
good. But that means he can't.
Receipt? No, I still have patients who had four uvulas, surgery perfect and relapse. Wow, how Relapse then progresses the disease.
That's why the follow-up is prolonged. Prolonged. 5 to 10 years less follow-up for these patients It has to be done. Okay good.
Another important part, Felipe, margins.
Margins, man, that's a whole different story.
who loves to fail tests sometimes questioning, understanding the difference of One margin leads to another. one comments Just a little bit.
So, here's the thing, guys, margin is... It's important because it's the surgery that you You're going to do it, right? It will be a basis for a lot of people.
on the margins. So, uh, the better margin.
The only thing that exists is the radical one, right? In this case, You go there and take all that away.
compartment, that entire member, but then you can't do sugar preservative. So, in the old days, in In the beginning, everything was on the radical edge, it was Putting for everyone, it was the One compartment for everyone solved the problem.
Rust was like that, you'd rip off the breast.
whole, her breast, she ripped off her pectoral muscle, she ripped it off.
The guy's ribcage would solve it, man.
Now to solve. The more radical, better. That was the idea of oncology. But this proved time and time again that Sometimes it's no use doing a radical margin, the tumor can still to go back. And sometimes a wide margin, right?
which is now basically the standard that What does "people do" mean?
So this image pattern exists.
There is this image pattern.
Basically, we are the standard that... What people want in cancer surgery is... Wide margin, okay? Which is smaller than Radical, what is that? Remove the tumor along with a healthy fabric cover, containing the reactive zone and the tumor within from him. So there is a space of fabric healthy that covers the entire reactive zone and the tumor at a wide margin. I don't need to Remove the entire compartment. And then book, okay? That's great too.
Questionable, right? the book is on the margin our 2 to 3 cm margin on the larger part m a 2 cm in real life is very different and There are studies showing that even people sometimes making very small margins very, very small, more than millimeters the recidivism rate doesn't change prognosis has There is a significant margin, you took the The tumor with margins didn't come, it didn't come.
No, there was no tumor left in the tissue.
patient, did not have the margin and is how to say marginal, that is, it has the the play that he watches until the very end of it.
It has a tumor; he can't see healthy tissue.
after the tumor. That's bad, but it happened.
margin, okay? From the book, decorate these, it's 2 to 3 cm to the bone, 1 to 2 cm on the side of the Okay, mes? And that's the standard that... What do people do nowadays for tumors?
evil. And then we have the margin.
marginal, where the reactive zone exists.
That's classic when you... if you If you are entering oncology, you will Looking at it benignly, you'll see that. THE tumor, you'll start saying it.
crossing the path to the tumor, you know.
which has a cover.
which is basically starting from If I go inside it, it's the tumor that... It distinguishes the tumor from healthy tissue. That It's the reactive zone. More classic in It's a little lipoma, right?
It's exactly when you get there, you see that you have a little cap there that covers that area Reactive effect of the tumor on healthy tissue. And there if I remove the tumor, it'll kind of be that way zone, right, kind of opening this capsule.
In order to remove it, it's the margin.
marginal. What if I go inside the tumor?
That's what we do with tumors.
benign, such as giant tumors, and then I'll go there and eat this tumor for inside, purifying it and tumors Evil, guys, we do traditional to contract with degree one It is cystic, neurismatic.
but it's not evil, malignant. Degree when sac degree one people It does more internationally, we do the extended cornetting inside the corral bag, I fear it might be evil, but it's a possibility.
So it's not a matter of image, Even though she has this thing about her, you know, so I'll make an image for everyone evil, trans image for the Benign, it depends on the case.
Okay? Just understanding what the concepts are, Because they're going to charge you. And just like There is room for reaction, there also is.
margin for amputations.
Now it's good, it's good to stay here just to To emphasize that the broad one is the standard, right?
So sometimes this can be charged for you. The wide one is the standard. If you Radical would be ideal.
Ideal. If you ask the pro, man, go to have a sarcoma there, a sarcoma cone I'm going to be more aggressive, I'll build the margin.
wide.
Ready.
He says "wide margin" is what's working there.
bigger.
It's bigger. Exactly. And then, in the amputation, Guys, it's pretty much the same thing.
I can perform an amputation.
intralesional at the level of the lesion, I can performing an amputation is marginal in the area broad reactive. So, the big idea amputation is the most common type of surgery, both extensive and radical.
Okay? That's what could get you. Put For example, in the sarcoma here, look, sarcoma from distal smoking, as is the case when the People are showing it here, guys. Yes.
If I undergo a transfemoral amputation, Is it broad or radical?
Transfemoral.
Transfemoral.
Radical.
It's large.
Exactly. That's what the prank is all about.
error.
You need to study, okay?
That's because, man, that's just how it is. The guy, man, is Amputation is radical, isn't it? Well, to do Amputation on the guy is radical, but the The entire compartment is the entire f.
So, hip disarticulation is the radical margin of this case.
Damn. I'll adjust it here.
But then, for example, if I take everything away... the whole thigh, the whole whole pain, do not disarticulate and to disarticulate.
It's just that there's no way to leave it.
just peel that skin off, let it go, take it off.
whole bone, go peel it and leave it The skin there, all limp and soft. There isn't, no.
There's no way around it, you understand?
So that's it, you understand? So in suppositions, the radical ones are the disarticulations. Ready. Basically That's what helps you, that's it.
disarticulate. I changed it.
Order to match the image, oh.
Intralesional, marginal, broad and Radical, right? Good.
Yes. Good. Perfect. Let's go. Let's talk So now, folks. So, we gave All of this here was just the basics, right?
But these things fall apart. Chapter The entire Camp discussion was about this.
And these things are super important, because So, uh, now we're talking about malignant tumors, now we're going to to start getting into the tumors themselves, right?
But how did you know that, man? That's it, you already wins half the battle. In the oral exam You said all of that here, my friend, Now, talking about the tumor itself is just the icing on the cake.
of the cake. The guy doesn't want me, I do.
I want to see you, because you know what a No, you know what you're going to do, don't you?
He's a crazy guy who's getting there. Ah, today It became the most common malignant bone tumor. He wants Knowing this, that you know, is all that. I want I want to know if you know how to drive, you Do you understand how it works? It covers a Just a little more concept, right? Exactly. Now The tumors, folks, that's why... People even made it in this kind of format here... cardio, Felipe prepared this, because It ultimately comes down to memorization.
step by step, right, like a A checklist of exactly what we have.
I want to know about each of the tumors. Exactly.
Right? So it becomes something a little more... memorization and the part up to this point was a It's more a matter of concept, even though I I like to emphasize this beginning of the lesson.
so much so that I didn't give anyone as much now because I know one thing that I I want you to take this with you for life.
That's what we've been talking about so far. If You're not going to do orthopedic oncology.
Send it to Felipe. That's what he's doing.
wanting to arrive, it reaches the point that is Knowing the subtypes of sarcoma won't... to make a difference in your lives, but that over there will You know it's a march. The image was well done. If you, well, the patient came for you, in a guy who had surgery, who isn't The oncologist, you know, man, do you think he did it?
The right margin? Did he do it?
Right surgery? Is it worth it?
Forward this to another colleague?
All of this helps you as an orthopedist.
until growth. This is already something of a pathologist. AND much more than orthopedists who are Charging pathologists for things, huh?
Giovan?
But it falls, it falls even more, Okay? I'm charging for a blade, man. Oh there It's becoming a business deal, but things are getting complicated.
getting worse and worse. Let's go. Saro, Okay. The most common way, right? In that way that... We talked about it, it's more common. uh, evil In the hematology department, okay? Who then peaks of incidence there, that second decade of life, patient aged 10 to 20 years of age, but as male and more once in oncology in general, benign And evil, if you're going to kick, kick a man.
Which is more common, okay? Because most of the tumors are male as more common. And normally at that peak of Growth, right? At that moment when the The patient is going to give that big stretch of growth, that's the moment when it will The sarcoma appeared, okay guys? In that that moment where then normally in metaphysealed region of long bones, especially in the knee area, right?
distal femoral and proximal tibial are the champions and then we have the humerus proximal also as the third place, Okay? the clinic. So, in this patient it will to have that insidious, progressive pain, night pain, pain when doing the activities. There may be an increase there.
local volume when it starts to have a Extraordinary expansion may have an invoice.
pathological, as the diagnosis, therefore, Wow, he went there and had to develop a pathological fracture in the tumor. I take fracture in pathological bone, right, for Guys, stop commenting on my post.
So, the people who are going to say that it is That's an incorrect term, pathological hole, but It's the term we like to use in Generally, because it's quicker to say.
Uh, and the lesion on the x-ray, that lesion which is typically a blastic lesion, right? So, osteosarcoma or sarcoma bone producer. So, he's going to be a injury that will produce bone, like this This is a classic image we have here.
This is if you say that any something other than a sarcoma, you're... Going crazy. Can you tell the The first hypothesis is sarcoma, the second It's sarcoma, and the third one is sarcoma.
