1/12. Presentations of physical illness in people with developmental disability: the example of gastro-oesophageal reflux.People with developmental disabilities are becoming an important part of the general practice population. Although they have a similar range of medical conditions to the general population, there are some important differences in prevalence, risk factors, presentation and management of particular conditions. We use gastro-oesophageal reflux to illustrate how developmental disability may affect the presentation, assessment and management of a common condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. Nasal pain disrupting sleep as a presenting symptom of extraesophageal acid reflux in children.A constellation of otolaryngologic signs and symptoms has been suggested to identify the association between extraesophageal reflux disease (EERD) and pediatric otolaryngologic disorders. We describe chronic nasal pain as a manifestation of laryngopharyngeal acid reflux in a 4-year-old boy who presented with frequent night awakenings due to severe nasal pain. His presentation, relevant history physical examination, diagnostic studies, and response to therapy are described. This is the first report documenting nasal pain resolved with acid suppressive therapy in a child with EERD. The incidence and pathogenesis of EERD induced nasal symptoms in children merits further investigation.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
3/12. gastroesophageal reflux disease in an 8-year-old boy: a case study.OBJECTIVE: To present the diagnosis and management of gastroesophageal reflux disease found in a pediatric patient, to discuss the importance of a detailed case history, and to bring forward some of the most important clues, both verbal and nonverbal, that can lead to the diagnosis. CLINICAL FEATURES: An 8-year-old boy was brought to a chiropractic clinic by his mother complaining of headache and neck pain. Based on the history and physical examination, a diagnosis of cervicogenic headache was made. INTERVENTION AND OUTCOME: Treatment consisted of chiropractic manipulation of the upper cervical spine in combination with cranial treatment was applied in addition to dietary advice. The headache returned and the patient was then referred to a colleague for a second opinion. Based on a detailed history, gastroesophageal reflux disease was diagnosed and the patient was referred to a specialist for suitable treatment. CONCLUSION: Because of the position as first-line health practitioners, it is inevitable that doctors of chiropractic will be faced with complaints of a nonbiomechanical nature. It is important to recognize conditions, such as gastroesophageal reflux, at an early stage and to refer appropriately.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
4/12. Dental erosion in patients with chronic alcoholism.tooth wear attributed to the physical wear of teeth by clenching and grinding (attrition) has been described previously in alcoholic patients. However, the pattern of wear seen in the series of cases reported here is more consistent with chemical damage (erosion) than attrition. A possible mechanism for this process is suggested, and it is further suggested that erosion is likely to play a more important role in the wear of the teeth in chronic alcoholic patients than attrition.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
5/12. The etiology and management of rumination and psychogenic vomiting: a review.Chronic vomiting, in the absence of discernible physical illness, is a problem sometimes seen in individuals labeled as mentally retarded or mentally ill. This behavior often becomes life-threatening, particularly when it occurs in young children. Over the decades several theoretical analyses have been made of this behavior, and a wide range of treatments have been developed. This paper is a summarization of current and historical literature related to three types of chronic vomiting: (1) rumination in the infant; (2) rumination in the older child and adult; and (3) psychogenic vomiting. Treatment strategies are reviewed in some detail and are evaluated for the practitioner using effectiveness and efficiency as the main evaluative criteria. Several ideas for further research and theoretical analysis are also suggested.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
6/12. A case of profound iron deficiency anemia owing to corrosive esophagitis in a 20-year-old developmentally delayed male.The level of severe compensated iron deficiency anemia incompatible with life is not defined in the pediatric or adolescent literature. A hemoglobin of 1.5 gm/dl in an older adolescent with few physical symptoms is distinctly unusual. A case of profound iron deficiency anemia in a 20-year-old developmentally delayed male is the subject of this brief report. There were only subtle physical findings in spite of this severe anemia. The anemia was the result of corrosive esophagitis associated with a hiatal hernia and reflux. physicians dealing with developmentally delayed adolescents should be aware of the fact that a severe anemia may develop, and such individuals should be periodically screened for anemia, melena, hematochezia, and hematemesis.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/12. Gastrointestinal abnormalities: a significant cause of feeding difficulties and failure to thrive in Brachmann-de lange syndrome.Gastroesophageal abnormalities occur with increased frequency in patients with Brachmann-de lange syndrome (BDLS) and contribute to problems with feeding, emesis and failure to thrive. Comprehensive evaluation including longitudinal assessment of growth and development of 8 patients with BDLS was performed. Clinically significant feeding problems occurred in 6 of the 8 patients and the affected children were subsequently evaluated for gastrointestinal abnormalities. Findings in these patients included tracheal aspiration, esophageal dysmotility, gastroesophageal reflux, hiatal hernia, and esophagitis. Medical treatment was instituted where appropriate, and surgical treatment was performed if the problems did not resolve with medical treatment. Improvement in weight centiles occurred in all patients fed by nasogastric or feeding gastrostomy tube but only one patient appeared to experience increase in rate of linear growth. Careful monitoring of symptoms and growth parameters, and prompt institution of appropriate medical and surgical measures can improve the health and physical outcome of many patients with BDLS.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
8/12. 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 = 0.25keywords = physical (Clic here for more details about this article) |
9/12. Congenital stridor.Congenital stridor is a common problem that has many very different etiologies. A complete history and physical examination will allow the astute clinician to direct the laboratory evaluation efficiently. Establishing a relationship with a specialist will be useful for consultation when considering a referral in questionable situa.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
10/12. Persistent failure-to-thrive: a case study.The inability to successfully feed a young infant or child is as worrisome to parents as it is to the health care provider. Early growth failures are likely to reflect difficulty with infant homeostasis and often respond to medical management of the physical problem that is temporarily interfering with the infant's ability to feed by mouth. In addition to medical management, however, treatment also necessitates investigation and management of behavioral problems that so universally accompany growth failure. This article presents a case study of a child who presented with poor growth and respiratory symptoms associated with nonregurgitant gastroesophageal reflux, a clinical entity that can be difficult to recognize. Although surgical management of this condition was successful, persistent failure-to-thrive continued and was seemingly recalcitrant to treatment. The use of cyproheptadine as an appetite stimulant to promote weight gain in this child is discussed with a review of the current literature regarding this pharmacologic approach to poor weight gain. A behavioral-based treatment plan is described as an alternate management method, avoiding the use of pharmacologic agents in general.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
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