approach to the patient with an adnexal mass

... 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 recognize To aid in the ... that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused ... (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than would hemorrhagic papules, which may indicate vasculitis or sepsis (Figs 52-4 and...

Ngày tải lên: 06/07/2014, 20:20

... predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); it is also commonly associated with xerosis and aged skin Systemic conditions that can be ... (i.e., 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...

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 ... 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, ... 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...

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

... irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous ... 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 ... (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

... against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted with forceps, and the bottom is cut with iris ... 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 by punch biopsy In the latter technique, ... History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history...

Ngày tải lên: 06/07/2014, 20:20

... suspected allergens is applied to the patient' s back under occlusive dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence ... a lesion and noting the amount of blanching that occurs Granulomas often have an opaque to transparent, brown-pink "apple jelly" appearance on diascopy Figure 52-11 Urticaria Discrete and confluent, ... edematous, erythematous papules and plaques are characteristic of this whealing eruption Wood's Light A Wood's lamp generates 360-nm ultraviolet (or "black") light that can be used to aid the...

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 ... 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 No nationwide cancer ... therefore, the incidence of cancer is estimated on the basis of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, which tabulates cancer incidence and...

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 ... cancer 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...

Ngày tải lên: 07/07/2014, 01:20

... Union Against Cancer and the American Joint Committee on Cancer (AJCC) The TNM classification is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor ... cancer are likely to fare worse, stage for stage, than fully active patients Physiologic reserve is a determinant of how a patient is likely to cope with the physiologic stresses imposed by the ... cancers, the International Federation of Gynecologists and Obstetricians (FIGO) classification for gynecologic cancers, and the Ann Arbor classification for Hodgkin's disease Certain tumors cannot...

Ngày tải lên: 07/07/2014, 01:20

... 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 ... 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 ... 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

... Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, ... 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 ... cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate cancer Prostatitis, antigen prostatic hypertrophy...

Ngày tải lên: 07/07/2014, 01:20

... 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 ... 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 ... consequence of the disease and some as a consequence of the treatment An understanding of these disease- and treatment-related problems may help in their detection and management Despite these concerns,...

Ngày tải lên: 07/07/2014, 01:20

... serotonin, histamine, opioid, and acetylcholine receptors The serotonin receptor antagonists ondansetron and granisetron are the most effective drugs against highly emetogenic agents, but they ... 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 physical examination The patient ... dexamethasone and oral metoclopramide, a dopamine receptor antagonist that also blocks serotonin receptors at high dosages The best strategy for preventing anticipatory emesis is to control emesis in the...

Ngày tải lên: 07/07/2014, 01:20

... 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

... 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 ... designers on the selected entities, and on the other hand to measure some shape properties to provide the interpretation of the object character Due to their first usage, these modelling tools have ... 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

... C-peptides lacking the five Table Measured and theoretical masses of the pancreatic islet peptides The experimental masses agree well with the theoretical masses of the candidate peptides Mass measurement ... 1b) The masses of the two intense signals to the right in the spectrum (Fig 1c) matched those of the proinsulin-derived C-peptides and The mass measurement error in a wellcalibrated FTICR mass ... from pancreatic islets (a), showing details of the insulin and (b) and C-peptides and (c) signals The most abundant peptides turned out to be those from proinsulin Insulin and and C-peptide and...

Ngày tải lên: 17/03/2014, 10:20

... 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 Manager uses the ... below illustrates the process If the instance is unable to meet the criteria it simply performs a cut and passes the call to the next instance Any instance that can provide the required service ... of the transaction, and then to process the transaction within that context Again, the system is aiming to find the object (the :representation of a realworld business) that is best suited to...

Ngày tải lên: 24/03/2014, 03:20

... beside these the greatest names in Venetian art, the Vivarini, the Bellini, Giorgione, Titian, and Tintoret The difference is striking The significance of the Venetian names is exhausted with their ... 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, ... themselves to work upon the specific problems of the art of figure-painting, and have neglected, more than any other school, to call to their aid the secondary pleasures of association With them...

Ngày tải lên: 29/03/2014, 12:20