1/14. Non-Hodgkin's lymphoma in a patient with human immunodeficiency virus.A 38-year-old woman with human immunodeficiency virus who was recently diagnosed with gastric ulcer presented to the hospital with nausea and vomiting of 1 month's duration. work-up of patient led to a diagnosis of diffuse, large B-cell non-Hodgkin's lymphoma. The patient underwent six cycles of chemotherapy, and repeated endoscopy and biopsy failed to reveal malignancy. She remains in remission 23 months posttreatment. Management of patients with human immunodeficiency virus and concurrent malignancy remains a challenge. The primary care physician plays a central role by collaborating with infectious disease and oncologist specialists to formulate a management plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. The child with persistent cough.Coughing is a healthy reflex. Causes of a cough can vary from minor upper respiratory illnesses to malignancy. When a child's cough continues for weeks, parents worry. Primary care providers must decide when reassessment is needed and if a vigorous workup and referral to a pulmonologist are required. The above discussion should assist these physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases.Twelve patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) were analysed. Eight of them had typical RS3PE without underlying disease, and four presented associated neoplasia. The first patients experienced an excellent response to low doses of prednisone, and they all achieved complete and permanent remission. The mean treatment duration was 18 months and the mean follow-up was 4.4 years. During the follow-up, none of these patients relapsed, had fever or general health deterioration, and hand and foot radiographs did not show erosion. One of them developed a panarteritis nodosa 6 years later. Four RS3PE patients had associated neoplasia. Two were with solid malignancies, and the other two presented haematological malignancies. In one of them RS3PE preceded the diagnosis of malignancy. The diagnosis of RS3PE in the other patients was subsequent to cancer. The first patients presented clinical characteristics suggestive of paraneoplastic RS3PE, and they had a poor response to corticosteroid therapy. Two patients died, and the rest of them had a complete response to surgical resection of the tumour or to chemotherapy. In general, idiopathic RS3PE patients do not show either general health deterioration or fever and they do respond to low doses of steroids (10 mg/day). We observed strong contrasts with the results obtained when treating RS3PE patients with associated neoplasia. In patients with RS3PE the presence of systemic symptoms along with resistance to low doses of corticosteroid therapy should alert the physician to the possible presence of malignancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Transfusion-related acute lung injury during plasma exchange: Suspecting the unsuspected.Transfusion-related acute lung injury (TRALI) has been implicated with use of almost all types of blood products that contain variable amounts of plasma. Even though the reported incidence of TRALI is rare, its overall occurrence is thought to be more common, as less severe cases remain unreported. More TRALI cases are unrecognized and misdiagnosed due to lack of suspicion and absence of appropriate investigation. There are exceedingly rare reports of TRALI during plasma exchange despite the fact that liters of plasma may be used for replacement during a single procedure. We describe a mild case of TRALI during plasma exchange for thrombotic thrombocytopenic purpura in a 56-year-old woman, status post autologous hematopoietic stem cell transplant for non-Hodgkin's lymphoma. She developed severe rigors, peripheral cyanosis, hypoxia, and a transient diffuse pulmonary infiltrate. Of the 10 U of plasma used, one was from a multiparous female donor with HLA antibodies reactive with patient's granulocytes in immunofluorescence and agglutination assays. This case emphasizes the fact that the physicians and apheresis staff should consider TRALI in the differential diagnosis for patients developing respiratory distress during or soon after the procedure. Diagnosing TRALI has implications not only for the plasma exchange recipient, but also for the management of donors found to have leukocyte antibodies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. The value of white blood cell count in patients with swollen discs.BACKGROUND: A broad differential diagnosis has to be considered in a patient with swollen discs. myeloproliferative disorders such as leukemia and lymphoma can in rare cases cause infiltrative optic neuropathy. history AND SIGNS: Two patients initially presented with slowly progressive severe visual loss. history was unremarkable except for previously noted slightly elevated white blood cell count for which - according to their general physicians - no treatment or work-up was required. At presentation, bilateral disc swelling was present. magnetic resonance imaging showed enhancement of the entire optic nerves sparing the chiasm. No other intracranial lesion was found. cerebrospinal fluid contained no malignant cells. THERAPY AND OUTCOME: After bone marrow aspiration the diagnosis of non-Hodgkin's lymphoma and granulocytic leukemia, respectively, was made. Treatment resulted in visual recovery. CONCLUSION: work-up in a patient with swollen discs should always include white blood cell count. If the result is abnormal further exploration should be pursued. Elevated white blood cell count may be the only hint of optic nerve infiltration caused by a myeloproliferative disorder and its treatment can result in remarkable recovery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Diffuse pulmonary uptake of indium-111-labeled leukocytes in drug-induced pneumonitis.indium-111-labeled-leukocyte scintigraphy was performed on three febrile patients, two of whom had no signs or symptoms referable to the respiratory tract. The third patient had dyspnea on exertion, unchanged over two months. Their past histories were remarkable in that all three had recently undergone chemotherapy for malignancy (2 lymphoma, 1 malignant thymoma). Diffuse pulmonary uptake of labeled leukocytes was observed in all three individuals. As a direct result of leukocyte imaging, all three underwent fiberoptic bronchoscopy and transbronchial biopsy. The final diagnosis in each of these patients was drug-induced pneumonitis, which responded to treatment with corticosteroids. This entity should be added to the group of conditions, both infectious and noninfectious, that cause diffuse pulmonary uptake on labeled leukocyte images. Moreover, in the appropriate clinical setting, even in the absence of pulmonary signs or symptoms, diffuse pulmonary uptake of labeled leukocytes should alert the physician to the possibility of drug-induced pneumonitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. discitis following lumbar puncture in non-Hodgkin lymphoma.discitis in children is a rare disorder of intervertebral disc and vertebral end plate. infection or trauma, like lumbar puncture, may be the possible causes. Low-back pain and gait disturbance are the main symptoms. The most appropriate diagnostic procedure is MRI. Treatment is mainly empirical. Here a case with non-Hodgkin lymphoma is discussed. Treatment consisted of strict bed rest and antibiotics. Safe and sterile technique is important in patients with invasive procedures like intrathecal chemotherapy. Although discitis is a self-healing condition, it might cause vertebral osteomyelitis. In this regard, physicians should be aware of this probable complication after lumbar puncture and manage it earlier in children with cancer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Curability of cancer in children.The case records of 173 patients treated for cancer during childhood, free of disease at least 5 years later and free of disease in 1967 were reviewed. There were 84 boys and 89 girls. Tumor types were lymphomas, including one acute leukemia, sarcomas of the bone and soft parts, Wilms' tumor, neuroblastoma and carcinomas. Among the long survivors there were clusters in the less than 1-year age group and more than twelve years. Although many of the children were well adjusted in later life, others developed emotional problems. Cancer detection in a well child population for the tumors characteristically seen in the different age groups is the responsibility of the parents and physicians rendering health supervision to the children.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Infectious syphilis mimicking neoplastic disease.Five patients who were initially evaluated for malignant neoplasm actually had infectious syphillis (one primary, two secondaries, two secondaries with persistence of primary). Two patients were considered for radical surgery and one for extensive radiation and/or chemotherapy. In four patients an elevated routine admission VDRL was the first indication of the correct diagnosis. Dark-field examination is the most important laboratory test in the diagnosis of primary syphillis; VDRL and FTA-ABS are most important in confirming secondary syphillis. Penicillin remains the drug of choice for therapy. At a time when the incidence of sexually transmitted diseases is increasing, it is extremely important to develop adequate educational programs for medical students and physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Human immunodeficiency virus--associated non-Hodgkin's lymphoma presenting as an auricular perichondritis.AIDS-related NHL is an aggressive neoplasm, usually of high or intermediate grade, frequently extranodal at initial treatment, and often the first manifestation of AIDS. Although complete remissions have been reported, they occur in only a minority of patients. We describe a patient with NHL of the external ear that masqueraded as an auricular perichondritis. This is the first case reported in which AIDS-related NHL first appeared in the ear, and this should alert physicians who treat patient with AIDS to be aware of the protean manifestations of this disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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