1/5. Bullous malignant melanoma: an unusual differential diagnosis of a hemorrhagic friction blister.BACKGROUND: A 66-year-old woman presented to our outpatient clinic with a 3 x 2.5-cm tense, hemorrhagic-appearing bulla on her forefoot. Histopathology and immunohistochemistry confirmed a transtumoral-transepidermal blister formation within an advanced acrolentiginous malignant melanoma (MM). OBJECTIVE: To study bullous malignant melanoma. methods: Blistering in MMs represents a rare but clinically important pitfall in clinical differential diagnosis. The blisters are typically due to the disruption of the cohesion between neoplastic cells and keratinocytes, but physical friction may also contribute. RESULTS: Hemorrhagic blistering is, in many cases, a relatively insignificant finding in which frictional forces are imposed. CONCLUSION: The case reported here underscores that in rare cases MMs, particularly if acrally located, can be complicated by hemorrhagic blistering. Because of the life-threatening consequences, one should be aware of this rare differential diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Wound care for burn patients in acute rehabilitation settings.Caring for patients who are recovering from severe burns is not common in most inpatient rehabilitation settings. nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center (HMC), a regional Level 1 burn and trauma center in Seattle, WA, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes HMC's nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve burn patients. Says one burn survivor: "nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aids the patient in his journey from fire victim to burn survivor."- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Giant bulla mimicking pneumothorax.It is usually thought by emergency physicians that the diagnosis of a pneumothorax is straightforward and easy to make and to treat, but the diagnosis may sometimes pose a challenge. The present report describes a case of a giant pulmonary bulla in a 40-year-old man that progressed to occupy almost the entire left hemithorax and also subsequently ruptured to produce a large left pneumothorax. The giant bulla was diagnosed only as a pneumothorax, and initially managed with a chest tube only. The differentiation between pneumothorax and a giant bulla can be very difficult, and often leads to inaccurate diagnosis and management. This case report demonstrates the clinical presentation of giant bulla and its complications such as pneumothorax and also highlights the difficulty in making this diagnosis and appropriately treating it. In this article, we emphasized how to differentiate between giant bulla and pneumothorax utilizing history, physical examination, and radiological studies including computed tomography (CT) scan.- - - - - - - - - - ranking = 5.2390644647773keywords = physical examination, physical (Clic here for more details about this article) |
4/5. Aplastic anemia associated with rubber cement used by a marathon runner.Marathon runners are subject to many unique physical problems, especially blistering of the feet. Once the feet have become blistered, some runners use rubber cement, which contains benzene as an impurity, to keep adhesive tape in place over the denuded areas while running. We report the case of a marathon runner who used rubber cement in this fashion for more than one year in whom aplastic anemia developed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. methylene blue-induced phototoxicity: an unrecognized complication.OBJECTIVE. To describe photosensitization after prenatal exposure to a toxic amount of methylene blue and to alert pediatricians that, in a review of the literature, photosensitization (which this dye is capable of) has not been reported as a complication of prenatal exposure. DESIGN AND patients. A descriptive report of physical findings and significant laboratory tests in a very low birth weight preterm infant with prenatal exposure to methylene blue and a comparison of this reported case with previously described patients' complications and treatment. SETTING. Neonatal intensive care unit. INTERVENTION. Monitoring of laboratory tests to assess for methylene blue toxicity: two exchange transfusions for methemoglobinemia, hemolytic anemia, and hyperbilirubinemia; phototherapy for hyperbilirubinemia; and pathologic examination of skin bullae. RESULTS. Within hours of exposure to phototherapy, redness developed on all exposed areas of the patient's skin (which was initially deep blue), followed by bullae and desquamation of about 35% of the total skin surface area. The desquamation of erythematous areas continued even after discontinuation of phototherapy. Complete re-epithelialization was attained by 3 weeks of age. In addition to this newly observed complication, the patient had other previously described toxic effects. CONCLUSION. We have reported a previously unrecognized complication associated with high prenatal exposure to methylene blue and treatment with phototherapy. methylene blue phototoxicity may be related to the high prenatal dose of the dye relative to patient's small size and young gestational age.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |