1/9. Phaeochromocytoma by way of case reports.Endocrine causes of hypertension are relatively rare, but their detection offers a real chance for cure. This is particularly true of phaeochromocytoma, a catecholamine-producing tumour derived from chromaffin tissue, which, if left undetected, is invariably fatal. The lethal nature of this tumour is dependent on two major characteristics: firstly, its ability to secrete catecholamines in excess, resulting in potentially catastrophic consequences; and, secondly, its malignant potential. Approximately 5-10% of these tumours are malignant, which, if metastasised, are generally refractory to treatment. Clearly, however, because only one in 1,000 hypertensives is likely to harbour a phaeochromocytoma, it is not cost-effective option to screen all hypertensives for this cause. Rather, a selective approach is preferred in which a high index of suspicion for the clinical characteristics of this tumour is used to guide the physician. The following two case reports derived from our records at Chris Hani Baragwanath Hospital will illustrate many issues related to diagnosis and management of this fascinating tumour.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. 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 = 2keywords = physician (Clic here for more details about this article) |
3/9. Treatment decisions in end-stage bladder cancer. Bilingual liaison rounds.A bilingual conference was held in order to assist a Spanish-speaking patient and her physicians in planning for her care. The patient spoke only Spanish and her oncologists were primarily English-speaking. Her daughter, who was bilingual, did not attend the conference. One of the authors translated and served as interpreter and liaison between the patient and her other physicians. The patient was severely depressed and terminally ill with end-stage bladder cancer. Her depression and hopelessness complicated her care.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/9. Carcinomatous meningitis from transitional cell carcinoma of the bladder: case report.In the past decade, there has been an increasing awareness of central nervous system metastases as a frequent complication of some malignancies, particularly in lung, breast and hematologic cancers. However, the central nervous system remains an uncommon location for metastases from certain primary tumors including those from the genitourinary system. We report on a patient with transitional cell carcinoma of the bladder who was treated with combination chemotherapy, and during the course of his disease developed carcinomatous meningitis. We anticipate this unusual complication of bladder transitional cell carcinoma will be seen more frequently, especially in the light of available data from effective chemotherapeutic regimens. We report this patient to alert physicians to this complication and to consider using prophylactic measures in responding patients as is the case in other malignancies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Vesical endometriosis: medical or surgical treatment.A case report of endometriosis of the bladder is presented, with special reference to treatment options. Recent experience with this lesion illustrates the dilemma facing the physician who must determine a course of treatment. It seems that removal of the bladder lesion by segmental cystectomy is the preferred treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. cyclophosphamide and carcinoma of bladder.A case of carcinoma of the bladder developing in a patient who received cyclophosphamide (Cytoxan) therapy for carcinoma of the breast is presented. Hemorrhagic cystitis si a well-documented complication of such therapy. Several recent reports of carcinoma of the bladder in patients receiving cyclophosphamide should make physicians aware of this potential association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. 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) |
8/9. Malignant fibrous histiocytoma of the bladder with focal rhabdoid tumor differentiation.A case of primary malignant fibrous histiocytoma of the bladder is presented. This tumor involving the bladder is rare and the unusual histological features in the present case caused significant delay in accurate diagnosis. Since early diagnosis and aggressive surgical resection are essential to the effective treatment of this neoplasm, physicians should continually bear in mind the possibility of this malignant tumor whenever the pathological diagnosis is inconclusive.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Tuberculous spondylitis as a complication of intravesical bacillus Calmette-Guerin therapy.We report a case of tuberculous spondylitis following intravesical bacillus Calmette-Guerin (BCG) instillation. A 90-year-old male physician living in South africa received an uncomplicated 6-week course of intravesical BCG (Japanese 172 strain) for high grade superficial bladder carcinoma. He experienced a sudden onset of debilitating lower back pain 16 months following this treatment. A lytic lesion involving the anterior T11 and T12 vertebral bodies was diagnosed and subsequently biopsied. An acid-fast organism was isolated after 3 weeks of incubation and was confirmed through deoxyribonucleic acid probe hybridization as a mycobacterium. High performance liquid chromatography analysis speciated the organism as mycobacterium bovis BCG, proving that it was acquired through the intravesical therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |