the patient with cardiac tamponade

... to the loss of the overlying retina If the edge of the dialysis remains close to the RPE, then the tear may not be discovered unless scleral depression is performed As the vitreous contracts, the ... observable with the fundus camera, for future reference cooperative.81 The optometrist should tell the patient that the risk associated with the treatment of a problematic retinal tear is less than the ... greater the possible loss of vision after reattachment of the retina The prognosis is very poor when the detachment involves the macula The longer the macula is detached, the poorer the resultant...

Ngày tải lên: 22/03/2014, 09:20

... differential diagnosis (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 ... skin lesions If the examiner focuses on linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and ... secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused by scratching Figure 52-1 Superficial spreading melanoma This is the most...

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 ... elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); it is also commonly associated with ... Erosion: Loss of epidermis without an associated loss of dermis Ulcer: Loss of epidermis and at least a portion of the underlying dermis Excoriation: Linear, angular erosions...

Ngày tải lên: 06/07/2014, 20:20

... possible to assess the distribution of the eruption accurately The patient should first be viewed from a distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution ... correlates highly with diagnosis (Fig 52-6) For example, a hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash ... during a physical examination: the distribution of the eruption, the types of primary and secondary lesions, the shape of individual lesions, and the arrangement of the lesions An ideal skin examination...

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

... 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 plaques with a target ... reaction to drugs (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

... the latter technique, a punch is pressed 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 ... selected 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 ... of the slide accelerates dissolution of keratin When the preparation is viewed under the microscope, the refractile hyphae will be seen more easily when the light intensity is reduced and the...

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 ... reactions (e.g., erythema, edema, or papulovesicles) This test is best performed by physicians with special expertise in patch testing and is often helpful in the evaluation of patients with chronic ... 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 pressure,...

Ngày tải lên: 06/07/2014, 20:20

... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease ... the 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 ... various populations in Table 77-2 Along with the decrease in incidence has come an increase in survival for cancer patients The 5-year survival for white patients was 39% in 1960–1963 and 68% in...

Ngày tải lên: 07/07/2014, 01:20

... 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 ... lymphoma Increasing evidence links the expression of certain genes with the prognosis and response to therapy (Chaps 79, 80) Occasionally a patient will present with a metastatic disease process ... workers, rehabilitation medicine specialists, and a number of other consulting professionals working closely with each other and with the patient and family ...

Ngày tải lên: 07/07/2014, 01:20

... categorizes the tumor on the basis of the size of the primary tumor lesion (T1–4, where a higher number indicates a tumor of larger size), the presence of nodal involvement (usually N0 and N1 for the ... other prognostic factors have been identified (Chaps 104, 105, and 106) In addition to tumor burden, a second major determinant of treatment outcome is the physiologic reserve of the patient Patients ... 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 cancer and its treatment This factor...

Ngày tải lên: 07/07/2014, 01:20

... to cure the patient and the pressure of a busy schedule greatly limit the time a physician spends with a patient who is receiving only palliative care Resist these forces In addition to the medicines ... interface with the Internet.2 The 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 ... complications of both the disease and its treatment as well as the complex psychosocial problems associated with cancer In the short term during a course of curative therapy, the patient' s functional...

Ngày tải lên: 07/07/2014, 01:20

... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific ... germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes ... Gestational trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma,...

Ngày tải lên: 07/07/2014, 01:20

... nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being ... biopsied If disease persists, the multidisciplinary team discusses a new salvage treatment plan If the patient has been rendered disease-free by the original treatment, the patient is followed regularly ... 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...

Ngày tải lên: 07/07/2014, 01:20

... which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause of pain ... caused by chemotherapy (Chap 81) Its severity can be predicted from the drugs used to treat the cancer Three forms of emesis are recognized on the basis of their timing with regard to the noxious ... signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in the medulla, the motor center...

Ngày tải lên: 07/07/2014, 01:20

... discussed openly with the patient An empathetic health care team is sensitive to the individual patient' s needs and permits negotiation where such flexibility will not adversely affect the course of ... course of treatment Cancer survivors have other sets of difficulties Patients may have fears associated with the termination of a treatment they associate with their continued survival Adjustments ... future as cytokine-mediated mechanisms are further elucidated Psychosocial Support The psychosocial needs of patients vary with their situation Patients undergoing treatment experience fear,...

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 ... 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 has been ... and the goal of palliative therapy is embraced in the hope of being able to live with disease; finally, at the disclosure of imminent death, another adjustment in outlook takes place The patient...

Ngày tải lên: 07/07/2014, 01:20

... pulse, and a BP of 137/58 mmHg The ventilator was turned back on, and the patient was treated with NTG, heparin, amiodarone drips and aspirin The next morning, the patient s troponin I level was ... in 43 patients with acute MI and severe pump failure In their series, the cardiac index increased from 1.7 to 2.2 L/min/m2, while the left ventricular filling pressure decreased by 35% The mean ... in some patients with cardiogenic shock due to acute MI or advanced heart failure The results are summarized in Table High doses of NTG were used in 22 patients, including 14 patients with acute...

Ngày tải lên: 11/08/2014, 14:20

... in this case the hernia sac was on the left side and the location of the stomach in front of the heart made very difficult an accurate echo evaluation of the cardiac function Further CT imaging ... bypass Lysis of the adhesions between the hernia sac and the lung parenchyma was necessary to relocate the protruded viscera into the abdomen without tendency (Figure 3) Finally the distended foramen ... confirmed the severe compression of the right ventricle In addition a severe aortic valvular stenosis complicated the diagnosis by worsening the clinical profile of the patient Up to now there has...

Ngày tải lên: 10/08/2014, 09:23

... decreased the absolute number of WT1/MHC tetramer+CD8+ cells and the decrease was maintained for two to three weeks On the other hand, in MLPC cells without the addition of WT1 peptides, the absolute ... imatinib therapy, we started WT1 peptide vaccination therapy in combination with imatinib in a CML patient who could not acquire a major molecular response through the administration with a single ... speculated to be the late effects of imatinib therapy at the dose of 600 mg a day However, bcr-abl transcripts gradually increased to more than 1,000 copies thereafter Since the patient was HLA-A*2402+...

Ngày tải lên: 26/10/2012, 09:39