1例眼眶原发非霍奇金淋巴瘤病人的护理

原发于眼眶的恶性淋巴瘤较罕见 ,其发生率不超过所有原发于结内和结外淋巴瘤的 1% ,占眼部所有恶性肿瘤的1.86% [1] 。我科于 2 0 0 4年 11月收治 1例原发于眼眶的恶性淋巴瘤病人 ,现将护理报告如下。1　病例介绍　　病人 ,男 ,42岁 ,2 0 0 3年 3月曾在外院行左眼眶肿瘤摘除术 ,术后病理检查报告提示淋巴组织增生 ,未行放疗和化疗。2 0 0 4年 5月病人左眼球突出 ,11月眼部CT检查示左眼眶后肿瘤复发 ,并累及双侧泪腺 ,分别于 11月 6日和 11月 2 4日于眼科医院再次行左眼眶肿瘤摘除术 ,术后病理检查报告提示非霍奇金淋巴瘤 (未注明细胞来源 )…     

Pharmacotherapy and the primary care physician

Clinical pharmacy services and pharmacotherapy specialists did not begin in primary care settings. Rather, the initial interdisciplinary teams took root in large hospitals and tertiary medical center inpatient services during the middle 1960s. By the early 1970s, however, numerous papers appeared that described a unique and exciting practice model that incorporated primary care physicians and clinical pharmacists. The sole purpose of the interdisciplinary concept was to allow each member to contribute their own expertise to improve patient care. In my experience, primary care physicians have been eager to consult clinical pharmacists and other health professionals. I believe that the reason for this is a fundamental philosophy that distinguishes these physicians from other medical specialists. Ingrained in their philosophy are concepts such as continuity of care and care of the entire patient. The latter relates, not only to multiple organ systems, but also the spiritual and behavioral characteristics of the person. The primary care physician is also viewed as the coordinator for all health care services required by their patients. Most primary care physicians welcome others' expertise as long as they continue to be the health care coordinator for the patient. The health care structure of the United States continues to shift to ambulatory care. This will provide additional opportunities for the types of group models described in this article. After 20 years, the positive impact that physician and pharmacotherapist teams can have on drug therapy is being recognized on a broader scale. These models should continue to move from the academic laboratory to private group practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Concomitant occurrence of genetically distinct Hodgkin lymphoma and primary mediastinal lymphoma

Synchronous Hodgkin Lymphoma and Primary Mediastinal B‐cell Lymphoma is possible, with molecular analyses proving the absence of clonal filiation between both entities. This suggests a common etiology but the existence of two divergent clones.     

Depression and fatigue in the primary care physician

Fatigue is a symptom that is found in a variety of psychiatric disorders. The nature of a physician's life may foster such symptoms that can be either a reaction to work or a sign of an emotional disorder. This article summarizes various developmental stages that can lead to such problems. These difficulties may also be found in the physician's family and can be easily overlooked.     

Food allergy for the primary care physician

Interest in food allergy has increased among physicians as well as the public. The symptoms are mainly in the gastrointestinal tract, the skin, and the respiratory system. Other organs are less commonly affected. The offending food can be suspected from the medical history, by skin testing, or by serum-specific IgE antibodies (RAST). Verification, however, depends on documentation of disappearance of symptoms after avoidance of the offending food and their recurrence on reintroduction of that food. Treatment is mainly dietary avoidance. Its success, however, depends on many factors. Pharmacologic agents may be needed in some cases for symptomatic relief and possibly for prophylaxis. The awareness on the part of the primary physician of the manifestations of food allergy and its diagnosis should enhance the physician's expertise in dealing with such patients regarding further management.     

Iatrogenic disease and the primary care physician

Primary care physicians need to be aware of iatrogenic disease and its causes. Adverse drug reactions, including drug-drug interactions, and certain diagnostic procedures may lead to iatrogenic complications. Hospitalized patients, especially the elderly, face increased risks of such complications. Physicians who are aware of common adverse reactions to drugs, drug combinations, and medical procedures may be able to help patients avoid unnecessary distress and morbidity.     

Diagnostic strategy of the primary care physician in microhematuria

The laboratory tests of the urine is of a great importance in the modern clinical practice. The detection and examination of peculiarities as well as of quantitative and qualitative parameters of erythrocyturia plays a significant role in the diagnostic tactic of practitioner.     

The primary care physician and palliative care.

Palliative care is about total patient care, management of disabling and debilitating symptoms, and the role of the primary care physician. As physicians, we must understand who, what, when, how, and where to institute, or refer patients for palliative care. Who? Any patient needing assistance with the control of physical and nonphysical symptoms can benefit from palliative care. What? An interdisciplinary team coordinating care planning of the patient. When? The earlier in the disease process the patient is referred, the sooner symptom control can be maximally achieved. How? The primary care physician makes the initial referral to the palliative care physician or team. Where? All hospices should have a palliative care physician or consultant. This article provides a broad overview of palliative care management and incurable illnesses.     

Efficient counseling techniques for the primary care physician

Up to 60% of ambulatory primary care patients have psychosocial factors contributing to their symptom presentation. Counseling, although helpful, is seen as requiring specialized training that most primary care physicians lack, as well as being complex and time-consuming. Several counseling methods have been developed that are brief, relatively easy for the physician to learn and implement, and patient-centered. These include the BATHE technique, the FRAMES strategy, the Stages of Change (Transtheoretical Model) approach, and Motivational Interviewing. Although limited, available research suggests that carefully targeted brief counseling in medical settings does produce meaningful change.     

Appendix: resources for the primary care physician

In travel medicine, as in all other disciplines, there are principles that physicians need to know and understand as well as constant and variable details that need not be memorized but must be readily accessible. This appendix provides a brief listing of resources helpful to primary care physicians who see their patients before and after travel.