Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1412 Testis Tumors Tetanus

➣PE, CXR, tumor markers q 1–3 months 1st year; q 3–6 months

2nd year; q 6 months year 3; then annually

➣abd CT q 3–6 months 1st year; q 6–12 months 2nd year

■for high-risk patients (advanced stage, high tumor volume):

➣PE, CXR, tumor markers q month 1st year; q 2–3 months 2nd

year; q 3–6 months 3rd year;q6months 4th and 5th years; then

annually

➣abd CT,±chest CTq3months 1st year; q 6 months 2nd, 3rd,

and 4th years; then annually

complications and prognosis

■cure rate most dependent on tumor volume

■98% cure if no nodal involvement

■>90% cure with minimal lymph node and lung involvement

■60–70% cure extensive lymph node and lung involvement

■complications related to Rx (surgery, XRT, chemotherapy) currently

low overall

TETANUS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■In US, most cases are in adults with inadequate immunity to tetanus

and follow puncture or laceration.

■The wound may be trivial.

■Can also follow burns, surgery, childbirth, abortion, injection drug

use (skin-popping), and frostbite.

■Symptoms: 3–10 days after injury, increase in muscle tone and rigid-

ity, progressing to painful spasms. Classically short nerves (head) are

affected more than long nerves (limbs). Dysphagia and trismus, pain

and stiffness in shoulders, neck and back.

■Hands and feet relatively spared.

Signs & Symptoms

■Trismus, facial grimace (risus sardonicus), arched back (opistho-

tonos),

■Painful Spasms (face > trunk > extremities) without loss of conscious-

ness

■Hyperactive deep tendon reflexes