1/11. Medical considerations in dental treatment of children with williams syndrome.williams syndrome is a rare disorder that was first described in 1961. It is thought to be caused by a microdeletion in the long arm of chromosome 7 at 7q11.23 and is a multisystem, congenital, and panethnic disorder characterized by a number of developmental and physical abnormalities, including congenital cardiovascular abnormalities, mental retardation and neurological features, growth deficiency, genitourinary manifestation, gastrointestinal and musculoskeletal problems, behavioral characteristics, craniofacial features, ophthalmologic features, and dental problems. We describe cases of children with williams syndrome treated in the department of pediatric dentistry of the Hadassah School of Dental medicine, Jerusalem, israel. The different treatments rendered to these children are discussed followed by general remarks drawn from those treatments and from a literature review. We conclude that sedation can be helpful in the younger age group to reduce anxiety and uncooperative behavior during minimal dental treatments. Treatment under general anesthesia seems more appropriate for older children and adolescents. Special attention should be given to initial evaluation of these patients, especially because with age aortic stenosis tends to intensify, which together with the progressive renal impairment can escalate blood pressure elevation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. mitral valve prolapse in juvenile thyrotoxicosis.To determine whether there is an association between mitral valve prolapse and juvenile thyrotoxicosis, we studied 13 thyrotoxic patients (3 males, 10 females, ages 8-17 years) by physical examination, chest radiograms, electrocardiograms and echocardiography. Five patients had an apical systolic murmur and two of these had echocardiographic evidence of mitral valve prolapse. The findings of mitral valve prolapse in 15% of the hyperthyroid patients and 1.7% in the control group suggests that this abnormality may be more frequent in hyperthyroid children. Echocardiograms should be performed in hyperthyroid children who present with an apical systolic murmur.- - - - - - - - - - ranking = 4.5614612715565keywords = physical examination, physical (Clic here for more details about this article) |
3/11. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 4.5614612715565keywords = physical examination, physical (Clic here for more details about this article) |
4/11. The medicalization of normal variants: the case of mitral valve prolapse.Mild mitral valve prolapse, hypoglycemia, irritable colon, and premenstrual syndrome are examples of anatomico-physiologic phenomena that largely overlap with normal. Such "overlap syndromes" become labeled disease entities by the medical community through a process called medicalization. This report uses mitral valve prolapse (MVP) to exemplify the effects of medicalization on patients, physicians, and society. Ascertainment bias and insufficient controlled clinical studies have led to the description of a clinical entity replete with false associations (e.g., mitral valve prolapse syndrome) and overly pessimistic prognostication (e.g., risk of sudden death or endocarditis), leading to clinical overreaction, overtreatment, and unnecessary induction of disability. Though some physical complications may be prevented by recognizing severe MVP, there is substantial risk of iatrogenic harm by attributing complex symptoms and illness behavior to mild MVP, which is probably a normal variant. A three-dimensional analysis of illness experience is presented that may be of use in conceptualizing the clinical approach to overlap syndromes such as mild MVP. Conservative criteria for the diagnosis of significant MVP have been developed at the National Institutes of health. Treatment of patients with mild MVP must emphasize that it is a normal variant without serious consequences. Because the risks of overmedicalization are so substantial, the impact of diagnostic labels on individual patients and society must be analyzed continually.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. Valve prolapse in Behcet's disease.Valve prolapse was diagnosed solely by echocardiography in three consecutive patients with Behcet's disease. Two patients had prolapse of the posterior mitral valve leaflet, but no clinical manifestations of valve prolapse. In the third patient aortic valve prolapse was associated with physical signs of aortic regurgitation and left ventricular failure. Valve prolapse in these cases may have resulted from structural and functional derangement caused by the underlying non-specific vasculitis that occurs in Behcet's disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/11. Panics, prolapse, and PVCs.There is a group of patients who presents with intense anxiety and physical complaints suggestive of cardiac or gastrointestinal disease. These patients are more commonly women and complain of palpitations, lightheadedness, chest pains, and dyspnea. A work-up may reveal positive findings such as extrasystoles and mitral valve prolapse that appear to confirm the organic etiology of the symptoms. Evidence is presented that the positive findings serve to confuse the picture and are an impediment, rather than an aid, to the physician in making the correct diagnosis. Effective treatment using tricyclic antidepressants or monoamine oxidase inhibitors is suggested.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. ventricular fibrillation in a patient with unsuspected mitral valve prolapse and a prolonged Q-T interval.mitral valve prolapse is a common cardiac abnormality associated with arrhythmias and sudden death. In most instances it can be diagnosed on the basis of physical findings. Those patients who are symptomatic or who display electrocardiographic abnormalities appear to be most susceptible to arrhythmias and, therefore, may be at increased risk for anaesthesia. Because the syndrome is relatively common and may present a very innocent clinical picture, anaesthetists should be aware of this condition and the problems it may present. A case of mitral valve prolapse syndrome associated with ventricular fibrillation on induction of anaesthesia is reported. The symptoms and pathophysiology of the disorder are reviewed and the potential problems and the anaesthetic management are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. Psychiatric implications of the mitral valve prolapse syndrome (MVPS).The mitral valve prolapse syndrome (MVPS) is an infrequent outcome of mitral valve prolapse, a common and usually benign structural abnormality. Psychiatric patients often present with symptoms indistinguishable from MVPS, knowledge of which is thus essential for differential diagnosis. Even when prolapse of the mitral valve is detected, the symptoms may be variously determined by both physical and emotional factors. Four illustrative case histories are presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Cardiovascular findings in congenital contractural arachnodactyly: report of an affected kindred.Three generations of a kindred had a history and physical findings consistent with congenital contractural arachnodactyly (CCA) segregating in an autosomal-dominant manner. Six of the seven affected patients we examined had mitral valve prolapse (MVP) diagnosed clinically or by echocardiography. The family members without CCA did not have MVP. This association of cardiac involvement with CCA further lessens the distinction between CCA and the marfan syndrome. The indication for ophthamologic and echocardiographic follow-up of patients carrying the diagnosis of CCA is stressed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/11. Cardiovascular anomalies in Marfan's syndrome: the role of echocardiography and beta-blockers.Six patients with Marfan's syndrome were included in a study to determine the effect of beta-blockers on progressive aortic dilation. patients' histories and results of physical examination, chest radiogram, electrocardiogram, and echocardiogram are reported. patients ranged in age from 5 years 8 months to 14 years; one was black, five were white, and four were male. The study included a brother and sister whose mother had had Marfan's syndrome and died at age 32. All six patients had aortic dilatation documented by echocardiography; two also had mitral valve prolapse. Auscultatory findings were unrevealing, but patients showed easy fatigability. During the prospective, randomized study, half of the patients were given beta-blockers; the other half formed a control group. Findings at short to midterm follow-up suggest that beta-blockers are beneficial in arresting progressive dilatation of the aorta.- - - - - - - - - - ranking = 4.5614612715565keywords = physical examination, physical (Clic here for more details about this article) |
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