1/6. Malignant melanoma of the ovary and exposure to clomiphene citrate: a case report and review of the literature.OBJECTIVE: The purpose of this article is to present a case of metastatic malignant melanoma of the ovary, a review of the current literature, and current recommendations for preventative and consultative management. STUDY DESIGN: This is a case report and literature review. A 34-year-old woman had symptoms of pelvic abscess 1 month after clomiphene citrate stimulation for infertility. After a failed course of antibiotic therapy, an exploratory laparotomy was performed. Bilateral malignant melanomas of the ovary were discovered. The patient died 4 weeks later of disseminated metastases. Retrospectively, a history of a "mole" with unknown histopathologic characteristics had been removed from her arm 15 years earlier. A review of the literature was performed to provide current findings regarding malignant melanomas of the ovary, as well as to evaluate the potential relationship between the use of ovarian stimulating drugs and the development of melanomas. RESULTS: Melanomas account for 3% of cancers, but the incidence of melanoma is rising. Genital melanomas are uncommon; the primary site is the vulva. Primary malignant melanoma of the ovary is rare; however, delayed recurrence from a primary skin site with metastasis to the ovary is documented. The literature suggests a possible relationship between the use of clomiphene citrate and an increase in melanomas of the skin. CONCLUSION: The gynecologist, as a primary provider, must be aware of the increasing incidence of malignant melanoma, as well as the recommendations for prevention. The gynecologist, as a consultant, must be aware of the risk of delayed recurrence of malignant melanoma. The potential for development of melanomas associated with the use of ovarian stimulation for infertility needs further monitoring and analysis.- - - - - - - - - - ranking = 1keywords = consultant (Clic here for more details about this article) |
2/6. Questions for the consultant: seizures and epilepsy.Issues regarding management of acute and chronic seizures constitute one of the more frequent consultations that all neurologists encounter. With a significant medical and surgical therapeutic armamentarium now available, many clinicians are perplexed about how to approach the most basic of seizure consultation questions. In this article, four of the most commonly asked seizure consultation questions are reviewed: when antiepileptic drug (AED) treatment should be initiated; how to choose an AED; when to refer a patient for surgery; and when to withdraw AEDs in a seizure-free patient. By utilizing frequently encountered clinical scenarios, the decision-making process to best illustrate application of existing clinical evidence to the individual patient is explored.- - - - - - - - - - ranking = 4keywords = consultant (Clic here for more details about this article) |
3/6. cytomegalovirus retinitis after intravitreous triamcinolone in an immunocompetent patient.PURPOSE: To report the case of a 75-year-old man with diabetes who developed cytomegalovirus (CMV) retinitis after intravitreous injection of triamcinolone acetonide (IVTA). DESIGN: Observational case report. methods: review of medical records. RESULTS: A 75-year-old man with diabetic macular edema developed arcuate retinal whitening after IVTA. A presumptive diagnosis of viral retinitis was made, and a vitrectomy was performed. polymerase chain reaction of the vitreous was positive for CMV dna. An infectious disease consultant found no signs of systemic CMV infection, and laboratory examination revealed that the patient was hiv negative. The patient responded well to intravitreal ganciclovir and oral valganciclovir, but when therapy was discontinued, the retinitis recurred and CMV dna was again detected in the vitreous. The retinitis once again responded to antiviral therapy. CONCLUSIONS: CMV retinitis can occur after local immunosuppression with IVTA. Clinicians should be aware of this rare complication of IVTA.- - - - - - - - - - ranking = 1keywords = consultant (Clic here for more details about this article) |
4/6. Recurrent aseptic meningitis for 24 years: diagnosis and treatment of an associated lesion.Recurrent meningitis in the absence of an identifiable causative organism or anatomical source is a difficult diagnostic challenge for any infectious disease consultant. We evaluated a 49-year-old woman with episodes of meningitis which occurred on at least nine separate occasions for over 24 years. No causative organism, physical agent, or underlying disease process was identified as the source of this patient's recurrent lymphocytic meningitis. When computerized tomographic head scanning was first performed in 1977, a prominence of the left lateral ventricle was evident. It was not until the area was subsequently evaluated with magnetic resonance imaging techniques 13 years later that a lesion could be clearly identified, removed, and evaluated at pathology. time alone will tell whether the lesion, a cavernous hemangioma, was truly the cause of this patient's recurrent aseptic meningitis for 24 years.- - - - - - - - - - ranking = 1keywords = consultant (Clic here for more details about this article) |
5/6. Recurrent near-syncope with flushing.Episodic vasomotor instability with flushing is an uncommon presentation that is suggestive of an endocrine etiology. This report is the case of a 42-year-old woman who presented to the ED 5 times in a 2-week period for recurrent, self-limited episodes of light-headedness associated with tachycardia, hypertension, and flushing. The patient's diagnosis eluded detection in both the outpatient and the inpatient settings for several months. The clinical diagnosis was ultimately confirmed by biochemical test samples obtained in the ED during a subsequent symptomatic event. The differential diagnosis of this patient's presentation includes pheochromocytoma, carcinoid syndrome, medullary thyroid carcinoma, systemic mastocytosis, and other endocrine and toxicologic diseases. ED management of the patient with transient yet significant vasomotor changes includes a workup for syncope, initiation of focused biochemical investigations, referral to the appropriate consultant, and consideration for admission.- - - - - - - - - - ranking = 1keywords = consultant (Clic here for more details about this article) |
6/6. The great imitator: rocky mountain spotted fever occurring after hospitalization for unrelated illnesses.We describe two patients who had rocky mountain spotted fever after they were admitted to the hospital for emergency and elective surgical procedures. We initially thought one patient had a hospital-acquired infection; the correct diagnosis was deduced from epidemiologic clues elicited by consultants. These two cases were also unusual in that one patient had a recurrent rash after an abbreviated course of low-dose doxycycline therapy and the other patient had transient and self-limiting postinfectious polyneuropathy. These cases illustrate that community-acquired infection with rickettsia rickettsii can occur simultaneously with other disease processes and sometimes mimic a nosocomial infection.- - - - - - - - - - ranking = 1keywords = consultant (Clic here for more details about this article) |