1/8. Artifactual electrocardiographic change mimicking clinical abnormality on the ECG.Electrocardiographic artifact is a common finding in patients requiring evaluation and monitoring in the prehospital, emergency department, or intensive care unit settings. Artifact results from both internal (physiological) and external (nonphysiological) sources. In most instances, artifact is recognized as an incorrect electrocardiographic signal--its only impact producing interference in electrocardiogram interpretation; artifact may also produce electrocardiographic signals which mimick disease--these signals the physician must recognize as artifact.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Early diagnostic magnetic resonance imaging in acute disseminated encephalomyelitis.We report two cases and review the literature concerning the importance of early magnetic resonance imaging (MRI) of the brain as a guide for the early diagnosis and treatment of acute disseminated encephalomyelitis (ADEM). A nonspecific term, ADEM refers to an acute disease that is postinfectious, parainfectious, postvaccinal, or of an unknown precipitating factor. Often when there is clinical suspicion of ADEM, MRI is not done before significant morbidity and mortality occur, despite the existence of adequate treatments. Primary care physicians should be aware of the importance of early MRI in ADEM.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Neurological deficits in solvent-exposed painters: a syndrome including impaired colour vision, cognitive defects, tremor and loss of vibration sensation.Five individuals are described who had participated in a study of former dockyard painters. All had worked between 16 years and 45 years as industrial painters, much of the time inside ships. All underwent structured neurological examination, colour vision testing (allowing calculation of a colour confusion index corrected for age and alcohol), and detailed psychometric testing. An occupational history sufficient to allow estimation of past exposure to solvents was taken. All gave a history of exposure to high concentrations of solvents at work, and several described episodes of acute narcosis. All showed neurological deficits and some had overt neurological disease, although in no case had this previously been linked to their work. The most striking features, sufficient to constitute a syndrome, were acquired blue-yellow colour vision deficits, coarse tremor, impaired vibration sensation in the legs and cognitive impairment. Their estimated cumulative exposures to solvents ranged between the equivalent of 13 and 37 calendar years working at the occupational exposure Standard concentration (OES years). This study for the first time gives an indication of the concentrations of solvents likely to lead to serious neurological disease in humans. It serves as a reminder to physicians to take an occupational history from patients with obscure neurological or psychological impairment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient.The authors report a case of probable serotonin syndrome caused by the coadministration of sertraline and oxycodone. A 34 year-old male patient experienced visual hallucinations and severe tremor after dramatically increasing his dosage of oxycodone while on stable amounts of sertraline and cyclosporin. Discontinuation of cyclosporin did not result in resolution of his symptoms. Consideration of a possible sertraline-oxycodone interaction led to withholding sertraline, which resulted in symptom resolution. serotonin syndrome has been noted with sertraline in combination with other drugs, but this is the first report in combination with a narcotic analgesic. Possible pharmacological mechanisms are discussed. In complicated patients that are taking multiple medications, physicians should be aware of this possible interaction to avoid delay in the diagnosis of serotonin syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Vocal tremor reduction with deep brain stimulation: a preliminary report.Vocal tremor has been a challenging problem for patients and their physicians. In some cases, it has been possible to lesson the symptom's tremor through medications and/or voice therapy. However, in most cases no good treatment has been available. Chronic stimulation of the thalamus has been successful in controlling tremors of the upper limb and other portions of the body. Our preliminary experience suggests that it may also be helpful in controlling vocal tremor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Carotid transient ischemic attacks presenting as limb-shaking syndrome: report of two cases.Limb shaking syndrome (LSS) is a rare presentation of transient ischemic attacks (TIAs), usually secondary to a critical carotid stenosis compromising intracranial circulation, first described 40 years ago. Two additional cases are described herein, aiming to add on to previous descriptions, and to warn physicians about this potentially harming and rather uncommon condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. AMP: a new form of marijuana.Marijuana soaked in formaldehyde, popularly called AMP, is an increasingly prominent abuse substance. Psychiatrists and emergency physicians should be alerted to AMP's unique symptom profile.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Diagnostic delay in presenile dementia.In a retrospective study, patients with presenile dementia and histories of symptoms of depressive illness and of antecedent diagnosis of depressive disorder were found to have significantly longer intervals from initial physician contact to final diagnosis than patients without such histories. patients with histories of psychiatric treatment prior to final diagnosis also had longer intervals, with differences approaching statistical significance. In contrast, intervals from symptom onset to first physician contact were noted to be shorter for those patients with these antecedent histories. A discussion of these results, a review of the relevant literature and an illustrative case report are presented.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |