1/7. Bizarre paediatric facial burns.child abuse and neglect account for a significant number of paediatric burn injuries. It is of great importance because of the high mortality, high frequency of repeated abuse, as well as the physical, psychological and social sequelae that it causes. Burn abuse is often under-recognized and under-reported because it is difficult to define non-accidental injury. On the other hand, false accusation of burn abuse is extremely damaging to the family. Bizarre and unusual burn injuries can be caused by accident and should not automatically be assumed to be deliberate injury. Three boys of age 1-7 years with bizarre facial burns were admitted to the burns Unit at the Prince of wales Hospital between February 1995 and July 1999. One was burned by his baby-sitter with hot water steam and the other two were burned by their mothers with hot boiled eggs. The unusual causes of their burns raised the suspicion of child abuse and formal investigations were carried out by the Social Services Department. Detail assessment including a developmental history of the child and the psychosocial assessment of the family revealed that these three boys were burned because of poor medical advice and innocent cultural belief.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. Bruising: a useful physical sign in ruptured knee joint.The clinical distinction of a ruptured knee joint or popliteal cyst from a deep venous thrombosis is important in the planning of treatment, particularly to avoid anticoagulant therapy. Bruising, which may be severe, may occur when inappropriate anticoagulants are administered. It is less well recognised that spontaneous bruising may occur with a ruptured knee joint even when anticoagulant therapy has not been given. A case is presented which demonstrates this useful physical sign and shows also the value of the patient's history in eliciting the diagnosis. The bruising extended to the foot, its gravitational and propulsive advance being halted by the pressure of footwear. This appearance has not been emphasised in the rheumatology literature.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
3/7. Management of laryngotracheal trauma.Blunt trauma to the neck requires a systematic analysis of the laryngotrachea, the esophagus and the cervical spine in addition to general trauma considerations. Acute airway decompensation is best managed by tracheotomy, although if the situation permits, an orderly physical examination including indirect laryngoscopy and selected roentgenographic studies will yield an appropriate picture of the injury. Although broad guidelines are helpful, each case may dictate an individual therapeutic modification.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/7. Training room evaluation of chest pain in the adolescent athlete.A physician or athletic trainer will often be faced with an athlete complaining of chest pain during or after an event. chest pain in children and adolescents is usually of a noncardiac origin; only 5% of cases are due to cardiac problems. With a properly documented history and physical evaluation, one can usually identify the etiology of the chest discomfort or at least rule out any serious difficulties. The various diagnostic possibilities include cardiac, musculoskeletal, pulmonary, gastrointestinal, and psychiatric causes of pain. We discuss several specific conditions, as well as the signs, symptoms, and basic management.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/7. An unusual presentation of liver laceration in a 13-yr-old football player.Abdominal injury occurs infrequently from athletic trauma, yet when it does occur, it can be very serious. Although rupture of a major blood vessel can lead to rapid loss of blood, insidious blood loss can also result from apparently insignificant injury of the spleen, liver, or kidney and lead to delayed problems. awareness of the potential for such injury is vital because outcome can be adversely affected by a low index of suspicion, and this can be compounded by the fact that the initial physical examination is not always a reliable indicator of the severity of injury. Classic reports of these injuries describe splenic injury from a left-sided blow and hepatic injury from right-sided trauma. We present a case report of liver laceration in a young football player not only to comment on its unusual mechanism and presentation, but also to illustrate the importance of rapid assessment and transport of the athlete with a serious abdominal injury to avoid the consequences of delayed diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/7. Two cases of psychogenic purpura.Psychogenic purpura, also known as recurrent painful bruising or autoerythrocyte sensitization syndrome (Gardner-diamond syndrome) is usually associated with emotionally disturbed patients. It is a troublesome entity for both patient and physician since extensive work-ups yield no diagnosis. We describe two females in their early twenties with recurrent painful bruising and diverse accompanying symptoms which appeared after physical trauma. One of the patients developed a bruise after intradermal injection of her own blood (with no reaction to saline injection). One patient had a personality (borderline) disorder, the other a factitious disorder. Punch biopsies revealed a perivascular inflammatory infiltrate, erythrocyte extravasation and no vasculitis. Psychogenic hemorrhagic disorders are uncommon yet must be considered in the differential diagnosis of purpura. patients are usually young emotionally troubled females who present painful recurrent bruises on extremities frequently after trauma or surgery. Autoimmune mechanisms and increased cutaneous fibrinolytic activity have been implicated, although further studies are needed. Correct diagnosis is important to avoid aggressive and even mutilating treatments, and an adequate comprehension of these purpuras is important for the attending physician.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/7. brown-sequard syndrome of the cervical spinal cord after chiropractic manipulation.We report a case of increased signal in the left hemicord at the C4 level on T2-weighted MR images after chiropractic manipulation, consistent with contusion. The patient displayed clinical features of brown-sequard syndrome, which stabilized with immobilization and steroids. Follow-up imaging showed decreased cord swelling with persistent increased signal. After physical therapy, the patient regained strength on the left side, with residual decreased sensation to pain involving the right arm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |