1/15. 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 = 1keywords = physician (Clic here for more details about this article) |
2/15. "Spinolaminar breach": an important sign in cervical spinous process fractures.OBJECTIVE: To report the sign of "spinolaminar breach" and its likely importance in fractures of the cervical spinous processes. DESIGN: Six cases of spinous process fractures demonstrating disruption of the spinolaminar line or "spinolaminar breach" were analyzed. Lateral and anteroposterior radiographs (n=6), CT scans (n=3) and MRI scans (n=1) were reviewed together by the authors, with consensus being reached as to the radiographic findings. Clinical records were also reviewed. RESULTS: The levels of injury were C6 (n=5) and C5 (n=2). Injuries were associated with delayed anterior subluxation (n=4) and neurological deficit (n=2). Five patients were male and one was female with a mean age of 31 years (range 8-59 years). Injuries resulted from motor vehicle accidents (n=4), a motor cycle accident (n=1) and a fall (n=1). CONCLUSION: "Spinolaminar breach", or disruption of the spinolaminar line, indicates a complex spinous process fracture with extension into the lamina and spinal canal. Spinous process fractures with spinolaminar breach may have associated posterior ligamentous injury with potential for delayed instability and neurological deficit. It is important that radiologists and physicians caring for the trauma patient be aware of this sign in order to avoid misdiagnosis as a "clay shoveler's fracture", which can lead to adverse outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/15. osteoporosis. An overview of the National osteoporosis Foundation clinical practice guide.During the past decade, numerous organizations and associations have published recommendations for the prevention and treatment of osteoporosis. For the primary care physician, the most applicable of these--due to its reliance on clinical trial data and its scope--is the clinical guide published by the National osteoporosis Foundation. The guide addresses risk assessment, bone mineral density testing, diagnosis, nutritional supplementation, and pharmacologic therapy, including consideration of the newer agents used to slow or manage osteoporosis progression. Reflecting one of the key deficiencies in the clinical trial data, the guide applies predominantly to a patient population of postmenopausal white females. The refined design of new osteoporosis studies will in time allow for recommendations that apply to a more diverse patient population.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/15. Vertebral fractures as initial signs for acute lymphoblastic leukemia.Common presenting symptoms of acute lymphoblastic leukemia in children are well known and include pallor, fatigue, and loss of appetite. Limb pain is sometimes described and can be misleading. We describe two recent cases seen in our emergency department, where vertebral fractures, a much rarer finding, were the only presenting symptoms that led to the diagnosis. One case had been thoroughly evaluated only 5 weeks prior to the diagnosis and included magnetic resonance imaging. The second patient was rapidly referred to our center with a history of acute lumbar pain. Emergency physicians caring for children must be aware of this rare type of presentation of leukemia.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/15. Wipeout.When prehospital providers transported this patient to the trauma center, they felt a bit awkward, to say the least. The patient appeared to be intoxicated, and had fallen from approximately three feet. Nevertheless, upon EMS' arrival, the patient was responding only to painful stimuli and was not moving his lower extremities. This prompted EMS to activate the trauma system and treat the patient accordingly: He was immobilized on a long backboard. During transport, however, the patient became responsive to verbal stimuli and began moving his lower extremities. When he was transferred to the ED staff, he appeared to be doing fine neurologically, except for the intoxication. The EMS crew felt a bit embarrassed for the activation of trauma services. Three hours later, however, the ED physician called the providers at their station to inform them that the patient had an unstable cervical spine fracture (see x-ray above), and their care was definitely appropriate.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/15. Combined odontoid and jefferson fracture in a child: a case report.STUDY DESIGN: A case of combined odontoid and Jefferson fracture is reported. OBJECTIVE: To alert spine physicians to the rare combination of an odontoid and Jefferson fracture in a child. methods: A 5-year old boy presented with neck pain and torticollis after falling on his head from a four-wheeler that had rolled over. A computed tomography scan confirmed a combined odontoid and Jefferson fracture. RESULTS: The child was successfully treated nonsurgically with a hard cervical orthosis. At this writing, the child clinically is asymptomatic 2 years after the injury. DISCUSSION: The fall on to the head caused the body weight to be transmitted to the atlas. The resulting force vector produced the classic Jefferson fracture of the atlas. As the atlas fracture spread with continued compressive and axial forces, tension was exerted on the alar ligaments (check ligaments), leading to the avulsion fracture of the odontoid. CONCLUSIONS: This is only the second reported case of a child with a combined Jefferson and odontoid fracture. This diagnosis should be considered in the evaluation of a child with neck pain and torticollis from a fall on the top of the head.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/15. Is the cervical spine clear? Undetected cervical fractures diagnosed only at autopsy.Undetected cervical-spine injuries are a nemesis to both trauma surgeons and emergency physicians. Radiographic protocols have been developed to avoid missing cervical-spine fractures but are not fail-safe. Three case reports of occult cervical fractures documented at autopsy in the face of normal cervical-spine radiographs and computerized tomography scans are presented.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/15. Osteoporotic fracture of the dens revealed by cervical manipulation.Osteoporotic vertebral fractures selectively affect the thoracolumbar junction, usually sparing the cervical spine. A 65-year-old woman with documented osteoporotic fractures and chronic alcohol abuse presented with neck pain and occipital neuralgia that started after she suddenly flexed then extended her neck. Following several sessions of cervical manipulation, her pain became more severe, and she was admitted. Imaging studies showed multiple fractures in the dens, C6 and C7. These apparently spontaneous fractures suggested a bone tumor, for which investigations were negative. osteoporosis was the only identifiable cause. The spinal manipulations probably worsened the lesions which were performed by a chiropractor who is not a physician and did not obtain cervical spine radiographs before treating the patient. osteoporosis contraindicates spinal manipulation at any level, including the cervical spine.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/15. The unstable occult cervical spine fracture: a review.The initial evaluation and management of cervical spine injuries is of critical importance because of the impact of early treatment and management on the patient's eventual outcome. The devastation and cost of missing even one unstable cervical spine fracture is tremendous. The existence of patients with an unsuspected cervical spine fracture who have few, if any, symptoms and/or signs of an injury to the cervical spine is a valid concern and a dilemma for the practicing physician. Thus the principle of the occult unstable cervical spine fracture, which has been established as the standard of care, has major significance and implications. Recently, however, the concept of the occult cervical spine fracture has been challenged. Does the entity of an occult cervical spine fracture exist? If so, how should this affect our indications for obtaining cervical spine radiographs? The author presents the case of an unstable occult cervical spine fracture and a review of the literature.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/15. Percutaneous vertebroplasty: a review for the primary care physician.The purpose of this article is to help primary care physicians who are often challenged with the management of vertebral compression fracture (VCF) by presenting clinical background and identifying candidates for percutaneous vertebroplasty, a minimally invasive procedure for treatment of VCF.- - - - - - - - - - ranking = 1.6666666666667keywords = physician (Clic here for more details about this article) |
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