1/34. A bleeding tendency as the first symptom of a choledochal cyst.We report an 8-month-old male presenting with gingival hemorrhages and nasal bleeding as the first symptom of a choledochal cyst (CC). On physical examination, there was a large cystic mass in the right upper abdominal quadrant. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin k deficiency. After administration of 5 mg vitamin K the bleeding tendency disappeared. At laparotomy, a large CC 5 cm in diameter was found and the liver showed moderate cholestasis. The sudden onset of a bleeding tendency in infants with congenital liver or biliary-tract disease may suggest not only biliary atresia, but also CC.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/34. Adrenal hemorrhage: a 25-year experience at the Mayo Clinic.OBJECTIVE: To characterize the clinical course of adrenal hemorrhage (AH) by using a systematic review of the presentation, associated conditions, and outcomes in patients with AH seen at our institution between 1972 and 1997 (a 25-year period). patients AND methods: A computer search of recorded dismissal diagnoses identified 204 patients with a diagnosis of AH, but only 141 fulfilled our study criteria. Their records were analyzed systematically by presentation, bilateral or unilateral hemorrhage, corticosteroid treatment, and survival. RESULTS: AH is a heterogeneous entity that occurs in the postoperative period, in the antiphospholipid-antibody syndrome, in heparin-associated thrombocytopenia, or in the setting of severe physical stress and multiorgan failure. Standard laboratory evaluation is not helpful in establishing the diagnosis. Of the 141 cases of AH, 78 were bilateral, and 63 were unilateral. Corticosteroid treatment in situations of severe stress or sepsis had little effect on outcome (9% vs. 6% survival with and without corticosteroid treatment, respectively). This is in sharp contrast to AH occurring postoperatively (100% vs. 17% survival with or without treatment, respectively) or in the antiphospholipid-antibody syndrome (73% vs. 0% survival, respectively). CONCLUSIONS: A high index of suspicion is required to make a timely diagnosis of AH. fever and hypotension in the appropriate clinical setting necessitate further investigation. Although the diagnosis of AH is infrequently made while the patient is alive, appropriate imaging techniques are useful for establishing a timely diagnosis. In severe physical stress or sepsis, AH may be a marker of severe, preterminal physiologic stress and poor outcome.- - - - - - - - - - ranking = 0.22441435375916keywords = physical (Clic here for more details about this article) |
3/34. Anticoagulant-related iliopsoas muscle bleeding leading to fatal exsanguination: report of two autopsy cases.Two cases of massive iliopsoas muscle bleeding leading to fatal exsanguination are presented. Both patients (two women, 61 and 74 years old, respectively) received oral anticoagulation with phenprocoumon. The intramuscular bleeding occurred spontaneously in women of relatively good physical condition. Intriguingly, phenprocoumon concentrations were within the therapeutic range (1.55 microg/ml and 1.26 microg/ml, respectively) as detected by toxicologic analysis. These cases demonstrate that severe bleeding in the iliopsoas muscle has to be considered in all patients receiving anticoagulant medication, even in those who have coagulation parameters within the therapeutic range. Especially in older patients with a high degree of comorbidity or in patients receiving analgesic drugs, the potential of fatal outcome of iliopsoas muscle bleeding seems to be of clinicopathologic relevance.- - - - - - - - - - ranking = 0.11220717687958keywords = physical (Clic here for more details about this article) |
4/34. A case of opiate-insensitive pain: malignant treatment of benign pain.OBJECTIVE: We report the case of a woman with presumed cancer pain treated with escalating doses of opiates despite no evident improvement in her pain and several deleterious side effects. PATIENT: A 62-year-old woman with cervical myelopathy and a diagnosis of a spinal cord tumor was referred to the University of washington Medical Center complaining of chest tightness, multiple joint pains, nausea, constipation, seizures and a deteriorating memory. At the time of admission she was confined to her bed with a full-time attendant and was receiving 240 milligrams of intravenous morphine per hour for her pain. INTERVENTION: Diagnostic studies failed to find any evidence of neoplasm and revealed only an old hemorrhage within the cervical spinal cord. A program of increasing physical and occupational therapy and decreasing opiate intake was initiated. RESULTS: Within a month the patient's pain complaints decreased, as did the rest of her presenting complaints. Her activities of daily living greatly increased making attendant care no longer necessary. CONCLUSIONS: This case report illustrates some of the hazards of opioid therapy in the management of patients with chronic pain. Our patient's opiate therapy was expensive, gave her undesirable side effects, and did not reduce her pain complaints or improve her function. In the treatment of chronic pain, of noncancerous or cancerous origin, a) systemic opioids may not be effective in reducing pain complaints in every patient, b) treatment efficacy evaluation should always include functional endpoints, and c) nonefficacious treatments should not be continued indefinitely.- - - - - - - - - - ranking = 0.11220717687958keywords = physical (Clic here for more details about this article) |
5/34. Idiopathic splinter hemorrhages.Splinter hemorrhages are non-blanchable usually distal reddish-brown linear hemorrhages beneath the nails. Among a variety of etiologic factors reported, trauma is the most common cause. A 26-year-old Hispanic female presented with asymptomatic, extensive fingernail hemorrhages of two months duration. There was no history of physical trauma to the nails. Treatment with a topical antifungal medication for one month produced no improvement. The past medical history was noncontributory. Extensive laboratory testing revealed no underlying systemic disease. Three months after the initial presentation, 6 of 10 fingernails showed signs of resolution without treatment. We conclude that idiopathic atraumatic subungual splinter hemorrhages can occur in healthy individuals. Spontaneous resolution occurred in our patient.- - - - - - - - - - ranking = 0.11220717687958keywords = physical (Clic here for more details about this article) |
6/34. Spontaneous retroperitoneal hemorrhage localized by blood pool scintigraphy.A healthy 17-year-old girl presented to the emergency department with a 1-day history of left upper quadrant abdominal pain associated with nausea and vomiting. Her hematocrit was 22. On physical examination, she had left upper quadrant fullness and tenderness. Initial computed tomography revealed a large, loculated, left-sided retroperitoneal hematoma. blood pool scintigraphy with labeled red cells revealed a very large photon-deficient area with 3 areas of active bleeding in the upper margin of the cold area. An angiogram showed active extravasation from the left inferior phrenic artery. The patient was felt to have had spontaneous adrenal hemorrhage, likely within a preexisting, large adrenal cyst. Spontaneous hemorrhage into an adrenal cyst is a rare entity that can be life-threatening if not treated early in its course.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/34. Hemotympanums secondary to spontaneous epistaxis in a 7-year-old.Hemotympanum is a well-known physical finding most often associated with basilar skull fractures and therapeutic nasal packing. A literature review demonstrated only five cases of hemotympanum associated with spontaneous epistaxis in adults. To our knowledge, there have been no reported cases in children. We present a case of a 7-year-old child with bilateral hemotympanums secondary to spontaneous epistaxis.- - - - - - - - - - ranking = 0.11220717687958keywords = physical (Clic here for more details about this article) |
8/34. Acute scrotum due to arterial bleeding mimicking non-seminomatous germ cell tumor.Men with testicular tumors usually present with painless increase in testis size incidentally noticed by the patient. We report a case of a young patient presenting as an emergency with acute onset of massive right-sided testicular pain without previous injury. After physical examination testicular torsion could not be excluded. Ultrasound examination of the testis was suspicious for testicular tumor. Surgical exploration of the right testis by inguinal approach was performed revealing subcapsular arterial bleeding due to a small nonseminomatous germ cell tumor non-palpable on clinical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/34. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.- - - - - - - - - - ranking = 0.11220717687958keywords = physical (Clic here for more details about this article) |
10/34. hemorrhage simulating tumor growth in malignant fibrous histiocytoma at MR imaging.During the course of preoperative chemotherapy for treatment of malignant fibrous histiocytoma of the lower extremity, the mass in three patients was found to be enlarged at physical examination. Magnetic resonance (MR) imaging demonstrated, and subsequent pathologic examination of resected specimens proved, that the enlargement was caused by extensive hemorrhage within the masses, rather than by tumor growth. MR imaging can demonstrate this phenomenon well, particularly on T1-weighted images.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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