1/18. Pseudo sister mary joseph's nodule.The sister mary joseph's nodule is a significant finding in the physical examination. It is sometimes the only indication of an intra-abdominal metastatic malignancy. We report a patient who presented with an umbilical nodule that was discovered to be an omphalith. A review of the literature discusses the sister mary joseph's nodule and this unusual finding.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. Paraneoplastic pemphigus caused by an epithelioid leiomyosarcoma and associated with fatal respiratory failure.A patient is described who initially presented with pemphigus vulgaris, limited to the oral cavity, and weight loss. Although the various laboratory studies pointed to the diagnosis of paraneoplastic pemphigus (PNP), the underlying neoplasm was not detected until 6 months later, when the patient developed shortness of breath and routine physical examination on admission revealed an abdominal mass, which eventually was proven to be an epithelioid leiomyosarcoma. In spite of radical excision of the tumour and intensive treatment of the dyspnoea, the patient died of respiratory failure 19 months after the PNP had been diagnosed. early diagnosis of PNP is stressed to possibly prevent fatal pulmonary involvement.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/18. Abdominal cancer, nausea, and vomiting.nausea and vomiting in abdominal cancer is perhaps one of the most difficult symptom complexes to manage, especially when complicated by bowel obstruction. There are many mechanisms of nausea in advanced abdominal cancer with a number of therapeutic interventions that can significantly enhance symptom control and overall quality of life. As with pain, the ideal approach should include a mechanistic analysis of the causes of nausea beginning with a thorough history, followed by a directed physical examination, and selected laboratory studies. The symptom history, in conjunction with a physical examination and directed tests should direct appropriate pharmacologic and nonpharmacologic interventions. The result is often the amelioration of significant suffering and enhanced quality of living.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
4/18. Spontaneous regression of subcutaneous metastasis of cutaneous melanoma.A case is presented of a 44-year-old Caucasian man who was operated on in October of 1988 for a cutaneous melanoma in his trunk and who in the space of 1 year manifested a single subcutaneous nodule compatible with a metastasis of melanoma by fine-needle aspiration biopsy. No other abnormal findings were revealed by physical and instrumental examinations. During the subsequent hospitalization, we witnessed (in conjunction with the occurrence of painful symptoms in the hands of an inflammatory nature) the total, progressive, spontaneous regression of the metastasis, which was confirmed by the clinic and the tests. After 15 months of follow-up, the patient has not shown any further signs of illness.- - - - - - - - - - ranking = 0.063421389834457keywords = physical (Clic here for more details about this article) |
5/18. Ultrasonic evaluation of ventral hernias disguised as intra-abcominal neoplasms.Most cases of ventral hernias are easily diagnosed by palpation, but palpation is a subjective examination that may be difficult or even misleading, especially in obese patients. In cases of diagnostic uncertainty, ultrasonic examinations offer an objective means of distinguishing between a mass in the abdominal wall and one actually deep to the peritoneum. In addition, if such a mass is detected, these studies provide information that can characterize its physical nature.- - - - - - - - - - ranking = 0.063421389834457keywords = physical (Clic here for more details about this article) |
6/18. Laparoscopic resection of an abdominal wall desmoid using a modified suture traction technique: the "marionette trick".Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars.- - - - - - - - - - ranking = 0.063421389834457keywords = physical (Clic here for more details about this article) |
7/18. abdominal wall neurofibroma presenting as an inguinal hernia.Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions. The following case report describes an abdominal wall neurofibroma presenting as an inguinal hernia in a young, active duty, male soldier with previously undiagnosed neurofibromatosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/18. Intraoral tumor with rapid growing. Report of a case.The appearance of an intraoral mass is common in our specialty. Most are benign lesions, but some are primary malignancies. Metastases account for less than 1% of all oral malignancies. An 86 year old woman was referred to our department with a large, asymptomatic, intraoral, fast-growing mass. She had no previous cancer history or other relevant physical findings. The radiology studies showed underlying bone erosion. The histological study showed a metastatic adenocarcinoma with a suspected origin in the abdomen. We were unable to identify it by non invasive diagnostic procedures. Given the patient's general status and despite the ominous prognosis of such lesions, we decided not to perform any aggressive therapy beyond removing the oral mass, in order to maintain her quality of life. There have been no local recurrences until this time.- - - - - - - - - - ranking = 0.063421389834457keywords = physical (Clic here for more details about this article) |
9/18. Phase I/II study, combination of radiotherapy and hyperthermia in patients with deep-seated malignant tumors: report of a pilot study by the radiation Therapy Oncology Group.This is a report of a Phase I/II study activated in March 1984 and completed in October 1988 by the radiation Therapy Oncology Group on the feasibility/toxicity of hyperthermia in patients with deep-seated malignant tumors. The main objective of this study was to evaluate the morbidity of regional hyperthermia (systemic and regional, acute and late effects); a secondary objective was to evaluate tumor response to combined irradiation and regional hyperthermia. A total of 54 patients with locally advanced abdominal or pelvic malignancy were accrued to this study; 42% were male and 58% female. Seventy-five of the patients had pelvic tumors and 25% abdominal tumors. Acute toxicities included grade 4 in three patients (1 cutaneous, 1 infection and 1 chemical peritonitis) one grade 3 (skin), and 12 grade 2 toxicities (6 skin and 6 gastrointestinal). With regard to late toxicities, grade 4 was noted in one patient (skin), grade 3 (GI) in one, and grade 2 (skin, peripheral neuropathy) in six patients. The prescribed course of hyperthermia was completed in 17 (32%) of patients. In 36 patients (68%) the course of hyperthermia was terminated, primarily because of patient discomfort. Tumor response was assessed by physical examination or radiological studies. Of 44 patients evaluable for response, there were 17 (39%) complete responses and 6 (14%) partial responders. Significant technical problems in heat delivery and thermometry remain.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/18. Tumour lysis syndrome and the anaesthesiologist: intensive care aspects of paediatric oncology.Children presenting with advanced leukaemia and non-Hodgkin's lymphoma may develop life-threatening complications in the early stages of management. Major metabolic disturbances with encephalopathy, septicaemic shock, pneumonitis, massive haemorrhage, or the physical effects of tumour masses may on occasion warrant intensive therapy. Close liaison between paediatric oncologists, oncological surgeons, and anesthesiologists is essential in establishing admission criteria for such cases and in defining therapeutic end points in the event of multisystem failure. This paper discusses the principles of intensive care management of patients with haematological malignancies by considering two cases who developed the tumour lysis syndrome with respiratory and renal failure. A case associated with metabolic encephalopathy is also described.- - - - - - - - - - ranking = 0.063421389834457keywords = physical (Clic here for more details about this article) |
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