1/63. Acute myocardial infarction associated with anabolic steroids in a young hiv-infected patient.The use and abuse of anabolic-androgenic steroids have increased over the past decade and pose a medical and public health problem. In addition to their use by athletes to increase muscle mass and improve performance, people with wasting and malignant diseases are finding that the agents improve both their physical appearance and strength. Unfortunately, anabolic steroids are associated with a number of adverse effects, not the least of which is acute myocardial infarction, which occurred in a 39-year-old man with human immunodeficiency virus infection. It is important for clinicians to be aware of the association and to counsel patients carefully about this and other untoward effects that may occur with the agents.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/63. Primary iliac muscle abscess due to staphylococcus aureus.A 55-year-old man presented with a 3-day history of lower back pain and right thigh pain. A diagnosis of discogenic pain had been made at two other hospitals. He had been admitted to a medical center for acute hepatitis 5 months prior to this admission. Large doses of parenteral hydrocortisone were used for 13 days to treat acute hepatitis. At the present admission, he was unable to stand and refused to move his right leg. There was mild tenderness in the right lower abdomen on deep palpation. Passive flexion and rotation of the right hip produced mild pain, while passive extension of the right hip produced severe pain and resistance. The Patrick test was positive and the psoas sign was present on the right side. The erythrocyte sedimentation rate (ESR) was 66/hr. The c-reactive protein (CRP) level was 0.161 g/L. Abdominal sonography showed a lobulated mass in the right iliac fossa. magnetic resonance imaging showed severe swelling of the right iliac muscle with a central heterogeneous mass. debridement, drainage of the abscess, and application of a septopal chain were performed via an anterior retroperitoneal approach, and parenteral cephazolin and gentamicin were administered. A culture of the abscess grew staphylococcus aureus. The ESR and CRP concentrations decreased to within the normal ranges 3 weeks later. awareness of this disease entity, careful physical examination, and appropriate imaging studies such as ultrasonography and magnetic resonance imaging are key to making a correct diagnosis.- - - - - - - - - - ranking = 6.9491172223099keywords = physical examination, physical (Clic here for more details about this article) |
3/63. Tuberculous infection of the gracilis muscle and tendon clinically mimicking deep venous thrombosis: sonographic findings.Musculoskeletal tuberculosis usually involves the spine. Tuberculous infection of muscles and tendons is rare. A patient with tuberculous infection of the gracilis muscle and tendon is reported. lower extremity Doppler ultrasound was initially performed, as the physical examination mimicked deep vein thrombosis. Sonography identified the abnormal muscle and tendon and was then used to guide aspiration. The sonographic appearance of the gracilis muscle and tendon is described and compared with correlative MR images.- - - - - - - - - - ranking = 6.9491172223099keywords = physical examination, physical (Clic here for more details about this article) |
4/63. The rehabilitation of a competitive swimmer with an asymmetrical breaststroke movement pattern.This case study describes the treatment and management of an 11-year-old competitive swimmer who was repeatedly disqualified from races because of an asymmetrical movement pattern, otherwise called stroke. The treatment was based on the impairments found during the physical examination that were considered relevant to the physical dysfunction resulting in the asymmetrical stroke. This gave rise to the hypothesis that muscle imbalances around the right shoulder and left hip, together with a relative restriction of motion in these joints, were resulting in the transmission of forces up and down the kinetic chain and that these were contributing factors to the asymmetrical breaststroke stroke. An eclectic approach was used in the analysis, and the subsequent treatment and management, of the problem. To achieve the goal of a symmetrical stroke, the muscle balance/imbalance approaches of Janda (1994), Sahrmann (1988) and Kendall et al. (1993) were used. The joint impairments were treated with techniques described by Maitland (1986) and Mulligan (1996), while the exercise programme included the core/stabilizing approach presented by Blanch (1997). The treatment period consisted of four phases of 3 weeks each. The result indicates that early identification and treatment of muscle imbalance syndromes and relative joint restrictions by the physiotherapist and coach working together may be useful in establishing good movement patterns and technique for competitive swimmers.- - - - - - - - - - ranking = 7.9491172223099keywords = physical examination, physical (Clic here for more details about this article) |
5/63. rectus abdominis endometrioma.A 31-year-old woman presented with complaints of increasingly severe right lower quadrant discomfort that had occurred for several days each month over the course of the previous 6 months. A tender mass of the abdominal wall was palpated on physical examination, and subsequent ultrasonography and magnetic resonance imaging disclosed a discrete mass of the body of the right rectus abdominis muscle which was confirmed as endometrial tissue on biopsy. rectus abdominis endometrioma is a relatively rare cause of abdominal pain which may mimic an acute abdomen. Clinical clues to the diagnosis include previous uterine or gynecological surgery/invasive procedure (with preservation of ovarian function), cyclical nature of the discomfort, and the presence of a palpable mass with or without associated skin color changes.- - - - - - - - - - ranking = 6.9491172223099keywords = physical examination, physical (Clic here for more details about this article) |
6/63. Focal myopathy induced by chronic heroin injection is reversible.We report a patient who developed a focal myopathy with prominent contractures of his thigh muscles induced by chronic heroin injection. Muscle biopsy and magnetic resonance imaging (MRI) were indicative of a fibrotic and inflammatory process. Treatment with steroids, D-penicillamine, and physical therapy led to full functional recovery within 6 months. Sequential electromyographic (EMG) studies and muscle biopsies showed evidence of regenerating muscle fibers and absence of inflammatory cells. We conclude that heroin-induced focal myopathy is reversible and that combination therapy with D-penicillamine and steroids may be useful.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/63. Acute quadriplegic myopathy with loss of thick (myosin) filaments following heart transplantation.Acute quadriplegic myopathy with loss of thick (myosin) filaments (AQM-LTF) is an acute toxic myopathy observed in critically ill patients and is characterized by proximal or diffuse weakness of extremities and difficulty in weaning from mechanical ventilation. In recent years, this myopathy has been described in transplanted patients, although only 5 cases have been reported following heart transplantation. We present 3 new cases and review the previous literature. We conclude that the clinical picture and outcome of AQM-LTF in heart-transplanted patients do not differ from those observed in other critically ill patients (transplanted and non-transplanted). Therefore, because AQM-LTF is often clinically suspected muscle biopsy should be quickly performed to confirm the diagnosis so that physical therapy may begin as soon as possible.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/63. Rectus sheath hematoma in an elderly woman under anti-coagulant therapy.Rectal sheath hematoma has been a well-known clinical entity from the ruin of the ancient greece. It is relatively rare, however, to encounter this abdominal disorder in the clinical setting. Furthermore, the initial symptoms of rectus sheath hematoma are often similar to those of acute abdominal disorders. Therefore, the majority of the patients with rectus sheath hematoma have been treated with operative procedures because of the difficulty of a differential diagnosis from other abdominal disorders. We recently treated a 74-year female diagnosed with rectus sheath hematoma with the anticoagulants after an episode of cerebral infarction. From the findings of the physical examinations, ultrasound, and computed tomography, we could correctly diagnose, and could treat her with completely conservative methods without any invasive techniques. It is stressed that it is important to recognize this entity of rectus sheath hematoma when patients are examined, after complaining of acute abdominal pain and with evidence abdominal masses in the clinical setting.- - - - - - - - - - ranking = 6.9491172223099keywords = physical examination, physical (Clic here for more details about this article) |
9/63. Deep soft tissue infections in the neutropenic pediatric oncology patient.PURPOSE: Necrotizing fasciitis and myonecrosis can be rapidly fatal without prompt and aggressive medical and surgical therapy. We reviewed our experience with necrotizing fasciitis and myonecrosis in neutropenic pediatric oncology patients to describe associated clinical characteristics and outline therapeutic interventions. patients AND methods: A retrospective chart review was performed for all cases of deep soft tissue infection found in neutropenic pediatric oncology patients during an 11-year period. RESULTS: Seven cases of necrotizing fasciitis and/or myonecrosis associated with chemotherapy-induced neutropenia were diagnosed during the study period. Deep soft tissue infection was diagnosed a median of 14 days after the initiation of chemotherapy. All of the patients presented with fever and pain, generally out of proportion to associated physical findings. Most patients (86%) also had tachycardia and subtle induration at the site of soft tissue infection. The pathogenic organism in four of seven patients originated in the gastrointestinal tract. patients were treated with antibiotics, surgical debridements, granulocyte colony-stimulating factor, and hyperbaric oxygen. Granulocyte transfusions were administered if there were no signs of neutrophil recovery. Five patients survived their deep soft tissue infection. CONCLUSIONS: The diagnosis of necrotizing fasciitis and/or myonecrosis should be considered in any neutropenic patient with fever, tachycardia, and localized pain out of proportion to the physical findings. Appropriate therapy includes broad-spectrum intravenous antibiotics and urgent surgical intervention. granulocyte colony-stimulating factor should be administered to all patients to enhance neutrophil recovery. Granulocyte transfusions should be considered if a prolonged period of neutropenia is anticipated.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
10/63. mulibrey nanism: review of 23 cases of a new autosomal recessive syndrome.Mulibrey (muscle, liver, brain, eye) nanism is probably an autosomal recessive condition characterized by progressive growth failure of prenatal onset, triangular face with hydrocephaloid skull, general thinness and muscular hypotonicity, peculiar voice, venous congestion caused by pericardial constriction, and pigment dispersion and yellowish dots in ocular fundi. Two thirds of the patients had cutaneous nevi flammei and one third cystic fibrous dysplasia of the tibia. Probably a substantial portion of the affected are lost by early abortion and others by infantile death. The physical capacity and life expectancy seem to vary depending on the degree of the cardiac affection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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