1/26. osteoradionecrosis of the cervical vertebrae and occipital bone: a case report and brief review of the literature.osteoradionecrosis (ORN) is a common complication of radiation therapy. We present the first case reported in the literature of ORN involving the first and second cervical vertebrae and occipital bone in a patient who was treated with surgery and radiation therapy 9 years prior for a TxN3M0 squamous cell carcinoma of the left neck arising from an unknown primary origin. A brief review of the pathophysiology and treatment of this pathological process is also presented. Although the mandible is the most commonly affected site in the head and neck, ORN may develop in an unusual location without any preceding trauma and display an insidious but rapidly progressive course. The pathophysiology of ORN is believed to be a complex metabolic and homeostatic deficiency created by radiation-induced cellular injury and fibrosis, which is characterized by the formation of hypoxic, hypovascular, and hypocellular tissue. The irradiated bone loses its capability to increase the metabolic requirements and nutrient supply required to replace normal collagen and cellular components lost through routine wear. This results in tissue breakdown and the formation of a chronic nonhealing wound. infection plays only a contaminant role, with trauma being a possible initiating factor. diagnosis of ORN begins with a complete physical examination, including fiberoptic examination and biopsy of any suspicious lesion to eliminate the possibility of recurrent tumor. Treatment of ORN commonly requires the debridement of necrotic bone and hyperbaric oxygen therapy. The head and neck surgeon must possess a high degree of suspicion to promptly diagnose ORN and initiate early treatment. Because of similarities in clinical presentation, the most important step in the initial management of suspected ORN is to eliminate the possibility of tumor recurrence or a new primary.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/26. Brick tea fluoride as a main source of adult fluorosis.An epidemiological survey was conducted in Naqu County, tibet in September 2001 to investigate the manifestations of fluorosis in adults caused by the habitual consumption of brick tea. Profiles were obtained for the total daily fluoride intake, environmental fluoride levels and average urinary fluoride concentration, and a physical examination and a skeletal radiographic study were conducted. One hundred and eleven 30-78-year-old adults were enrolled. It was found that the fluoride level of water sources in Naqu County was 0.10 /-0.03 mg/l; no evidence of fluoride air pollution was found, but the brick tea water processed foods--zamba and buttered tea--had fluoride contents of 4.52 /-0.74 mg/kg and 3.21 /-0.65 mg/l, respectively. The adult daily fluoride intake reached 12 mg, of which 99% originated from the brick tea-containing foods. The positive rate of clinical symptoms by physical examination was 89%; furthermore, 42 of the 111 subjects were diagnosed by X-ray. The positive examination rate was 83%. Although the osteosclerosis-type skeletal fluorosis (overall increased bone matrix density) affected 74%, arthropathy and arthritis affected a significant number of the patients, resulting in functional disability. The results suggest that this brick tea-type fluorosis had even more severe adverse effects on human health compared with both the water-type and coal combustion-type fluorosis that occurred in other areas of china.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
3/26. Pseudomass of the sternal manubrium in osteogenesis imperfecta.Skeletal abnormalities such as hypertrophic callus formation and "popcorn" calcifications are rare radiological findings of osteogenesis imperfecta, causing tumor-like appearances on imaging. We report on a 7-year-old girl with osteogenesis imperfecta presenting with hepatomegaly and palpable lymphadenopathy in the left inguinal region on physical examination. Computed tomography examination revealed a high-density mass-like lesion of the manubrium sterni. ultrasonography and a lateral roentgenogram of the chest verified that this was a pseudomass caused by a bowed sternal manubrium.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/26. Dual ectopic thyroid: report of a case.Dual ectopic thyroid is very rare. We report a case of dual ectopic thyroid in the lingual and infrahyoid areas in a 20-year-old female patient with no thyroid gland in its normal anatomical location. On physical examination, there was a 7 x 5 cm anterior midline neck swelling just below the hyoid bone and a 2 x 2 cm mass in the base of the tongue. triiodothyronine (T(3)), thyroxine (T(4)), and thyroid-stimulating hormone (TSH) levels were normal. A thyroid scan with technetium-99m sodium pertechnate confirmed dual ectopic thyroid with no iodine uptake in the normal anatomical location of the thyroid gland. The infrahyoid ectopic thyroid was surgically removed for cosmetic reasons, and the lingual thyroid, which was symptomatic, was left untouched. The importance of thyroid scanning in the evaluation of anterior midline neck swellings and treatment options are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/26. Epiphyseometaphyseal cupping of the distal femur with knee-flexion contracture.An 11-year-old child with a history of receiving megadoses of vitamin a as an infant, and a 4-year-old child with a history of fulminant staphylococcal septicemia with multiple joint involvement presented with recalcitrant knee-flexion contractures. Roentgenography revealed epiphyseometaphyseal cupping (ie, epiphyseal invagination) of the distal femur. osteotomy resulted in only temporary correction. Our experience suggests that in the skeletally immature child, skin traction, physical therapy, splinting, and, in some instances, two-pin tibial traction should be the treatments of choice.- - - - - - - - - - ranking = 0.17270343773795keywords = physical (Clic here for more details about this article) |
6/26. Symptomatic herniation pit of the femoral neck: a case report.OBJECTIVE: To discuss herniation pits of the femoral neck as a possible source of hip pain in a young athletic population. CLINICAL FEATURES: A 25-year-old former varsity volleyball player sought treatment for recurrent episodes of sharp left hip pain after intense physical activity. Radiographs revealed a small, oval, lobulated radiolucency with a thin sclerotic border in the superolateral aspect of the left femoral neck. Passive internal rotation of the left hip reproduced the complaint. Iliopsoas tendinitis/bursitis tests did not reproduce the complaint. INTERVENTION AND OUTCOME: The patient reported no significant reduction of hip pain after a variety of conservative therapies including soft tissue therapy, stretching, interferential current, and long-axis distraction. CONCLUSION: There is evidence to suggest that herniation pits of the femoral neck are a result of mechanical stress from the overlying joint capsule and iliopsoas tendon. Herniation pits of the femoral neck should be considered a potential cause of hip pain, particularly if the patient is physically active.- - - - - - - - - - ranking = 0.3454068754759keywords = physical (Clic here for more details about this article) |
7/26. Heterogeneity in the clinical presentation of Eagle's syndrome.OBJECTIVE: Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/26. Three-dimensional computed tomography and surgical treatment for Eagle's syndrome.Eagle's syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle's syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.- - - - - - - - - - ranking = 0.17270343773795keywords = physical (Clic here for more details about this article) |
9/26. A syndrome of widened medullary cavities of bone, aortic calcification, abnormal dentition, and muscular weakness (the Singleton-Merten syndrome).Two patients with clinical and radiological features similar to those of Singleton and Merten's patients are described. These patients exhibit features of a unique clinical syndrome of unknown etiology: generalized muscular weakness with secondary hip and foot deformities, progressive calcification of the thoracic aorta beginning in childhood, calcific aortic stenosis leading to heart failure, dysplasia of the teeth, poor physical development, osteoporosis, expanded medullary cavities of the metacarpal and metatarsal bones, and chronic psoriaform skin lesions.- - - - - - - - - - ranking = 0.17270343773795keywords = physical (Clic here for more details about this article) |
10/26. Nonspecific findings on MR imaging. The importance of correlative studies and clinical information.Although magnetic resonance (MR) imaging is highly sensitive for the detection of abnormalities of the musculoskeletal system, changes in marrow and soft-tissue signal intensity are often nonspecific, and benign conditions may be mistaken for malignancy. In an effort to identify the cause of this type of misdiagnosis in MR examinations, the MR scans were reviewed of 30 patients whose images manifested bone and/or soft-tissue changes that were initially believed to be consistent with malignancy but were later found to represent benign conditions. Of the 30 patients, MR abnormalities were attributable to trauma in 11, benign tumors and tumorlike conditions in ten, infection in seven, and prior radiotherapy in two. In 24 cases, correlative imaging studies (14 patients), appropriate clinical history (six patients), and/or physical and laboratory examinations (four patients) would have avoided these misdiagnoses.- - - - - - - - - - ranking = 0.17270343773795keywords = physical (Clic here for more details about this article) |
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