1/739. Femoral neck stress fracture presenting as gluteal pain in a marathon runner: case report.A case is described of a 50-year-old man with a femoral neck stress fracture presenting as gluteal pain. An operative pinning procedure of the femoral neck was performed for stabilization. Femoral neck stress fractures are often misdiagnosed early in their presentation. The signs and symptoms can mimic those of more commonly seen disorders. Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
2/739. Pigmented villonodular synovitis of the knee: a description of two cases treated in arthroscopy.The authors present two cases of pigmented villonodular synovitis of the knee. After a discussion of the aspecificity of clinical findings and difficulties in diagnosis based on radiographic evaluation, they conclude that diagnosis may be possible preoperatively by MRI, and that arthroscopic surgery allows for suitable treatment of localized forms of the disease.- - - - - - - - - - ranking = 5keywords = ill (Clic here for more details about this article) |
3/739. Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature.Autoerythrocyte sensitization (psychogenic purpura) is an unusual diagnosis, but one that has a characteristic dermatologic manifestation of painful bruising. A typical case is presented, as well as a review of the literature. Treatment consists of psychiatric therapy, which is most effective when initiated early in the disease, so early diagnosis will not only minimize the cost of the medical evaluation but will also benefit the patient.- - - - - - - - - - ranking = 2keywords = ill (Clic here for more details about this article) |
4/739. Muscle pain as a prominent feature of facioscapulohumeral muscular dystrophy (FSHD): four illustrative case reports.Clinical studies of facioscapulohumeral muscular dystrophy (FSHD) rarely report muscle pain as a significant feature of the condition. We report four adult patients with FSHD in whom muscle pain was a presenting complaint and remains their most disabling symptom. These four patients were investigated using a pain questionnaire and diary. Inflammatory and metabolic causes of muscle pain were sought by muscle biopsy and a range of biochemical investigations. All patients reported between three and seven different pains of varying site and nature. None of the group had more than one painfree day per month and all complained of disturbed sleep. While some pains could potentially be attributed to postural problems, others were clearly myalgic in nature, though most often not specifically exercise-related. These myalgic pains could be particularly difficult to control. Results of metabolic investigations and muscle biopsy revealed no clue to the pathogenesis of these pains and there was no evidence for any exceptional inflammatory response. We believe that pain in FSHD is an under-reported but significant symptom and that further work is necessary to determine its prevalence, understand its cause and provide effective treatment.- - - - - - - - - - ranking = 4keywords = ill (Clic here for more details about this article) |
5/739. Suggestions for improving AIDS treatment in hospitals.On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local hiv clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.- - - - - - - - - - ranking = 3.6767979453116keywords = illness, ill (Clic here for more details about this article) |
6/739. Treatment of painful skin ulcers with topical opioids.Recent research suggests that opioid receptors on peripheral nerve terminals may play an important role in the modulation of pain. Clinical applications of this knowledge have been rather slow to evolve. We describe a consecutive series of nine patients with painful skin ulcers due to a variety of medical conditions. All patients were treated with a topical morphine-infused gel dressing. Seven of the nine patients experienced substantial and another experienced a lesser (but still significant) degree of analgesia. The ninth reported no relief, but his wound was not an open ulcer. Discussion centers on the practical application of this development in the large number of patients with painful skin lesions.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
7/739. Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
8/739. Effectiveness of a psychiatric pain clinic.Medical charts were reviewed for 101 consecutive outpatients seen between January 1, 1993 and July 1, 1996 at a unidisciplinary, psychiatric pain clinic, which exists within a hospital-based, university-run, outpatient service with primary and specialty care clinics. Mean duration of pain was 7 years. Multiple sites of pain were present in 69% of patients. Eighty-eight percent fulfilled DSM-IV criteria for pain disorder. The patients had significantly fewer medical visits and diagnostic tests 6 months after attending the pain clinic, compared with 6 months before (P < 0.0001). Interventions frequently included detoxification and reduction and substitution of medication, and always included psychotherapeutic approaches, particularly support and suggestions.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
9/739. pain and the guillain-barre syndrome in children under 6 years old.During a 15-year period, 29 children, under the age of 6 years, with acute guillain-barre syndrome were seen at our institution. A review of their charts revealed that pain was a symptom in all patients and was present on admission in 79% of cases. pain was often the most important symptom and led to misdiagnosis in 20 patients (69%). In 11 of these children, symptoms were present for more than a week before the correct diagnosis was made. The most common pain syndrome was back and lower limb pain, present in 83% of patients. Pediatricians should consider guillain-barre syndrome in their differential diagnosis when faced with a child who has lower limb pain and areflexia.- - - - - - - - - - ranking = 6keywords = ill (Clic here for more details about this article) |
10/739. Axillary schwannoma masquerading as cervical radiculopathy.A 58-year-old woman, suffering from radicular-like pain in the left arm for 3 years, presented an entirely negative cervical imaging. Careful clinical examination disclosed Tinel's sign in the axilla. This clinical finding led to further investigation of this region. Computed tomography and magnetic resonance imaging disclosed a small tumour highly suggestive of a schwannoma. Surgical exploration and microscopic examination confirmed a diagnosis of schwannoma located on the radial trunk of the left brachial plexus. After tumour excision, the patient had immediate relief of pain without sensitive or motor sequelae. No recurrence has been observed after 3 years.- - - - - - - - - - ranking = 5keywords = ill (Clic here for more details about this article) |
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