1/217. Chronic urticaria as a presenting sign of hairy cell leukemia.Chronic urticaria is a common clinical disorder that is idiopathic in over 75% of cases. Less commonly, urticaria may be the presenting manifestation of an allergic or infectious disease, endocrinopathy, inherited syndrome, or autoimmune disorder. Rarely, urticaria may be a sign of underlying malignancy, including leukemia. C.C. is a 48-year-old white female who was referred for evaluation of recurrent urticaria for 3 years. The pruritic, erythematous wheals were pinpoint, and appeared to be precipitated by heat, stress, and effort. Prick tests were negative except to D. pteronyssinus. CBCs over the past 5 years revealed WBCs of 2,300-5,000 cells/mm3. skin biopsy revealed interstitial edema with infiltration of eosinophils and mast cells consistent with urticaria. The impression was probable cholinergic urticaria, for which hydroxyzine was prescribed with fair symptomatic control. One year later, she presented with bright red blood per rectum. Repeat physical examination revealed lymphadenopathy and splenomegaly. Subsequent laboratory studies showed pancytopenia. endoscopy was normal except for small, nonbleeding hemorrhoids. bone marrow biopsy revealed histologic evidence of hair, cell leukemia that was treated with 2-chlorodeoxyadenosine. Upon initiation of chemotherapy her pruritus and urticaria subsided. Recent CBC revealed Hgb 9.2 g/dL, platelets 290,000 cells/mm3, and WBC 4,100 cells/mm3. Peripheral blood smear showed no hairy cells.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/217. Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain.Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/217. Chronic dacryoadenitis misdiagnosed as eyelid edema and allergic conjunctivitis.PURPOSE: To report the case of a 53-year-old woman with a 2-year history of episodic upper eyelid swelling and nonspecific complaints, who was diagnosed as having allergic conjunctivitis. methods: A complete ocular examination, orbital computerized tomographic (CT) scans followed by complete physical and systemic examinations. RESULTS: The results of physical and systemic examinations were unremarkable for systemic lymphoma and a primary focus of cancer. The results of the ocular examination were normal. CT scans demonstrated well-defined lesions bilaterally with a homogeneous internal structure in the lacrimal gland fossa, which suggested a diagnosis of chronic dacryoadenitis. The differential diagnosis included lymphoma and orbital metastases. The patient refused a biopsy and was started on a tapering dose of 60 mg oral prednisolone daily. The follow-up CT scans 1 month after cessation of 6-week oral corticosteroid treatment showed near complete resolution of the orbital lesions. CONCLUSION: This case demonstrates that orbital inflammation can be misdiagnosed as refractory allergic conjunctivitis.- - - - - - - - - - ranking = 0.50290737494479keywords = physical (Clic here for more details about this article) |
4/217. Treatment planning in pain medicine. Integrating medical, physical, and behavioral therapies.This article addresses a systematic approach to the treatment of chronic pain. The first section presents a biopsychosocial model of pain. The second section presents an application of the biopsychosocial approach to the clinical assessment and management of clinical cases with chronic pain.- - - - - - - - - - ranking = 1.0058147498896keywords = physical (Clic here for more details about this article) |
5/217. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle.Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/217. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/217. giant cell arteritis presenting as chronic cough and prolonged fever.A 62-year-old man presented with a 3-month history of chronic non-productive cough and unexplained fever. Further questioning revealed that he had headaches and myalgia. Bilateral thickened temporal arteries were noted on physical examination. The erythrocyte sedimentation rate was 96 mm in 1 h. A biopsy specimen of the left temporal artery showed inflammatory changes consistent with the diagnosis of giant cell arteritis. Commencement of prednisolone resulted in rapid and dramatic resolution of his symptoms. physicians should be aware of respiratory symptoms in patients with giant cell arteritis in order to avoid delay in diagnosis and therapy of this condition.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/217. Hepatic calcification by sequelae of chronic schistosomiasis japonica: report of four cases.Due to the elimination of intermediate hosts and the improvement of clinical care, most parasitic infections have been effectively controlled in developing countries. Recently, the increase of the worldwide tourism, especially to Mainland china, and the migration of overseas workers from endemic countries have led to more parasitic infections that should not be overlooked by physicians. Assessment of diffuse liver disease with physical examination and laboratory findings is notoriously inaccurate. Thus, physicians use liver biopsy for accurate diagnoses. We present 4 patients with hepatic schistosomiasis japonica which were diagnosed using imaging before liver biopsy. Hepatic schistosomiais japonica has a tendency to cause dystrophic calcification and fibrosis in the liver. According to the results, a combination of ultrasonography and computed tomography (CT), used to recognize characteristic calcification patterns, seem useful to physicians for accurate diagnoses. Thus, unnecessary biopsy procedures can be avoided.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/217. Patient management and decision making in complete denture fabrication using a duplicate denture procedure: a clinical report.A patient may have difficulty adapting to a new prosthesis for either physical or psychological reasons. This article describes a procedure for duplicating an existing denture and gives the practitioner an alternative to the traditional denture fabrication techniques. The duplicated denture fabrication technique minimizes the changes to the new denture, making it easier for the patient to adapt to new dentures. However, in-depth communication with the patient is necessary for successful denture therapy.- - - - - - - - - - ranking = 0.25145368747239keywords = physical (Clic here for more details about this article) |
10/217. A developmentally sensitive approach to clinical hypnosis for chronically and terminally ill adolescents.Adolescents who suffer from terminal and/or chronic medical illnesses must face difficult developmental issues coupled with increased burdens of physical discomfort and uncertainty about survival. Clinical hypnosis is one technique that can be used to help these individuals gain a sense of comfort and control over their lives. I describe the use of a developmentally sensitive hypnotherapeutic intervention for chronically and terminally ill adolescents. I have used the technique for the reduction of various types of physical and psychological discomfort secondary to a range of medical problems such as cancer, end-stage renal disease, organ transplant, and hiv disease. The treatment focuses on the use of personalized procedures that attempt to increase perceptions of control through interactive formats. movement through a personally intriguing journey is used as a metaphor for controlling and moving away from discomfort. I also present three case examples as well as general treatment recommendations for clinical use.- - - - - - - - - - ranking = 0.50290737494479keywords = physical (Clic here for more details about this article) |
| | Next -> |