1/6. Amnesic syndrome and severe ataxia following the recreational use of 3,4-methylene-dioxymethamphetamine (MDMA, 'ecstasy') and other substances.A 26-year-old woman suffered disseminated intravascular coagulation (DIC) and a brief respiratory arrest following recreational use of 3,4-methylene-dioxymethamphetamine (MDMA; 'ecstasy'), together with amyl nitrate, lysergic acid (LSD), cannabis and alcohol. She was left with residual cognitive and physical deficits, particularly severe anterograde memory disorder, mental slowness, severe ataxia and dysarthria. Follow-up investigations have shown that these have persisted, although there has been some improvement in verbal recognition memory and in social functioning. magnetic resonance imaging and quantified positron emission tomography investigations have revealed: (i) severe cerebellar atrophy and hypometabolism accounting for the ataxia and dysarthria; (ii) thalamic, retrosplenial and left medial temporal hypometabolism to which the anterograde amnesia can be attributed; and (iii) some degree of fronto-temporal-parietal hypometabolism, possibly accounting for the cognitive slowness. The putative relationship of these abnormalities to the direct and indirect effects of MDMA toxicity, hypoxia and ischaemia is considered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.- - - - - - - - - - ranking = 15.203983119436keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Trans-metatarsal amputation as a complication of child sexual abuse.A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/6. Hemangiomas: new insights and classification.Infantile hemangiomas are the most common tumors of infancy, but less common vascular tumors also can affect young infants and children. In most cases, the diagnosis of IH can be made clinically, but imaging studies and even biopsy may be required in less-than-typical cases. With a careful history and physical examination focusing on the timing, location, and type of hemangioma, as well as extracutaneous signs and symptoms, the general pediatrician will know when to be concerned about a high risk vascular tumor and proceed with referral or further evaluations.- - - - - - - - - - ranking = 15.203983119436keywords = physical examination, physical (Clic here for more details about this article) |
5/6. An unusual complication of fetal blood sampling during labor.A female infant was delivered at term after biophysical and biochemical monitoring during the intrapartum period. At birth excessive bleeding was noted from the scalp incision sites, leading to severe anemia. The infant was also found to have congenital syphilis. The clinical course was complicated by the development of disseminated intravascular coagulation leading to death despite intensive management. Identification and appropriate management of excessive pre- and postnatal bleeding from a sampling incision is emphasized.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Platelet dysfunction associated with abdominal aortic aneurysm.An 82-year-old man with a one-year history of spontaneous ecchymoses and posttraumatic bleeding was found on physical examination to have a pulsatile abdominal mass. ultrasonography revealed a large abdominal aortic aneurysm with a freely moving 1.5--2-cm intraluminal thrombus. Laboratory data disclosed intravascular hemolysis, disseminated intravascular coagulation, and a prolonged bleeding time. Further investigation of platelet function demonstrated decreased glass bead retention (0-15%), and reduced or delayed aggregation responses to adenosine diphosphate, epinephrine, and collagen. Studies of platelet factor 3 availability, antiplatelet antibodies, and aggregation response to ristocetin were normal. Transfusion of ten units of normal platelets failed to shorten the patient's bleeding time, despite a marked rise in platelet count. glass bead retention studies on normal and patient blood were not altered by mixture with patient and normal platelet-poor plasma, respectively. Platelet dysfunction in the presence of arterial aneurysm does not appear to have been reported previously.- - - - - - - - - - ranking = 15.203983119436keywords = physical examination, physical (Clic here for more details about this article) |