1/198. Atlantoaxial rotary subluxation in children.Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/198. Successful low-dose cytosine arabinoside treatment in a patient with acute leukemia from idiopathic myelofibrosis.We report a 63-year-old male with acute leukemia developed from idiopathic myelofibrosis. cytogenetic analysis revealed chromosomal abnormalities; 46,XY,t(3;21)(q21;q22) del(20q). Intensive chemotherapies [combination of adriamycine/vincristine/prednisolone, or idarubicine/cytosine arabinoside (Ara-C)] were unsuccessful. The patient was then treated with continuous intravenous low-dose Ara-C because of his poor physical condition and showed marked hematological improvement. Leukemic cells disappeared from the peripheral blood and the segmented neutrophil count recovered. The dysplastic morphology observed in the segmented neutrophils suggests that the recovery of the neutrophils has resulted mainly from the differentiation activity of Ara-C.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
3/198. Abdominal aortic aneurysm compression is probably responsible for the recurrent episodes of acute pancreatitis: case report.An aged male with a known history of abdominal aortic aneurysm suffered from epigastralgia, vomiting and cold sweating for one day. According to the physical examination, serum amylase level and computed tomographic examination, acute pancreatitis was diagnosed. Surgical intervention for the abdominal aortic aneurysm was not performed because of his age, and finally this patient died after three recurrent episodes. Acute pancreatitis co-existing with an intact abdominal aortic aneurysm has never been reported before. The possible pathogenesis of this recurrent acute pancreatitis was discussed.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
4/198. Acute diverticulitis of the caecum.Two cases of inflammation of a solitary diverticulum of the caecum are reported. These probably represent the first cases to be reported in Chinese. The pathogenesis of solitary diverticulum of the caecum is different from that of multiple diverticulosis of the colon. A study of these cases was made to understand better this uncommon entity. Before operation, the symptoms, signs and physical findings of caecal diverticulitis are those found in appendicitis. The diagnosis at operation in some cases is difficult because the inflammatory reaction may simulate a malignant process. Local excision is the operation of choice. Our two patients were treated by right hemicolectomy. Discussion is presented of the clinical presentation, pathology and treatment of this condition, so that its prompt recognition may avoid the incorrect diagnosis of caecal malignancy, which in turn would lead to unnecessary radical surgery resulting in a high mortality rate.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
5/198. Deep venous thrombosis and pulmonary embolism as a complication of bed rest for low back pain.A case of bilateral lower extremity deep venous thrombosis and pulmonary embolism as a complication of bed rest prescribed for an acute low back pain episode is presented. A 29-year-old woman with low back pain was prescribed more than 2 weeks of bed rest, during which she developed progressive bilateral lower extremity complaints that were ascribed to nerve root irritation. Her symptoms were initially treated with physical therapy and epidural steroid injections. A Doppler examination and ventilation-perfusion scan revealed extensive deep venous thromboses and mismatches consistent with pulmonary embolism. This case illustrates an unusual extraspinal source of lower extremity symptoms associated with low back pain and further supports the role of early mobilization in the treatment of back pain.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
6/198. Tracheobronchial foreign body management in an acutely ill neonate.Pediatric foreign body management has become refined in recent years, both from a diagnostic and therapeutic standpoint. history, physical examination, and radiographic evaluation performed in a timely manner can lead to safe and successful foreign body retrieval. Advancement in videoendoscopic instrumentation and anesthetic techniques enable the airway surgeon to achieve simultaneous airway stabilization and foreign body removal. In the emergency setting, the surgeon may not have access to such instrumentation. We present a case of an acutely ill, extremely low birthweight infant who incurred foreign body aspiration. Basic tools of expediency and control of the airway remind us once again that technique must precede technology.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/198. Gestational thyrotoxicosis with acute wernicke encephalopathy: a case report.A 35-year-old hyperthyroid woman who developed nausea, vomiting, tachycardia, nystagmus and mental disturbance, was referred to our hospital with a suspected diagnosis of thyroid storm. However, the thyroid gland was only slightly palpable, bruits were not audible, and exophthalmos was not present. serum levels of thyroid hormone were increased, but TSH receptor antibodies were negative. Echography and color flow doppler ultrasonography revealed a slightly enlarged thyroid gland and a slightly increased blood flow, both of which were much less milder than those expected for severe hyperthyroid Graves' disease. Under the diagnosis of hyperthyroidism due to gestational thyrotoxicosis associated with wernicke encephalopathy, vitamin B1 was administered on the first day of admission. Her consciousness became nearly normal on the second day except for slight amnesia. Her right abducent nerve palsy rapidly improved, but horizontal and vertical nystagmus, diminished deep tendon reflexes and gait ataxia improved only gradually. MRI findings of the brain were compatible with acute wernicke encephalopathy. We concluded that history taking and physical findings are important to make a differential diagnosis of gestational thyrotoxicosis with acute wernicke encephalopathy from Graves' thyroid storm, and that wernicke encephalopathy should be treated as soon as possible to improve the prognosis.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
8/198. Acute and post-traumatic stress disorder after spontaneous abortion.When a spontaneous abortion is followed by complicated bereavement, the primary care physician may not consider the diagnosis of acute stress disorder or post-traumatic stress disorder. The major difference between these two conditions is that, in acute stress disorder, symptoms such as dissociation, reliving the trauma, avoiding stimuli associated with the trauma and increased arousal are present for at least two days but not longer than four weeks. When the symptoms persist beyond four weeks, the patient may have post-traumatic stress disorder. The symptoms of distress response after spontaneous abortion include psychologic, physical, cognitive and behavioral effects; however, patients with distress response after spontaneous abortion often do not meet the criteria for acute or post-traumatic stress disorder. After spontaneous abortion, as many as 10 percent of women may have acute stress disorder and up to 1 percent may have post-traumatic stress disorder. Critical incident stress debriefing, which may be administered by trained family physicians or mental health practitioners, may help patients who are having a stress disorder after a spontaneous abortion.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
9/198. Posterior shoulder dislocation: avoiding a missed diagnosis.Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/198. Neurological crisis mimicking acute pancreatitis in tyrosinemia type I.Hereditary tyrosinemia results from an inborn error in the final step of tyrosine metabolism. Neurological manifestations have been reported in nearly half of patients during illness to have characteristics of altered consciousness, weakness, anorexia, vomiting, and pain in the extremities and abdomen. His physical findings and laboratory results pointed out acute pancreatitis. There have been some reports of acute and chronic pancreatitis in patients with metabolic diseases; however, this is the first case with tyrosinemia type I who exhibited clinical and biochemical findings of acute pancreatitis during neurological crisis. The presented case suggests the possibility that the pancreas is affected in neurological crisis. The determination of amylase concentration both in serum and urine samples of further cases will clarity the association between pancreatitis and neurological crisis.- - - - - - - - - - ranking = 0.14013368805682keywords = physical (Clic here for more details about this article) |
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