1/8. Bilateral tubal ectopic pregnancy: a tale of caution.diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnancy and discuss its clinical features and diagnostic difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review.We report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acute cerebral infarction at 23 years of age and was found to have non-ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non-ketotic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years. The association of glucose intolerance with other vascular risk factors in young adult survivors of BMT was recently highlighted in a follow-up study of 23 survivors of BMT [1], but none presented with such gross mixed hyperlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accelerated vascular risk at a young age who will require early treatment to modify it.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Intraperitoneal blood missed on a FAST examination using portable ultrasound.Bedside ultrasonography is rapidly gaining popularity in the evaluation of emergency patients. Several manufacturers have developed hand-held ultrasound machines that make the technology easy to transport and available in settings where such diagnostic tests were previously unobtainable. The miniaturization of equipment often means compromises and no studies exist comparing the high quality imaging capabilities of larger conventional ultrasound units to hand-held machines on actual patients. We present 3 cases in which intra-abdominal fluid stripes, important markers of intraperitoneal bleeding, were not visible with a popular hand-held unit, but were identified with a larger mobile ultrasound machine. These findings should caution emergency physicians to be aware of this limitation along with the many advantages of these new and popular hand-held ultrasound units.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Abdominal catastrophes.The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. The patient improved with IV hydration and oxygen administration. Abdominal x-ray films ruled out a bowel obstruction, and chest x-ray films ruled out a pulmonic process. Laboratory tests revealed hemoconcentration and leukocytosis. No other laboratory test results were abnormal. While waiting for the surgeon to arrive, the patient remains stable, so the ED physician orders a CT scan of the abdomen. Taking another look at the plain x-ray films, the emergency physician in our case presentation sees a suggestion of free air under the right hemidiaphragm above the liver on the CXR and between the liver and the right abdominal wall on the decubitus ABD x-ray. The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. Ultrasound for the primary care physician. Applications in family-centered obstetrics.Ultrasound imaging is a noninvasive diagnostic tool that enhances the patient's and physician's understanding of prenatal care. According to a multisite study, use of ultrasound by primary care physicians appears to improve prenatal patient education and support early formation of the family unit. Other potential benefits include early detection of fetal abnormalities, savings in time and cost, and enhanced continuity of care. However, consultation with and referral to specialists, when appropriate, remain essential ingredients for state-of-the-art healthcare. Further studies defining the role and boundaries of ultrasound in primary care are needed.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
6/8. Phasic contraceptive pills and functional ovarian cysts.This seven-case anecdotal report is presented to alert physicians to the possibility of the formation of functional ovarian cysts during use of phasic contraceptive pills. The patients were studied by the combination of history, physical examination, ultrasound examination, and in two cases surgery. The occurrence of functional ovarian cysts during the use of phasic contraceptive pills is well established while not well appreciated by practicing physicians. This seven-case presentation strongly suggests that phasic contraceptive pills may be a threat to patient health and safety. It is suggested that further studies be undertaken to better understand the pathophysiology.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/8. Fate of ovary transposed during treatment of Hodgkin's disease.Although successful transposition of the ovaries at the time of staging laparotomy for Hodgkin's disease is well documented, little comment has been made on potential complications. This case report of a primary ovarian neoplasm (benign) developing in a transposed ovary serves to alert physicians as to possible ovarian problems in such patients. ultrasonography or computed tomography is invaluable in following up the patient with laterally transposed ovaries no longer accessible to routine bimanual clinical evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Symptoms associated with menstruation.Symptoms associated with menstruation during the teenage and young adult years may represent a spectrum of possibilities varying from a relatively benign deviation from normal to a serious life-threatening disease. Nevertheless, even for the young woman found to be without serious disease, menstrual problems have special meaning associated with the fear of being different from peers, concern about being less than complete or wholesome, and anxiety regarding future functioning as a normal woman. The physician must be aware of the adolescent's sensitivity in this area. Her apprehension should influence the manner in which the various abnormalities of menstruation are evaluated and managed. The physician must understand and appreciate the potential for profound emotional effects and psychological implications of menstrual conditions. The manner in which we care for the adolescent with menstrual symptoms will determine to a significant degree how successfully the patient will cope with abnormalities of menstruation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |