Improving Diagnostic Image: the inside outside


A 40-year-old man had a diagnosis of disseminated melanoma. The diagnosis was made after a surgical biopsy from an inguinal adenopathy. When he was going to be discharged he suffered a syncope. A blood test showed an hemoglobin level of 7,5 g/dl, coincident with abdominal pain.

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Diagnostic Error: a cultural problem Dr.Lucian Leape)

Dr. Leape has enhanced the importance of “respect” in general to improve health care.

He considere The spectrum of Disrespectful Behavior:
A. Overt: disruptive/demeaning Behavior of physicians
B. Covert: Passive resistance: “the major cause of failure of QI and safety projects is a lack of physician participation”.
C. Institutional Disrespect: of workers ( workplace environment,workloads, psychological disrespect) and of patients(sharing decisions,)

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Thyroid cancer in young girls: I didn,t expect it



When I was reading some papers about cancer in adolescents and young adults (AYA) I was shocked when I discovered the high relative incidence of thyroid cancer in young girls. After the Chernobyl disaster we know that radiation exposure is a risk factor but little is known about other associations.Incidence rate: 1/200.000

I got a clear take home message: Don,t forget to include the thyroid in the physical examination of an adolescent or young adult girl.

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Bone tumors in adolescents: not an easy diagnosis





Ewing´s sarcoma (perone)

Bone or muscular pain is common in adolescents (15-19-year-old). Growth and sport activity, are usually explanations for many of these situations.  But like a needle in a haystack , there are two types of tumors that can be easily missdiagnosed: Ewing´ s sarcoma and osteosarcoma…

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A big lump in the anterior cervical area: a differential diagnosis




The decision making process when a patient has a mass in the anterior neck must be quick and precise because a vocal cord paralysis, a tracheal estenosis or a pulmonary aspiration can be present…. Continue reading