1/14. cauda equina syndrome in patients undergoing manipulation of the lumbar spine.cauda equina syndrome has been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1989 revealed ten reported cases of cauda equina syndrome in patients undergoing manipulation without anesthesia. This article presents three new cases where a temporal association was found between the onset of cauda equina symptoms and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. In each of these cases both the chiropractic practitioner and the emergency room physician failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patients went untreated for several days. This may have led to residual symptomatology. It is concluded that patients who present with bowel or bladder disturbances, leg weakness, or rectal and genital sensory changes after manipulation, be recognized as experiencing a cauda equina syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. Complications associated with intermittent pneumatic compression.The intermittent pneumatic compression device (IPCD) is prophylaxis for prevention of deep-venous thrombosis (DVT). This pneumatic leg sleeve has been used extensively in high-risk surgical patients, without complication. We describe two cases, one with peroneal neuropathy and the other with compartment syndrome, associated with IPCD use during surgery. Case 1 involves a patient with pancreatic cancer and weight loss who developed bilateral peroneal nerve palsies during surgery. Case 2 involves a patient with bladder cancer who developed lower leg compartment syndrome during prolonged surgery in the lithotomy position. These cases are unusual for several reasons. First, patients wearing IPCDs during surgery are at increased risk of neurovascular compression. Second, significant weight loss may predispose the peroneal nerve to injury from intermittent compression garments. Third, patients undergoing surgery in the lithotomy position are at risk of compartment syndrome. Therefore, physicians may wish to use another method of DVT prophylaxis in surgical patients with cancer or significant weight loss, or those who are undergoing procedures in the lithotomy position.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Repetitive strain injuries. How to deal with 'the epidemic of the 1990s'.Occupational trends, especially the mushrooming of computer use in the united states, have brought with them a virtual epidemic of repetitive strain injury of the upper limb. What can you as a primary care physician do to stem the tide? In this article, the authors fill you in on treatment of the most common injuries as well as remark on the ramifications for business and industry.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases.Steroid injection can provide symptomatic relief in patients with carpal tunnel syndrome (CTS). Its role should be limited to a diagnostic aid in cases in which symptoms are atypical, a temporizing agent in patients with severe symptoms either who are awaiting surgery or in whom spontaneous remission might be expected, and as a definitive treatment in patients who do not desire surgery. Injection should be performed using proper technique by physicians skilled in carpal tunnel surgery. A soluble preparation of dexamethasone is recommended. Immediate paresthesia in the median nerve distribution or exacerbation of symptoms beyond 48 hours following injection is suspect for inadvertent nerve injury; therefore, early surgical decompression is indicated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Piriformis syndrome.The author presents a case of a female runner with left buttock pain aggravated by exercise. She underwent extensive testing by other physicians and received cortisone injections on two occasions. The patient was referred to the podiatry department because of continued discomfort and the inability to run. Examination revealed pain on hip flexion and abduction against resistance. Because of the possibility of piriformis syndrome, she started stretching exercises, reduced her activity, and the pain disappeared. The diagnosis of piriformis syndrome was confirmed by a general surgeon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Vascular decompression of the cochlear nerve in tinnitus sufferers.An estimated 40 million Americans suffer from tinnitus, and approximately 20% of these sufferers feel that the quality of their life is significantly impaired by this symptom. Despite thorough evaluation, the underlying etiology in the majority of these patients remains obscure or conjectural. Most of these patients will, however, benefit from consultation and avoidance of caffeine, nicotine, and salt, while others require biofeedback, amplification, masking, and even psychotherapy. On rare occasions, physicians are presented with a patient complaining of unilateral tinnitus of undetermined etiology who, in spite of a thorough evaluation and all conventional therapies, continues to be severely handicapped by that symptom. Early findings suggest that these patients may be suffering from vascular loop compression of the cochlear division of the eighth cranial nerve. When patients are carefully selected, retrosigmoid decompression of that vascular loop has provided gratifying relief.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Orbital emphysema: a potentially blinding complication following orbital fractures.A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Bilateral femoral neuropathy after microsurgical reversal of tubal sterilization: case report and analysis of contributing factors.A case of bilateral femoral neuropathy after microsurgical tuboplasty for reversal of sterilization is reported. Although the prognosis is favourable and full recovery is usually observed, the disabling effect of the neuropathy may last for several months. This report is an attempt to alert fertility surgeons to the possible occurrence of such a complication disturbing to both patient and physician, by analysing the mechanisms of injury and possible ways of its prevention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Computed tomographic scanning and the lumbar spine. Part II: Clinical considerations.With the advent of computed tomography of the lumbar spine, the theories of a small number of pioneering physicians regarding the pathologic sequela of degenerative disc disease and the entities of central and lateral spinal stenosis have been translated into objective determinations which can now be observed by all. CT scanning has provided clinicians with a better appreciation of the diagnostic limitations of myelography and of the pathologic sequela of hemilaminectomy, dorsal-lateral fusion, and discectomy itself. Since the identification by CT scanning of the loss of disc volume, leading to lateral nerve entrapment and nerve compression resulting from fusion overgrowth, it has become clear that our present modes of therapy require comprehensive reevaluation. Because of the findings of CT scanning, dorsal-lateral fusion now appears to have a much reduced role in the treatment of degenerative disc disease and spinal stenosis. In an era in which unnecessary surgery is a matter of concern, CT scanning is an important means of ensuring that surgery will be undertaken only after thorough pathologic conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Fatiguing weakness: an initial symptom in cervical compressive radiculopathy.exercise-induced weakness (fatiguing) is described in three patients with cervical compressive radiculopathy. In all three cases, the patients had symptoms only while at work, and in two cases, symptoms occurred in life-threatening situations. All patients had seen several physicians with a functional diagnosis being considered in all cases because of symptoms only at work and the absence of objective findings during examination. Precise history and examination techniques led to the correct diagnosis and treatment after appropriate investigation. The fatiguing weakness in our cases is thought to be a manifestation of early or mild neurologic involvement unmasked by exercise, rather than a manifestation of compression or ischemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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