1/15. Primary pulmonary osteogenic sarcoma.A 56-year-old man initially presented to his family physician with tingling in the fingertips of his left hand. A chest radiograph revealed a left upper lobe mass. Local resection found a soft tissue osteogenic sarcoma. This is a report of a rare case of primary pulmonary osteogenic sarcoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. fibromyalgia and Tinel's sign in the foot.In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel's sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of rheumatology recognizes fibromyalgia as a condition characterized by multiple "tender points" on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel's sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/15. Cervical spine meningioma presenting as otalgia: case report.OBJECTIVE AND IMPORTANCE: Cervical spine meningiomas have not been reported to present as otalgia. It is important to include otalgia in the differential diagnosis and workup, especially when more common causes of ear pain have been excluded. CLINICAL PRESENTATION: A 66-year-old woman presented to her primary care physician with severe ear pain. She underwent routine diagnostic testing and eventually was referred to a neurologist. After conservative management failed, the patient underwent cervical spine magnetic resonance imaging, which revealed a large meningioma encompassing C2-C3. INTERVENTION: The patient underwent a cervical laminectomy with complete resection of the tumor. She experienced immediate postoperative resolution of her symptoms. CONCLUSION: This case illustrates the importance of aggressive evaluation of otalgia when routine diagnostic studies are inconclusive. Cervical meningiomas are associated with significant potential morbidity and should be excluded early in the diagnostic process.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. Chemotherapy-induced palmer planter erythrodysesthesia.We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. Emergency department presentations of transverse myelitis: two case reports.Transverse myelitis, a diagnosis that may be made in the emergency department (ED) by emergency physicians, can be difficult to diagnose because of its variable signs and symptoms and its poorly understood pathogenesis. In this article, we recount 2 cases of transverse myelitis to demonstrate its presentation, diagnosis, and management in the ED.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. Distal phalange necrosis: a severe manifestation of palmar plantar erythrodysesthesia.Palmar plantar erythrodysesthesia is a cutaneous drug reaction induced by chemotherapy. We present a case of a patient with neurosensorial deficit affected by ovarian cancer who experienced a painless necrosis of a distal phalange of the hand during treatment with pegylated liposomal doxorubicin. Palmar plantar erythrodysesthesia may be underestimated by physicians in paucisymptomatic patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. diagnosis of a rare source of upper extremity symptoms in a healthy woman after weight lifting.STUDY DESIGN: Resident's case problem. BACKGROUND: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening. diagnosis: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias decreased pulses, and venous distension, warranted a timely referral by the physical therapist bavk to the referring physician. DISCUSSION: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/15. Protracted Lhermitte's sign following head and neck irradiation.Lhermitte's sign is a rare complication of head and neck irradiation involving the delivery of dose to the cervical spinal cord. Although uncommon, symptoms of lightning-like electric sensations spreading into both arms, down the dorsal spine, and into both legs on neck flexion following head and neck irradiation, causes great concern in both the patient and the physician. This spontaneously reversible phenomenon is important for the otolaryngologist and radiation oncologist to recognize and discuss. A particularly severe and protracted case of Lhermitte's sign involving a patient recently completing a radical course of radiation for nasopharyngeal carcinoma is described in detail, including a review of the literature surrounding the cause and management of this condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. neurologic manifestations of vitamin B-12 deficiency in a military hospital.Although it is well recognized that patients with cobalamin (vitamin B-12) deficiency can develop neuropsychiatric problems, primary care physicians do not frequently realize that patients presenting with only vague neurologic complaints can have vitamin B-12 deficiency as the etiology. During a 1-year period, six patients presented to the neurology Clinic at Brooke Army Medical Center, Fort Sam Houston, texas, after evaluation at the primary care level for their neurologic complaints. All six had cobalamin deficiency, and none were anemic. Military primary care physicians should be aware of the various neurologic presentations of these patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/15. nitrous oxide-induced myelopathy-neuropathy: potential for chronic misuse by dentists.The myelopathy and neuropathy associated with chronic misuse of nitrous oxide are potentially reversible if the habit is discontinued. This occurred in each of the reported cases, including our case, when it was transiently discontinued. Although a causal relationship between nitrous oxide and this myelopathy-neuropathy has not been proved, the circumstantial evidence is convincing. Both physicians and dentists should be aware of this potentially serious complication of chronic self-administration of nitrous oxide, especially in persons inclined to misuse drugs. dentists, with their access to nitrous oxide, may be particularly at risk.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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