1/8. diffusion-weighted MR imaging of Carmofur-induced leukoencephalopathy.Carmofur (1-hexylcarbamyl-5-fluorouracil), a derivative of 5-fluorouracil (5-FU), has been widely used in japan as a postoperative adjuvant chemotherapy agent for colorectal and breast cancer. Periventricular hyperintensity on T2-weighted MR images in carmofur-induced leukoencephalopathy confront the physician with a broad range of differential diagnoses. We describe two cases of carmofur-induced leukoencephalopathy in which diffusion-weighted MR imaging revealed periventricular hyperintensity. We compared their findings with those of age-related periventricular hyperintensity in five patients and found discrepancies in signal intensity of periventricular areas. Our results suggest that diffusion-weighted MR imaging may be useful to differentiate carmofur-induced leukoencephalopathy from age-related periventricular hyperintensity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Percutaneous gadolinium injection under MR guidance to mark target for CT-guided radiofrequency ablation.Selection of the appropriate imaging tool depends on a number of factors that reflect the patient, the procedure, and the physician. Multiple imaging techniques are often required to perform elements of a whole procedure. A patient with an allergy to iodinated contrast material and a 3.0-cm hepatic metastasis that was invisible on computed tomography (CT) was treated with CT-guided radiofrequency ablation by first injecting gadolinium under magnetic resonance guidance to mark the location of the lesion. gadolinium's high atomic number makes it a viable contrast agent for attenuating x rays under fluoroscopic or CT guidance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. 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) |
4/8. Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature.BACKGROUND: Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. As this condition is not widely appreciated by pathologists or clinicians, we describe herein a case of colonic polyposis and sigmoid colonic carcinoma with obstructive colitis. PATIENT PRESENTATION: A 47-year-old Taiwanese woman presented to Cardinal Tien Hospital with a 3-day history of acute onset of abdominal pain, vomiting, and watery diarrhea. A lower gastrointestinal series using water-soluble contrast medium revealed annular narrowing of the sigmoid colon and showed polyposis at the rectosigmoid colon and regional colitis over the proximal descending colon. She was treated by total colectomy. Microscopic sections showed poorly differentiated adenocarcinoma, tubular adenomas, and a segment of obstructive colitis measuring 25 cm in length 5 cm proximal to the colon tumor. The tumor was also retrieved for simultaneous analyses of replication error and loss of heterozygosity. A total of three instances of loss of heterozygosity were demonstrated at the P53, MET, and D8S254 gene loci. No examples of replication error were detected. CONCLUSION: Obstructive colitis can cause diagnostic and therapeutic problems. colitis areas may be a source for septicemia or may perforate and lead to peritonitis. The frequently normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications. awareness of the features and incidence of obstructive colitis should help physicians avoid these diagnostic and therapeutic problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Colorectal screening after polypectomy: a national survey study of primary care physicians.BACKGROUND: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy. OBJECTIVE: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer. DESIGN: Cross-sectional study of physicians. SETTING: united states. PARTICIPANTS: A random sample of 500 physicians from the American College of physicians and 500 physicians from the American Academy of family physicians, obtained by using a mail survey. MEASUREMENTS: physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma. RESULTS: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less. LIMITATIONS: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice. CONCLUSION: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.- - - - - - - - - - ranking = 12keywords = physician (Clic here for more details about this article) |
6/8. colonoscopy in clinical practice.colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. 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 = 1keywords = physician (Clic here for more details about this article) |
8/8. Resected sigmoid carcinoma with 13-year metastasis-free interval. Sternal recurrence detected by immunoscintigraphy.Colorectal cancers rarely present with bone metastases. Regular postoperative monitoring after resection by conventional imaging techniques and carcinoembryonic antigen levels aids physicians in identifying such tumor recurrences. However, some recurrences might elude detection by bone scan, computed tomography, and magnetic resonance imaging, and newer tests such as immunoscintigraphy using radioimmune-tagged monoclonal antibodies may be more diagnostic. Here we report a case, presenting with delayed recurrence at a rare bony site, in which application of immunoscintigraphy helped in the definitive detection of the tumor recurrence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |