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STEOSARCOMA-Case-Presentation-ppt-At-Shaheed-Suhrawardy-Medical-College-Hospital-Dhaka-Bangladesh.pptx

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STEOSARCOMA-Case-Presentation-ppt-At-Shaheed-Suhrawardy-Medical-College-Hospital-Dhaka-Bangladesh.pptx Powered By Docstoc
					CASE
PRESENTATION
   ON
                         Presenting By-
                         Dr. Golam Muhamud (Suhash).




Prepared By-
Dr. Md Nazrul Islam
MBBS, M . sc. (B M E).
• She has h/o wt. loss, and loss of appetite but she has /had
  no complaints of pain, swelling and deformity in other parts
  of the body. She has no history of cough , haemoptysis, DM ,
  HTN and asthma.
• With these complaints she got herself admitted into Shaheed
  Suhrawardy Medical college Hospital for better management.
   She had no history of
   tuberculosis.
 Drug history:
• H/O taking analgesic for 3
  months but could not mentioned
  the name of drugs.
None of her family member suffered from
such illness.
Personal history:
Nothing contributory
• MP-4 to 6 days
• MC-regular
• Age of menarche-13yrs.
Immunized against –
Tuberculosis
& Tetanus
•   Appearance- Ill looking
•   Body builds- Below average
•   Co-operation- Co-operated
•   Decubitus- Supine
•   Anaemia- Moderate
•   Jaundice- Absent
•   Cyanosis- Absent
•   Clubbing- Absent
•   Koilonychia-Absent
•   Lekonychia- Absent
•   Lymph nodes- Not palpable
•   Dehydration- No sign
•   Pulse - 84 Beat/min
•   Blood pressure- 100/60mm of Hg
• Temperature-normal
• Respiratory rate-16/min
Look-
Fluctuation test- negative,
Trans-illumination test-negative,
Patellar tap test- negative.
Shortening of limb - 3 cm.
Muscle wasting-
            Thigh – 4 cm.
            Leg – 2 cm
   Distal neurovascular status- normal
   Regional lympnodes not enlarged.
Movement:
 walk with support.
 Left knee (ROM)–
 • Active flexion -Absent
 • Active extension-Absent
 • Patellar movement-Absent
 Left hip & ankle: normal range of
  movement
Locomotor system
Gait: Can walk with support
Inspection: Flexion attitude-
Left knee(20 degree)
Palpation: Tenderness – affected
area.
Spine: Normal
Higher psychic function: Normal
Cranial Nerve examination: Normal
Motor function:
 Inspection:
  Gross Muscle wasting in left thigh &
  leg.
Deep tendon reflex:
 All jerks are present & normal
Sensory function test:
 All the sensory functions are normal.
 Inspection: Normal in size & shape of the chest-
 Respiratory rate: 16 /min
 Palpation: Trachea centrally placed, normal chest
 expansibility
 Percussion: Resonant all over the chest except right
 upper, middle and lower zone where dullness is present.
 Auscultation: Bronchial breathing sound with diminished
 breathing sound in Rt. Upper middle and lower zone.
 Pulse: 84 bts/ min
 B.P. 110/60 mm of Hg
 JVP: Not raised.
 Inspection: NAD
 Palpation: Apex beat in Lt 5th intercostal space,
   Percussion: superficial cardiac dullness presence over the precordium.
   Auscultation: s1 & s2 is audible
• Inspection: nothing abnormality detected
• Palpation: soft, non tender
• Percussion: tympanic
 Auscultation: bowel sound present
 Per-rectal examination: normal findings.
   Ms. Fatema, 18 years ill-looking, moderately
 anaemic, non icteric, nondiabetic, normotensive
 woman coming from Mirpur, Dhaka admitted in
 Shaheed Suhrawardy Medical College Hospital
 with thecomplaints of –
• pain, just above the left knee joint 3 months back
 ,
• swelling above the left knee joint 2 months back
• The pain was initially mild , fixed, non
  radiating, aching in nature but gradually it
  becomes intolerable which was aggravated
  during walking and worse at night &
  incompletely relived by taking NSAIDs.This
  pain was not associated with fever.
• She also noticed an ill defined swelling above
  left knee joint which was initially.
  Small in size then it increases rapidly to a
  large size.It is associated with pain but not
  related to trauma.
• She also gives H/O inability to walk due to
  pain,swelling and restriction of movement.
• She gives H/O wt loss,loss of appetite but
  she has no H/O pain,swelling,deformity in
  other parts of body.
• On local examination- an ill defined diffuse
  swelling occupying over the supracondylar region
  of the left thigh with shiny skin and presents of
  engorged vein and wasting of the thigh and leg.
• She has a deformity of knee and cannot walk
  without support.
• The surface of swelling smooth, margin- ill-
  defined, local temperature-raised ,
  tenderness present, over lying skin is free,
  consistency-hard, not movable and fixed with
  underlying structure.
• Shortening of the left limb was found 3 cm
  than the right. She was unable to walk
  without support.
• There was gross muscle wasting in left Lower
  limb, measuring thigh- 4cm, leg- 2 cm.
• Neuromuscular status of left lower limb normal
  and regional lympnodes are not
  enlarged.Movement of the left knee joint absent
  hip and spine are normal.
• On respiratory system examination-there was a
  dullness in Rt upper and lower zone of lung and
  breath sound also diminished in same
• Extensive bone destruction is seen in
  the left lower femoral shaft,
  condyles and tibial condyles with
  soft tissue extension.
• peripheral calcification also seen.
• Bone destruction also seen in L5
  vertebra.
Multiple metastatic nodules in both lungs along
with Rt. Sided Hydro-pneumothorax-
     S. creatinine     0.6 mg/ dl
     Blood urea      30 mg / dl
     S. calcium      7.5 mg / dl
     S. alkaline phosphates        110 IU/ L
     SGPT:26 IU/L , SGOT :33 IU/L
     S. bilirubin:1.0 mg/dl
•   FNAC Sarcomatous leison,suggestive of
    osteosarcoma.
•   Biopsy (incisional): Feature of osteosarcoma with
    osteod formation and many giant cells.

				
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