1/24. Severe anorexia nervosa associated with osteoporotic-linked femural neck fracture and pulmonary tuberculosis: a case report.We report a case study of a 38-year-old woman who had been suffering from anorexia nervosa (AN) since the age of 26. Before admittance to our clinic, she weighed 23.8 kg (at a height of 164 cm, 8.8 body mass index [BMI]) but still carried out strenuous physical activities. After good psychotherapeutic response and weight gain (34.4 kg), she accidentally fell and broke her femoral neck-favored as it was by osteoporosis. The X-ray taken before dynamic hip screw implantation coincidentally showed signs of pulmonary tuberculosis (TB), which could then be proven by computed tomography (CT) scans and cultures from a bronchoscopy. Other than lack of appetite and loss of weight, which we attributed to AN, there were no other clinical or biochemical indicators which could have pointed to an earlier TB diagnosis. As a result, the need for screening procedures is discussed. The manifestation of TB during the first weight gain after 12 years of severe malnutrition, during which there were no serious infections, seems to endorse former observations that AN patients appear to be "resistant" to some extent against infectious diseases, a "protection" which may be lost with convalescence and weight gain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/24. Near-normal linear growth in the setting of markedly reduced growth hormone and IGF-1. A case report.A 14.2-year-old prepubertal boy diagnosed with complete-type growth hormone deficiency and tertiary hypothyroidism, keeps growing in the height range between -1 and -2 SD. He has been treated with levothyroxine only. To understand the growth mechanism of this boy, we analyzed the serum growth hormone (GH) with a radioimmunoassay (RIA), serum GH bioactivity with Nb2 and erythroid progenitor cell bioassays, and growth hormone-binding protein (GHBP) with a ligand-mediated immunofunctional assay (LIFA). In addition, IGF-1 and free IGF-1 were analyzed by immunoradiometric assay (IRMA) and insulin-like growth factor-binding protein-3 (IGFBP-3) by Western immunoblot. Peak GH-RIA responses to insulin, arginine and GH-releasing factor, and nocturnal GH secretion, were low (0.5-2.3 ng/ml); bioactive GH was low (0.313 ng/ml), and GHBP was elevated (84 ng/ml). The serum levels of IGF-1 and free IGF-1 were continuously low, 17.1-39.3 and 0.17-0.26 ng/ml, respectively. Moreover, serum IGFBP-3 levels were low (1.68- 1.39 mg/l) and IGFBP-3 protease activity was negative. prolactin and insulin were in the normal range. The result of the assay for growth-promoting activity showed that the patient's serum stimulated normal erythroid progenitor cells twice as potently as did healthy thin adult control serum. These results suggest that GH and IGF-1 are not indispensable for maintaining physical growth in this boy. Thus, it appears that circulating GH and IGF-1 are not mandatory requirements for maintaining normal physical growth, and other, as yet uncharacterized, pathways or growth factors might be sufficiently compensatory under certain conditions.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/24. Access to TV contingent on physical activity: effects on reducing TV-viewing and body-weight.One child was recruited for a study assessing the effectiveness of a device aimed at reducing excessive television viewing and increasing exercising. The device was comprised of a control box which attaches to the electrical cord of a television set, and two sensors which attached to the wheel and corresponding wheel rim of a stationary bicycle. The child in this study was watching an excessive amount of TV (averaging over 4 hours per day), and she had a weight problem. An ABAB design was used in the study. After collecting baseline data, the child was required to ride a bicycle for 60 minutes to watch 60 minutes of TV, and this program successfully reduced TV viewing. Reductions in TV viewing and weight loss were found at a follow-up.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
4/24. Intense immunosuppression followed by purified blood CD34 cell autografting in a patient with refractory juvenile rheumatoid arthritis.A 15-year-old boy with refractory juvenile rheumatoid arthritis (JRA) underwent intense immunosuppressive therapy followed by purified blood CD34 cell autografting. He had been taking prednisolone (PDN) daily or every other day combined with methotrexate once a week to control the disease for 7 years. He suffered from psychological complications and a very short stature due to the adverse effects of these drugs. CD34 cells were purified in bulk from G-CSF-mobilized PBSC using an Isolex 300. After the administration of cyclophosphamide (200 mg/kg) and anti-lymphocyte globulin (45 mg/kg), 3.6 x 10(6)/kg purified CD34 cells were infused. His post-transplant course was uneventful except for herpes-zoster infection. He is now more than 1 year post transplant and has not taken any immunosuppressive medication. His rate of growth has increased (>10 cm/year) due to the effects of the cessation of PDN and the administration of recombinant human growth hormone (rGH), in contrast to the gain of 2 cm in the preceding 3 years with rGH treatment. Although the durability of this remission is unknown, intense immunosuppressive therapy followed by purified blood CD34 cell autografting might be acceptable for adolescent patients with refractory JRA to achieve a drug-free period for physical and psychological maturation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/24. Use of modafinil in spastic cerebral palsy.After an initial patient with cerebral palsy had an apparent dramatic reduction in spasticity when placed on modafinil, a pilot study was undertaken in 10 pediatric patients to confirm or refute the benefit of modafinil in cerebral palsy. Nine of 10 patients completed the 1-month treatment period. The study patients were treated with 50 or 100 mg of modafinil once daily in the morning. An assessment was made at baseline and at 1 month on treatment. All patients had a clinical examination, Modified Ashworth Scale scores (spasticity) determined by a physical therapist, and videotaping of ambulation. In comparing visit 1 (baseline) and visit 2 (on treatment), statistically significant improvement in the modified Ashworth Scale scores was noted in seven of the nine patients completing the study (P = .0080). A blinded review of the videotapes did not show statistically significant differences in ambulation, but the speed (ft/sec) of gait improved in six of the nine patients (P = .0192). In this study, modafinil, a newly released central stimulant for narcolepsy, showed benefit in treating spasticity in patients with cerebral palsy. A second larger, placebo-controlled, double-blinded trial is planned to confirm these initial results and observations. Modafinil appears to benefit spastic cerebral palsy by a yet to be determined mechanism; however, a primary effect of modafinil on brainstem structures is hypothesized to reduce spasticity of central origin.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/24. Estimation of caloric deficit in a fatal case of starvation resulting from child neglect.We report the case of a 3-year-20-day-old girl who died of starvation as a result of severe neglect. Her body weight had been 12 kg 70 days before her death, but was only 5 kg at the time of autopsy. From information supplied by her parents to police, we calculated her daily caloric intake and estimated the factors for physical activity. The daily recommended dietary allowance for the victim was calculated from 700 kcal/ day x the appropriate factor for physical activity. In the absence of enough food, body fat (7.2 kcal/g body fat) and protein (4 kcal/g protein) would have been used to compensate until death. The calculated body weight at the time of death was around 5 kg. The statements of the parents therefore appear to be true.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
7/24. child abuse: acute water intoxication in a hyperactive child.A 4-year-8-month-old boy was brought to our emergency department with coma and seizure. Initial physical examination showed evidence of physical child abuse and sudden body weight gain of 3.4 kg in one day. The laboratory results showed normal renal function with severe hyponatremia and the MRI study showed diffuse brain swelling. All of these findings were compatible with the diagnosis of acute water intoxication. Careful history taking from the boy and his parents separately confirmed the course of chronic polydipsia with acute compulsive water drinking. After clinical assessment and follow-up by psychiatrist, the patient was diagnosed with hyperactivity disorder. We present this case and show the possibility of correlation between compulsive water drinking, child abuse and hyperactivity disorder on acute water intoxication.- - - - - - - - - - ranking = 2.4648383691634keywords = physical, physical examination (Clic here for more details about this article) |
8/24. Ambulation in a wheelchair-bound stroke survivor using a walker with body weight support: a case report.Treadmill systems with body weight support (BWS) have been demonstrated to increase over-ground walking speed, endurance, and balance. However, their use is limited to physical therapy gyms. Training cannot be carried over to home without significant expense. We present the case of a 43-year-old white female with no past medical history who suffered significant neurological impairment as a result of a basilar artery aneurysm. The patient was issued a walker system with BWS that allowed her to function significantly better than before she received the walker system. Implications of using the walker system with BWS in the inpatient, outpatient, and home settings are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/24. Malnutrition, a rare form of child abuse: diagnostic criteria.Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/24. Physical and psychological characteristics of five male bulimics.The case histories of five men who met DSM-III criteria for bulimia and details of their physical characteristics are given. Various eating disorder questionnaires were administered and the results indicated that most of these instruments would not have identified the men as suffering from an eating disorder. The necessity of caution in asserting the prevalence of bulimia using these measures is emphasised.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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