1/7. carcinoembryonic antigen: clinical and historical aspects.To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The ohio State University hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Clubbed fingers: indicators of serious disease.Clubbed fingers were noted by a dentist in a woman patient having respiratory symptoms. He referred her to a physician to be examined for pulmonary disease. Bronchogenic carcinoma was diagnosed.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/7. Rheumatoid arthritis-like syndrome: a presenting symptom of malignancy. Report of 3 cases and review of the literature.Recent onset arthritis might be an early manifestation of an occult malignancy. Three patients are described: one with carcinoma, primary site unknown; one with oat cell carcinoma of the bronchus; and one with breast cancer. The presenting symptom of their disease was polyarthritis. Two of the patients were seropositive and in two patients the arthritis regressed following the removal of the tumor. awareness of paraneoplastic arthritis, especially if its appearance is explosive or in relatively old age, should caution the physician of the possibility of a potentially curable, but hidden neoplasm.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/7. Benign pulmonary tumors.Benign pulmonary neoplasms are relatively uncommon. The symptoms vary, depending on the location of the tumor. Specific diagnosis can be a time-consuming process and requires an orderly plan. Polytomography or computed tomographic scan, bronchoscopy, percutaneous biopsy or thoracotomy may be required. Tissue diagnosis must be sought. Surgical resection is the usual treatment. The family physician should act as coordinator, since multiple consultations may be necessary.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/7. Foregut cysts in infants and children. Diagnosis and management.The charts of 15 patients with foregut cysts were reviewed. The lesions were intrathoracic in 14 patients and in the cervical area in one child. The importance of early diagnosis and surgical management is stressed. In untreated infants with foregut cysts, severe progressive and life-threatening airway obstruction may develop. Since the symptoms of this congenital lesion may simulate other more common diseases of the tracheobronchial tree and esophagus, the physician should become familiar with this disease entity so that proper diagnosis and surgical treatment will not be delayed. The study includes symptomatology, methods of diagnosis, pathologic findings and classification of the cysts.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/7. Occult bronchogenic carcinoma masquerading as esophageal cancer. case reports with recommendations for a change in reporting esophageal cytology.We describe two patients with benign esophageal stricture in whom exfoliative esophageal cytologic features positive for squamous cell carcinoma is attributed to roentgenographically occult lung cancer. The discovery of alveolar macrophages within the esophageal washings of these patients prompted a retrospective analysis assessing the prevalence of esophageal washings contaminated by cellular material from the lower respiratory tract. Alveolar macrophages were observed in 11 of 28 patients (39%) and in 12 of 33 specimens (36%). Alveolar macrophages were noted in half of patients with benign esophageal disease, but in only one of eight cases with proved esophageal cancer. Criteria alerting physicians to the coexistence of benign esophageal stricture and occult respiratory neoplasm are given, and recommendations for a change in reporting esophageal cytologic features are proposed.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/7. Fatal hemorrhage from additional primary esophageal squamous cell carcinoma in a patient previously having primary bronchogenic adenocarcinoma.A unique occurrence is presented of additional primary epidermoid carcinoma of the esophagus with fatal bleeding into the upper digestive tract after 3 years of diagnosis of primary bronchogenic adenocarcinoma of an 81-year-old Thai man. The primary bronchogenic adenocarcinoma was surgically removed and followed by radiotherapy and chemotherapy without evidence of tumor recurrence at autopsy. The epidermoid carcinoma of the lower one-third of the esophagus metastasized to the pleura of the remaining right lung. There was no complaint of dysphagia. Outward extension through the esophageal wall rather than intraluminal protrusion of the squamous cell carcinoma was thought to result in the absence of dysphagia. Although it is uncommon physicians should be aware of the occurrence of multiple neoplasms.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |