1/13. 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 = 1keywords = physician (Clic here for more details about this article) |
2/13. The pulmonary physician in critical care * illustrative case 4: neuromusculoskeletal disorders.The case history is presented of a patient admitted to the ICU with ventilatory insufficiency following thoracotomy for thymic resection. The role of non-invasive ventilation for weaning in patients following phrenic nerve injury is discussed.- - - - - - - - - - ranking = 0.57142857142857keywords = physician (Clic here for more details about this article) |
3/13. Complete digeorge syndrome: development of rash, lymphadenopathy, and oligoclonal T cells in 5 cases.BACKGROUND: Five patients with digeorge syndrome presented with infections, skin rashes, and lymphadenopathy after the newborn period. T-cell counts and function varied greatly in each patient. Initial laboratory testing did not suggest athymia in these patients. OBJECTIVE: The purpose of this study was to determine whether the patients had significant immunodeficiency. methods: research testing of peripheral blood included immunoscope evaluation of T-cell receptor beta variable gene segment repertoire diversity, quantification of T-cell receptor rearrangement excision circles, and detection of naive T cells (expressing CD45RA and CD62L). RESULTS: The patients were classified as having digeorge syndrome on the basis of syndromic associations and heart, parathyroid, and immune abnormalities. Immunoscope evaluation revealed that the T-cell repertoires were strikingly oligoclonal in all patients. There were few recent thymic emigrants, as indicated by the very low numbers of naive T cells (<50/mm(3)) and the absence of T-cell receptor rearrangement excision circles. These studies showed that all 5 patients were athymic. Two patients died, one from infection. No thymus was found during the complete autopsy performed on one patient. CONCLUSION: patients with digeorge syndrome, skin rash, and lymphadenopathy should undergo analysis of naive T-cell numbers and of T-cell receptor beta variability segment repertoire to determine whether they are athymic, even if they have T cells with mitogen responsiveness. It is important for physicians to realize that patients with complete digeorge syndrome remain profoundly immunodeficient after development of these atypical features (rash, lymphadenopathy, and oligoclonal T cells). Prompt diagnosis is necessary for appropriate management.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
4/13. Atypical mycobacterial cervicofacial lymphadenitis in children: a disease as old as mankind, yet a persistent challenge.The diagnosis of atypical cervicofacial lymphadenitis is often not readily clinically apparent. parents may bring a child to the physician's attention long before the development of the classic findings. When assessing the child with acute-onset cervicofacial lymphadenitis, there are 2 imperative clinical determinations: Is the lymphadenitis of viral, bacterial, or mycobacterial etiology? If of mycobacterial etiology, is it an atypical or tuberculous mycobacterial process? The goal in management is to avoid misdiagnosis and lengthy duration of symptoms before appropriate therapy is instituted. This paper includes a case study-based review of the evaluation, diagnosis, and management of cervicofacial lymphadenitis in children due to atypical mycobacterial organisms.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
5/13. Aneurysms of the coronary arteries in infants and children. A review, and report of six cases.In recent years large numbers of the so-called "mucocutaneous lymph node syndrome" or "Kawasaki's disease" have been described by Japanese workers, but instances of this disorder are only now being reported as isolated cases by European or North American physicians. The disease has, therefore, been considered to be a new entity. One of its most striking features is the development of aneurysms of the coronary arteries in infants or children, which may lead to sudden death. Aneurysms of the coronary arteries in childhood are rare, and hence it was considered relevant to report six such cases, and to examine their possible relationship to Kawasaki's disease. The pathological changes underlying the latter disorder are not well known; they are considered to be indistinguishable from infantile polyarteritis nodosa. A diagnosis of polyarteritis nodosa was also thought to be most likely to apply in the cases presented here, particularly in view of the frequency with which aneurysms of the coronary arteries have been found in this disorder. In the absence of valid pathological distinctions between Kawasaki's disease and infantile polyarteritis nodosa, the question arises whether these entities are, in fact, different, and whether Kawasaki's disease is the new entity it is assumed to be.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
6/13. congenital abnormalities of the lymphatic system: a new clinical classification.The numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician's understanding of the condition. The clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment. Future research should concentrate on the specific causes and the treatment of these congenital abnormalities.- - - - - - - - - - ranking = 0.28571428571429keywords = physician (Clic here for more details about this article) |
7/13. Eosinophilic granulomatous lymphadenopathy: association with hyper-IgE and eosinophilia.Cervical lymph node enlargement is probably the most frequently detected childhood lymphadenopathy. We report 2 cases of cervical lymphadenopathy in children associated with hyper-IgE and eosinophilia, displaying the features of necrotizing eosinophilic granulomatosis. Immunohistochemical analysis and a serological work-up failed to elucidate the underlying etiology. We would like to call the attention of physicians and pathologists to this unusual clinical picture, different from the fatal form of necrotizing eosinophilic granulomatosis, and we suggest a role for the eosinophils in the pathologic appearance of the lymph nodes.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
8/13. Lympho-glandular toxoplasmosis. A diagnosis often missed.Lymphoglandular toxoplasmosis has a reputation for mimicking several other diseases, especially infectious mononucleosis. Thus, the correct diagnosis often is not discovered until common conditions have been ruled out and the patient has been subjected to excisional lymph node biopsy. The physician who considers toxoplasmosis early and orders appropriate serologic tests can spare the patient unnecessary surgery.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
9/13. thorium dioxide: still around.patients who have received thorium dioxide (Thorotrast) are at risk for hepatic and other malignancies. Because of the need to identify and carefully follow up these patients, we have presented three cases with the characteristic radiologic findings on plain films so that physicians unfamiliar with this appearance will now be aware of it.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
10/13. Metastatic renal cell carcinoma simulating sarcoidosis. Analysis of 12 patients with bilateral hilar lymphadenopathy.Case summaries of four patients with bilateral hilar lymphadenopathy (BHL) caused by metastatic renal cell carcinoma are presented, and these and eight similar cases from the literature are analyzed. In nine patients, sarcoidosis was the provisional clinical diagnosis, but four of these patients had a past history of renal cell carcinoma. In the remaining five patients, a distinction from sarcoidosis could not be made by history, physical examination, and chest roentgenogram. This underscores the need for tissue confirmation in the diagnosis of sarcoidosis and alerts the physician to consider metastatic renal cell carcinoma in the differential diagnosis of BHL.- - - - - - - - - - ranking = 0.14285714285714keywords = physician (Clic here for more details about this article) |
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