1/5. High-altitude decompression illness: case report and discussion.decompression illness (DCI) can occur in a variety of contexts, including scuba diving and flight in nonpressurized aircraft. It is characterized by joint pain, neurologic injury, and respiratory or constitutional symptoms. To prepare flight crews for accidental decompression events, the Canadian Armed Forces regularly conducts controlled and supervised depressurization exercises in specialized chambers. We present the cases of 3 Canadian Armed Forces personnel who successfully completed such decompression exercises but experienced DCI after they took a 3-hour commercial flight 6 hours after the completion of training. All 3 patients were treated in a hyperbaric oxygen chamber. The pathophysiology, diagnosis and management of DCI and the travel implications for military personnel who have undergone such training exercises are discussed. Although DCI is relatively uncommon, physicians may see it and should be aware of its presentation and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion.BACKGROUND: Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. methods: We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS: A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS: Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. rehabilitation of a patient with complete mandibulectomy and partial glossectomy.Following a number of radiologic and surgical procedures for the treatment of oral cancer, a patient with severe facial disfigurement and alteration of the vocal tract acquired acceptable speech. Consultation among referring physicians and speech pathologists can aid such a patient by facilitating the rehabilitative process through improvement of communicative skills.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. The surgery for epilepsy with speech arrest.The problems confronting patients with epilepsy, their families, and the surgeons wishing to help such patients, are discussed. It is important for physicians in other specialties to realize that epilepsy surgery is not nowadays complex, difficult, painful or uncertain; furthermore such operations are based on finding and removing focal lesions rather than "epileptogenic cortex" and the result in terms of integration of the patient into society is much improved if such intervention is performed while the patient is young, with time to gain academic and social skills after the operation. The selection of patients suitable for operation is discussed as well as methods of determining which hemisphere is dominant for speech and whether or not the focal lesion involves language centres. The majority of patients with drug resistant epilepsy suitable for operation have abnormalities in one temporal lobe. The pathological lesion is described and the advantages and disadvantages of various operations for temporal lobe epilepsy discussed. Extra-temporal cortical resection in the dominant hemisphere is also considered, particularly with reference to the preservation of language function. It is important that neurosurgeons realise that MRI and CT scanning have transformed epilepsy surgery from being a rather nebulous, time consuming art, to being for the majority of patients, a clear cut, straight forward procedure firmly based on "Oslerian" pathological principles. Far too few patients are being offered an operation (which renders 60-70% seizure free); neurosurgeons should respond to this challenge.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. asperger syndrome associated with Steinert's myotonic dystrophy.Steinert's myotonic dystrophy was diagnosed in a 10-year-old girl with asperger syndrome. This form of myotonic dystrophy is one of a growing list of genetic diseases that can be diagnosed by analysis of a gene with trinucleotide repeats that may expand. The patient has the largest such expansion known within her pedigree. She has many of the psychological deficits that have been reported in adult-onset myotonic dystrophy. This is the first known report of an association of this disorder with asperger syndrome. Recently Moebius syndrome has been found in association with disorders of the autistic spectrum; physicians practicing developmental medicine should now also consider Steinert's myotonic dystrophy when evaluating children with facial diplegia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |