1/13. Heterogeneity in the clinical presentation of Eagle's syndrome.OBJECTIVE: Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Recognizing an index case of type 1 neurofibromatosis.Neurofibromatosis is a relatively common autosomal dominant disorder with variable penetrance. The disorder usually presents in childhood. Hallmarks of type 1 neurofibromatosis are cafe-au-lait macules and neurofibromas. Neurologic complications include mental retardation, learning disabilities and seizures. Tumors of the eighth cranial nerve, as well as other intracranial and spinal neoplasms, are the typical lesions in type 2 neurofibromatosis. Both forms of neurofibromatosis have a highly variable course and may result in progressive neurologic deterioration, disfigurement and impingement syndromes. In the 50 percent of cases that represent new mutations, diagnosis may be delayed if the physician is not familiar with the salient features of the disorder. Thorough initial evaluation, genetic counseling and close follow-up are important aspects of management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. congenital abnormalities of the lymphatic system: a new clinical classification.The numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician's understanding of the condition. The clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment. Future research should concentrate on the specific causes and the treatment of these congenital abnormalities.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/13. Concurrent musculoskeletal pain in a patient with symptomatic lower extremity arterial insufficiency.The etiology of back and lower extremity pain can, at times, be difficult to differentiate. This is especially true in cases where two pain-producing conditions coexist. Such difficulties have been reported in cases of coexisting vascular and neurogenic claudication. We report the case of a 66-year-old woman with concurrent musculoskeletal pain and hip claudication. Her arterial insufficiency was initially masked by her diffuse pain complaints and only became apparent to us after successful treatment of her soft tissue problems. We caution physicians to be aware of coexisting musculoskeletal pain that may mask significant underlying pathology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. Sternocostoclavicular hyperostosis: rheumatologic, radiologic, and dermatologic characteristics.Two recently observed patients with sternocostoclavicular hyperostosis exemplify the characteristic presentation of this rheumatologic disorder. We describe its manifestations, review the literature on this subject, and discuss clinical and radiologic aspects, including the frequently associated dermatologic disorder palmoplantar pustulosis. Sternocostoclavicular hyperostosis is an increasingly common diagnosis, and practicing physicians should be aware of the distinctive features that allow accurate differentiation from psoriatic arthritis and other diseases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Anterior cervical pain syndromes.The paucity of clinical findings in patients with glossopharyngeal neuralgia, superior laryngeal neuralgia, styloid process syndrome, hyoid syndrome, or carotidynia presents an enigma to the patient and the physician. Manifest symptoms appear extraneous or incongruous unless the essential element is identified. Common to all these syndromes is the radiation of pain over the neck and face, starting from the anterior cervical area of the neck. Case histories of seven patients are presented. The rationale of underlying pathophysiologic mechanisms is discussed and supported by relevant recent basic pain research, and conceptual speculations are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. osteoradionecrosis of the temporal bone.Six cases of osteoradionecrosis of the temporal bone are described. Persistent symptoms of otitis externa refractory to local treatment measures should alert the physician to the possibility of underlying osteoradionecrosis. Treatment of superficial parotidectomy and partial temporal bone resection with preservation of the facial nerve is indicated if local aggressive conservative measures fail to control the disease. Benign mixed tumors of the parotid gland should be treated surgically with avoidance of radiotherapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Musculoskeletal syndromes associated with malignancy.Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/13. Analysis of bone biopsies.The orthopedic surgeon is frequently confronted with the decision of when to perform a bone biopsy and whether to do a needle biopsy or an open biopsy. Frequently consultations are received from other services requesting bone biopsies with questionable indications. The indications and contraindications for performing bone biopsies are discussed as well as advantages and disadvantages of either closed or open technique. Four selective cases are discussed with illustrations. The challenge of undiagnosed osseous lesions is best met by rational evaluation of each individual case and coordinated with the team effort of the primary care physician, surgeon, pathologist, and radiologist. The decision for either an open or closed biopsy technique must be based on the experience and skills of the surgeon and pathologist.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Regional soft tissue rheumatic pain syndromes: a common challenge in daily practice.Soft tissue pain syndromes, problematic in themselves, may aggravate other underlying disorders. The physician who is familiar with the characteristic features of each of the many syndromes may more readily recognize them in practice. Treatment should be tailored to the individual and based on a home exercise program. Success of treatment corroborates the diagnosis and may prevent a state of chronic incapacitating pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |