1/12. osteophyte-induced dysphagia: report of three cases.Dysphagia is a common complaint of patients seen by physicians. osteophyte compression due to diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease and cervical spondylosis has been identified as a cause of dysphagia. We report three elderly male cases of whom two had dysphagia due to DISH and one had dysphagia due to osteophyte compression associated with severe cervical spondylosis. Clinical and radiographical findings including barium oesophagogram and computed tomography are presented. endoscopy should be carefully performed to rule out additional pathology in such patients. Medical treatment preferably with liquid forms of NSAIDs and diet may cause satisfactory improvement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Inferior vena cava thrombosis: an unusual complication of a large simple non-parasitic liver cyst requiring an integrated approach.Most of the simple hepatic cysts are asymptomatic and have a benign course. However, some exceptional life-threatening complications may occur. We herein report the successful management of a case who suffered from a cystic compression of the inferior vena cava complicated by thrombosis of the inferior vena cava itself. To our knowledge this is the first report of such a complication and diagnostic and therapeutic aspects are discussed. This case is paradigmatic of the possible complexity of the diagnosis and treatment of cystic lesions of the liver and should induce physicians to consider a therapeutic approach if a clear tendency to enlarge can be recognized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. A case of benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma.We report a patient with benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma. A 66-year-old woman consulted a local physician because of general fatigue. blood biochemical tests showed increased levels of biliary tract enzymes. Abdominal ultrasonography (US) revealed tapering and blockage of the midportion of the bile duct and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) demonstrated obstruction of the midportion of the bile duct. Later, because a marked increase in biliary tract enzymes and jaundice appeared, percutaneous transhepatic biliary drainage (PTBD) was performed. Post-PTBD cytological examination of bile was negative for cancer. A third biopsy showed slight hyperplasia with no malignant findings. Recholangiography, performed through PTBD, suggested gradual improvement of bile duct stricture, but could not completely exclude the possibility of malignancy; thus, resection of the bile duct including the stricture site was performed, and the resected specimen was submitted for intraoperative frozen section examination. Histopathological diagnosis did not reveal malignant findings. After cholecystectomy and bile duct resection, hepaticojejunostomy (Roux-en-Y) was performed. Because only erosion and desquamation of the mucosal epithelium and mild submucosal inflammatory cell infiltration and fibrosis were observed, chronic cholangitis was diagnosed histopathologically. Surgical resection of the bile duct should be considered for potentially malignant stricture of the bile duct.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Pentaethylene-terephthalate (PET) bottles: a new device for autoerotic strangulation of the penis causing serious injury.Strangulation of the penis by application of constricting devices may present a challenge for the treating physician. Depending on the type of constricting material, special equipment is essential for successful removal of the foreign bodies. We report a new form of constricting device, the neck of a coca cola bottle made of Pentaethylene-terephthalate (PET). Particular difficulties were encountered upon removal. Technical details of this case are described. Prior literature on the treatment of penile strangulation is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Toe-tourniquet syndrome: a diagnostic dilemma!Strangulation of digits, the 'toe-tourniquet' syndrome needs prompt intervention as failure to recognise the condition can lead to ischaemia and loss of the appendage. It is a common condition though relatively under reported. Those who deal with children more frequently are aware of the condition but this is not the case for all medical practitioners and hence the diagnostic dilemma for accidental injury or child abuse arises.We report this case to increase physician awareness of the syndrome, to highlight the importance of early release of the tourniquet and to avoid misinterpretation of the condition as child abuse.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Postviral bronchial hyperreactivity syndrome: recognizing asthma's great mimic.Although there are no prospective studies regarding the frequency of postviral bronchial hyperreactivity syndrome, it is a common complication of upper and lower respiratory tract viral infections. The respiratory symptoms closely resemble those of asthma, but they are present for only 3 weeks to 3 months following the acute infection phase. Defining the mechanisms of this syndrome may provide insight into the pathogenesis of asthma. Postviral bronchial hyperreactivity syndrome is frequently misdiagnosed and inappropriately managed because many physicians are unfamiliar with this illness. Because of its characteristic history, diagnosis is straightforward when the physician knows what to look for, and response to therapy is excellent. This report presents a case history followed by a review of the proposed mechanisms of bronchial hyperreactivity following viral respiratory infections. The clinical features and criteria for diagnosing postviral bronchial hyperreactivity syndrome are also discussed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/12. hair-thread tourniquet syndrome .We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Penile tourniquet syndrome caused by hair.We have described two circumcised children who developed a urethral fistula caused by long hairs constricting and ulcerating the penis. These cases are presented to remind physicians to examine the infant's penis when he presents with a swollen glans, abnormal urinary stream, and a parent with long hair.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. fecal impaction as a cause of acute lower limb ischemia.Acute lower extremity ischemia secondary to fecal impaction has not been previously reported. Herein, we report the case of an elderly man who was referred to our medical center with an acutely ischemic right lower extremity and a possible abdominal aortic aneurysm. The suspicious abdominal mass noted by his local physician was found to be a large fecal impaction of the rectosigmoid which, by direct pressure, was compressing and occluding the right common iliac artery. After disimpaction, there was complete resolution of the vascular symptoms and signs in the right lower extremity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. An unusual variant of popliteal artery entrapment.A 43-year-old woman presented with incapacitating exertional pain in the right foot, ankle, and lower calf of 1 years' duration following a minor ankle sprain. Evaluation by several physicians had been inconclusive. physical examination identified normal pedal pulses at rest but obliteration of pulses with active plantar flexion. Segmental pressures were normal at rest and duplex scanning showed occlusion of the popliteal artery with active plantar flexion. The findings were confirmed by arteriography despite a normal course of the popliteal artery. magnetic resonance imaging (MRI) showed no muscular abnormality. At exploration entrapment was noted to be the result of compression by branches of the sural nerve and vein as they coursed medially inserting into the medial head of the gastrocnemius muscle. Division of the neurovascular bundle resulted in complete resolution of symptoms and arterial compression on duplex examination postoperatively. This case was unusual because of the patient's age, sex, and the pathologic findings that had not been previously reported. In this case MRI was not useful in demonstrating a muscular or neurovascular bundle abnormality, supporting the use of duplex scanning as the noninvasive diagnostic modality of choice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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