1/49. Too hot to handle: an unusual exposure of HDI in specialty painters.BACKGROUND: Hexamethylene Diisocyanate (HDI) is a color stable aliphatic isocyanate that is used in specialty paints as a hardener. Due to the lower vapor pressure of its commercial biuret form, it is considered a relatively "safe" isocyanate from an exposure standpoint. This case series reports on an unusual toxic exposure to HDI. Between November 1993 and May 1994, seven specialty painters and one boiler maker who were working at three different power plants were examined at the Institute of Occupational and environmental health at west virginia University. At their respective work sites, HDI was applied to the hot surfaces of boilers that were not shut down, and allowed sufficient time to cool. Consequently, these workers were exposed to volatile HDI and its thermal decomposition products. methods: All of these workers underwent a complete physical examination, spirometry, and methacholine challenge testing. RESULTS: All 8 workers complained of dyspnea, while 4 of the 8 also complained of rash. On examination 3 workers were methacholine challenge positive and 2 had persistent rash. At follow-up 4 years later, 5 workers still had to use inhalation medication and one had progressive asthma and dermatitis. All 8 workers, by the time of the follow-up, had gone through economic and occupational changes. CONCLUSIONS: This case series reports on an unusual exposure to HDI. It is unusual in that: 1) There were two simultaneous sentinel cases with two different material safety data sheets (MSDS) for the same product, 2) Exposure was to volatile HDI and its decomposition products and 3) Hazardous conditions of exposure occurred at three different sites.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/49. Kinetic alteration of theophylline at therapeutic doses.OBJECTIVE: To report a case of a patient diagnosed as having bronchial asthma treated with intravenous infusion of theophylline, who presented an episode of altered theophylline metabolism with a disproportionately increase in serum concentrations together with tachycardia and symptoms of intoxication. CASE SUMMARY: A 51-year-old white woman with a history of bronchial asthma was treated with intravenous infusion of theophylline in an intensive care Unit. Bayesian pharmacokinetic approach for dose individualization was done and linear kinetics of theophylline were observed. At therapeutic dose, an alteration of theophylline metabolism had happened, that induced a decrease on the theophylline clearance coinciding with an increase of dose. The serum concentration at this dose was 23.9 microg/ml and this was associated with symptoms compatible with intoxication by theophylline. All factors that could change theophylline elimination were analyzed. A possible drug interaction, hypothyroidism and cardiac failure were ruled out. Clinical hepatic insufficiency was not determined, but an increase of hepatic enzymes was observed. theophylline infusion was suspended during 5 hours, the serum levels returned to therapeutic values and hepatic enzymes returned to their initial values. DISCUSSION: Episodes of anormal theophylline kinetics may occur, even with doses and serum concentrations considered to be therapeutic, especially in critically ill patients or those whose physical condition has deteriorated. This makes it necessary to carry out therapeutic drug monitoring of theophylline in this group of the population.- - - - - - - - - - ranking = 0.13959113918774keywords = physical (Clic here for more details about this article) |
3/49. rhabdomyolysis triggered by an asthmatic attack in a patient with McArdle disease.We describe a patient with McArdle disease who developed rhabdomyolysis triggered by a bronchial asthmatic attack. A 64-year-old man had chronic pulmonary emphysema with asthma, and an asthmatic attack led to severe rhabdomyolysis that required continuous hemodiafiltration. After 2 years, a physical examination revealed atrophy of the extremities compared with previous examinations, especially of the intercostal muscles. During that time, he suffered two severe bronchial asthmatic attacks. His serum level of creatinine kinase remained between 4,000 and 7,000 IU/l when he did not suffer from asthmatic attacks and rhabdomyolysis had abated. Therefore, we suspected that his recent muscle atrophy was caused by asthmatic attacks, and discussed the possibility of his respiratory muscle weakness due to McArdle disease in relation to his severe bronchial asthmatic attacks as well as chronic obstructive pulmonary disease.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/49. Leukaemia presenting as respiratory distress in a child with asthma.asthma is the most common reason for children to present to an emergency department complaining of shortness of breath. The diagnosis, based on one or more of a positive history of atopy, physical examination findings consistent with reactive airways disease, and a clinical response to bronchodilator therapy is usually straightforward. It is important however, to consider other diagnoses, particularly when patients present differently from that which has previously been documented and/or have unexplained physical findings.- - - - - - - - - - ranking = 1.1395911391877keywords = physical examination, physical (Clic here for more details about this article) |
5/49. Violence: an unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations.In the united states, rising trends in asthma prevalence and severity, which disproportionately impact minorities and the urban poor, have not been fully explained by traditional physical environmental risk factors. Exigencies of inner-city living can increase psychosocial risk factors (e.g., stress) that confer increased asthma morbidity. In the united states, chronic exposure to violence is a unique stressor existing in many high-risk urban neighborhoods. In this paper, we describe a series of cases that exemplify a temporal association between exposure to violence and the precipitation of asthma exacerbations in four urban pediatric patients. In the first three cases, the nature of the exposure is characterized by the proximity to violence, which ranged from direct victimization (through either the threat of physical assault or actual assault) to learning of the death of a peer. The fourth case characterizes a scenario in which a child was exposed to severe parental conflict (i.e., domestic violence) in the hospital setting. Increasingly, studies have begun to explore the effect of living in a violent environment, with a chronic pervasive atmosphere of fear and the perceived or real threat of violence, on health outcomes in population-based studies. Violence exposure may contribute to environmental demands that tax both the individual and the communities in which they live to impact the inner-city asthma burden. At the individual level, intervention strategies aimed to reduce violence exposure, to reduce stress, or to counsel victims or witnesses to violence may be complementary to more traditional asthma treatment in these populations. Change in policies that address the social, economic, and political factors that contribute to crime and violence in urban America may have broader impact.- - - - - - - - - - ranking = 0.27918227837549keywords = physical (Clic here for more details about this article) |
