1/18. Primary lymphoma of the liver: report of a case.We describe herein a female patient with non-Hodgkin's lymphoma of the liver and present a review of the related literature. The patient was referred with the diagnosis of malignant hemangiopericytoma (with an open biopsy). The physical examination, standard laboratory test results and tumor marker levels were all normal. A nonstandard left lobectomy was performed. Histopathological and immunohistochemical examinations revealed non-Hodgkin's lymphoma of B-cell type. The findings of a peripheral blood smear and bone marrow biopsy were normal. There was no other site of involvement based on physical or radiological examinations. These findings established the diagnosis of primary hepatic lymphoma. Fewer than 100 cases have been reported in the world literature. The best treatment results have been obtained by a resection followed by chemotherapy when feasible.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. adult-onset recalcitrant eczema: a marker of noncutaneous lymphoma or leukemia.BACKGROUND: Generalized eczema or erythroderma may be the presenting sign of cutaneous T-cell lymphoma. Additionally, intractable pruritus has been associated with Hodgkin's lymphoma. However, reports of adult-onset eczematous dermatitis has rarely been linked to noncutaneous lymphoproliferative disorders. OBSERVATIONS: We observed one patient in 1993 who had the onset of intractable dermatitis characterized by prurigo nodularis-like lesions and widespread erythematous plaques. After 18 months of cutaneous symptoms he experienced dyspnea. At this time Hodgkin's disease was diagnosed. This observation prompted us to evaluate subsequent patients with adult-onset eczema who were poorly responsive to therapy and in whom an obvious cause could not be determined. Over the next 24 months we identified an additional 2 patients with lymphoma who met this criteria. CONCLUSION: Unexplained eczema of adult onset may be associated with an underlying lymphoproliferative malignancy. When a readily identifiable cause (eg, contactants, drugs, or atopy) is not found, a systematic evaluation should be pursued. patients should be evaluated with a careful physical examination, complete blood cell counts, peripheral blood smears, chest roentgenography, computed tomography of the chest and abdomen, and serum protein electrophoresis.- - - - - - - - - - ranking = 0.92126204331005keywords = physical examination, physical (Clic here for more details about this article) |
3/18. Acute deterioration of charcot-marie-tooth disease IA (CMT IA) following 2 mg of vincristine chemotherapy.BACKGROUND: Severe up to life-threatening neuropathy has been observed in patients with hereditary neuropathies receiving vincristine. CASE REPORT: A 52-year-old female painter suffering from high-grade non-Hodgkin's lymphoma (stage IVB) was treated with a total of 4 mg of vincristine during two courses of CHOP chemotherapy (cyclophosphamide, vincristine, adriamycin, prednisone). At onset of treatment no neurological problems were reported. There was good lymphoma response to chemotherapy. At the same time, however, the patient gradually developed dysphagia, dysarthria, muscular weakness of both lower and upper extremities, areflexia, paraesthesia of the fingertips and bilateral sensory impairment of feet and lower legs. These symptoms continually worsened over a period of seven weeks until she was unable to walk or to perform her work. Electrophysiological studies showed peripheral axonal and demyelinative sensorimotor neuropathy in correlation to histological findings. Molecular analysis revealed 17p11.2 duplication typical for charcot-marie-tooth disease IA. While continuing chemotherapy without the use of vincristine the patient's neurologic symptoms slowly recovered within six months. CONCLUSION: Prior to administration of vincristine family and patient history as well as physical examination should be performed carefully to look for underlying hereditary neuropathy. For those patients with a clinical history or symptoms suggestive for CMT nerve conduction velocity studies and on an individual base even molecular genetic analysis are necessary to prevent serious neurologic complications. worsened significantly resulting in dependency on a wheelchair and inability to perform her work as a painter. Finally she consulted a neurologist and was admitted to hospital for further diagnostic studies and continuation of treatment for her lymphoma in March 1998 with a provisional diagnosis of severe vincristine-induced neuropathy. Medical history at time of admission included hyperthyroidism, that was currently treated with propylthiouracil, a MALT lymphoma 1983, that was treated surgically only, and a meningoencephalitis in 1968. No further medication was taken. In addition she had a history of lyme disease since 1993 with positive IgM-titer until December 1997, when antibiotic therapy with doxycycline and ceftriaxone was administered successfully. family history obtained on admission revealed that her mother had non-specific neuropathic symptoms as well as a poorly defined foot deformities of the mother's father. The patient's brother does not show any neurologic impairment and is in good physical health.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/18. Primary pelvic non-Hodgkin's lymphoma.OBJECTIVE: To describe five cases of primary pelvic non-Hodgkin's lymphoma, a rare gynecologic malignancy. methods: The charts of five women with primary pelvic non-Hodgkin's lymphoma were reviewed. Histologic classification was based on the Working Formulation, and staging was based on the Ann Arbor system. Disease status was monitored with physical examination and imaging studies. RESULTS: During a 10-month period, five women were diagnosed with primary pelvic non-Hodgkin's lymphoma, including one parasacral, one uterine, one vaginal, and two ovarian tumors. Presentations included abdominal and pelvic pain, abdominal and pelvic mass, and abnormal vaginal bleeding. Treatment included combination chemotherapy, with or without radiation. Four patients were alive and disease free 20--33 months after therapy. CONCLUSION: Primary pelvic non-Hodgkin's lymphoma may present like other more common gynecologic cancers. It should be considered in the differential diagnosis of gynecologic malignancy.- - - - - - - - - - ranking = 0.92126204331005keywords = physical examination, physical (Clic here for more details about this article) |
5/18. Malignant lymphoma presenting as unilateral eyelid mass.A 58 year-old man presented with a large mass in the upper eyelid of his only eye. He had no systemic symptoms, but his physical examination revealed slightly enlarged preauricular and axillary lymph nodes. Biopsies of the upper eyelid mass and the ipsilateral preauricular lymph node revealed a poorly differentiated lymphocytic lymphoma. This case is of ophthalmic interest because the eyelid mass was the initial manifestation of the lymphoma.- - - - - - - - - - ranking = 0.92126204331005keywords = physical examination, physical (Clic here for more details about this article) |
6/18. Understanding non-Hodgkin's lymphomas.NHLs are a complex group of diseases whose morphology and clinical presentation guide treatment choices. nurses caring for these patients need to have an understanding about how these diseases present themselves and how the treatment options affect patients' emotional and physical well-being.- - - - - - - - - - ranking = 0.078737956689947keywords = physical (Clic here for more details about this article) |
7/18. Verruciform xanthoma of the esophagus.Verruciform xanthoma is a distinctive lesion of oral mucosa and genital skin. It can be solitary or multifocal, as well as sporadic or associated with inflammatory, autoimmune, immunodeficient, metabolic, neoplastic, or congenital diseases. To our knowledge, it has not yet been described in the esophagus. The case of a 61-year-old man suffering from primary non-Hodgkin lymphoma of the testis is presented. Two years after initial diagnosis, mediastinal adenopathies were disclosed. Fractioned radiotherapy was administered; 3 years later, verruciform xanthoma of middle third of the esophagus was endoscopically resected. Histologically, the lesion showed acanthotic squamous mucosa infiltrated by neutrophils. Papillae were packed with foam cells that were positive for CD68 and vimentin antibodies. Verruciform xanthoma is a condition observed exclusively in squamous epithelia. From our viewpoint, physical agents play a preponderant role in the etiology, although viral agents may occasionally be involved in the development of this enigmatic lesion.- - - - - - - - - - ranking = 0.078737956689947keywords = physical (Clic here for more details about this article) |
8/18. Atypical lymphocytosis resembling non-Hodgkin's lymphoma in peritoneal effusion of infectious mononucleosis: a case report.Peritoneal effusion appears to be an unusual complication of infectious mononucleosis (IM). The cytological features of peritoneal effusion from a patient affected by IM are presented. The patient was a 21-year-old Japanese woman, with typical and physical findings of IM. ascites disappeared with resolution of acute IM. The cytospin smears of the ascitic fluid were highly cellular, consisting exclusively of lymphoid cells. Lymphoid cells were composed of large cells with broad basophilic cytoplasm, as well as of small to medium-sized cells having scant cytoplasm and irregularly shaped nuclei. The overall cytomorphological pictures posed serious difficulties in differentiating this condition from those of peripheral T-cell lymphomas manifesting ascites. The majority of atypical lymphocytes, including large cells, expressed CD3 and CD8. The present case indicates that IM should be added to the list of lesions considered for the differential diagnosis of non-Hodgkin's lymphoma of the peritoneal fluid, particularly regarding young adults.- - - - - - - - - - ranking = 0.078737956689947keywords = physical (Clic here for more details about this article) |
9/18. decision making for a painful hip: a case requiring referral.STUDY DESIGN: Resident's case problem. BACKGROUND: The purpose of this resident's case problem is to describe a 39-year-old female patient with insidious onset of hip pain. This patient had discrete findings on subjective physical examination that prompted referral for further imaging studies of the left hip and pelvis. Despite having seen multiple providers, no imaging of the involved hip or pelvis had been performed. A prolonged duration of symptoms, severe gait disturbance with an associted Trendelenburg sign, difficulty sleeping, and an empty end feel with passive range of motion increased concern that a pathological process might be present. diagnosis: Imaging studies revealed a large destructive soft-tissue tumor later found to be non-Hodgkin's lymphoma. DISCUSSION: It is incumbent upon physical therapists to be aware of the potential for severe pathological conditions that mimic musculoskeletal complaints to exist and understand how to identify patients for whom further testing and/or referral may be appropriate. Existing guidelines for low back pain may assist with decision making in the absence of specific guidelines for when to request imaging in patients with nontraumatic hip and pelvis pain. Proficiency in screening for conditions not amenable to physical therapy treatment or that require consultation to other health care professionals is essential to physical therapy practice.- - - - - - - - - - ranking = 1.1574759133799keywords = physical examination, physical (Clic here for more details about this article) |
10/18. streptococcus agalactiae sepsis after transfusion of a plateletpheresis concentrate: benefit of donor evaluation.BACKGROUND: Bacterial contamination of platelet (PLT) components is an important cause of transfusion reactions. Recent efforts have focused on heightened surveillance to detect contamination before transfusion to limit recipient morbidity and mortality. Although identifying the cause of contamination is most often viewed in the context of recipient safety, this case illustrates the importance of a thorough evaluation on donor safety. CASE REPORT: A 68-year-old woman experienced a severe febrile reaction after a plateletpheresis transfusion. Blood cultures from the patient and from the plateletpheresis component were both positive for the presence of streptococcus agalactiae. No abnormalities were identified on review of collection and processing records. The donor was asymptomatic and had a negative review of systems, a normal physical exam, normal laboratory values, and negative blood and urine cultures. One of three stool samples was positive for the presence of occult blood. colonoscopy revealed a Dukes Stage B colonic adenocarcinoma. Fifteen months after surgical resection and adjuvant chemotherapy, the donor had no evidence of recurrent tumor. CONCLUSION: Identification of bacteria in blood components should trigger a comprehensive donor evaluation, particularly if donor bacteremia is suspected. Organisms that may be associated with an enteric source should prompt a thorough gastrointestinal evaluation. Because the primary reservoir of S. agalactiae in the human body is the gastrointestinal tract, and because no findings suggested an alternate portal of entry in our male donor, a gastrointestinal source was suspected. In this case, an evaluation for organism-specific pathology led to early identification of a potentially curable large bowel lesion.- - - - - - - - - - ranking = 0.078737956689947keywords = physical (Clic here for more details about this article) |
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