A Serious Diagnosis Lacking Common Symptoms

​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the region nor any history of fecal or urinary incontinence, IV drug use, or saddle anesthesia.His vital signs were an oral temperature of 98.3°F, a heart rate of 70 bpm, a blood pressure of 113/60 mm Hg, a respiratory rate of 16 bpm, and a pulse oximetry of 98% on room air.The patient also complained of numbness in his left foot and severe pain and weakness upon flexion and extension of his left knee and hip. No other abnormalities were noted. An ECG was negative, as was the cervical, thoracic, and lumbar spine CT without contrast.The patient was given fentanyl 50 mcg IV for pain relief, and reported improvement, but he complained of weakness on flexion and extension of his left hip and left ankle. A stroke code was called, and the teleneurologist said the findings suggested a peripheral defect not related to a CVA.An MRI of the lumbar spine without contrast fou...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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AM Abstract Adoptive transfer of T cells transgenic for tumor-reactive T-cell receptors (TCR) is an attractive immunotherapeutic approach. However, clinical translation is so far limited due to challenges in the identification of suitable target antigens as well as TCRs that are concurrent safe and efficient. Definition of key characteristics relevant for effective and specific tumor rejection is essential to improve current TCR-based adoptive T-cell immunotherapies. We here characterized in-depth two TCRs derived from the human leukocyte antigen (HLA)-mismatched allogeneic repertoire targeting two different myel...
Source: Nuklearmedizin - Category: Radiology Authors: Tags: Front Immunol Source Type: research
ConclusionsThe study recommend the development of a model to guide the integration of breast cancer prevention and early detection into palliative care
Source: International Journal of Africa Nursing Sciences - Category: African Health Source Type: research
Advances in nanophotonics could one day lead to new treatments for cancer, mental disorders More at https://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=298904&WT.mc_id=USNSF_1 This is a Research News item.
Source: NSF Discoveries - Category: Science Source Type: research
CONCLUSION: The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling. PMID: 31315494 [PubMed - in process]
Source: Journal of Orthopaedic Surgery - Category: Orthopaedics Authors: Tags: J Orthop Surg (Hong Kong) Source Type: research
Publication date: Available online 19 July 2019Source: The American Journal of SurgeryAuthor(s): Tyler Gaines, Nina Harkhani, Hegang Chen, Rena D. MalikAbstractBackgroundThe aim of this study is to evaluate the components of current parental leave policies in surgical practice and evaluate surgeon perceptions of parental leave.MethodsPracticing surgeons were recruited to complete a survey via social media outlets and e-mail. Participants were asked questions regarding existing policies and their perspectives towards parental leave.ResultsThe survey was completed by 431 surgeons, of which 90% were female and 45% in academic...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Publication date: Available online 18 July 2019Source: The American Journal of SurgeryAuthor(s): Brigid K. Killelea, Emily J. Gallagher, Sheldon M. Feldman, Elisa Port, Tari King, Susan K. Boolbol, Rebeca Franco, Kezhen Fei, Derek Le Roith, Nina A. BickellAbstractIntroductionAlthough breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known abo...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Publication date: Available online 18 July 2019Source: The American Journal of SurgeryAuthor(s): Kristin E. Rojas, Thais A. Fortes, Peter L. Flom, Donna-Marie Manasseh, Charusheela Andaz, Patrick I. BorgenAbstractBackgroundA 10-step protocol employing multimodal analgesia was implemented in patients undergoing mastectomy to decrease the quantity of opioids prescribed at discharge.MethodsPatients who received the Enhanced Recovery After Surgery (ERAS) protocol were compared to a control group. Inpatient and discharge prescription of opioids were compared using oral morphine equivalents (OMEs), along with postoperative pain ...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Publication date: Available online 18 July 2019Source: The American Journal of SurgeryAuthor(s): Laura H. Rosenberger, Samantha M. Thomas, Jennifer K. Plichta, Oluwadamilola M. Fayanju, Terry Hyslop, Rachel A. Greenup, E. Shelley HwangAbstractBackgroundSentinel lymph node biopsy has supplanted axillary lymph node dissection (ALND) in clinically node-negative breast cancer and select node-positive disease. We hypothesized a decreasing rate of both ALND and resident exposure over time.MethodsWe identified women with clinical Stage I-III breast cancer in the National Cancer Data Base (2004-2014). Adjusted multivariate logisti...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
ConclusionsAmong breast cancer patients, nearly one-third exhibit clinical-pathological stage discordance. This high likelihood of discordance is important to consider for counseling and treatment planning.
Source: The American Journal of Surgery - Category: Surgery Source Type: research
ConclusionsA significant proportion (56%) of symptomatic IFDVT patients are not being appropriately referred to or discussed with vascular services. Of these, 43% would have been eligible for consideration of early thrombus removal. Adherence to the National Institute for Health and Care Excellence guidelines could be improved by increasing awareness among emergency department colleagues.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
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