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Shoulder and elbow
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Check whether they are experiencing pain in the shoulder, then feel gently, but firmly, around the entire joint on both sides. Pay attention separately to the glenohumeral joint and the scapulo–thoracic interface. Push your fingers gently into the space between the acromium and the clavicle, and into the anterior glenohumeral joint space. Palpate the humeral shaft and head by pushing your fingers into the axilla. Observe the patient for pain and tenderness. Feel for joint swelling consistent with an effusion.
Animal Models of Meniscal Repair
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Jan Klompmaker, René P. H. Veth
Smillie87 mentioned the main features of a meniscal lesion. Most importantly the symptoms are intermittent. The patient is older than the age of 30 and younger than 57. A history of trauma may be absent in case of a cleavage tear but is often present in case of a longitudinal tear. Local pain is present in the joint line. There is a feeling of giving-way and instability. Lack of extension (locking) of the knee is present when a flap is interposed between the femur and tibia. Effusion is not a specific symptom.
Thoracic Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
A pleural effusion describes the abnormal accumulation of fluid in the pleural space. This can be due to a wide variety of causes. They are often grouped into ‘transudative’ or ‘exudative’ causes depending on their protein content and other factors. A wide differential often requires both visualisation of the effusion using ultrasound and safe sampling of the fluid under ultrasound guidance.
The role of Iloprost on bone edema and osteonecrosis: Safety and clinical results
Published in Expert Opinion on Drug Safety, 2018
Ippokratis Pountos, Peter V Giannoudis
Bone marrow edema (BME) was first introduced in 1959 by Curtiss and Kincaid [4]. It was characterized by pain, decreased bone density, and spontaneous regression in women during the last trimester of pregnancy (Table 1). With the introduction of the MRI BME was established as a condition, having low signal on T1 weighted images, high signal on T2-weighted images accompanied by normal subchondral area [5,6]. This term was used as there was ‘lack of a better term and to emphasize the generic character of the condition.’ As a consequence, a number of different terms were used to describe this pathology including transient osteoporosis, regional migratory osteoporosis, transitory demineralization, and bone algodystrophy. BME mainly involves the lower limbs and rarely the upper limbs [7]. It affects mostly the middle-aged population (20–40 years of age) and males (male to female ratio 3:1) [8]. The clinical picture is characterized by an abrupt or gradual onset of pain on exertion but also pain at rest at night. Soft-tissue swelling, arthralgia, and joint effusion and limitation of the range of movement can develop [9]. It can take up to 18 months for the condition to resolve, usually spontaneously [10].
Role of bevacizumab in the management of the patient with malignant pleural effusion: more questions than answers
Published in Expert Review of Respiratory Medicine, 2018
Ralph Llewel Sabang, Deepthi Gandhiraj, Michael Fanucchi, Oleg Epelbaum
NSCLC is the most common cause of MPE, which tends to respond poorly to conventional systemic chemotherapy in this type of histology. The literature examining the potential role of bevacizumab for MPE control in NSCLC has evolved in recent years but remains limited. Available data on intravenous bevacizumab as an adjunct to cytotoxic chemotherapy consist of a handful of small studies all performed in Asia and all lacking a control group among other sources of bias. The earliest of these investigations by Kitamura and colleagues included 13 patients with MPE secondary to NSCLC who had either not undergone intervention for the MPE, previously failed pleurodesis, had loculated fluid, or had unexpandable lung [17]. Treatment consisted of conventional chemotherapy plus bevacizumab as either an initial or second-line regimen. Pleural effusion control was defined as lack of increase in the amount of fluid 8 weeks after initiation of bevacizumab-containing treatment as determined by computed tomography (CT) of the chest. In total, 12 of the 13 patients (92.3%) achieved effusion control by that definition in this retrospective study. Similarly, Masago and colleagues retrospectively analyzed 21 patients with stage IV lung adenocarcinoma complicated by MPE, most of whom had received prior chemotherapy, and assessed the response of the MPE to a variety of bevacizumab-containing regimens [18]. Complete response (CR) of the MPE was defined as disappearance of the fluid for a 4-week period, whereas a reduction in the amount of fluid for 4 weeks was considered a partial response (PR). Of the 21 patients, 15 were responders (71.4%) with 7 CRs and 8 PRs achieved.
Studies in lung cancer cytokine proteomics: a review
Published in Expert Review of Proteomics, 2021
Hanie Abolfathi, Mojgan Sheikhpour, Seyed Sadegh Shahraeini, Shohreh Khatami, Seyed Ali Nojoumi
To analyze and compare the expression level of proteomes in NSCLC, samples such as tissue, blood, Pleural Effusion (PE), saliva, Tissue Interstitial Fluid (TIF), sputum and Bronchoalveolar lavage fluid (BALF) can be used (Figure 2) [54]. In proteomic studies, the number and type of samples are of significance. To obtain reasonable and reliable statistical results, a large number of standard samples should be selected and the histological type and the heterogeneity of tissue samples ought to be considered [55]. The tissue samples can be formalin-fixed paraffin-embedded (FFPE) or fresh frozen [56]. Moreover, blood is a very useful sample for evaluating cancer proteomes and tumor markers. The serum and plasma are separated from the whole blood by a centrifuge and then the proteome composition is assessed [57]. Another sample is PE identified as an appropriate sample for cancer markers and proteome studies using proteomic techniques. Pleural Effusion is a fluid accumulated in the pleural cavity and is present in the patient’s lung. The proteome composition of PE is greater than that of plasma; as a result, thousands of detectable proteins are present in PE. Additionally, urine can be utilized as an evaluable sample for cancer proteome identification [58–60]. On the other hand, urine is a very efficient sample because of its ease of collection, being noninvasive, good stability, and the presence of thousands of detectable proteins [61,62]. The other samples such as TIF [63], saliva [64], BALF [65], and sputum [66] were being used in recent proteome studies. The results of the studies showed that these samples have large proteins applicable for cancer markers and proteome recognition.