1/4. High fever. Experience in private practice.Experience with confirmed high fever, 40 C (104 F) or more, in a private practice during 14 years is presented. The records of 1,500 patients covering 8,000 patient years disclosed only 108 confirmed episodes of high fever. Eleven diagnostic categories included 149 diagnoses. Fourteen of 43 roentgenographic examinations yielded positive findings, including two cases of pneumonia not detected on physical examination. Two of six stool cultures yielded specific enteric pathogens. Convulsions occurred in 12 of the 108 episodes of high fever, and recurred only once in one child. There were no deaths in this series of children with high fevers. Only one diagnosis, pneumonia, was significantly more frequent in confirmed high fever than in unconfirmed high fever. Lastly, the ability of a group of mothers to read thermometers set at three different temperatures proved to be surprisingly good.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/4. Isolated nasopharyngeal aspergillosis caused by A flavus and associated with oxalosis.We report a case of isolated nasopharyngeal aspergillosis in a 52-year-old woman with Hashimoto's thyroiditis. We found the nasopharyngeal lesion incidentally while evaluating bilateral cervical lymphadenopathy, which we had discovered during a routine follow-up examination pursuant to the patient's thyroid problem. biopsy analysis of the nasopharyngeal lesion revealed the presence of a mycelium made up of septate hyphae and associated oxalosis. Mycologic examination confirmed that aspergillus flavus was the responsible pathogen. No systemic involvement or involvement of other head and neck sites was found. The patient had been exposed to a considerable amount of dust during the construction of her house, and this may have been the precipitating factor in the development of her infection. We treated the patient with a 4-week course of itraconazole. At the end of therapy, she exhibited no evidence of A flavus on physical and mycologic examinations.- - - - - - - - - - ranking = 0.054262516308076keywords = physical (Clic here for more details about this article) |
3/4. Subacute infratemporal fossa cellulitis with subsequent abscess formation in an immunocompromised patient.OBJECTIVES: To present a case of subacute infratemporal fossa cellulitis with subsequent abscess formation to show important anatomic relationships as they effect presentation and treatment of infections in this area. STUDY DESIGN: Case report and brief literature review. methods: The case of an immunocompromised patient who developed subacute infratemporal fossa cellulitis with subsequent abscess formation is presented. A literature review discusses etiology, diagnosis, and treatment of these infections. RESULTS: Careful history and physical examination revealed unilateral facial pain, swelling, and trismus to be caused by an infratemporal fossa abscess. Intraoral drainage and intravenous antibiotic therapy led to resolution of the infection. CONCLUSION: Infratemporal fossa abscesses are potentially dangerous complications of odontogenic infections. Although clinical diagnosis may be difficult, knowledge of relevant anatomy and pathways of spread allow more effective diagnosis and treatment of these infections.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/4. Acquired nasopharyngeal stenosis: a warning and review.OBJECTIVES: To present and discuss the clinical presentation and treatment planning in children with acquired nasopharyngeal stenosis (NPS) following tonsillectomy and adenoidectomy. DESIGN: Case series. SETTING: Tertiary care center. patients AND OTHER PARTICIPANTS: Nine children identified over 2 years (1995-1996) with newly diagnosed NPS were evaluated. Seven of these children underwent adenoidectomy using a potassium titanyl phosphate laser technique at a neighboring facility. These children were aged 15.6 to 62.1 months at the time of original surgery, and all presented with nasal obstruction and mouth breathing beginning within 10 weeks after surgery. In addition, 5 had newly documented obstructive sleep apnea. RESULTS: Of the 9 children, 1 required a tracheotomy. After undergoing an adenoidectomy, chronic rhinosinusitis developed and aggressive medical treatment failed in 4 children. time from symptom onset to diagnosis of NPS ranged from 2 to 34 months. The diagnosis of NPS depends on obtaining a thorough medical history and conducting a physical examination that includes nasopharyngoscopy. Most children underwent a computed tomographic scan prior to repair. The scarring encountered in these patients involved the soft palate and the posterior pharyngeal wall and/or choanae bilaterally. Five children had no identifiable eustachian tube opening into the nasopharynx, and all 5 children had chronic otitis media with effusion or persistent otorrhea. CONCLUSIONS: Nasopharyngeal stenosis following adenoidectomy and/or tonsillectomy is difficult to correct. Multiple surgeries may be required to relieve the obstruction. Standard operative techniques using the lateral pharyngeal flap and transpalatal or endoscopic intranasal approaches were adapted to the clinical situation. Prolonged use of nasal stents is mandatory to produce a nasopharyngeal opening. Adjunctive treatment may include pressure equalization tubes. However, the best treatment remains prevention.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |