approach to the patient with an abdominal or rectal mass

... (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than would hemorrhagic papules, ... erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient ... skin or systemic disease For instance, the sometimes minor differences in color and shape that distinguish a melanoma (Fig 52-1) from a benign nevomelanocytic nevus (Fig 52-2) can be difficult to...

Ngày tải lên: 06/07/2014, 20:20

... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing ... Violaceous to purple, polygonal lesions that resemble those seen in lichen planus Milia: Small, firm, white papules filled with keratin Morbilliform: Generalized, small erythematous macules and /or papules ... epidermis without an associated loss of dermis Ulcer: Loss of epidermis and at least a portion of the underlying dermis Excoriation: Linear, angular erosions that may be covered by crust and are...

Ngày tải lên: 06/07/2014, 20:20

... generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to the sun-exposed portions of the face Once the distribution of the lesions has ... examining the skin it is usually advisable to assess the patient before taking an extensive history This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated ... lesions, the shape of individual lesions, and the arrangement of the lesions An ideal skin examination includes evaluation of the skin, hair, and nails as well as the mucous membranes of the mouth,...

Ngày tải lên: 06/07/2014, 20:20

... The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with...

Ngày tải lên: 06/07/2014, 20:20

... multiple erythematous plaques with a target or iris morphology It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's ... contact (Fig 52-10) or primary irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption ... (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... Ongoing or previous illnesses History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) ... areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed ... information In most instances, they can be performed at the bedside with a minimum of equipment Skin Biopsy A skin biopsy is a straightforward minor surgical procedure; however, it is important...

Ngày tải lên: 06/07/2014, 20:20

... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled Urticaria (Fig 52-11) will blanch with ... not Diascopy is performed by pressing a microscope slide or magnifying lens against a lesion and noting the amount of blanching that occurs Granulomas often have an opaque to transparent, brown-pink ... minutissimum) to show a characteristic coral pink color, and wounds colonized by Pseudomonas to appear pale blue Tinea capitis caused by certain dermatophytes such as Microsporum canis or M audouini...

Ngày tải lên: 06/07/2014, 20:20

... desperate significance Cancer is an exception to the coordinated interaction among cells and organs In general, the cells of a multicellular organism are programmed for collaboration Many diseases ... traitorous behavior of cancer cells is that the patient feels betrayed by his or her body The cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem ... diseases occur because the specialized cells fail to perform their assigned task Cancer takes this malfunction one step further Not only is there a failure of the cancer cell to maintain its specialized...

Ngày tải lên: 07/07/2014, 01:20

... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past ... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease or a...

Ngày tải lên: 07/07/2014, 01:20

... used, such as the patient' s age or Karnofsky performance status (Table 77-4) Older patients and those with a Karnofsky performance status

Ngày tải lên: 07/07/2014, 01:20

... may precede or follow other treatment approaches It is best for the treatment plan either to follow a standard protocol precisely or else to be part of an ongoing clinical research protocol evaluating ... skilled physician also has much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and the pressure ... the time a physician spends with a patient who is receiving only palliative care Resist these forces In addition to the medicines administered to alleviate symptoms (see below), it is important...

Ngày tải lên: 07/07/2014, 01:20

... Tumor Markers Tumor Markers Cancer NonNeoplastic Conditions Hormones Human chorionic gonadotropin Gestational trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer ... Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate cancer Prostatitis, antigen prostatic ... immunoglobulin CA-125 Ovarian cancer, some lymphomas Menstruation, peritonitis, pregnancy CA 19-9 Colon, pancreatic, breast cancer CD30 ulcerative colitis Hodgkin's disease, anaplastic Pancreatitis, large...

Ngày tải lên: 07/07/2014, 01:20

... most patients who are cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms ... the history and physical examination are the major investigations performed As time passes, the likelihood of recurrence of the primary cancer diminishes For many types of cancer, survival for ... Physicians should strive to keep communications open and nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity...

Ngày tải lên: 07/07/2014, 01:20

... temporal features, provocative and palliative factors, and intensity (Chap 12); a review of the oncologic history and past medical history as well as personal and social history; and a thorough ... therapy and can be controlled with oral dexamethasone and oral metoclopramide, a dopamine receptor antagonist that also blocks serotonin receptors at high dosages The best strategy for preventing anticipatory ... serotonin, histamine, opioid, and acetylcholine receptors The serotonin receptor antagonists ondansetron and granisetron are the most effective drugs against highly emetogenic agents, but they...

Ngày tải lên: 07/07/2014, 01:20

... tumorderived factors (e.g., bombesin, adrenocorticotropic hormone) and host-derived factors (e.g., tumor necrosis factor, interleukins and 6, growth hormone) contribute to the altered metabolism, and a ... glucose intolerance, and lipolysis cannot be reversed by the provision of calories It remains controversial how to assess nutritional status and when and how to intervene Efforts to make the assessment ... position; and, after 1– h, the tube is again attached to suction for another 24 h The tube is then disconnected from suction and allowed to drain by gravity If

Ngày tải lên: 07/07/2014, 01:20

... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions ... discussions can be difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything that can be done to ... acceptance, and hope Of course, patients not all progress through all the stages or proceed through them in the same order or at the same rate Nevertheless, developing an understanding of how the patient...

Ngày tải lên: 07/07/2014, 01:20

... wore an elastic abdominal belt and was provided with analgesics and physical therapy with intense respiratory training The suction drains and suture material were removed on schedule, the postoperative ... of the colon showed signs of adhesions in the colon sigmoideum and transversum, but no other pathologies; the laboratory values were normal Apart from an appendectomy performed 20 years ago, the ... artery flap (SIEA-flap) or gluteal artery perforator flap (GAPflap) [13] These flaps preserve the anterior rectus sheath and therefore minimize the risk of a hernia or bulge formation, although this...

Ngày tải lên: 11/08/2014, 23:21

... product and end-users identify this language as the most important for improving their normal activities and communication Therefore for the prototype development it has been decided to give the ... implies to have tools able to preserve the aesthetic design intent during the required model modifications and able to extract the aesthetic character from CAD models and compare it to others and /or ... www.think3.com) For the propagation of the change to the surface, the following aspects have to be kept into account and are now under consideration: • How to preserve the CSE s’ semantic: e.g if the CSE...

Ngày tải lên: 16/03/2014, 18:20

... its high-level analysis, performs like a human receptionist or operator and passes the enquiry to the most relevant subclass for a more detailed analysis specific to that subclass Any available ... travel, or events, say) on to the class candidate list within Domain Spotter Otherwise it performs a Prolog cut and allows the call to pass to another subclass In the next dialogue turn the Dialogue ... above), the user may supply rather more than this Using the heuristics of the relevant Expert subclass (here the Travel Expert), the system analyses the supplied information, to try to establish the...

Ngày tải lên: 24/03/2014, 03:20

... unknown to Michelangelo as to Dante before him, or, for that matter, to any other of the world’s creative geniuses at any time Even had he felt them, he had no means of expressing them, for his ... line, the significant light and shade, the significant look up or down, and the significant gesture, with means technically of the simplest, and, be it remembered, with no knowledge of anatomy, ... for the materially significant which makes us realise to the utmost their power and dignity; and the spiritual significance thus gained he uses to give the highest import to the event he is portraying;...

Ngày tải lên: 29/03/2014, 12:20