There is a good rational to assume that the smaller a tumor the better the outcome. However, there are several variables and prognostic factors involved in the clinical evolution of a patient, not only time. The process of diagnostic in cancer have been artificially divided in different segments related to the patient, the appointment with a doctor and the pattern of referral. In all these models the physician looks like the perfect machine prepared for a perfect diagnosis….
Improving medical diagnosis
Hypophysitis was an unusual complication in the late pregnancy and postpartum. Now, other clinicians and mainly oncologist have to think on this important problem because the new immunological treatments are associated with a low percentage (1%) with this syndrome and the recognition could be difficult, but there is a key symptom…
A-72-year-old man with a previous diagnosis of Chronic Obstructive Pulmonary Disease had a diagnosis of pneumonia after three days with high fever, cough and a productive sputum. He stayed at the hospital and started with antibiotics, enoxaparin, and oxygen, with a favourable clinical evolution. The doctor ordered a new X-ray but the patient started with dyspnea during his journey to the radiology department. Can you suggest a reason for that?
Chance or a clever clinical observation is at the origin of the discovery of new clinical entities. A cluster of opportunistic pulmonary infections in young people was associated with HIV infection. Diethylstilbestrol taken by women was related to vaginal cancer in their daughters. NUT Midline carcinoma (the name coming from the rearrangements of the gene NUT) has been defined as a new clinical entity after the observation of several cases with undifferentiated carcinoma located in the midline, from the nasopharyngeal area to the mediastinum…
Pulmonary embolism and cancer are a very well known association, but only a high index of suspicion will help to reach the diagnosis because very often this entity appears in the context of a progressive disease in a patient with several symptoms such as dyspnea, fever, fatigue, making the diagnosis of Pulmonary embolus a difficult task.
Diagnosis in Medical Oncology is facing a revolution. Morphology and a limited set of cellular markers are the keystone of the diagnosis and at the end, we will classify a lung cancer in two categories, non-small cell lung cancer or small cell cancer, a colorectal cancer in just a category, breast cancer could be divided based on morphology in ductal or lobular and we can continue with the rest of the tumors. But the landscape is evolving…
Dr. Joseph William Noble, a British doctor, was born in 1798 in Frisby , Leicester, England. He studied at the Cambridge University and he obtained his title at the Trinity College. He was a famous doctor and a member of the Parliament.He died in Málaga, while travelling, after attending a sick person with cholera in the same hotel where he stayed. He is buried in Málaga, in the Anglican Church cemetery. After his death their daughters decide to build a hospital in Málaga devoted to poor people, sailors and fisherman. The family donates the hospital to the town hall for sanitary purposes ,but now is an administrative office.
We want to recover the hospital for a museum of the Medicine dedicated to showing to young persons advances in several fields.
A 72-year-old man went to the hospital with high fever, weight loss and hyporexia and general clinical deterioration. In the first differential diagnosis list the problem of the patient was not included.
Can you suggest a diagnosis?
A diagnosis of a colorectal or ovarian cancer is a therapeutic challenge still nowadays. The treatment usually is based on a combination of surgery and chemotherapy with a clear improvement in the outcome. The follow-up of these patients is clearly established, but in some situations related to other abdominal characteristics the conclusions can be distorted
Skeletal abnormalities can be present in a new born. Some are usually detected after the paediatrician examines the boy or girl, like hip dysplasia. Others can go undetected when attention is not given even in minor signs or symptoms.