1/15. review article: the risk of lymphoma associated with inflammatory bowel disease and immunosuppressive treatment.lymphoma complicating inflammatory bowel disease is well described. Whether the risk of lymphoma is increased by immunosuppressive treatment with azathioprine, 6-mercaptopurine or infliximab is a common concern among patients and physicians considering using these agents. This review aims to quantify the lymphoma risk in inflammatory bowel disease and the added risk attributable to these treatments. The evidence from published cases is that lymphomas occur at sites of active inflammatory bowel disease more often than expected for this to be a chance association. Studies on inflammatory bowel disease populations are conflicting, with some follow-up studies from large inflammatory bowel disease clinics showing an increase in lymphoma incidence, while other population-based studies show little or no increase in risk of lymphoma. A small increase in lymphoma risk in inflammatory bowel disease, perhaps 2-3-fold, may be compatible with both sets of data. Studies of the risks associated with immuno- suppression are less satisfactory, with smaller numbers of patients and relatively short follow-up. The available evidence would support a further increase in lymphoma risk associated with immunosuppressive treatment in inflammatory bowel disease of around fivefold compared to no immunosuppressive use, and tenfold compared to the general population. The risks appear to be less than that associated with renal and hepatic transplant-related immunosuppression. Infliximab treatment is still too new to make a full assessment of its long-term safety, but post-marketing surveillance currently suggests that lymphoma risk may not be any greater than that associated with azathioprine and 6-mercaptopurine. population-wide surveillance for lymphoma in inflammatory bowel disease would be required to narrow the confidence intervals on these estimates of lymphoma risk in inflammatory bowel disease and immunosuppressive treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. Care of the patient with hematologic malignancy: a point of view.The patient with hematologic malignancy is nowadays afforded longer periods of remission through appropriate chemotherapy and, while this provides comfort and encouragement to the patient, the usual outcome is death. The problems that face the patient, the families of patients, and the primary care physician during the course of malignant disease are discussed. Perspectives on the reactions of all concerned are presented for three phases of illness: The Initial or Diagnostic and Remission-Induction Phase, The Treatment Phase with its remissions and exacerbations, and The Final Phase, or dying process. Case presentations are used to illustrate the problems which affect patients, their families, and the physician. While pharmacologic treatment is important and essential, emphasis is placed on emotional support to be offered by the physician and his team throughout the three phases of illness.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
3/15. Malignant lymphoma accompanied by renal cell carcinoma - a not so rare coincidence?We report a case of a patient who presented with a left sided inguinal swelling. Ultrasound examination clearly revealed a bilateral inguinal lymphoma. In addition, a renal cell carcinoma was diagnosed through ultrasound. The differences in texture between lymph nodes and renal tumour as well as the even concentric swelling of the lymph node sinus permitted a clear cut differentiation between the two entities. CT could not provide this clear distinction. Despite some controversy several case reports as well as a few retrospective studies showed an increased coincidence of renal cell carcinoma and malignant lymphoma. However, a pathophysiological connection has not yet been discovered. This report presents another case of synchronous appearance of renal cell carcinoma and malignant lymphoma and demonstrate the relevance of ultrasound in the discrimination between the two clinical entities. It is essential for physicians performing either sonography and/or CT to be aware of this coincidence to avoid misdiagnosis of lymphadenopathy in patients with renal cell carcinoma as metastasis and, vice versa, renal tumours in lymphoma patients as renal manifestation of the lymphoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. Intravascular lymphoma and thyroid gland.Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of neoplastic cells in the small blood vessels that frequently goes undiagnosed until the time of autopsy. The neoplastic cells are usually of B-cell origin. The clinical course was examined to determine factors that would facilitate antemortem diagnosis. IVL is observed with clinical, histopathological and immunohystochemical methods. This is a unique case because the thyroid gland is a rare place for IVL. Accent is given on immunohystochemical methods and tissue biopsy in the differential diagnosis of IVL when nervous system and thyroid gland dysfunction occur This report indicates that micro-ecosystem of multinodular goitrous might influence the expression of chemokines and/or adhesion moleculs on endothelial and lymphoma cells, leading to heavy infiltration of thyroid gland. Concurrently, that may guide the physician to tissue biopsy facilitating antemortem diagnosis and institution of appropriate therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. Primary central nervous system lymphoma. A report of 9 cases and review of the literature.Primary central nervous system (CNS) lymphoma appears to be on the increase. This increase is real rather than due to changes in nosology, physician awareness or increase in high-risk groups. Diagnostic guidelines appear to be well defined and widely accepted. We report 9 cases of primary CNS lymphoma seen at our institution over a 5-year period. The clinical presentation was variable, but consisted mostly of headache, motor dysfunction, and memory and behavioural disturbance. Surgery is of value for diagnosis. In general, surgical decompression is not recommended. glucocorticoids and radiotherapy appear effective in the short term. The role of chemotherapy is uncertain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. Malignant lymphomas of the oral soft tissues.Two cases have been presented in which a malignant lymphocytic tumor was found in the oral soft tissues. The first was a "histiocytic lymphoma" that appeared as a rapidly growing, ulcerative lesion. This tumor was the initial presentation of disease and may be considered a primary lesion. The second was a "poorly differentiated lymphocytic lymphoma" which formed a mass in the mental area. In that case, the tumor was associated with widespread disease. Both of these lesions had previously been diagnosed by physicians as inflammatory processes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. An unusual cause of back pain in a young athlete. A case report.back pain in the young athlete is a common problem seen in many sport medicine clinics. Not only can this be a difficult problem for the physician to manage (due to inability to pinpoint the pathology), but it is a frustrating experience for the athlete, unable to compete or train effectively. The sport medicine physician must, therefore, always be alert and obsessed with obtaining a precise diagnosis to be followed by specific treatment. When presented with the adolescent athlete suffering with back pain, one must consider the full gamut of diagnostic possibilities. Mechanical or spondylogenic causes are most common; however, potentially more serious infective, metabolic, and neoplastic conditions should also be considered.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/15. Chronic radiation enteritis complicating non-Hodgkin's lymphoma.A case of radiation enteritis in a patient with non-Hodgkin's lymphoma is described. The patient's complaints suggested recurrence of her lymphoma and radiographic studies were nondiagnostic of radiation-induced enteritis, delaying diagnosis and appropriate therapy. An inadvertent error in radiotherapy technic and fibrous adhesions resulting from the staging laparotomy contributed to the radiation injury. radiation enteritis is a rare complication of irradiation of abdominal lymphoma, but it must be considered by physicians who encounter a similar situation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. 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) |
10/15. Musculoskeletal syndromes associated with malignancy.Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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