1/15. Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. femoral neuropathy after pelvic surgery.Postoperative femoral neuropathy is an uncommon complication occurring after pelvic surgery. Inappropriate stretching and prolonged compression of the nerve are 2 major mechanisms of the neuropathy. Here we report 2 cases of femoral neuropathy immediately following pelvic surgery. Both cases had neither previous vascular nor peripheral nerve disease. They suffered from weakness of left hip flexion and knee extension and sensory impairment over the left lower limb after surgery. electromyography and nerve conduction studies confirmed left femoral neuropathy. Both of the patients received physical therapy and had nearly total neurological recovery within 3 months. We report this unusual complication that followed major pelvic surgery and also review the literature and discuss the possible etiology for prevention of this injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/15. Iatrogenic Horner's syndrome.PURPOSE: To report two cases of Horner's syndrome. One presented after the ablation of a schwannoma of the cervical sympathetic chain, the second after upper thorascopic sympathectomy for primary palmar hyperhidrosis. methods: A 42-year-old man underwent excision of a left neck mass found during routine physical examination. A 20-year-old girl with axillary and palmar hyperhidrosis was treated with cervical sympathectomy. RESULTS: In the early postoperative days, miosis, ptosis, anhidrosis, and enophthalmos were observed. CONCLUSIONS: In the ablation of a schwannoma, postoperative Horner's syndrome is associated with the relationship between nerves and the tumor mass, which makes it impossible to separate them surgically in most cases. In thorascopic sympathectomy, patients should be warned of this complication.- - - - - - - - - - ranking = 4.5512707454688keywords = physical examination, physical (Clic here for more details about this article) |
4/15. Misdiagnosis of olfactory neuroblastoma.OBJECT: Olfactory neuroblastoma (ON) is a rare neoplasm arising from the olfactory epithelium and found in the upper nasal cavity. The authors studied the frequency with which ON is misdiagnosed with other tumors of the paranasal sinuses such as neuroendocrine carcinoma (NEC), pituitary adenoma, melanoma, lymphoma, and sinonasal undifferentiated carcinoma (SNUC). Based on the belief that misdiagnosis commonly occurs, they emphasized the importance of establishing the correct diagnosis, because the treatment regimens and prognosis of these tumor types are often significantly different. methods: Twelve consecutive patients in whom ON was diagnosed were referred to the Department of neurosurgery at the M. D. Anderson Cancer Center between January 1998 and March 2000. Demographic data were collected, physical findings and mode of treatments were documented, and neuroimaging studies were assessed. Pathologists at the authors' institute reviewed the histological specimens. Only in two of 12 patients was the diagnosis of ON confirmed. Lesions in 10 patients were misdiagnosed; there were two cases of melanoma, three cases of NEC, three cases of pituitary adenoma, and two cases of SNUC. Eight of 10 patients in whom lesions were misdiagnosed required significant alteration in the initially proposed treatment plan. CONCLUSIONS: Neurosurgeons should be acutely aware of the variety of neoplasms that occur in the paranasal region. The correct diagnosis should be ensured before initiating treatment to provide the optimum therapy and spare the patients from needless and potentially toxic treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/15. Treatment concepts for idiopathic and iatrogenic femoral nerve mononeuropathy.Femoral mononeuropathy has many etiologies and is often quite disabling, causing lower extremity paresthesia, anesthesia, pain, or paresis. Despite its morbidity, few therapies have been described to treat the femoral nerve palsy that does not resolve with conservative management or that is refractory to physical therapy. In this report, we present 3 cases of femoral nerve palsy; one as a complication of local nerve block, one as a complication of laparotomy, and one of idiopathic origin. In each case, symptomatic and objective improvement was achieved with femoral neurolysis. We suggest guidelines for the management of those patients who fail to respond to conservative therapy and indications for surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/15. Medically induced drug addiction.Iatrogenic, or medically induced, drug addiction is a problem affecting both patients and physicians. We describe the function of a new center devoted solely to managing iatrogenic addiction. The center accepts patients on physician referral only. The addiction usually arises as a complication of a medical disorder that is accompanied by pain and requires comprehensive and multidisciplinary evaluation and treatment. Detoxification from the offending medication, provision of chronic analgesia, and maintenance are managed with methadone. All appropriate modalities of treatment including psychotherapy, physical therapy, and relaxation techniques are employed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/15. Genital examination and exposure experienced as nosocomial sexual abuse in childhood.Three pediatric cases of girls, one with idiopathic precocious puberty and two with a birth defect of the sex organs, exemplify the proposition that genital exposure and the physical examination of the genitals may be experienced subjectively as nosocomial sexual abuse. Negative sequelae persisted into adulthood. The dogma of the new victimology industry is that children never lie about sexual abuse. Consequently providers of pediatric and ephebiatric (pubertal and adolescent) sexual health care already are progressively at risk of being falsely accused of nosocomial (from the Greek nosokomeion, from nosos, disease, komeion, to take care of: pertaining to or originating in a hospital, as nosocomial disease) sexual abuse.- - - - - - - - - - ranking = 4.5512707454688keywords = physical examination, physical (Clic here for more details about this article) |
8/15. Acute brain edema due to water loading in a young woman.Increased intracranial pressure developed in a mentally and physically normal patient following ingestion of 30 glasses of water as a voluntary preparation for ultrasonic gynecological examination. hyponatremia resulted and induced brain edema which provoked increased intracranial pressure. hyponatremia was treated by intravenous infusion of hypertonic NaCl and mannitol solutions. Corticosteroids were added and continued for a week. The patient totally recovered 4 days after admission.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/15. Iatrogenic arteriovenous fistula after multiple arterial punctures.Multiple arterial punctures in the neonate can result in iatrogenic arteriovenous fistula formation. In one case, a 3-month-old infant who had been born prematurely was noted to have physical findings consistent with arteriovenous malformation following approximately 90 arterial blood gas determinations over a 13-week period. The area was explored and the lesion was treated surgically with good results.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/15. Medication bezoar: intestinal obstruction by an isocal bezoar. Case report and review of the literature.Medications may occasionally obstruct the gastrointestinal tract by virtue of their physical mass. Obturative obstruction of the alimentary tract is reportedly caused by an increasing number of medications, including hydroscopic bulk laxatives, cholestyramine, nonabsorbable antacids, and vitamin C tablets. Inspissated Isocal tube feedings caused jejunal obstruction in a postoperative patient. Medication bezoars are a rare cause of intestinal obstruction that may result in significant patient morbidity, including bowel necrosis, perforation, and peritonitis. The radiographic appearance may mimic an abdominal abscess.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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