And I'll tear up my diploma if it's not something.
If the radiologist says it like that, I'll tear it up.
I'll tear up my diploma if this isn't it.
sarcoma that has no cure. It's a classic.
right? This belief of having a triangle of Code, right? So here we see this that image is a bit more digital over there A little triangle is forming. And here's what We can see it, of course, it's the sun's rays, right?
What exactly are sun rays? And the perióo, o ele vai crescer tão quickly that he will westernize the periócio em uma oscificação perpendicular periodic that forms these Solid rays inside it, right? Headquarters Periodontalization, right? The code is a Same thing, he retorts, right? He He rebounds, he gets up, he goes costifying, raising the periodical, right? R just keeps occluding sort of with in this soft tissue injury and the onion also kind of comes from a ossification, but it goes as it goes growing a little more eh It grows more slowly than it grows.
more quickly, it will form these Those more lamellar ones, right?
Okay?
So, regarding pathology, if you ask, will... Could it be a sarcoma that produces osteoid?
So that's the word osteoid, oh vi Malignant osteoid in the slab. He finished. AND to discuss. He finished. Let's go up.
It doesn't even have chemistry. Saacoma no no It doesn't even do MDM2, but really the Pathologist performs thorough monitoring of chemistry.
coma doesn't need to do anything else, okay?
staging, as we discussed MRI of the segment with contrast Chest CT scan plus ptography, Okay? Searching for pulmonary metals, which is... Most importantly, remember this until one The oral exam is interesting; you need to know how to speak and To understand this, right, regarding the pulmonary goal.
Yes. And then there's the chemotherapy treatment.
neoduvante, okay? always remember, you have to first, follow-up therapy.
For this patient, surgery with Wide margins, okay? Or radicals, by Less wide margin, aiming for R0, right?
Don't leave a tumor, okay? It does not have possibility of radiotherapy, he recalls.
because it is a tumor that it is radioresistant in the sense that if I It has very high radiation, right?
more than 50 grams, I can even kill the That sucks, but I'm going to kill everything around me. AND In Brazil, we don't have anything yet that... There are new things coming, Vitor, They're inventing things over there in the United States.
business called Proton Bean and in Japan's business is called carbon and that's What is it? It's a particle accelerator.
below the hospital.
Put your hand on it, put it on, put it on, it's real, it's real.
real.
Then he puts the guy's arm inside the... particle accelerator.
It's utter madness. So why what is the What was that guys thinking? What happens?
The radioactive agent in radiotherapy is the photon.
So the photon is able to carry a maximum amount of radiation quanta inside the photon. But if I use one heavier particle, I can carry more radiation per particle and I can play more radiation in a smaller area. So the guys, man, so if I throw a radioactive proton In business, will it work?
Then, they made a particle computer.
below the hospital that leads inside It's a business deal and plays a pro within the tumors. They are starting to develop protocols for this, what is protuío, But that's what exists.
Be afraid.
That exists. And it has been shown that Maybe in the future we'll start to not... speaking more than radio sarcoma is radioresistant, It can be done using prothrombin, orthosarcoma And it kills, right? And without killing the tissues.
around.
So, but is that radiotherapy or...?
to be What to send?
Yes, exactly. No, no, I'm trending. Yes, yes Hiroshima, right? Nagas nuclear therapy. AND, right? Crazy, right? That's cool. Good, One more thing for you to know, right? You to know. Well, prognosis It will depend on the tumor necrosis, right? THE People will remember, right? Three grapes or Four, excellent prognosis. And metals pulmonary. Metastasis, guys. He spoke malignant tube prognosis. Worse, the The main prognostic factor is the tumor.
malignant? Metastasis. First thing, the He asked for a prognosis, and began by saying... metastasis, patient with metastasis and Prognosis, logically. That means, This means the disease is already there.
widespread.
Hey guys, the sack is so important, which we even divide into subtypes. You You need to know this, there's nothing else to do.
If you do it, it will fall, and it has been falling a lot.
Because there's no other way. So, more common conventional that it is classically a high-risk tumor degree, actually the conventional one, in That's right, it's the high-level intramedullary one.
degree, right? There is an intramedullary Low degree, okay? That which is not there never was.
He's charging for it, okay? Masular de high degree conventional 80 to 90% of cases sensitive to chemotherapy. Excellent prognosis. It's the best one available.
prognosis. We have the telegraph.
This will probably be when the sarcoma that you'll encounter on a test Oral, for example.
It's right there in the objective test, very much so.
Another one will probably fall soon.
Yes, these details will come up, they'll charge for it.
other.
So, the telestatic, guys, what's the... His big question? It's the taste with the People see that image, right? He is the same the tumor that it produces is a blastic lesion, Right, a mixed injury, right? In other words, it produces osteoid. Transic non-lytic lesion, purely lithic, sometimes it even looks like a a very aggressive situation, right? TGC is very aggressive, isn't it? Yeah, and Well, he is sensitive to chemotherapy, but It has one and has a similar prognosis.
aocom. But that's the big question. To the Sometimes you might find that it's not the right thing to do.
Absolutely not, and wanting to curet a teljectase thinking it's a TGC or If a cyst is detected, a biopsy should be performed first. And it is That's why you have to be sure.
of these tumors isopathologically for Do not confuse with this type of tumor.
So sarcoma sometimes doesn't produce the Even if it's sarcoma, bones are bizarre, but it is.
real. There are some small cells there that are Basically, I like sarcoma and like, right? Very similar to, right? All it does is one tumor also high grade with cells small reducers. He has one.
The prognosis is worse than usual.
So despite I having a good answer chemotherapy, but chemotherapy I and Ossacon are different and you don't even though you still use blue ones, you still use chemotherapy for osarcoma, but she The prognosis is a little worse, okay?
And radiotherapy responds to No, don't answer, don't answer. It is a sarcoma to have them small, he is a sarco.
Good.
So I have periosteal. And here's the tip.
The peristyle is to decorate that it is the intermediate level. So peri and Intermediate, okay? Decorate this because That's what they're going to charge him for. The only thing That's what charging him was all about. The only one that is from The intermediate level is the periosteal level, okay?
Peripheral bone growth, right? And there Yes, there is a subtype, right, of High-grade periosteal, okay? But the classical is of an intermediate level that was That was charged, okay? It has paraosteal. So, what is this one?
classically it is a low-grade tumor and That's how it grows. Even more classically in the posterior region of the femodistal in women of approximately 30 or 40 years of age age, okay? That girl over there who starts to to complain about knee pain, squat, like an acorn, and it's a sarcoma.
And then he has the best prognosis.
He took a low dose and he took a low dose.
A person with a certain degree of aging doesn't undergo chemotherapy, right?
He commented, "There's no better therapy."
only if And the big, the big one is an asterisk here.
It is from this parausteal that he makes differential diagnosis with osteochondroma.
That, This is extremely important, one of the things that more falls. And that's where the CT scan helps to To identify, right? We do that Digital tomography scan, you can see In osteochondroma, the bone marrow enters the Chondrome pedicle, can you see it?
right? And in the parochial, no, he seems to be a bone mass that is coming out directly from the cortex there.
Yes, theoretically it grows from more distal periosteum. So there is a zone separating the cortex from the tumor of the bone cortex normal.
And another important difference is... with myificant. Sometimes it's difficult for you to differentiate that parastial is not a ociifying myositis forming there in the region, right? You have to have the bios confirm.
Even if it can't be, okay? And then the secondary is usually the highest degree and is The worst prognosis. Normally secondary is radiotherapy which People have already commented, right? He has Very bad prognosis.
Good, good. This one here, folks, is for the test.
The theoretical part is a little slide that will save you there.
in a question. I'll send my regards.
Okay? Go up there a little bit, guys, the Salt, I think it's Salmon Teresina, which He was with us at Ortop on the road.
Yesterday, okay? He sent a "hi" over there to people. Hey there, Yasmin de Castro, from... Salvador, people from Salvador. Then the There are quite a few students there. We Lucote was at the congress there that year.
I've been through this with you. We'll go soon.
I'll visit you guys there in Salvador too.
Feira de Santana. We're planning so I can visit those guys there.
also. Perfect. And the second most common It's still on the child's mind that the test is being conducted. Yes, in the test second most common. In the child he with Certainty is the second most common in general.
but in the oldest adult it is the third, right? Well, just like with kids again teenagers aged 5 to 15 years old and then I already put it there, look, super genetics Importantly, translocation 1122, forming EWS1 fusion genome fly one. AND It's bizarre, but unfortunately you have to know.
why? Because it's genetic alterations.
It's not WS1 R1 fly one, it's from Pióstico and already I'll charge you for that.
Uh-huh. So the translocation is not 1122 He had a worse prognosis at IWIN and already had a question only about factors I. predictions. So you have to I don't know what that 1122 is. If you If you like political advocacy, then put that... 22 there is good or bad, it depends on you, but use it to remember Iwin, Okay?
Okay. Let's see if you remember that one.
It's Iwing, which has a better prognosis.
than the zoos, not 1122, okay guys? That so when it comes up on the test, the guy doesn't He studied it, he thinks it was absurd.
right? But it's already something that we, Ah, it's so overdone, man, uh, translocation 11 22, there you have it, because It's part of it, it's like a characteristic of the tumor, it doesn't have a worse prognosis.
Actually, Vitor, that's the point, in The truth is, the field is... Late, huh? So, nowadays, for to be considered this coma of Ion, has that there is provocation 1122. As not 11:22 nowadays we will have discovered and like, right, which are tumors that are from family, but they are not true, It's trolling 1122, okay?
good?
So normally a tumor that has a The characteristic is to be more diaphyseal, okay?
So, from the aphysary artery of the femur, of the tibia, it has significant involvement of the pelvis and surrounding area ribs, when there is a lung mass, It has a tumor called a asking tumor.
right, which is when there's a mass pulmonary extrasystoles, you know that there are That one. This one has much more.
symptoms. Then he develops those symptoms.
B, pain, fever, night fever, sweating night, It's about appetite, weight loss, Symptoms are important because sometimes It's in the instructions, right? right? Weight loss.
Well, Saccom doesn't cause weight loss.
Sacomente is fine, there's no weight loss.
He has no faith.
Exactly. Now, what about weight loss?
Faith, it almost seems like an infection. Sometimes It is often highly suggestive of the diagnosis.
no, VHS elevated, CRP elevated. How not It has all of these features to make a diagnosis.
differential, super acute, right? He has that classification by Roberts that to Sometimes it appears in evidence that the staff A bunch of them falls from there. You're falling for that way too much.
Well, X-rays are more permeable. AND When we talk about permeative, we mean... to say that you can't define it that way right where it begins, where it ends and She's kind of destroying the bone in that way.
path. There is no focal destruction of bone, as we often see in Oh, sarcoma, okay? I saw this image clearly.
characteristic, forming those reactions personalities that we see here are classic Made from onion peel, right? Lamelada, making perostial reaction blades to coming out of the bone, okay? And there is one dissociation often has a dissociation resonance, radiography, Okay? There's a lot of that, but the X-ray, ah, more in the tiny bone, resonance, gigantic extraosseous mass, a tumor that it extends thus, grasping the bone circumferentially by Outside, right? Too big. There is a lot in and in small cell tumors compartment, Yes, already leaving the compartment, already wanting It would become gigantic there. So, in Pathological conditions will have this and cells small, netted, and blue. And then we It has classic markers and then simitochemicals, right, like CD99 and Genetics, Fly One, which is the marker.
Also typical of IW, okay?
Parking, same thing. Segment, CT scan plus PET/CT, cytology that That is, research metapulmonary issues as well.
It's the most common one at IWI. equal treatment a sarcoma. Chemotherapy is not the table.
Two sarcomas, not worth it here.
I'll comment for you. Surgery or Radiation therapy can be radiosensitive, so You could be a radiotherapy patient, like... People commented, the tumors that are inoperable patients undergo radiotherapy such as Local control, adjuvant chemotherapy.
Yes, the worst thing is that I think the worst is yet to come.
patients with metastatic cancer, right?
pulmonary, bone marrow, very large volumes Larger, older patients have worse prognosis, more abnormal test results worst prognosis, myths don't fly one, All of this has a prognosis in the I. It is It's important to have this understanding of I. Bo's predictions, let's go. Chondrosarcoma, right, ours?
third tumor. And then there's a discussion.
typical of his differentiation from a a condition called cartilage tumor atypical.
This was a discussion in the street and it reached... to the point that we decided that it is the The only difference between when the sarcoma grade one and cartilaginous tumor The location is atypical. Nowadays it is That's the location. tumor that is a aggressive castrating tumor, but not so aggressive, if it doesn't reach the point of having a gigantic mass of soft tissues, no it even has a very large cortical distribution extensive, but it's just very large, more which is 6 cm, has an industrial cut, but he is eh in axial writing he is with sacômagra um e escrita apendicular ele é tumbucast jusatípico. We even talked about it.
That's from the last live stream, just a recommendation.
That's what that differentiation should be. AND then this one is different from the others that were younger dividers, this is for people old. So from the world of more people Old fourth, seventh decade of life, right?
Skectaxial, as we discussed, proximal, pelvic structure, proximal, proximal humenus, the area most commonly affected by sarcoma, Okay? The clinic then lyconic lesion with these calcifications as you see in Popcorn, right? With those rings and bows, right?
What does it do when someone shows up there?
classification that we call cartilage endocracy, right? And it can having thickened or ruptured cortex in cases that are more aggressive, degree Two, level three, okay? like this image This is the image here, at first glance.
from image to the opposite is a concom Degree two, degree three, it's not possible.
considering this level one has already broken the The cortical bone must have extraosseous mass, it is not a concatology So we have a sarcomatous tumor.
malignant cartilage producer and he is classically a tumor that does not respond neither chemotherapy nor radiotherapy except two subtypes that are there in the field Mesenchymal and undifferentiated are two subtypes that it is possible to do chemotherapy for these two counterarchomas, okay? It might come up on the test.
For you guys.
The internship, same thing. And the treatment that's where we record intralesional, as we discussed, due to the severity of the injury. Grade two, grade Three, broad reaction, okay guys?
Chemotherapy, radiotherapy, little Effective in conventional ways, right? Eh, And CCOM is a big problem because it is... Exactly. We have to do it.
Sometimes surgeries, sometimes more extensive ones.
what we do, what we want, because surgery is our bullet of Silver, we only have surgery.
There isn't one, right? There isn't a single helper.
an assistant who can help us.
to control this tumor if you don't do A more aggressive surgery, okay? And there Prognosis depends on the grade, grade one The prognosis, however, differs from these.
That's what's so gnostic about it, right? Grade three The outlook is also very bad.
Chordome. Vitor has this one.
That's how I see it.
It's PTSD, right? It's a good deal. Me too I have tepto. Cord as well. Cord is It's a very complicated business, folks.
Look, Perhaps there's more reason. Proof, people. Look, cordãoma is the tone like this When you arrive at the doctor's office, you become like this: "My God, what am I going to do?"
"How to do it?" Man, it's really difficult. Why?
I'm not patient, he's an adult anymore.
Old, right? It's almost over, seven decades of life. And it's a tumor that grows very slowly, It's a tumor that's consuming your body.
The patient, feeling hot, starts complaining of pain, you keep complaining about things, you It kind of happens when he starts operating.
and relapse without knowing what to do, because he didn't take what he responded to very well.
as well as adjuvant treatments with Chemotherapy or radiotherapy, okay? He is More common in the sacrum, okay? He is the evil one.
The most common sacral lesion will be a chordoma.
Okay? If It's already been on the test, what is the malignant tumor?
What is the most common type of sacrum?
Cordoma, okay guys? And another place Also common is the base of the skull region, Okay? The cli region is all about tranquility.
The C2 mobile column may also be common.
Well, clinically, so the lytic lesion, Expansive, right? Usually central, okay?
And that's important, isn't it?
Focus on the bag, okay? More centralized there in the region of the vertebral body with association of soft tissue masses, calcifications and usually this sign hyperintense, right, high signal on T2, right?
Classic Cordoma, right guys?
It is a tumor that is reborn as a note.
There is also the notal tumor which is not chordoma, okay? That's not evil, okay? AND Well, this pathology exists in some people.
cases. And he has this characteristic of pathological conditions that are the formation of cells Physaliphorous, okay? These are well cells vaculadas.
I'm charging for a blade, right? There is nothing Right? Go for it, go for it, go for it cobra esses vacunos fisalíferos aí do do Just a cord, so you all know, okay?
Yes, it's good that you know why.
It sounds far-fetched, but there's this image on... campel.
He has. It's there.
It's more out there in the field, in Felipe's class.
It has this image and stuff. So it is It's important that you take a look and to know why it is a question that is Easy, right? It's a topic that seems difficult.
But it's a question that's easy. You look there, it seems That's it, understand? He remembered that image.
From the field, and that's it. AND The treatment is a block reaction, right? Eh, with the widest possible margins.
It is often very difficult to block Or as a group?
En bloc. En bloc. En bloc.
In block. Yes, it's been a long time because that's how it is.
Having the term is like this. You Man, today I look like a bum.
but the term the term the term comes in French in block form. That's why That's cool, man. I'm learning a lot.
It's like I quote, you know? The one that uses in Exactly. It's the same quote. Exactly. In blockade. Good is broad, if possible.
It's often not possible, right? One Extremely difficult surgery. Cheectomy A very difficult surgery to perform.
There's that reconstruction in Torre Eel, it is not? That's what was on my test.
That's it, that's the reconstruction after that.
Crectomy, which is spinopelvic fixation, right?
Torreif is the non-technical term. Term The technical aspect is spinopelvic fixation. You are going perform a spinal fusion procedure.
with pedicled screws also in region of the sacrum in order to to fix this. Espino, right, from the da spine with the pelvis back that since I'm fed up. Being able to use or not grafts, right, sometimes we graft from the bank, right, to be able to help... To provide further integration at that location.
Eh, high-dose radiotherapy. Then, Same thing I said, remember?
protombinha, do co, do carboí que eu What were you talking about? These are still being much more studied by chordoma.
Chordoma of the tumors that are inside the newer protocols for ProTombin there In the United States, okay?
But can you imagine putting your ass in the particle accelerator to carry a ex A particle traveling at the speed of light, right?
Local recurrence is the norm.
You never, sometimes, often don't can perform a surgery that is RER, many times you can't because you Root prey, you don't want to leave the guy Without pooping, without peeing, there is no as. And late metastasis, right, evolving to the lung, very slowly and the patient that you have difficulty with He will suffer a lot until treatment.
to allow this disease to progress. Unfortunately, it is difficult.
Good, myeloma.
Proof, So, the oldest patient, okay guys?
Slightly older than the chordoma. He He is the patient who has myaloma.
Metastasis, right? The elderly person with Cancer in the bone, right? More common in men, more common in patients of the black race, right? Also important quote. Oh man, I can't even talk about it.
right? That's it. Sorry, guys. Sorry Okay, really, stop with that.
It's no longer possible. You could say that it doesn't exist.
Race, right? Needs more ancestry Afro-descendant, some have a tendency to have more. Okay, clinic, so injuries Bone lesions are widespread. So, patient already having several bone injuries. taca bucado, right? It looks like pepper is coming out of the skull.
right? There are several injuries that this It looks like it's popping, doesn't it, right on the bone?
entire patient associated with clinical matters. So there is anemia that Metastasis doesn't occur, but it doesn't occur in other things either.
Yes, there is hypercalcemia in metastasis.
It's not possible, he has kidney failure, which is... That crab, right, that we're talking about.
Múcho myaloma, okay? which is C of hypercalcemia, the R of renal injury, renal lesion, the A for anemia and the B for lesions.
Bones, good sandpaper, right? And all of this, guys, it's related to what is Meloma, which is a plasma cell tumor.
Skipping ahead to the image part, but okay Saying that is important, because If you understand this, you understand that the plasma cell tumor meloma. What Is it a plasma cell? It is a cell that produces immunoglobulin, eh-producing cell antibody. Beauty? Then he produces a The only antibody that does what, therefore that he has this thing called a peak monoclonal. What is it? The single antibody that he produced 1 million times that antibody. So how does it produce A single antibody, what is an antibody?
crowd? Protein. Protein if you take lots of creatine, lots of steroids, It destroys the kidneys.
It'll ruin your kidney, won't it, man? Same This time it's not a broken protein, It will end up making a mess.
It's going to be a mess, it's going to be a disaster, it's going to to cause kidney damage. Beauty? And then I have a business growing there within marrow. What else is produced in the bone marrow?
Joan? In your theme. So the first What is the thing you're going to lose? In Did you know that, Jov?
I think so, still.
So what's next? Anemia. That's why the Anemia is humiliating me.
That's why it causes anemia, you guys understand?
And why does it cause hypercalcemia? Wow, I I'm going to have bone destruction. O o Your calcium isn't in your bones, it's in your blood.
That's exactly it. So, if I'm destroying The bone, I'm absorbing the calcium.
So, from hypercalcemia, because that The calcium all goes into the bloodstream and I destroy it.
the bone. Why? Because of myeloma, right?
this characteristic of myeloma is not the Myeloma that's destroying the bone. AND an increase in osteoclastic activation, often mediated by rank L, which My student has this hyperactivity of Rank L that he causes, yeah good? Lytic lesions that really take a bite out of you, right?
very common in the bones of the skull. And in The resonance shows this medullary infiltrate.
It's more diffuse than we see it, you know?
bite or noise moth noise, or comes out pepper. Several people are saying that.
Pepper is usually what I use when I talk about skull.
In the skull. In the skull, it's basically just... pepper. Exactly. Electrofes pico We talked about immunoclonal. You can do that then.
Immunofixation, right? In order to see what it is the chain of events that has been committed. Normally Lightweight chains, right? Cover, blade can commit a bone marrow biopsy or myelogram. So, so in order to be able to you define my loma, it's written there the exchange, which is the old standard that was more than 30% of bone marrow plasma bone, but some alteration that is suggestive as crab nowadays is more That's 10%, okay? yet another one from Scrab, that is, traction that causes injury to a target organ or the business called slim, which is... Some are markers that the injury has already occurred.
These are biomarkers that indicate the lesion.
It's already more aggressive, which are basically I have a relationship of proteins are myological and proteins increased totals, I have one involvement of various lesions in magnetic resonance imaging, more than five magnetic resonance imaging lesions attacking. Five injuries, type in spine, five vertebrae. Yes. No, five.
Bone injuries, injuries to the body as a whole.
Bones, like, the spine counts as one.
No, each vertebra counts as... Every injury counts. My multiple loma That's fine too, consider it soon.
My loma mu because she has plasmacytoma.
right? So me lomaamente vai ser reference to the quantity of The amount of plasma is a single lesion.
right? So a single injury of half loma It's already widespread, right? And the treatment is with quemato, right? There are these.
Drugs, right?
Onida, dexamethasone. Radiotherapy is Great and very useful in these cases.
and very much the importance in myeloma and in metagenes of drug use Reabsorptive, right? Vossonasica, the acid zoolendronic. Sometimes we forget.
that this name zooledronic acid is Alendronate's brother, is a brother of risedronate has nothing to do with it, but it is He's a brother, he's an endocrine system, he's the strongest.
of all of them, which is most commonly used in oncology, Hey guys, what's up? Famous Denoso MB The rank inhibitor has another pathway.
different from the overly flashy one, okay? But what is There is still no evidence that it is better than Which is alendronic acid, right? Hey guys!
One less top marble, but still the References still refer to the use of the acid if possible. The prognosis is variable, right?
The patient is very elderly, right? It has improved a lot.
The prognosis is better for older patients.
Many times it already has others comorbidities that complicate the prognosis from him. And in our part, which is a risk of Mirelus has a fracture, be careful because he already... He spoke further ahead about this patient.
And then we arrived at our other place.
Sweetie, okay?
I know that slide, huh? It does not give this slide is from my class.
No means no. I made this one. This is what I made.
Ah, I see, I see.
That one is from my class, right?
There you go.
So, let's split it up, guys. The most common, breast and prostate, okay? And then the kidney and the The lungs are the most common source of origin.
unknown, which is that metastasis, You don't know where it is. AND What is acrometastasis? Metastasis below elbow level and below the Knee level is the lung. The most common I ate that, okay? That's the question.
Beaten during the test, fell several times.
It's important to know this, okay?
So, the most common one usually is meta Cereblastic cells are exactly that, folks, that's it.
What's in the book is what we know.
That's the case, but you see, it's not, it's not Like, you know? So there will be prostate metastases, metastasitic breast, kidney blast metastases, Hey guys, what's up? That's not just because it's the standard that's in the most common book and goes It's going to fall on you guys like this, okay? Then, breast and prosthesis usually causes blastic surgery.
lung fazta and our classic Professor Giovan, who has already spoken several times Sometimes in his class it's criticism, criticism Critical, which is the kidney/thyroid.
Good one, damn it.
The rhyming trick. The only one I can create The kidney, guys. He has a thing specific thing that has been changing, but it's still Out in the countryside, right? So I'll speak from here.
For you. It is usually a tumor.
which is also radiochemically resistant And in the event that I have an injury Isolated metastatic bone metal bone, if I have a reaction with wide margins of this metastasis, is the only metals, if I make one that is unique isolated, that I make wide margins, Theoretically I'm curing the patient.
I can cure this patient. In the others It needs systemic treatment, but Why isn't there any in the river? Why Theoretically, the river has no treatment.
systemic. Type when sarcoptic man, did you understand? There's no way to do it, there's no way.
Radio, right? or outside, if possible, or Changing. Yes, things are changing. So there is some new drugs out there with the immunotherapy, right, which is the aspect that Oncology has recently been the area of focus for treatment.
renal tube, right, and safim, the things used, right? Then So, perhaps that will change recently.
Give it some time and don't let it get worse.
to say that it's met, then we arrive at Mirelus, another favorite for the race, okay?
AND, It will fall to you or Mirelus, perhaps.
One of us will be speaking during the oral exam, right? what How is the classification of Mirels, okay? Another of the classifications, if you have to decorate one classification, decorate in Mirels, which has That's a classification based on Okay guys? So I'm going to use four criteria. It was developed for metastasis, but it can be used Also, multiple aluminum, okay? So I'm going see if the site is in the upper levels, add one point, if it's in the lower brackets, add two.
points and if it is trochanteric skin, add three. Why? Because Mirels is a an assessment of whether or not I need to fix prophylactically. So the more there is a place that is most at risk of breaking if I if you have a lung injury It's going to be, right? They are a super place.
