Academic literature on the topic 'Paget's disease. eng'

This book, like all the other Oxford Handbooks, aims to provide a compact, but comprehensive, guide to medical practice. It has been designed to slip inside the pocket of a white coat and to be rapidly retrieved for reference. There are many blank facing pages for notes and for amending or annotating the text to fit in with local practice. The core text is based on an anatomical list of ear, nose, and throat (ENT) diseases. There are separate sections on ENT examinations, investigations, common operations, ward care, and emergencies. There is also a separate section on the work of other ENT he

On October 8, 2014, Thomas Eric Duncan died in a Dallas hospital from Ebola virus infection. From the moment he was diagnosed with Ebola newspapers all over the country blared the news that the first case of Ebola in the United States had oc¬curred. Blame for his death was immediately assigned to the hospital that cared for him and to the U.S. Centers for Disease Control and Prevention (CDC). By the end of the month a total of four cases had developed in the United States: two in people— including Duncan— who acquired it in African countries where the disease was epidemic and two in nurses who cared for Duncan. Headlines about Ebola continued to dominate the pages of American newspapers throughout the month, warning of the risk we now faced of this deadly disease. These media reports were frightening and caused some people to wonder if it was safe to send their children to school or ride on public transportation— even if they lived miles from any of the four cases. “There are reports of kids being pulled out of schools and even some school closings,” reported Dean Baker in the Huffington Post. “People in many areas are not going to work and others are driving cars rather than taking mass transit because they fear catching Ebola from fellow passengers. There are also reports of people staying away from stores, restaurants, and other public places.” An elementary school in Maine suspended a teacher because she stayed in a hotel in Dallas that is 9.5 miles away from the hospital where two nurses contracted the virus. As Charles Blow put it in his New York Times column, “We aren’t battling a virus in this country as much as a mania, one whipped up by reactionary politicians and irresponsible media.” It turns out that Thomas Duncan was not the only person who died in the United States on October 8, 2014. If we extrapolate from national annual figures, we can say that on that day almost 7,000 people died in the United States.

We have arranged the differential diagnosis in order of likelihood in a man of this age with more likely diagnoses in larger font and less likely diagnoses in smaller font in Figure 12.1. Pathologies that should be excluded at the earliest possible opportunity are shown in bold. Bear in mind that this differential diagnosis refers to epigastric pain as a presentation of ‘acute abdomen’ and thus differs markedly from epigastric pain presenting as outpatient dyspepsia. Note that although we have adopted a standard approach of history, examination, and investigations over the course of the following pages, you should use clinical judgement to deviate from this path if one of the ‘must exclude’ diagnoses is suspected, or if there is a need for urgent resuscitation. For example, if a 69-year-old male diabetic patient with known unstable angina presents with exercise-induced epigastric pain, you would be wise to perform an electrocardiogram (ECG) and obtain baseline observations at the earliest opportunity. Various characteristics of the pain will help to narrow our differential diagnosis of epigastric pain: Site: • Pain that has spread from the epigastrium to involve the rest of the abdomen may suggest peritonitis from a perforated GI tract (e.g. perforated gastric ulcer, which causes epigastric pain because the stomach is embryologically a foregut structure). • Pain that has spread from the epigastrium to involve the chest may be cardiac. • Biliary disease, although anatomically located in the right upper quadrant, may present with purely epigastric symptoms. Onset: • Pain that is of very sudden onset suggests perforation of a viscus (e.g. a perforated duodenal ulcer or Boerhaave’s perforation) or myocardial infarction. • Pain from acute pancreatitis and biliary colic develops maximal intensity over 10–20 minutes. • Inflammatory processes such as acute cholecystitis or pneumonia typically take hours to reach their peak. Character: • ‘Crushing’ or ‘tightness’ qualities are typical of cardiac pathology. • Sharp, ‘burning’ pain is typical of peptic ulcers, gastritis, and duodenitis. • Deep, ‘boring’ pain is typical of pancreatitis. Radiation: • Back pain is classically associated with pancreatitis, leaking abdominal aortic aneurysms, and sometimes seen with peptic ulcers.