1/14. tobacco and public health.OBJECTIVES: An interactive program for physicians and surgeons was used to focus their attention on current issues of lung cancer in the united states. The issues examined were the risks for the development of lung cancer in smokers, spouses of smokers, recipients of second-hand or sidestream smoke, and the appropriate workup and treatment of patients with lung cancer. DESIGN: Case presentation with interactive questions and answers. patients: Six patients are presented whose cases demonstrate issues that are relevant and timely to the practice of thoracic surgery and oncology Interventions: Treatment for the five case presentations is used for interactive teaching purposes. CONCLUSIONS: lung cancer is epidemic in the united states, particularly among women at the present time. Physician awareness of the environmental and other factors contributing to the disease should stay current with the population variables that we are seeing in clinical practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. colon carcinoma after thymectomy for myasthenia gravis: report of a case.A 74-year-old Japanese man was admitted to our hospital with anemia, 4 years after a thymectomy for thymoma associated with myasthenia gravis. A diagnosis of sigmoid colon carcinoma was confirmed, followed by surgical resection. This case is presented to reinforce that physicians should bear in mind the possibility of extrathymic malignancies in patients with thymoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. ARF after retrograde pyelography: a case report and literature review.Acute renal failure (ARF) occasionally occurs after intravenous injection of contrast medium, but complications are rare after retrograde pyelography. After reviewing the reports in the English-language literature, the authors found very few on those complications after retrograde pyelography. The authors present a patient who had ARF after the technique. The patient had a history of hypopharyngeal cancer with underlying serum creatinine level at the high end of the normal limits. Bilateral flank pain and decreased urine amount were noted soon after the procedure of retrograde pyelography. Subsequently, blood urea nitrogen and creatinine levels both elevated, and hemodialysis was needed. Several days later, diuretic phase took place. Thereafter, the symptoms subsided gradually. Pyelorenal extravasation of contrast medium was remarkable during the procedure. There was no evidence of hydronephrosis during the course of ARF. Early awareness and management may prevent the complications of ARF such as acute lung edema and hyperkalemia. Therefore, clinical physicians should be aware of the occurrence of ARF and its clinical presentation after performing retrograde pyelography.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. 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) |
5/14. 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 = 1keywords = physician (Clic here for more details about this article) |
6/14. Postoperative myocardial infarction after radical cystoprostatectomy masked by patient-controlled analgesia.We present a case report where improper patient use of patient-controlled analgesia (PCA) in the postoperative period resulted in a significant delay in diagnosis of a postoperative myocardial infarction. Despite its excellent safety record and documented efficacy in controlling pain, PCA does have its limitations and can present a danger to the patient if operator error, patient error, or mechanical errors occur. Although the latter is rarely of concern, the two former possibilities exist. Other reported complications of PCA are discussed. We recommended that physicians, when considering use of patient-controlled anesthesia, discuss the qualitative and quantitative aspects of pain associated with the particular type of surgery performed to avoid missed postoperative complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Bilateral breast carcinoma after radiation therapy for Hodgkin's disease.The success of modern cancer therapy is resulting in an increasing number of long-term cures. The price of success, however, is the incidence of treatment-related morbidity and mortality. The physician should be aware of the potential sequelae of cancer therapy. A case of bilateral breast cancer occurring 13 years after radiation therapy for Hodgkin's disease prompted me to examine the incidence of this problem and to make recommendations for surveillance of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Bilateral testicular cancer.Although the case we described is not common, the incidence of testicular cancer, as well as bilateral testicular cancer, is rising. The primary care physician can help reduce morbidity in these patients by encouraging monthly self-examinations of the testicles and by paying attention to high-risk subgroups, such as those with a family history of testicular cancer, a personal history of cryptorchidism, infertility, or a contralateral testicular volume less than 12 mL. The primary care physician should, in at least these cases, discuss the option of a testicular biopsy to rule out CIS in the contralateral testicle. Treatment and follow-up options can then be explored to reduce further sequelae from this disease.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/14. Oat cell carcinoma of the lung in patients with CLL.Two malignancies in one patient was a remote possibility in the distant past, but currently more of these cases are being seen. At our institution, several patients with Chronic Lymphocytic leukemia (CLL) were seen to develop oat cell carcinoma of the lung. The decreased immunity and B-cell dysfunction in CLL probably accounts for this secondary malignancy. We are presenting these cases to alert physicians of combined malignancies in a patient with increased aggressiveness of oat cell carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Uptake of I-131 by an abdominal neurilemoma mimicking metastatic thyroid carcinoma.I-131 whole-body imaging may show characteristic findings in functioning, metastatic differentiated thyroid carcinoma. Nonthyroidal tumor uptake of I-131 is rare, but may mislead the physician to inappropriate treatment. A case is reported of a 59-year-old woman with papillary thyroid carcinoma who demonstrated strong uptake of I-131 in an abdominal cystic neurilemoma. Her serum thyroglobulin concentration at that time was low, at 3.35 ng/ml. Although the concentrating mechanism of I-131 was not clear, several clues pointed to the possibilities of nonthyroidal tumor uptake: 1) faster clearing of radioactivity than usual thyroid tissue, 2) persistent low serum thyroglobulin concentration, and 3) the presence of a cystic component in the nonthyroidal tumor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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