1/64. Candida lambica polyarthritis in a patient with chronic alcoholism.We describe a patient with an indolent polyarthritis over a period of several years caused by Candida lambica probably acquired from a contaminated wound. C. lambica has not been previously reported to cause infectious arthritis. Hematogenous spread was manifest by 4 separate sites of involvement. Chronic alcoholism was the only apparent risk factor for dissemination. The infection seems to be environmentally acquired.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/64. Approaching the patient with chronic malabsorption syndrome.The causes of chronic malabsorption may be categorized as decreased intestinal absorption, most commonly caused by celiac sprue; or maldigestion caused by pancreatic insufficiency. The initial step in the evaluation of these patients should include stool studies to confirm fat malabsorption. If fat malabsorption is confirmed, endoscopy with small-bowel biopsies and aspirates for bacterial culture usually follows. A normal endoscopic examination should lead to assessment of pancreatic function. In the setting of normal pancreatic function and the absence of bile acid deficiency, a barium radiograph of the small bowel should be made, looking for anatomical abnormalities. Celiac sprue is an intolerance to gluten caused by a combination of genetic, environmental, and immunologic factors. It classically causes malabsorption. However, it is likely that many patients who exhibit only minor manifestations of the disease go unrecognized and untreated. A presumed diagnosis of celiac sprue is confirmed after a clinical and endoscopic response to a gluten-free diet. Serological markers are available with high degrees of sensitivity and specificity, but duodenal biopsy remains the gold standard for diagnosis. A minority of patients are unresponsive to a gluten-free diet, and intestinal lymphoma should be suspected in these cases.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/64. Management of encopresis in early adolescence in a medical-psychiatric unit.The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/64. Partnership in education: an example of client and educator collaboration.This article describes one education strategy designed to assist nursing staff in the process of "learning to surrender" the service providers' need to direct client decision-making. Using the health promotion principle of "client as expert," a nurse educator and a client with advanced multiple sclerosis co-present an inservice class about the importance of personal empowerment and environmental mastery for maintaining physical and psychological well-being in the face of a chronic disorder. This collaborative strategy provided the client a forum from which to share his personal experience and professional knowledge to influence attitudes and provide valuable information to nursing staff in a long-term care facility. Collaborating with the client to bring information to nursing staff is one means to foster a climate of client empowerment, influence staff perceptions and communicate the unique experiences of the client.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/64. Restructuring the therapeutic environment to promote care and safety for the obese patient.Fifty-four percent of American adults are overweight. obesity is a chronic disease associated with a number of conditions, such as diabetes, heart disease, hypertension, certain types of cancers, and breathing problems. The direct and indirect costs related to obesity exceed $70 billion annually. Because of the many cost and quality issues related to obesity, national attention is turning toward the special needs of this population. Strategies to restructure therapeutic intervention with attention to risk management, economic implications, and patient satisfaction are important considerations when managing the obese patient.- - - - - - - - - - ranking = 4keywords = environment (Clic here for more details about this article) |
6/64. Evaluating and monitoring the adolescent with pulmonary function testing.This article reviews pulmonary function tests (quantitative measurements of physiologic functioning of lungs, chest wall, and respiratory muscles) as valuable tools for the diagnosis and management of chronic respiratory disease in adolescents. Advances in technology have made pulmonary function testing more available and, for some tests, easier to perform. Pulmonary function evaluation is used for diagnosis of pulmonary disease. Testing will identify abnormal physiologic processes that result in obstructive or restrictive pulmonary disease and, together with a complete history, physical examination, and other tests, help to determine the specific etiology. Pulmonary function measurement may be used to manage a patientis disease over time. Quantitative evaluation of the response to many specific therapies, such as asthma medications and environmental control, can only be achieved by measuring pulmonary function. Monitoring pulmonary toxicity of medications, such as chemotherapeutic agents, is also done by measuring pulmonary function. In many patients with chronic pulmonary disease, such as cystic fibrosis, the pulmonary function laboratory can be used to assess the patient's physiologic limitation.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/64. Multiple lung abscesses due to Ochroconis gallopavum, a dematiaceous fungus, in a nonimmunocompromised wood pulp worker.An occurrence of multiple chronic lung abscesses managed by lobectomy is described. These abscesses were present for 13 years in the patient, a nonimmunocompromised wood pulp worker. The patient had hemoptysis at presentation. The organism isolated was Ochroconis gallopavum, a dematiaceous fungus known to cause disease in immunocompromised patients and epidemic encephalitis in poultry. The fungus is typically found in warm environments and in decaying compost; for this reason, we postulate that his illness was occupationally acquired.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/64. Hepatocellular carcinoma despite long-term survival in chronic tyrosinaemia I.Tyrosinaemia I (fumarylacetoacetate hydrolase deficiency) is an autosomal recessive inborn error of tyrosine metabolism that produces liver failure in infancy or a more chronic course of liver disease with cirrhosis, often complicated by hepatocellular carcinoma, in childhood or early adolescence. We studied a 37-year-old woman with tyrosinaemia I whose severe liver disease in infancy and rickets during childhood resolved with dietary therapy. From 14 years of age she resumed an unrestricted diet with the continued presence of the biochemical features of tyrosinaemia, yet maintained normal liver function. In adult years she accumulated only small amounts of succinylacetone. Despite this evolution to a mild biochemical and clinical phenotype, she eventually developed hepatocellular carcinoma. Her fumarylacetoacetate hydrolase genotype consists of a splice mutation, IVS6-1g>t, and a novel missense mutation, Q279R. Studies of resected liver demonstrated the absence of hydrolytic activity and of immunological expression of fumarylacetoacetate hydrolase in liver tumour. In nontumoral areas, however, 53% of normal hydrolytic activity and immunologically present fumarylacetoacetate hydrolase was found. This case demonstrates the high risk of liver cancer in tyrosinaemia I even in a seemingly favourable biological environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/64. Allergic vulvovaginitis in infancy: study of a case.BACKGROUND: the role of dust mites (Dermatophagoides pt.) in the pathogenesis of allergic vulvovaginitis is still controversial. association between this mite and atopic dermatitis, conjunctivitis, rhinitis or asthma is already known.Some authors study the possible relationship between some vulvovaginitis and local hypersensitivity. The aim of this study was to corroborate the allergic aetiology due to the mite Dermatophagoides pt. in a girl with vulvovaginitis and perennial rhinitis. methods AND RESULTS: we studied a nine year-old patient with symptoms of perennial rhinitis and unspecific vulvovaginitis of torpid evolution. In vivo and in vitro allergologic tests were performed as well as complete analytic tests including immunoglobulins, urine tests, nasal culture, exudative vaginal culture, and parasitic test.skin test was positive for Dermatophagoides pt. as well as specific IgE (99.5 kU/L). Total IgE was elevated for her age (492 kU/L). In the rest of the complementary tests, no values out of normality or pathological findings were obtained. CONCLUSIONS: considering these results, it was suspected that the nasal symptoms and the vulvovaginitis presented by the patient are of allergic aetiology by hypersensitivity to the mite Dermatophagoides pt. The study did not prove relation with bacteria, parasites, candida albicans or any inhalant allergens other than mites.After three months of treatment with oral antihistamines and topical chromones, as well as environmental avoiding measures, the symptoms totally yielded.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/64. The concept of total pain: a focused patient care study.This article considers the care of a patient admitted into a hospice environment for pain management and respite care. The concept of 'total' pain is discussed together with the need for a multidimensional assessment of pain to enable effective management to be accomplished. A multiprofessional approach to care along with inclusion of both the patient and her husband in decision making achieved the best possible quality of life for them both. A palliative care approach requires healthcare professionals to focus on the achievement of quality of life for all patients whose disease is not responsive to curative treatment. This is achieved by providing relief from pain and other distressing symptoms, including psychological, spiritual and social aspects of care, together with the acknowledgement of patient and relative autonomy. Hence, the study also exemplifies contemporary palliative care in action.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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