Real-time ultrasound elasticity of the breast: initial clinical results.
*Elasticity Imaging Techniques; *Image Processing; Adult; Aged; Biopsy; Breast; Breast – Pathology; Breast Diseases/diagnostic imaging/pathology; Breast Neoplasms – Diagnosis; Breast Neoplasms/*diagnostic imaging/*pathology; Computer-Assisted; Data Analysis Software; Diagnosis; Differential; Elasticity; Equipment and Supplies; Female; Humans; Immunohistochemistry; Mammary/*methods; Middle Aged; Needle; Ohio; Sensitivity and Specificity; Ultrasonography
PURPOSE: To determine the sensitivity and specificity of a real-time elasticity imaging (EI) ultrasound (US) system in the characterization of breast lesions as benign or malignant. METHODS: A total of 208 patients with 251 lesions were scheduled to undergo a US-guided breast biopsy for a mass identified on B-mode US, and each received a real-time elasticity image of the lesion before the biopsy. The lesion size measurements were obtained, and the EI/B-mode size ratio was obtained. The pathology report was obtained and correlated with the EI/B-mode ratio. An EI/B-mode ratio equal to or greater than 1 was considered malignant lesion, whereas EI/B-mode ratios of less than 1 were considered benign. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated. RESULTS: Of the 251 lesions biopsied, 197 were pathologically benign, and 54 were malignant. Of the 54 malignant lesions, all had an EI/B-mode ratio equal to or greater than 1. Of the 197 benign lesions, 187 had an EI/B-mode ratio of less than 1. Ten benign lesions had an EI/B-mode ratio of greater than 1. The benign lesions that had an EI/B-mode ratio of greater than 1 were lesions with dense fibrosis, and in addition, a characteristic artifact was identified, which was visualized in all simple and complex cysts. The results correspond with a sensitivity of 100%, specificity of 95%, a positive predictive value of 84%, and a negative predictive value of 100%. CONCLUSIONS: Initial results of a real-time EI system for characterization of breast lesions suggest this technique can provide significant new diagnostic information. As a result, this information may significantly improve the ability to select patients for breast biopsy, resulting in a reduction in the number of benign breast biopsies.
Barr Richard G
Ultrasound quarterly
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e3181dc7ce4" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e3181dc7ce4</a>
Shear wave ultrasound elastography of the prostate: initial results.
*Endosonography; Aged; Biopsy; Biopsy – Methods; Diagnosis; Differential; Elasticity; Elasticity Imaging Techniques/*methods; Equipment and Supplies; Follow-Up Studies; Health Screening; Human; Humans; Magnetic Resonance Imaging; Male; Middle Age; Middle Aged; Ohio; Predictive Value of Tests; Prospective Studies; Prostate – Analysis; Prostate – Anatomy and Histology; Prostate-Specific Antigen – Blood; Prostate/*diagnostic imaging/pathology; Prostatic Hypertrophy; Prostatic Neoplasms – Diagnosis; Prostatic Neoplasms – Pathology; Prostatic Neoplasms/*diagnostic imaging/pathology; Rectum; ROC Curve; Sensitivity and Specificity; Spectrum Analysis; Ultrasonography – Methods
PURPOSE: This prospective study was to evaluate shear wave elastography (SWE) in the detection of prostate cancer (PC). METHODS: Patients scheduled for a transrectal ultrasound (TRUS) biopsy of the prostate because of elevated prostate-specific antigen levels or abnormal digital rectal examination result underwent a standard TRUS and SWE. A second TRUS examination and sextant biopsy by a second physician blinded to SWE results was then performed. Pathologic result was reviewed, and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. RESULTS: A total of 53 patients (318 sextants) participated in the study. Mean age was 64.2 years (range, 53-79 years). A total of 26 foci of PC were detected in 11 patients (20.7%). On the basis of the receiver operating characteristic curve, a value of 37 kPa was used as the cutoff between benign and malignant. This produced a sensitivity of 96.2% (25/26), a specificity of 96.2% (281/292), a PPV of 69.4% (25/36), and an NPV of 99.6% (281/282). Six (55%) of 11 false-positive samples were secondary to benign calcifications. The Young modulus of PC ranged from 30 to 110 kPa (mean [SD], 58.0 [20.7] kPa). At the patient level, if a cutoff of 40 kPa was used, all PCs would have been detected, and the positive biopsy rate would be 11 (50%) of 22 compared to 11 (20.8%) of 53 without SWE–a 140% increase in the positive biopsy rate. CONCLUSIONS: Shear wave elastography has a high sensitivity, specificity, PPV, and NPV for the detection of PC. With a high PPV, patients with elevated prostate-specific antigen levels or abnormal results in the digital rectal examination and negative SWE may not require biopsy. This could significantly reduce the negative biopsy rate in PC detection.
Barr Richard G; Memo Richard; Schaub Carl R
Ultrasound quarterly
2012
2012-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e318249f594" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e318249f594</a>
Lung cancer metastatic to breast: case report and review of the literature.
Adenocarcinoma; Adenocarcinoma – Ultrasonography; Adenocarcinoma/*diagnostic imaging/*secondary; Breast Neoplasms; Breast Neoplasms – Ultrasonography; Breast Neoplasms/*diagnostic imaging/*secondary; Diagnosis; Differential; Female; Humans; Lung Neoplasms – Ultrasonography; Lung Neoplasms/*diagnostic imaging; Mammary/*methods; Middle Age; Middle Aged; Ultrasonography; Ultrasonography – Methods
The incidence of metastases to the breast from nonbreast carcinoma is less than 1% of all breast cancers; of these, adenocarcinoma of the lung to breast is a small proportion (\textless0.1% of breast carcinomas). The imaging findings of a case of metastatic lung adenocarcinoma to the breast are presented with a review of the literature. Imaging findings including elastography suggesting the breast mass is not a primary breast cancer are highlighted. The importance of notifying the pathologist that nonbreast metastatic disease is in the differential is discussed. The use of appropriate tumor markers is needed; otherwise, the lesion may be interpreted as a triple negative breast cancer.
Sousaris Nicholas; Mendelsohn Geoffrey; Barr Richard G
Ultrasound quarterly
2013
2013-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/RUQ.0b013e3182a00fc4" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0b013e3182a00fc4</a>
Benign hyperostotic mass of the frontal bone.
Bone Transplantation/methods; Diagnosis; Differential; Female; Frontal Bone/diagnostic imaging/surgery; Humans; Hyperostosis Frontalis Interna/*diagnosis; Osteotomy/methods; Tomography; X-Ray Computed; Young Adult
Diagnosis of a slow-growing mass of the cranium can be challenging. We present a rare clinical report of a 19-year-old woman with a unilateral mass of the frontal bone. Pathological diagnosis was hyperostosis, which is extremely rare in this age group. A comprehensive review of literature with recommendations for diagnostic modalities and treatment options is reported. Specifically, hyperostosis frontalis interna can be evaluated with computed tomography imaging of the cranium and treated with resection and reconstruction with split calvarial bone grafts. Annual radiographic imaging is recommended to ensure remission.
Chen Oriana I; Murthy Ananth S
The Journal of craniofacial surgery
2012
2012-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SCS.0b013e31824209a1" target="_blank" rel="noreferrer noopener">10.1097/SCS.0b013e31824209a1</a>
Air in temporomandibular joint: an indirect, specific CT sign of temporal bone fracture in the setting of head trauma.
Craniocerebral Trauma/diagnostic imaging; Diagnosis; Differential; Humans; Male; Pneumocephalus/*diagnostic imaging/etiology; Skull Fractures/complications/*diagnostic imaging; Temporal Bone/diagnostic imaging/*injuries; Temporomandibular Joint/*diagnostic imaging/injuries; Tomography; X-Ray Computed; Young Adult
Montaser Anoosh; Goyal Manish; Weiner Mark A
The Journal of trauma
2011
2011-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/TA.0b013e3181e9c14d" target="_blank" rel="noreferrer noopener">10.1097/TA.0b013e3181e9c14d</a>
The CARE approach to reducing diagnostic errors.
*Checklist; 80 and over; Aged; Allergic Contact/*diagnosis/therapy; Bias; Communication; Dermatitis; Dermatology/*methods; Diagnosis; Diagnostic Errors/*prevention & control; Differential; Female; Humans; Patient Care Planning
BACKGROUND: Diagnostic errors appear to be the most common, costly, and dangerous of all medical mistakes. There has been a notable increase on the focus of error prevention as part of a growing patient safety movement. However, diagnostic errors have received less attention than other types of error. Our goal is to present a short mnemonic that can act as a checklist or posted reminder to help practitioners in dermatology or any field of medicine to avoid diagnostic errors. METHODS: To meet this goal, the authors reviewed the literature and discussed errors and potential errors they have experienced over 55 years of combined practice, to create a short mnemonic. RESULTS: The CARE method has helped the authors prepare and review their differential diagnoses in the relatively fast-paced practice of dermatology, but it has yet to be tested on a large scale. CONCLUSION: The CARE (communicate, assess for biased reasoning, reconsider differential diagnoses, enact a plan) method is an efficient, recallable checklist that uses an educational approach to reduce diagnostic error while reminding us to simply "care" from a humanistic perspective. This method may help reduce preventable diagnostic errors and improve patient care.
Rush Jess L; Helms Stephen E; Mostow Eliot N
International journal of dermatology
2017
2017-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/ijd.13532" target="_blank" rel="noreferrer noopener">10.1111/ijd.13532</a>
An unusual dermatitis with annular lesions.
Atopic/*pathology; Biopsy; Child; Congenital/*pathology; Dermatitis; Diagnosis; Differential; Hair/*abnormalities/*pathology; Humans; Ichthyosiform Erythroderma; Male; Psoriasis/pathology; Scalp/pathology; Syndrome
Cernik Christina; Trevino Julian; Janik Matthew
Pediatric dermatology
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1525-1470.2008.00622.x" target="_blank" rel="noreferrer noopener">10.1111/j.1525-1470.2008.00622.x</a>
Metastatic colorectal carcinoma: an unusual presentation.
Aged; Carcinoma; Colorectal Neoplasms/*pathology; Diagnosis; Differential; Humans; Lip Neoplasms/*secondary; Lymphatic Metastasis/pathology; Male; Signet Ring Cell/*secondary; Skin Neoplasms/*secondary; Sweat Gland Neoplasms/pathology
Cutaneous metastases from colorectal carcinomas occur infrequently, usually in the setting of disseminated disease. They most commonly appear on the abdominal wall or perineal area; metastases to other locations of the skin are rare. We describe a case of colorectal signet ring carcinoma with metastasis to the upper lip. To the authors' knowledge, this is the second reported case of colorectal carcinoma with metastasis to the lip and first with signet ring features. Because of the rarity of cutaneous metastases, the primary physician or pathologist may overlook this diagnosis. However, this entity should be considered in the differential diagnosis of adnexal tumors as it may be the initial presentation of the colon carcinoma.
Moonda Afreen; Fatteh Shokat
Journal of cutaneous pathology
2009
2009-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1600-0560.2008.01007.x" target="_blank" rel="noreferrer noopener">10.1111/j.1600-0560.2008.01007.x</a>
Inflammatory arthritis in Pongo.
*Primate Diseases; Animals; Diagnosis; Differential; Female; Joints/pathology; Male; Museums; Osteoarthritis/pathology/*veterinary; Pongo pygmaeus; United States; Wild
As the arboreal ape, Pongo, has an unusual ground ambulation adaptation, it was of interest to assess the impact of Pongo gait on patterns of arthritis. While osteoarthritis was not identified in Pongo, 11% of individual skeletons were afflicted with an inflammatory, erosive arthritis. The presence of sacroiliac involvement and the nature and distribution of erosive lesions allowed definitive diagnosis of spondyloarthropathy. Character, distribution, and radiologic appearance revealed a picture distinguishable from spondyloarthropathy in other primates.
Rothschild B M; Woods R J
Journal of medical primatology
1996
1996-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1600-0684.1996.tb00037.x" target="_blank" rel="noreferrer noopener">10.1111/j.1600-0684.1996.tb00037.x</a>
Cerebral venous thrombosis masquerading as pseudotumour cerebri in a paediatric patient.
*Magnetic Resonance Angiography; Antiphospholipid Syndrome – Complications; Antiphospholipid Syndrome – Diagnosis; Antiphospholipid Syndrome/complications/*diagnosis; Child; Diagnosis; Differential; Humans; Intracranial Embolism and Thrombosis – Diagnosis; Intracranial Embolism and Thrombosis – Etiology; Intracranial Hypertension – Diagnosis; Lateral Sinus Thrombosis/*diagnosis/etiology; Magnetic Resonance Angiography; Male; Pseudotumor Cerebri/*diagnosis
Ridha Faisal; Erzurum Sergul A
Journal of paediatrics and child health
2014
2014-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jpc.12548" target="_blank" rel="noreferrer noopener">10.1111/jpc.12548</a>
Thyroid Ultrasound: State of the Art. Part 2 - Focal Thyroid Lesions.
*Practice Guidelines as Topic; Computer Assisted – Methods; Computer-Assisted/*methods; Diagnosis; Differential; Evidence-Based; Evidence-Based Medicine; Humans; Image Enhancement – Methods; Image Enhancement/methods; Image Interpretation; Medical Practice; Practice Guidelines; Reproducibility of Results; Scales; Sensitivity and Specificity; Thyroid Gland; Thyroid Gland – Pathology; Thyroid Gland/*diagnostic imaging/pathology; Thyroid Nodule; Thyroid Nodule – Pathology; Thyroid Nodule/*diagnostic imaging/pathology; Ultrasonography – Methods; Ultrasonography – Standards; Ultrasonography/*methods/*standards
Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.
Dighe Manjiri; Barr Richard; Bojunga Jorg; Cantisani Vito; Chammas Maria Cristina; Cosgrove David; Cui Xin-Wu; Dong Yi; Fenner Franziska; Radzina Maija; Vinayak Sudhir; Xu Jun-Mei; Dietrich Christoph F
Medical ultrasonography
2017
2017-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.11152/mu-999" target="_blank" rel="noreferrer noopener">10.11152/mu-999</a>
The often overlooked digital tuft: clues to diagnosis and pathophysiology of neuropathic disease and spondyloarthropathy.
*Foot Bones/pathology; Adult; Alcoholism/complications; Arthropathy; Bone/etiology; Diabetes Mellitus/pathology; Diagnosis; Diaphyses/pathology; Differential; Female; Fractures; Humans; Leprosy/diagnosis/pathology; Male; Middle Aged; Neurogenic/*diagnosis/etiology/pathology; Neurosyphilis/diagnosis/pathology; Scleroderma; Spondylarthropathies/*diagnosis/pathology; Stroke/complications; Systemic/diagnosis
OBJECTIVE: To assess diagnostic implications of abnormalities of the pedal digital tufts and to identify features to facilitate distinguishing of spondyloarthropathy and leprosy. BACKGROUND: Better criteria for distinguishing between these disorders are necessary if their character, natural history, and evolution are to be understood. METHODS: Pedal x rays of 91 consecutive patients with diabetes, 21 alcoholic patients, 100 with spondyloarthropathy, 8 with scleroderma, and 137 with leprosy, and 188 defleshed skeletons of individuals with alcoholism, syphilis, cerebrovascular disease, and paraplegia from the Terry and Hamman-Todd collections were examined for evidence of osseous and articular pathologies. Digital tuft abnormalities were divided into irregularity, divot, flattening, resorption, whittling, and fragmentation. RESULTS: Tuft divots were more common in alcoholics than in diabetic, and were more common in both than in the other groups studied. Tuft flattening was limited to alcoholic and neurosyphilis groups. Tuft whittling was especially prominent among individuals with spondyloarthropathy, contrasted with leprosy and diabetes. Aligned fractures were more common in diabetics than individuals with leprosy. Misaligned fractures were limited to individuals with leprosy and neurosyphilis. Leprosy and spondyloarthropathy were complicated by phalangeal and metatarsal whittling more commonly than other diseases studied. Background pedal abnormalities, derived from individuals with cardiovascular syphilis, cerebrovascular accidents, and paraplegia, was limited to abnormal divots only. CONCLUSIONS: Pedal digital tufts undergo a variety of pathological alterations useful in the recognition of disorders traditionally considered neuropathic in aetiology and in distinguishing differential considerations. Tuft flattening appears specific for alcoholism and neurosyphilis, and misaligned fractures seem specific for neurosyphilis and leprosy, providing differential assistance related to spondyloarthropathy. Conversely, periosteal reaction distinguishes spondyloarthropathy from leprosy.
Rothschild B M; Behnam S
Annals of the rheumatic diseases
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/ard.2004.021303" target="_blank" rel="noreferrer noopener">10.1136/ard.2004.021303</a>
Trigeminal neuralgia.
*Trigeminal Neuralgia/diagnosis/physiopathology/therapy; Analgesics; Carbamazepine/therapeutic use; Diagnosis; Differential; Humans; Non-Narcotic/therapeutic use; Physical Examination
Trigeminal neuralgia is an uncommon disorder characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Typically, brief attacks are triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze. The pain is nearly always unilateral, and it may occur repeatedly throughout the day. The diagnosis is typically determined clinically, although imaging studies or referral for specialized testing may be necessary to rule out other diseases. Accurate and prompt diagnosis is important because the pain of trigeminal neuralgia can be severe. Carbamazepine is the drug of choice for the initial treatment of trigeminal neuralgia; however, baclofen, gabapentin, and other drugs may provide relief in refractory cases. Neurosurgical treatments may help patients in whom medical therapy is unsuccessful or poorly tolerated.
Krafft Rudolph M
American Family Physician
2008
2008-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/bmj.g474" target="_blank" rel="noreferrer noopener">10.1136/bmj.g474</a>
Diagnosis of 'possible' mitochondrial disease: an existential crisis.
clinical genetics; diagnosis; evidence based practice; metabolic disorders
Primary genetic mitochondrial diseases are often difficult to diagnose, and the term 'possible' mitochondrial disease is used frequently by clinicians when such a diagnosis is suspected. There are now many known phenocopies of mitochondrial disease. Advances in genomic testing have shown that some patients with a clinical phenotype and biochemical abnormalities suggesting mitochondrial disease may have other genetic disorders. In instances when a genetic diagnosis cannot be confirmed, a diagnosis of 'possible' mitochondrial disease may result in harm to patients and their families, creating anxiety, delaying appropriate diagnosis and leading to inappropriate management or care. A categorisation of 'diagnosis uncertain', together with a specific description of the metabolic or genetic abnormalities identified, is preferred when a mitochondrial disease cannot be genetically confirmed.
Parikh Sumit; Karaa Amel; Goldstein Amy; Bertini Enrico Silvio; Chinnery Patrick F; Christodoulou John; Cohen Bruce H; Davis Ryan L; Falk Marni J; Fratter Carl; Horvath Rita; Koenig Mary Kay; Mancuso Michaelangelo; McCormack Shana; McCormick Elizabeth M; McFarland Robert; Nesbitt Victoria; Schiff Manuel; Steele Hannah; Stockler Silvia; Sue Carolyn; Tarnopolsky Mark; Thorburn David R; Vockley Jerry; Rahman Shamima
Journal of medical genetics
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/jmedgenet-2018-105800" target="_blank" rel="noreferrer noopener">10.1136/jmedgenet-2018-105800</a>
Relevance of routine admission electrocardiograms for psychiatric patients.
Adult; Aged; Arrhythmias; Cardiac/diagnosis/*epidemiology/etiology; Comorbidity; Cost Savings; Diagnosis; Diagnostic Tests; Dual (Psychiatry); Electrocardiography/economics/*statistics & numerical data; Female; Humans; Male; Mental Disorders/diagnosis/*epidemiology/rehabilitation; Middle Aged; Myocardial Ischemia/diagnosis/*epidemiology/etiology; Patient Admission/economics/*statistics & numerical data; Routine/economics/*statistics & numerical data; Sensitivity and Specificity; Treatment Outcome
OBJECTIVE: To make clinically relevant recommendations for electrocardiogram (ECG) testing among psychiatric patients, the study examined the practice of ordering ECGs for this population. METHODS: The records of 4,045 patients consecutively admitted for psychiatric care to seven community teaching hospitals over one year were examined. The frequency of ECG orders was documented, and abnormal ECG results were grouped into two categories: relevant to psychiatric treatment (ischemia or conduction defects) and incidental to treatment (minor abnormalities and screening abnormalities). For those with abnormalities, additional cardiac follow-up data were recorded. Associations between ECG results and patients' characteristics were analyzed. RESULTS: ECGs were performed for 2,857 (71 percent) of first admissions, of which 2,225 (78 percent) showed neither relevant nor screening abnormalities. Eighteen percent of those tested had relevant abnormalities, most commonly a first-degree atrioventricular block or some evidence of a myocardial infarction. ECG screening abnormalities were found for another 4 percent, primarily left ventricular hypertrophy (3 percent), but no follow-up occurred for 46 percent of these patients. Among patients under 40 years of age, 8 percent had relevant abnormalities, and 3 percent had screening abnormalities. Among patients without apparent cardiac risk, 10 percent had relevant and 3 percent had screening abnormalities. More than half the patients who had a second or third admission during the year had a repeat ECG, even when previous ECGs were normal. CONCLUSIONS: Routine ECG is not an effective treatment or screening tool in this population, and substantial cost savings could result from more selective testing, particularly among young patients, those at low risk, and those with repeat admissions.
Heiselman D E; Bredle D L; Kessler E; Rutecki G W; Hines R M; Whittier F C; Bunn P D; Ognibene A J
Psychiatric services (Washington, D.C.)
1997
1997-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1176/ps.48.10.1323" target="_blank" rel="noreferrer noopener">10.1176/ps.48.10.1323</a>
The Case of the Previously Shaky, Unimmunized, Itchy Infant With Rash and Pancytopenia.
Anticonvulsants/*adverse effects; Antipyretics/therapeutic use; Convulsions; Diagnosis; Differential; Drug Hypersensitivity Syndrome/*diagnosis; Drug Reaction With Eosinophilia and System Symptoms Syndrome – Diagnosis; Exanthema/etiology; Febrile – Drug Therapy; Febrile/drug therapy; Humans; Infant; Male; Pancytopenia/etiology; Phenobarbital – Administration and Dosage; Phenobarbital – Adverse Effects; Phenobarbital/*adverse effects; Seizures
Wolski Thomas P Jr; Blasick Stephanie; Blackford Martha G
Clinical pediatrics
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0009922816629618" target="_blank" rel="noreferrer noopener">10.1177/0009922816629618</a>
A Rare Case of Tubulointerstitial Nephritis and Uveitis Syndrome Treated with a Multi-Specialty Approach.
Female; Humans; Young Adult; Follow-Up Studies; Biopsy; Glucocorticoids/administration & dosage; Kidney/*diagnostic imaging; Prednisolone/administration & dosage/*analogs & derivatives; Prednisone/*administration & dosage; Recurrence; Uveitis/diagnosis/*drug therapy; Diagnosis; Dose-Response Relationship; Drug; Differential; Drug Therapy; Combination; Interstitial/diagnosis/*drug therapy; Nephritis
BACKGROUND It is important for an ophthalmologist and nephrologist to look for hidden causes of uveitis and nephritis, respectively. Delay in diagnosis leads to increased morbidity and failure to systemically manage the patient results in future recurrence of disease. It is likely that TINU remains underdiagnosed and could potentially account for some of the cases of idiopathic uveitis, especially when greater than 50% of uveitis cases have no identifiable cause. Fewer than 300 cases of tubulointerstitial nephritis and uveitis (TINU) syndrome have been reported. In TINU syndrome, inflammation affects the renal tubules, interstitial tissue, and uveal tract. Its pathogenesis remains poorly understood. CASE REPORT We report a rare case of TINU syndrome in a 23-year-old female who was treated using a multispecialty approach. Her primary care physician diagnosed her with proteinuria and acute kidney injury and referred her to the nephrologist, who later referred her to the ophthalmologist. A left kidney biopsy confirmed acute interstitial nephritis. Following the discovery of a "pink eye", the patient was referred to ophthalmology and diagnosed with anterior uveitis, confirming TINU syndrome. Without the additional findings of uveitis, the diagnosis would have been missed. Resolution was obtained through steroid therapy. CONCLUSIONS Correctly diagnosing TINU syndrome requires a multispecialty approach and may not be obvious upon initial presentation. Therefore, the ophthalmologist needs to consider TINU in the differential diagnosis for a patient with bilateral uveitis and evaluate a urinalysis for proteinuria as part of the work up.
Purt Boonkit; Hiremath Siri; Smith Sarah; Erzurum Sergul; Sarac Erdal
The American journal of case reports
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.12659/ajcr.900701" target="_blank" rel="noreferrer noopener">10.12659/ajcr.900701</a>
Mediastinal mass in a 25-year-old man.
Adult; Humans; Male; Biopsy; Flow Cytometry; Radiography; Carcinoid Tumor/*complications/diagnosis/secondary; Chest Pain/diagnosis/*etiology; Mediastinal Neoplasms/*complications/diagnosis/secondary; Thymus Neoplasms/*complications/diagnostic imaging/pathology; Tomography; Diagnosis; Differential; X-Ray Computed; Thoracic
A 25-year-old black man presented with left-sided chest pain and cough for 3 days. His pain was pressure-like and nonradiating and was aggravated with movement and relieved when the patient lay at a 45 degrees angle. The patient denied fevers, chills, night sweats, and swelling but reported gaining 4 to 6 kg (10 to 15 lbs) in the past few months. His cough had started 2 weeks prior with yellow mucus production but he denied facial swelling or tenderness. He had no chronic medical conditions and was not taking medications. He had no known exposure to chemicals, fumes, or dust and no history of tobacco or alcohol abuse.
Waghray Abhijeet; Sherpa Lakpa; Carpio Gandhari; Barreiro Timothy J
Chest
2014
2014-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1378/chest.13-1444" target="_blank" rel="noreferrer noopener">10.1378/chest.13-1444</a>
Six stroma-based RNA markers diagnostic for prostate cancer in European-Americans validated at the RNA and protein levels in patients in China.
diagnosis; Adult; Humans; prostate cancer; Male; Middle Aged; Aged; Young Adult; Gene Expression Profiling; Gene Expression Regulation; Tumor Microenvironment; Biomarkers; China; European Continental Ancestry Group/genetics; microenvironment; Prostate/pathology; Prostatic Neoplasms/*diagnosis/*genetics; race; stroma; 80 and over; Neoplastic; Tumor/*genetics
We previously analyzed human prostate tissue containing stroma near to tumor and from cancer-negative tissues of volunteers. Over 100 candidate gene expression differences were identified and used to develop a classifier that could detect nearby tumor with an accuracy of 97% (sensitivity = 98% and specificity = 88%) based on 364 independent test cases from primarily European American cases. These stroma-based gene signatures have the potential to identify cancer patients among those with negative biopsies. In this study, we used prostate tissues from Chinese cases to validate six of these markers (CAV1, COL4A2, HSPB1, ITGB3, MAP1A and MCAM). In validation by real-time PCR, four genes (COL4A2, HSPB1, ITGB3, and MAP1A) demonstrated significantly lower expression in tumor-adjacent stroma compared to normal stroma (p value
Zhu Jian-Guo; Pan Cong; Jiang Jun; Deng Mingsen; Gao Hengjun; Men Bozhao; McClelland Michael; Mercola Dan; Zhong Wei-D; Jia Zhenyu
Oncotarget
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.18632/oncotarget.4430" target="_blank" rel="noreferrer noopener">10.18632/oncotarget.4430</a>
Incidental findings in the cervical spine at CT for trauma evaluation.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Registries; Incidental Findings; Injury Severity Score; Length of Stay/statistics & numerical data; Data Collection; Tomography; Human; Middle Age; Adolescence; Retrospective Design; Diagnosis; Cervical Vertebrae/*diagnostic imaging/*injuries; Spinal Injuries/*diagnostic imaging; 80 and over; X-Ray Computed/*methods; Nonparametric; Statistics; Nonparametric Statistics; Trauma Severity Indices; 80 and Over; Length of Stay – Statistics and Numerical Data; X-Ray Computed – Methods; Cervical Vertebrae – Injuries; Cervical Vertebrae – Radiography; Spinal Injuries – Radiography
OBJECTIVE: CT is the standard of care for assessment of traumatic injuries. Because of the detail depicted with this technique, findings incidental to the injury are easily detected. We sought to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT. MATERIALS AND METHODS: The trauma registry was accessed to identify the cases of patients evaluated with cervical spine CT at a level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to bodily location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed. RESULTS: We identified incidental CT findings in 230 of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation. We stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age (p \textless 0.0001). The likelihood of trauma-related incidental findings was associated with injury severity score (p \textless 0.0001). CONCLUSION: Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.
Barboza Richard; Fox Jason H; Shaffer Lynn E T; Opalek Judy M; Farooki Shella
AJR. American journal of roentgenology
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.08.1420" target="_blank" rel="noreferrer noopener">10.2214/AJR.08.1420</a>
Sarcoidosis appearing in a tattoo.
