1/8. 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) |
2/8. colonoscopy in clinical practice.colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/8. Juvenile polyp in a 10-month-old infant.A 10-month-old boy had episodes of apparent colic with bloody diarrhea. On investigation after prolapse of a rectal mass, a pedunculated polyp was found and removed by transanal ligation. The abdominal pain had been caused by the polyp intussuscepting the sigmoid colon into the rectum. Although rectal bleeding in children under age 1 is rarely caused by rectal polyps, physicians should consider this diagnosis in children of any age when recurrent colic and blood-streaked diarrhea occur.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/8. Detecting colorectal neoplasms. Assessment based on hypothetical cases.Because of the controversy surrounding the detection of colorectal neoplasia, I used 10 hypothetical, typical patients to assess the testing attitudes of 33 experienced colonoscopists. There was great disagreement on the type and frequency of the advised diagnostic investigation in some cases. The magnitude of interphysician variation in testing attitudes has major implications concerning cost and risk. This is particularly applicable to the interval between follow-up colonoscopies after polypectomy and cancer surgery, and the evaluation of patients with a positive fecal occult blood test. I reviewed the recent literature most pertinent to the patients. Although I could not derive firm guidelines for most of the cases from my review, consideration of the case management decisions, in light of available information, suggests that some gastroenterologists are testing many patients more than necessary, especially with colonoscopy.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/8. Gardner's syndrome with an unusual fibro-osseous lesion of the mandible.A girl with a family history of Gardner's syndrome presented with an actively growing central lesion of the mandible and localized subcutaneous fibrous hyperplasia which required surgical intervention and bone grafting. The importance of this syndrome is the development of intestinal polyposis which become malignant. The presence of dentofacial stigmata and surface tumors should alert the dentist and physician to the possibility of Gardner's syndrome.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/8. Basal cell carcinoma in a patient with intestinal polyposis.A 22-year-old female, with multiple polyposis of the colon and two central nervous system tumors, also suffered from recurrent basal cell carcinoma. The purpose of this report is to alert physicians to the possibility that basal cell carcinoma occurring at an unusually young age may be another manifestation of the familial polyposis syndromes.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/8. Primary carcinoma of the remnant stomach--report of three cases.Among the 318 patients operated on for gastric carcinoma during the last six years in our department, three patients were operated on for carcinoma which developed in the remnant stomach 25, 22 and 12 years respectively after partial gastrectomy for peptic ulcers. Their surgical results were uniformly poor because of far advanced malignant lesions. Another patient who developed adenomatous polyps near the stoma 23 years after gastrectomy for duodenal ulcer was treated by polypectomy through gastrotomy. Both from our experiences and from review of literatures, it was concluded that patients gastrectomized for benign lesions should be followed up regularly ten or more years after the surgery, especially by gastroscopy, in order to detect remnant stomach carcinoma as early as possible. And any physicians should always be aware of this disease and should not attribute any late appearing abdominal complaints to gastrectomy itself.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/8. Nonsurgical causes of pneumoperitoneum.The radiographic manifestation of free air in the peritoneal cavity suggests serious intra-abdominal disease and the need for urgent surgical management. Yet, about 10% of all cases of pneumoperitoneum are caused by physiologic processes that do not require surgical management. We retrospectively reviewed cases of nonsurgical causes of pneumoperitoneum at the 2 teaching hospitals of a university medical center between January 1990 and December 1995. Successful management by observation and supportive care without surgical intervention was defined as the diagnostic feature of nonperforation. Failure of a laparotomy to delineate a surgical cause or to result in a reparative procedure is congruent with a nonsurgical cause of pneumoperitoneum. During this period, 8 patients (6 men and 2 women; mean age, 61 years) were identified with nonsurgical causes of pneumoperitoneum. Two patients underwent negative laparotomy, and the other 6 were successfully managed nonoperatively and discharged from the hospital. In 6 patients, a cause of the pneumoperitoneum was identified. The causes may be grouped under the following categories: postoperatively retained air, thoracic, abdominal, gynecologic, and idiopathic. In our review of the literature, 61 of 139 reported cases underwent surgical treatment without evidence of perforated viscus. To avoid unnecessary surgical procedures, both primary medicine physicians and surgeons need to recognize nonsurgical causes of pneumoperitoneum. Conservative management is warranted in the absence of symptoms and signs of peritonitis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |