1/9. Collusion in doctor-patient communication about imminent death: an ethnographic study.OBJECTIVE: To discover and explore the factors that result in the "false optimism about recovery" observed in patients with small cell lung cancer. DESIGN: A qualitative observational (ethnographic) study in 2 stages over 4 years. SETTING: lung diseases ward and outpatient clinic in a university hospital in the netherlands. PARTICIPANTS: 35 patients with small cell lung cancer. RESULTS: False optimism about recovery usually developed during the first course of chemotherapy and was most prevalent when the cancer could no longer be seen on x-ray films. This optimism tended to vanish when the tumor recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. patients gradually found out the facts about their poor prognosis, partly by their physical deterioration and partly through contact with fellow patients in a more advanced stage of the illness who were dying. False optimism about recovery was the result of an association between physicians' activism and patients' adherence to the treatment calendar and to the "recovery plot," which allowed them to avoid acknowledging explicitly what they should and could know. The physician did and did not want to pronounce a "death sentence," and the patient did and did not want to hear it. CONCLUSION: solutions to the problem of collusion between physician and patient require an active, patient-oriented approach by the physician. Perhaps solutions have to be found outside the physician-patient relationship itself--for example, by involving "treatment brokers."- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. Undifferentiated small-cell neoplasm of the petrous apex. A case report.We present a rare case of undifferentiated small-cell neoplasm involving the temporal bone petrous apex. The symptoms, physical examination, importance of roentgenographic findings, and pathologic findings are reviewed. While not absolutely conclusive, the collective evidence in this case supports a diagnosis of small-cell carcinoma of the lung with metastasis to the petrous apex. A discussion of temporal bone malignancies, their frequencies, and characteristics is included. To our knowledge, a review of the literature over the past 25 years reveals no other published cases of an undifferentiated small-cell carcinoma in the temporal bone.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Metastatic liver disease and fulminant hepatic failure: presentation of a case and review of the literature.Although liver metastases are commonly found in cancer patients, fulminant hepatic failure (FHF) secondary to diffuse liver infiltration is rare. Furthermore, clinical presentation and laboratory findings are obscure and far from being pathognomonic for the disease. We report a case of a patient who died in the intensive care unit of our hospital from multiple organ failure syndrome secondary to FHF, as a result of liver infiltration from poorly differentiated small cell lung carcinoma. We also present the current knowledge about the clinical picture, laboratory findings and physical history of neoplastic liver-metastasis-induced FHF.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. Multiple bilateral choroidal metastatic tumors from a small-cell neuroendocrine carcinoma of unknown primary site.PURPOSE: To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary. methods: The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented. RESULTS: The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identify the primary site. CONCLUSIONS: Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe this case together with a review of the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting.STUDY DESIGN: Resident's case problem. BACKGROUND: This paper describes the clinical course of a patient with low back pain (LBP) and left lower extremity pain and tingling, and how the physical therapist used clinical examination findings and a lack of improvement with conservative measures to initiate further medical evaluation, which resulted in a diagnosis of cancer as the primary cause of the patient's low back and hip pain. diagnosis: A 45-year-old man with chief complaints of left-sided LBP, left posterior thigh pain, and tingling along the anterolateral aspect of his left lower extremity was initially seen by a physical therapist in a direct access setting. Several components of the patient's history and physical examination were consistent with a mechanical neuromusculoskeletal dysfunction. However, there were signs and symptoms present that may have been suggestive of more serious underlying disease. Specifically, the patient's most intense pain was in the evening and into the night and an atypical pattern of restricted motion at the left hip was noted. Therefore, the physical therapist recommended that the patient schedule an appointment with his physician for medical evaluation. A short-term course of physical therapy treatment was also undertaken to address neuromusculoskeletal impairments. Despite 5 physical therapy visits over the course of a month, while the patient waited for his scheduled physician appointment, the patient's condition gradually worsened. After medical evaluation, the patient was eventually diagnosed with small cell carcinoma of the lung, with metastases to the spine and pelvis. Despite 2 cycles of chemotherapy, the patient succumbed to the cancer 5 months after he was first seen in physical therapy. DISCUSSION: It is important that physical therapists have an understanding of the clinical findings associated with the presence of serious underlying diseases causing LBP, as this information provides guidance as to when communication with the patient's physician is warranted.- - - - - - - - - - ranking = 12keywords = physical (Clic here for more details about this article) |
6/9. Ectopic production of antidiuretic hormone (adh), adrenocorticotrophic hormone (ACTH) and beta-melanocyte stimulating hormone (beta-msh) by an oat cell carcinoma of the lung.A 61 year old woman presented with profound hyponatremia and markedly low serum osmolality. urine osmolality was greater than the serum osmolality, an abnormality that was corrected by water restriction, suggesting inappropriate ADH secretion. Although there were no physical signs of Cushing's syndrome, her serum potassium level was low and markedly elevated levels of plasma and urine corticosteroids were not altered by the administration of large amounts of dexamethasone, suggesting the ectopic ACTH-MSH syndrome. plasma levels of immunoreactive ACTH and beta-msh were elevated. At autopsy, a metastastic oat cell carcinoma of the lung, not detected antemortem by chest roentgenograms and bronchoscopy, was found. Immunoreactive ADH, ACTH and beta-msh were detected in the primary tumor and in metastases to the liver. beta-msh was also detected in the spleen, in which metastases were observed. This is the first documented case of the simultaneous production of ADH, ACTH and beta-msh by neoplastic tissue associated with clinical manifestations of the syndrome of inappropriate ADH secretion and the ectopic ACTH-MSH syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Painful oral mucosal ulcers in a patient with small cell carcinoma of the lung.This case illustrates the development of multiple painful oral ulcers caused by methotrexate that was one of a combination of chemotherapeutic drugs administered for the treatment of small cell carcinoma of the lung. Although the oral mucositis is self-limiting and resolves when the drug dose is reduced or therapy is discontinued, severe pain and discomfort may cause physical debilitation. Moreover, the risk of secondary oral infections is high in patients undergoing such therapy, and if the appropriate treatment is not instituted, fatal systemic dissemination of the infection may occur.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. Sequential scintigraphic staging of small cell carcinoma.Thirty patients with small cell carcinoma (SCC) of the lung were sequentially staged following a history and physical exam with liver, bran, bone, and gallium-67 citrate scans. Scintigraphic evaluation disclosed 7 of 30 patients (23%) with advanced disease, stage IIIM1. When gallium-67 scans were used as the sole criteria for staging, they proved to be accurate and identified six of the seven patients with occult metastatic disease. gallium-67 scans proved to be accurate in detecting thoracic and extrathoracic metastases in the 30 patients with SCC, especially within the liver and lymph node-bearing area. The diagnostic accuracy of gallium-67 fell in regions such as bone or brain. Despite the limitations of gallium-67 scanning, the authors conclude that these scans are useful in staging patients with SCC and should be the initial scans used in staging such patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. Carcinoma of the cervix--a review.Carcinoma of the cervix is the fourth most common neoplasm in women. The mortality from this tumor has dropped with the advent of Papanicolaou smears and routine periodic screening, particularly in high risk populations. diagnosis and staging includes a careful physical examination, the use of colposcopy, directed biopsy, intravenous urogram and cystoscopy. Computed tomography and lymph-angiography may be helpful for detection of iliac or paraaortic lymph nodes. Early, noninvasive stages of this disease (CIN) may be treated with cryosurgery or laser vaporization. carcinoma in situ (CIS) and microinvasive carcinoma is usually treated with simple hysterectomy for cure. More advanced invasion localized to the cervix may be treated with radical hysterectomy or radiation therapy with 90% of patients surviving 5 years. More advanced tumors are treated with external and intracavitary radiation therapy. For patients with paraaortic lymph node involvement or recurrent tumor, 5-year survival is less than 10%. Chemotherapy may provide some palliation to patients with recurrent tumors but does not increase long term survivorship.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |