1/15. Two cases of neuroblastoma presenting to the emergency department.neuroblastoma is the second most common malignant solid tumor in the pediatric population. Recent advances in treatment options and identification of prognostic subsets have made early detection important. Early classification into a favorable stage and subset may carry a 10-year survival of about 90% (1). With newer treatment regimens, the probability of long-term survival in patients with metastatic disease has also increased about fourfold since 1979 (2). Emergency physicians can contribute to improved morbidity and mortality with appropriate evaluation and disposition of the patient presenting with neuroblastoma. Two patients, a 6-month-old and a 2-week-old, presented to the Emergency Department with weakness. Both had a presumptive diagnosis of neuroblastoma made by the emergency physician. A brief discussion of the incidence, presentation, and diagnosis of neuroblastoma follows.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. A case of spinal cord compression syndrome by a fibrotic mass presenting in a patient with an intrathecal pain management pump system.A 45-year-old woman presented with increasing low back pain, progressive anesthesia in her lower extremities and difficulty ambulating. She had a history of chronic low back pain problems for which, 26 months earlier, she had an intrathecal infusion pump permanently placed for pain and spasm control. Urgent magnetic resonance imaging (MRI) of the lumbar spine revealed a mass at the site of the tip of the intrathecal catheter with high grade spinal cord compression at the level of L-1. At surgical laminectomy the compressing lesion was found to be a reactive tissue fibroma. As more patients receive these devices the physician should consider cord compression syndrome in patients presenting with symptoms of increasing low back pain, anesthesia and progressive proprioceptive loss.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/15. Desmoid tumor of the spinal canal causing scoliosis and paralysis.STUDY DESIGN: This report describes a case of successful surgical excision of an intrathoracic paraspinal desmoid tumor with an intraspinous extension causing scoliosis and paralysis in a 12-year-old girl. OBJECTIVES: The purpose of this report is to illustrate the potential spectrum of disease of a desmoid tumor and to make physicians aware of the rare possibility of an intraspinal extension of a paraspinal desmoid tumor. SUMMARY OF BACKGROUND DATA: Surgical excision of desmoid tumors in the pediatric population is the standard of care for initial treatment. There have been no clinical reports in the spine literature of a desmoid tumor causing scoliosis or of a desmoid tumor with an intraspinous extension causing paralysis. methods: The tumor was decompressed from a posterior approach followed by an anterior resection and an anterior spinal fusion. Two weeks later a posterior spinal fusion was performed to correct the spinal deformity. The patient also received radiation therapy after surgery for 5 weeks. RESULTS: The patient tolerated the procedure well, has been free of recurrence for 9 years, and is currently doing well. CONCLUSION: This case report should help expand the understanding of the spectrum of this uncommon tumor.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/15. Sacral hemangioma with sinus tract in an infant.Congenital midline cutaneous lesions should always alert the clinician to the possibility of spinal dysraphism. These lesions can take many different forms. The physician should be cognizant of such lesions in order to avoid potential neurologic complications. We present a patient with a midline sacral hemangioma associated with a congenital enteric sinus cyst, a previously unreported association.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/15. Vertebral osteomyelitis mimicking bone metastasis in breast cancer patients.Vertebral osteomyelitis can be a diagnostic pitfall for physicians, since it is protean and often subtle in its clinical presentation. It can coexist with metastatic lesions or mimic vertebral bone metastasis. When it occurs in patients with breast cancer, who are prone to have bone metastasis, it can present perplexing diagnostic problems. Misdiagnosing vertebral osteomyelitis as bone metastasis or vice versa results in delayed diagnosis and inappropriate treatment and may cause serious morbidity. We emphasize this problem by presenting the cases of two patients with breast cancer whose clinical course was complicated by vertebral osteomyelitis. When the clinical course of breast cancer is different from this usual presentation, a different process should be suspected, and histologic diagnosis should be promptly sought. Fine-needle aspiration biopsy and culture of suspicious-appearing bony lesions is recommended as a rapid and reliable method of establishing a definite diagnosis in this circumstance.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/15. Symptomatic expansile vertebral hemangioma causing conus medullaris compression.OBJECTIVE: To present a case of symptomatic, expansile L1 vertebral hemangioma. CLINICAL FEATURES: A 46-year-old man presented with progressive neurologic changes and insidious onset of low back pain. INTERVENTION AND OUTCOME: After a trial of 3 visits of conservative chiropractic care, no improvement was noted. magnetic resonance imaging was obtained, revealing an expansile hemangioma with extra-osseous component compromising the conus medullaris at the level of the L1 lumbar vertebra. Neurosurgical intervention resulted in clinical improvement. CONCLUSION: Primary care physicians treating patients with low back pain should be aware of neurologic red flags requiring prompt attention. magnetic resonance imaging is the imaging modality of choice when evaluating a neurologic abnormality presumably related to a space-occupying lesion. Although a disk herniation is the most common cause of these symptoms, clues in the history and examination must prompt physicians to expand their differential diagnosis to include a variety of other extradural masses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. adamantinoma of the spine: case report.OBJECTIVE: We report a patient with a cervicothoracic spinal and a mandibular adamantinoma. adamantinoma is a rare malignant neoplasm of bone and, to our knowledge, there have been only five cases of spinal adamantinoma reported. The pathogenesis of the adamantinoma, as well as the management of this extremely rare spinal tumor, is reviewed. CLINICAL PRESENTATION: A 55-year-old man was admitted to our service with cervical pain and signs of C8 and T1 radiculopathy. On physical examination, cervical spine deformity, swelling in the left mandible region, and signs of C8 and T1 radiculopathy were observed. Neuroradiology examinations showed an osteolytic mass of the C6, C7, and T1 vertebral bodies, extending into the lateral masses and transverse processes. After surgical procedures, the patient had clinical improvement. INTERVENTION: Corpectomy of C6, C7, and T1 was performed through a cervicothoracic anterior approach. Anterior stabilization of the spine was obtained using an autologous iliac crest graft and osteosynthesis with an anterior plate. On a second procedure, posterior tumor resection and spinal stabilization were performed. After the 1-year follow-up examination, a new anterior procedure was performed because of tumor recidivity and spine instability. CONCLUSION: adamantinoma, an extremely rare lesion, is a locally aggressive tumor with slow growth and the potential to metastasize. Although it is an extremely rare occurrence in the spine, adamantinoma should be considered on the diagnosis of tumors of the vertebrae. Neuroradiological examinations are not specific in the differentiation of this tumor from other conditions. This fact, coupled with the limited experience that most physicians in general have in dealing with this tumor, makes the diagnosis and treatment of adamantinoma challenging.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/15. Emergent signs of cancer. Recognizing them early in the office or ER.Primary care physicians have a crucial role in recognition of potentially emergent conditions in patients with known or suspected cancer. This task presents a significant challenge because the initial manifestations of these conditions are usually nonspecific. In most cases, therapy is far more effective when diagnosis is made at the earliest possible point. Thus, physicians should become familiar with conditions commonly seen in cancer patients, such as superior vena cava syndrome, malignant pericardial effusion, spinal-epidural metastasis, and altered mentation from brain metastases, metabolic encephalopathy, or hypoglycemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. 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 = 1keywords = physician (Clic here for more details about this article) |
10/15. Traumatic fascicular neuroma.A 72-year-old man had developed amiodarone neuropathy. He was found, at biopsy, to have a fascicular neuroma of his right sural nerve, unassociated with his underlying neuropathy, apparently due to blunt trauma, as electroneurographic needling of this nerve could safely be ruled out by the patient and his physicians. Such fascicular neuromas, which may remain without sensory deficits, may develop at an unknown frequency, and may only be uncovered by biopsy--or autopsy--in a coincidental neuropathic process.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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