1/13. Renal infarction: an uncommon mimic presenting with flank pain.A 39-year-old woman arrived to the emergency department complaining of a constant, progressive, left flank pain, with no beneficial effect from spasmolytic and nonsteroidal antiinflammatory drugs. Two years before, she suffered another episode of right flank pain and stranguria, but instrumental examinations (ultrasonography, urography) remained negative. Besides a mild tenderness in the left flank, physical examination was normal. blood chemistry panel showed leukocytosis (17.2 x 10(3) mL, neutrophils 82.8%) and a slight increase of serum lactate dehydrogenase (LDH) (543 U/L versus 230 to 460 U/L). Urinanalysis showed a slight hemoglobinuria (0.5 mg/dL), and sediment contained some red cells and leukocytes. Diagnostic examinations (ultrasonography, computed tomography) showed a left renal nonhomogeneous space-occupying lesion, orientative for renal malignancy. She was transferred to the urology department and operated. Both intraoperatory and histological diagnosis was ischemic infarction and, after exclusion of all possible underlying causes, final diagnosis was idiopathic renal infarction. Diagnostic procedures and literature reports are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. Diabetic muscle infarction.Diabetic muscle infarction is a rare complication of diabetes mellitus that is not clearly defined in the orthopaedic literature. This study is a descriptive case series of 7 new cases of diabetic muscle infarction and 55 previously reported cases in the literature. In the majority of patients, diabetic muscle infarction presents as a localized, exquisitely painful swelling and limited range of motion of the lower extremity. No cases affecting the muscles of the upper extremity have been observed. The onset is usually acute, persists for several weeks, and resolves spontaneously over several weeks to months without the need for intervention. Diabetic muscle infarction is a condition that should be considered in the differential diagnosis of any diabetic patient with lower extremity pain and swelling without systemic signs of infection. magnetic resonance imaging is sensitive and specific enough to make the diagnosis. Muscle biopsy and surgical irrigation and debridement are not recommended since they are associated with complications. pain management and activity restriction in the acute phase followed by gentle physical therapy is the treatment of choice. Recurrences in the same or opposite limb are common. Although the short-term prognosis is very good and the majority of cases resolve spontaneously, the long-term survival is uncertain in this patient population.- - - - - - - - - - ranking = 0.096477362357877keywords = physical (Clic here for more details about this article) |
3/13. Laparoscopically assisted treatment of acute abdomen in systemic lupus erythematosus.The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/13. Thoracic paraparesis following an embolic vascular event during lumbar spinal surgery.OBJECTIVE: A case report illustrating the rare occurrence of thoracic paraparesis following the presumed occurrence of an embolic vascular event during lumbar spinal surgery is presented. The goal is to investigate the potential causes of acute postoperative paraparesis following lumbar spine surgery. A discussion of the symptoms, diagnosis, differential diagnosis, and management of spinal cord ischemia and postembolic infarction is presented. This manuscript is intended to heighten the awareness of the potential for this rare complication to improve the speed and accuracy of diagnosis, allowing the timely institution of appropriate treatment. methods: Data analyzed include the patient history, preoperative and postoperative physical examination, clinical course, imaging studies, and input of various consulting services. A review of the English literature on spinal cord ischemia and postembolic infarction was performed. RESULTS: The most likely etiology for the patient's acute postoperative paraparesis appears to be related to an embolic spinal cord infarction. CONCLUSIONS: Management of a spinal cord ischemic event should focus on the following key issues: a prompt diagnosis with timely perioperative imaging studies (magnetic resonance imaging), the attainment of a normotensive state, the institution of systemic anticoagulation if clinically warranted, and maximization of physical function through early rehabilitation.- - - - - - - - - - ranking = 1.0964773623579keywords = physical examination, physical (Clic here for more details about this article) |
5/13. Hypercoagulability in a patient with marfan syndrome.A 39 year old man with marfan syndrome presented with multiple pulmonary emboli and renal, hepatic, and splenic infarcts of unknown aetiology. The combination of thromboemboli and physical features initially suggested homocystinuria; however, laboratory examination showed no evidence for this disorder. Laboratory evaluation identified no coagulation abnormalities. This patient represents the unusual occurrence of hypercoagulability in a patient with marfan syndrome.- - - - - - - - - - ranking = 0.096477362357877keywords = physical (Clic here for more details about this article) |
6/13. Anterior hypopituitarism: a consequence of head injury.Anterior pituitary insufficiency in patients with traumatic brain injury is rare. Only sporadic cases have been reported in the literature. The authors report a case of panhypopituitarism that developed in a 19-year-old man and was diagnosed six months after the patient sustained severe craniocerebral trauma in a motor vehicle accident. After an initial slow improvement in neurologic function he very gradually retrogressed in physical and mental capacities. An acute adrenal crisis led to the diagnosis of hypopituitarism. Institution of appropriate hormone therapy resulted in steady improvement in motor and cognitive functioning. The authors reviewed the literature and discuss the possible pathophysiology. They exhort physiatrists to be aware of this rare but potentially fatal consequence of craniocerebral trauma.- - - - - - - - - - ranking = 0.096477362357877keywords = physical (Clic here for more details about this article) |
7/13. Renal infarction after aerobics.Renal infarction is most frequently due to emboli from the heart or aorta. Other causes include atheromatous disease, renal artery aneurysm, vasculitis, hypotension, hypercoagulable states, aortic dissection, and major trauma. Most renal infarctions are segmental. The extent of disease is dependent upon the size and number of renal vessels involved, coexistent renal disease, and collateral circulation. flank pain, fever, leukocytosis, hematuria, renal failure, or hypertension may suggest the diagnosis, but these findings are nonspecific and diagnosis will depend not only on history and physical examination, but also on the appropriate imaging tests. The type of treatment is dictated by the etiology of the infarction.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/13. Diagnosis and outcome of bowel infarction on an acute medical service.Twenty patients with surgically or pathologically documented bowel infarction are compared with seven patients who were believed to have bowel infarction but had negative findings at laparotomy. The presentation of verified bowel infarction was nonspecific; abdominal pain, tenderness, and distension were the most common, occurring in 15 patients. No physical finding or laboratory test distinguished bowel infarction from mimicking conditions. patients in both groups had an extremely poor prognosis. An approach to management is suggested.- - - - - - - - - - ranking = 0.096477362357877keywords = physical (Clic here for more details about this article) |
9/13. A case of a primary hepatic tumor causing segmental changes on imaging and its relation to Zahn's infarct.A 69-year-old female was admitted to our hospital for further examination of an intrahepatic mass which had been found while undergoing a complete physical examination. The mass measured 4 cm in size and was located in the medial segment (S4) of the liver. On computed tomography (CT), S4 was observed to be 'atrophied' and was well enhanced segmentally. A celiac angiogram showed segmental staining, and a transarterial portogram demonstrated portal stoppage of S4 from the left branch. However, no segmental intensity difference was seen on magnetic resonance imaging (MRI). An aspiration biopsy showed adenocarcinoma and thus an operation was performed under a tentative diagnosis of intrahepatic cholangiocarcinoma. The postoperative diagnosis of the tumor was combined hepatocellular and cholangiocellular carcinoma. However, no histological abnormality was seen in S4, contrary to the expectation of Zahn's infarct. In this study, we discuss the mechanism and imaging findings of Zahn's infarct, the possible reasons as to why no pathological change was seen in S4, as well as stress the rarity of reports on Zahn's infarct in cases of portal thrombus due to hepatocellular carcinoma.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/13. Mesenteric venous thrombosis: a case report.Mesenteric venous thrombosis is an uncommon entity. The preoperative diagnosis is largely clinical; the hallmark is pain that is out of proportion to the physical findings. Treatment consists of thrombectomy with resection of necrotic small bowel and mesentery. In the absence of trauma or infection, an investigation of intrinsic anticoagulant deficiencies is warranted since these deficiencies are inherited in an autosomal dominant fashion. Treatment is warfarin sodium therapy.- - - - - - - - - - ranking = 0.096477362357877keywords = physical (Clic here for more details about this article) |
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