1/13. 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) |
2/13. Endoscopic diagnosis of anorectal melanoma.Symptoms of anorectal melanoma commonly are attributed to hemorrhoids. The authors believe recognition of the sigmoidoscopic appearance will allow the physician to distinguish this condition from the more common anorectal disorders.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/13. Cerebrovascular events associated with infusion through arterially malpositioned triple-lumen catheter: report of three cases and review of literature.Analysis of 10 adult patients treated from January 1998 to November 2004 for arterial misplacement of triple-lumen catheter (TLC) during internal jugular vein cannulation was performed. Three cases that developed neurologic symptoms occurring in the context of infusion through a TLC that was arterially malpositioned are presented, along with the review of literature. In 7 patients, the diagnosis of arterial misplacement was suspected by the color or flow characteristics of blood and confirmed by a combination of blood gas analysis, connecting catheter to transducer, and/or chest film. In the remaining 3 patients, intraarterial misplacement was not suspected. In these patients, the initial review of chest films by qualified physicians prior to starting infusion failed to detect malposition of the catheter. Retrospectively, subtle clues suggestive of arterially placed TLCs were found. All 3 patients developed neurologic symptoms. Initiation of neurologic workup delayed a correct diagnosis by 6 to >48 hours. A volumetric pump was used for infusion in all patients. Of the 3 patients with neurologic symptoms, 1 recovered completely, 1 became comatose, and 1 partially improved.Based on our observations and review of literature, we conclude that cursory examination of chest films to verify proper positioning of central venous catheter attempted through the internal jugular vein may fail to detect arterial malposition. Infusion by volumetric pump precludes backflow of blood in the intravenous tubing as an indicator. Neurologic symptoms concurrent with the infusion of fluids and medication should raise suspicion of accidental arterial infusion.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/13. An unusual presacral mass: extramedullary hematopoiesis.Presacral masses are a rare finding in the adult patient, confronting the physician with diagnostic and therapeutic challenges. We present an unusual case of a symptomatic presacral mass caused by extramedullary hematopoietic tissue in a thalassemic patient and review the unique aspects of this entity.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/13. 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) |
6/13. 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) |
7/13. Hartmann's pouch carcinoma.Since 1921, when Henry Hartmann first described his procedure for rectal carcinoma, multiple modifications of the original technique have been proposed. However, the basic principle of a rectal pouch has always been retained. Two cases of carcinoma developing in such a pouch are described; both occurred years after creation of the pouch. One was managed by local resection through a transsacral approach; the other required an abdominoperineal resection. Consideration must be given to careful examination and sigmoidoscopy of these pouches as they tend to be forgotten by the physicians due to their hidden location.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/13. 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 = 0.5keywords = physician (Clic here for more details about this article) |
9/13. Rectal syphilis mimicking histiocytic lymphoma.homosexuality is being recognized with increasing frequency in the united states, and the physician must be knowledgeable of the presentations of venereal infection in this population. A 23-year-old man who denied homosexuality presented with a rectal mass and diffuse adenopathy. biopsy of the mass was interpreted as histiocytic lymphoma. Subsequent serology had positive results for syphilis. Further questioning revealed a history of anorectal intercourse, and special stains of the mass revealed spirochetes. syphilis must be considered in any young patient presenting with a rectal mass, regardless of the biopsy histologic characteristics or sexual history.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/13. Occult causes of hypokalemia.Most causes of hypokalemia are obvious from the clinical picture and the values for plasma electrolytes. In cases with obscure etiology, a pretreatment estimation of urinary potassium and chloride often helps lead the clinician into new and fruitful avenues of clinical investigation. Here we present four cases of hypokalemia in which the pathogenesis was initially enigmatic but was clarified somewhat by the determination of the urinary electrolytes. These simple, inexpensive investigations were initiated by the clinical chemistry laboratory in each case. The results encouraged the physicians to consider further clinical investigations, which led to a definitive diagnosis, before invoking expensive hormonal analyses.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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