1/16. Low-intensity laser therapy for benign fibrotic lumps in the breast following reduction mammaplasty.BACKGROUND AND PURPOSE: Fibrotic masses in the breast secondary to fat necrosis or hematoma are a complication of breast reduction mammaplasty. The treatment commonly recommended for this condition is early surgical debridement of necrotic tissue from the entire area, which causes scarring. This case report describes the use of low-intensity laser therapy for fibrotic lumps following reduction mammaplasty. CASE DESCRIPTION: The patient was a 46-year-old woman who had breast reduction surgery 80 days prior to referral for physical therapy. At the time of referral, the largest mass was 8.0 cm in diameter. The patient reported pain and said she was distressed about the breast disfigurement. Laser irradiation was initiated at an energy density (ED) of 20 J/cm2 and a pulse repetition rate of 5,000 pulses per second. The laser settings were adjusted during the 8-month treatment period. The final ED was 50 J/cm2. OUTCOMES: The mass was 33% of its original size after 3 treatments over the initial 11-day period. Pain relief was immediate. The rate of resolution decreased after the initial period. The patient had some tissue thickening at the time of discharge after 6 months of treatment. DISCUSSION: This case demonstrates the potential use of laser therapy as a treatment for benign breast lumps following mammaplasty.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Percutaneous release of abductor pollicis brevis muscle fibrosis in a bowler--a case report.The authors reported a patient with abductor pollicis brevis muscle fibrosis of the right thumb, stemming from a bowling injury that had occurred 6 years previously. At that time in the acute stage, a Chinese bonesetter treated the injury using manipulation, massage and herbal drugs. Abduction contracture of the patient's right thumb developed. She began to experience chronic pain at dorsal side of her right thumb and discovered that she could not move her thumb into a retro position. When she came into our hospital, physical examination revealed an abduction contracture of patient's right thumb, the angle of separation was 60 degrees, and the angle of circumduction was fixed at 90 degrees. In addition, a fibrotic band was palpable in abductor pollicis brevis muscle. The patient responded well to percutaneous release and physical therapy. As far as we know, this is an unusual case, which has not been reported before.- - - - - - - - - - ranking = 7.2595266663678keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Chronic interstitial lung disease with lung fibrosis in a girl: uncommon sequelae of Epstein-Barr virus infection.A 12-month-old immunocompetent girl presented with tachypnea, inspiratory crackles, mild hypoxemia, and failure to thrive after an acute Epstein-Barr virus (EBV) infection. The course of acute EBV infection was demonstrated by viral load measurement in plasma and peripheral blood mononuclear cells (PBMC) by using real-time polymerase chain reaction (PCR). EBV dna was further detected by PCR in bronchoalveolar lavage (BAL) fluid and from a lung-tissue specimen obtained by open-lung biopsy, which indicates the pulmonary involvement of active EBV infection. histology revealed an uncharacteristic interstitial infiltration and fibrosis. Following topic and systemic treatment with corticosteroids, the child became asymptomatic and showed normal weight gain as well as mental and physical development. Pulmonary parenchymal involvement during the course of primary EBV infection may result in interstitial lung disease and fibrosis not only in immunodeficient, but in immunocompetent children as well. Treatment with combined inhaled and oral steroids seems to be a treatment option in these patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/16. Congenital contracture of the quadriceps muscle: a case report with magnetic resonance imaging.INTRODUCTION: Case report of a rare form of congenital contracture of the quadriceps muscle. Congenital contracture of the quadriceps muscle is encountered very rarely in daily orthopaedic practice. A few cases have been reported, but unfortunately these did not detail the MRI findings of congenital contracture. MATERIALS AND methods: A 34-year-old woman presented with difficulty in sitting with full flexion of the bilateral knee joints. She had no history of intramuscular injection, and her brother had a similar abnormality. A physical and radiographical review of the case was conducted. RESULTS: A palpable corded induration was detected in the quadriceps muscle which prevented further flexion of the bilateral knee joints. magnetic resonance imaging of both thighs demonstrated marked atrophy of the rectus femoris muscle and dark signal intensity of the muscle on both T1-weighted and T2-weighted images. It was suggested that the muscles had been replaced by fibrosis. CONCLUSION: This appears to be the first report to include MRI findings of congenital contracture. Clinical awareness of congenital contracture with unique clinical symptoms and radiographic findings may aid the correct diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. Spontaneous bacterial peritonitis due to Brucella infection.Brucella infection is a systemic disease, but the microorganism rarely causes infections in the gastrointestinal system such as hepatitis, cholecystitis, colitis and pancreatitis. Spontaneous bacterial peritonitis due to Brucella is extremely rare. Herein, we report a case of cirrhosis complicated with nongranulomatous hepatitis and peritonitis, both due to Brucella. A 63 year-old man with diabetes mellitus was admitted to hospital with complaints of weakness, backache, abdominal pain and abdominal swelling. On the basis of physical examination and laboratory findings, cryptogenic cirrhosis and spontaneous bacterial peritonitis were diagnosed. Due to persistent fever and backache, serum Brucella agglutination test was performed and found to be positive. brucella melitensis was isolated from ascitic fluid culture. Liver biopsy findings revealed cirrhosis and a nongranulomatous hepatitis which was thought might be due to Brucella infection. doxycycline and rifampicin, in addition to diuretics were administered for spontaneous ascites infection due to Brucella. A week later, the patient's condition improved and he became afebrile. After two months of therapy, the ascites had almost disappeared.- - - - - - - - - - ranking = 6.2595266663678keywords = physical examination, physical (Clic here for more details about this article) |
6/16. neostigmine for the treatment of acute hepatic encephalopathy with acute intestinal pseudo-obstruction in a cirrhotic patient.We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple air-fluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gut-derived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.- - - - - - - - - - ranking = 6.2595266663678keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Post-traumatic severe trismus caused by impairment of the masticatory muscle.Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/16. Allogeneic marrow transplantation in patients with severe systemic sclerosis: resolution of dermal fibrosis.OBJECTIVE: To evaluate the safety and efficacy of allogeneic hematopoietic cell transplantation (HCT) after myeloablative conditioning in patients with severe systemic sclerosis (SSc). methods: Eligibility criteria for the study included SSc patients with features indicative of a poor prognosis. The myeloablative conditioning regimen included busulfan, cyclophosphamide, and antithymocyte globulin. Prophylaxis for graft-versus-host disease (GVHD) consisted of cyclosporine and methotrexate. bone marrow was transplanted from HLA-identical siblings. RESULTS: Two patients with diffuse cutaneous SSc and lung involvement who were refractory to conventional immunosuppressive treatment were enrolled in the study. In patient 1, there were no complications related to the conditioning regimen, and GVHD did not develop after transplantation. At 5 years after HCT, there was nearly complete resolution of the scleroderma and marked improvement in physical functioning. Internal organ function improved (lung) or remained stable. On examination of serial skin biopsy samples, there was resolution of the dermal fibrosis. Patient 2 experienced skin toxicity from the conditioning regimen and hypertensive crisis that was likely related to high-dose corticosteroids given for treatment of GVHD. Although this patient experienced an improvement in scleroderma and overall functioning, a fatal opportunistic infection developed 17 months after HCT. CONCLUSION: Allogeneic HCT may result in sustained remission of SSc. GVHD and opportunistic infections are the major risks associated with allogeneic HCT for SSc, as for allogeneic HCT in general.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. Nephrogenic systemic fibrosis among liver transplant recipients: a single institution experience and topic update.Nephrogenic systemic fibrosis (NSF) is a recently characterized systemic fibrosing disorder developing in the setting of renal insufficiency. NSF's rapidly progressive nature resulting in disability within weeks of onset makes early diagnosis important. Two reports of NSF after liver transplantation are known of. We present three cases of NSF developing within a few months after liver transplantation and review the current literature. Loss of regulatory control of the circulating fibrocyte, its aberrant recruitment, in a milieu of renal failure and a recent vascular procedure appear important in its development. Known current therapies lack consistent efficacy. Only an improvement in renal function has the greatest likelihood of NSF's resolution. Delayed recognition may pose a significant barrier to functional recovery in the ubiquitously deconditioned liver transplant patient. Early recognition and implementation of aggressive physical therapy appear to have the greatest impact on halting its progression.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/16. Aesthetic results following partial mastectomy and radiation therapy.This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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