1/9. popliteal artery entrapment syndrome: diagnosis and management, with report of three cases.popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lowerlimb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. The importance of the complete history in the discovery of a potential suicide: a case report.suicidal ideation and completed suicides are an increasing problem among the elderly. In 1992, the elderly accounted for 13% of the population but represented 20% of all completed suicides. There are recognized risk factors for suicides in elderly patients, which include depression, deteriorating physical health, and loss of independent functioning. A complete history enables the examiner to establish a relationship with the patient and to formulate a diagnosis. Unfortunately, histories are often incomplete. Many factors can account for this, including financial pressures, patient volume, and overspecialization. The physiatric history is the integration of many parts. It incorporates not only the physiatrist's evaluation but those of other disciplines as well, for example, physical and occupational therapy. The physiatric history is a sensitive tool for assessing the state of being of the whole patient. We describe a case in which a careful and complete physiatric history and physical examination revealed an elderly patient with suicidal ideation and a plan.- - - - - - - - - - ranking = 1.258348641562keywords = physical examination, physical (Clic here for more details about this article) |
3/9. Cystic adventitial disease of the popliteal artery. Report of 1 case and review of the literature.Cystic adventitial disease (CAD) of the popliteal artery is a rare but well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial and the literature reports various hypotheses for its origin. Diagnosis starts with thorough history taking and physical examination; non invasive diagnostic studies comprise color duplex scanner (ECD), computed tomography (CT), better if elicoidal (3D CT) and magnetic resonance imaging (MRI), which can aid in establishing correct recognition of the disease in most cases. A 48-year-old man presented with intermittent right calf claudication that had begun 4 months earlier; the symptom-free interval was about 100 m. MRI and MR angiography of right popliteal fossa revealed the presence of an oval cystic (maximum diameter 45 mm). The caudal aspect of the cyst showed pedicles protruding between the popliteal vein and the popliteal artery that compressed the artery, causing complete occlusion of its lumen. Surgery was performed through the posterior approach using an S-shaped incision; the affected segment of the popliteal artery was successfully excised and replaced with an autogenous external saphenous vein graft. A follow-up is underway, both clinical and with; no cyst recurrence has so far been detected either clinically or by duplex scanner during the 15-month postoperative follow-up period; the graft is patent and the patient is completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of adventitial cystic disease of the popliteal artery. Medical history, clinical examination and non invasive instrumental investigations, such as duplex scanner, elicoidal CT and/or MRI, may aid in establishing the correct diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/9. Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years' observation.A Japanese boy aged 14 years presented with gross hematuria associated with mild proteinuria and was diagnosed as having nutcracker syndrome. magnetic resonance angiography (MRA) revealed significant compression of the left renal vein between the aorta and the superior mesenteric artery with collaterals. A percutaneous renal biopsy on the right kidney revealed no evidence of glomerular or interstitial changes with immune deposition. He was observed closely without any intervention thereafter. Although repeat MRA performed 4 years after our first observation disclosed the development of collateral veins, severe hematuria with an intermittent exacerbation remained unchanged. During the next 2 years, the hematuria completely subsided spontaneously. Although the etiology of spontaneous remission of the disease remains speculative, his good physical development (i.e., approximately 10 cm taller than his height at the onset) may change presumptive hemodynamic factors. These clinical observations suggest that a proportion of pubertal patients with nutcracker syndrome should be treated conservatively for a relatively long time.- - - - - - - - - - ranking = 0.12917432078099keywords = physical (Clic here for more details about this article) |
5/9. The management of lower extremity wounds complicated by acute arterial insufficiency and ischemia.Although wound care therapy has made significant advances in the past several years, clinicians encounter dilemmas on a day-to-day basis. One of these dilemmas is managing ischemic wounds. Certain characteristics (ischemic appearance, a history of a lack of healing, physical examination that finds no pulses, or a transcutaneous oxygen evaluation to suggest tissue hypoxia) will identify the wound as hypoxic or related to arterial disease. The clinician faces several decisions: Should an arteriogram be performed? Should an MRI or ABIs be ordered? Is a vascular surgery consult necessary? In response to this area of diagnostic and management conflict, the authors developed an algorithm for the treatment of patients with ischemic wounds. This article addresses the management of wounds primarily caused by peripheral arterial occlusive disease and includes discussion of the initial wound care consult, the factors that identify and classify patients with arterial wounds, and a description of how transcutaneous oximetry is used to evaluate this subgroup of patients. In addition, the concept of the Vascular Center is introduced and explained, including arterial vascular consultation and evaluation, arterial vascular anatomy, and noninvasive vascular studies that are important tools in the Vascular Center, as well as endovascular interventions such as arteriography, angioplasty and arterial stenting. The basics of arterial revascularization, the use of hyperbaric oxygen therapy to manage the patients with ischemic wounds, and outcome data from a case study illustrating the management algorithm utilized at the authors' facility also are presented.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/9. Limb deficiency and prosthetic management. 4. Comorbidities associated with limb loss.This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed. overall Article Objective: To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome.- - - - - - - - - - ranking = 0.12917432078099keywords = physical (Clic here for more details about this article) |
7/9. PVD: nurse--patient interventions.The intervention program described began with teaching patients in simple terms about PVD, associated risk factors, and why change is important. teaching aids such as posters and booklets were used to supplement discussion. Positive reinforcement was emphasized. Phone calls, follow-up visits, encouragement and praise were frequent. Newsletters focusing on different aspects of the various risk factors were developed and mailed monthly. patients were encouraged and helped to develop an individualized program of change based on discussions and practicality. They were encouraged to start slowly and increase gradually. Emphasis was placed on reinforcement, self-help, and praise for efforts. patients were encouraged to keep a brief daily log of progress and thoughts. Regularly scheduled physical assessments provided a tool to assess change and provide tangible evidence of their ability to set a goal, follow through, and make life-style change.- - - - - - - - - - ranking = 0.12917432078099keywords = physical (Clic here for more details about this article) |
8/9. Acute dysvascular limb in a young adult. A case study.Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Making the diagnosis when the patient has 'blue toes'.Painful "blue toes" describes a physical sign whose meaning may be discovered through a carefully taken history, physical, and laboratory evaluation. Accurate diagnosis is important, because therapy for one specific condition may be contraindicated for another. When embolism is suspected, ultrasound examination of the heart, aorta, and periphery may be useful prior to angiography in order to avoid exacerbation of cholesterol crystal embolization. Transesophageal echocardiography or MRI may be needed to exclude a thoracic aortic source. The differential diagnosis can be divided into three categories: emboli from the cardiac and arterial system, acquired hypercoagulability disorders, and syndromes that lead to peripheral vascular pathology. A clinical approach to the evaluation of patients is presented, with case reports.- - - - - - - - - - ranking = 0.25834864156197keywords = physical (Clic here for more details about this article) |