1/12. Leukocytoclastic vasculitis: a rare manifestation of propylthiouracil allergy.OBJECTIVE: To report a case of leukocytoclastic vasculitis as a manifestation of propylthiouracil allergy. methods: We present the history, findings on physical examination, and results of laboratory evaluation in a 25-year-old woman. Associated reports from the literature are reviewed. RESULTS: The patient, with a history of Graves' disease, was referred for evaluation of a purpuric rash on the pinnas and buttocks bilaterally. Findings included exophthalmos and bilateral goiter with neck bruits. She was biochemically hyperthyroid. biopsy of the skin lesions revealed leukocytoclastic vasculitis. propylthiouracil therapy was discontinued, and prednisone was prescribed. Treatment with radioactive iodine resulted in appreciably diminished skin lesions and reduction in the size of the thyroid gland, but thyroxine and triiodothyronine levels increased. Administration of a second, higher dose of radioactive iodine with concomitant lithium carbonate resulted in clinical and biochemical improvement. Six months after initial assessment, the rash had resolved, and the patient's free thyroxine value had normalized, although the thyrotropin level was still suppressed. CONCLUSION: Leukocytoclastic vasculitis, although rarely seen as a manifestation of propylthiouracil allergy, has been reported in the medical literature and should be considered in the differential diagnosis of patients with a vasculitic rash. Treatment consists of discontinuation of the offending medication and administration of a corticosteroid and, occasionally, cyclophosphamide or plasmapheresis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/12. The safety of low-dose larrea tridentata (DC) Coville (creosote bush or chaparral): a retrospective clinical study.OBJECTIVE: To determine whether internal use of low doses of larrea tridentata tincture or topical applications of this traditional herbal medicine are safe. DESIGN: Retrospective review of all people prescribed larrea for internal or for topical use over a 22-month period. SETTING/LOCATION: A general naturopathic practice in Sedona, arizona. SUBJECTS: Thirteen patients were identified for whom larrea tincture for internal use was prescribed. An additional 20 female and 3 male patients were identified for whom an extract of larrea in ricinus communis (castor) oil for topical use was prescribed. No patient had any history of liver disease. INTERVENTIONS: larrea was prescribed as part of the usual care of each patient. In all cases it was given as either part of a complex herbal formula individualized for each patient containing less than 10% larrea tincture or as an extract in ricinus oil for topical use. OUTCOME MEASURES: serum liver enzyme levels as well as blood urea nitrogen and creatinine levels, glucose levels, electrolytes, bilirubin levels, iron levels, ferritin levels, lipid levels, and complete blood count (CBC) were available for analysis in four patients; general clinical history and physical examination findings were relied on in all other cases. RESULTS: The four patients with complete before and after blood chemistry panels and CBC had no indication of liver damage from use of larrea. This included one patient who was taking medications with significant potential for hepatotoxicity. No patient in the study, whether using larrea for short term or long, internally or externally, showed any sign of organ damage during the period of follow-up. CONCLUSIONS: Relatively small intakes of larrea tincture, or topical application of extracts in ricinus oil, are safe when prescribed by a clinically trained botanical prescriber. larrea should be used with caution in persons with a history of previous, or current, liver disease. It may be preferable to avoid the use of larrea capsules because they have been associated with potentially dangerous overdosing.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/12. A case of cold-dependent exercise-induced anaphylaxis.exercise-induced anaphylaxis (EIA) is a form of physical urticaria that is induced by exercise. A 16-year-old Japanese boy had a 4-year history of recurrent wealing and dyspnoea after physical exercise such as jogging, playing handball or riding a bicycle in winter. The episodes were not associated with ingestion of foods including wheat or soya bean. A provocation test, with 15 min of exercise and 2 min of cold stimulation immediately before or immediately after the exercise, elicited a weal that was localized to the test area. A challenge test with ingestion of boiled soya beans and exercise did not elicit a weal. Therefore, in this case, cold exposure, but not food ingestion, was essential for inducing EIA. Cold-dependent EIA is different from cold urticaria, food-dependent EIA, cholinergic urticaria and cold-induced cholinergic urticaria, and may be a distinct entity.- - - - - - - - - - ranking = 0.42941220901249keywords = physical (Clic here for more details about this article) |
4/12. Bee moth (Galleria mellonella) allergic reactions are caused by several thermolabile antigens.BACKGROUND: Exposure and contact with bee moth (Galleria mellonella) larvae (Gm) can cause an allergic reaction both in anglers and breeders. We described the case of an amateur fisherman who experienced an allergic reaction using Gm but not using heat-treated Gm (h-Gm) (mummies). The aim of this study was to demonstrate by immunoblotting and radioallergosorbent test (RAST)-inhibition experiments the loss of allergenic epitopes in h-Gm extracts. methods: Galleria mellonella larvae and h-Gm were homogenized and extracted at 10% (w/v) in 0.5 M phosphate-buffered saline, pH 7.4 containing 0.5% NaN(3) for 16 h at 4 degrees C. Gm and h-Gm extracts were electrophoresed in a 10% polyacrylamide precast Nupage Bis-Tris gel at 180 mA for 1 h and the resolved proteins stained with 0.1% Coomassie brilliant blue and the molecular weight calculated. For the immunoblotting detection of allergenic components the resolved extracts were transferred onto a nitrocellulose membrane and incubated with the patient's serum. Bound specific-IgE was detected by peroxidase-conjugated anti-human IgE. RAST inhibition experiments were performed according to the Ceska method. RESULTS: The protein profile of Gm and h-Gm extracts resulted markedly different in number, intensity and the position of bands, indicating that heat-treatment modifies the chemical-physical characteristics of the protein contents. The Gm extract showed a strong-coloured band at 73 kDa and more than 20 components ranging from 12 to 133 kDa; h-Gm showed two main band at 77 and 38 kDa and about 15 faint bands between 20 and 133 kDa apparently without any correspondence to the bands present in the Gm extract. immunoblotting with the patient's serum demonstrated several bands of reactivity with the Gm extract ranging from 20 to 100 kDa and no recognizable bands, but only a diffuse smear with h-Gm. When used in a RAST inhibition experiment the h-Gm extract demonstrated an inability to compete with the Gm one for the binding to patient's IgE serum. CONCLUSIONS: The h-Gm seems to lose the allergenic epitopes and has two advantages for anglers: to avoid new possible sensitizations as well as allergic symptoms in sensitized people, without interfering with their skills and satisfaction in their fishing performance.- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
5/12. Clinical holistic medicine: developing from asthma, allergy, and eczema.This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
6/12. Insect bite-induced hypersensitivity and the SCRATCH principles: a new approach to papular urticaria.Insect bites and the associated hypersensitivity reactions known as papular urticaria account for a significant number of all referrals from pediatricians and dermatologists to our pediatric dermatology clinic. Unfortunately, children affected by these eruptions are frequently misdiagnosed and often subject to expensive evaluations including invasive and unnecessary procedures. Here we review the course of 4 children with the typical physical findings and natural history of these reactions. On the basis of our clinical findings and experience with this patient population, we propose a set of principles (termed "SCRATCH") as clinical features to aid clinicians in making an early and accurate clinical diagnosis. We conclude that a more appropriate term for future study and diagnosis of this entity is insect bite-induced hypersensitivity.- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
7/12. environmental illness. A controlled study of 26 subjects with '20th century disease'.environmental illness is a polysymptomatic disorder believed by "clinical ecologists" to result from immune dysregulation brought on by common foods and chemicals. We systematically evaluated 26 subjects who had been assigned a diagnosis of environmental illness. The subjects indicated a strong interest in their diagnosis, were generally satisfied with their clinical ecologist, and were dissatisfied with traditional medical approaches. Subjects reported varying treatments, including dietary restrictions, avoidance of offending agents, and physical treatments. Using the Diagnostic interview Schedule, we found that 15 (65%) of 23 subjects met criteria for a current or past mood, anxiety, or somatoform disorder compared with 13 (28%) of 46 age- and sex-matched community controls. We conclude that patients receiving this diagnosis may have one or more commonly recognized psychiatric disorders that could explain some or all of their symptoms.- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
8/12. Chronic hyperalgesia and skin warming caused by sensitized C nociceptors.A patient suffering from an acquired painful syndrome, due to injury to primary somatic afferent units, was studied. Clinical features included chronic spontaneous burning pain in one hand, abnormal painful response to nonnoxious cutaneous stimuli, and deviation of temperature and dystrophic changes in symptomatic skin. Diagnostic stellate ganglion blocks did not improve spontaneous or stimulus-induced pains, and observation of sympathetic efferent neural activity and vasomotor effector responses revealed no abnormality, failing to support an autonomic contribution to the pathogenesis of the pains. A quantitative psychophysical assessment documented exaggerated magnitude of pain in response to noxious stimuli in symptomatic skin, together with abnormal painful quality and prolongation of sensation induced by nonnoxious tactile or warm stimuli. Such mechanical and thermal hyperalgesia persisted during A fibre blocks, suggesting transmission by primary afferents with unmyelinated C fibres and implying sensitization of C polymodal nociceptors. Direct microneurographic recordings of single, identified C polymodal nociceptors from symptomatic skin confirmed the presence of units with pathologically enhanced receptor responses: lowered threshold and very prolonged afterdischarges. While bypassing skin receptors, strongly intraneural microstimulation in fascicles supplying symptomatic or control skin evoked equivalent magnitudes and temporal profiles of pain from both sides. Thus secondary CNS dysfunction need not be postulated to explain the painful syndrome. skin grafted onto the affected region partially recovered tactile and thermal sensation (but not pain) without expressing the painful syndrome. This supports the overall conclusion that in this patient A fibres are not involved as primary carriers of input decoded as pain. Sensitization of C polymodal nociceptors is consistent with the features of hyperalgesia in this patient: pain evoked by nonnoxious stimuli, exaggerated pain magnitude, and abnormally prolonged aftersensation of pain. This is the first documentation of chronic sensitization of human C polymodal nociceptors as a symptom of disease. In the context of sensitized C nociceptors and in the absence of sympathetic vasoconstrictor deficit, the abnormally elevated temperature in symptomatic skin is interpreted as due to antidromic vasodilatation triggered by neurosecretion from hyperactive nociceptors.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
9/12. Workers with multiple chemical sensitivities: psychosocial intervention.Treatment of MCS, an illness characterized by reaction to a multiplicity of factors coming from within the patient and from the social and physical environment, must incorporate multiple types of help, all directed toward supplying what these patients require. Medical, psychiatric, and social work treatment are all significant and all different, with overlap in several areas. As in all practice in the medical setting, the overall function of the social worker is to enable the MCS patient to make use of what the physician has to offer by supporting the patient's capacity to cope with the social and emotional impact of his/her illness.- - - - - - - - - - ranking = 0.21470610450625keywords = physical (Clic here for more details about this article) |
10/12. The occurrence of multiple physical allergies in the same patient: report of three cases.The syndromes of idiopathic anaphylaxis, exercise-induced anaphylaxis, and other physical allergies are well described as separate entities. This article describes the combination of these problems in the same patient. Two patients with idiopathic anaphylaxis are described. One also has exercise-induced anaphylaxis, and one also has exercise-induced bronchospasm and exercise-induced urticaria and angioedema. A third patient with exercise-induced anaphylaxis, idiopathic urticaria, angioedema, cholinergic urticaria, and dermatographism is described.- - - - - - - - - - ranking = 1.0735305225312keywords = physical (Clic here for more details about this article) |
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