1/8. Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): a case study.We report on a patient who had taken the centrally acting analgesic tramadol for over 1 year. The compound had proven to be sufficient to treat her painful episodes related to fibromyalgia. Due to lack of supply while being on a trip, intake of the drug was stopped abruptly, resulting in the development of classical abstinence-like symptoms within 1 week. Abstinence-like symptoms consisted of restlessness and insomnia for which the benzodiazepine lorazepam was given. Diarrhoea and abdominal cramps were treated with the peripherally active opioid loperamide, while bouts of cephalgia were treated with sumatriptan. Diffuse musculoskeletal-related pain and restless leg syndrome (RLS) were treated with dextromethorphan. All these different medications proved to be efficacious as they resulted in the cessation of symptoms. Within 1 week symptoms ceased and the patient regained her normal activities without any sequelae. Although tramadol is considered a non-habit- and non-dependence-forming analgesic, abstinence symptoms are likely to develop following abrupt cessation of intake, especially when the compound had been taken over 1 year. Therefore patients should be advised of such an effect whenever they decide to stop intake or their physician is planning to switch to another medication. To avoid abstinence-like symptoms doses should be slowly tapered down.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. An unusual cause of recurrent biliary colics.Hepato-biliary ascariasis is a rare condition in non-endemic areas; however, it should always be taken into account in patients with recurrent biliary colics and/or cholangitis, since these are among the most frequent modes of clinical presentation. We report a case of a young woman suffering from recurrent biliary colics in whom a diagnosis of biliary ascariasis was made. Endoscopic retrograde cholangiopancreatography with sphincterotomy and endoscopic extraction of the worm, using a Dormia basket, proved to be a safe and effective procedure for removing the living ascaris from the biliary tree and relieving symptoms. In the era of worldwide travels, physicians in Western countries should be more aware of this infection especially in patients with biliary symptoms who have travelled to endemic areas or immigrant from endemic countries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Salicylate toxicity associated with administration of Percy medicine in an infant.Percy medicine is a nonprescription gastrointestinal suspension containing bismuth subsalicylate as the active ingredient (1050 mg/10-ml dose). A 3-month-old infant with colic developed salicylate toxicity requiring hospitalization in the pediatric intensive care unit (PICU) as a result of continued administration of this medicine. bismuth subsalicylate has an aspirin equivalency conversion factor of 0.479 (approximately half the strength of aspirin). For 3.5 weeks the infant's parents administered the medicine, which provided the equivalent of aspirin 57-84 mg/kg/day with no reported problems. However, on the day of admission the baby presented with central nervous system depression and respiratory distress. Assessment at a local emergency facility revealed metabolic acidosis; his serum salicylate concentration was 747 mg/L. After acute management, the patient was transferred to our hospital, where he was treated with whole bowel irrigation and alkalinization therapy. Subsequently, the baby required 4 days of management in the PICU and 2 additional days of observation in a general nursing unit before he was discharged home without incident. The parents had chosen Percy medicine based on the picture of a baby on the front of the package and because of its placement on the shelf next to a drug their family physician had recommended previously. Salicylate-containing products are not routinely recommended for children aged 1 year or younger. The general public may assume that over-the-counter products are safe because they do not require a prescription. health care professionals must be responsible for educating the public regarding risks associated with over-the-counter products and the need to read and follow label directions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. When renal colic is really malingering.renal colic malingerers feign symptoms of pain and hematuria, usually to obtain parenteral narcotics. These patients must be identified early to minimize waste of time and supplies by emergency department staff. However, they often use clever ploys to avoid undergoing diagnostic procedures that would unmask them and cut off their drug supply. These malingerers must be differentiated from patients with somatization disorders and those with hard-to-diagnose renal disease, which further complicates their detection. Fortunately, the informed physician can usually suspect the truth early and take steps to reach the proper "diagnosis."- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. hypnosis in the treatment of acute pain in the emergency department setting.Emergency ward physicians are presented daily with patients in pain. Provisions of safe, quick pain control remains one of their major duties. hypnosis can be used as an effective adjunct or substitute for analgesic medications when these drugs prove to be ineffective or contraindicated. Four such illustrative cases of attempted pain control are presented. The psychological foundations of pain and its assessment are discussed. The emergency ward physician can obtain facility in hypnotic techniques with only modest training. hypnosis may then become a valuable tool in helping him provide safe and effective pain management.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/8. Understanding the management of the child with pain.Pain experienced by the child or perceived by the child's parents generally results in the child being taken forthwith to the doctor. Often the cause of the pain is obvious, such as an injury or an "acute" abdomen, and resolution may be readily achieved with the aid of medical science, the concern of the doctor, and the dedication of the parents. However, there are situations in which, despite the full resources of the physician and other helping professionals, resolution of the child's pain may not be forthcoming. This can particularly be observed in infants and children who are at risk and may have injuries inflicted by the persons looking after them. Infants and children may experience, or are thought to experience, pain in a recurrent and often troublesome way. Yet physical examination often reveals no abnormalities and further investigation is unhelpful. Resolution of the pain requires an understanding of the meaning of the pain to the child and its significance within the family. The clinical features of this kind of pain are described to highlight those aspects which may be helpful in its resolution.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. exercise-induced diarrhea: when to wonder.exercise-associated lower gastrointestinal symptoms seem to be a fairly common clinical finding occurring in anywhere from 10-50% of runners. However, it is unclear what percentage of those affected may have discrete medical conditions that are exacerbated by strenuous physical exertion. Perhaps, difficult physical training sessions function as a "stress test" for the colon. A case report of exercise induced diarrhea is presented with a discussion of the current medical literature and proposed management for the primary care sports physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Anticholinergic poisoning in colicky infants treated with hyoscyamine sulfate.hyoscyamine, one of the principal alkaloid components of belladonna, is a potent anticholinergic agent. Because of its anticholinergic properties, hyoscyamine sulfate drops are often prescribed for the treatment of colic in infants. Anticholinergic poisoning in infants is rare. However, five cases are reported of infants with anticholinergic toxicity following the administration of hyoscyamine drops for the treatment of colic. Common presenting symptoms included irritability, tachycardia, and erythematous flushed skin. These cases emphasize the need for a heightened awareness by emergency physicians and pediatricians of possible anticholinergic toxicity caused by the use of hyoscyamine for infant colic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |