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statpearls_NBK430685\article-100616_4 | Cefotaxime -- Indications | Compared with the other cephalosporins, a favorable characteristic of cefotaxime is that it does not cause a notable occurrence of coagulopathies and pseudocholelithiasis. [4] Trials comparing cefotaxime with the third-generation cephalosporin ceftriaxone have exhibited similar clinical efficiency. [4] Clinical trials have also shown 75% to 100% resolution in hospitalized patients with moderate to severe infections. [5] [4] Cefotaxime may also be interchangeable with ceftriaxone as off-label use for the treatment of endocarditis by Haemophilus parainfluenzae , H. aphrophilus , Actinobacillus actinomycetemcomitans , Cardiobacterium hominis , Eikenella corrodens , and Kingella kingae (HACEK) organisms. [6] Cefotaxime can readily cross the blood-brain barrier when administered intravenously and may treat gram-negative infections resistant to previous generations of cephalosporins. [7] | Cefotaxime -- Indications. Compared with the other cephalosporins, a favorable characteristic of cefotaxime is that it does not cause a notable occurrence of coagulopathies and pseudocholelithiasis. [4] Trials comparing cefotaxime with the third-generation cephalosporin ceftriaxone have exhibited similar clinical efficiency. [4] Clinical trials have also shown 75% to 100% resolution in hospitalized patients with moderate to severe infections. [5] [4] Cefotaxime may also be interchangeable with ceftriaxone as off-label use for the treatment of endocarditis by Haemophilus parainfluenzae , H. aphrophilus , Actinobacillus actinomycetemcomitans , Cardiobacterium hominis , Eikenella corrodens , and Kingella kingae (HACEK) organisms. [6] Cefotaxime can readily cross the blood-brain barrier when administered intravenously and may treat gram-negative infections resistant to previous generations of cephalosporins. [7] |
statpearls_NBK430685\article-100616_5 | Cefotaxime -- Indications -- Susceptible Organisms | Gram-positive bacteria Enterococcus spp Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae Streptococcus pyogenes Streptococcus viridans spp Anaerobic bacteria Bacteroides spp. Clostridium spp Fusobacterium spp Peptococcus spp Peptostreptococcus spp Gram-negative bacteria Acinetobacter spp. Citrobacter spp Enterobacter spp Escherichia coli Haemophilus influenzae Haemophilus parainfluenzae Klebsiella spp. Morganella morganii Neisseria gonorrhoeae Neisseria meningitidis Proteus mirabilis Proteus vulgaris Providencia rettgeri Providencia stuartii Serratia marcescens | Cefotaxime -- Indications -- Susceptible Organisms. Gram-positive bacteria Enterococcus spp Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae Streptococcus pyogenes Streptococcus viridans spp Anaerobic bacteria Bacteroides spp. Clostridium spp Fusobacterium spp Peptococcus spp Peptostreptococcus spp Gram-negative bacteria Acinetobacter spp. Citrobacter spp Enterobacter spp Escherichia coli Haemophilus influenzae Haemophilus parainfluenzae Klebsiella spp. Morganella morganii Neisseria gonorrhoeae Neisseria meningitidis Proteus mirabilis Proteus vulgaris Providencia rettgeri Providencia stuartii Serratia marcescens |
statpearls_NBK430685\article-100616_6 | Cefotaxime -- Mechanism of Action | Cefotaxime is a bactericidal agent that exerts its mechanism of action by binding penicillin-binding proteins (PBPs) via beta-lactam rings and inhibiting the definitive activity of transpeptidation in peptidoglycan cell wall synthesis of susceptible bacterial organisms. [8] [9] Its action demonstrates a great affinity for PBP Ib and PBP III cell wall proteins. | Cefotaxime -- Mechanism of Action. Cefotaxime is a bactericidal agent that exerts its mechanism of action by binding penicillin-binding proteins (PBPs) via beta-lactam rings and inhibiting the definitive activity of transpeptidation in peptidoglycan cell wall synthesis of susceptible bacterial organisms. [8] [9] Its action demonstrates a great affinity for PBP Ib and PBP III cell wall proteins. |
statpearls_NBK430685\article-100616_7 | Cefotaxime -- Mechanism of Action | The inability to form a bacterial cell wall further causes the autolysis of the bacteria. [7] Similarly to other third-generation cephalosporins, its broad spectrum action makes it efficacious against gram-positive and gram-negative bacteria. | Cefotaxime -- Mechanism of Action. The inability to form a bacterial cell wall further causes the autolysis of the bacteria. [7] Similarly to other third-generation cephalosporins, its broad spectrum action makes it efficacious against gram-positive and gram-negative bacteria. |
statpearls_NBK430685\article-100616_8 | Cefotaxime -- Mechanism of Action -- Resistance | Beta-lactamases can cause hydrolysis to cefotaxime, further hindering its bactericidal effects. Although susceptive, cefotaxime is quite durable against the activity of most β-lactamases. | Cefotaxime -- Mechanism of Action -- Resistance. Beta-lactamases can cause hydrolysis to cefotaxime, further hindering its bactericidal effects. Although susceptive, cefotaxime is quite durable against the activity of most β-lactamases. |
statpearls_NBK430685\article-100616_9 | Cefotaxime -- Mechanism of Action -- Metabolism | Once administered, cefotaxime undergoes metabolism within the liver, and the majority of it is excreted renally. In the liver, cefotaxime converts to desacetylcefotaxime, which is further converted to desacetylcefotaxime lactone and then to M metabolites. [10] More than 80% is recovered in the urine, with one-third being in the form of desacetylcefotaxime (des-CTX). Although desacetylcefotaxime (des-CTX) is the major metabolite of cefotaxime, its activity is eight-fold weaker than cefotaxime. [11] | Cefotaxime -- Mechanism of Action -- Metabolism. Once administered, cefotaxime undergoes metabolism within the liver, and the majority of it is excreted renally. In the liver, cefotaxime converts to desacetylcefotaxime, which is further converted to desacetylcefotaxime lactone and then to M metabolites. [10] More than 80% is recovered in the urine, with one-third being in the form of desacetylcefotaxime (des-CTX). Although desacetylcefotaxime (des-CTX) is the major metabolite of cefotaxime, its activity is eight-fold weaker than cefotaxime. [11] |
statpearls_NBK430685\article-100616_10 | Cefotaxime -- Administration | Cefotaxime is available and distributed in powder form and as a premixed solution for intramuscular and intervenous administration. The powder form is available in 500 mg, 1 g, 2 g, and 10 g vials. The premixed solution is available as 1g and 2g for injection. | Cefotaxime -- Administration. Cefotaxime is available and distributed in powder form and as a premixed solution for intramuscular and intervenous administration. The powder form is available in 500 mg, 1 g, 2 g, and 10 g vials. The premixed solution is available as 1g and 2g for injection. |
statpearls_NBK430685\article-100616_11 | Cefotaxime -- Administration -- Gonococcal Infections | Urethritis (Males): 0.5 g intramuscular injection (can be administered as a single dose) Cervicitis (Females): 0.5 g intramuscular injection (can be administered as a single dose) Rectal infection (Males): 1 g intramuscular injection (can be administered as a single dose) Rectal infection( Females): 0.5 g intramuscular injection (can be administered as a single dose) Cefotaxime has no coverage for Chlamydia trachomatis, and treatment should be added if this organism is suspected. | Cefotaxime -- Administration -- Gonococcal Infections. Urethritis (Males): 0.5 g intramuscular injection (can be administered as a single dose) Cervicitis (Females): 0.5 g intramuscular injection (can be administered as a single dose) Rectal infection (Males): 1 g intramuscular injection (can be administered as a single dose) Rectal infection( Females): 0.5 g intramuscular injection (can be administered as a single dose) Cefotaxime has no coverage for Chlamydia trachomatis, and treatment should be added if this organism is suspected. |
statpearls_NBK430685\article-100616_12 | Cefotaxime -- Administration -- Septicemia | 2 g I.V. every 6 to 8 hours. (Daily dose of 6 to 8 grams) | Cefotaxime -- Administration -- Septicemia. 2 g I.V. every 6 to 8 hours. (Daily dose of 6 to 8 grams) |
statpearls_NBK430685\article-100616_13 | Cefotaxime -- Administration -- Spontaneous Bacterial Peritonitis (SBP) | Cefotaxime is the drug of choice in patients with SBP due to its ability to achieve excellent levels in the blood and ascitic fluid. The typical dose in SBP would be 2 g intravenous every 8 hours. | Cefotaxime -- Administration -- Spontaneous Bacterial Peritonitis (SBP). Cefotaxime is the drug of choice in patients with SBP due to its ability to achieve excellent levels in the blood and ascitic fluid. The typical dose in SBP would be 2 g intravenous every 8 hours. |
statpearls_NBK430685\article-100616_14 | Cefotaxime -- Administration -- Uncomplicated Infections | 1 g intramuscular or IV every 12 hours. (Daily dose of 2 grams) | Cefotaxime -- Administration -- Uncomplicated Infections. 1 g intramuscular or IV every 12 hours. (Daily dose of 2 grams) |
statpearls_NBK430685\article-100616_15 | Cefotaxime -- Administration -- Moderate to Severe Infections | 1 to 2 g intramuscular or IV every 8 hours. (Daily dose of 3 to 6 grams) | Cefotaxime -- Administration -- Moderate to Severe Infections. 1 to 2 g intramuscular or IV every 8 hours. (Daily dose of 3 to 6 grams) |
statpearls_NBK430685\article-100616_16 | Cefotaxime -- Administration -- Life-threatening Infections | 2 g intramuscular or IV every 4 hours. (Daily dose of 12 grams) | Cefotaxime -- Administration -- Life-threatening Infections. 2 g intramuscular or IV every 4 hours. (Daily dose of 12 grams) |
statpearls_NBK430685\article-100616_17 | Cefotaxime -- Administration -- Cesarean Section | First dose: 1 g IV (Umbilical cord should be clamped) Second dose: 1 g intramuscular or IV (six hours after the first dose) Third dose: 1 g intramuscular or IV (twelve hours after the first dose) | Cefotaxime -- Administration -- Cesarean Section. First dose: 1 g IV (Umbilical cord should be clamped) Second dose: 1 g intramuscular or IV (six hours after the first dose) Third dose: 1 g intramuscular or IV (twelve hours after the first dose) |
statpearls_NBK430685\article-100616_18 | Cefotaxime -- Administration -- Surgery Prophylaxis | 1 g intramuscular or IV 30 minutes before surgery. | Cefotaxime -- Administration -- Surgery Prophylaxis. 1 g intramuscular or IV 30 minutes before surgery. |
statpearls_NBK430685\article-100616_19 | Cefotaxime -- Administration -- Neonates (age 0 to 4 weeks) | (Age 0 to 1 week) 50 mg/kg per dose IV every 12 hours (Age 1 to 4 weeks) 50 mg/kg per dose IV every 8 hours | Cefotaxime -- Administration -- Neonates (age 0 to 4 weeks). (Age 0 to 1 week) 50 mg/kg per dose IV every 12 hours (Age 1 to 4 weeks) 50 mg/kg per dose IV every 8 hours |
statpearls_NBK430685\article-100616_20 | Cefotaxime -- Administration -- Infants and Children (age 1 month to 12 years old) | 50 to 180 mg/kg intramuscular or IV every 6 to 8 hours (for individuals with body weight <50kg) 1 to 2 grams intramuscular or IV every 8 hours. (for individuals with body weight >50kg) Individuals with a body weight>50 kg should follow adult dosing. The daily dosage should not exceed 12 grams for infants and children. | Cefotaxime -- Administration -- Infants and Children (age 1 month to 12 years old). 50 to 180 mg/kg intramuscular or IV every 6 to 8 hours (for individuals with body weight <50kg) 1 to 2 grams intramuscular or IV every 8 hours. (for individuals with body weight >50kg) Individuals with a body weight>50 kg should follow adult dosing. The daily dosage should not exceed 12 grams for infants and children. |
statpearls_NBK430685\article-100616_21 | Cefotaxime -- Adverse Effects | Local reaction: pain, swelling Hypersensitivity: rash, pruritis, anaphylaxis Gastrointestinal effects: nausea, vomiting, diarrhea Pseudomembranous Colitis Headache Elevation in liver enzymes Elevation in BUN and creatinine Hematologic: Neutropenia, leukopenia, agranulocytosis | Cefotaxime -- Adverse Effects. Local reaction: pain, swelling Hypersensitivity: rash, pruritis, anaphylaxis Gastrointestinal effects: nausea, vomiting, diarrhea Pseudomembranous Colitis Headache Elevation in liver enzymes Elevation in BUN and creatinine Hematologic: Neutropenia, leukopenia, agranulocytosis |
statpearls_NBK430685\article-100616_22 | Cefotaxime -- Adverse Effects | Local reactions such as pain, swelling, and rash are the most common adverse effects following cefotaxime administration. Like other cephalosporins, cefotaxime does not cause disulfiram-like reactions. Cefotaxime used concurrently with nephrotoxic agents may promote nephrotoxic effects on the kidney, and such use requires caution. Patients with hypersensitivity to the cephalosporin or penicillin group may result in an anaphylactic reaction and are manageable with epinephrine, antihistamines, vasopressors, or corticosteroids. | Cefotaxime -- Adverse Effects. Local reactions such as pain, swelling, and rash are the most common adverse effects following cefotaxime administration. Like other cephalosporins, cefotaxime does not cause disulfiram-like reactions. Cefotaxime used concurrently with nephrotoxic agents may promote nephrotoxic effects on the kidney, and such use requires caution. Patients with hypersensitivity to the cephalosporin or penicillin group may result in an anaphylactic reaction and are manageable with epinephrine, antihistamines, vasopressors, or corticosteroids. |
statpearls_NBK430685\article-100616_23 | Cefotaxime -- Contraindications | Hypersensitivity to cefotaxime is an absolute contraindication to its use. Patients with known allergies to penicillin or other cephalosporins should also avoid cefotaxime. | Cefotaxime -- Contraindications. Hypersensitivity to cefotaxime is an absolute contraindication to its use. Patients with known allergies to penicillin or other cephalosporins should also avoid cefotaxime. |
statpearls_NBK430685\article-100616_24 | Cefotaxime -- Monitoring | Cefotaxime administration and dosing require adjusting in geriatric populations, patients with decreased renal function, and hepatic dysfunction. Renal function and liver enzymes require routine monitoring. The half-life of cefotaxime is generally one hour, and severe kidney dysfunction may prolong the half-life of cefotaxime and its metabolite desacetylcefotaxime. [9] CBC should also be monitored with cefotaxime use as there are reports of hematologic changes such as neutropenia, leukopenia, and agranulocytosis. Cefotaxime, like other cephalosporins, may also cause a false positive direct coombs test. | Cefotaxime -- Monitoring. Cefotaxime administration and dosing require adjusting in geriatric populations, patients with decreased renal function, and hepatic dysfunction. Renal function and liver enzymes require routine monitoring. The half-life of cefotaxime is generally one hour, and severe kidney dysfunction may prolong the half-life of cefotaxime and its metabolite desacetylcefotaxime. [9] CBC should also be monitored with cefotaxime use as there are reports of hematologic changes such as neutropenia, leukopenia, and agranulocytosis. Cefotaxime, like other cephalosporins, may also cause a false positive direct coombs test. |
statpearls_NBK430685\article-100616_25 | Cefotaxime -- Monitoring | Cefotaxime is an FDA Pregnancy Category B drug. Cefotaxime use in pregnancy has not been studied clearly and should be used cautiously. Cefotaxime is reported to cross the placenta during pregnancy. It is also present in low concentrations in breast milk during lactation. | Cefotaxime -- Monitoring. Cefotaxime is an FDA Pregnancy Category B drug. Cefotaxime use in pregnancy has not been studied clearly and should be used cautiously. Cefotaxime is reported to cross the placenta during pregnancy. It is also present in low concentrations in breast milk during lactation. |
statpearls_NBK430685\article-100616_26 | Cefotaxime -- Toxicity | Cefotaxime is metabolized by the liver and excreted through the kidneys, and dysfunctions may result in decreased drug clearance leading to increased plasma concentrations. About 50 to 60% of the agent is excreted unchanged, and 15 to 20% is excreted as a desacetyl metabolite desacetylcefotaxime. [9] Toxicity may result in convulsions, dyspnea, hypothermia, cyanosis, reversible encephalopathy, and death. Mortality has occurred with dosages of 6000 mg/kg/day. Treatment for cefotaxime toxicity requires supportive management. | Cefotaxime -- Toxicity. Cefotaxime is metabolized by the liver and excreted through the kidneys, and dysfunctions may result in decreased drug clearance leading to increased plasma concentrations. About 50 to 60% of the agent is excreted unchanged, and 15 to 20% is excreted as a desacetyl metabolite desacetylcefotaxime. [9] Toxicity may result in convulsions, dyspnea, hypothermia, cyanosis, reversible encephalopathy, and death. Mortality has occurred with dosages of 6000 mg/kg/day. Treatment for cefotaxime toxicity requires supportive management. |
statpearls_NBK430685\article-100616_27 | Cefotaxime -- Enhancing Healthcare Team Outcomes | Cefotaxime is a broad-spectrum antibiotic that is FDA-approved and indicated to treat gram-positive, gram-negative, and anaerobic organisms of susceptible strains causing pneumonia, urinary tract infections, cervicitis, endometritis, urethritis, and sepsis. The care for patients suffering from infectious diseases prompts critical care from an interprofessional team of healthcare professionals, as preventable contagious disorders can lead to medication resistance, complications, and mortality. These healthcare professionals include a primary care physician, an internist, an infectious disease specialist, critical care, a gynecologist, a nurse, and a pharmacist. | Cefotaxime -- Enhancing Healthcare Team Outcomes. Cefotaxime is a broad-spectrum antibiotic that is FDA-approved and indicated to treat gram-positive, gram-negative, and anaerobic organisms of susceptible strains causing pneumonia, urinary tract infections, cervicitis, endometritis, urethritis, and sepsis. The care for patients suffering from infectious diseases prompts critical care from an interprofessional team of healthcare professionals, as preventable contagious disorders can lead to medication resistance, complications, and mortality. These healthcare professionals include a primary care physician, an internist, an infectious disease specialist, critical care, a gynecologist, a nurse, and a pharmacist. |
statpearls_NBK430685\article-100616_28 | Cefotaxime -- Enhancing Healthcare Team Outcomes | Primary care clinicians, internists, and specialists should educate the patients about the consequences of non-compliance with therapy for the full duration and how resistance to treatment can further cause complications and result in mortality. The primary care physician should routinely monitor renal function, liver enzymes, and CBC as cefotaxime is metabolized and cleared in the liver and kidneys, respectively, and has also been shown to cause hematologic adverse effects. Cefotaxime should be renally dosed in patients with compromised renal function, such as CKD or ESRD, and patients receiving hemodialysis. | Cefotaxime -- Enhancing Healthcare Team Outcomes. Primary care clinicians, internists, and specialists should educate the patients about the consequences of non-compliance with therapy for the full duration and how resistance to treatment can further cause complications and result in mortality. The primary care physician should routinely monitor renal function, liver enzymes, and CBC as cefotaxime is metabolized and cleared in the liver and kidneys, respectively, and has also been shown to cause hematologic adverse effects. Cefotaxime should be renally dosed in patients with compromised renal function, such as CKD or ESRD, and patients receiving hemodialysis. |
statpearls_NBK430685\article-100616_29 | Cefotaxime -- Enhancing Healthcare Team Outcomes | Patients developing diarrhea while receiving treatment with antibiotics should be assessed for Clostridium difficile infection. Colonic flora is changed when receiving treatment with antibiotics, making it susceptible to Clostridium difficile infection resulting in mild to severe forms of diarrhea. Diagnostics and treatment focused on Clostridium difficile , electrolyte, and volume depletion should be initiated, and discontinuing management with cefotaxime should be considered. | Cefotaxime -- Enhancing Healthcare Team Outcomes. Patients developing diarrhea while receiving treatment with antibiotics should be assessed for Clostridium difficile infection. Colonic flora is changed when receiving treatment with antibiotics, making it susceptible to Clostridium difficile infection resulting in mild to severe forms of diarrhea. Diagnostics and treatment focused on Clostridium difficile , electrolyte, and volume depletion should be initiated, and discontinuing management with cefotaxime should be considered. |
statpearls_NBK430685\article-100616_30 | Cefotaxime -- Enhancing Healthcare Team Outcomes | Counseling and careful monitoring are necessary during pregnancy, as clinical studies during its use in pregnancy are limited, and cefotaxime FDA pregnancy category B. Cefotaxime is reported to also be present in breastmilk in low amounts, and infants should be monitored accordingly. [12] Physicians should be up to date with the newly FDA-approved cefotaxime indications dosing, and their effects in the event drug resistance does develop. | Cefotaxime -- Enhancing Healthcare Team Outcomes. Counseling and careful monitoring are necessary during pregnancy, as clinical studies during its use in pregnancy are limited, and cefotaxime FDA pregnancy category B. Cefotaxime is reported to also be present in breastmilk in low amounts, and infants should be monitored accordingly. [12] Physicians should be up to date with the newly FDA-approved cefotaxime indications dosing, and their effects in the event drug resistance does develop. |
statpearls_NBK430685\article-100616_31 | Cefotaxime -- Enhancing Healthcare Team Outcomes | During the treatment of gonorrhea causing urethritis or cervicitis, treatment for chlamydia should be added as cefotaxime does not have coverage for this organism. An interprofessional healthcare team approach to antimicrobial care with cefotaxime involving collaborative interventions and communication is key to building patient rapport and developing a therapeutic alliance so the patients comply with therapy adequately to eradicate the bacteria and prevent further spread. Continued communication and teamwork between healthcare professionals will improve antimicrobial stewardship, improve patient outcomes, limit microbial resistance, and lower the incidence of multidrug-resistant organisms. | Cefotaxime -- Enhancing Healthcare Team Outcomes. During the treatment of gonorrhea causing urethritis or cervicitis, treatment for chlamydia should be added as cefotaxime does not have coverage for this organism. An interprofessional healthcare team approach to antimicrobial care with cefotaxime involving collaborative interventions and communication is key to building patient rapport and developing a therapeutic alliance so the patients comply with therapy adequately to eradicate the bacteria and prevent further spread. Continued communication and teamwork between healthcare professionals will improve antimicrobial stewardship, improve patient outcomes, limit microbial resistance, and lower the incidence of multidrug-resistant organisms. |
statpearls_NBK430685\article-100616_32 | Cefotaxime -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Cefotaxime -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
statpearls_NBK430685\article-100629_0 | Endovascular Papillary Angioendothelioma -- Continuing Education Activity | Endovascular papillary angioendothelioma (EPA), also known as Dabska tumor (DT) and papillary intralymphatic angioendothelioma (PILA), represents a borderline entity between hemangioma and angiosarcoma. DT has an overall favorable prognosis; however, there is potential for local recurrence and low-grade metastasis. This activity reviews the evaluation, treatment, and prognosis of endovascular papillary angioendothelioma and highlights the role of the interprofessional team in the care of patients with this condition. | Endovascular Papillary Angioendothelioma -- Continuing Education Activity. Endovascular papillary angioendothelioma (EPA), also known as Dabska tumor (DT) and papillary intralymphatic angioendothelioma (PILA), represents a borderline entity between hemangioma and angiosarcoma. DT has an overall favorable prognosis; however, there is potential for local recurrence and low-grade metastasis. This activity reviews the evaluation, treatment, and prognosis of endovascular papillary angioendothelioma and highlights the role of the interprofessional team in the care of patients with this condition. |
statpearls_NBK430685\article-100629_1 | Endovascular Papillary Angioendothelioma -- Continuing Education Activity | Objectives: Describe the pathophysiology of endovascular papillary angioendothelioma. Review the appropriate evaluation of endovascular papillary angioendothelioma. Outline the management options for patients with endovascular papillary angioendothelioma. Summarize the importance of collaboration and communication amongst the interprofessional team to enhance care coordination for patients with endovascular papillary angioendothelioma. Access free multiple choice questions on this topic. | Endovascular Papillary Angioendothelioma -- Continuing Education Activity. Objectives: Describe the pathophysiology of endovascular papillary angioendothelioma. Review the appropriate evaluation of endovascular papillary angioendothelioma. Outline the management options for patients with endovascular papillary angioendothelioma. Summarize the importance of collaboration and communication amongst the interprofessional team to enhance care coordination for patients with endovascular papillary angioendothelioma. Access free multiple choice questions on this topic. |
statpearls_NBK430685\article-100629_2 | Endovascular Papillary Angioendothelioma -- Introduction | Endovascular papillary angioendothelioma (EPA), also known as Dabska tumor (DT) and papillary intralymphatic angioendothelioma (PILA), represents a borderline entity between hemangioma and angiosarcoma. EPA has an overall favorable prognosis. However, it does have the potential for local recurrence and low-grade metastasis. It most frequently presents in children in various skin locations, subcutaneous tissue, and in deeper areas of the body. However, there have been reports of EPA in adults and internal organs. [1] | Endovascular Papillary Angioendothelioma -- Introduction. Endovascular papillary angioendothelioma (EPA), also known as Dabska tumor (DT) and papillary intralymphatic angioendothelioma (PILA), represents a borderline entity between hemangioma and angiosarcoma. EPA has an overall favorable prognosis. However, it does have the potential for local recurrence and low-grade metastasis. It most frequently presents in children in various skin locations, subcutaneous tissue, and in deeper areas of the body. However, there have been reports of EPA in adults and internal organs. [1] |
statpearls_NBK430685\article-100629_3 | Endovascular Papillary Angioendothelioma -- Introduction | Lesions are typically two to three centimeters in size at the time of presentation. A biopsy is diagnostic, and treatment is wide surgical excision. [2] Because of the rarity of these tumors, most of the information is available from case reports and case series. | Endovascular Papillary Angioendothelioma -- Introduction. Lesions are typically two to three centimeters in size at the time of presentation. A biopsy is diagnostic, and treatment is wide surgical excision. [2] Because of the rarity of these tumors, most of the information is available from case reports and case series. |
statpearls_NBK430685\article-100629_4 | Endovascular Papillary Angioendothelioma -- Etiology | Endovascular papillary angioendothelioma may appear de novo or arise within an area of chronic lymphedema or a preexisting vascular malformation such as a hemangioma or a lymphangioma circumscriptum, etc. [3] [4] [5] The common differentials include retiform hemangioendothelioma, angiosarcoma, reactive angioendotheliomatosis, and benign intravascular endothelial hyperplasia. [6] | Endovascular Papillary Angioendothelioma -- Etiology. Endovascular papillary angioendothelioma may appear de novo or arise within an area of chronic lymphedema or a preexisting vascular malformation such as a hemangioma or a lymphangioma circumscriptum, etc. [3] [4] [5] The common differentials include retiform hemangioendothelioma, angiosarcoma, reactive angioendotheliomatosis, and benign intravascular endothelial hyperplasia. [6] |
statpearls_NBK430685\article-100629_5 | Endovascular Papillary Angioendothelioma -- Etiology | A lymphatic origin for this entity has been proposed due to common morphologic and immunophenotypic findings between adjacent lymphatics and lymphangioma in EPA, as well as the expression of vascular endothelial growth factor and lymphatic immunohistochemical marker, D2-40. [7] | Endovascular Papillary Angioendothelioma -- Etiology. A lymphatic origin for this entity has been proposed due to common morphologic and immunophenotypic findings between adjacent lymphatics and lymphangioma in EPA, as well as the expression of vascular endothelial growth factor and lymphatic immunohistochemical marker, D2-40. [7] |
statpearls_NBK430685\article-100629_6 | Endovascular Papillary Angioendothelioma -- Epidemiology | The Dabska tumor was originally described by Dabska et al. in 1969 in a case series with six patients, all children. [2] Since then, less than 40 cases have been described in the literature. These reported cases show no clear gender predilection, and approximately 75% of patients are children; however, it has also been reported in the elderly. [8] A case series of 12 patients showed an age range of 8-59 with a mean of 30 years, suggesting a wider range. [9] Although it usually presents as an intradermal lesion, there have been reports of involvement of the spleen, testicle, tongue, and bone. [10] [11] [12] [13] | Endovascular Papillary Angioendothelioma -- Epidemiology. The Dabska tumor was originally described by Dabska et al. in 1969 in a case series with six patients, all children. [2] Since then, less than 40 cases have been described in the literature. These reported cases show no clear gender predilection, and approximately 75% of patients are children; however, it has also been reported in the elderly. [8] A case series of 12 patients showed an age range of 8-59 with a mean of 30 years, suggesting a wider range. [9] Although it usually presents as an intradermal lesion, there have been reports of involvement of the spleen, testicle, tongue, and bone. [10] [11] [12] [13] |
statpearls_NBK430685\article-100629_7 | Endovascular Papillary Angioendothelioma -- Pathophysiology | Endovascular papillary angioendothelioma is within a borderline area between benign lesions such as hemangioma and malignant ones like angiosarcoma. There have been cases of these tumors arising within preexisting vascular lesions such as cavernous hemangiomas. Morphologic similarity has also been observed with retiform hemangioendothelioma and may represent the spectrum of the same lesion. Based on the literature review, currently, the diagnosis of EPA is limited to low-grade sarcoma, demonstrating characteristic histopathological and immunohistochemistry features. [6] | Endovascular Papillary Angioendothelioma -- Pathophysiology. Endovascular papillary angioendothelioma is within a borderline area between benign lesions such as hemangioma and malignant ones like angiosarcoma. There have been cases of these tumors arising within preexisting vascular lesions such as cavernous hemangiomas. Morphologic similarity has also been observed with retiform hemangioendothelioma and may represent the spectrum of the same lesion. Based on the literature review, currently, the diagnosis of EPA is limited to low-grade sarcoma, demonstrating characteristic histopathological and immunohistochemistry features. [6] |
statpearls_NBK430685\article-100629_8 | Endovascular Papillary Angioendothelioma -- Histopathology | Histopathological evaluation remains a gold standard for the diagnosis of these rare tumors. They are characterized by numerous interconnecting vascular channels with papillary projections or tuft like structures as observed in renal glomeruli. Endothelial cells lining the vascular channels have a classic hobnail or matchstick appearance due to an apically placed nucleus that produces a surface bulge. [11] [14] Also, these cells demonstrate a high nuclear to cytoplasmic ratio with mitotic activity to a moderate degree. [14] Intravascular and perivascular lymphocytic infiltrates have also been observed. [6] Among all these features, the demonstration of papillary projections seems to be the most important for the diagnosis of endovascular papillary angioendothelioma. | Endovascular Papillary Angioendothelioma -- Histopathology. Histopathological evaluation remains a gold standard for the diagnosis of these rare tumors. They are characterized by numerous interconnecting vascular channels with papillary projections or tuft like structures as observed in renal glomeruli. Endothelial cells lining the vascular channels have a classic hobnail or matchstick appearance due to an apically placed nucleus that produces a surface bulge. [11] [14] Also, these cells demonstrate a high nuclear to cytoplasmic ratio with mitotic activity to a moderate degree. [14] Intravascular and perivascular lymphocytic infiltrates have also been observed. [6] Among all these features, the demonstration of papillary projections seems to be the most important for the diagnosis of endovascular papillary angioendothelioma. |
statpearls_NBK430685\article-100629_9 | Endovascular Papillary Angioendothelioma -- Histopathology | Immunohistochemistry further aids in diagnosis by identifying the tissue origin. EPA tumor cells react positively to vascular and lymphatic markers. They are classically positive for CD34, VEGFR - 3, CD31, D2-40, and factor VIII related antigen. [6] D2-40 is a lymphatic endothelial marker; its positivity differentiates it from other tumors exhibiting similar characteristics on histology. [6] | Endovascular Papillary Angioendothelioma -- Histopathology. Immunohistochemistry further aids in diagnosis by identifying the tissue origin. EPA tumor cells react positively to vascular and lymphatic markers. They are classically positive for CD34, VEGFR - 3, CD31, D2-40, and factor VIII related antigen. [6] D2-40 is a lymphatic endothelial marker; its positivity differentiates it from other tumors exhibiting similar characteristics on histology. [6] |
statpearls_NBK430685\article-100629_10 | Endovascular Papillary Angioendothelioma -- Histopathology | Small storage granules consisting of von Willebrand factor and P-selectin, called Weibel Palade bodies, might be demonstrated upon examination under the electron microscope of the tumor cells. Also seen are irregular nuclei, abundant perinuclear cytoplasmic filaments, and pinocytotic vesicles. [11] | Endovascular Papillary Angioendothelioma -- Histopathology. Small storage granules consisting of von Willebrand factor and P-selectin, called Weibel Palade bodies, might be demonstrated upon examination under the electron microscope of the tumor cells. Also seen are irregular nuclei, abundant perinuclear cytoplasmic filaments, and pinocytotic vesicles. [11] |
statpearls_NBK430685\article-100629_11 | Endovascular Papillary Angioendothelioma -- History and Physical | Generally, endovascular papillary angioendothelioma presents as a slow-growing, painless nodule that is typically localized to the subcutaneous tissue of the extremities, dermis, and less commonly on the trunk, head, and neck. [11] Some cases have been reported in deeper locations such as the bone, brain, spleen, tongue, and testis. [8] Notably, no other primary sources were discovered in these instances, nor was lymph node involvement identified. [6] | Endovascular Papillary Angioendothelioma -- History and Physical. Generally, endovascular papillary angioendothelioma presents as a slow-growing, painless nodule that is typically localized to the subcutaneous tissue of the extremities, dermis, and less commonly on the trunk, head, and neck. [11] Some cases have been reported in deeper locations such as the bone, brain, spleen, tongue, and testis. [8] Notably, no other primary sources were discovered in these instances, nor was lymph node involvement identified. [6] |
statpearls_NBK430685\article-100629_12 | Endovascular Papillary Angioendothelioma -- History and Physical | Most cutaneous tumors come to medical attention when they are two to three centimeters in size. [15] However, much larger lesions have been reported, and have been seen up to 40 centimeters in diameter. The tumors may vary in appearance. Some are described as an ill-defined mass, a plaque, or a nodule with projections into the surrounding tissue. The overlying skin may be pink, blue, or violaceous in color with an atrophic dermis. | Endovascular Papillary Angioendothelioma -- History and Physical. Most cutaneous tumors come to medical attention when they are two to three centimeters in size. [15] However, much larger lesions have been reported, and have been seen up to 40 centimeters in diameter. The tumors may vary in appearance. Some are described as an ill-defined mass, a plaque, or a nodule with projections into the surrounding tissue. The overlying skin may be pink, blue, or violaceous in color with an atrophic dermis. |
statpearls_NBK430685\article-100629_13 | Endovascular Papillary Angioendothelioma -- History and Physical | Symptomatology is also variable. Patients may complain of pain, ulceration, or bleeding from the affected site. [6] Though these lesions tend to be low grade, cases of regional nodal involvement and pulmonary metastasis have been reported in the literature. [16] Hence, it is essential for complete physical evaluation, including a metastatic workup. | Endovascular Papillary Angioendothelioma -- History and Physical. Symptomatology is also variable. Patients may complain of pain, ulceration, or bleeding from the affected site. [6] Though these lesions tend to be low grade, cases of regional nodal involvement and pulmonary metastasis have been reported in the literature. [16] Hence, it is essential for complete physical evaluation, including a metastatic workup. |
statpearls_NBK430685\article-100629_14 | Endovascular Papillary Angioendothelioma -- Evaluation | The definitive diagnosis of EPA is made with a biopsy. As this is such a rare entity, protocols for disease involvement, surveillance, and follow-up have yet to be established. It is reasonable to consider obtaining a chest radiograph for any patient with pulmonary symptoms due to a reported case of a patient dying of pulmonary metastases. Lymph node examination may be performed if there is suspicion for involvement. [15] | Endovascular Papillary Angioendothelioma -- Evaluation. The definitive diagnosis of EPA is made with a biopsy. As this is such a rare entity, protocols for disease involvement, surveillance, and follow-up have yet to be established. It is reasonable to consider obtaining a chest radiograph for any patient with pulmonary symptoms due to a reported case of a patient dying of pulmonary metastases. Lymph node examination may be performed if there is suspicion for involvement. [15] |
statpearls_NBK430685\article-100629_15 | Endovascular Papillary Angioendothelioma -- Treatment / Management | Surgical excision is recommended. In general, the prognosis is favorable for Dabska tumors even with invasion into deeper structures. However, the malignant potential of this tumor should not be ignored, and close follow-up should be maintained. [6] Regional lymphadenectomy should be performed when those structures appear involved. [15] | Endovascular Papillary Angioendothelioma -- Treatment / Management. Surgical excision is recommended. In general, the prognosis is favorable for Dabska tumors even with invasion into deeper structures. However, the malignant potential of this tumor should not be ignored, and close follow-up should be maintained. [6] Regional lymphadenectomy should be performed when those structures appear involved. [15] |
statpearls_NBK430685\article-100629_16 | Endovascular Papillary Angioendothelioma -- Treatment / Management | In one case report, the authors chose to follow National Comprehensive Cancer Network (NCCN) practice guidelines in oncology for soft tissue sarcoma of extremity/trunk stage IIA (T1bN0M0G2), which recommends chest imaging (plain radiograph or chest computed tomography) every 3 to 6 months for 2 to 3 years, then every six months for two years, and then annually for ongoing monitoring. [6] | Endovascular Papillary Angioendothelioma -- Treatment / Management. In one case report, the authors chose to follow National Comprehensive Cancer Network (NCCN) practice guidelines in oncology for soft tissue sarcoma of extremity/trunk stage IIA (T1bN0M0G2), which recommends chest imaging (plain radiograph or chest computed tomography) every 3 to 6 months for 2 to 3 years, then every six months for two years, and then annually for ongoing monitoring. [6] |
statpearls_NBK430685\article-100629_17 | Endovascular Papillary Angioendothelioma -- Differential Diagnosis | The differential diagnosis of this tumor is histologic, as many neoplasms display intravascular proliferation. The differential should include intravascular papillary endothelial hyperplasia (Masson tumor), epithelioid hemangioendothelioma, angiosarcoma, lymphangioma-like Kaposi sarcoma, and retiform hemangioendothelioma. [7] | Endovascular Papillary Angioendothelioma -- Differential Diagnosis. The differential diagnosis of this tumor is histologic, as many neoplasms display intravascular proliferation. The differential should include intravascular papillary endothelial hyperplasia (Masson tumor), epithelioid hemangioendothelioma, angiosarcoma, lymphangioma-like Kaposi sarcoma, and retiform hemangioendothelioma. [7] |
statpearls_NBK430685\article-100629_18 | Endovascular Papillary Angioendothelioma -- Differential Diagnosis | The unique feature of EPA is the papillary structure lined by atypical columnar endothelial cells. A similar formation has been described extravascularly in the patch stage Kaposi sarcoma. Ordinary angiosarcomas may also show focal morphologic patterns of EPA, and in a study of 80 cases of angiosarcoma of soft tissue, 14% showed evidence papillary fronds. [16] Angiosarcoma, however, shows more significant endothelial atypia and diffuse growth outside of blood vessels. [7] | Endovascular Papillary Angioendothelioma -- Differential Diagnosis. The unique feature of EPA is the papillary structure lined by atypical columnar endothelial cells. A similar formation has been described extravascularly in the patch stage Kaposi sarcoma. Ordinary angiosarcomas may also show focal morphologic patterns of EPA, and in a study of 80 cases of angiosarcoma of soft tissue, 14% showed evidence papillary fronds. [16] Angiosarcoma, however, shows more significant endothelial atypia and diffuse growth outside of blood vessels. [7] |
statpearls_NBK430685\article-100629_19 | Endovascular Papillary Angioendothelioma -- Differential Diagnosis | Organized thrombi cause the Masson phenomenon, showing papillary processes of the fibrous cores covered with a layer of endothelial cells. Unlike EPA, the Masson phenomenon is contained within blood vessels, and there are often visible intravascular thrombi. It lacks the presence of columnar endothelial cells and has a single endothelial cell layer surrounding hyalinized stromal cores. [7] | Endovascular Papillary Angioendothelioma -- Differential Diagnosis. Organized thrombi cause the Masson phenomenon, showing papillary processes of the fibrous cores covered with a layer of endothelial cells. Unlike EPA, the Masson phenomenon is contained within blood vessels, and there are often visible intravascular thrombi. It lacks the presence of columnar endothelial cells and has a single endothelial cell layer surrounding hyalinized stromal cores. [7] |
statpearls_NBK430685\article-100629_20 | Endovascular Papillary Angioendothelioma -- Differential Diagnosis | Epithelioid hemangioendothelioma display endothelial cells with eosinophilic vacuolated cytoplasm. The tumor cells arrange as cords, trabeculae, or sheets with myxoid or hyalinized stroma, and often spread outside of the blood vessel. [7] | Endovascular Papillary Angioendothelioma -- Differential Diagnosis. Epithelioid hemangioendothelioma display endothelial cells with eosinophilic vacuolated cytoplasm. The tumor cells arrange as cords, trabeculae, or sheets with myxoid or hyalinized stroma, and often spread outside of the blood vessel. [7] |
statpearls_NBK430685\article-100629_21 | Endovascular Papillary Angioendothelioma -- Differential Diagnosis | Of note, there have been reports in the literature of benign acquired vascular proliferations displaying areas with Dabska features simulating malignancy. Therefore, the presence of atypical architectural features in an otherwise benign-looking acquired vascular proliferation should not lead to unnecessarily aggressive treatment. [17] | Endovascular Papillary Angioendothelioma -- Differential Diagnosis. Of note, there have been reports in the literature of benign acquired vascular proliferations displaying areas with Dabska features simulating malignancy. Therefore, the presence of atypical architectural features in an otherwise benign-looking acquired vascular proliferation should not lead to unnecessarily aggressive treatment. [17] |
statpearls_NBK430685\article-100629_22 | Endovascular Papillary Angioendothelioma -- Surgical Oncology | Currently, wide local excision remains the treatment of choice for these tumors. [16] In most of the patients, this treatment is sufficient without any recurrence. However, a few cases of lymph nodal involvement and pulmonary metastasis have been reported, thus advocating the need for close follow up and long term evaluation. [16] | Endovascular Papillary Angioendothelioma -- Surgical Oncology. Currently, wide local excision remains the treatment of choice for these tumors. [16] In most of the patients, this treatment is sufficient without any recurrence. However, a few cases of lymph nodal involvement and pulmonary metastasis have been reported, thus advocating the need for close follow up and long term evaluation. [16] |
statpearls_NBK430685\article-100629_23 | Endovascular Papillary Angioendothelioma -- Radiation Oncology | Evidence for radiation therapy in these tumors is limited. Of the six patients reported by the Dabska et al. group, three received radiation therapy; of these, two received preoperative radiation while one received it after surgery. [14] Those who received preoperative radiation did not report any response; however, this could be due to the suboptimal dose delivered to these patients. The recommended radiation dose in the preoperative setting for sarcomas is around 50Gy, and the dose they received was around 30Gy. Currently, there are no recommendations for radiation therapy; however, due to deep invasion features observed, it may play a role in the recurrent setting. | Endovascular Papillary Angioendothelioma -- Radiation Oncology. Evidence for radiation therapy in these tumors is limited. Of the six patients reported by the Dabska et al. group, three received radiation therapy; of these, two received preoperative radiation while one received it after surgery. [14] Those who received preoperative radiation did not report any response; however, this could be due to the suboptimal dose delivered to these patients. The recommended radiation dose in the preoperative setting for sarcomas is around 50Gy, and the dose they received was around 30Gy. Currently, there are no recommendations for radiation therapy; however, due to deep invasion features observed, it may play a role in the recurrent setting. |
statpearls_NBK430685\article-100629_24 | Endovascular Papillary Angioendothelioma -- Radiation Oncology | Due to the rarity of these tumors, the benefit of radiation therapy in a randomized trial would be difficult to obtain. Hence it would be prudent to consider radiation in tumors showing features of a high risk of recurrences such as size > 5 cm, deep invasion, and positive margins based upon their behavior pattern similar to low-grade sarcomas. | Endovascular Papillary Angioendothelioma -- Radiation Oncology. Due to the rarity of these tumors, the benefit of radiation therapy in a randomized trial would be difficult to obtain. Hence it would be prudent to consider radiation in tumors showing features of a high risk of recurrences such as size > 5 cm, deep invasion, and positive margins based upon their behavior pattern similar to low-grade sarcomas. |
statpearls_NBK430685\article-100629_25 | Endovascular Papillary Angioendothelioma -- Pertinent Studies and Ongoing Trials | Due to the rarity of these tumors, it is challenging to obtain level I evidence for treatment recommendations. Currently, the practice guidelines are obtained from published case series and reports. | Endovascular Papillary Angioendothelioma -- Pertinent Studies and Ongoing Trials. Due to the rarity of these tumors, it is challenging to obtain level I evidence for treatment recommendations. Currently, the practice guidelines are obtained from published case series and reports. |
statpearls_NBK430685\article-100629_26 | Endovascular Papillary Angioendothelioma -- Treatment Planning | Patterns of failure are yet to be determined for this rare tumor; meanwhile, it would be prudent to consider radiation in a post-operative setting for tumors exhibiting high-risk features for recurrence. Dose, technique, and volume delineation should be based on the principles of radiation therapy in sarcoma. | Endovascular Papillary Angioendothelioma -- Treatment Planning. Patterns of failure are yet to be determined for this rare tumor; meanwhile, it would be prudent to consider radiation in a post-operative setting for tumors exhibiting high-risk features for recurrence. Dose, technique, and volume delineation should be based on the principles of radiation therapy in sarcoma. |
statpearls_NBK430685\article-100629_27 | Endovascular Papillary Angioendothelioma -- Medical Oncology | Based on the literature review, the role of systemic therapy remains yet to be established. Chemotherapy has shown response in angiosarcomas; there may be a role for chemotherapy in the metastatic setting. [18] It is highly recommended for institutions to report their experience with radiation therapy and systemic therapy, which will further add to the literature and guide others in treating these rare tumors with the best possible approach. | Endovascular Papillary Angioendothelioma -- Medical Oncology. Based on the literature review, the role of systemic therapy remains yet to be established. Chemotherapy has shown response in angiosarcomas; there may be a role for chemotherapy in the metastatic setting. [18] It is highly recommended for institutions to report their experience with radiation therapy and systemic therapy, which will further add to the literature and guide others in treating these rare tumors with the best possible approach. |
statpearls_NBK430685\article-100629_28 | Endovascular Papillary Angioendothelioma -- Prognosis | In general, endovascular papillary angioendothelioma are low-grade tumors with favorable outcomes managed with surgery alone. Long term review of originally described patients with Dabska tumors has reported excellent outcomes. [14] However, lymph node metastasis and pulmonary metastasis have been documented, so close follow up and evaluation is warranted. [16] | Endovascular Papillary Angioendothelioma -- Prognosis. In general, endovascular papillary angioendothelioma are low-grade tumors with favorable outcomes managed with surgery alone. Long term review of originally described patients with Dabska tumors has reported excellent outcomes. [14] However, lymph node metastasis and pulmonary metastasis have been documented, so close follow up and evaluation is warranted. [16] |
statpearls_NBK430685\article-100629_29 | Endovascular Papillary Angioendothelioma -- Complications | Endovascular papillary angioendothelioma are slow-growing tumors with favorable prognosis. However, there have been reports of pulmonary metastasis; hence these tumors are not to be underestimated and should be evaluated and treated in time. | Endovascular Papillary Angioendothelioma -- Complications. Endovascular papillary angioendothelioma are slow-growing tumors with favorable prognosis. However, there have been reports of pulmonary metastasis; hence these tumors are not to be underestimated and should be evaluated and treated in time. |
statpearls_NBK430685\article-100629_30 | Endovascular Papillary Angioendothelioma -- Deterrence and Patient Education | Endovascular papillary angioendothelioma must be kept in the differential, especially for children presenting with slow-growing intradermal nodules and evaluated accordingly. Awareness among dermatologists is crucial, as most likely, they will be the primary providers to whom the children will present. | Endovascular Papillary Angioendothelioma -- Deterrence and Patient Education. Endovascular papillary angioendothelioma must be kept in the differential, especially for children presenting with slow-growing intradermal nodules and evaluated accordingly. Awareness among dermatologists is crucial, as most likely, they will be the primary providers to whom the children will present. |
statpearls_NBK430685\article-100629_31 | Endovascular Papillary Angioendothelioma -- Enhancing Healthcare Team Outcomes | Endovascular papillary angioendothelioma, also known as Dabska tumor and papillary intralymphatic angioendothelioma, is a rare tumor of deeper skin. The diagnosis is made with a biopsy. Because of the vast differential for a painless skin lesion, the management should be by an interprofessional team that consists of a dermatologist, plastic surgeon, oncologist, and general surgeon. | Endovascular Papillary Angioendothelioma -- Enhancing Healthcare Team Outcomes. Endovascular papillary angioendothelioma, also known as Dabska tumor and papillary intralymphatic angioendothelioma, is a rare tumor of deeper skin. The diagnosis is made with a biopsy. Because of the vast differential for a painless skin lesion, the management should be by an interprofessional team that consists of a dermatologist, plastic surgeon, oncologist, and general surgeon. |
statpearls_NBK430685\article-100629_32 | Endovascular Papillary Angioendothelioma -- Enhancing Healthcare Team Outcomes | Primary clinicians who are not familiar with the management of such lesions should refer the patient to an oncologist. EPA has an overall favorable prognosis, but it does have the potential for local recurrence and low-grade metastasis. Thus, long term follows up is required. | Endovascular Papillary Angioendothelioma -- Enhancing Healthcare Team Outcomes. Primary clinicians who are not familiar with the management of such lesions should refer the patient to an oncologist. EPA has an overall favorable prognosis, but it does have the potential for local recurrence and low-grade metastasis. Thus, long term follows up is required. |
statpearls_NBK430685\article-100629_33 | Endovascular Papillary Angioendothelioma -- Review Questions | Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. | Endovascular Papillary Angioendothelioma -- Review Questions. Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. |
statpearls_NBK430685\article-100713_0 | Disability Evaluation -- Continuing Education Activity | Impairment and disability are a concern for people around the globe. Injury, illness, or disease that inhibits an individual from participating in their home environment, social environment, or work environment can have widespread effects on their lives and livelihood. This article succinctly presents relevant terminology and definitions, important concepts such as disability claims and return to work, and introduces the impairment rating system. | Disability Evaluation -- Continuing Education Activity. Impairment and disability are a concern for people around the globe. Injury, illness, or disease that inhibits an individual from participating in their home environment, social environment, or work environment can have widespread effects on their lives and livelihood. This article succinctly presents relevant terminology and definitions, important concepts such as disability claims and return to work, and introduces the impairment rating system. |
statpearls_NBK430685\article-100713_1 | Disability Evaluation -- Continuing Education Activity | Objectives: Summarize the differences between impairment, disability, and handicap. Outline the diagnosis-based impairment method and how to determine an impairment score. Describe and review the Americans with Disabilities Act. Discuss the interprofessional approach to safely and quickly returning a patient to work when recovering from a disability. Access free multiple choice questions on this topic. | Disability Evaluation -- Continuing Education Activity. Objectives: Summarize the differences between impairment, disability, and handicap. Outline the diagnosis-based impairment method and how to determine an impairment score. Describe and review the Americans with Disabilities Act. Discuss the interprofessional approach to safely and quickly returning a patient to work when recovering from a disability. Access free multiple choice questions on this topic. |
statpearls_NBK430685\article-100713_2 | Disability Evaluation -- Introduction | According to the CDC, 1 in 4 Americans lives with a disability. This equates to approximately 61 million Americans. Disability, by nature, is a dynamic concept because it involves the relationship between the patient and their injury, physical environment, social atmosphere, economic factors, and religious beliefs. Patients can be affected in functions related to cognition through functions involved with living independently. Although 2 in 5 patients above the age of 65 have a disability, anyone can become disabled at any time in their life. The number of disabled persons is forecasted to be a rapidly growing statistic for several reasons. One reason is the incidence and prevalence of obesity, heart disease, and diabetes. The aforementioned chronic conditions are all risk factors for disability, and as a result of their increase, the incidence of disability will too increase. Another reason is the increase in life expectancy due to advances in medicine and surgery. More people are surviving what would previously be considered a life-ending ailment. However, a common complication of surviving one of these previously life-ending ailments is residual limb deformity, chronic pain, and impaired mobility, to list a few. These complications can affect the way a person interacts with their environment, therefore, leading to disability. Disability has a continuously evolving definition and legal interpretation, as can be expected by the continuous change in socioeconomics and prevalence of chronic disease. | Disability Evaluation -- Introduction. According to the CDC, 1 in 4 Americans lives with a disability. This equates to approximately 61 million Americans. Disability, by nature, is a dynamic concept because it involves the relationship between the patient and their injury, physical environment, social atmosphere, economic factors, and religious beliefs. Patients can be affected in functions related to cognition through functions involved with living independently. Although 2 in 5 patients above the age of 65 have a disability, anyone can become disabled at any time in their life. The number of disabled persons is forecasted to be a rapidly growing statistic for several reasons. One reason is the incidence and prevalence of obesity, heart disease, and diabetes. The aforementioned chronic conditions are all risk factors for disability, and as a result of their increase, the incidence of disability will too increase. Another reason is the increase in life expectancy due to advances in medicine and surgery. More people are surviving what would previously be considered a life-ending ailment. However, a common complication of surviving one of these previously life-ending ailments is residual limb deformity, chronic pain, and impaired mobility, to list a few. These complications can affect the way a person interacts with their environment, therefore, leading to disability. Disability has a continuously evolving definition and legal interpretation, as can be expected by the continuous change in socioeconomics and prevalence of chronic disease. |
statpearls_NBK430685\article-100713_3 | Disability Evaluation -- Introduction | When discussing disability, it is important to understand the terminology. Simply put, three main words: impairment, disability, and handicap. Impairment is essentially a dysfunction of a body system, such as an organ system or the musculoskeletal system. This can affect how a patient interacts with their home, social, or work environments and can often present as a lack of ability to do something. This is known as a disability. It is important to highlight that not all impairments lead to a disability. Disability can be further categorized into temporary or permanent and partial or total disability. Lastly, the term handicap relates the consequences of a disability for a patient to the community or social environment. For example, a person with an above-the-knee amputation has difficulty walking long distances and therefore needs to park their vehicle close to the entrance. | Disability Evaluation -- Introduction. When discussing disability, it is important to understand the terminology. Simply put, three main words: impairment, disability, and handicap. Impairment is essentially a dysfunction of a body system, such as an organ system or the musculoskeletal system. This can affect how a patient interacts with their home, social, or work environments and can often present as a lack of ability to do something. This is known as a disability. It is important to highlight that not all impairments lead to a disability. Disability can be further categorized into temporary or permanent and partial or total disability. Lastly, the term handicap relates the consequences of a disability for a patient to the community or social environment. For example, a person with an above-the-knee amputation has difficulty walking long distances and therefore needs to park their vehicle close to the entrance. |
statpearls_NBK430685\article-100713_4 | Disability Evaluation -- Introduction | As a result of the continuous evolution of disablement, its conceptualization has evolved as well. There are three main paradigms through which disablement can be viewed and interpreted. The medical paradigm is the original model for disability guidelines. The medical model focuses on the pathology causing the impairment. It seeks to relate organ dysfunction at the simplest level to physical dysfunction. The main problem with this interpretation is that not all organ or system dysfunction has a specific treatment, therapeutic endpoint, or clear-cut disability. The social paradigm interprets the social and functional barriers associated with certain impairments. What special accommodations are required as a result? | Disability Evaluation -- Introduction. As a result of the continuous evolution of disablement, its conceptualization has evolved as well. There are three main paradigms through which disablement can be viewed and interpreted. The medical paradigm is the original model for disability guidelines. The medical model focuses on the pathology causing the impairment. It seeks to relate organ dysfunction at the simplest level to physical dysfunction. The main problem with this interpretation is that not all organ or system dysfunction has a specific treatment, therapeutic endpoint, or clear-cut disability. The social paradigm interprets the social and functional barriers associated with certain impairments. What special accommodations are required as a result? |
statpearls_NBK430685\article-100713_5 | Disability Evaluation -- Introduction | The benefit of this paradigm is that it allows people with a disabling impairment to become empowered and participate in society. The biopsychosocial paradigm is the preferred interpretation for disablement because it is multifaceted. The biological facet incorporates any mental or physical impairment. The psychological facet attempts to interpret the emotional state of the individual and take into account various personal and religious beliefs. The social facet addresses the environmental and infrastructural changes that are required to make the physical environment adaptable for patients with disabilities. The International Classification of Functioning, Disability, and Health (ICF) currently adopts the biopsychosocial paradigm. The ICF is the current scheme for disability created by the World Health Organization, created in 2001. The ICF is a comprehensive outline that incorporates the confounding factors between disease state and impairment or, more simply put, between health and function. [1] [2] | Disability Evaluation -- Introduction. The benefit of this paradigm is that it allows people with a disabling impairment to become empowered and participate in society. The biopsychosocial paradigm is the preferred interpretation for disablement because it is multifaceted. The biological facet incorporates any mental or physical impairment. The psychological facet attempts to interpret the emotional state of the individual and take into account various personal and religious beliefs. The social facet addresses the environmental and infrastructural changes that are required to make the physical environment adaptable for patients with disabilities. The International Classification of Functioning, Disability, and Health (ICF) currently adopts the biopsychosocial paradigm. The ICF is the current scheme for disability created by the World Health Organization, created in 2001. The ICF is a comprehensive outline that incorporates the confounding factors between disease state and impairment or, more simply put, between health and function. [1] [2] |
statpearls_NBK430685\article-100713_6 | Disability Evaluation -- Introduction | As eluded to earlier, there is a large legal component to disablement. The nature of the concept of disability is typically viewed in terms of ability to work and medical care costs. If someone is unable to work or participate in their environment because of a disability, they will need support from government services and legislation. In the United States, the Americans with Disabilities Act (ADA) was passed in 1990. Simply put, this piece of legislation would guarantee Americans with disabilities the equal right to employment opportunities, transportation, and public access. The ADA defines disability as “a physical or mental impairment that substantially limits one or more of the major life activities, a person who has a history or record of such impairment, or a person who is perceived by others as having such an impairment.” The ADA is a massive piece of legislation, and so this article will only highlight the stipulations relating to employment. For further information on the ADA, please visit ada.gov. [3] | Disability Evaluation -- Introduction. As eluded to earlier, there is a large legal component to disablement. The nature of the concept of disability is typically viewed in terms of ability to work and medical care costs. If someone is unable to work or participate in their environment because of a disability, they will need support from government services and legislation. In the United States, the Americans with Disabilities Act (ADA) was passed in 1990. Simply put, this piece of legislation would guarantee Americans with disabilities the equal right to employment opportunities, transportation, and public access. The ADA defines disability as “a physical or mental impairment that substantially limits one or more of the major life activities, a person who has a history or record of such impairment, or a person who is perceived by others as having such an impairment.” The ADA is a massive piece of legislation, and so this article will only highlight the stipulations relating to employment. For further information on the ADA, please visit ada.gov. [3] |
statpearls_NBK430685\article-100713_7 | Disability Evaluation -- Introduction | Employment is a major life activity, which in some instances can be life-sustaining. The ADA asks for reasonable accommodation of the employer unless it poses an undue hardship on the employer regarding cost or feasibility. If accommodation is provided, then there is no technical disability associated with a specific impairment in that specific environment. As mentioned before, not every impairment is a disability. For example, a soccer player with a transmetatarsal amputation may have to end his career and thus is disabled. Meanwhile, a computer technician with the same impairment may still be able to work and is therefore not disabled. Determining the feasibility of reasonable accommodation is up to the employer. | Disability Evaluation -- Introduction. Employment is a major life activity, which in some instances can be life-sustaining. The ADA asks for reasonable accommodation of the employer unless it poses an undue hardship on the employer regarding cost or feasibility. If accommodation is provided, then there is no technical disability associated with a specific impairment in that specific environment. As mentioned before, not every impairment is a disability. For example, a soccer player with a transmetatarsal amputation may have to end his career and thus is disabled. Meanwhile, a computer technician with the same impairment may still be able to work and is therefore not disabled. Determining the feasibility of reasonable accommodation is up to the employer. |
statpearls_NBK430685\article-100713_8 | Disability Evaluation -- Introduction | Understanding how impairment will affect a particular individual is important because it will dictate if and how compensation is received. There are several rating systems for both impairment and disability to standardize assessment. However, one common flaw to the system is that the impairment system is often used in lieu of the disability rating system due to the complexity of the process. Multiple compensation systems have their own criteria and definitions. This article will touch on some of the common disability systems before going into the rating schema. | Disability Evaluation -- Introduction. Understanding how impairment will affect a particular individual is important because it will dictate if and how compensation is received. There are several rating systems for both impairment and disability to standardize assessment. However, one common flaw to the system is that the impairment system is often used in lieu of the disability rating system due to the complexity of the process. Multiple compensation systems have their own criteria and definitions. This article will touch on some of the common disability systems before going into the rating schema. |
statpearls_NBK430685\article-100713_9 | Disability Evaluation -- Introduction | The Social Security Disability Insurance and Supplemental Social Security Income (SSDI and SSI) are two parallel disability insurance systems dictated by federal government legislation. SSDI is a system that provides benefits to persons who worked in a qualifying job for at least 5-10 years before the onset of the disability and became disabled before the age of 65. SSI, in contrast, provides income to individuals over the age of 65 or those who are blind or disabled. SSI does not require a work history. The process to apply for SSI starts with the Disability Determination Service. Application for SSI can either be accepted or rejected. If the latter, then it can be resubmitted for reconsideration, and in some instances, there can be a court hearing. [4] [5] [6] | Disability Evaluation -- Introduction. The Social Security Disability Insurance and Supplemental Social Security Income (SSDI and SSI) are two parallel disability insurance systems dictated by federal government legislation. SSDI is a system that provides benefits to persons who worked in a qualifying job for at least 5-10 years before the onset of the disability and became disabled before the age of 65. SSI, in contrast, provides income to individuals over the age of 65 or those who are blind or disabled. SSI does not require a work history. The process to apply for SSI starts with the Disability Determination Service. Application for SSI can either be accepted or rejected. If the latter, then it can be resubmitted for reconsideration, and in some instances, there can be a court hearing. [4] [5] [6] |
statpearls_NBK430685\article-100713_10 | Disability Evaluation -- Introduction | The industrial revolution inspired the Federal Workers’ Compensation Systems at the turn of the 20th century. As more people were employed by factories and worked in dangerous working conditions, the rate of disability or death resulting from work activities increased. As a result, a monetary compensation system was developed for individuals injured while at work or as a consequence of their employment. Some examples of the Federal Worker’s Compensation programs include Federal Employees’ Act, the Longshore and Harbor Workers’ Compensation Act, Energy Employees Occupational Illness Compensation Act, and The Federal Black Lung Program. Many state programs exist as well, and they all have similar fundamental features, which include: compulsory insurance required for all employers, a no-fault system for injuries or illness acquired at work or through the course of work, wage loss benefits, survivor benefits, compensation for permanent partial or permanent total disability, and many more with various stipulations associated. | Disability Evaluation -- Introduction. The industrial revolution inspired the Federal Workers’ Compensation Systems at the turn of the 20th century. As more people were employed by factories and worked in dangerous working conditions, the rate of disability or death resulting from work activities increased. As a result, a monetary compensation system was developed for individuals injured while at work or as a consequence of their employment. Some examples of the Federal Worker’s Compensation programs include Federal Employees’ Act, the Longshore and Harbor Workers’ Compensation Act, Energy Employees Occupational Illness Compensation Act, and The Federal Black Lung Program. Many state programs exist as well, and they all have similar fundamental features, which include: compulsory insurance required for all employers, a no-fault system for injuries or illness acquired at work or through the course of work, wage loss benefits, survivor benefits, compensation for permanent partial or permanent total disability, and many more with various stipulations associated. |
statpearls_NBK430685\article-100713_11 | Disability Evaluation -- Introduction | The Veterans Benefits Admiration offers disability for individuals and service members previously in full-time active military service and were discharged generally or honorably. There are three broad categories: (1) A service-connected disability, which is a disability that resulted from direct injury or disease while on active duty; (2) Nonservice-connected disability, which is due to an injury not incurred while on active duty; (3) Presumptive service connection which is a category that covers various chronic conditions that manifest within 1 year from discharge from active duty. The amount of compensation is related to the severity of impairment and disability endured and is not subject to state or federal income tax. | Disability Evaluation -- Introduction. The Veterans Benefits Admiration offers disability for individuals and service members previously in full-time active military service and were discharged generally or honorably. There are three broad categories: (1) A service-connected disability, which is a disability that resulted from direct injury or disease while on active duty; (2) Nonservice-connected disability, which is due to an injury not incurred while on active duty; (3) Presumptive service connection which is a category that covers various chronic conditions that manifest within 1 year from discharge from active duty. The amount of compensation is related to the severity of impairment and disability endured and is not subject to state or federal income tax. |
statpearls_NBK430685\article-100713_12 | Disability Evaluation -- Introduction | Personal injury claims are insurance provided to individuals who have injury arising out of negligence or intentional act. Personal injury claims typically arise from motor vehicle accidents, slip and fall claims, physical assault claims, and nursing home negligence. [7] [8] | Disability Evaluation -- Introduction. Personal injury claims are insurance provided to individuals who have injury arising out of negligence or intentional act. Personal injury claims typically arise from motor vehicle accidents, slip and fall claims, physical assault claims, and nursing home negligence. [7] [8] |
statpearls_NBK430685\article-100713_13 | Disability Evaluation -- Function | When an individual is applying for disability or filing a personal injury claim, the insurance company or court will ask for a second opinion, also known as an independent medical examination (IME). An IME is a one-time evaluation by a physician not directly involved in the patient's primary treatment. The IME is to answer questions related to the claim and to make diagnoses relevant to the claim. The information obtained in an IME can be used in litigation. Considering the nature of disability claims, the legal system is often involved. In these instances, the purpose of litigation is to establish causality and relate the current injury to any pre-existing and underlying conditions. Two main types of causation include medical causation, which is a cause and effect relationship between the disability claim and injury, and legal causation, which is to establish whether or not an injury would have occurred regardless of the alleged act. Further, when relating an injury to a pre-existing condition, there are two main categories, aggravation, and exacerbation. | Disability Evaluation -- Function. When an individual is applying for disability or filing a personal injury claim, the insurance company or court will ask for a second opinion, also known as an independent medical examination (IME). An IME is a one-time evaluation by a physician not directly involved in the patient's primary treatment. The IME is to answer questions related to the claim and to make diagnoses relevant to the claim. The information obtained in an IME can be used in litigation. Considering the nature of disability claims, the legal system is often involved. In these instances, the purpose of litigation is to establish causality and relate the current injury to any pre-existing and underlying conditions. Two main types of causation include medical causation, which is a cause and effect relationship between the disability claim and injury, and legal causation, which is to establish whether or not an injury would have occurred regardless of the alleged act. Further, when relating an injury to a pre-existing condition, there are two main categories, aggravation, and exacerbation. |
statpearls_NBK430685\article-100713_14 | Disability Evaluation -- Function | Aggravation is defined as a permanent worsening of an existing condition that never returns to baseline. Exacerbation, on the other hand, is only a temporary worsening of the pre-existing condition as it eventually returns to the baseline level of injury or pain. An important concept when discussing disability is Maximum Medical Improvement (MMI). MMI is the point at which the individual is not expected to make any further functional improvement after sufficient time was given for physiologic healing and all appropriate modalities were exhausted. Pre-existing conditions need to be taken into account when determining MMI. [9] [10] | Disability Evaluation -- Function. Aggravation is defined as a permanent worsening of an existing condition that never returns to baseline. Exacerbation, on the other hand, is only a temporary worsening of the pre-existing condition as it eventually returns to the baseline level of injury or pain. An important concept when discussing disability is Maximum Medical Improvement (MMI). MMI is the point at which the individual is not expected to make any further functional improvement after sufficient time was given for physiologic healing and all appropriate modalities were exhausted. Pre-existing conditions need to be taken into account when determining MMI. [9] [10] |
statpearls_NBK430685\article-100713_15 | Disability Evaluation -- Function | It is important for primary care physicians and all physicians alike to understand that certain workgroups have pre-established rights. For example, prolonged high-stress environments have been shown to be a risk factor for cardiovascular disease. As such, employees of law enforcement or fire departments have a presumed risk for cardiovascular disease, and therefore cardiovascular disease in these populations can be considered work-related. This concept applies to many occupations. | Disability Evaluation -- Function. It is important for primary care physicians and all physicians alike to understand that certain workgroups have pre-established rights. For example, prolonged high-stress environments have been shown to be a risk factor for cardiovascular disease. As such, employees of law enforcement or fire departments have a presumed risk for cardiovascular disease, and therefore cardiovascular disease in these populations can be considered work-related. This concept applies to many occupations. |
statpearls_NBK430685\article-100713_16 | Disability Evaluation -- Function | The impairment rating system is complex and can be challenging to understand. However, the system is designed to be easily interpreted by physicians who care for patients with disabilities. The American Medical Association (AMA) produced a document called “AMA Guides to the Evaluation of Permanent Impairment.” This guide was intended to break down the disability rating system further and is frequently updated to reflect current guidelines and medical standards. An impairment rating is defined as “a consensus-derived percentage estimate of a loss of activity reflecting the severity of a given health condition and the degree of associated limitations in terms of activities of daily living.” Impairment ratings are further broken down to include: qualitative measurements, which are anatomically based and would include impairments such as amputation, joint ankyloses, neuropathies, and various other deformities; quantitative impairments, which are also anatomically based and are measured on a continuous scale that corresponds to the degree of impairment; and diagnosis based impairment (DBI) which is an ordinal ranking system that categorizes impairment by severity (such as a ligament sprain as least severe to a ligament rupture as most severe). The diagnosis-based impairment method can be seemingly complex and difficult to interpret. | Disability Evaluation -- Function. The impairment rating system is complex and can be challenging to understand. However, the system is designed to be easily interpreted by physicians who care for patients with disabilities. The American Medical Association (AMA) produced a document called “AMA Guides to the Evaluation of Permanent Impairment.” This guide was intended to break down the disability rating system further and is frequently updated to reflect current guidelines and medical standards. An impairment rating is defined as “a consensus-derived percentage estimate of a loss of activity reflecting the severity of a given health condition and the degree of associated limitations in terms of activities of daily living.” Impairment ratings are further broken down to include: qualitative measurements, which are anatomically based and would include impairments such as amputation, joint ankyloses, neuropathies, and various other deformities; quantitative impairments, which are also anatomically based and are measured on a continuous scale that corresponds to the degree of impairment; and diagnosis based impairment (DBI) which is an ordinal ranking system that categorizes impairment by severity (such as a ligament sprain as least severe to a ligament rupture as most severe). The diagnosis-based impairment method can be seemingly complex and difficult to interpret. |
statpearls_NBK430685\article-100713_17 | Disability Evaluation -- Function | After a diagnosis is made, the diagnosis must be matched with a class on the provided DBI grid (Image 1). The regional body parts are then further subdivided. Once the appropriate grid location is identified, then the grade modifiers are determined to adjust for the level of severity. The grade modifiers include a physical exam (GMPE), functional history (GMFH), and clinical studies (GMCS). The final impairment score is a summation of the grade modifiers. [11] [12] [13] | Disability Evaluation -- Function. After a diagnosis is made, the diagnosis must be matched with a class on the provided DBI grid (Image 1). The regional body parts are then further subdivided. Once the appropriate grid location is identified, then the grade modifiers are determined to adjust for the level of severity. The grade modifiers include a physical exam (GMPE), functional history (GMFH), and clinical studies (GMCS). The final impairment score is a summation of the grade modifiers. [11] [12] [13] |
statpearls_NBK430685\article-100713_18 | Disability Evaluation -- Function | Accurate diagnosis is important because each body region is subdivided, as previously mentioned. The spine has four anatomic regions: cervical, thoracic, lumbar, and pelvis. Each region has its own qualitative rating. The upper extremities are broken down into the digits and hand, wrist, elbow, and shoulder. Each region has a separate grid with adjustments that can be made for peripheral nerve injuries, CRPS, or amputation injuries, to list a few. The lower extremity is divided into three anatomic regions: ankle and foot, knee, and hip. Similar to the upper extremity, the lower extremity regions can have adjustments made for various pathologies. If there are multiple impairments, the impairments must be combined as described in the AMA guide and not simply summated. [14] | Disability Evaluation -- Function. Accurate diagnosis is important because each body region is subdivided, as previously mentioned. The spine has four anatomic regions: cervical, thoracic, lumbar, and pelvis. Each region has its own qualitative rating. The upper extremities are broken down into the digits and hand, wrist, elbow, and shoulder. Each region has a separate grid with adjustments that can be made for peripheral nerve injuries, CRPS, or amputation injuries, to list a few. The lower extremity is divided into three anatomic regions: ankle and foot, knee, and hip. Similar to the upper extremity, the lower extremity regions can have adjustments made for various pathologies. If there are multiple impairments, the impairments must be combined as described in the AMA guide and not simply summated. [14] |
statpearls_NBK430685\article-100713_19 | Disability Evaluation -- Issues of Concern | Disability and return to work. The main goal of disability management is to assist the patient in maintaining functional status or return to functional work status as soon as possible. Long periods of being out of work can, and have been shown to, contribute to poor physical and mental health. Common medical problems can be easily accommodated at the place of employment. | Disability Evaluation -- Issues of Concern. Disability and return to work. The main goal of disability management is to assist the patient in maintaining functional status or return to functional work status as soon as possible. Long periods of being out of work can, and have been shown to, contribute to poor physical and mental health. Common medical problems can be easily accommodated at the place of employment. |
statpearls_NBK430685\article-100713_20 | Disability Evaluation -- Issues of Concern | The American College of Occupational and Environmental Medicine (ACOEM) provides good resources for managing disability patients preparing to return to work. An abbreviated list would include socioeconomic and psychological factors, attitudes and beliefs, health behaviors, clinical measures taken, perception of injury and pain, previous health interventions and diagnostic workups, employer/employee relationship, legal factors, and social environment. These aforementioned factors are often modifiable and identified early on. For example, there are screening tools that can be used to identify the patients perceived level of injury or pain: The Orebro musculoskeletal pain questionnaire is a self-survey that indicates perceived pain; The Back Disability Risk Questionnaire is a self-reported survey administered during the first two weeks of injury to identify the patients perceived level of injury; The Center of Epidemiologic Studies for Depression scale is a short self-reported questionnaire that identifies depression symptoms and has a good predictive ability for chronic pain patients. Additionally, the employer/employee relationship can be easily improved from the time of employment through the time of injury. | Disability Evaluation -- Issues of Concern. The American College of Occupational and Environmental Medicine (ACOEM) provides good resources for managing disability patients preparing to return to work. An abbreviated list would include socioeconomic and psychological factors, attitudes and beliefs, health behaviors, clinical measures taken, perception of injury and pain, previous health interventions and diagnostic workups, employer/employee relationship, legal factors, and social environment. These aforementioned factors are often modifiable and identified early on. For example, there are screening tools that can be used to identify the patients perceived level of injury or pain: The Orebro musculoskeletal pain questionnaire is a self-survey that indicates perceived pain; The Back Disability Risk Questionnaire is a self-reported survey administered during the first two weeks of injury to identify the patients perceived level of injury; The Center of Epidemiologic Studies for Depression scale is a short self-reported questionnaire that identifies depression symptoms and has a good predictive ability for chronic pain patients. Additionally, the employer/employee relationship can be easily improved from the time of employment through the time of injury. |
statpearls_NBK430685\article-100713_21 | Disability Evaluation -- Issues of Concern | The ACOEM promotes the adoption of an injury-prevention cooperate infrastructure as a majority of work-related injuries are preventable. This infrastructure would include incentivizing healthy lifestyles and return to work programs. Promoting a safer environment and maintaining an interest in the employees’ health and safety enhances the inherent relationship. If an employee is to be injured at work, the ACOEM has shown that early positive contact by the employer has shown to be a strong predictor of earlier return to work. The Canadian Institute for Work and Health has identified seven principles associated with return to work as seen in. [15] [16] [17] | Disability Evaluation -- Issues of Concern. The ACOEM promotes the adoption of an injury-prevention cooperate infrastructure as a majority of work-related injuries are preventable. This infrastructure would include incentivizing healthy lifestyles and return to work programs. Promoting a safer environment and maintaining an interest in the employees’ health and safety enhances the inherent relationship. If an employee is to be injured at work, the ACOEM has shown that early positive contact by the employer has shown to be a strong predictor of earlier return to work. The Canadian Institute for Work and Health has identified seven principles associated with return to work as seen in. [15] [16] [17] |
statpearls_NBK430685\article-100713_22 | Disability Evaluation -- Issues of Concern | If the patient has the opportunity to return to work with modified duties, the patient should do so under the advisement and recommendation of the treating physician. Doing so can be productive and therapeutic. Modified work programs include either decreased or flexible work hours, decreased required shift tasks, and/or workplace modifications to accommodate needs. If the patient has no opportunity to have a temporary or modified job, then the patient may require a temporary total disability claim until MMI is achieved. The Functional Capacity Evaluation (FCE) is a standardized assessment of an injured individual’s ability to return to a transitional, modified work environment. The FCE may require performance-based tests using job-specific equipment in a simulated or real environment. An additional Job Site Evaluation (JSE) can be obtained by using a specially trained therapist to assess the functions of the job and the physical demands required. [18] | Disability Evaluation -- Issues of Concern. If the patient has the opportunity to return to work with modified duties, the patient should do so under the advisement and recommendation of the treating physician. Doing so can be productive and therapeutic. Modified work programs include either decreased or flexible work hours, decreased required shift tasks, and/or workplace modifications to accommodate needs. If the patient has no opportunity to have a temporary or modified job, then the patient may require a temporary total disability claim until MMI is achieved. The Functional Capacity Evaluation (FCE) is a standardized assessment of an injured individual’s ability to return to a transitional, modified work environment. The FCE may require performance-based tests using job-specific equipment in a simulated or real environment. An additional Job Site Evaluation (JSE) can be obtained by using a specially trained therapist to assess the functions of the job and the physical demands required. [18] |
statpearls_NBK430685\article-100713_23 | Disability Evaluation -- Clinical Significance | Documentation and key components. A thorough history and physical is important at the first evaluation for a disability claim. In addition to noting the precise details of the injury and body parts affected, it is also important to note the functional limitations caused by the impairment. The functional history should include various environments (home, work, social, community, etc.) and different activities (ADLs and iADLs). | Disability Evaluation -- Clinical Significance. Documentation and key components. A thorough history and physical is important at the first evaluation for a disability claim. In addition to noting the precise details of the injury and body parts affected, it is also important to note the functional limitations caused by the impairment. The functional history should include various environments (home, work, social, community, etc.) and different activities (ADLs and iADLs). |
statpearls_NBK430685\article-100713_24 | Disability Evaluation -- Clinical Significance | An important standardized scale is the Functional Independence Measure (FIM), which quantifies the patient’s level of independence. The physical examination should use techniques and maneuvers that are standardized. These may include Manual Muscle Testing (MMT), Range of Motion evaluation with a goniometer, Modified Ashworth Scale for spasticity, and other special tests designed to identify the presence or specific injuries. These tests should be repeated at each visit to show progression or digression of the patient’s progress with therapy. [19] [20] | Disability Evaluation -- Clinical Significance. An important standardized scale is the Functional Independence Measure (FIM), which quantifies the patient’s level of independence. The physical examination should use techniques and maneuvers that are standardized. These may include Manual Muscle Testing (MMT), Range of Motion evaluation with a goniometer, Modified Ashworth Scale for spasticity, and other special tests designed to identify the presence or specific injuries. These tests should be repeated at each visit to show progression or digression of the patient’s progress with therapy. [19] [20] |
statpearls_NBK430685\article-100713_25 | Disability Evaluation -- Other Issues | Independent Medical Examiner and litigation. The IME can be asked to provide witness testimony in the court of law. Previously, expert witnesses were exempt from medical malpractice claims and other lawsuits. However, there have been Supreme Court rulings that held expert witnesses liable to traditional malpractice. IMEs must be up to date on current medical-legal terminology and also the current legal standards. | Disability Evaluation -- Other Issues. Independent Medical Examiner and litigation. The IME can be asked to provide witness testimony in the court of law. Previously, expert witnesses were exempt from medical malpractice claims and other lawsuits. However, there have been Supreme Court rulings that held expert witnesses liable to traditional malpractice. IMEs must be up to date on current medical-legal terminology and also the current legal standards. |
statpearls_NBK430685\article-100713_26 | Disability Evaluation -- Enhancing Healthcare Team Outcomes | An impairment that causes disability is an injury that extends beyond the physical body part. Patients who become disabled are transitioning into life with a different set of circumstances. The patients are affected personally, socially, professionally, and spiritually. Fortunately, due to progressive movements and increased awareness, the amount of funding and resources available to these patients has increased astronomically. The recent legislation approved mandates accessibility to all public spaces and appropriate accommodation in workplaces so that these individuals can continue to participate in the community in ways similar to how they had previously. | Disability Evaluation -- Enhancing Healthcare Team Outcomes. An impairment that causes disability is an injury that extends beyond the physical body part. Patients who become disabled are transitioning into life with a different set of circumstances. The patients are affected personally, socially, professionally, and spiritually. Fortunately, due to progressive movements and increased awareness, the amount of funding and resources available to these patients has increased astronomically. The recent legislation approved mandates accessibility to all public spaces and appropriate accommodation in workplaces so that these individuals can continue to participate in the community in ways similar to how they had previously. |
statpearls_NBK430685\article-100713_27 | Disability Evaluation -- Enhancing Healthcare Team Outcomes | It is paramount for the physician and all providers participating in the care of a patient with a disability to understand and be familiar with the resources available. The care team should include, but not be limited to, the physician, physical therapist, and/or occupational therapist, and/or speech therapist, psychologist, and case manager. Further, when a patient is on disability from work, it should be the care team's responsibility to return the patient to work as quickly and as safely as possible. | Disability Evaluation -- Enhancing Healthcare Team Outcomes. It is paramount for the physician and all providers participating in the care of a patient with a disability to understand and be familiar with the resources available. The care team should include, but not be limited to, the physician, physical therapist, and/or occupational therapist, and/or speech therapist, psychologist, and case manager. Further, when a patient is on disability from work, it should be the care team's responsibility to return the patient to work as quickly and as safely as possible. |
statpearls_NBK430685\article-100713_28 | Disability Evaluation -- Enhancing Healthcare Team Outcomes | Studies presented by the American College of Occupational and Environmental Medicine and the Canadia Institue for Work and Health have identified factors that promote a patient's return to work and further discuss the consequences of prolonged time off from work. [Level 5] For these reasons, it is important to have an interprofessional team approach to patients with disabilities. | Disability Evaluation -- Enhancing Healthcare Team Outcomes. Studies presented by the American College of Occupational and Environmental Medicine and the Canadia Institue for Work and Health have identified factors that promote a patient's return to work and further discuss the consequences of prolonged time off from work. [Level 5] For these reasons, it is important to have an interprofessional team approach to patients with disabilities. |
statpearls_NBK430685\article-100713_29 | Disability Evaluation -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Disability Evaluation -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
statpearls_NBK430685\article-101263_0 | Cancer Antigen 125 -- Introduction | Cancer antigen 125 (CA125) is an antigenic tumor marker expressed by epithelial ovarian neoplasms and cells lining various organs such as the endometrium, fallopian tubes, pleura, peritoneum, and pericardium. [1] [2] CA125 is used as one of the serological tests in cases when an ovarian neoplasm is suspected and for monitoring patients who have already been diagnosed with epithelial ovarian cancers. [2] [3] However, due to its low sensitivity, the test has limited use in diagnosing early ovarian cancer. The specificity is particularly low in premenopausal women; thus, it is most useful in postmenopausal women. [4] | Cancer Antigen 125 -- Introduction. Cancer antigen 125 (CA125) is an antigenic tumor marker expressed by epithelial ovarian neoplasms and cells lining various organs such as the endometrium, fallopian tubes, pleura, peritoneum, and pericardium. [1] [2] CA125 is used as one of the serological tests in cases when an ovarian neoplasm is suspected and for monitoring patients who have already been diagnosed with epithelial ovarian cancers. [2] [3] However, due to its low sensitivity, the test has limited use in diagnosing early ovarian cancer. The specificity is particularly low in premenopausal women; thus, it is most useful in postmenopausal women. [4] |
statpearls_NBK430685\article-101263_1 | Cancer Antigen 125 -- Etiology and Epidemiology | CA125 is an epitope found on mucin 16 (MUC16), a glycoprotein antigen present on the cell surface. This antigen is normally expressed in tissues derived from coelomic epithelia, such as the ovary, fallopian tube, peritoneum, pleura, pericardium, colon, kidney, and stomach. [2] [5] Currently, 3 antibodies can help identify the CA125 antigen, and all 3 groups recognize nonoverlapping epitopes. [2] The first group involves OC125-like antibodies, the second involves M11-like antibodies, and the third involves OV197-like antibodies. [3] [6] | Cancer Antigen 125 -- Etiology and Epidemiology. CA125 is an epitope found on mucin 16 (MUC16), a glycoprotein antigen present on the cell surface. This antigen is normally expressed in tissues derived from coelomic epithelia, such as the ovary, fallopian tube, peritoneum, pleura, pericardium, colon, kidney, and stomach. [2] [5] Currently, 3 antibodies can help identify the CA125 antigen, and all 3 groups recognize nonoverlapping epitopes. [2] The first group involves OC125-like antibodies, the second involves M11-like antibodies, and the third involves OV197-like antibodies. [3] [6] |
statpearls_NBK430685\article-101263_2 | Cancer Antigen 125 -- Etiology and Epidemiology | In a study carried out by Bast et al in 1983, elevated levels of serum CA125 (>35 U/mL) were present in 82% of patients with epithelial ovarian cancer, 28.5% of patients with non-gynecological cancers such as pancreatic, lung, breast, and colorectal, and 6% of the patients with benign diseases such as an ovarian cyst. [7] Among gynecologic malignancies, elevated levels of CA125 correlate with adenocarcinoma of the endometrium and endocervix. [8] CA125 also becomes elevated under certain physiological conditions, such as during menstruation, the first trimester of pregnancy, the postpartum period, fibroids, and pelvic endometriosis. [3] [9] [10] [11] | Cancer Antigen 125 -- Etiology and Epidemiology. In a study carried out by Bast et al in 1983, elevated levels of serum CA125 (>35 U/mL) were present in 82% of patients with epithelial ovarian cancer, 28.5% of patients with non-gynecological cancers such as pancreatic, lung, breast, and colorectal, and 6% of the patients with benign diseases such as an ovarian cyst. [7] Among gynecologic malignancies, elevated levels of CA125 correlate with adenocarcinoma of the endometrium and endocervix. [8] CA125 also becomes elevated under certain physiological conditions, such as during menstruation, the first trimester of pregnancy, the postpartum period, fibroids, and pelvic endometriosis. [3] [9] [10] [11] |
statpearls_NBK430685\article-101263_3 | Cancer Antigen 125 -- Pathophysiology | The inherent function of CA125 membrane protein is still not completely clear. The latest studies suspect that the oligosaccharides associated with CA125 might play a role in cell-mediated immunity. [12] CA125 may have a role in inhibiting cytotoxic responses of the natural killer cells. [13] [14] Under physiological conditions, CA125 is expressed on the cell membrane. However, due to the presence of the cells' junctional complexes, it cannot cross into the bloodstream. Pathological states associated with the disruption of this membrane barrier lead to the antigen being shed into the blood and a consequent serological rise in the levels of CA125. [1] CA125 has been considered to play a role in promoting tumorigenesis and metastasis. This mechanism is believed to occur due to the binding between CA125 and mesothelin, a glycoprotein expressed on the mesothelial cells of the peritoneum. [15] Elucidating this role of CA125 in oncogenesis has proposed a potential therapeutic avenue through the creation of monoclonal antibodies targeting CA125. [15] [16] | Cancer Antigen 125 -- Pathophysiology. The inherent function of CA125 membrane protein is still not completely clear. The latest studies suspect that the oligosaccharides associated with CA125 might play a role in cell-mediated immunity. [12] CA125 may have a role in inhibiting cytotoxic responses of the natural killer cells. [13] [14] Under physiological conditions, CA125 is expressed on the cell membrane. However, due to the presence of the cells' junctional complexes, it cannot cross into the bloodstream. Pathological states associated with the disruption of this membrane barrier lead to the antigen being shed into the blood and a consequent serological rise in the levels of CA125. [1] CA125 has been considered to play a role in promoting tumorigenesis and metastasis. This mechanism is believed to occur due to the binding between CA125 and mesothelin, a glycoprotein expressed on the mesothelial cells of the peritoneum. [15] Elucidating this role of CA125 in oncogenesis has proposed a potential therapeutic avenue through the creation of monoclonal antibodies targeting CA125. [15] [16] |
statpearls_NBK430685\article-101263_4 | Cancer Antigen 125 -- Pathophysiology | In the case of ovaries, it appears that CA125 expresses when the ovarian epithelium undergoes metaplasia into a Müllerian-type endothelium or a neoplastic transformation. [1] [2] Upon their malignant transformation, the tumor cells invade and disrupt the architecture to enter the bloodstream. [17] In benign ovarian cysts, although the antigen may be shed into the cystic fluid, it is not present in the bloodstream. [8] | Cancer Antigen 125 -- Pathophysiology. In the case of ovaries, it appears that CA125 expresses when the ovarian epithelium undergoes metaplasia into a Müllerian-type endothelium or a neoplastic transformation. [1] [2] Upon their malignant transformation, the tumor cells invade and disrupt the architecture to enter the bloodstream. [17] In benign ovarian cysts, although the antigen may be shed into the cystic fluid, it is not present in the bloodstream. [8] |
statpearls_NBK430685\article-101263_5 | Cancer Antigen 125 -- Specimen Requirements and Procedure | CA125 is detectable through serological-based tests or tissue-based studies of malignant ovarian or endometrial tissue specimens. [18] In addition, it may be present in body fluids such as pleural fluid, peritoneal fluid in benign or malignant conditions, and ovarian cystic fluid. [8] Serological assays on serum or plasma samples are the most commonly used quantitative analysis method for analyzing CA125 levels in the blood. To maintain the stability of the specimen, the serum must be separated from the clot and stored at −30 °C (long term) or 4 °C (short term). [19] | Cancer Antigen 125 -- Specimen Requirements and Procedure. CA125 is detectable through serological-based tests or tissue-based studies of malignant ovarian or endometrial tissue specimens. [18] In addition, it may be present in body fluids such as pleural fluid, peritoneal fluid in benign or malignant conditions, and ovarian cystic fluid. [8] Serological assays on serum or plasma samples are the most commonly used quantitative analysis method for analyzing CA125 levels in the blood. To maintain the stability of the specimen, the serum must be separated from the clot and stored at −30 °C (long term) or 4 °C (short term). [19] |
statpearls_NBK430685\article-101263_6 | Cancer Antigen 125 -- Specimen Requirements and Procedure | When the CA125 assay is used for cancer diagnosis, sampling should not be conducted immediately before or during menstruation because the physiological elevation of the CA125 levels may provide false-positive results. [9] [20] The serum samples for CA125 should not be collected within 2 weeks of surgery, as the levels may become falsely elevated secondary to tissue damage. CA125 levels have a half-life of 6 days and may require a few weeks to return to normal levels after surgery. A pre-treatment sample should be used as a reference for evaluating CA125 levels postoperatively. [21] | Cancer Antigen 125 -- Specimen Requirements and Procedure. When the CA125 assay is used for cancer diagnosis, sampling should not be conducted immediately before or during menstruation because the physiological elevation of the CA125 levels may provide false-positive results. [9] [20] The serum samples for CA125 should not be collected within 2 weeks of surgery, as the levels may become falsely elevated secondary to tissue damage. CA125 levels have a half-life of 6 days and may require a few weeks to return to normal levels after surgery. A pre-treatment sample should be used as a reference for evaluating CA125 levels postoperatively. [21] |
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