It's risky, isn't it? It could break. Well, from the light One point, if things go wrong.
If it breaks, it'll be a huge mess.
Take one point, moderate, two points and It's functional, but not serious, okay guys?
It's not severe pain, it's intense pain. Functional It's that pain that makes it so hard to do anything.
thing. It hurts to move, it hurts to It hurts to move the limb when you walk, okay?
This is functional pain, okay? Size So it's in relation to the diameter of the tumor in relation to two points of cortical. So if it's less than 1/3, 1 point. Between 1/3 and 2/3, two points. AND more than 2/3 of the diameter of bone, three points. And then that Obvious, right? If they are blastic, it is bone producer, that's a point. Mista has There's some bone there, two points. heddle None, it's all three points. And then if the if the sum is greater than seven or greater or equal to eight, indicates Preventative festivity, okay? Hey there, philatic!
It's something that can be added together.
With cement, okay? It is possible that also use often cementing in order to be able to have the Whether or not you can control that injury is fine, okay?
It really depends on the specific case.
patient to patient, if cemented associaci associamente a à fixa.
So, metastasis, guys, disease of adult, usually with a history of cancer.
Or hidden, okay? What will be there where?
most common written form, column, location most common, most common of all, transition, thora columbá why?
Batson's venous plexus. So, this is my plexus.
This is a classic.
Yes, then, solar plexus.
It's the same thing as infections.
Same thing as with tuberculosis infection.
Same reason. Batson's plexus is the area with higher blood flow in that region, stasis. And there is a The tendency of injuries and as well as the infections establishing themselves in that Local, okay? The most common place that has to metallic is a transition column tocolumbar. Beauty? Pelvic floor is a very local area.
common, rib, very common, region of From the proximal region, the proximal wire region is The most common types of metastasis, the clinical presentation is pain. So metals hurt, hurt, hurt for Wow, a bone right there in that spot that you can't see.
Growing up hurts, it hurts like hell.
in that place. pathological invoice, is a something that we pick up out of nowhere, several patients with pathological fractures arrived without knowing that it had metastasis. And then people will have to do all the staging this patient, such as the People commented, X-ray, CT scans, MRI of the case, PTC, depending on each case, okay? Mirelos, We discussed it, assess the risk of fracture. Miros and fracture may not.
Fracture or bone fracture treatment pathological. Mirels is for pre-future prophylactic. It broke down, I fought no more.
How to classify with Mirel, okay?
Prophylactic.
Basically, we'll always prefer fix with the plates. We're going to avoid it.
to use. Why? Because often these injuries, they won't resolve themselves, and then... The plate has a very high risk of coming loose.
Bigger than the poles, okay? As stems she It will become intermedullary in the bone. Then she has a possibility of letting go and having form of them is much smaller than With the license plate, okay guys? And the treatment It depends, right? Systemic control Oncological, it is more important. He can undergo radiotherapy treatment or palliative radiotherapy depumor, fixations prophylactic or therapeutic, depending than what we find. Sometimes In some cases, even endoprostheses are used.
possibility of treatment, because why not It is only possible to fix the profilament. THE importance of using the dual-function of MAB is no longer in use. So in metastasis it is proven to reduce pain and improve quality of life. It's important to do the I'll use it, okay? Even with unbroken goals, Okay? and preoperative embolization, Kidney and thyroid tumors can be used to prevent bleeding. They are Tumors that bleed a lot, right? They are very Vascularized, right?
Good.
Here's a bonus for us guys, the adamantinoma, which is coming up in exams.
Get up, will you? Get comfortable.
Yes, there it is. Adamantinoma, guys, We even talked about him when we... He said he would do osteofibrosis in last live stream. He is her brother.
entity, okay? Rare, low-grade Anum It typically affects that region.
classically from the diaphysis, from the aunt, okay?
85% of cases, and when it involves the tibia, it is in the Fibula on the same side, okay? Normally patients from their second or third decade of life, uh, he's the tomocentric one.
normally in the anterior cortex of tibial defense forms these lesions that They look like they're bubbles of soap. These are multiple lesions of the cortex, Hey guys, what's up? And it has a differentiating factor that It is fibrous dysplasia, which is a super similar to this one, actually that We talked, It is even questionable whether dyspoma is a pre-lesion of the damantinoma. But, Hey guys, check this out. On the blade he It has nothing to do with estrus. On the blade It is a tumor that is biphasic, it It has the characteristics of having this area that You can see it here, look, it's more purple, epithelioid, right? Epithelial, governed by sarcomatous pattern cells, that is, he seems much more like sometimes a carcinoma on the slide of It's a classic sarcoma, right? So there You're not sure if it was doinoma, are you?
but in the image it looks very much like fibrosis, osteofibrosis in the case And the one for soft tissues, right? Let's take Water, right? Giving that little something is something, it is Something to talk about. Look out for that evil one. He has Something to talk about, guys. It's a thing, it is malignant.
Even the teacher's water ran out here, look.
Could the support staff there bring a a little bit of water.
This is another one of those slides.
Just one thing, there are comments, people down there that we're not See? Is it possible to give it a spin around there?
Comment just to see if there's nothing else.
again.
There's a guy from Acre here, look. Joshua of Acre.
The monster guy.
That guy is from Acre talking.
Yeah, right, I digress. Jonathan, can you lower it?
Just a quick slideshow so we can see it.
guys? Spinning, spinning, spinning comments, the chat, so we can give a look. Acre appeared there, look.
Good. Ah, great. The comment was about Acre.
He can, I thought he had said something.
thing. It cost.
Ah, they asked about the raffle.
He said he is, right? We'll talk, okay, the People are already talking about the guy who's from Acre.
He's from Acre.
Yes, they asked about the raffle. And me I sent you the link, see if you can.
There's still time for you to participate.
it's OK? From the Tor app raffle by one year that we're going to draw from now on Just a little bit. Let's go, Felipe. Get out of here!
today.
Let's go. And truth. So, tor of parts Hey guys. So, this is the slide.
so I can learn about epidemiology. It falls That's great too. So, much less than that the bones. If everything we've said is true But what falls the most? Now we're going talking about things that fall a little less, But it has been falling. It's important that you have notion. So, a law of soft tissues The most common thing in childhood is the tail of the measure.
We can't see it with our own eyes.
This slide It's important. Slide is important, fall That's awesome. So, he assumed that we You don't see sarcoma, it's more common in the head.
and neck. A part of eh members upper limbs, lower limbs do not have So much rapid sarcophagus here, Felipe.
Good. Thanks. Thanks. To everyone. Then, sarcoma of parts, but more like below At one year old, it's infantile fibrosarcoma.
This question has already come up.
I think all of those have already fallen, man. All These issues have already been addressed.
People brought them because they were These are exactly the same old questions.
If I'm not mistaken, there's a part of Campel, that's all, that's it, he's going to... go He just keeps talking, one topic at a time.
of each of these malignant tumors milled parts, okay? Then the sarcoma of parts The most common type of foot cancer is sarcoma.
Synovial, right? And the most common hand technique is the ptolithic sarcoma. And the malignant tumor. AND This is crap, isn't it? The one you're going to taking it from the meral as well.
That's bad.
Bad. Both are very bad. Uh, why Rodrigo Far's wife was just a sign.
comial.
Damn, What a mess, huh?
Little thing. But it's okay, she's fine. Good, Eh, Sarcoma is most common in the hand.
chonosarcoma, okay, guys? Now in parts The most common type of soft tissue in the hand is epithelioid.
Okay? Be careful during the exam so you don't go Go there and make a mistake, okay? When the sarcoma is much more common than Sarcomyoid, right? Hey everyone, if you kicking first like this, look, more common Of all of them, man, he saw a tumor made of parts molcomatose, question hypothesis diagnoses, always talking about sacoma high-grade pleomorphic. What is the high-grade heart disease? It's the sarcoma that I I don't know what it is.
Hmm. It's the one that doesn't have any differentiation from It's neither smooth muscle nor muscle.
Skeletal, it's neither fibrosis nor is it not Nothing, I don't know, a sarcoma is a sarcoma of autographs that we can't tell apart Whatever it may be, the most common of all is that People have it. Then there's liposarcoma, second most common and then in sequence Synovial sarcoma, the third most common, Okay? Then I saw a sarcoma kick those three.
Okay, memorize these three hypotheses.
For you to say during the exam.
Speaking a little bit about the most... They're popular, aren't they? So, liposarcoma second most common, usually older patients, right, sometimes even older than patients with Lipoma, right? The thigh is the most common location.
You'll see that the thigh is a location It is very common to have sarcomas that have That's a lot of tissue for it to grow in, right?
general sarcoma. There are several subtypes.
So, the truly differentiated asset, which is the most It's something we all have, right? You may have one.
Local recurrence, but much less frequent.
methods, the best prognosis. THE mixoid, the one we talked about, retroperitoneal metastasis, so it has to perform abdominal CT scan with contrast, pelvis, and has the type pleomorphic, which is a type of high degree rarer, and then yes, there is a treatment.
more systemic than what needs to be done, Okay? The resonance is similar to a lipoma.
So here we are seeing the cut.
Here, look, T2-weighted axial image. And there, Wow, as was considered in T2, he has That's a weak signal, right? We did this Injury up here in the rectus femoris.
Here's the signal from below, but the classic one... Lipom is T1, right? That's what we see.
high-signal lesion and classic T1 of Saying it's lipomatous, okay? He can crude interceptions, as we see Here, in high signal within the injury, okay?
And stolia has this cell formation.
With this ring-shaped design, okay?
Go ahead and have a little ring, you can have it.
treatment, then tumor resection, radiotherapy, adjuvant, neoadjuvant, questionable, questions, okay crowd? Radiation therapy will always require to do new things and we'll always want to.
to do post-therapy, because radiotherapy afterwards that you operate the irradiated case for Closing the deal solely to the grace of God is also very... That's bad, you understand? chemotherapy patient without consensus, usually in patients We're going to do a high-level job.
chemotherapy recurrence 10% survival In 5 years, it's good; 60% of patients... novial third most common why that I didn't include that additional information here.
guys because ps is a no, it's not a diagnosis, it is an absence of diagnosis, it's a tumor that we don't It needs a definition, right? It just wouldn't have definition, although we have some things growing there specific immunotherapies for PS that They're popping up around here. Beauty?
Third most like The guy, Tom's guy, he does it, he does it.
A black monster that he doesn't even notice, right?
Something is growing there.
Well, uh, the S's are a bit younger, right?
Around 35 years old. It's the sack more like from the foot, as we discussed and It has this indolent initial course. AND It's very funny with synovial fluid, guys, it is.
It's a complicated business. Despite that name synovial, it has nothing to do with the Sinov. It is not a growing tumor.
within the synovial fluid, it grows per articular.
It grows normally there, tissue.
mole ali que pode ser próximo da articulation, hence the name synovial.
But sometimes he's like that, he is a ball that you've had for 10 years, You know that little ball you're holding?
Now, what about your leg? That's messed up.
Wake up only if you guys wake up. Only you wake up. Then, out of nowhere, I'm talking about black women.
And out of nowhere, overnight, he starts growing, growing, growing, growing. AND It's a big, unborn bag. Yeah, the bag was already gone.
It was the synovial sac. But he may have this appearance of staying for 5, 10 years doing nothing, indolent, quiet, without doing nothing and then suddenly he starts to Grow, okay? He has a characteristic to have this formation of calcifications.
If you see this, this CT scan... In the axial area, you can see calcification.
within the tumor lesion that this The patient has it, okay? This is quite typical of soap opera by the few who make the classifications and it is also a tumo padom biphasic which, like an odontinoma, had that visax pad, the synovial one too Not all of them, okay? But there are some that There is padombifasic which is cells epithelioid, right? It seems that it seems that There's an epithelial gland here, look, in this innermost part, surrounded by sarcomatous cells. treatment. Then It is one of the tumors that he is sensitive to.
to chemotherapy, then you can do neoadjuvant chemotherapy depend. And radiotherapy will be adjuvant, dry wounds, has survivor similar to those of liposarcoma recurrence is also common Similar as well. And what is rhabdomyolysis?
More than just doing things like a child.
That's basically it. And what else? Just that For now, there has already been a question, and it has been a long time.
The weather hasn't dropped yet, you see? That's because These are old issues from Rabom, but it fell through.
The risk of falling is huge. It might fall from new.
The older the billing cycle, the more They're going to revisit, right? Bigger possibility of falling again.
Then he took the one that we don't see so often, Vitor, it's basically the tomo that grows head neck. We rarely go.
to catch a tail of infantile sarcoma, uh, Coming soon to us. He has some Subtypes, okay? And then there's the type, for For example, the pleomorphic, which is the subtoo of the adult, the embryonic and the alveolar, which is the child's subtoo. Uh, tumor Aggressive, it grows quickly, right? He does metastumonal, lonoidal, bone. And the Treatment is a combination of things.
Radio communication is so important that... chemotherapy protocols in Sarcomas in children are divided into chemotherapy for rabdomil and for non- rabdomil. so important Chemotherapy has this treatment, it has this importance treatment of the tail They take it from the middle. So, about the tumors that it has to speak, you have to talk about Chemotherapy for this tumor, fall there What if it falls? Tom is undergoing chemotherapy.
protocol for tumor, rhabdomyosarcoma, radiotherapy and surgery for termination of tumor. The survival rate of patients with embryonic, which is the most common, is quite Good, another 35%. Okay good.
And that.
It's something, come on. That's something.
Guys, this is the ultimate in... A malignant tumor, right? from here, if you take this live stream here, revisit it, rewatch it, catch the detail, you You can kill someone there, I'll tell you almost everything, right? 90% I don't know what new thing falls there that never It fell, right? But Felipe really did bring it.
a really cool summary, an explanation nice. It's very conceptual, we know.
That's not all, but this live stream will stay.
Available for you guys on YouTube, go ahead.
then go on Spotify as well.
Review it, listen again, it will... entering there for osmosis in the head of you. Guys, whenever we do These live streams, these orthopedic talks, bring... Is there anyone cool here, a teacher, a We always bring a special offer.
For those watching this live stream, okay?
So, quickly, here's what we want to do.
Let me explain a little bit about the review, you know.
For those of you who may not know the Okay, so, it just fell into my lap.
There he is, like an abandoned student, a student of Street, right? So we bring a little bit.
than what is top review, of our products, from our offers so that so that you can study with the teacher.
Felipe, regarding the tumor part, study with the People, other topics, the others the teachers we have, right, and all the tools, right, that we have Available there, right, Víor? That.
Hey guys, listen up. Ah, Now I think it's difficult, I don't know. In In truth, we have been surprised.
I think if you haven't heard of it, we're going to bring some things from Something new for you this year. Eh, But you can go ahead, go ahead, our slide.
But there are some things that we I want to bring you better things.
They know each other, right? Our courses include... They're already here, perhaps a little bit.
Tired of hearing us talk, right?
But our extensive course, Our standard course, so to speak, right? THE course, uh, our most complete course, where you have more than 150 lessons, classes which are being renovated there directly, constantly. These classes here, including this whole part that Did you see Felipe talking, they... They are, they are there in our more detailed explanations More details to come for those of you who want them.
to know. Well, when you have the extensive, you will also have access to The TOR application and the ability that... We'll show it later to the author, and I... I already said that, right? Author and to our skills. Okay, let me pass by here.
Grab the glue, Vitor, there's so much to do!
that has to be in the extension that has to Good.
It really is the most comprehensive course, isn't it?
Exactly. Our most comprehensive course. THE There are also things that happen when you enter, When you become our student, you enter There in our community, you will have then access this Thor app, which It's the cherry on top, isn't it? Ah, Thor That's ours, that's how it is, it's difficult, uh, you Having a competitor in the market. He can Hey G, put the app there. Eh, you won't find one on the market competitor for this app. You are going There are similar things there, okay? Yeah, but You'll hardly ever find something that... resemble the user experience That you have in this app, okay? AND When you take Extensif, you have access to the extensive also through TOR app, right? Uh, currently the People already have a question bank there.
With almost 5,000 questions, okay? You are going Having to is an everyday thing. Today, today That's what I told you, right? that to a student Our team has already sent some hand samples.
that we will add to the platform and it's constantly adding and automatically putting it on the platform People will comment. Uh, what is it?
That's great too, you have access through app, but you can also even Access via other platforms. you You can access our course there, you can access the platform of questions through the computer, browser or the application itself, which is a very rounded way of You can access this content of ours. You You can do it very easily, you can you answer the questions?
You can see the courses too, you You can download the lessons, you can watch them in a way offline, which is a pretty good thing.
interesting. The hospital there you have a hospital that doesn't have very good internet good, you don't have it, your mobile internet plan is not That's really cool, you'll have it there.
then one possibility to access the content. You're not going, that's not why.
That you're going to stop studying, okay?
Counting that R1 there from Anesthesiology, right?
making a little block, that's what it's doing.
Taking about an hour, you Have you attended a couple of classes yet?
Without a doubt, right?
AND. What's also interesting, Vitor, What's additional is that these comments of Questions, folks, they are comments.
In text, video comments, okay? And the People also put this year, uh, Question tracks in the Extensive course, right?
So, since the bank is already quite large, well-stuffed, sometimes that week you can't do everything questions on that topic, right? So, the We selected 10 questions from each.
the theme, which are the most important ones, you shouldn't miss visiting, whether to reinforce a classroom concept, whether to complement something. AND Then, if you have time, you will.
in the other questions. Sometimes themes, it has 50 questions. You can do it in spaced reviews throughout the year. These Spaced revisions are something that helps.
very much in the retention of content and brings the artificial intelligence into application. So this app has AI. As you ask questions, He's starting to understand what it's like for him.
Performance, right? And cross that with the The prevalence of the theme in the theote, right? Then, For example, it arrives there in the month of September, October, man, I don't know what which I need to revise. You click there in a role that he will play for you.
that thing you're doing worse with which falls more, because sometimes it has a The topic is that you're bad, you won't do much.
Well, it doesn't fall. So leave this one alone if There will be some free time at the end of the year. And it has that topic that comes up quite often, you You need to be 100% there because you have high blood pressure.
chance of falling. So that's it.
technology embedded in the application for to help you optimize the time that People know that it's very scarce there... resident. We were residents, the People know how this works.
Show us a little bit, Giovan da platform.
In the next slide we're going to show a little bit, you know, about navigation, like that It's beautiful, intuitive. Here we are showing all the metrics. Then You can do it, oh, I want to study. There Can you open the metric and see the...?
which might be more interesting You actually study. It's OK? Now We're going to show you here, look. You You can do it, can you see? Look, organize it!
Well, you're right in front of me, I I can see where it is now. You can you see the issues there, do Questions, can you put together a workout?
Can you do the trail of questions. Look how cool this is!
also. Can you see this, this, us?
It just showed you guys filtering, none.
another app has such a filter Just as good as ours here. Put keyword, by topic, by test, by year. Hey, you can favorite your questions to then only study the favorites.
You can create your own practice test.
You can filter out the wrong ones, right? AND and so on. Can you see the statistics, how are people doing covering all of Brazil. Today we It has more than 650 students in Brazil.
all. So you can have a one a very faithful way of showing how it is statistics of those questions for Well, I messed this up, but Almost everyone got it wrong, okay, one teaspoon, man, I messed that up.
But everyone's getting it right, man, I'm going.
To fall behind, right? And remember that the Teote, despite being proof of sufficiency, we have the proof now.
of R4, right, which ends up being a competition. So you can measure your level so you can understand what they are your chances or improve your chances throughout the year.
Awesome! So like this, and so on People talk, but very quickly what We're going to talk here, it's going to stay.
obsolete, because next week it should have An update and a new feature. Then It's an app that's really in Constant change, it's not that thing what you're going to access there is a stop A move that will click, that will throw you to one page, it had a good investment.
great in this app, in development. So it is, it is, it is a Extremely useful tool.
Another thing worth remembering, Vitor, these are simulations, okay? So we There are some brand new simulations, right? It's already today Hey, he must have almost 900 there.
unprecedented issues. And these simulations people will release it periodically for You also commented, text, video.
what you can do if you use it in with a computer, you can simulate Just like your test will be teot, which is on the computer. It cannot Returning to the issues, there is time for That's the question, right? And you after the end of You can prove you can study the comments so you can review how It was his performance. So the practice tests are also one thing, a tool that is You can create your own practice tests.
also, apart from those that we release periodically.
Perfect. What do we have more of?
So, there are some products there, right, Giovan? We have The Intensive course too, okay? And the Intensive It's a course that Giovan always... Say it's an incomplete course, okay?
So you'll have fewer classes because precisely, he is focused on that.
final sprint, on that final stretch. And there It's no use thinking in this final stretch.
You'll review everything quickly.
On the contrary, you have to focus on which will likely fall, probably on what has higher chance of falling. So the idea of The course is about maximizing your... chance of success in the teote. So here's the People will have classes, for example, where You'll get it, damn it, it only fell in the last few days.
years ago, Teot, ACL treatment.
You go to the LCA and the class will begin.
fart, treatment. You won't have any frills.
of anatomy, of this, of that, because the That's what's been happening. So, we're going to Focus on that in this class. So he is a a much more concise course, a very... more focused there at that stage. They are not Cut classes, they are different classes.
These are new classes that we created, they are other classes different from the classes of Extensive and it really is and it's focused In this final stretch, in this very end.
of the preparation of his theote. This is Intense, personal. Of course you all Our material has been released since... The moment you enter the course, but the Our suggestion for Intensive is R3.
That is, or until R1, R2 will perform the TPOT.
right? On the eve of the test he went formatted for you to do in six weeks with daily classes and mock exams Weekly, right? So it's a pretty thing It's really intensive, okay? And the date has already been released for proof of the first phase of Teot and TPOT, January 10, 2027. Then the People have already scheduled the release, right?
...of having the intensive course, right, the suggestion of intensive in the months of November and December to give a little break from New year for you to take practice tests that... We'll release it too and arrive at Flying test.
Good. And then we have our skills, okay? The Skills is a It was a really cool course that we took.
Thinking about it that way, there are some good courses out there.
preparatory, part of skills right at the final stretch of your race, but the People know that you sometimes live there.
in the interior of, I don't know, Ceará, you You live in a remote area, it's difficult for you having to come here, having to stop to work, having to leave the residence, Finally, having to travel here before of your test. The cost is high, these are expenses.
usually expensive. hotel, lodging, the Airline flights are getting more and more expensive. And there, What did we think? Let's get these skill stations that fall in your test. Let's get the companies that carry this material For your test, okay? I'll give one For example, Striker a Johnson, uh, that those are the materials that will to be there, because sometimes you are accustomed to material that is not the The material that's on your test, go record all these stations and you can Watch this without interruption.
Yeah, whenever you want, wherever you want.
If you want, you can also download it offline.
For you to watch. So, you can Download everything there, it's at home and at the time of... You can watch at the hospital there. And then the The big idea behind this course was that, Training for the second stage of the theo. Only what we started to notice an effect a very positive side effect, which is the use this course is for residents to to assist in daily tasks. Then You imagine you're an R1, you're I'm dying to have surgery, but you don't have it.
time to study to make a PFN, for to do a DHS. What do you do? You Open the skills, you go there, give it a Take a look at the class, can you watch it?
even in version 2.0. So, uh, in 10 minutes You can watch everything there, or even less and it's already ready, you don't anymore You enter your surgery raw, you go there ready to answer questions main things that will be done and eventually until actually achieving the Surgery, right? Good. And here it has already gone beyond 50 stations, okay? It's even outdated.
This presentation here. We did recorded new material last month and released it.
for you all the trauma stuff, Prosthesis, arthroscopy, pediatric, right?
Plenty of stuff there for you to use.
day by day.
Let's show you a little bit of the platform.
There are members there, right, Geovan? So it's a another way for you to enjoy, of You will have access to the content. So you See, it's a completely built platform, Specifically, it's our platform.
original content, where you have access to it.
courses, you have access to the classes, you If you have access to the trails, you can do it.
Look, to complete the questions, you have all the classifications there of the questions, it has the From there, you can already be thrown to part of the questions, okay? So, it's a an extremely intuitive platform, it is a the platform that works from a That's a really cool way, it won't keep giving It crashes all the time, okay? It's not a thing It's rented, it's actually ours, okay?
good? Yeah, and then you can even access it.
Everything, right? Can you see the courses?
can you enter the part of questions as well. And there is one that... Jovan is showing it now, there is a new feature that we brought this year, which is the schedule intelligent. So, we know that the We have a schedule, okay? we We need to give you some direction, even for... We can help structure our course.
So, there's a basic schedule there that... People go from the most basic part to... the most complex part, you are free to To follow him or not? You can use the a o there A smart schedule works in your favor.
So, what is this? You are going There in the flow, click, choose the test there.
what you want to focus on. So, for example, In your case, it's the theodic one. You are going There, click on teó, but eventually There may already be questions from R4 here.
I also want to give Tarot a review.
Do you want to review for the Tarot that they are Slightly different issues, aren't they?
You can select. I clicked, no, I I want you, you can pass, cool. And then you Go ahead, choose your specialty, that It's something that only happens in that system, which is orthopedics, and then you can't synchronize this schedule with the schedule of your residence, by For example, or you can even synchronize This schedule is compatible with your res.
That's cool too. Sometimes you're spinning.
there on the knee and you want to study the most important knee topics in that month, in that module you're in, you Can you synchronize with that for you?
Keep up with what you're experiencing.
At home? That's really cool. Then That's cool because you Can you make a schedule?
personalized, individual, for each one It will be different based on the criteria.
whichever you want, or according to criterion X that He will choose for you, which is the relevance criteria of the topics, or then synchronized with your schedule As a resident, you can drive. And then he mount, you show up there for you guys, right?
a screen where you will put How many hours will you study per day?
the days of the week you will study, When are you going to finish? So, geez, I want to study this by such and such a date.
because after that I already want to be Reviewing, understand? So you are a powerful management tool and then He'll give you the schedule, okay?
ready? Selected test, how many hours you will study, date you will Finally, you can proceed.
So there you have a little schedule.
Already assembled as suggested, you just need to Click and continue with the lessons. Click, Continue with the lessons, click, continue with the classes. Keep writing checks to your suggested schedule and then you have a lot more guidance when studying, because this is a problem for you, right? You optimize your time a lot, You can't waste any time.
You need to do more than just study, Sleep and eat. So, if you don't know manage your study, you won't eat and He won't go to sleep. So, you're not going to Eat and you won't go to sleep. So, that's it.
It's a problem for you, I have Sure, right? So, uh, with that new tool that we now have Also on the platform, it became much more easy for you to really focus on your study, yours to develop and reach the great The objective is to pass the Teote exam, but also proper orthopedic training.
This is practically a mentorship program.
right? The guy will deliver it to you week by week.
What do you need to study this week?
that week according to the time you It happens, right? But it's a mentorship program.
AI, right? Smarter mentoring possible with the data from the theotes of every year they opened for people. So why do you choose, for that students choose top review, right? Why is it that 45% of those who passed... last year's teot chose the Top Review? Because we have this content.
very complete, we have updates, we have everything at our fingertips I can make things easier for you. All Our products have a warranty. So, if If you don't like it, you can ask for it.
Money back in up to one week.
Can you test the platform?
You can speak to our sales team there.
so I can test it there for two or three days.
to see if it works for you, if you You like this, but where can I get it? Then These are possibilities that we put forward.
For you. All of ours, our students, They have direct contact with us.
teachers from a group of WhatsApp that we can get there Share information. For example, The date for the Teot exam was released today, He let go there. Oh, it's going to change. The staff of Sbot's set posted a photo with Campbell, embraced with a new Campbell. We know that will be included in the reference, we I'll let you know, right? So we're going to talking to you all on a daily basis, like That's how our packages work, right? Then over the years we have understood the which works for each resident in each phase he is in, whether he is R1, R2, R3 or that orthopedist, since you want... to perform the teote. First package are For R3, right? Who are going to take the test at Beginning of the year 2027, okay? We call This complete preparation package for 2027.
You will have access to all of this material.
which we explained to you, extensive, question application, skills, all the updates that you had during that period, all the Content released at the time of purchase.
until your TEOT in 2027. Everyone who Acquire this complete preparation in 2027.
You win a More Top Box. We'll send it to... At your house, there's a box over there with a notebook.
pen, power bank, right? Several things, bottle, things you're going to use in your daily life as a gift there, a I'm pleased to meet you. Whoever buys this The package is available today for the price of 7997.
You can pay in up to 12 installments.
Card, okay? That's a possibility.
For you. But calm down, you're the one who's... By watching the live stream here with us, you have a coupon that I'll show you in a moment you'll get a 5% discount on top That amount, is that okay? So, who's here?
Participating in the live stream gets you a 5% discount.
in all our products here announced during the live stream. Package two, Guys, it's for R2. It is the one who will Make the Teot in 2028. Then you acquire now and has access until TOOT 2028 for 2 years for all courses: Extensive, Intensive, application, Tor, skills and the updates. Whoever purchases this package, In addition to winning the Topbo Box, you also win a headphones, an original Apple AirPods 4, It's pretty, but it costs around R$ 2,000.
Right, with noise cancellation for you guys.
They use it in their daily lives at home.
so that you can study our material.
Whoever buys this package gets 2 years of access is cheaper than, you know, renew every year. So, it comes out to 11497 Also available in up to 12 installments with your credit card. To Whoever is watching the live stream here will get a coupon.
at the very end so you can have 5% of discount on that amount. Three-pack pro R1, who will take the Teot 2029 exam. So You will have access from today until Teort 2029.
3 years of all content, all of the automatic updates that will Entering the platform. It also wins top spots.
The box also includes Apple headphones, okay?
good? It's cheaper than renewing the every year. Today it's going for 15497 Pay in up to 12 installments with a 5% discount here.
from the live stream. Ah, Giovani, I'm not, I'm not.
I want to take a little more of trust, I want to have a product of entrance, then I'll see if I go in.
Intensive or not. We have the package.
From the Extensive plan to Toot 2027. It's included.
also the question application, such skills as well. It's just not included The Intensive. And here too, it doesn't win top.
box. It also costs 6997 in 12 installments.
card. All of this here, folks, is cute on the Hotmart platform, generates I'll send you an invoice there, they'll ask for the data to issue this invoice, for people send these gifts to home of You guys, okay? This is how it works acquisition.
Good. So, the draw is happening, huh? People are We're only here because of the raffle, right? No They don't want to know about any course at all.
Let's go. We had the subscribers here.
in this live stream. And we're going to draw the names now.
Access to the question app, okay?
It's not the extensive version, it's not the intensive version. THE People already drew the winners during last month's live stream.
The Extensive one, right? There was a student here, A new student, right? Who won the Extensive. And now we're going to draw lots.
one year of access to the Thor app, Tor questioning application. I already I put everyone's name here.
who signed up, right? for this raffle.
Look for your email there and let's go.
there. Let's draw lots now. So, that's 95.
of the night. You guys lasted almost 2 hours. We're right here. Victor Aché, I think that's it, [email protected].
Victor, welcome to using the question app. Talk to the our team, send a message to our team, for our support, for us I'll make this access available to you, okay? and to have access there for a year to that application. Perfect. Let's go. Let's go Come back here. So, guys, as I I made a deal with you all, everyone who is Here on the live stream you have access to these packages.
to these complete preparations, to extensive with an additional discount, 5% discount. All you have to do is put it in.
Orthoped coupon in capital letters at the time of your purchase, but this coupon has Valid, okay? Okay? So it's for those who are Watching live here, okay? So go ahead, We're going to extend this coupon until... May 31st, until the end of the month, until Sunday at midnight. So you're going to have from today until Sunday midnight to Organize and take advantage of this 5% coupon.
To purchase, simply scan this QR code.
The code that's appearing on your screen is... good? That you are able to access All of our products, right? cute there explaining the access time, what wins, what's included, everything Cute for you on this page of Access this link to purchase.
Perfect. And if you're getting to know the People, starting from the live stream, right? Follow us!
On Instagram, on YouTube, right here. Give the Your thumbs up, right? Turn on notifications for YouTube so you don't miss anything videos that we'll be releasing, cuts class, question comments, live streams Which we also have, right? That's enough.
Good luck to us on Spotify too.
It will appear on Spotify in the next few days.
This is a live stream for you to revisit as well. If Do you want direct contact with the seller?
to ask questions, to have some time to free access to our platform, this The QR code here works for you too.
That's it, right, Victor? It's done.
It's done. I think that was it, right?
What message do you have for them there?
End, Guys, again. Oh, thank you, let's go.
sleep. We're incredibly tired.
To perceive honestly. We wanted It's practically upside down, right? We wanted Just want to thank you all again.
opportunity to be here. Eh, Thank you to our teacher and our Distinguished Professor Felipe from the tumor here, Tumors and difficult topics, right? And the His category is tumors and difficult topics.
Value it more. It's not just the tumor that already is That's difficult, it's beyond that, isn't it? We caught everything.
We didn't want to teach and played.
For Felipe to test him, you understand? There He learned, he gave a good lesson, he liked it, that's it.
Great, it worked! Hey, just kidding!
In addition, we wanted to thank here... Felipe, once again, sensational lesson.
He really provided a mega summary.
You have no idea how much this is Yes, you know, it's hard work, but it's valuable. He I brought you the most important information.
important here for your theo from part of malignant tumors. I don't have I have no doubt when the next one will come out.
Teote, we'll come back and revisit.
These live streams here and see how much of what It fell, but it wasn't mentioned here. So, by Please save this video.
so you can watch it later, more for forward because this information was precious. Thank you again very much.
Felipe.
So, guys, uh, we already talked about it.
There's quite a bit there about malignant tumors. I I think the evil tumão is the one who wants to... the cherry on top of our area of Orthopedic oncology, right? that which People are more careful, more affectionate, more affection in speaking, despite being a a super difficult topic, because it's a topic that It messes with the lives of families, doesn't it? Stir with the lives of people who are very Guys, guys! He took it.
benign, we know that life exists.
She had the whole job to treat, but she took it.
evil, sometimes we won't have This whole life for this, okay? Then, Yeah, I'm very careful about this topic.
I think it's a topic that is super relevant, that has a tendency, uh, despite the benign ones having proven to be also quite prevalent, having to take extra care when doing the It's a test question, right? So, they are issues that will be a little more charged to you, charged a little.
more than one line of reasoning that we, as Orthopedists don't usually have... right? If there's anything more clinical than staging, understanding the disease Okay, guys, all in one piece? And you are Here, right? So, big hug. We If you need anything, you have our contact information there.
on Instagram.
our students also from our group of students, right, who can answer questions.
And we'll continue, right? There will be plenty.
Something for us to discuss new topics.
They're arriving soon, right? When it is long, right? There are some difficult issues there that We have something to comment on as well.
It's only for R3 that it's short, right? But It's for us.
Alright, guys, here's another great one.
Thank you very much. Thank you all!
immensely. Go and rest. A great hug.
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