Harrison's Internal Medicine Chapter 82. Infections in Patients with Cancer
Infections in Patients with Cancer: Introduction Infections are a common cause of death and an even more common cause of morbidity in patients with a wide variety of neoplasms. Autopsy studies show that most deaths from acute leukemia and half of deaths from lymphoma are caused directly by infection. With more intensive chemotherapy, patients with solid tumors have also become more likely to die of infection.
improvement occurred in the diagnosis and treatment of the disease. The aim of this
disease is to re-review pulmonary embolism in the light of new developments. In this
book, in addition to risk factors causing pulmonary embolus, a guide for systematic
approaches to lead the risk stratification for decision making is also presented.
A number of techniques can assist the physician with the growing number of recommended screening tests. An appropriately configured electronic health record can provide reminder systems that make it easier for physicians to track and meet guidelines. Some systems provide patients with secure access to their medical records, providing an additional means to enhance adherence to routine screening. Systems that provide nurses and other staff with standing orders are effective for smoking prevention and immunizations.
It is more enjoyable to read about complications than to manage them. Surgical
complications are challenging for several reasons. It is difficult to watch patients and
their families suffer. Although some complications are minor setbacks that resolve
over time, some lead to longstanding disability. As surgeons, we sometimes doubt
ourselves in the wake of a complication and lose confidence in our abilities. In some
cases, surgeons avoid surgery or practice heightened defensive surgery, rendering
them surgically dysfunctional.
We were able to obtain satisfactory postoperative PSA levels by RTUR-PCa comparable with
open radical prostatectomy. But we recently started to think that, after a considerable
number of the procedures, minimal residual prostate tissue at the part where cancer was not
detected by biopsy might not necessarily prevent the radicality of the disease in carefully
selected patients. We performed prostate biopsy to get information about the localization of
cancer. The results of cancer localization from operative specimens were consistent with
those from biopsy specimens in 46.7%....
Potential Biases of Screening Tests The common biases of screening are lead time, length-biased sampling, and selection. These biases can make a screening test seem beneficial when actually it is not (or even causes net harm). Whether beneficial or not, screening can create the false impression of an epidemic by increasing the number of cancers diagnosed. It can also produce a shift in proportion of patients diagnosed at an early stage that improves survival statistics without reducing mortality (i.e.
A similar problem can affect patients whose lymph node integrity has been disrupted by radical surgery, particularly patients who have had radical node dissections. A common clinical problem following radical mastectomy is the development of cellulitis (usually caused by streptococci or staphylococci) because of lymphedema and/or inadequate lymph drainage. In most cases, this problem can be addressed by local measures designed to prevent fluid accumulation and breaks in the skin, but antibiotic prophylaxis has been necessary in refractory cases.
The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biological therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them. Independent of prognosis, the diagnosis brings with it a change in a person's self-image and in his or her role in the home and workplace.
Chemoprevention of Cancers of the Upper Aerodigestive Tract Smoking causes diffuse epithelial injury in the head, neck, esophagus, and lung. Patients cured of squamous cell cancers of the lung, esophagus, head, and neck are at risk (as high as 5% per year) of developing second cancers of the upper aerodigestive tract. Cessation of cigarette smoking does not markedly decrease the cured cancer patient's risk of second malignancy, even though it does lower the cancer risk in those who have never developed a malignancy.
Sepsis with Skin Manifestations (See also Chap. 18) Maculopapular rashes may reflect early meningococcal or rickettsial disease but are usually associated with nonemergent infections. Exanthems are usually viral. Primary HIV infection commonly presents with a rash that is typically maculopapular and involves the upper part of the body but can spread to the palms and soles. The patient is usually febrile and can have lymphadenopathy, severe headache, dysphagia, diarrhea, myalgias, and
Erratic eating is one of the manifestations of mental disorders. Patients can not eat or drink, or eating too much can not be controlled.For mental health care possible, it is important to reserve the disease, early detection and treatment of disorders to prevent complications, and rehabilitation for patients with community reintegration. However, psychiatric symptoms were relatively discreet, sometimes hard to distinguish from the normal operation
Infections are a common cause of death and an even more common cause of morbidity in patients with a wide variety of neoplasms. Autopsy studies show that most deaths from acute leukemia and half of deaths from lymphoma are caused directly by infection. With more intensive chemotherapy, patients with solid tumors have also become more likely to die of infection. Fortunately, an evolving approach to prevention and treatment of infectious complications of cancer has decreased rates of infection-associated mortality and will probably continue to do so. ...
The physician treating the acutely ill febrile patient must be able to recognize infections that require emergent attention. If such infections are not adequately evaluated and treated at initial presentation, the opportunity to alter an adverse outcome may be lost. In this chapter, the clinical presentations of and approach to patients with relatively common infectious disease emergencies are discussed. These infectious processes and their treatments are discussed in detail in other chapters. ...
When health care workers interact with patients, they should address the patient by
name, and respect the patient’s time by attending to the patient as soon as possible.
When a patient’s ideas are different from the health care worker’s, the health care
worker should accept that the patient has different views, and then make sure the
patient knows the health care worker’s point of view about TB. Health care
workers can make it clear that even if they do not share the patient’s views, they
respect them. Knowing and respecting the patient’s views will improve...
A pre-tested questionnaire was used by a trained
counselor to obtain information on demographic
characteristics, social and medical history from the
subjects. Other important information about PTB such
as previous BCG vaccination, contact with an index
case and exposure to tuberculin skin test were also
Laboratory investigations: Three early morning sputum
were collected from each consenting asymptomatic
subject. The samples were transported to TB laboratory
of the department of Medical Microbiology and
Parasitology, UCH, for immediate processing.
The Coalition remains united in efforts to support the achievement of the United Nations’ Millennium
Development Goal (MDG) 4 of reducing maternal, newborn and child mortality by two-thirds
by 2015. In 2010, Coalition member organizations urged their governments to support a World
Health Assembly resolution stating that intensified efforts to address the prevention and treatment
of pneumonia are vital to reducing child mortality and achieving MDG 4, and requiring countries
to report back annually on progress controlling childhood pneumonia.
In our modern world, where international travel is common
and rapid, a disease can spread around the globe very quickly.
On an international level, the World Health Organization (WHO)
has developed and monitored International Health Regulations
(with origins in the mid-19th century) to help prevent
epidemics from spreading worldwide. The regulations are
being revised to address bioterrorism as well as chemical and
Surgical Atlas of Pediatric Otolaryngology is a unique and comprehensive reference
for clinicians who care for infants and children with disorders of the
ears, nose, throat, head, neck, and related structures. Over 200 procedures
are described in 650 figures in 900 parts, with step-by-step instructions for
patient preparation, surgical techniques, postoperative care, and prevention