Adult; Female; Humans; Tattooing/*adverse effects; Abdomen; Coloring Agents/adverse effects; Sarcoidosis/*diagnosis/*etiology/pathology; Skin Diseases/*diagnosis/*etiology/pathology; Diagnosis; Differential
BACKGROUND: Sarcoidosis is a systemic disease that may present as tattoo granulomas. OBJECTIVE: A patient with systemic sarcoidosis who developed a granulomatous reaction within a tattoo is presented to stimulate interest in this unusual phenomenon. METHODS AND RESULTS: A patient with a 6-year history of pulmonary sarcoidosis developed sarcoidal granulomas restricted to one pigment of a tattoo. Previous reports of sarcoidal granulomas within tattoos are reviewed, and information about the pathogenesis of this process is explored. CONCLUSION: Sarcoid granulomas may develop in tattoos as an isolated local reaction or as the presenting sign of systemic sarcoidosis. The reaction itself may provide insight into further understanding the pathogenesis of sarcoidosis.
Ali Saba M; Gilliam Anita C; Brodell Robert T
Journal of cutaneous medicine and surgery
2008
2008-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2310/7750.2007.00040" target="_blank" rel="noreferrer noopener">10.2310/7750.2007.00040</a>
Crusted (Norwegian) scabies. A simple office test demystifies the 'great imitator'.
Female; Humans; Aged; Anti-Inflammatory Agents/adverse effects; Coloring Agents; Insecticides/therapeutic use; Office Visits; Permethrin; Pyrethrins/therapeutic use; Scabies/*diagnosis/drug therapy; Steroids; Diagnosis; Differential; Administration; Cutaneous
Nowak M A; Mirando W S; Brodell R T
Postgraduate medicine
1999
1999-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.1999.05.1.762" target="_blank" rel="noreferrer noopener">10.3810/pgm.1999.05.1.762</a>
Resistant' nail fungus. Are you fighting the real invader?
Female; Humans; Middle Aged; Hydroxides; Potassium Compounds; Cysts/*diagnosis/surgery; Hand Dermatoses; Nail Diseases/*diagnosis/surgery; Onychomycosis/*diagnosis; Diagnosis; Differential
Helms S E; Brodell R T
Postgraduate medicine
1999
1999-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.1999.06.636" target="_blank" rel="noreferrer noopener">10.3810/pgm.1999.06.636</a>
The persistent nonhealing ulcer. Could it be basal cell carcinoma?
Humans; Male; Aged; Chronic Disease; Risk Factors; Skin Neoplasms/complications/*pathology; Ulcer/*etiology; Diagnosis; Carcinoma; Differential; Basal Cell/complications/*pathology; Basal Cell – Diagnosis; Basal Cell – Physiopathology
Brodell R T; Wagamon K
Postgraduate medicine
2001
2001-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.2001.01.842" target="_blank" rel="noreferrer noopener">10.3810/pgm.2001.01.842</a>
Childhood shingles. Herpes zoster can occur in healthy children too.
Female; Humans; Child; Risk Factors; Prognosis; Antiviral Agents/therapeutic use; Age Distribution; Valacyclovir; Acyclovir/*analogs & derivatives/therapeutic use; Herpes Zoster/*diagnosis/drug therapy/epidemiology; Immunocompetence; Morpholines/therapeutic use; Primary Health Care/methods; Silver Sulfadiazine/therapeutic use; Valine/*analogs & derivatives/therapeutic use; Virus Activation; Virus Latency; Diagnosis; Differential; Herpesvirus 3; Drug Therapy; Combination; Human/physiology; Herpes Zoster – Diagnosis – In Infancy and Childhood; Herpes Zoster – Drug Therapy – In Infancy and Childhood
Brodell Robert T; Zurakowski Julie E
Postgraduate medicine
2004
2004-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.2004.04.1493" target="_blank" rel="noreferrer noopener">10.3810/pgm.2004.04.1493</a>
Uncovering tinea incognito. Topical corticosteroids can mask typical features of ringworm.
Female; Humans; Male; Middle Aged; Time Factors; Treatment Outcome; Anti-Inflammatory Agents/*administration & dosage/*adverse effects; Butoxamine/administration & dosage; Glucocorticoids/*administration & dosage/*adverse effects; Hydroxides; Leg Dermatoses/diagnosis/drug therapy; Morpholines/administration & dosage; Potassium Compounds; Telangiectasis/diagnosis/drug therapy; Tinea/*diagnosis/*drug therapy/microbiology; Middle Age; Diagnosis; Differential; Administration; Topical; Creams; Tinea; Tinea – Diagnosis; Tinea – Drug Therapy
Oklota Carrie A; Brodell Robert T
Postgraduate medicine
2004
2004-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3810/pgm.2004.07.1560" target="_blank" rel="noreferrer noopener">10.3810/pgm.2004.07.1560</a>
An elderly woman with severe anemia.
Female; Humans; Aged; Severity of Illness Index; Biopsy; Fatal Outcome; Liver Neoplasms/complications/diagnostic imaging/secondary; Malignant Carcinoid Syndrome/*complications/diagnosis; Tomography; Diagnosis; Differential; X-Ray Computed; Fine-Needle; Anemia; Iron-Deficiency/diagnosis/*etiology
Hayek Emil
Cleveland Clinic journal of medicine
2007
2007-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3949/ccjm.74.3.172" target="_blank" rel="noreferrer noopener">10.3949/ccjm.74.3.172</a>
Parvovirus mimicking acute HIV infection.
Adult; Humans; Male; HIV Infections/*diagnosis; Parvoviridae Infections/*diagnosis; Diagnosis; Differential
Saed Stephanie; Weinstein Velez Mara; Tomecki Kenneth J; Fernandez Anthony P
Cleveland Clinic journal of medicine
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3949/ccjm.82a.14141" target="_blank" rel="noreferrer noopener">10.3949/ccjm.82a.14141</a>
Sonographic Elastography of Mastitis.
Adult; Female; Humans; Middle Aged; Aged; Retrospective Studies; Ultrasonography; Sensitivity and Specificity; breast; breast ultrasound; Breast/diagnostic imaging; Elasticity Imaging Techniques/*methods; elastography; mastitis; Mastitis/*diagnostic imaging; shear wave elastography; strain elastography; Diagnosis; Differential; Computer-Assisted; Image Interpretation; Mammary/*methods
Sonographic elastography has been shown to be a useful imaging modality in characterizing breast lesions as benign or malignant. However, in preliminary research, mastitis has given false-positive findings on both strain and shear wave elastography. In this article, we review the findings in mastitis with and without abscess formation on both strain and shear wave elastography. The elastographic findings in all cases were suggestive of a malignancy according to published thresholds. In cases of mastitis with abscess formation, there is a characteristic appearance, with a central very soft area (abscess cavity) and a very stiff outer rim (edema and inflammation). This appearance should raise the suspicion of mastitis with abscess formation, since these findings are rare in breast cancers.
Sousaris Nicholas; Barr Richard G
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2016
2016-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/ultra.15.09041" target="_blank" rel="noreferrer noopener">10.7863/ultra.15.09041</a>
Effect of Precompression on the Power Doppler Assessment of Breast Lesion Vascularity.
Adult; Female; Humans; Middle Aged; Aged; Ultrasonography; Sensitivity and Specificity; breast cancer; breast ultrasound; Image-Guided Biopsy; *Ultrasonography; breast mass; Breast Neoplasms/*blood supply/*diagnostic imaging/pathology; Breast/blood supply/diagnostic imaging/pathology; power Doppler sonography; precompression; preload; vascularity; Color; Diagnosis; 80 and over; Differential; Doppler; Neovascularization; Interventional; Mammary; Pathologic/diagnostic imaging/*pathology
OBJECTIVES: To evaluate the effect of precompression on power Doppler visualization of blood flow in breast masses. METHODS: This Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study evaluated 30 patients with breast masses (16 benign and 14 malignant) undergoing ultrasound-guided breast biopsy. A computational mathematics program was used to calculate the number of color pixels in a region of interest at various degrees of compression of the breast by the transducer. The amount of precompression was calculated as previously described. The percentage of color pixels compared to minimal compression was plotted against the percentage of precompression. The amount of precompression needed to decrease the number of color pixels by 50% and 100% was calculated. The differences between benign and malignant lesions were compared. RESULTS: The mean percentages of precompression +/- SD needed to decrease the number of color voxels by 50% in were 15.9% +/- 6.43% (range, 8%-30%) for benign lesions and 14.0% +/- 4.17% (range, 8%-20%) for malignant lesions (P = .35). The percentages of precompression needed to decrease the number of color pixels by 100% in were 34.7% +/- 12.33% (range, 23%-62%) for benign lesions and for malignant lesions 26.7% +/- 3.89% (range, 18%-31%), which were statistically significant (P = .027). CONCLUSIONS: The amount of precompression normally used when obtaining B-mode images can substantially decrease the number of color voxels on power Doppler sonography. When performing quantitative work on Doppler evaluation of breast lesions, precompression needs to be controlled.
DeVita Robert; Barr Richard G
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/ultra.16.01024" target="_blank" rel="noreferrer noopener">10.7863/ultra.16.01024</a>
Malignant mesothelioma: a case presentation and review.
Humans; Male; Aged; Biopsy; Radiography; Fatal Outcome; Tomography; Adenocarcinoma/diagnosis/secondary; Mesothelioma/diagnostic imaging/*pathology; Pleural Neoplasms/diagnostic imaging/*pathology; Diagnosis; Differential; X-Ray Computed; Thoracic
Diffuse malignant mesothelioma is the most common primary tumor involving the pleura. Unfortunately, it also poses the most difficulty for physicians to diagnose and treat. Latency from the time of initial asbestos exposure, clinical features of chest pain and dyspnea, and radiographic findings of pleural effusion or pleural thickening are the characteristic features. Pathologic verification remains challenging. The primary distinctions to be made are between reactive and neoplastic mesothelial processes and between malignant mesothelioma and metastatic adenocarcinoma. Adequate tissue sampling is important to help diagnose malignant mesothelioma. This article describes a rare subtype of mesothelioma and illustrates the difficulty in establishing the diagnosis. Also included is a discussion of the clinical features, diagnostic dilemmas, and unsatisfactory outcome associated with this disease.
Barreiro Timothy J; Katzman Philip J
The Journal of the American Osteopathic Association
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Bedside testing: the diagnostic cornerstone of dermatology.
Humans; Skin Diseases/diagnosis; Staining and Labeling/methods; Diagnosis; Herpesviridae Infections/*diagnosis; Microscopy/*methods; Scabies/*diagnosis; Tinea/*diagnosis; Differential
Brodell R T; Helms S E
Comprehensive therapy
1997
1997-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Swelling of the lips.
Humans; Male; Middle Aged; *Edema/blood/diagnosis/etiology; Complement C1 Inhibitor Protein/*analysis; Complement C1q/analysis; Complement C3/analysis; Complement C4/analysis; Lip/*pathology; Medical History Taking; Diagnosis; Differential
Brodell Robert T; Bukavina Laura; Rangwani Neil
American Family Physician
2015
2015-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Magnetic resonance imaging to avoid laparotomy in pregnancy.
Adult; Female; Humans; Pregnancy; *Magnetic Resonance Imaging; Pregnancy Complications; Laparotomy; Adnexal Diseases/*diagnosis; Leiomyoma/*diagnosis; Prenatal Diagnosis/*methods; Teratoma/*diagnosis; Uterine Neoplasms/*diagnosis; Diagnosis; Differential; Neoplastic/*diagnosis
OBJECTIVE: To determine whether magnetic resonance imaging (MRI) in pregnancy would help define a benign pelvic mass, thereby avoiding laparotomy. METHODS: During a 2-3-year period, five pregnant women with adnexal masses suspected to be leiomyomas underwent MRI. RESULTS: Four patients had evidence of leiomyoma and one had a benign cystic teratoma. All avoided laparotomy because of the almost certain radiologic findings of a benign process. In two women, there was an important effect on the pregnancy; one had fetal growth retardation and the other an outlet obstruction precluding vaginal delivery. Four of the patients underwent cesarean delivery. CONCLUSIONS: Magnetic resonance imaging can be used in the differential diagnosis of an adnexal mass in pregnancy. This will enable some pregnant patients to avoid laparotomy and its concomitant risks.
Curtis M; Hopkins M P; Zarlingo T; Martino C; Graciansky-Lengyl M; Jenison E L
Obstetrics and gynecology
1993
1993-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Locked-in syndrome: report of a case.
Humans; Male; Middle Aged; Prognosis; *Quadriplegia/diagnosis; Coma/diagnosis; Diagnosis; Differential
Locked-in syndrome is a unique clinical condition associated with ventral pontine lesions. The locked-in state is characterized by tetraplegia and mutism with maintenance of alertness as well as vertical eye movements and eye blinking, by which communication is possible. A case of locked-in syndrome in a 58-year-old man that demonstrates the clinical manifestations of the disorder is reported. Unless the physician is familiar with the signs and symptoms of the locked-in syndrome, the diagnosis may be missed and the patient may erroneously be considered comatose.
Gallo U E; Fontanarosa P B
The American journal of emergency medicine
1989
1989-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0735-6757(89)90278-7" target="_blank" rel="noreferrer noopener">10.1016/0735-6757(89)90278-7</a>
Toxic streptococcal syndrome.
Adult; Female; Humans; Pharyngitis/*complications; Streptococcus pyogenes; Sinusitis/*complications; Streptococcal Infections/*complications; Diagnosis; Emergency Service; Hospital; Differential; Shock; Septic/blood/*diagnosis/etiology
The streptococcal toxic shocklike syndrome is a recently recognized, multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome, but is caused by toxins elaborated by group A beta-hemolytic Streptococcus. We describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome (fever, hypotension, multisystem dysfunction, and diffuse macular erythroderma followed by desquamation) and who demonstrated serologic evidence suggesting streptococcal infection. In patients presenting with clinical findings consistent with a toxic shocklike syndrome, the emergency physician should consider streptococcal infection as a potential etiology.
Gallo U E; Fontanarosa P B
Annals of emergency medicine
1990
1990-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)82299-1" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)82299-1</a>
Anorexia and bulimia.
Adult; Female; Humans; Male; Adolescent; Combined Modality Therapy; Anorexia Nervosa/complications/diagnosis/*therapy; Bulimia/complications/diagnosis/*therapy; Diagnosis; Differential
Anorexia nervosa and bulimia nervosa are eating disorders with distinct clinical presentations. Reduced caloric intake, a hallmark of both disorders, is manifested by self-induced starvation in anorexia and by binge eating and gastrointestinal purging in bulimia. Treatment includes nutritional intervention, psychotherapy and pharmacotherapy in either the ambulatory or the hospital setting.
Giannini A J; Newman M; Gold M
American Family Physician
1990
1990-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4135/9781412972031.n20" target="_blank" rel="noreferrer noopener">10.4135/9781412972031.n20</a>
Disseminated brown tumors from hyperparathyroidism masquerading as metastatic cancer: a complication of parathyroid carcinoma.
Female; Humans; Middle Aged; Carcinoma/*complications; Hyperparathyroidism/complications; Kidney Neoplasms/pathology; Osteitis Fibrosa Cystica/*diagnosis/*etiology; Parathyroid Neoplasms/*complications; Diagnosis; Carcinoma; Differential; Renal Cell/secondary
Osteitis fibrosa cystica (brown tumors) can be a skeletal manifestation of advanced hyperparathyroidism, including parathyroid cancer. Severe osteitis fibrosa cystica can mimic metastatic bone diseases especially in patients with a history of cancer. Because the treatment and prognosis of these two problems differ greatly considering hyperparathyroidism in the differential diagnosis of patients found to have osteolytic lesions is critical for the appropriate management of these patients. In this case report we describe a patient with a history of renal cell cancer and presumed osteolytic bone metastases. During prophylactic intramedullary rodding to prevent pathologic fracture of her femur she was found to have a benign lesion related to her previously undiagnosed hyperparathyroidism caused by an underlying parathyroid cancer. A detailed review of this disease and the associated bone changes is also included to underscore the importance of an adequate differential diagnosis as well as optimal management. Patients with hypercalcemia or bony lesions should not automatically be treated palliatively for metastatic disease just because of a past medical history of cancer. Hyperparathyroidism is a readily curable problem if properly diagnosed.
Gupta A; Horattas M C; Moattari A R; Shorten S D
The American surgeon
2001
2001-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
A reappraisal of appendicitis in the elderly.
Female; Humans; Postoperative Complications; Male; Middle Aged; Time Factors; Aged; Retrospective Studies; Appendicitis/complications/*diagnosis/mortality/surgery; Diagnosis; 80 and over; Differential
Historically, appendicitis in the elderly is associated with higher morbidity and mortality. Ninety-six patients over 60 years of age with appendicitis treated over a 10-year period were reviewed. Only 20% presented classically with anorexia, fever, right lower quadrant pain, and an elevated white blood cell count. One third of the patients had greater than 48 hours delay to admission. Objective diagnostic testing was often confusing and unreliable. At the time of admission, only 51% were diagnosed as having possible appendicitis. Eighty-three percent of our patients underwent surgery within 24 hours, and 72% had frank perforation. Thirty-two percent of those surviving developed complications, and 83% of these patients had perforated appendicitis. Complications were twice as likely in patients with perforation. Despite the relatively high morbidity, there were only four deaths in patients with coexistent carcinoma. Because of the later and atypical presentation of appendicitis in this age group, a high index of suspicion and early operation are important in avoiding perforation and subsequent morbidity.
Horattas M C; Guyton D P; Wu D
American journal of surgery
1990
1990-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9610(06)80026-7" target="_blank" rel="noreferrer noopener">10.1016/s0002-9610(06)80026-7</a>
Bilateral adrenal metastases simulating abnormal renal uptake on a Ga-67 scan.
Female; Humans; Middle Aged; Kidney/*diagnostic imaging; Radionuclide Imaging; Radiopharmaceuticals; Adrenal Gland Neoplasms/pathology/*secondary; Gallium Radioisotopes; Lung Neoplasms/*pathology; Diagnosis; Carcinoma; Differential; Non-Small-Cell Lung/pathology/*secondary
Konez O; Goyal M; Chalfant M L
Clinical nuclear medicine
2001
2001-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).