1/9. Management pitfalls in the use of embolization for the treatment of severe epistaxis.Angiographic embolization for the treatment of severe recurrent epistaxis was added to the traditional treatment options--nasal packing, cauterization, and surgical vessel ligation--in 1974. Since then, clinical experience has shown that this procedure is safe and effective. When epistaxis cannot be controlled with cautery, nasal packing is the most common next step. As such, it is often performed by emergency physicians and other clinicians who are not otolaryngologists. We report two cases in which intranasal neoplasms were obscured as a result of a significant distortion of the normal anatomy. This distortion was secondary to emergency-room treatment of severe epistaxis by repeated nasal packing followed by angiographic embolization. Pre-embolization angiographic studies and subsequent postembolization endoscopic evaluations did not reveal the presence of the occult neoplasms because of the presence of inflammation and edema after treatment. Clinicians should be aware that nasal packing and embolization can obscure the underlying source of epistaxis, and follow-up radiologic studies and endoscopic evaluations are essential to avoid delays in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Sacral hemangioma with sinus tract in an infant.Congenital midline cutaneous lesions should always alert the clinician to the possibility of spinal dysraphism. These lesions can take many different forms. The physician should be cognizant of such lesions in order to avoid potential neurologic complications. We present a patient with a midline sacral hemangioma associated with a congenital enteric sinus cyst, a previously unreported association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations.Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was evaluated and documented. Complete resolution or significant improvement occurred in 80% of all patients treated. Complete resolution occurred in 49% of haemangiomas, 32% of venous malformations, and 80% of cystic hygromas. Significant improvement occurred in 38% of haemangiomas, 52% of venous malformations, 13% of cystic hygromas and 50% of lymphatic malformations. Of the six patients who presented with a painful lesion, four experienced complete resolution and two had significant improvement to treatment. Local complications encountered were superficial ulceration occurring in 2 patients, and cellulitis in 1 of the 95 patients. Systemic complications were flu-like symptoms in three patients and partial, transient hair loss in two patients. None of the patients presented with haematological toxic effects or signs of pulmonary involvement (fibrosis, hypertension). IBI is an effective treatment in haemangiomas and vascular malformation lesions, obviating the need for invasive primary surgery or systemic treatment regimens in 80% of cases, and allowing for limited need of secondary surgical or adjunctive procedures in cases with a moderate result.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Misdiagnosis of fabry disease: importance of biochemical confirmation of clinical or pathological suspicion.Generalized angiokeratoma are associated with three lysosomal storage disorders, one of which is fabry disease (alpha-galactosidase A deficiency). Treatment for fabry disease with supplementation of recombinant enzyme is available in the european union and subsequently physicians' awareness may rise. A patient who was erroneously diagnosed with fabry disease is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Symptomatic expansile vertebral hemangioma causing conus medullaris compression.OBJECTIVE: To present a case of symptomatic, expansile L1 vertebral hemangioma. CLINICAL FEATURES: A 46-year-old man presented with progressive neurologic changes and insidious onset of low back pain. INTERVENTION AND OUTCOME: After a trial of 3 visits of conservative chiropractic care, no improvement was noted. magnetic resonance imaging was obtained, revealing an expansile hemangioma with extra-osseous component compromising the conus medullaris at the level of the L1 lumbar vertebra. Neurosurgical intervention resulted in clinical improvement. CONCLUSION: Primary care physicians treating patients with low back pain should be aware of neurologic red flags requiring prompt attention. magnetic resonance imaging is the imaging modality of choice when evaluating a neurologic abnormality presumably related to a space-occupying lesion. Although a disk herniation is the most common cause of these symptoms, clues in the history and examination must prompt physicians to expand their differential diagnosis to include a variety of other extradural masses.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/9. Multiple cutaneous angiomas and poems syndrome.INTRODUCTION: poems syndrome is characterized by polyneuropathy, organomegaly, endocrinopathy, M-proteins, and skin lesions. CASE: We describe here a case in which the eruption of diffuse cutaneous angiomas in a woman with a history of bone plasmocytoma and progressive polyneuropathy helped physicians to diagnose poems syndrome. DISCUSSION: Other manifestations of poems syndrome in this patient included endocrine dysfunction (hypothyroidism, adrenal insufficiency, and hypogonadism), sclerotic bone lesions of the femoral shaft, ribs, and vertebral body, monoclonal gammopathy, and anasarca. Steroid treatment led to dramatic improvement of polyserositis and a generally good outcome, despite persistence of the cutaneous lesions. This case points out this unusual cutaneous manifestation associated with poems syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. A deep-tissue hemangioma presenting as a rapidly progressive expanding mass and thrombocytopenia in an infant.OBJECTIVE: We present a case of kasabach-merritt syndrome with discussion of hemangiomas of childhood relevant to the emergency physician. DESIGN: This is a case report. SETTING: The case is described in the setting of a tertiary care hospital level I pediatric emergency department. patients: A single case is discussed. INTERVENTIONS: The patient's condition was diagnosed and referred to the appropriate hematology service. methylprednisolone (2 mg/kg/day) therapy was instituted. CONCLUSIONS: Children may present to the emergency department with a mass requiring diagnosis. The emergency physician must efficiently and economically identify the cause and complications from a variety of etiologies. Hemangiomas with complicating thrombocytopenia and microangiopathic hemolysis are rare and must be correctly identified. The emergency physician should occasionally review such unusual diagnoses to maintain their differential diagnosis skills.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
8/9. Increased risk of symptomatic hemangiomas of the airway in association with cutaneous hemangiomas in a "beard" distribution.We evaluated the frequency of an association of cutaneous cervicofacial hemangiomas in a "beard" distribution (including the preauricular areas, chin, anterior neck, and lower lip) with symptomatic hemangiomas of the upper airway or subglottic areas. Of 529 patients seen, 187 were pediatric patients with hemangiomas of the head and neck. Sixteen of the 187 patients (8.5%) had cutaneous lesions with a beard distribution, with a score of 4 or greater. Ten of these 16 (63%) patients had some degree of symptomatic airway involvement, and four of the 10 (40%) required tracheotomy. The presence of cutaneous hemangiomas in a beard distribution should alert the evaluating physician to the potential association of upper airway or subglottic involvement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Erotomania associated with temporal lobe abnormalities following radiotherapy.OBJECTIVE: The aetiology of primary erotomania is usually discussed in terms of psychological disturbance in the patient. A case associated with demonstrable left temporal lobe abnormalities is described. CLINICAL PICTURE: An elderly female patient presented with the delusion of being loved by a physician who had treated her previously. She had received radiotherapy to her left periorbital area in childhood. Structural and functional neuroimaging revealed medial temporal lobe damage. TREATMENT AND OUTCOME: She was treated with haloperidol with moderate improvement in her distress. CONCLUSIONS: This case illustrates the contribution of both cerebral injury and psychosocial factors in the eventual development of this unusual psychiatric syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |