1/6. lead poisoning caused by Indian ethnic remedies in italy.BACKGROUND: Complementary or alternative medicine has become widespread in Western Countries and since the remedies are "natural" they are believed to be free of toxic effects and health risks. Ethnic remedies may contain lead, other metals and toxic substances. OBJECTIVES: To show how lead poisoning as a result of using ethnic remedies may be severe enough to cause serious damage to health, and to increase awareness among family doctors and occupational physicians of the risks associated with ethnic remedies. methods AND RESULTS: Description of ethnic remedy-related lead poisoning in 2 native Italian adults, with clinical, laboratory and toxicological data. CONCLUSIONS: When metal poisoning is diagnosed, ethnic remedies should be included among the putative sources so as to avoid erroneous attribution to workplace exposure and application of unneeded preventive measures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. megacolon: constipation or volvulus?Pediatric abdominal complaints are common presentations in emergency departments, and emergency physicians are challenged every day with a vast array of gastrointestinal disorders. Differentiating the child with a benign abdominal process from the child with a more serious condition can be difficult. We report a case of massive dilatation of the colon due to fecal impaction. Means for distinguishing constipation from alternative diagnoses are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Hirschsprung's disease in adolescents. Misadventures in diagnosis and management.Three male adolescents, ages 13, 15, and 17 years, presented with complications of their Hirschsprung's disease, including acute enterocolitis with sepsis, chronic enterocolitis with anemia and leukocytosis, and severe fecal impaction. All had experienced delay in diagnosis resulting from either physician error in diagnosis or physician misinformation concerning the surgical treatment of the disease. These three patients illustrate some of the pitfalls in the diagnosis and surgical management of patients with Hirschsprung's disease. Misinformation concerning the surgical correction of this disease still exists, and these patients emphasize the necessity of continued, updated information in the diagnosis, management, and outcome of patients with Hirschsprung's disease.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/6. Shunt dysfunction and constipation: could there be a link?A ventriculoperitoneal (VP) shunt is the treatment of choice for hydrocephalus, functioning by means of a pressure differential between the ventricular system and peritoneal cavity. constipation is frequently a concomitant problem in children with VP shunts. A case study is reported in which signs and symptoms of shunt dysfunction appear to have developed as a result of constipation. nurses and physicians must address the need for preventing constipation much more aggressively in the population requiring shunts.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Acute urinary retention in children.Acute urinary retention (AUR) is an uncommon diagnosis in childhood, associated with a variety of causes. The emergency physician is often the first to be called upon to evaluate and treat these children. To assist in making the diagnosis, we present our five-year experience with AUR presenting to the pediatric urology service, often through the pediatric emergency department. We present and discuss examples of not only the common reasons for AUR but also uncommon diagnoses and, in two cases, etiologies for retention we believe have not been previously described in the pediatric literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Lipoid pneumonia: a silent complication of mineral oil aspiration.INTRODUCTION: Chronic constipation is a common symptom in pediatrics, and physicians often use mineral oil to treat chronic constipation in children. mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likelihood of its aspiration and subsequent impaired clearance from the respiratory tract. We report a case of a child with neurodevelopmental delay with chronic constipation and a history of chronic mineral oil ingestion presenting as asymptomatic exogenous lipoid pneumonia (ELP). CASE history: A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiograph obtained during evaluation for thoracic scoliosis. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. He was asymptomatic at presentation and physical examination was unremarkable. The patient was advised to stop administration of the mineral oil and was treated empirically with antibiotics during a 3-month period. At follow-up examination the patient continued to be asymptomatic, with the radiologic persistence of the infiltrate. diagnosis of lipoid pneumonia was made by diagnostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spectrometry. DISCUSSION: The clinical presentation of ELP is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. bronchoscopy with BAL can be successful in establishing the diagnosis of ELP by demonstration of a high lipid-laden macrophage index. Treatment of ELP in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil. CONCLUSION: Lipoid pneumonia as a result of mineral oil aspiration still occurs in the pediatric population. It can mimic other diseases because of its nonspecific clinical presentation and radiographic signs. In patients with swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELP should be considered in the differential diagnoses if mineral oil use has occurred. Our case points to the need for increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |