Oncologic Emergencies
|
|
- Richard Kelly
- 5 years ago
- Views:
Transcription
1 Oncologic Emergencies Francis L. Counselman, M.D., CPE, FACEP Department of Emergency Medicine Eastern Virginia Medical School Norfolk, Virginia Superior Vena Cava Syndrome Compression of SVC by mediastinal or pulmonary mass or intraluminal occlusion by thrombosis 1
2 Epidemiology Male:Female ratio 2.5:1 Average age 56yo Approx 60% of patients without history of cancer Incidence 5-15% of all Lung CA 5% of all Lymphomas 1% of all Pulmonary Mets 2
3 Etiology Malignancy: Most common Mediastinal fibrosis Aortic aneurysm Granulomatous infection Goiter Iatrogenic: 20-40% Radiation fibrosis Malignancies and SVC Lung 75% Lymphoma 10-15% Metastatic 10% Breast Thymus Testicular 3
4 Symptoms Gradual onset Malignancy: more rapid progression Benign: slower progression 75% have signs/symptoms more than one week Symptoms worse upon awakening Symptoms Headache 80% Dyspnea 65% Cough 55% Nausea/vomiting Dysphagia Tightness of shirt collar Visual changes 4
5 Symptoms Altered mental status Syncope Swollen arms Hoarseness Orthopnea Stridor Seizure Weight loss Physical Exam Dilated neck veins 80% Thoracic vein distention 74% Face/upper torso edema 70% Cyanosis of upper body 44% Plethora 14% 5
6 6
7 Physical Exam Worsening of symptoms with arms above head (Pemberton s sign) Paralyzed true vocal cords Tachypnea Horners syndrome Abdominal vein distention 7
8 Imaging CXR Venogram Radionuclide scan Contrast chest CT scan Ultrasound Echocardiography MRI 8
9 CXR Mediastinal widening 64% Pleural effusion 25% Right hilar mass Bilateral diffuse infiltrates 9
10 CXR Cardiomegaly Anterior mediastinal mass Upper lobe collapse Calcified paratracheal nodes Normal CXR in 16% of SVC Syndrome 10
11 Venogram Gold standard (old) Advantages Disadvantages Contrast Chest CT Scan 92% sensitivity; 96% specificity Location/extent of tumor or thrombus Info for needle biopsy Plan radiation portals 11
12 Ultrasound of Subclavian Veins Quick, noninvasive, inexpensive and no radiation Indirect evaluation of SVC patency Echocardiography Transesophageal Bedside procedure No contrast material Differentiates between intravascular obstruction and extravascular compression 12
13 Magnetic Resonance Imaging Contrast 94% sensitivity 100% specificity Limited use 13
14 Management Initiate diagnostic workup Can better plan appropriate treatment with histologic diagnosis Management Elevate head of bed Oxygen Steroids? Diuretics IV access 14
15 Management Upper airway obstruction Cerebral edema Rare but life-threatening Require endovenous stent placement and radiation therapy Management Radiation therapy Subjective response within 72h Objective response within 7 to 14 days 15
16 Management Thrombolytic therapy/anticoagulation Common with indwelling catheters Contraindicated if brain mets Management Chemotherapy Surgery Endovascular stents 16
17 Hypercalcemia of Malignancy Most common metabolic complication Occurs in 10-30% of all CA patients In ED: malignancy (44%) followed by hyperparathyroidism (20%) Differential Diagnosis PAM P SCHMIDT 17
18 Primary Diagnosis Primary Hyperparathroidism Addisons Disease Multiple Myeloma Pagets Disease Differential Diagnosis Sarcoidosis Cancer Hyperthyroidism Mild-Alkali Syndrome Immobilization D Vitamin Toxicity Thiazide Diuretics 18
19 Pathophysiology Tumor secretion of PTH-related protein Responsible 80% of time Stimulates osteoclast mediated bone resorption Stimulates renal tubular reabsorption of calcium Pathophysiology Local bone destruction from mets with osteoclast activating factors Tumor production of Vitamin D analogues 19
20 Solid Tumors with Bone Mets Breast 42% Lung 15% Prostate Clinical Presentation Consider in all patients with malignant disease who feel sick Bones, stones, moans and groans 20
21 Clinical Presentation Weakness Lethargy Fatigue Dehydration Gastrointestinal Anorexia Nausea/vomiting Constipation Abdominal pain Obstipation Ileus 21
22 Renal Polyuria Polydypsia Dehydration Nocturia Nephrolithiasis Nephrocalcinosis Neurologic Anxiety Agitation Depression Impaired concentration Fatigue 22
23 Neurologic Increased sleep requirements Altered level of consciousness* Decreased DTRs Ataxia Cardiovascular Hypertension Arrhythmias Vascular calcifications EKG abnormalities Digitalis sensitivity 23