6/49. Non-compliance in adolescents with chronic lung disease: causative factors and practical approach.Compliance with medical therapies may be considered a challenge in many age groups but especially so in adolescence. The adolescent patient with chronic lung disease may struggle to progress smoothly through the phases of adolescence because of fears of peer rejection and isolation occurring as a result of social, emotional and physical consequences of their underlying lung disease and its treatment. Non-compliance can be viewed as a scale from episodic compliance to frequent compliance with patients moving between ends of the spectrum. Health professionals need to consider the likely degree of compliance with therapies that they recommend, discuss the issue of compliance and the consequences of non-compliance with the adolescent patient and arrive at a workable compromise. This article discusses persistent asthma, cystic fibrosis and advanced neuromuscular disease to illustrate practical approaches to enhancing patient compliance in adolescence.- - - - - - - - - - ranking = 0.13959113918774keywords = physical (Clic here for more details about this article) |
7/49. asthma associated with worsening leg ulcer: a case of vasculitis in primary care.A 71-year-old black woman was admitted to the hospital with a 2-month history of a nonhealing leg ulcer. Her medical history included diabetes mellitus type 2, congestive heart failure, allergic rhinitis, and asthma. The patient's asthma was labile and steroid-dependent until 2 years before admission, at which time zafirlukast therapy was started. On further questioning, the patient revealed a 6-month history of malaise and a 40-lb weight loss. A physical examination showed a 2-cm Stage 3 ulcer on the medial aspect of the right ankle with diminished sensation in both feet and left footdrop. electromyography revealed mononeuritis multiplex. The patient's white blood cell count was 11,100/mm3 with 60% eosinophils. A sural nerve biopsy showed vasculitis consistent with churg-strauss syndrome. One week after prednisone therapy was initiated, the patient's foot strength was nearly normal and her eosinophilia had resolved. Although churg-strauss syndrome is a rare disorder, in the setting of asthma and multiple disparate signs and symptoms, the broad diagnostic category of serious vasculitic illness should be considered.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/49. psychophysiologic disorders in children and adolescents.Psychosomatic disorders in children and and adolescents is a topic that covers a wide variety of illnesses and one which is difficult if not impossible to define accurately. In general, chronic emotional states, often nonspecific, serve as strong contributors to the development of a physical illness. The particular illness is often dictated by varying degrees of biological predisposition in one physiological system-i.e., such a predisposition in the respiratory system may lead to asthma or in the gastrointestinal system to ulcerative colitis. In some cases the biological factor is large and the emotional factor minimal, while in other cases the reverse is true. In the early days of research in psychosomatic disorders it was widely believed that each disorder was accompanied by certain specific emotional problems. Further study has shown this is not true. It was also felt that many, if not most of these disorders could be cured by psychotherapy, and this also has proven to be a fallacy. we have moved more and more to the team approach. Since both psyche and soma are involved, more than one specialist is usually required. In children and adolescents this may involve a child psychiatrist, a pediatrician, an allergist or gastroenterologist, a social worker and a psychologist. It requires time and patience to form an effective and smoothly functioning team in which all members respect one another's potential contribution. Some examples of team operation are presented and some of the problems outlined. In addition, there is attention given to the special problems of the adolescent and also the child with chronic nonspecific physical complaints as well as the child who requires hospitalization.- - - - - - - - - - ranking = 0.27918227837549keywords = physical (Clic here for more details about this article) |
9/49. enalapril-induced cough in the emergency department.A case of enalapril-induced cough is reported. In the Emergency Department, the patient initially was misdiagnosed with bronchial asthma and, later, with early congestive heart failure, despite normal physical examination and investigations. The cough subsided within 5 days of cessation of enalapril. It is important to recognize this side effect in patients taking enalapril.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/49. A coughing child: could it be asthma?BACKGROUND: A child presenting with cough is common in general practice. Usually the cough is due to an upper respiratory tract infection, however, parents are often concerned that the cough may be asthma. OBJECTIVE: This article focusses on identifying various causes of persistent cough, especially asthma. DISCUSSION: Significant causes of an acute cough need to be considered such as inhaled foreign bodies, aspiration, infections such as pertussis and pneumonia, and asthma. Clinical history, followed by physical examination and consideration of special investigations will guide the diagnosis. cough as the sole symptom of asthma is unusual. There is usually associated wheeze and shortness of breath. A family or personal history of atopic symptoms lend weight to the possibility of asthma. In children with asthma, physical examination and even spirometry may be normal between episodes. In some cases where asthma is suspected, a trial of bronchodilation with formal assessment of response may be appropriate.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
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