1/9. Not all facial paralysis is Bell's palsy: a case report.Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. A case of adenoid cystic carcinoma (ACC) of the breast and review of the utility of preoperative imaging diagnose.A case of adenoid cystic carcinoma (ACC) of the breast in a 66-year-old woman is reported herein. ACC accounts for about 0.1% of all breast cancers. Our patient presented with a small, elastic and hard mass, measuring 2.0x2.0 cm, between both outer quadrants of the right breast. Although physical examination, ultrasonography and magnetic resonance (MR) mammography suggested a benign tumor, aspiration biopsy cytology (ABC) was performed twice, and the second ABC specimen was evaluated as suspicious for breast carcinoma. breast conserving surgery with a level II lymph node dissection was subsequently performed. There was no lymph node metastases and estrogen receptor (ER) status was negative. light microscopy revealed various growth patterns, with the cells showing biphasic cellularity. According to immunohistochemical analyses, CEA, actin and vimentin were positive, S-100 protein was negative, and the cytokeratin reaction was partially positive. Therefore, ACC of the breast was diagnosed. Although ACC of the breast is a rare neoplasm, it should be considered in the differential diagnosis even if various diagnostic imaging studies suggest a benign tumor of the breast. awareness of this tumor will help prevent misdiagnosis.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
3/9. Adenoid cystic carcinoma of the breast: truly uncommon or easily overlooked?BACKGROUND: Adenoid cystic carcinoma of the breast is an uncommon histologic form of breast cancer, comprising in most series less than 1% of all mammary cancers. Due to the rarity, little information about its presentation on image studies has been noted in the literature. Here we report two additional cases with emphasis on the intriguing image presentations. CASE ONE: A 67-year-old woman came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. mammography showed a small well-defined nodule in the medial part of the left breast without mammographic evidence of malignancy. ultrasonography showed a 1.5 cm nodule with well-defined margin and heterogenous echogenicity in the medial part of the left breast. Unusually, a painful sensation was experienced on compression by the probe. The final pathological report was adenoid cystic carcinoma. CASE TWO: A 48-year-old woman also came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. mammography showed dense mammary tissue with no mammographic evidence of malignancy. ultrasonography showed two contiguous well-defined nodules with heterogenous echogenicity in the upper, middle part of the left breast. Unusually, a painful sensation was also noted on compression by the probe. Histopathological examination showed typical features of an adenoid cystic carcinoma. CONCLUSION: Adenoid cystic carcinoma of the breast fails to show the typical appearance of invasive ductal carcinoma on both mammogram and ultrasonography, probably due to its relatively well-defined nature with less surrounding architectural disruption and fibrosis. Hence a "negative" finding or a benign-looking breast lesion on mammography cannot completely exclude the existence of this disease. The presence of a painful breast lesion without obvious inflammatory evidence while compressed is a meaningful clue, which should lead to the suspicion of adenoid cystic carcinoma of the breast.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
4/9. Two cases of adenoid cystic carcinoma: preoperative cytological findings were useful in determining treatment strategy.Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and is known to have an excellent prognosis. We report two cases of ACC diagnosed by preoperative fine-needle aspiration cytology (FNAC), which proved to be very useful in determining the appropriate treatment. The patients were a 57-year-old woman (case 1) and a 71-year-old woman (case 2). On physical examinations and imaging studies both tumors were recognized as lobulated tumors that measured 3.0 x 2.3 cm (case 1) and 3.9 x 3.4 cm (case 2) respectively. FNAC materials showed clusters of malignant cells surrounding globules of mucus, therefore, ACC was diagnosed. Considering the characteristics of ACC, breast-conserving surgeries with axillary dissection and adjuvant radiotherapy were performed instead of primary chemotherapy or mastectomy. Histologically, a distinctive biphasic pattern was observed that consisted of true laminae and pseudocystic spaces. Tumor sizes were 4.0 x 3.3 cm (case 1) and 4.6 x 3.8 cm (case 2), respectively, and surgical margins were negative on microscopic examination. lymph node metastasis was not present in either case. Even though ACC is very rare, preoperative diagnosis can be made based on its characteristic features. Preoperative diagnosis is extremely useful for determining appropriate treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
5/9. Malignant neoplasms of the paranasal sinuses involving the skin.Malignant neoplasms of the mucosa and minor salivary glands of the paranasal sinuses may involve the skin by direct extension. When a tumor appears on the overlying skin, these sinuses should be considered as a possible site of origin. Adenoid cystic carcinoma of the paranasal sinuses arise from minor salivary glands. They can infiltrate overlying skin and easily be confused with a primary cutaneous adenoid cystic carcinoma. Malignant melanomas of the paranasal sinuses are clinically very aggressive. They are often amelanotic, and this may lead to an incorrect histopathologic diagnosis. Hence, physical and radiological examination of the nose, mouth, and paranasal sinuses should be performed whenever a tumor appears in the overlying skin that does not have a clear cutaneous origin or whenever the primary site of a metastatic malignant melanoma is unknown.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
6/9. Carcinoid tumors of the middle ear.Carcinoid tumors of the middle ear are rare lesions that represent a class within the spectrum of adenomatous neoplasms. We present four cases that were diagnosed and treated at our institution since 1973, and review the pool of 12 cases in regard to their presentation, symptomatology, physical examination, audiometric and radiographic evaluations, operative procedure and findings, histopathology, and postoperative course. Successful treatment of these low-grade malignancies requires complete excision of the tumor mass, along with the ossicles if they are involved with disease, in order to prevent local recurrence. Although locally invasive, these tumors have a low propensity for distant metastasis. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
7/9. Adenoid cystic carcinoma of the upper lip.An elderly man had a large adenoid cystic carcinoma (ACC) of the upper lip. Because of the patient's desire not to have a major surgical resection, the primary modality of treatment was irradiation. A local recurrence following radiation therapy did require surgery, however without morbidity. During the postoperative course extreme physical deterioration of the patient necessitated a complete medical work-up. This revealed lung nodules, not seen previously, which were suspected of being malignant. A barium enema also revealed a sigmoid lesion suggestive of malignancy. Since none of the suspected distant sites were histologically examined, the course of the ACC is left to conjecture. Also, it is left to conjecture as to what course might have followed had the patient been treated initially with a surgical resection. The patient died 20 months after the original diagnosis of the lip tumor was made.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
8/9. Stent flexibility: an essential feature in the treatment of dynamic airway collapse.Implantation of endobronchial stents for treatment of dynamic airway collapse represents a suitable therapeutic option to alleviate distressing symptoms. We report the case of a 43 year old patient suffering from progressive respiratory distress 2 weeks after insertion of a balloon-expandable radial noncompliant Palmaz stent in an unstable segment of the left main bronchus, with the aim of preventing symptomatic airway collapse. Bronchial instability had developed following sleeve resection of the right lung due to adenoid cystic carcinoma. Explanation revealed compression and deformation of the stent. Peak expiratory flow (PEF) had declined a low of 1.38 L.s-1 (forced expiratory volume in one second (FEV1) 1.02 L). With placement of a Strecker stent, having the ability to re-expand within certain limits, bronchial collapse could be avoided and marked clinical improvement as well as expiratory flow increase was noted (PEF 7.10 L.s-1; FEV1 = 2.03 L). At 13 months follow-up, clinical status was unchanged. A decline in forced expiratory flow (PEF 5.96 L.s-1; FEV1 1.69 L), however, indicated a possible change in the structural integrity of the Strecker stent. We conclude that physical properties of endobronchial stents may be crucial for good functional results in major airway collapse. Stiff prostheses, when compressed, can induce severe airway obstruction.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
9/9. An adjuvant afterloading brachytherapy device for use after orbital exenteration in patients with orbital malignancies.In cases of malignant diseases situated within the orbit and threaten to extend beyond it, removal of the orbit and periorbital contents may be indicated, followed by adjuvant chemotherapy or irradiation. An effective radiotherapy device for treatment of residual or suspicious cancer in the enucleated orbit consists of an external-beam radiation source (60Co) and an intraoperatively fitted mould as a guide for the flexible afterloading tubes using a 192Ir source. Considering the physical dose distribution and the local situation, this therapy permits a high dose with homogeneous dose distribution to the target area of the orbit but also allows significant dose reduction to adjunctive critical structures. Four patients with different orbital malignancies were treated by means of a combination of percutaneous radiotherapy with afterloading brachytherapy following orbital exenteration. The individual mould of the orbital cavity is modeled at the end of the operation. The technique of radiotherapy, dose distribution, and follow-up of the disease are demonstrated. Orbital malignancies with an extremely poor prognosis may profit from the application of this combined radiotherapy to avoid supraradical surgical intervention.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |