1/36. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients.This report describes the evaluation of 1,278 patients referred to The Johns Hopkins Hospital with dilated cardiomyopathy. After a careful history and physical examination, selected laboratory tests, and endomyocardial biopsy, a specific diagnosis was made in 49% of cases. In 16% of cases the biopsy demonstrated a specific histologic diagnosis. myocarditis and coronary artery disease were the most frequent specific diagnoses; 51% of patients were classified as idiopathic. Thus a rigorous and systematic search can demonstrate an underlying cause for approximately one-half of patients with unexplained cardiomyopathy. Endomyocardial biopsy plays a crucial role in this evaluation. Six cases are presented which demonstrate the utility of endomyocardial biopsy in specific clinical situations. In addition to its routine use in monitoring rejection in heart transplant recipients, endomyocardial biopsy is indicated in the evaluation of possible infiltrative cardiomyopathy, in differentiating restrictive cardiomyopathy from constrictive pericarditis, and in diagnosing and monitoring doxorubicin cardiotoxicity. The importance of diagnosing myocarditis remains controversial, and disagreement persists about the utility of immunosuppressive therapy in these patients. A combination of clinical and histologic features can divide patients with myocarditis into 4 subgroups--acute, fulminant, chronic active, and chronic persistent. This classification provides prognostic information and may identify those patients who may respond to immunosuppression, as well as those likely to have adverse outcomes from such treatment. The continued development of novel molecular techniques may allow endomyocardial biopsy to provide greater prognostic and therapeutic information in the future.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/36. Velocardiofacial syndrome in childhood-onset schizophrenia.OBJECTIVES: Deletion of chromosome 22q11 (velocardiofacial syndrome) is associated with early neurodevelopmental abnormalities and with schizophrenia in adults. The rate of 22q11 deletions was examined in a series of patients with childhood-onset schizophrenia (COS), in whom early premorbid developmental and cognitive impairments are more pronounced than in adult-onset cases. METHOD: Through extensive recruiting and screening, a cohort of 47 patients was enrolled in a comprehensive study of very-early-onset schizophrenia. All were tested with fluorescence in situ hybridization for deletions on chromosome 22q11. RESULTS: Three (6.4%) of 47 patients were found to have a 22q11 deletion. All 3 COS patients with 22q11 deletions had premorbid impairments of language, motor, and social development, although their physical characteristics varied. brain magnetic resonance imaging revealed increased midbody corpus callosum area and ventricular volume in relation both to healthy controls and to other COS patients. CONCLUSIONS: The rate of 22q11 deletions in COS is higher than in the general population (0.025%, p < .001) and may be higher than reported for adult-onset schizophrenia (2.0%, p = .09). These results suggest that 22q11 deletions may be associated with an earlier age of onset of schizophrenia, possibly mediated by a more salient neurodevelopmental disruption.- - - - - - - - - - ranking = 0.11285251499942keywords = physical (Clic here for more details about this article) |
3/36. work environment of Danish shift and day workers.OBJECTIVES: Both shift work and other work environment factors have been shown to be related to heart disease. This study examined whether shift work is associated with other work environment factors related to heart disease in a random sample of the population. If so, shift work could be acting as a proxy for work environment differences. methods: Data on 5940 employees in the Danish work environment Cohort Study from 1990 were reanalyzed. The information included work schedules [permanent day work, irregular workhours (including morning work), 2-shift or fixed evening and 3-shift or fixed night], length of workweek, physical factors (noise, heat, dust, passive smoking, walking, standing and monotonous repetitive tasks), and psychosocial factors (including demands and control dimensions, social support, conflicts and job insecurity). RESULTS: At least 1 group of shift workers had a higher prevalence of nearly every unfavorable work environment factor investigated. Exceptions were dust exposure and quantitative demands. Especially conflicts at work and low decision latitude were higher among all the groups of shift workers, and all-day walking or standing work and part-time jobs were more often found among female shift workers. The 3 different shiftwork groups were exposed to different parts of the work environment, and also men and women in shift work differed in relation to the work environment. Age and social class influenced the relationship, but not in any particular pattern. CONCLUSIONS: In a heterogenous population shift work was found to be associated with other work environment factors suspected to cause heart disease.- - - - - - - - - - ranking = 0.11285251499942keywords = physical (Clic here for more details about this article) |
4/36. survivors of childhood cancers: implications for obstetric anaesthesia.Treatment of many childhood malignancies involves surgery, radiotherapy and chemotherapy. If the child survives, normal physical development can be impaired and abnormalities with anaesthetic implications may be present. We discuss two women with a range of problems who presented for obstetric anaesthesia, having survived childhood malignancies. Common features included anthracycline cardiotoxicity and short stature. Both patients received incremental spinal anaesthesia in order to titrate the dose of local anaesthetic required to produce an adequate block height and to minimize cardiovascular instability.- - - - - - - - - - ranking = 0.11285251499942keywords = physical (Clic here for more details about this article) |
5/36. Free-floating ball thrombus in the left atrium.Free-floating ball thrombi in the left atrium are rarely seen. They can cause sudden death by occluding the mitral valve. A 47-year-old female patient who showed signs of mitral stenosis during a physical examination and atrial fibrillation by electrocardiography was not administered anticoagulant therapy. On the transthoracic echocardiogram, a stenotic mitral valve and a floating mobile mass were seen inside the large left atrium. This mass was rounded (ball-like), had smooth contours, and occasionally occluded the stenotic mitral valve. The patient underwent emergency surgery to remove the mass, which was later proven to be a thrombus pathologically. Additionally, mitral valve replacement was performed. The importance of anticoagulant therapy for patients with rheumatic mitral stenosis has been emphasized by this case.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/36. mulibrey nanism: review of 23 cases of a new autosomal recessive syndrome.Mulibrey (muscle, liver, brain, eye) nanism is probably an autosomal recessive condition characterized by progressive growth failure of prenatal onset, triangular face with hydrocephaloid skull, general thinness and muscular hypotonicity, peculiar voice, venous congestion caused by pericardial constriction, and pigment dispersion and yellowish dots in ocular fundi. Two thirds of the patients had cutaneous nevi flammei and one third cystic fibrous dysplasia of the tibia. Probably a substantial portion of the affected are lost by early abortion and others by infantile death. The physical capacity and life expectancy seem to vary depending on the degree of the cardiac affection.- - - - - - - - - - ranking = 0.11285251499942keywords = physical (Clic here for more details about this article) |
7/36. Utility of hand-carried ultrasound for consultative cardiology.Although the stethoscope has been an important part of the bedside cardiac diagnostic examination for generations of physicians, this clinical tool has been relatively unchanged in over 150 years. echocardiography is established as an essential diagnostic imaging method for patients with known or suspected cardiovascular diseases. However, routine echocardiography systems are large and heavy, and although they are portable, they remain inconvenient for bedside patient rounds. Technologic advances have resulted in miniaturization of electronic components and small, lightweight ultrasound systems have been recently introduced. These hand-carried units offer clinically acceptable two-dimensional image quality for rapid "quick-look" bedside diagnostics, in particular focusing on global and regional left ventricular function and presence or absence of pericardial effusion. This article proposes a general approach to the rapid hand-carried ultrasound cardiac exam as an extension of the physical examination. It details case examples and reviews the initial clinical experience of hand-carried ultrasound on cardiac consultation rounds. hand-carried ultrasound has promise to have an immediate impact on bedside patient management though expediting and facilitating the delivery of medical care.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/36. Anniversary reactions presenting as physical complaints.The literature concerning anniversary reactions is reviewed. Five cases seen by various medical specialists for physical complaints, and subsequently referred for psychiatric evaluation are presented. Each case was felt to represent an anniversary reaction. The necessity of considering the possibility of an anniversary reaction, when the genesis of a complaint is unclear, is emphasized.- - - - - - - - - - ranking = 0.5642625749971keywords = physical (Clic here for more details about this article) |
9/36. Near-syncope after exercise.syncope and near-syncope are great diagnostic challenges in medicine. On the one hand, the symptom may result from a benign condition and pose little or no threat to health other than that related to falling. On the other hand, syncope or near-syncope can be the manifestation of a serious underlying condition that poses an imminent threat to life. patients with a cardiac cause of syncope are at far greater risk of dying in the first year after an episode of syncope or near-syncope than individuals with a noncardiac cause. A cardiac cause of syncope should be considered in every patient with syncope or near-syncope, but it is particularly common in older patients or in patients with known structural heart disease, arrhythmia, or certain electrocardiographic abnormalities. Although many diagnostic tests may be helpful in the evaluation of syncope and near-syncope, the history, physical examination, and electrocardiogram pinpoint the cause in many circumstances. syncope after exercise may be due to left ventricular outflow tract obstruction from aortic stenosis or hypertrophic obstructive cardiomyopathy but can also suggest the diagnosis of postexercise hypotension in which an abnormality in autonomic regulation of vascular tone or heart rate results in vasodilation or bradycardia after moderate-intensity aerobic activity. The patient discussed in this case highlights the importance of the clinical history in the evaluation of this condition, since the diagnosis was revealed as the patient's story was described and eventually acted out.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/36. heart transplantation in a 68-year-old patient with senile systemic amyloidosis.Senile systemic amyloidosis (SSA) results from deposition, predominantly in the heart, of amyloid fibrils derived from wild-type transthyretin (T TR) molecules. Cardiac autopsies indicate that SSA progressively increases in subjects 80 years of age and older. However, only a few cases of patients with SSA and cardiac failure have been recognized by cardiac biopsies during life. Here, we report a case of heart transplantation in a 68-year-old male patient with SSA. After cardiopulmonary resuscitation in October 1998, he underwent complete evaluation. Myocardial biopsies revealed the presence of amyloid deposition. Immunohistochemical staining of the amyloid indicated T TR. Genomic dna analysis of the T TR exons did not result in any identification of a mutation. In 2001, heart transplantation was performed because progressive heart failure occurred. At the 1-year follow-up, no amyloid deposits were found in the donor heart. At the 2-year follow-up, the patient's physical and mental health was excellent. We conclude that heart transplantation can be an effective treatment in progressive heart failure due to SSA.- - - - - - - - - - ranking = 0.11285251499942keywords = physical (Clic here for more details about this article) |
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