24 Musculoskeletal Bone pain Diagnosis Serum calcium EKG Urinalysis Serum chloride Parathyroid hormone (PTH) 24
25 Serum Calcium Asymptomatic < 12mg/dl ph Albumin level Rate of rise Serum Calcium Ionized serum calcium level If measure total calcium: Corrected Ca = measured Ca + (0.8 x [4-albumin]) Moderate: 12 to 14 mg/dl Severe: >14mg/dl 25
26 EKG QT interval shortening Prolongation of PR Prolongation of QRS AV block Coving of ST-T segments 26
27 Urinalysis Decreased specific gravity Increased glucose Increased Na Increased K Increased Mg Proteinuria Serum Chloride Cl <100mEQ/L indicates hypercalcemia secondary to PTHrP Less responsive to bisphosphonates 27
28 Parathyroid Hormone (PTH) - Level < 20pg/mL not consistent with primary hyperparathyroidism - If negative, consider ordering PTH-related peptide (PTHrp) Management Treat underlying cause Rehydration Diuresis Electrolyte balance Specific measures 28
29 Treatment Asymptomatic or mildly symptomatic with Ca <12mg/dL does not require immediate treatment Level >14mg/dL requires treatment, regardless of symptoms Rehydration IV NS 200 to 500 cc/hr 100 to 150 cc/hr urine output 29
30 Diuresis Rehydrate first Lasix no longer routine Consider if edema or CHF Electrolyte Balance Potassium Magnesium 30
31 Calcitonin Increases renal calcium excretion. Decreases bone resorption Fast acting 4 IU/kg IM or SQ If responds, repeat every 6 to 12 hours Bisphosphonates First line therapy Inhibits osteoclast mediated bone resorption More potent than calcitonin Max effect in 2-4 days 31
32 Bisphosphonates Zoledronic acid 4mg IV over 15min* Pamidronate 60-90mg IV over 2 to 4 hours Management Concurrent administration IV NS Calcitonin IM or SQ Zoledronic acid (ZA) IV 32
33 Dialysis Hemodialysis Peritoneal dialysis Renal failure Spinal Cord Compression 5% of all CA patients Peak age: 55 to 65yo 80% have dx of CA Prognosis time dependent First described in
34 Sites of Metastasis 60% Thoracic 30% Lumbosacral 10% Cervical Location of Metastasis Vertebral column 90% Paravertebral space 10% Epidural space < 5% 34
35 Primary Cancer Breast 20 to 30% Lung 15 to 20% Prostate 15 to 20% Lymphoma Renal Multiple myeloma Back Pain 95% of cases Gradual and progressive Precedes other symptoms by 2 months Dull, aching, constant DJD v Metastatic disease 35
36 Pain Localized initially Referred or radicular Increased with cough, sneeze, weight bearing Pain at night Clinical Presentation Numbness Parasthesias Coldness 36
37 Clinical Presentation Autonomic dysfunction Indicates T10-T12 involvement Present 50% at time of diagnosis Poor prognostic sign Clinical Presentation Weakness Initial complaint 36% Very poor prognostic sign 37
38 Physical Exam Vertebral tenderness 33% Straight leg raise Neck flexion Neurologic exam hyperresponsive DTRs 38
39 Diagnosis Plain films Myelogram Bone scan Spinal CT scan MRI Plain Films 80% sensitivity Vertebral body collapse Osteolytic lesion Osteoblastic lesion Paraspinal mass 39
40 Spinal CT Scan Transaxial plane only Excellent detail Preferred with myelogram 40
41 Magnetic Resonance Imaging Gold standard 95% accuracy No contrast material No ionizing radiation Images in multiple plains 41
42 Imaging Guidelines for Patient with history of CA and Back Pain High suspicion or abnormal neuro exam emergent Low suspicion and normal neuro exam outpatient imaging within 48 to 72 hours and consult Management Consultation Steroids Radiation Surgery Chemotherapy 42
43 Steroids Relieves pain Reduces edema Reduces inflammation Short-term benefit Dexamethasone 10mg IV bolus then 16 mg/day (bid to QID) If dense paresis, consider 96 mg IV, then 24mg IV QID 43
44 Radiation Therapy Definitive treatment Pain relief in 70 to 80% of cases Better prognosis if initiated prior to paraplegia Radiation Therapy 81% ambulatant pretreat remained ambulatory post RT 17% nonambulant pretreat became ambulatory post RT 73% had improvement in pain 44
45 Surgery Decompress spinal cord and nerve roots Radiation therapy Indications in development Rarely helpful Chemotherapy 45
Oncologic Emergencies
Oncologic Emergencies Peter Bjerkerot RN, OCN 1339 Normandy Drive Atlanta, GA 30306-2574 404.754.5952 WebPage http://boyrn.com peter.bjerkerot@mindspring.com Full Disclosure Statement Celgene Nurse Advisory
More informationHYPERCALCEMIA. Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences
HYPERCALCEMIA Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences ESSENTIALS OF DIAGNOSIS Serum calcium level > 10.5 mg/dl Serum ionized
More informationhypercalcemia of malignancy hyperparathyroidism PHPT the most common cause of hypercalcemia in the outpatient setting the second most common cause
hyperparathyroidism A 68-year-old woman with documented osteoporosis has blood tests showing elevated serum calcium and parathyroid hormone (PTH) levels: 11.2 mg/dl (8.8 10.1 mg/dl) and 88 pg/ml (10-60),
More informationHematologic Emergencies. Udomsak Bunworasate Chulalongkorn University
Hematologic Emergencies Udomsak Bunworasate Chulalongkorn University Hematologic Emergencies Hyperleukocytosis Tumor lysis syndrome SVC syndrome Spinal cord compression Hypercalcemia 1. Hyperleukocytosis
More informationEmergencies in Palliative Medicine
Emergencies in Palliative Medicine Objectives Recognise palliative care emergencies Be aware of their existence Recognise signs and symptoms of common emergencies Anticipate occurrence of emergencies Manage
More informationMalignant related superior vena cava (SVC) syndrome
Malignant related superior vena cava (SVC) syndrome Manit Sae-teaw B.Pharm, BCP, BCOP Grad dip in Pharmacotherapy Faculty of pharmaceutical sciences Ubon Ratchathani University 1 Outline Introduction Etiology
More informationIt s Not A Tumor! Oncologic Emergencies
It s Not A Tumor! Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator Department of Emergency Medicine Harbor-UCLA Medical Center Increasing
More informationOncological emergencies. Harmesh Naik, MD. Medical Oncology Hope Cancer Clinic
Oncological emergencies Harmesh Naik, MD. Medical Oncology Hope Cancer Clinic Presentation to Internal Medicine GME resident physicians: October 24, 2013 Presentation goals Briefly review clinical presentation,
More informationOncologic Emergencies
Oncologic Emergencies Objectives Identify the major oncologic emergencies Describe the assessment for each emergency Outline the standard of care of patients experiencing oncologic emergencies Structural
More informationOncologic Emergencies: When to call the Radiation Oncologist
Oncologic Emergencies: When to call the Radiation Oncologist Dr. Shrinivas Rathod Radiation Oncologist Radiation Oncology Program CancerCare Manitoba and University of Manitoba Disclosures Speaker s name:
More informationIt s Not A Tumor! Oncologic Emergencies
It s Not A Tumor! Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator Department of Emergency Medicine Harbor-UCLA Medical Center Increasing
More informationFaculty/Presenter Disclosure
CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure Speaker: Dr. Kimberly Hagel Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees:
More informationApproach to a patient with hypercalcemia
Approach to a patient with hypercalcemia Ana-Maria Chindris, MD Division of Endocrinology Mayo Clinic Florida 2013 MFMER slide-1 Background Hypercalcemia is a problem frequently encountered in clinical
More informationBone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital
Bone Metastases Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital 1 Outline Pathophysiology Signs & Symptoms Diagnosis Treatment Spinal Cord Compression 2 General Information
More informationCurrent Management of Metastatic Bone Disease
Current Management of Metastatic Bone Disease Evaluation and Medical Management Dr. Sara Rask Head, Medical Oncology Simcoe Muskoka Regional Cancer Centre www.rvh.on.ca Objectives 1. Outline an initial
More informationProfessor Dr. Saiyeedur Rahman Professor and Head Department of Medicine SBMCH, Barisal
Professor Dr. Saiyeedur Rahman Professor and Head Department of Medicine SBMCH, Barisal What is Oncologic Emergency? An oncologic emergency is an acute, potentially life-threatening event resulting from
More informationPalliative RT. Jiraporn Setakornnukul, M.D. Radiation Oncology Division Siriraj Hospital, Mahidol University
Palliative RT Jiraporn Setakornnukul, M.D. Radiation Oncology Division Siriraj Hospital, Mahidol University Scope Brain metastasis Metastasis epidural spinal cord compression SVC obstruction Bone pain
More informationPalliative Care Emergencies
Palliative Care Emergencies LAURA BARNFIELD What might constitute an emergency in Palliative Care? 1 Palliative Care Emergencies Major haemorrhage Metastatic Spinal Cord Compression (MSCC) Superior Vena
