1/13. Orthopaedic rehabilitation in a case of Tay-syndrome.This paper reports on the orthopaedic rehabilitation of a patient with Tay-syndrome. Tay-syndrome is a rare monogen-inherited ektodermal dysplastic syndrome with ichtyosis, fragility of the hair and physical and mental retardation. The congenital ichtyosis is ubiquitous. Only the skin on the flexion side of the extremity joints are not involved (orthocerathosis combined with paraceratotic strings). In this case, a young boy developed bilateral subluxation of the hips and was not able to stand or walk freely. Contemporary pre- and neonatal care has prolonged the survival of newborns with severe genodermatoses, including this syndrome. In this case, it has provided the necessity for orthopaedic treatment of the problems caused by osteosclerosis and muscular spasticity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. The perplexing problem of prostatitis.prostatitis presents the physician with a perplexing problem. It is seen often but is not easily treated. The acute form is serious but responds to antibiotic therapy. Chronic prostatitis does not respond well to any form of therapy, and opinion is divided regarding its cause. Bacterial localization tests have helped significantly in the diagnosis of chronic prostatitis. When Gram-negative organisms are found only in the prostatic fluid or in the last voided urine, bacterial prostatitis can be diagnosed. Most antibiotics, however, do not cross prostatic epithelium to combine with prostatic fluid; those that do are not effective against Gram-negative organisms. New agents hold promise but lack the test of time. While some cases of chronic disease definitely are caused by bacterial infection, most probably are not. The diagnosis in these instances is abacterial prostatitis. Treatment is symptomatic and varied. A phenomenon that adds to the mystery of etiology is the fact that antibiotics, particularly tetracycline, may help. psychotherapy often is needed but seldom is accepted. The physician must rule out underlying causes, such as a physical abnormality of the urinary system, for any form of prostatitis before considering it an isolated disorder.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Hematologic and molecular spontaneous remission following sepsis in acute monoblastic leukemia with translocation (9;11): a case report and review of the literature.Spontaneous remission in patients with acute myeloid leukemia (AML) is a rarely reported phenomenon of usually short duration. The etiology remains unclear, but an association with preceding blood transfusions or bacterial infections has been reported. Triggered immune responses are suggested to play a potential role in the development of spontaneous remission. Acute monocytic leukemia was diagnosed in a 61-yr-old male patient. cytogenetic analysis revealed a sole translocation (9;11) (q22;q23) and RT-PCR the MLL/AF9 fusion gene. As a result of the patient's reduced performance status and septic condition, cytostatic therapy was withheld. No microorganisms could be detected. Hematologic and molecular remission occurred after initiating antibiotic therapy without any cytostatic treatment; 29 months after the initial diagnosis, he is in complete remission, and excellent physical condition. Our report includes a review of the literature since 1985, reporting cases of patients with AML and spontaneous remission together with informative cytogenetics. Balanced translocations such as in core binding factor (CBF) leukemias appear somewhat overrepresented. We speculate that AML-specific T cells might be relevant for induction of spontaneous remission and need to be further investigated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Bacterial pituitary abscess: an unusual cause of panhypopituitarism.OBJECTIVE: To describe a case of primary bacterial pituitary abscess manifesting as hypopituitarism. methods: We present the case history, hormonal and bacteriologic data, and findings on imaging studies in a 34-year-old man. RESULTS: The patient had an 8-month history of intermittent fever, headache, nausea, vomiting, and weight loss. Because a computed tomographic scan of the head showed a cystic sellar mass with ring enhancement, he was referred to our medical center. On physical examination, he showed signs of meningeal irritation and had mild hypotension. Hormonal evaluation revealed evidence of hypocortisolism, hypothyroidism, and hypogonadism. Three weeks after treatment with antibiotics and hormonal replacement, he underwent transsphenoidal surgical exploration and evacuation of purulent material from the sella. On culture, this specimen grew coagulase-negative staphylococci and propionibacterium granulosum. Nine months later, dynamic testing showed persistent central hypocortisolism, hypothyroidism, and hypogonadism. CONCLUSION: Bacterial pituitary abscess is rare but manifests similar to other pituitary masses with headaches, visual field defects, and hormonal disturbances. For the correct preoperative diagnosis of this condition, the physician must have a high index of suspicion, and the characteristic ring enhancement must be present on imaging studies.- - - - - - - - - - ranking = 12.301148995786keywords = physical examination, physical (Clic here for more details about this article) |
5/13. Imperforate hymen complicated with pyocolpos and lobar nephronia.An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by physicians. Lobar nephronia is a rare condition in pediatric patients that can be screened by ultrasound or computed tomography to distinguish it from a renal abscess. Treatment for lobar nephronia requires at least 14 days of antimicrobial therapy and a follow-up assessment by renal ultrasonography or dimercaptosuccinic acid scan. We report an unusual case of a 2-year-old girl with an imperforate hymen and pyocolpos. The pyocolpos compressed the left lower ureter to cause hydroureter, hydronephrosis, and nephronia. Partial hymenotomy was performed to drain the pus, and antibiotics were administered for a total of 3 weeks. There was a good outcome. This case demonstrates the need to perform a full physical examination, particularly a genital examination, in newborns. Further, if gynecologic pathology is suspected, then urologic screening studies are recommended to rule out potential associated anomalies.- - - - - - - - - - ranking = 12.301148995786keywords = physical examination, physical (Clic here for more details about this article) |
