1/4. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia.We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor.The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors' clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. cerebrospinal fluid rhinorrhea: an allergist's perspective.Perplexing cases of profuse rhinorrhea may be referred for allergy evaluation as reported in three patients ultimately found to have cerebrospinal fluid rhinorrhea. physicians should be alert to this possibility when confronted with patients needing towels to collect nasal discharge, or whose handkerchiefs are limp upon drying. Coughing and choking at night are common. patients should be asked to lie face down during the course of physical examination, as rate of flow often increases greatly in this position.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. An adjuvant afterloading brachytherapy device for use after orbital exenteration in patients with orbital malignancies.In cases of malignant diseases situated within the orbit and threaten to extend beyond it, removal of the orbit and periorbital contents may be indicated, followed by adjuvant chemotherapy or irradiation. An effective radiotherapy device for treatment of residual or suspicious cancer in the enucleated orbit consists of an external-beam radiation source (60Co) and an intraoperatively fitted mould as a guide for the flexible afterloading tubes using a 192Ir source. Considering the physical dose distribution and the local situation, this therapy permits a high dose with homogeneous dose distribution to the target area of the orbit but also allows significant dose reduction to adjunctive critical structures. Four patients with different orbital malignancies were treated by means of a combination of percutaneous radiotherapy with afterloading brachytherapy following orbital exenteration. The individual mould of the orbital cavity is modeled at the end of the operation. The technique of radiotherapy, dose distribution, and follow-up of the disease are demonstrated. Orbital malignancies with an extremely poor prognosis may profit from the application of this combined radiotherapy to avoid supraradical surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |