1/5. Manipulation with the patient under anesthesia.Manipulation while the patient is under anesthesia is an old, widely recognized procedure in musculoskeletal medicine. It is used for treating acute and chronic musculoskeletal conditions with significant biomechanical dysfunction unresponsive to conservative therapy. The procedure is helpful when muscle spasm and irritability preclude success without anesthetization of the patient. safety and effectiveness are favored by appropriate selection of patients, knowledge of indications and contraindications, suitable anesthetic, and services of a qualified physician trained in structural diagnosis and manipulative technique. A team approach is recommended. To illustrate effective use of the procedure, a classic case is described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Prolonged effect of botulinum toxin injection in the treatment of cricopharyngeal dysphagia: case report and literature review.Cricopharyngeus (CP) muscle spasm can lead to severe dysphagia. Myotomy of the CP muscle was the treatment of choice. Recently, botulinum toxin type A (BtxA) has been used for CP spasm. It usually brings improvement in deglutition but most patients require reinjection in 3-5 months. We report a 35-year-old man who had an arteriovenous malformation hemorrhage in the brain stem resulting in CP spasm and consequently severe dysphagia. He received BtxA injection and deglutition and nutrition remained good one year after treatment. A literature review analyzing 28 patients and our patient showed negative correlations between age and BtxA dose and between age and duration. Efficacy was positively correlated with duration and BtxA dose was positively correlated with pretreatment severity. In conclusion, physicians would use higher doses on patients with more severe cases but use lower doses on older patients. Those who obtained better post-treatment results would enjoy longer effective duration. Thus, the effective duration of the BtxA is multifactorial.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Self-directed EMG training for the control of pain and spasticity in paraplegia: a case study.A 25-year-old paraplegic woman was able to gain control of her debilitating leg and bladder spasms and abdominal pain using self-directed EMG biofeedback. The case is significant in that she previously had only cursory exposure to biofeedback as an undergraduate student and received only minimal support and direction from an instructor. She proceeded through daily home practice using a borrowed EMG unit and audiotapes from Lester Fehmi's Open Focus series. Records were kept of the frequency and intensity of her pain and spasms, as well as the frequency and procedures of her home practice. She also maintained a record of specific psychosocial events in her life, which, over time, showed a strong, consistent pattern of influence on the recurrence and severity of her symptoms. The woman's physician declared her medical progress remarkable and encouraged her biofeedback work. At 2-year follow-up, she remains virtually symptom- and medication-free. Her successful biofeedback training program provides support for the value of client-directed biofeedback in selected cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Fatal nonatherosclerotic myocardial infarction in a young man with allergic bronchial asthma.A 34-year-old man with allergic asthma died an (instantaneous) sudden cardiac death as a result of multiple myocardial infarcts. These occurred in the absence of coronary atherosclerosis. The major mechanism by which the infarcts occurred was recurrent coronary artery spasm. The latter can occur spontaneously, asthma patients being particularly prone to it. However, various medications prescribed by different physicians may also have played a role.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. facial nerve dysfunction in osteopetrosis.When facial nerve dysfunction occurs in conjunction with one of the rare temporal bone dysplasias, the physician faces a therapeutic dilemma. There is no consensus in the literature regarding the management of facial paralysis or facial spasm under these circumstances. During the past 2 years, four patients were seen with forms of osteopetroses and neurotologic symptoms. A patient with malignant, recessive osteopetrosis and a patient with Engelmann's disease were surgically managed for facial paralysis and facial spasm. The outcome of the treatment is discussed as well as the available literature on this subject. A new complication of facial nerve decompression in children with osteopetrosis is described, as well as appropriate caveats in the management of facial nerve disorders in the osteopetroses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |