Biopsy of lung lesion shows CNS metastasis.??. Is it a primary in the lung or metastasis in the lung.Hiw ever this is a case of disseminated malignancy. Primary site ?? Lung / secondary in the lung and brain. Ref the case to Oncologist for further management.
What were the hormone and HER 2 status of the breast primary? Is the chest mass a breast or a second primary? What do you mean by " biopsy of the lung mass shows CNS metastasis", this statement makes no sense. How many CNS lesions are there and where are they present? In addition for treatment, we need to know what the primary is (breast?, lung?, anything else), and if this is breast then what is the hormone and HER2 status of the tumor. Based on the extensive CNS metastasis I think this patient probably has HER2+ breast cancer or SCLC of the lung, but you need to give more information about the pathology. Since the patient has paresis, I would consider starting the patient on dexamethasone 4 mg BID which shows decrease vasogenic edema and help with the paresis. Then there is the question of starting prophylaxis for seizures as this patient has multiple CNS lesions. (which depends on the location of the lesions) You should refer this patient ASAP to a medical oncologist for a workup and management
Metastasis with complications. Chemoradiotherapy or palliative therapy and after proper evaluation and assessment by oncologist .
? SECONDARIES.. IN CNS .. WITH.. COMPLICATIONS.. NEED'S.. ONCOLOGISTS OPINION.. CHEMOTHERAPY..
Chemotherapy + Radiotherapy Physiotherapy Symptomatic treatment Ref to Oncologist
Possibilities of secondary metastasis of ca breast . Needs oncchologist opinion and urgen treatment as may start convulsions
Numbness can occur along a single nerve on one side of the body, or it may occur symmetrically, on both sides of the body. Numbness is often caused by damage, irritation or compression of nerves. Treatments Here are a few tips for dealing with numb arms: If you tend to have numb arms in the morning, try adjusting your sleeping position. A wedge pillow can keep you from sleeping on your arms. When your arm becomes numb during the day, try performing some simple movements to improve circulation. Avoid repetitive shoulder, arm, wrist, and finger movements. Try to disrupt the pattern by taking frequent breaks from these movements. If arm numbness is interfering with your work or other daily activities, it’s a good idea to let you check it out. Specific treatments depend on the cause. Treating the underlying condition may ease your symptoms. Treatment for numbness and tingling depends on its cause. Numbness related to MS is usually relatively harmless and painless. Niacin, a B complex vitamin, may help reduce inflammation and related numbness. In cases of severe or painful numbness, treatment may involve a short round of corticosteroids, which also quickens recovery by reducing inflammation. Several medications designed to treat different conditions may also help reduce numbness and tingling associated with MS, such as: gabapentin pregabalin carbamazepine phenytoin amitriptyline, imipramine, and nortriptyline Other conditions Several different treatment plans may help reduce or manage numbness and tingling not related to MS, such as: Stroke. Medications to treat clots for ischemic stroke (if within 3 hours of first symptoms), and surgery or endovascular procedures for hemorrhagic stroke. Transverse myelitis. Pain medications, antivirals, intravenous immunoglobulin, or plasma exchange therapy. Meningitis. Antibiotics, anticonvulsants, and corticosteroids. Tumors. Surgery, radiation therapy, chemotherapy, and other drug therapies. Diabetic neuropathy. Physical activity, healthful diet, following diabetes treatment plans, checking feet daily for changes, and getting regular foot exams. Carpal tunnel. Wrist braces, over-the-counter pain medications, nerve gliding exercises, or surgery. Avoiding trigger activities. Pernicious anemia. Vitamin B12 injections, pills, or nose gels or sprays. Hypocalcemia and hypomagnesemia. Infusions or supplements, dietary changes, staying away from triggers, treating underlying causes.
Looks metastasis Advance case of malignancy Req chemo and radiotherapy Oncologist opinion Physiotherapy too
Early medical management is advisable. Adv MRI brain and PET scan.
CP angle facial nerve involvement by metastasis to be thought
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GANGRENE is death of a body tissue which is caused due to loss of blood supply or inadequate blood supply to the tissue. . Causes of gangrene 1)Vascular– gangrene is seen is vascular diseases such as peripheral arteriosclerosis, thrombosis of the large arteries, thrombosis of terminal aorta etc. 2)Infection– gangrene is mainly produced by clostridium perfringens, and other clostridia, bacteria such as streptococcal,staphylococcal may also produce certain forms of gangrene. 3)Neoplasm– multiple myelomas are generally associated with Raynaud phenomenon which produces gangrene. 4)Neurological– peripheral neuropathy, syringomyelia, trasverse myelitis, may beassociated with gangrene. 5)Intoxication– should keep in mind that use of ergot alkaloids may also be associated with gangrene. 6)Trauma– laceration of major artery of extremities or pressure from splinters may cause gangrene. 7)Decreased temperature– extremes of cold may produce frostbite which can ultimately lead to gangrene. 8)Autoimmune diseasessuch as lupus erythematosus, sclerederma and rheumatoid arthritis may be associated with Raynaud phenomenon and gangrene. 9)Endocrine– gangrene can be associated with diabetes. Homeopathic treatment of gangrene# Homeopathy is one of the most popular holistic systems of medicine. *Arsenic album– medicine for senile gangrene; gangrene accompanied by foetid diarrhoea; ulcers extremely painful with elevated edges, better by warmth and aggravation from cold; great weakness and emaciation. *Bromium– hospital gangrene; cancerous ulcers on face; stony hard swelling of glands of lower jaw and throat *Carbo veg– senile and humid gangrene inthe persons who are cachectic in appearance; great exhaustion of vital powers; marked prostration; foul smell of secretions; indolent ulcers, burning pain; tendency to gangrene of the margins; varicose ulcers. *Bothorps– gangrene; swollen, livid, cold with hemorrhagic infiltration; malignant erysipelas. *Echinacea– enlarged lymphatics; old tibial ulcers; gangrene; recurrent boils; carbuncles. *Lachesis– gangrenous ulcers; gangrene after injury; bluish or black looking blisters; vesicles appearing here and there, violent itching and burning; swelling and inflammation of the parts; itching pain and painful spots appearing after rubbing. *Crotolus H–gangrene, skin separated from muscles by a foetid fluid; traumatic gangrene; old scars open again. *Secale cor– pustules on the arms and legs, with tendency to gangrene; in cachectic, scrawny females with rough skin; skin shriveled, numb; mottled dusky-blue tinge; blue color of skin; dry gangrene, developing slowly; varicose ulcers; boils, small, painful with green contents; skin feels too cold to touch yet covering is not tolerated. Great aversion to heat; formication under skin. *Antrhacinum– gangrene; cellular tissues swollen and oedematous; gangrenous Parotitis; septicemia; ulceration, and sloughing and intolerable burning. *Cantharis– tendency to gangrene; vesicular eruptions; burns, scalds, with burning and itching; erysipelas, vesiculartype, with marked restlessness. *Mercurius– gangrene of the lips, cheeks and gums; inflammation and swelling of the glands of neck; pains aggravated by hot or cold applications. *Sulphuric acid– traumatic gangrene; hemorrhages from wounds; dark pustules; blue spots like suggillations; bedsores. *Phosphoric acid– medicine for senile gangrene.. THANK YOU.Dr. Akshay Ingole5 Likes8 Answers
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DIABETIC NEUROPATHIES. Diabetic neuropathies are a family of nerve disorders caused by diabetes. WHAT CAUSES DIABETIC NEUROPATHY. Nerve damage is likely due to a combination of factors. 1.METABOLIC FACTORS. : hyperglycemia, long duration of diabetes, abnormal blood fat levels and low levels of insulin. 2.NEUROVASCULAR FACTORS : Neurovascular factors leading to damage of blood vessels that carry oxygen and nutrients to nerves. 3.AUTOIMMUNE FACTORS : Causes inflammation of nerves. 4.MECHANICAL FACTORS : Injury to nerves as in carpel tunnel syndrome. 5.INHERITED TRAITS : That increase susceptibility to nerve disease. 6.LIFESTYLE FACTORS : Smoking, alcohol. SYMPTOMS. Symptoms depends on the type of neuropathy and which nerves are affected.Symptoms involve sensory,motor and autonomic nervous system. 1.Tingling, numbness or pain in the toes,feet,legs,hands,arms and fingers. 2.Wasting of muscles of hand or feet. 3.Indigestion, nausea, vomiting, diarrhea,c constipation. 4. Dizziness or fainting due to a drop in blood pressure after standing or sitting up. 5.Problems with urination. 6.Erectile dysfunction. 7.Weakness. TYPES OF NEUROPATHY. Diabetic neuropathy can be classified as 1.Peripheral neuropathy. 2.Autonomic neuropathy. 3.Proximal neuropathy. 4.Focal neuropathy. PERIPHERAL NEUROPATHY. Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy ,is nerve damage in arms and legs.Symptoms are *Numbness or insensitivity to pain or temperature. *A tingling,burning or prickling sensation. *Sharp pains or cramps. *Extreme Sensitivity to touch. *Loss of balance and coordination. Peripheral neuropathy also causes muscle weakness and loss of refle guyxes.Blisters and sites may appear on the numb areas of the foot because pressure or injury goes unnoticed.I f an infection occurs and is not treated promptly,the infection may spread to the bone and the foot may need amputation.Many amputations can be prevented if minor problems are treated in time. AUTONOMIC NEUROPATHY. Autonomic neuropathy affects the nerves that control the heart,blood pressure and blood glucose levels.Autonomic neuropathy also affects internal organs causing problems with digestion,respiration. urination,sexual response and vision. 1.HYPOGLYCEMIA UNAWARENESS. Normally,symptoms such as shakiness,sweating and palpitations occurs when the blood glucose levels drop below <<70 mg/dl.In people with autonomic neuropathy,symptoms may not occur making hypoglycemia to be recognized. 2.HEART & BLOOD VESSELS. Damage to the nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. Due to this,blood pressuremay drop sharply after standing or sitting,causing a person to feel light headed or faint. Damage to nerves that control heart rate makes the heart rate to stay high , instead of rising and falling in response to normal body functions and physical activity. 3.DIGESTIVE SYSTEM. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty slowly,a condition called GASTROPARESIS. Gastroparesis can lead to persistent nausea and vomiting,bloating and loss of appetite. Gastroparesis also makes blood glucose levels to fluctuate widely ,due to abnormal food digestion. Nerve damage to the OESOPHAGUS MAKES SWALLOWING DIFFICULT. Nerve damage to bowels can cause constipation alternating with uncontrolled diarrhea, 3.URINARY TRACT & SEX ORGANS. Autonomic neuropathy often affects the organs that control urination and sexual functions. Nerve damage can prevent the bladder from emptying completely , allowing the bacteria to grow in bladder and kidneys causing urinary tract infections. When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy also leads to decreased sexual response in men and women. A man may have erectile dysfunction or may reach sexual climax without ejaculating normally. A woman may have difficulty in arousal,lubrication or orgasm. 5.SWEAT GLANDS. Nerve damage may cause improper working of sweat glands.It can also result in profuse sweating at night or while eating. 6.EYES. Due to autonomic neuropathy,pupils become less responsive to changes in light.A s a result,a person may not be able to see well when light is turned on In a dark room or have trouble driving at night. PROXIMAL NEUROPATHY. Proximal neuropathy//lumbosacral plexus neuropathy //femoral neuropathy //diabetic amyotrophy causes pain in the thighs,buttocks,hips or legs,usually on one side of the body. FOCAL NEUROPATHY. Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso or leg. Focal neuropathy is painful and unpredictable.and occurs most often in older adults with diabetes. However,it tends to improve itself over weeks or months and does not cause long term damage. Focal neuropathy can cause *Inability to focus the eye. *Diplopia. *Aching behind the eye. *Bell's palsy. *Severe pain in the lower back and pelvis. *Pain in the front of the thigh. *Pain in the chest and stomach. *Pain on the outside of the shin or inside of the foot. *Chest pain and abdominal pain is mistaken for heart attack or appendicitis. CAN DIABETIC NEUROPATHIES BE PREVENTED. THE BEST WAY TO PREVENT NEUROPATHY IS TO KEEP BLOOD GLUCOSE LEVELS AS CLOSE TO THE NORMAL RANGE AS POSSIBLE.MAINTAINING SAFE BLOOD GLUCOSE LEVELS PROTECTS NERVES THROUGH OUT THE BODY.Dr. Suvarchala Pratap16 Likes25 Answers
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Friends today I am discussing about a very common problem facing by the patients having diabetes. Most of the patient complaint about sexual weakness having Type 2 diabetes. Type 2 Diabetes and Sexual Health Sexuality issues for both men and women With chronic illness, sex often gets put on the back burner. But sexuality and sexual expression are at the top of the list when it comes to quality of life, no matter what problems a person may face. People with type 2 diabetes are no different. It’s important to recognize and address sexuality issues that affect people with diabetes. Type 2 diabetes can cause sexual complications for both genders, and can also cause gender-specific issues. Sexuality issues for both men and women A common sexuality problem in people with type 2 diabetes is a decrease in libido, or loss of a sex drive. This can be frustrating if someone had a thriving libido and satisfying sex life prior to a type 2 diabetes diagnosis. Causes of a low libido associated with type 2 diabetes include: side effects of medications for high blood pressure or depression extreme fatigue lack of energy depression hormonal changes stress, anxiety, and relationship issues Diabetic neuropathy, a type of nerve damage associated with diabetes, can cause issues. Numbness, pain, or lack of feeling can also occur in the genitals. This can lead to erectile dysfunction. It may also inhibit orgasm or make it difficult to feel sexual stimulation. These side effects can make sex painful or unenjoyable. Communication between partners about sexual issues is important. A lack of communication can impact the sexual and intimate side of a relationship. An illness can make it easy for couples to “check out” of the relationship sexually. Sometimes it may seem easier to avoid talking about this issue rather than seeking a solution. If one partner becomes the primary caregiver of the other, it can also change how each person views the other. It’s easy to get caught up in the roles of “patient” and “caregiver” and let the romance can slip away. Sexuality issues for men The most widely reported problem men face is erectile dysfunction (ED). Some cases of diabetes are first diagnosed when a man seeks treatment for erection dysfunction. Failure to achieve or maintain an erection until ejaculation can be caused by damage to: nerves muscles vascular structures About half of men with diabetes will experience ED at some point. Side effects of certain medications can alter testosterone levels, also causing erectile dysfunction. Other conditions that accompany diabetes can also contribute to ED, including: obesity high blood pressure depression, low self-esteem, and anxiety not enough exercise Retrograde ejaculation is also another sexual issue men may experience as a complication of type 2 diabetes. This is when semen is ejaculated into the bladder instead of out of the penis. It’s caused by your internal sphincter muscles not working property. These muscles are responsible for opening and closing passages in the body. Abnormally high glucose levels can result in nerve damage to the sphincter muscles, causing retrograde ejaculation. Sexuality issues for women For women, the most common sexual issue that comes with type 2 diabetes is vaginal dryness. This can be caused by hormonal changes or from reduced blood flow to the genitals. Women who have diabetes have increased rates of vaginal infections and inflammation, both of which can make sex painful. Nerve damage to the bladder can cause incontinence and make sex embarrassing. Women with diabetes are also more likely to have more frequent urinary tract infections. This can make sex painful and uncomfortable. How to prevent type 2 diabetes from hijacking your sex life Sexual problems that occur with type 2 diabetes can be frustrating, embarrassing, and cause anxiety. You may feel that giving up on sexual expression is easier than finding ways to cope or adjust. Here are some tips you can try to maintain an active sex life despite having type 2 diabetes: Fight low energy and fatigue If low energy and fatigue are a problem, try having sex at a different time of day, when your energy is at its peak. Nighttime may not always be the right time. After a long day, and with the added fatigue that comes with diabetes, the last thing you may have energy for is sex. Try sex in the mornings or afternoons. Experiment to see what works best for you. Use lubricants to overcome dryness Use lubricant liberally to deal with vaginal dryness. Water-based lubricants are best and there is a plethora of brands available. Don’t be afraid to stop during sex to