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Nasal and Sinus Malignancy
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Sinonasal malignancies are an uncommon heterogeneous group of tumours. They are often misdiagnosed as benign conditions. Extension of these tumours into the orbit, brain, and infratemporal fossa causes profound symptoms, with significant implications for morbidity and prognosis. Surgery and radiotherapy remain the mainstays of treatment. The prognosis is relatively poor compared with that for tumours at other head and neck subsites.
What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
I’d say the opposite of joy in work is malpractice. Being sued is my one overwhelming and pervasive fear. I was sued once for malpractice and it was a terrible, destructive, devastating experience. I misdiagnosed a patient. It was a mistake. It was a rare neurological disease and I just missed it. I thought it was something else entirely, so I had very little defense. The lawsuit went on for probably three years until it was over. In the end, we settled the case and the patient was compensated. Did I let that affect the way I practiced medicine? I don’t think I did.
Neurology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Multiple sclerosis is a condition caused by inflammatory patchy destruction of the myelin and axons in the central nervous system, producing a variety of clinical patterns, relapsing and remitting disease, progressive disease, or a mixture of the two. Misdiagnosis and treatment are of legal note.
Factors affecting the accuracy of amyloidosis identification and referral to a specialty centre
Published in Amyloid, 2023
Andrew Staron, Lisa M. Mendelson, Tracy Joshi, Frederick L. Ruberg, Vaishali Sanchorawala
Errors at the diagnostic level can have downstream consequences. Individuals may be subjected to additional invasive testing and unnecessary referrals, generating added financial costs and psychological harm. Misdiagnosis also carries a risk of therapeutic harm, as it can lead to the provision of inappropriate therapies that carry toxicities. An understanding of the factors contributing to inaccuracies in disease detection and referral may help minimise these harms. Herein, we reported a false positive referral rate of 6% at a major centre of excellence for amyloidosis. The false positive referral rate upsurged to 13% in the latest year of our study, likely on account of more testing for amyloidosis in the community with increasing disease awareness and accessibility to the non-invasive imaging-based approach for detecting ATTR cardiac amyloidosis.
Diagnostic value of probe-based confocal laser endomicroscopy versus conventional endoscopic biopsies of non-muscle invasive bladder tumors: a pilot study
Published in Scandinavian Journal of Urology, 2021
Sami Beji, Gitte Wrist Lam, Peter Busch Østergren, Anders Toxvaerd, Jens Sønksen, Mikkel Fode
Meanwhile, we believe that the main potential value in CLE is its possible ability to spare patients from unnecessary surgery. Therefore, the most important parameter from a clinical standpoint is the NPV for HUCG. This showed more promising results between 77% and 89%. This corroborates previous findings that CLE may be valuable when distinguishing between HG bladder tumors and more indolent findings. Thus, Liem et al. found a CLE specificity for LG lesions of an impressive 96%. However, in our study, it is important to note that the majority of histology showed normal tissue or LG lesions, which could in part explain the high NPVs. Even with this theoretical advantage, the NPV of the intraoperative CLE evaluations only reached 81%. Considering the prognosis for HG bladder lesions, this number is not high enough to omit surgery based on CLE. The problem is highlighted as the histopathology of one biopsy showed a pT1 HG urothelial carcinoma, while all three CLE observations concluded that the lesion was non-invasive LGUC. Such a misdiagnosis would be devastating to the patient.
Radiological honeycombing: pitfalls in idiopathic pulmonary fibrosis diagnosis
Published in Expert Review of Respiratory Medicine, 2020
Vasilios Tzilas, Simon Walsh, Argyrios Tzouvelekis, Demosthenes Bouros
Emphysema is defined pathologically as permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis [31]. This was erroneously interpreted that no fibrosis is present in emphysema. Unfortunately, in the literature, there is no uniformity in nomenclature and definition regarding the spatial co-existence of emphysema and fibrosis. Several names have been used as smoking-related interstitial fibrosis (SRIF) [32] and airspace enlargement with fibrosis (AEF) [33]. From a pathologist’s point of view, microscopic fibrosis can be seen as a local phenomenon in centrilobular and particularly paraseptal emphysema [34]. Macroscopically these areas can appear on CT as clustered cysts. It is important not to mistake this appearance as honeycombing that will lead to a false UIP diagnosis (Figure 9). While honeycombing usually appears as round cysts of relatively similar size abutting the pleura, in fibrosis associated with emphysema cysts tend to be larger, with thinner walls, of different sizes and with relatively less involvement of the subpleural parenchyma [33,35,36]. It is essential to highlight that SRIF is a distinct pathological condition from UIP and its natural course is largely unknown. Misdiagnosis should be avoided as it can lead to unnecessary treatment. Also, in SRIF the development of fibrosis is a local phenomenon, thus the presence of fibrosis away from areas of emphysema further points toward the co-existence of a fibrotic ILD.