1/63. The dentist's role in end-of-life care.dentists and dental specialists have much to offer in ensuring proper pain management in end-of-life care for terminally ill patients. As the population of the united states ages and devastating disease processes continue to affect many, the need for oral comfort care measures will further increase. In an ideal situation, the dentist will be among those consulted in advance of beginning therapeutic regimens that have significant oral side-effects or for cases in which oral care after treatment has begun is accompanied by greatly increased risk. The objectives for dentists caring for terminally ill patients include ensuring comfort, eliminating sites of infection or potential infection, understanding the patient's preferences enhancing oral function, and, when desired, protecting self-esteem through esthetic maintenance. The provision of adequate pain management and comfort care is an unequivocal ethical obligation for the benefit of these patients. dentists have a further ethical obligation to share their knowledge with physicians and patients to set a higher standard for comfort care for the terminally ill.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/63. Abnormal uterine bleeding as a presenting sign of metastases to the uterine corpus, cervix and vagina in a breast cancer patient on tamoxifen therapy.Metastases to the female genital tract from extragenital cancers are uncommon. The ovaries are most often affected with the breast and gastrointestinal tract being the most common sites of the primary malignancy. Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries and in the majority of cases the ovaries are also involved. A case of metastases restricted to the uterine corpus, cervix and vagina from breast carcinoma, without involvement of the ovaries, is described. The patient who had been on tamoxifen therapy presented with postmenopausal bleeding. The diagnosis of uterine metastases was established during endometrial ablation and confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that abnormal uterine bleeding in a breast cancer patient, regardless of whether she is receiving or not receiving tamoxifen, should always alert the physician to consider the possibility of uterine metastases from breast carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/63. Genetic susceptibility for specific cancers. Medical liability of the clinician.The use of genetic profiling techniques to detect individuals with an increased susceptibility to heritable cancers has provoked recent legal interest in the duties of the attending physician and in the rights of patients and their families. In the current study specific prima facie and recently litigated cases are presented and explored to delineate the issues facing physicians and to illustrate the prerogatives of patients who are caught up in a heritable cancer enigma. Various courts have attempted to answer questions involving lawsuits in which incidents of breast/ovarian carcinoma and colon carcinoma have provoked claims of negligence against health care providers. health care workers involved in the care of these patients have specific duties to these individuals. It would appear that physicians are being forced to assume the additional duty of delving into a patient's family history of cancer through multiple generations. This duty is followed by a responsibility to provide detailed counseling to those patients in whom such activity impacts the diagnosis and management of familial cancer.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/63. Clinical assessment of a breast mass: a case study.The estimated 180,300 new cases of breast cancer that were diagnosed in the united states during 1998 represent only a small percentage of the breast masses discovered by women and their healthcare providers during the same year. Almost half of women who have regular menstrual cycles will experience a breast mass during their reproductive years; and from 50% to 90% of all women will encounter fibrocystic breast changes. Imaging (ultrasound and mammography) and manual palpation have been demonstrated to be the most useful methods of breast mass detection and evaluation. A woman's age and reproductive status are factors to be considered in the selection of a protocol for the clinical assessment of a breast mass. While a suspicious lesion warrants immediate physician referral, nurse practitioners have important roles to play in the identification, documentation, and appropriate follow-up of breast masses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/63. Occult breast cancer detection with technetium-99m-sestamibi: a case report.A 74-y-old woman with a 4-y history of left arm lymphedema and multiple negative mammography studies presented to her physician with a palpable subcutaneous nodule in the left upper arm. After biopsy the nodule was read pathologically as secondary breast carcinoma. We report a finding of a positive 99mTc-sestamibi scintimammography in the presence of an unremarkable mammogram. The study also revealed a positive uptake in a metastatic lesion in the manubrium of the sternum.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/63. breast cancer detection using magnetic resonance imaging in breasts injected with liquid silicone.Two patients who had received silicone injections in their breasts several years ago presented with breast complaints. Excluding cancer in these patients was very difficult. Mammograms were very difficult to interpret, as were the physical findings. Carcinoma was successfully detected by magnetic resonance imaging. When women who underwent the injudicious injection of silicone reach the cancer-prone age, the examining physicians should have a greater awareness of the detection and management of carcinoma coexistent with silicone mastopathy. We think that MRI is potentially valuable in the evaluation of the breast lesions; it plays an important role in the detection of breast cancer in breasts augmented with liquid silicone.