add more lubricant. Improve libido through medication Hormonal replacement therapy can help both men and women with issues such as: decreased libido vaginal dryness erectile dysfunction Ask your doctor if this is a possibility for you. Hormone replacement can come in the form of: Maintain good overall health for a healthy sex life. For people with diabetes, this includes maintaining proper blood sugar levels. Sex is exercise in the sense that is uses energy, so be aware of your glucose levels. If you’re on medications that increase the amount of insulin in your body, hypoglycemia can also occur during sex. Consider checking your blood sugar levels before engaging in sexual activity. Also keep in mind that what’s good for your heart is good for your genitals. Sexual arousal, vaginal lubrication, and erection all have a lot to do with blood flow. Engage in a lifestyle that promotes good heart health and proper blood circulation. This includes participating in regular exercise. This can also have the added benefits of improving your energy level, mood, and body image. Don’t let incontinence be a barrier Many type 2 diabetes patients experience incontinence. Embarrassed? Don’t be. Everyone urinates. If you experience urine leaks and are uncomfortable sharing your body with someone sexually, you should feel free to talk about it. Padding the bed can go a long way to help. Lay down a couple of towels or purchase urine pads from a medical supply company to help ease the situation. Talk about it Discuss sexuality issues with your doctor. Sexual dysfunctions can be an indicator of disease progression or a sign that the disease isn’t under control. Don’t be afraid to discuss sexual side effects of medications. Ask if there are different medications that don’t have the same side effects. Also, feel free to ask about erectile dysfunction drugs. Some men are candidates for ED drugs and some aren’t. Penile pumps may also be an option. Pay close attention to your relationship. Find other ways to express intimacy when desire isn’t at its peak. You can express intimacy that doesn’t involve intercourse with: massages baths cuddling Make time for each other to be a couple that is not focused on caregiving. Have a date night where the topic of diabetes is off limits. Communicate with your partner about your feelings and possible sexual issues that may occur. Consider support groups or counseling to help with the emotional issues associated with illness or sex. Homoeopathic medicines Agnus Castus: Homeopathic medicine Agnus Castus is used in cases where there is complete inability to attain penile erection during the sexual act. Homeopathic medicine Agnus Castus can be used in cases of erectile dysfunction and sexual weakness where the male has a mental aversion to indulge in sex, along with decreased physical strength. Caladium: Homeopathic medicine Caladium is of great help for treatment of erectile dysfunction when the male is unable to have an erection despite having a sexual desire or urge. Lycopodium: Homeopathic medicine Lycopodium is of great help for both young people and elderly people suffering from erectile dysfunction. Tribulus Terrestris: The main indication for using Homeopathic medicine Tribulus Terrestris is the presence of urinary troubles along with erectile Dysfunction. Nuphar Luteum: Homeopathic medicine Nuphar Luteum can be beneficial for all those males with erectile Dysfunction in whom the desire to indulge in sexual activity is totally absent. There is no sexual desire with relaxed genitalia.Dr. Rajesh Gupta11 Likes19 Answers
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patient had infected wound in left great toe since 3 days.yncontrolled t2dm k/c/o dm since 13 years.your suggestions.Dr. Venkatesh Pujar4 Likes28 Answers
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58 year lady comments on her toes. She states that during the day her toes gets red, hot toes but no swelling but pain. This redness occurs mainly in the evening but also during the day but to a lesser extent. The rest of her feet feel cold with a noticeable colour difference She has had previous episodes last year of this but it went away lasting a few months. On examination she has no sensory loss in either feet, full motor function and all her pulses are palpable. Her soles of her feet have numerous callouses,. her past medical history include diabetes for 6 years, and general arthritis in her knees, back and hands. Any idea?Dr. Kamal Singh8 Likes25 Answers