6/13. aeromonas hydrophila-associated colitis in a male homosexual.A 37-year-old homosexual man was evaluated for a one-week history of hematochezia. Results of a physical examination were remarkable only for grossly bloody stool. sigmoidoscopy to 30 cm showed a friable mucosa compatible with an acute colitis, and a rectal biopsy specimen demonstrated an increased plasma cell infiltrate. Stool cultures subsequently yielded aeromonas hydrophila; serum human T-cell lymphotropic virus type III antibody titer was positive. The patient responded to a course of treatment with sulfamethoxazole and trimethoprim with resolution of his symptoms and restoration of the bowel to a normal sigmoidoscopic appearance. aeromonas hydrophila infection should be considered in the differential diagnosis of acute proctocolitis, particularly in patients with underlying immunodeficiency states.- - - - - - - - - - ranking = 12.301148995786keywords = physical examination, physical (Clic here for more details about this article) |
7/13. frontal sinusitis and its intracranial complications.Although there has been a significant decrease in the incidence of frontal sinus disease since the advent of antibiotics, frontal sinus infection still occurs and may follow a clinical course not unlike that seen during the preantibiotic era. Secondarily to cranial and intracranial invasion the following complications may occur: osteomyelitis, cavernous sinus thrombosis, meningitis, extradural, subdural and cerebral abscess. The proximity of the frontal sinus to both the dura and the marrow of the frontal bone, as well as a rich communicating venous system, lends support to the facility of intracranial extension. Classically, frontal sinusitis presents with headache or pain usually following an upper respiratory infection. Purulent nasal discharge may be noted on physical examination. Roentgenographic studies will show opacification or an air-fluid level within the sinus. We present 4 cases of intracranial complications of frontal sinusitis seen in male adolescents. It is our contention that this disease bears a notable preponderance in males; a postulation that appears to be substantiated in the literature. Frequently even the classic signs and symptoms of frontal sinusitis may be undetected, which indicates that certainly the more subtle presentation of this disease may escape diagnosis during the course of examination. The use of CT scanning has proved an invaluable tool in the diagnosis of both frontal sinusitis and intracranial involvement. The importance of its incorporation into the diagnostic workup of the patient with frontal sinus disease cannot be overemphasized. We advocate aggressive medical and surgical management for all adolescents presenting with frontal sinusitis in an attempt to avoid possible intracranial complications.- - - - - - - - - - ranking = 12.301148995786keywords = physical examination, physical (Clic here for more details about this article) |
8/13. teratogens associated with congenital contractures in humans and in animals.An evaluation of over 350 patients in a study of congenital contractures of the joints (arthrogryposis) included a review of family, pregnancy, and delivery histories for teratogenic exposures. Fifteen out of the total 350 patients studied had a possible teratogenic exposure: an infectious agent (viral or bacterial), maternal drug or toxin ingestion, chronic maternal neurologic or muscular illness, or a direct physical insult such as a structural uterine anomaly. literature was reviewed for all human and animal cases reported with congenital contractures of the joints with an associated teratogenic insult. Those findings are discussed here.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/13. Sudden natural death in later childhood and adolescence.During a 6-year period 389 children and adolescents aged between 1 and 20 years died violently and 31 died suddenly, naturally, and unexpectedly in an area of southern sweden. In about half of these 31 cases, death was caused by common infectious diseases--for example broncho-pneumonia, myocarditis, or acute epiglottiditis. In one group death was certainly sudden, but was caused by a known chronic disease--such as epilepsy or bronchial asthma. Three young men died from chronic heart disease, and one died from adrenal failure during or immediately after physical exertion. There were 4 cases of sudden, natural death for which the cause was unknown--that is 0.007 per 1000 live births. This figure is extremely low compared with the incidence of sudden unexplained infant death--that is deaths of infants aged between one week and one year.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Bacterial discitis caused by limb gangrene requiring below-knee amputation.Two patients presented with disabling back pain and were unable to participate in physical therapy activities after being admitted to an acute rehabilitation center. Both patients had bacterial discitis of the lumbar spine that was apparently caused by infected ischemic limb tissue, ultimately removed at below-knee amputation. The literature describes many cases of bacterial discitis infected from many sources, but not from ischemic limb tissue requiring subsequent amputation. Many such cases may exist, however, and earlier recognition of this condition will enable appropriate treatment before vertebral destruction and/or neurological sequelae.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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