1/12. multiple sclerosis.multiple sclerosis (MS) is the most common disabling neurologic disease of young people affecting between 350 and 450,000 individuals in the united states. Substantial advances have been made in the diagnostic assessment and treatment interventions over the last 10 years such that we are now able effectively to treat both the disease process and the associated symptomatic complaints associated with MS. Most patients consult with their primary care physician at the time when the first clinical manifestations of MS emerge. These physicians play a central role in the early identification and treatment of patients with MS. This article emphasizes the expanding diagnostic and therapeutic capabilities evolving for the MS patient and the crucial role played by primary care physicians in collaboration with neurologists in the coordination of the initial diagnostic and treatment plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Phantom breast pain as a source of functional loss.Although physicians are aware of phantom limb pain, which can occur in up to 85% of patients who undergo amputation, and its potential effect on functional status, the presence of phantom pain after amputation of other body parts such as the breast and its effect on function may be less appreciated. We report the case of a 63-yr-old woman with multiple sclerosis who underwent a modified radical mastectomy for left intraductal breast carcinoma. After her mastectomy, she required a brief course of inpatient rehabilitation and was discharged from rehabilitation independent, with feeding, dressing, hygiene, and transfers. Two months after her mastectomy, she had difficulty with these tasks because of phantom breast pain. Accurate diagnosis of her pain and successful treatment resulted in a return to premorbid functional status.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/12. MS Management in Complex Cases: report from the MS Forum satellite symposium at the 20th ECTRIMS Congress, 6 October 2004, Vienna, austria.The disease course of MS is varied and unpredictable. patients, therefore, need 'expert' advice, which puts a great burden on the physician, especially when results from large-scale studies are unavailable. Educational forums, such as MS Forum symposia, are ideal opportunities to discuss diagnosing, treating and managing complex MS.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/12. nephrotic syndrome associated with interferon-beta-1b therapy for multiple sclerosis.A 43-year-old woman with multiple sclerosis (MS) had nephrotic syndrome 21 months after starting treatment with interferon (IFN)-beta-1b (subcutaneous administration). She had taken no drug except for the IFN-beta-1b. Because nephrotic syndrome may be induced by IFN therapy, the IFN was stopped. Percutaneous renal biopsy revealed that she had minimal change nephrotic syndrome. As nephrotic-range proteinuria, hypoalbuminemia, and general edema were worsening even 2 weeks after cessation of the drug, oral corticosteroid therapy (prednisolone 40 mg/day) was started. The nephrotic syndrome was treated successfully with prednisolone. The dosage of prednisolone was tapered, without a relapse, and then the corticosteroid therapy was stopped. IFN-beta-1b therapy was then resumed, and the patient is in remission for both nephrotic syndrome and MS. Though proteinuria and nephrotic syndrome is a rare adverse effect of IFN-beta-1b therapy, physicians treating MS patients with this agent should pay careful attention to new clinical symptoms and laboratory findings.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/12. Special considerations in the management of a patient with multiple sclerosis and a burn injury.The purposes of this report were to describe a successful treatment of a burn injury in a patient with multiple sclerosis as well as to outline specific aspects of therapy that contributed to minimizing the risk of complications in this challenging patient. multiple sclerosis is the leading cause of neurologic morbidity and death among young adults. It is an inflammatory disease of the central nervous system that involves the autonomic and somatic components and is characterized by a primary destruction of myelin. The demyelinated nerves exhibit an increased temperature sensitivity that accounts for the adverse effects of elevated core temperature on the neurologic signs and symptoms of this disease. Because burn injury, infection, and vigorous exercise elicit an elevation of core temperature with an accompanying deterioration in neurologic function, lowering the elevated core body temperature is mandatory. The dysautonomias of multiple sclerosis may be as devastating as their somatic counterparts and may have life-threatening implications. In recent years, advances in our understanding of the pathophysiology of central nervous system dysfunction have enabled physicians to improve dramatically the management of symptoms in multiple sclerosis without significantly altering the progressive long-term course of the disease.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/12. A nurse-managed multiple sclerosis clinic: improved quality of life for persons with MS.multiple sclerosis (MS) is a complex disease, the symptoms of which may wax and wane on a daily basis. Conventional treatment for MS patients may involve numerous trips to a variety of clinics, physicians, and rehabilitation settings. This article describes a nurse-managed MS clinic which employs an interdisciplinary and holistic approach to treatment of MS patients with the goal of improving their quality of life and coordinating their health care. In this article, the services of the clinic are described, emphasizing the roles of the nurse practitioner (clinic manager), rehabilitation nurse specialist, and nursing director of the hospital-based home care program. A case study example of the interdisciplinary nature of this clinic's program with one MS patient is included.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/12. multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis. This is the second reported case of coincident multiple sclerosis, myasthenia gravis, and thyroid-related disease complex.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/12. The concurrence of multiple sclerosis and amyotrophic lateral sclerosis.We report the clinical and pathological findings of the unusual combination of two idiopathic central nervous system diseases, multiple sclerosis and amyotrophic lateral sclerosis in a 56 year old physician with a twenty-seven year history of a disease initially characterized by relapses and remissions, followed by an eight year quiescent period. During the last year of life there was rapid deterioration with development of generalized weakness, atrophy, weight loss and fasciculations of body and tongue, and associated difficulty with swallowing and sudden respiratory failure. The autopsy confirmed characteristic "burned out" plaques of multiple sclerosis and anterior horn cell and axonal degeneration of amyotrophic lateral sclerosis.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/12. multiple sclerosis and hysteria. Lessons learned from their association.Four patients with organic neurological disease (multiple sclerosis) had additional major hysterical disability. patients with unequivocal organic disease often have coexistent psychological disturbances. The preexisting personality, nature of the organic disease and its disability, and the psychosocial setting interact and create an illness whose components are difficult to separate. In some patients there are definite secondary gains from an illness. The combination of hysteria and multiple sclerosis serves as a model for the coexistence of organic and psychological disorders; it serves as an example of the general questions of how the sick deal with their infirmities and how the physician comprehensively deals with illness.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/12. Dietary vitamin B12 deficiency in a patient with multiple sclerosis.The authors present a case of dietary vitamin B12 deficiency in a patient with multiple sclerosis. A simple schemata for evaluating patients for vitamin B12 deficiency is included as a clinical aid for physicians.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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