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/63. Infusion port dislodgement of bilateral breast tissue expanders after MRI.Tissue expanders are placed routinely for breast reconstruction, and magnetic resonance imaging (MRI) is a common diagnostic procedure. Many studies have reported on the safety of MRI in patients with nonferromagnetic implants; however, many tissue expanders contain ferromagnetic components. The authors present a case of bilateral tissue expander infusion port dislodgment after MRI. A 56-year-old woman underwent bilateral mastectomy and immediate reconstruction with McGhan BIOSPAN tissue expanders. These implants contain integral nonferromagnetic infusion ports, as well as small, powerful Magna-Site magnets. Several weeks postoperatively the patient underwent MRI of her spine, which was ordered by her primary physician for back pain. Subsequently, the infusion ports could not be located with the finder magnet. A chest radiograph was obtained, which demonstrated bilateral dislodgment of the infusion ports. Surgical removal and replacement of the tissue expanders were required. safety considerations of MRI have been discussed extensively in the literature, and data on MRI with various implanted devices have been obtained. The potential risks of performing MRI on patients with metallic implants include conduction of electrical currents, heating of the implant, misinterpretation resulting from artifact, and the possibility of movement or dislodgment of the implant. The small magnet integral to many tissue expanders may be overlooked by patients and physicians during pre-MRI screening. All patients undergoing tissue expansion with implants that contain integral ports should be thoroughly warned about the potential hazards of MRI.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/63. risk in numbers--difficulties in the transformation of genetic knowledge from research to people--the case of hereditary cancer.Difficulties in communicating diagnostic information are exacerbated when the 'diagnosis' is a 'genetic risk' for cancer. The risk estimation demanded in this situation differs from other types of probability estimations. Observations of participants in 45 consultation sessions between physicians and potential patients were conducted at a clinic for hereditary cancer to explore the communication of genetic information. Thirty-three sessions were audiotaped, transcribed verbatim and analyzed, along with notes from the other sessions. A dominant theme was found to be numerical discussion of risk. Further analysis resulted in the description of problems for practitioners in the process of translating scientific knowledge into clinical management. Problems in providing information include unclear aims of the consultation sessions, mixing various types of background information and probabilities, recognizing how low the predictive values are, and difficulties in communicating the relationship between probability and conclusions. Problems in communicating information about the genetic risk for cancer are of at least two types: dilemmas arising from uncertainties implicit in the nature of the information itself and difficulties in communicating information in a manner that those concerned can interpret. These issues need clarification, so that information with far-reaching consequences can be made as clear and comprehensible as possible for those involved.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/63. Carcinomatous meningitis in a patient with metastatic breast cancer.Metastases are defined as the appearance of neoplasms in parts of the body remote from the site of the primary tumor. Metastasis can occur through one of three processes: direct seeding of body cavities or surfaces, lymphatic spread, and hematogenous spread. The importance of laboratory utilization in the diagnosis of metastasis is explored using a case study of a 39-year-old female with metastatic breast carcinoma to the brain. This case study was carried out using clinical records, laboratory results, pathology reports, and physician interviews. cerebrospinal fluid was obtained and examined in hematology, chemistry, and microbiology. Tissue from the breast was examined both before and after chemotherapy. Morphologic comparisons of both primary and metastatic tumor cells were carried out. The breast tissue showed infiltrating mammary carcinoma, ductal type, with 8/11 auxiliary lymph nodes showing metastasis. Evaluations of cerebrospinal fluid cell count results revealed the presence of malignant cells in remarkable numbers. Based on cytological and hematological results, a diagnosis of meningeal carcinomatosis was determined and treatment was started. Following the intrathecal chemotherapy, serial cerebrospinal fluid examinations showed the percentage of malignant cells decreased and no cells were detected 11 days after treatment. Metastasis, including meningeal carcinomatosis is a common occurrence with breast carcinoma. An effective chemotherapeutic treatment is evaluated for this disease when an accurate diagnosis is made. As demonstrated by this case study, proper use of the laboratory can help establish the diagnosis of metastasis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/63. Cowden disease.Cowden disease represents an unusual, but unique syndrome which can be recognized most consistently by the development of characteristic verrucous, keratotic, papular, and nodular lesions about facial orifices, on the oral mucosa, and over the dorsal surfaces of the forearms and hands. The cause of these diverse hyperplastic changes is not known. Recognition of these lesions as signs of more extensive disease should alert the physician to examine the thyroid gland, breasts, female reproductive tract, GI tract, and skeleton for evidence of the associated changes we have enumerated. Because of the tendency for lesions of the thyroid, breast, and intestines to undergo malignant change, these patients require close observation and evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |