1/9. Ileosigmoid knotting: a case report and review.Ileosigmoid knotting, or compound volvulus, has not been reported previously in australia. A 41 year old woman of Anglo-Saxon origin presented with a short history of extreme abdominal pain that was out of proportion to her physical findings. At operation it was found that her entire ileum was tightly knotted around the redundant, twisted sigmoid colon. Both closed loops were gangrenous and it was impossible to unravel the bowel. She recovered uneventfully following resection and primary anastomosis of both portions of the intestine. Most patients with this uncommon condition have been reported from finland and eastern africa. An arrangement of the small bowel and sigmoid colon on long, narrow mesenteries would appear to be a prerequisite. The brevity of the history and the severity of the abdominal pain call for early laparotomy. Prolonged attempts to untie the knot are dangerous. It is safer to divide the ileum at the knot and resect it in order to release the sigmoid colon. Primary anastomosis is feasible where the history is short and the uninvolved intestine is clean and collapsed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. pyoderma gangrenosum.pyoderma gangrenosum is an uncommon skin disorder often associated with systemic disease, especially chronic ulcerative colitis (Figures 1, 2, and 3). Therapy is twofold--local care and control of the underlying illness. While the overall prognosis is good and the disease is rarely fatal, pyoderma gangrenosum is physically and mentally crippling with a propensity for recurrence.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma.Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
4/9. Large vessel occlusive disease associated with crest syndrome and scleroderma.OBJECTIVES--To report the cases of three patients with crest syndrome and one patient with diffuse scleroderma who had severe macrovascular disease and only minimal vascular risk factors. methods--The medical histories, physical examinations, and results of clinical investigations were reviewed in four patients. RESULTS--These four patients had severe morbidity from macrovascular disease of the arms and legs in the presence of minimal underlying vascular risk factors. These patients represent 11% of the women with scleroderma seen at our hospital since 1974. This is a greater than threefold increase above the expected proportion of symptomatic vascular disease seen in population studies. In the patients with crest syndrome, large vessel disease was first seen more than 10 years after the onset of Raynaud's phenomenon, which was the first manifestation of the disease. A pathological specimen of the ulnar artery from one patient showed severe luminal narrowing by an acellular material with no evidence of atheroma. CONCLUSIONS--These cases suggest an association of both the crest syndrome and scleroderma with macrovascular disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. Bacterial discitis caused by limb gangrene requiring below-knee amputation.Two patients presented with disabling back pain and were unable to participate in physical therapy activities after being admitted to an acute rehabilitation center. Both patients had bacterial discitis of the lumbar spine that was apparently caused by infected ischemic limb tissue, ultimately removed at below-knee amputation. The literature describes many cases of bacterial discitis infected from many sources, but not from ischemic limb tissue requiring subsequent amputation. Many such cases may exist, however, and earlier recognition of this condition will enable appropriate treatment before vertebral destruction and/or neurological sequelae.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. Pedal manifestations of meningococcal septicemia.While there have been several reports of upper and lower extremity amputations secondary to meningitis and purpura fulminans in the literature, the incidence is probably rare. Delmas et al studied five pediatric subjects with gangrene caused by meningococcemia, with four requiring amputation. Weiner reported that all 12 patients in his review received a lower extremity amputation, with several requiring upper extremity amputation. Joint contracture, while not as commonly discussed as amputation, is nonetheless an important and perhaps more common finding. Urbaniak et al indicated that of six patients reviewed, three developed significant joint contractures. With the exception of the gangrenous changes discussed, it was joint contracture that was the most limiting factor in progression to full activity and weightbearing in the authors' subject. Prompt, aggressive physical therapy is tantamount to effecting an acceptable long-term outcome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Peripheral atheroembolism: an enigma.Fifteen patients with peripheral atheroembolism were studied and followed up for from one to three years. Clinical recognition of this condition is often masked by its elusive presentation. foot pain may be the very earliest symptom. Transient presentation is an important feature. Eventually, gangrene develops in the toes. ankle pulses are present on physical examinations. Both aortography showing proximal ulcerative plaques and digital arteriograms revealing the sharp cutoff pattern of an arterial embolus provide diagnostic confirmation. The results of treatment were satisfactory in all instances following aortoiliac endarterectomy or Dacron graft interposition. In five patients wiht gangrenous changes, toe amputation was necessary.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. Peripheral gangrene in childhood: further observations on its aetiology and psycho-social sequelae in nigeria.Nine children, aged one day to 10 years, presented with gangrene at the Paediatrics Department, University College Hospital, Ibadan. The aetiological factors included septic skin spots (4 cases), snake bite (1 case), femoral vein thrombosis (1 case), and congenital arterial block by embolized placental tissue (1 case). One patient had polyarteritis of undetermined aetiology, and another probably had vasculitis complicating a staphylococcal septicaemia. Two of the nine patients died. Five of the seven survivors had a significant physical handicap subsequently.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. gangrene and spontaneous perforation of the cecum as a complication of pseudo-obstruction of the colon: report of three cases and speculation as to etiology."Pseudo-obstruction of the colon" refers to a condition in which physical and radiologic findings identical to those associated with mechanical obstruction of the large bowel are found, but in which no organic cause of colonic distention can be identified. These cases may involve progressive proximal large-intestinal dilation to the point of cecal perforation or necrosis. Two cases of spontaneous perforation of the cecum and one case of gangrene of the cecum secondary to proximal distention of the right colon that followed pseudo-obstruction of the colon are presented. Various etiologic factors reported in the medical literature are discussed and analyzed, and an anatomicophysiologic explanation of a possible mechanism, based on sympathetic-parasympathetic neurostimulatory imbalance, is offered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |