1/133. Suggestions for improving AIDS treatment in hospitals.On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local hiv clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/133. vulvodynia and vulvar vestibulitis: challenges in diagnosis and management.vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/133. What if your patient prefers an alternative pain control method? Self-hypnosis in the control of pain.Despite the availability of specialized treatments for chronic pain, including biofeedback training, relaxation training, and hypnotic treatment, most physicians rely on the traditional approaches of surgery or pharmacotherapy. The patient in this case study had severe and chronic pain but found little relief from pain medications that also caused side effects. She then took the initiative to learn and practice self-hypnosis with good results. Her physician in the resident's internal medicine clinic supported her endeavor and encouraged her to continue self-hypnosis. This patient's success shows that self-hypnosis can be a safe and beneficial approach to control or diminish the pain from chronic pain syndrome and can become a useful part of a physician's therapeutic armamentarium.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/133. Extremity pain in a child: a case report of leukemia.Early clinical diagnosis of leukemia in a child is difficult. leukemia must be considered in the differential diagnosis of extremity pain in children, especially if the "bone" pain is out of proportion to a suspected etiology. Initial laboratory studies, radiographs, and scintigraphy may be normal. Indistinct radiographic findings of periosteal reaction, osteolytic lesions, sclerotic lesions, osteopenia, or leukemic lines in a child older than two years should alert a physician to the possibility of leukemia. Clinical suspicion of leukemia should be piqued if bone scan results seem to be inconsistent with a suspected diagnosis or unanticipated sites of increased metabolic activity are found in the lower extremities. If leukemia is probable, a bone marrow aspiration may be needed to confirm the diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/133. Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. Pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/133. Empowering the patient: hypnosis in the management of cancer, surgical disease and chronic pain.In the past decade, the increasing acceptance of hypnosis as a therapeutic adjunct by physicians and health care professionals both within and outside of the mental health community has resulted in broader use of the technique with patients in both hospital and outpatient settings. In our recent experiences with urologic patients, our staff has found that many bring a surprisingly sophisticated knowledge of clinical hypnosis to the office and often have had experience with some form of therapeutic hypnosis prior to consulting us. Consequently, we find we often encounter a surprising openness to the use of hypnosis as a part of the treatment programs we employ. As a result we have been able to utilize clinical hypnosis successfully in several treatment areas to the benefit of our patients. This paper will describe several programs in place at our practice which utilize clinical hypnosis as an adjunct to treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/133. neuromuscular blockade administration to end suffering: an ethical dilemma.critical care nurses face ethical issues every day in relation to end-of-life decisions. This article presents a case study involving the administration of a neuromuscular blocking agent prior to removing a patient from the respirator. The decision to use a paralyzing agent caused an ethical conflict between the nurse and physician. The article discusses ethical principles in relation to end-of-life decisions from the nurse, physician, and family's perspective. Whatever the belief, critical care nurses must consider the belief's of the patient and family while trying to maintain their own convictions.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/133. Erdheim Chester disease: a rare cause of knee and leg pain.A case of Erdheim Chester disease in a 51-year-old Turkish patient is described. Erdheim Chester disease is a rare form of lipoid granulomatosis. knee and leg pain are the most common symptoms, and physicians working in orthopaedics and traumatology are the first to be consulted. Our patient demonstrated a typical bilateral, symmetric sclerosis of the metaphyseal region of long bones of the lower extremity, histologic examination revealed foamy, lipid-loaded histiocytes. The patient also suffered from arterial hypertension, diabetes insipidus and exophthalmos of the left eye. The diagnosis was confirmed by a bone biopsy, and the patient was treated with non-steroidal anti-inflammatory drugs, corticosteroids and vincristine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/133. Ultrasonographic diagnosis of testicular torsion by emergency physicians.Testicular torsion has an incidence of one case per 4,000 men/boys. Most frequently affected are pubescent boys. Average testicular salvage rate is only 50%, and infertility can result Testicular torsion remains problematic for emergency physicians (EPs) as clinical diagnosis can be difficult and other testicular pathology can present similarly. In many institutions there are delays in obtaining Doppler or Scintigraphy studies during off-hours. We report two cases of testicular torsion diagnosed by the treating EPs using power Doppler in the emergency department (ED). Rapid diagnosis of torsion led to successful salvage of the affected testicle in both cases. These represent the first cases for emergency screening ultrasound examinations (ESUEs) of testicular torsion in the literature. Rapid technological advances over the last decade have brought portable equipment with high-resolution capability to the bed-side for EPs, who should consider using it more frequently to evaluate testicular torsion.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
10/133. Understanding the psychiatric complications of pain disorders.This paper is helpful in evaluating pain disorder from a clinical and psychiatric perspective. Pain is one of the most recurrent symptom in the daily work of any physician. epidemiology, diagnosis and two case reports are included in this article. Differential diagnoses and psychiatric complications of pain disorder are discussed in order to facilitate the physician to recognize fundamental sequalae of pain disorder.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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