More informationEducational Session: Oncology Emergencies
Educational Session: Oncology Emergencies Diane M. Birnbaumer, MD, FACEP 3/24/2010 10:00 AM - 11:00 AM Oncologic Emergencies Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California,
More informationBCCA Protocol Summary Guidelines for the Diagnosis and Management of Malignancy Related Hypercalcemia
BCCA Protocol Summary Guidelines for the Diagnosis and Management of Malignancy Related Hypercalcemia Protocol Code Tumour Group Supportive Care Group Contacts SCHYPCAL Supportive Care Lisa Wanbon (VIC)
More informationCalcium and Parathyroid Disorders
Calcium and Parathyroid Disorders Hussain Mahmud, MD Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes, and Metabolism University of Pittsburgh Butler Memorial Hospital November
More informationMalignant Spinal cord Compression. Dr. Thiru Thirukkumaran Palliative Care Services - Northwest Tasmania
Malignant Spinal cord Compression Dr. Thiru Thirukkumaran Palliative Care Services - Northwest Tasmania Background Statistics of SCC -1 Incidence of SCC Vertebral body metastases 85 % Para-vertebral (Lymphoma)
More informationPalliative Care Emergencies. Additional module if needed
Palliative Care Emergencies Additional module if needed Learning objectives Understand emergency /urgent / important Describe common emergencies in PC Explore principles of essential management Outline
More informationWhat Lung Cancer Patients Need to Know About Bone Health. A Publication of The Bone and Cancer Foundation
What Lung Cancer Patients Need to Know About Bone Health A Publication of The Bone and Cancer Foundation Contents THIS PUBLICATION PROVIDES IMPORTANT INFORMATION ABOUT THE RELATIONSHIP BETWEEN LUNG CANCER
More informationOncologic Emergencies
Oncologic Emergencies Luca Delatore, MD James Emergency Department Medical Director Associate Professor Clinical Department of Emergency Medicine The Ohio State University Wexner Medical Center Prevalence
More informationOncologic Emergencies
Oncologic Emergencies Luca Delatore, MD James Emergency Department Medical Director Associate Professor Clinical Department of Emergency Medicine The Ohio State University Wexner Medical Center Prevalence
More informationHyperparathyroidism. When to Suspect, How to Diagnose, When and How to Intervene. Johanna A. Pallotta, MD, FACP, FACE
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline Definition of hyperparathyroidism
More informationHypercalcemia & Parathyroid Disorders. W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology
Hypercalcemia & Parathyroid Disorders W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology Objectives Review diagnostic workup for hypercalcemia Review management of primary hyperparathyroidism Review
More informationAmjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES
Amjad Bani Hani Ass.Prof. of Cardiac Surgery & Intensive Care FLUIDS AND ELECTROLYTES Body Water Content Water Balance: Normal 2500 2000 1500 1000 500 Metab Food Fluids Stool Breath Sweat Urine
More informationHypercalcemia. Hypercalcemia: When to Worry, When to Treat! Mineral Metabolism : A Short Course
Hypercalcemia: When to Worry, When to Treat! Michael A. Levine has no financial relationships to disclose or Conflicts of Interest to resolve. Michael A. Levine, M.D. This presentation will not involve
More informationDefinition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate (start to develop symptoms) 3.0 3.4
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationABSITE Review. RTC Conference Christina Bailey January 15, 2009
ABSITE Review RTC Conference Christina Bailey January 15, 2009 How It s Broken Down? 220 questions Junior level (PGY 1 and 2) Exam 60% Basic Science 40% Clinical Management Senior Level (PGY 3-5) exam
More informationDefinition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Authoriser: Fiona Davidson Page 1 of 5 Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate
More informationParathyroid Disease Scenarios for the Practicing Clinician. Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix
Parathyroid Disease Scenarios for the Practicing Clinician Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix Clinical Scenario-1 73 year man (BK) with hypercalcemia
More informationSymptom management: Hypercalcemia
Symptom management: Hypercalcemia Dr Claire Higham 10.11.16 NLCFN National Conference 2016 Consultant Endocrinologist The Christie Hospital Manchester, UK Hypercalcemia of malignancy 2-30% of patients
More informationManagement of hypercalcemia of malignancy
Integrative Cancer Science and Therapeutics Research Article ISSN: 2056-4546 Management of hypercalcemia of malignancy Sonia Amin Thomas (Sonia Patel)* and Soo-Hwan Chung Philadelphia College of Osteopathic
More informationCancer of Unknown Primary (CUP) Protocol
1 Department of Oncology. Cancer of Unknown Primary (CUP) Protocol Version: Document type: Document sponsor Designation Document author [ s] Designation[s] Approving committee / Group Ratified by: Date
More informationCASE PRESENTATION. Kārlis Rācenis MD - Latvia
CASE PRESENTATION Kārlis Rācenis MD - Latvia o Patient men, 32-years-old o Admitted to the hospital at 12.09.16 due to kidney biopsy no complains 21.07 29.07.2016 Admitted to the hospital Acute kidney
More information80 year old female with parathyroid mass and refractory hypercalcemia. Endorama September 24 th, 2015 Rajesh Jain
80 year old female with parathyroid mass and refractory hypercalcemia Endorama September 24 th, 2015 Rajesh Jain HPI 80 F with pulmonary hypertension, rheumatic mitral stenosis, atrial fibrillation on
More informationPotential conflicts of interest: None
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene November 6, 2013 Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline
More informationPalliative Care Emergencies
Palliative Care Emergencies Dr. T. Thirukkumaran Palliative Care Services Northwest Tasmania What are the emergencies in Palliative Medicine? Palliative Emergencies (a) Disease related or Symptom related
More informationAcute renal failure and unknown cause hypercalcemia (case report)
Acute renal failure and unknown cause hypercalcemia (case report) Clinic for hemodialysis CCU Sarajevo ... What is hypercalcemia??? ... What is hypercalcemia??? The definition of hypercalcemia is having
More informationCase of the Day Chest
Case of the Day Chest Darin White MDCM FRCPC Department of Radiology, Mayo Clinic 76 th Annual Scientific Meeting Canadian Association of Radiologists Montreal, QC April 26, 2013 2013 MFMER slide-1 Disclosures
More informationRespiratory Interactive Session. Elaine Borg
Respiratory Interactive Session Elaine Borg Case 1 Respiratory Cytology 55 year old gentleman Anterior mediastinal mass EBUS FNA Case 1 Respiratory Cytology 55 year old gentleman with anterior mediastinal
More informationMediastinal Tumors: Imaging
Mediastinal Tumors: Imaging References Imaging in Oncology, Husband and Reznek Computed Tomography and Magnetic Resonance of the thorax, Naidich, Zerhouni, Siegelman, Mediastinal compartments Anterior:
More informationPDF created with pdffactory Pro trial version
Neuroblastoma Tumor derived from neural crest cell that form the sympathetic ganglia&adrenal medulla. Causes *unknown. *familial neuroblastoma has been reported but is rare. * The incidence is 1:100,000
More informationRecognition & Treatment of Malignant Spinal Cord Compression Study Day
Recognition & Treatment of Malignant Spinal Cord Compression Study Day 11 th May 2017 Dr Bernie Foran Consultant Clinical Oncologist & Honorary Senior Lecturer Weston Park Hospital Outline of Talk Clinical
More informationManagement of Acute Oncological emergencies
Management of Acute Oncological emergencies Malignant Spinal cord compression (MSCC) Neutropenic sepsis Superior vena caval obstruction Hypercalcemia Hyponatremia Bowel obstruction Brain Metastasis with
More informationPediatric Oncology. Vlad Radulescu, MD
Pediatric Oncology Vlad Radulescu, MD Objectives Review the epidemiology of childhood cancer Discuss the presenting signs and symptoms, general treatment principles and overall prognosis of the most common
More informationVertebral and Paravertebral Diseases
Department of Radiology University of California San Diego Vertebral and Paravertebral Diseases John R. Hesselink, M.D. Vertebral / Paravertebral Disease (Extradural) Metastatic disease Primary bone tumors
More informationBone Health in the Cancer Patient. Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018
Bone Health in the Cancer Patient Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018 Overview Healthy bone is in a constant state of remodelling
More informationSuspecting Tumors, or Could it be cancer?
Suspecting Tumors, or Could it be cancer? Donna E. Reece, M.D. Princess Margaret Cancer Centre University Health Network Toronto, ON CANADA 07 February 2018 Background Low back pain is common However,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominal radiotherapy, toxic effects of, 636 637 Acute promyelocytic leukemia, associated with acquired bleeding problems, 614 615 Acute renal
More informationB. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life.
B. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life. b. Deficiency of dietary iodine: - Is linked with a
More informationLearning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship
Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with
More informationThe Role of Radiotherapy in Metastatic Breast Cancer. Shilpen Patel MD, FACRO Associate Professor Departments of Radiation Oncology and Global Health
The Role of Radiotherapy in Metastatic Breast Cancer Shilpen Patel MD, FACRO Associate Professor Departments of Radiation Oncology and Global Health Indications for Palliative Pain Control Radiation Bone
More informationAPPROACH TO PLEURAL EFFUSIONS. Raed Alalawi, MD, FCCP
APPROACH TO PLEURAL EFFUSIONS Raed Alalawi, MD, FCCP CASE 65-year-old woman with H/O breast cancer presented with a 1 week H/O progressively worsening exersional dyspnea. Physical exam: Diminished breath
More informationKaroline Nowillo, MD. February 1, 2008
Case Presentation Karoline Nowillo, MD SUNY Downstate t February 1, 2008 Case Presentation Chief complaint enlarging goiter x 8 months History of present illness shortness of breath, heaviness in chest
More informationNEOPLASMS OF THE THYROID PATHOLOGY OF PARATHYROID GLANDS. BY: Shifaa Qa qa
NEOPLASMS OF THE THYROID PATHOLOGY OF PARATHYROID GLANDS BY: Shifaa Qa qa Neoplasmas of the thyroid thyroid nodules Neoplastic ---- benign, malignant Non neoplastic Solitary nodules ----- neoplastic Nodules
More informationRecognition & Treatment of Malignant Spinal Cord Compression Study Day
Recognition & Treatment of Malignant Spinal Cord Compression Study Day 16 th October 2014 Dr Bernie Foran Consultant Clinical Oncologist & Honorary Senior Lecturer Weston Park Hospital Outline of Talk
More informationPRIMARY HYPERPARATHYROIDISM PRIMARY HYPERPARATHYROIDISM. Hyperparathyroidism Etiology. Common Complex Insidious Chronic Global Only cure is surgery
ENDOCRINE DISORDER PRIMARY HYPERPARATHYROIDISM Roseann P. Velez, DNP, FNP Francis J. Velez, MD, FACS Common Complex Insidious Chronic Global Only cure is surgery HYPERPARATHYROIDISM PARATHRYOID GLANDS
More informationCCRN Review - Renal. CCRN Review - Renal 10/16/2014. CCRN Review Renal. Sodium Critical Value < 120 meq/l > 160 meq/l
CCRN Review Renal Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Sodium 136-145 Critical Value < 120 meq/l > 160 meq/l Sodium Etiology
More informationProstate Case Scenario 1
Prostate Case Scenario 1 H&P 5/12/16: A 57-year-old Hispanic male presents with frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has
More informationHEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
More informationCalcium metabolism and the Parathyroid Glands. Calcium, osteoclasts and osteoblasts-essential to understand the function of parathyroid glands
Calcium metabolism and the Parathyroid Glands Calcium, osteoclasts and osteoblasts-essential to understand the function of parathyroid glands Calcium is an essential element for contraction of voluntary/smooth
More informationRadiation 2012 econference
Copyright 2012 Oncology Nursing Society. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, without
More informationThe parathyroid glands participate in the regulation
41 HERNAN I. VARGAS STANLEY R. KLEIN The parathyroid glands participate in the regulation of calcium metabolism. Disorders of the parathyroid gland are most commonly a result of hyperfunction and rarely
More informationDisodium pamidronate for treating severe hypercalcemia in a hemodialysis patient
Disodium pamidronate for treating severe hypercalcemia in a hemodialysis patient Hernán Trimarchi, Fernando Lombi, Mariano Forrester, Cristina Elizondo, Deirdre Sawinski, Horacio Pereyra and Emilio Freixas
More informationCase Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue
Case Scenario 1 Oncology Consult: Patient is a 51-year-old male with history of T4N3 squamous cell carcinoma of tonsil status post concurrent chemoradiation finished in October two years ago. He was hospitalized
More informationFREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS The following questions are representative of questions that patients and family members ask when they visit the Bone and Cancer Foundation website or contact the Foundation
More informationLung Cancer-a primer. Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo
Lung Cancer-a primer Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo CLINICAL CATEGORIES THE SOLITARY PULMONARY NODULE MULTIPLE PULMONARY NODULES Differential Diagnosis Malignant
More informationWoman, 66, With Persistent Abdominal and Back Pain
Woman, 66, With Persistent Abdominal and Back Pain Jennifer L. Osborne, MPAS, PA-C, David J. Klocko, MPAS, PA-C A 66-year-old Latin American woman presented to the emergency department (ED) with persistent
More informationI-Ming Chen, MD. Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer
Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer I-Ming Chen, MD Division of CardioVascular Surgery Taipei Veterans General Hospital, Taiwan (Live
More informationHypocalcemia 6/8/12. Normal value. Physiologic functions. Nephron a functional unit of kidney. Influencing factors in Calcium and Phosphate Balance
Normal value Hypocalcemia Serum calcium Total mg/dl Ionized mg/dl Cord blood 9.0 ~ 11.5 5.0 ~ 6.o New born (1 st 24 hrs) 9.0 ~ 10.6 4.3 ~ 5.1 24~ 48 hrs 7.0 ~12.0 4.0 ~4.7 Child 8.8 ~10.8 4.8 ~4.92 There
More informationContents. Contributors. Reviewers. Acknowledgements I CARDIOVASCULAR COMPLICATIONS
Contributors Reviewers Acknowledgements Preface xii xvi xvii xviii I CARDIOVASCULAR COMPLICATIONS 1 Cardiac Complications of Cancer and Anticancer Treatment 3 Introduction 3 Malignant Pericardial Effusion
More informationINDEX. Note: Page numbers of issue and article titles are in boldface type. cell carcinoma. ENDOCRINE SURGERY
ENDOCRINE SURGERY INDEX Note: Page numbers of issue and article titles are in boldface type. Adenylate cyclase, in signal transduction 425-426 Adrenal incidentalomas, 499-509 imaging of, 502-504 in patients
More informationNursing Process Focus: Patients Receiving Dextran 40 (Gentran 40)
Assess for presence/history of hypovolemia, shock, venous thrombosis. Assess vital signs: Hypovolemic shock secondary to surgery, burns, hemorrhage, other serious condition PT and PTT abnormalities Venous
More information2018 OCN Keywords January 22, 2018 Subject Area Weight Keywords
Subject Area Weight Keywords Care Continuum 19% Care Continuum Coordination of Care Navigation Psychosocial Symptom Management Health Promotion/Screening and Early Detection Disease Prevention High-Risk
More informationLooking Outside the Box: Incidental Extracardiac Finding in Echo
Looking Outside the Box: Incidental Extracardiac Finding in Echo Dr. Aijaz Shah Head of Division, Adult Echocardiography Laboratory Prince Sultan Cardiac Centre Riyadh Case 1 17 year old boy presented
More informationUpper Extremity Venous Duplex. Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016
Upper Extremity Venous Duplex Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016 Patricia A. (Tish) Poe, BA RVT FSVU Director of Quality Assurance Navix Diagnostix Patricia A. Poe
More informationPalliative Emergencies. Ken Stakiw
Palliative Emergencies Ken Stakiw Disclosure None to disclose for this lecture Have received honoraria from a number of agencies and companies previously Intend to discuss some off label use of medications
More informationHypercalcemia. Brian Rose, M.D. Bozeman Health June 6, 2018
Hypercalcemia Brian Rose, M.D. Bozeman Health June 6, 2018 Hypercalcemia Diagnosis PTH Mediated Primary Hyperparathyroidism Lithium Familial Hypocalciuric Hypercalcemia Non PTH mediated Malignancy Humoral
More informationCase study Group 2 presentation
Case study Group 2 presentation Patient profile HN 3095-57 Female 60 years old Hometown : Sa Kaeo province Occupation : farmer No drug and food allergy Chief complain Left neck mass 10 years PTA that gradually
More informationCase Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2
Case Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2 Case 79 yo M with hx of T3N0 colon cancer diagnosed in 2008 metastatic liver disease s/p liver segmentectomy 2009
More informationOUTLINE. Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis
THYROID DISEASE OUTLINE Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis OUTLINE Hypothyroidism - Hashimoto s thyroiditis,
More informationHYPERCALCAEMIA 101 FOR THE INTERNIST
HYPERCALCAEMIA 101 FOR THE INTERNIST Dr Chionh Siok Bee Dept of Medicine, National University Hospital siok_bee_chionh@nuhs.edu.sg Medicine Review Course 18/09/2011 Outline of Talk Definition of hypercalcaemia
More informationHIGH LEVEL - Science
Learning Outcomes HIGH LEVEL - Science Describe the structure and function of the back and spine (8a) Outline the functional anatomy and physiology of the spinal cord and peripheral nerves (8a) Describe
More informationBRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION
BRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION GRAND ROUND WARD 7C DATE: 25 TH MARCH 2015 PRESENTER: DR E. SAYO FACILITATOR: DR J MECHA DEMOGRAPHIC DATA NAME : CM AGE: 69 YEARS ADDRESS : KIAMBU OCCUPATION:
More informationSpecific Basic Standards for Osteopathic Fellowship Training in Pulmonary / Critical Care Medicine
Specific Basic Standards for Osteopathic Fellowship Training in Pulmonary / Critical Care Medicine American Osteopathic Association and American College of Osteopathic Internists BOT Rev. 2/2011 These
More informationClinical Radiological Pathological Conference
Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion
More informationDiagnostic Bedside Ultrasound for the Hospitalist
Diagnostic Bedside Ultrasound for the Hospitalist Trevor Jensen MD MS Assistant Professor, UCSF Nima Afshar MD Associate Professor, UCSF Diagnostic Bedside Ultrasound AKA Point-of-Care Ultrasound (POCUS)
More informationDefinition. Epidemiology. Lung Cancer is a disease which cancer (malignant tumors) cells grow in the lungs. LUNG CANCER Debra Mercer BSN, RN, RRT
LUNG CANCER Debra Mercer BSN, RN, RRT Definition Lung Cancer is a disease which cancer (malignant tumors) cells grow in the lungs. Epidemiology Leading cancer killer in both men and women in the US - 169,
More informationInstrumental determination of electrolytes in urine. Amal Alamri
Instrumental determination of electrolytes in urine Amal Alamri What is the Electrolytes? Electrolytes are positively and negatively chargedions, Found in Within body's cells extracellular fluids, including
More informationLung Cancer - Suspected
Lung Cancer - Suspected Shared Decision Making Lung Cancer: http://www.enhertsccg.nhs.uk/ Patient presents with abnormal CXR Lung cancer - clinical presentation History and Examination Incidental finding
More informationHypoparathyroidism By John Halpern, DO, FACEP Coauthored by N. Ewen Wang, MD
Hypoparathyroidism By John Halpern, DO, FACEP Coauthored by N. Ewen Wang, MD Reprinted with permission from: E-Medicine: Instant Access to the Minds of Medicine http://www.emedicine.com/emerg/topic276.htm
More informationWe are gong to focus on: Unit 9. Before we begin: Chronic Renal Failure/Uremia ESRD/Dialysis Prostate Cancer Testicular Cancer Renal Cancer
Unit 9 Problems with excretion Before we begin: You are to understand on your own: A & P of Renal System Common terms of renal system How to perform a focused health history How to perform a Physical Exam
More informationElectrolyte Emergencies
Electrolyte Emergencies Hyponatremia/hypernatremia Hypokalemia/hyperkalemia Hypocalcemia/hypercalcemia Hypomagnesemia/hypermagnesemia Hypophosphatemia/hyperphosphatemia Hyponatremia Symptomatic: headaches,
More informationThe use of surgery in the elderly. for management of metastatic epidural spinal cord compression
The use of surgery in the elderly Bone Tumor Simulators for management of metastatic epidural spinal cord compression Justin E. Bird, M.D. Assistant Professor Orthopaedic Oncology and Spine Surgery Epidemiology
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More information