1/8. Prenatal sonographic diagnosis of dilated cavum vergae.Several cases of enlarged cavum vergae have been reported, but prenatal diagnosis of this condition is very rare. We report 3 cases of dilated cavum vergae diagnosed prenatally using sonography. In 1 of the 3 fetuses, ventriculomegaly and lumbar meningomyelocele were additional sonographic findings. In 1 of the 3 infants, a stereotactic cyst-peritoneal shunt was placed at 6 months of age to relieve intracranial hypertension due to progressive enlargement of the cavum vergae. The infant who had a meningomyelocele required surgical repair of this defect shortly after birth; in the third infant, the dilated cavum vergae remained asymptomatic, and no surgery was necessary. When interhemispheric cystic lesions are identified prenatally, physicians must distinguish them from pathologic cysts and determine whether associated malformations are present. Sonography is useful for both the differential diagnosis and identification of associated anomalies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Early detection of cardiac disease masquerading as acute bronchospasm: The role of bedside limited echocardiography by the emergency physician.We report two cases in which the patients experienced dyspnea, cough, and acute bronchospasm. Pulmonary pathology was initially suspected. Failure to respond to an initial trial of inhaled bronchodilator prompted the use of bedside limited echocardiography by the emergency physician. The potential role of limited echocardiography by the emergency physician as a triage tool in facilitating early diagnosis and emergent therapy, reducing time to final discharge, and enhancing interaction between the pediatric emergency physician and cardiology consultants is highlighted.- - - - - - - - - - ranking = 7keywords = physician (Clic here for more details about this article) |
3/8. Massive gastric distention in the intubated patient. A marker for a defective airway.Tracheal intubation is a commonly performed procedure generally associated with a low complication rate. A clinical sign that could lead to early detection of complications could improve management of mechanically ventilated patients. We present two instances of potentially lethal complications that were heralded by the presence of massive gastric distention. This finding should alert physicians that an abnormal communication may exist between the endotracheal tube and the gastrointestinal tract.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Acute gastric necrosis in anorexia nervosa and bulimia. Two case reports.In recent years we have treated two patients with gastric infarction as a complication of anorexia nervosa and bulimia. We found only three other cases reported in the literature. Surgical intervention was delayed in all five patients either because the diagnosis was missed by the physician or because the patient failed to seek medical attention. physicians should be alerted to the possibility of acute gastric dilatation if a young woman, who may be undernourished and anorexic, complains of abdominal pain after ingestion of a large meal. Often this condition can be treated conservatively before irreversible damage to the gastric wall has taken place. If the gastric dilatation progresses, the stomach loses its contractility, resulting in venous occlusion, infarction, and gastric perforation. An extensive operation is required, and the patient undergoes an often complicated and prolonged hospital course.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Aortic dilation, dissection, and rupture in patients with turner syndrome.We report two patients with turner syndrome who had aortic dissection and rupture, one with prior repair of coarctation. We also note the high incidence (8.8%) of unrecognized aortic root dilation in a group of 57 patients with turner syndrome whom we prospectively evaluated by echocardiography. Our analysis and review of previously reported cases suggests that multiple risk factors may exist for aortic dissection, including coarctation, bicuspid aortic valve, and systemic hypertension, but that these need not be present. Aortic root dilation may be an additional finding that suggests the patient with turner syndrome is also at risk. When it is present, magnetic resonance imaging visualizes the entire aorta and allows quantification of the site and degree of dilation. In patients with dissection, the aorta often exhibits pathologic evidence of cystic medial necrosis similar to the finding in patients with marfan syndrome. Therapeutic methods to decrease risk, such as those directed toward prevention of bacterial endocarditis, blood pressure control, and perhaps prophylactic beta blockade or surgical reconstruction, may need to be considered. patients with turner syndrome, their families, and the physicians who care for them should be aware of the significance of unexplained chest pain, dyspnea, or hypotension as potential manifestations of aortic dissection or rupture.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. ileus of the colon with cecal dilatation and perforation.Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. The dilated common duct sign. A potential indicator of a sphincter of oddi dyskinesia.The cholescintigraphic findings of a sphincter of oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the sphincter of oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. We postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the sphincter of oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Reversible cystic dilatation of distal airways due to foreign body.We describe a child with foreign body aspiration whose chest radiograph showed an unusual appearance of multiple round lucencies simulating bronchiectasis. This appearance is contrary to the usual appearance of emphysema due to the check-valve type of obstruction. This report is particularly useful for pediatricians and family physicians, who should be aware of the variable appearances of foreign body aspiration. Our case emphasizes the necessity of early bronchoscopy in pediatric patients with unresolving pneumonia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |