1/16. prostate adenocarcinoma presenting with inguinal lymphadenopathy.The lymphatic spread of prostate adenocarcinoma most often involves the iliac, obturator, and hypogastric nodes. Inguinal lymphadenopathy is very rare during the early stages of this disease, especially in the absence of pelvic lymphadenopathy or other metastases. We present a case of prostate adenocarcinoma with inguinal node involvement during the initial presentation, emphasizing the importance of a complete physical examination and the consideration of other concurrent diseases.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. mycobacterium gastri causing disseminated infection in children of same family.Two children of the same family were admitted to the pediatric ward with a history of productive cough, nocturnal sweats, and weight loss. On physical examination, lymphadenopathy was seen on both sides of the neck and axillae. The sizes of the lymph nodes varied, and some showed fistula formation with drainage. A chest x-ray of the boy revealed diffuse nodular densities, while in the girl, peribronchial thickening in both lower lung zones and hilar adenopathy were detected. Sonography of the abdomen and pelvis in both cases showed multiple para-aortic adenopathies with hypodense centers. Microscopic examination of sputum, gastric washings, and node biopsy specimens proved positive for acid-fast bacilli. Systematic identification of acid-fast bacilli on Lowenstein-Jensen culture media identified the isolates as mycobacterium gastri. These appear to be the first cases of pediatric infection and the fourth report of human infection caused by this atypical mycobacterium.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Congenital dyserythropoietic anaemia type II-like dysplastic anaemia preceding the development of non-Hodgkin lymphoma--a case report.Anaemia is a frequent complication in patients with haematological malignancies and is caused by a variety of mechanisms including neoplastic cell infiltration into the bone marrow, haemolysis, nutritional deficiencies and defect in erythropoiesis or dysplastic anaemia as a result of the disease itself. However, acquired dysplastic anaemia which mimic congenital dyserythropoietic anaemia (CDA) type II morphology in the bone marrow is very rare. A 41-year-old Chinese man presented with refractory symptomatic anaemia in September 2001. He was clinically pale with no other significant physical finding. His initial peripheral blood picture showed normochromic normocytic anaemia with haemoglobin level of 26g/L, with no evidence of haemolysis and a poor reticulocyte response of 0.6%. bone marrow aspiration was done and showed congenital dyserythropoietic anaemia (CDA) type II-like morphology. He was treated symptomatically with regular blood transfusions approximately every 3 weeks, until August 2002 when he developed multiple cervical lymphadenopathy with loss of appetite, loss of weight and low grade fever. biopsy of the lymph node confirmed the diagnosis of small lymphocytic lymphoma. Staging with computed tomography and bone marrow aspirate revealed the infiltration of lymphoma cells into the marrow cavity consistent with the staging of IVB. This case report illustrates that CDA type II-like dysplastic anaemia can preceed the development of lymphoma.- - - - - - - - - - ranking = 0.069249050414932keywords = physical (Clic here for more details about this article) |
4/16. Angio-immunoblastic lymphadenopathy terminating as Hodgkin's disease.The clinical course of a 33-year-old man with generalized lymphadenopathy bearing all physical, laboratory and histologic characteristics of "angio-immunoblastic lymphadenopathy with dysproteinemia" (AILD) is described. Therapy was without significant benefit and the patient died 22 months after initial diagnosis. At autopsy in addition to the characteristic cellular polymorphism of AILD, numerous Hodgkin's cells and Sternberg-Reed cells were identified in the lymph nodes and spleen. Pleomorphic cellular infiltrates containing an increased number of immunoblasts and some giant cells were found also in the portal spaces of the liver. The evolution of Hodgkin's disease (H.D.) from AILD suggests that the latter may have represented a reaction to the agent which causes H.D..- - - - - - - - - - ranking = 0.069249050414932keywords = physical (Clic here for more details about this article) |
5/16. Sinus histiocytosis with massive lymphadenopathy (Destombes-Rosai-Dorfman syndrome) occurring as a single enlarged submandibular lymph node: a light and immunohistochemical study with review of the literature.Sinus histiocytosis with massive lymphadenopathy (SHML) is primarily a disease of children and young adults in which there is a pronounced and persistent cervical lymph node enlargement that usually is bilateral and is accompanied by fever. The histology, which varies according to the stage of the disease, is characterized by an exuberant intrasinusoidal histiocytic proliferation. The present case involves a 4-year-old girl who had several episodes of upper respiratory infection and otitis media; subsequently, a walnut-sized enlargement developed in the left anterior portion of the neck. Results of a physical examination were essentially normal. A laboratory work-up was noncontributory. serologic tests for toxoplasmosis, infectious mononucleosis, and cat-scratch disease were negative. immunoelectrophoresis disclosed normal values for IgG, IgM, IgA, and IgE. The histopathology was characteristic of SHML. The lymph node demonstrated pericapsular and capsular fibrosis and widely dilated subcapsular, trabecular, and medullary sinuses packed with histiocytes and plasma cells. "Lymphophagocytosis" and large atypical histiocytes resembling reed-sternberg cells were noted. immunohistochemistry demonstrated a polyclonal population of plasma cells mostly stained with rabbit anti-human igG. The cytoplasm of the histiocytes, having ingested lymphocytes, was positively stained for IgG. Other groups of lymph nodes were affected during the next several months. The patient's condition has now been followed for 2 years, and the lymphadenopathy has almost completely regressed. The site distribution of the head and neck extranodal manifestations of SHML was analyzed in 54 cases.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/16. Thorn-induced non-specific granulomatous left biceps myositis with left subareolar lymphadenopathy.In surveying the pediatric and orthopedic literature, very little has been written about foreign bodies in skeletal muscle or muscle tissue inflammation in response to foreign bodies. When it is known that a foreign body has penetrated the muscle or if it is externally visible, there is no diagnostic problem. However, this can become a perplexing problem when history and physical examination are not clearly diagnostic. We present a case in which a thorn penetrated the left biceps muscle of a 10-year-old girl. The thorn remained there for 3 weeks without disturbing the child. It produced a local sterile granulomatous reaction in the muscle. Two weeks later, left subareolar lymphadenopathy appeared with no involvement of the axillary lymph nodes.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Tonsillar calculi. Report of a case and review of the literature.A large tonsillar calculus in a 77-year-old demented woman with a history of chronic oral infections and multiple episodes of pneumonia is reported. Earlier literature describes these calcium-laden tonsilloliths as occurring in adolescence following chronic tonsillitis. Improvement in health care of the young and antibiosis militate against tonsilloliths as a serious problem in the young patient. Conversely, an ever-increasing aged population, with impaired self-care abilities or diminished cerebral function, many of whom populate nursing care facilities, and increased routine oropharyngeal screening of the aged may add significantly to the number of reported cases. In view of the potential for continuous oropharyngeal disease and the possibilities of swallowing disturbances, pneumonia, or food or liquid aspiration, which may result in lethal complications the authors urge the clinician to assess masses or calcified objects viewed on physical examination or radiographs, explore their etiology, evaluate them for removal, and not dismiss them as clinically insignificant.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/16. Metastatic renal cell carcinoma simulating sarcoidosis. Analysis of 12 patients with bilateral hilar lymphadenopathy.Case summaries of four patients with bilateral hilar lymphadenopathy (BHL) caused by metastatic renal cell carcinoma are presented, and these and eight similar cases from the literature are analyzed. In nine patients, sarcoidosis was the provisional clinical diagnosis, but four of these patients had a past history of renal cell carcinoma. In the remaining five patients, a distinction from sarcoidosis could not be made by history, physical examination, and chest roentgenogram. This underscores the need for tissue confirmation in the diagnosis of sarcoidosis and alerts the physician to consider metastatic renal cell carcinoma in the differential diagnosis of BHL.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/16. An autopsied case of an elementary school boy with sudden death four years after Kawasaki disease: on the problem of present method of cardiac mass screening of school children.An 8 year-old boy died suddenly 4 years after the onset of Kawasaki disease. He was examined by a cardiac mass screening for school children one and a half year before the death, and was evaluated as having no sequela of Kawasaki disease. The autopsy showed coronary arterial aneurysms and obstruction with fresh and old myocardial infarction. One of the problems of the present method for cardiac mass screening for school children is that it is performed only with history taking, physical findings and electrocardiograms. This method is completely insufficient to find out coronary involvement as a sequela of Kawasaki disease. All the children with history of Kawasaki disease should be examined by two dimensional echocardiography, which is the most sensitive and specific noninvasive method to detect the coronary involvement in our experience.- - - - - - - - - - ranking = 0.069249050414932keywords = physical (Clic here for more details about this article) |
10/16. Unusual site of spontaneous first-rib fracture: case report.Spontaneous fractures of the first rib are uncommon and are usually thought to be associated with a malignant process. However, fatigue fractures of the first rib are being encountered increasingly in association with various physical activities. Typically, the fractures occur at the subclavian groove, but in the 48-year-old woman described in this report the fracture was unexpectedly situated in the posterior portion of the rib and was the result of snow shovelling, which was a new activity for the patient.- - - - - - - - - - ranking = 0.069249050414932keywords = physical (Clic here for more details about this article) |
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