1/9. Gingival telangiectases: an underappreciated physical sign of juvenile dermatomyositis.BACKGROUND: medline searches (1966-June 1969) failed to identify references that give detailed descriptions of the oral manifestations of dermatomyositis (DM). However, several reports predating medline provided more complete descriptions of oral lesions associated with DM. OBSERVATIONS: We describe 5 cases of juvenile DM with oral manifestations, primarily in the form of gingival telangiectases. These findings are compared with those descriptions found in earlier reports. CONCLUSIONS: Oral lesions in juvenile DM have rarely been reported. mucous membrane involvement associated with DM may include telangiectases, edema, erosions, ulcers, and leukoplakia-like areas. In cases of DM, gingival telangiectases likely represent an underappreciated diagnostic finding analogous to nail-fold telangiectases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. Fulminant dermatomyositis after removal of a cancer.dermatomyositis developed suddenly in a diabetic patient with crest syndrome after the removal of a malignant tumor. Scrupulous physical examination excluded further systemic or cutaneous involvement. We raise certain still unsolved aspects regarding the association between dermatomyositis and neoplastic disorders.- - - - - - - - - - ranking = 2.1614230357743keywords = physical examination, physical (Clic here for more details about this article) |
3/9. dermatomyositis: evolution of a diagnosis.BACKGROUND AND PURPOSE: As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. CASE DESCRIPTION: The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. OUTCOMES: A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. DISCUSSION: Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/9. Periorbital edema: an important physical finding in dermatomyositis.Periorbital edema is frequently present in dermatomyositis and can be seen in the absence of other skin lesions. Sometimes, as in the two cases reported here, it can be the dominant physical sign.- - - - - - - - - - ranking = 1.25keywords = physical (Clic here for more details about this article) |
5/9. Muscular strength as an index of response to therapy in childhood dermatomyositis.dermatomyositis, an inflammatory disease of unknown etiology, causes diffuse symmetrical weakness and atrophy, muscular pain and tenderness, induration of muscles, and the tendency to develop contractures. The disease may follow a prolonged course which can best be managed with steroids and regulation of physical activity if there is an objective criterion for determining the extent of clinical involvement. In 6 children with dermatomyositis, quantitative muscular strength was compared with clinical evaluation of the state of the disease, serum enzyme levels, and other laboratory measures of systemic inflammation. Quantitative evaluation of ankle plantar flexor strength by the method of Beasley or handgrip force by the method of Mundale indicated that muscular strength provided a better criterion for the clinical status of the patient than any of the other laboratory tests studied. In dermatomyositis, the inflammation is equally great in distal and proximal muscles when tested quantitatively. These tests, when used together with enzyme levels and clinical evaluation, permit more effective management of dermatomyositis in children.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
6/9. Ovarian cancer in patients with dermatomyositis.A consensus regarding adequate screening to detect early malignancy in the setting of dermatomyositis (DMM) has yet to be reached. This issue is particularly relevant with regard to ovarian cancer, as early detection with routine examinations, ultrasound, and abdominal CT may not be successful. Four of 15 women diagnosed with and seen in our department for DMM between 1986 and 1993 were subsequently diagnosed with metastatic papillary serous ovarian carcinoma. One additional patient developed metastatic pelvic papillary adenocarcinoma, believed to be of ovarian origin. These diagnoses of advanced cancer were unexpected, as all women had undergone repeated cancer screenings beyond what is normally recommended for patients with DMM. The 5 women were strikingly similar in their initial presentations and subsequent courses. In each, the diagnosis of DMM was delayed from 2 to 10 months, as they were initially misdiagnosed with a photoinduced or contact dermatitis. All except 1 had severe, recalcitrant skin disease despite attempted therapy with antimalarial and immunosuppressive agents. All 4 patients who survived the postoperative period after tumor debulking showed either improvement or resolution of their DMM. It appears that women with DMM have an increased incidence of ovarian cancer, which is usually diagnosed months to a few years (range, 0 d to 6 y) after DMM has been diagnosed. Although recommendations have been made regarding cancer screening in these individuals, recommendations for initial and surveillance examinations vary from routine history and physical examination to evaluations including extensive radiologic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2.1614230357743keywords = physical examination, physical (Clic here for more details about this article) |
7/9. dermatomyositis, carcinoma of colon and meningioma in the same patient.dermatomyositis and carcinoma of colon were diagnosed in a 66-year-old woman. Meticulous physical examination excluded further systemic or cutaneous involvement. The musculocutaneous disorders responded well to daily oral corticosteroid, and the malignant tumor was totally removed surgically. After a seven-year follow-up of actual dermatomyositis controlled by maintenance doses of prednisone ranging from 5 to 15 mg daily, the patient developed a meningioma. Current concepts and data regarding various aspects of the combination between dermatomyositis and tumors are discussed. To our knowledge, this is the first reported case of meningioma associated with dermatomyositis.- - - - - - - - - - ranking = 2.1614230357743keywords = physical examination, physical (Clic here for more details about this article) |
8/9. dermatomyositis and nasopharyngeal carcinoma.A nasopharyngeal carcinoma was diagnosed in a 37-year-old man with a two year history of dermatomyositis. The physical and laboratory examinations excluded further medical problems. To our knowledge, this is the first case of dermatomyositis associated with nasopharyngeal carcinoma in a white Israeli Jewish patient.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
9/9. Spontaneous abdominal hematoma in dermatomyositis.dermatomyositis is associated with a number of systemic manifestations and diseases. We present 2 patients with dermatomyositis, aged 11 and 50 years, who developed acute abdominal pain, both a result of spontaneous hemorrhage. hemorrhage was detectable by physical examination in one and on computed tomography scan of the abdomen in the other. Both patients made a full recovery with supportive treatment. While the cause of the hemorrhage was uncertain, in 1 patient massive calcinosis of the abdominal wall was present, and trauma may have been the precipitant. Spontaneous abdominal hematoma is a cause of acute abdominal pain in patients with dermatomyositis, and surgery may be avoided if the diagnosis is recognized.- - - - - - - - - - ranking = 2.1614230357743keywords = physical examination, physical (Clic here for more details about this article) |