1/14. Seventeen-year follow-up of a reattachment of a nonunited anterior tibial spine avulsion fracture.Seventeen years ago we treated a nonunited avulsion fracture of the anterior tibial spine with open reduction and pull-out wires. When the patient was 9 years old, she fell and bruised her left knee. The knee was immobilized for a month in a long cast. When she was 24 years old, she felt severe knee pain and giving way after playing tennis 1 month before her first visit to our hospital. She complained of knee pain, giving way, locking, and 15 degrees loss of knee extension. Radiographs showed a large nonunited fragment at the intercondylar eminence of the tibia. She underwent a reattachment surgery. When she was re-evaluated 17 years after surgery, she had no pain, no giving way, no locking, and no loss of knee extension. On physical examination, there was no instability. Plain anteroposterior and lateral radiographs showed a well-united fragment of the anterior tibial spine. In conclusion, the open reduction for knee pain, giving way, locking, and loss of knee extension caused by nonunion of avulsion of the anterior tibial spine yielded satisfactory results. We believe that in cases of nonunited anterior tibial spine fractures it is necessary to attempt to secure the anterior cruciate ligament in an anatomic position.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/14. Diabetic neuropathy, the great masquerader: truncal neuropathy manifesting as abdominal pseudohernia.OBJECTIVE: To describe a patient with diabetic truncal neuropathy and suggest a helpful diagnostic approach to this entity. methods: We present a case report, with a focus on physical, computed tomographic, and electromyographic findings. RESULTS: Because of an extensive differential diagnosis, diabetic truncal neuropathy is a rarely recognized and often misdiagnosed condition in patients with diabetes mellitus. In a 55-year-old man with a 13-year history of diabetes but no retinopathy, vasculopathy, or nephropathy, pain and a visible bulge in the left lower abdominal quadrant prompted radiographic assessment of the abdomen. A computed tomographic scan of the abdomen disclosed no mass but a weakening of the abdominal musculature suggestive of a pseudohernia. Subsequent electromyography showed evidence of polyradicular neuropathy. The patient was given treatment for pain control, and the pseudohernia resolved within 1 year. CONCLUSION: In patients with diabetes who have a painful abdominal mass, the potential presence of a diabetic truncal neuropathy should be considered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/14. Near fatal subacute thallium poisoning necessitating prolonged mechanical ventilation.The authors describe a case of severe sensory-motor polyneuropathy caused by subacute thallium-intoxication rapidly progressing to respiratory failure due to complete muscle paralysis. After more than 2 months of mechanical ventilation, weaning from the ventilator was possible. Further intensive physical rehabilitation required an additional 6 months hospital stay, and 18 months later, neurological recovery was complete except for the distal lower limbs muscles. The authors discuss the different forms of thallotoxicosis and the present treatment is reviewed. Maximal prolonged therapeutic support should be offered in severe thallotoxicosis because of possible near complete recovery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/14. Severe hypokalaemic paralysis from an unusual cause mimicking the Guillain-Barre syndrome.We report a case of hypokalaemic quadriparesis occurring 37 years after a bilateral ureterosigmoidostomy. The history and physical signs as well as cerebrospinal fluid analysis initially led to a diagnosis of guillain-barre syndrome. acidosis and profound hypokalaemia were present and a dramatic improvement occurred after rapid correction of the potassium depletion. The underlying mechanism of potassium depletion which occurs after this mode of urinary diversion are briefly discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/14. cytomegalovirus infection in the normal host.CMV mononucleosis often resembles EBV infectious mononucleosis; however, certain features of the history and physical may help to distinguish CMV from EBV. While CMV mononucleosis is usually self-limited, certain laboratory abnormalities may persist for months or years after the patient has recovered. Previous reports on CMV in the non-immunocompromised host have rarely described systemic complications. We have reviewed 10 cases of CMV with systemic manifestations at one institution over a 15-year period. These patients had prolonged fevers (often greater than three weeks) and the diagnosis was often unsuspected during the early part of the illness. While two patients required mechanical ventilation, all patients had self-limiting disease and survived. When CMV is suspected and diagnosed early in the course, numerous diagnostic (and potentially dangerous) tests can be avoided in a viral illness in which prolonged fever is common.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/14. Unintended plasma exchange therapy in poliomyelitis: difficulties in the differential diagnosis of paralytic poliomyelitis and polyradiculitis.During the recent polio epidemic in finland, 3 patients were initially misdiagnosed as Guillain-Barre polyradiculitis, and 1 of them was treated with plasma exchange. The follow-up until 2 years showed no difference in the recovery between this patient and the 2 other poliomyelitis patients treated without plasma exchange. The importance of the differential diagnosis between acute poliomyelitis and acute Guillain-Barre polyradiculitis is emphasized. An evaluation scheme includes sequential physical and cerebrospinal fluid examinations, together with viral antibody determinations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/14. diagnosis of misdiagnosis: on some of the origins and functions of psychophysical misdiagnosis.Four cases of Peripheral Neurological Disorders (PND) are reviewed as models of misdiagnosis. Weaknesses in the logical process of diagnosis formation, combined with the dismissive function of the diagnosis, may lead to psychiatric misdiagnoses such as hysteria. The same logical and emotional factors can prevent correction of misdiagnosis and thus the misery of the patient may continue. Comments are made about the dangers of misusing the diagnosis of hysteria.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
8/14. guillain-barre syndrome with secondary bilateral posterior interosseous nerve syndrome.A case of guillain-barre syndrome (GBS), with secondary entrapment of the posterior interosseous nerve bilaterally, is presented. It is felt that this was caused by the edema associated with the primary GBS, which led to compression with an anatomically narrowed supinator space, previously aggravated by repetitive pronation-supination. diagnosis of such cases demands careful serial physical examinations, electromyography, and nerve conduction velocity studies. Appropriate splinting and careful exercise to balance muscle return are essential in physiatric management.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/14. Emergent exploratory laparotomy for a patient with recent Guillain-Barre recurrence: a case report.A case study is presented of a 20-year-old male with a recent exacerbation of guillain-barre syndrome who had an emergent exploratory laparotomy under general endotracheal anesthesia. His preoperative history and physical examination indicated complicating factors, including blunt abdominal trauma, ethanol ingestion, and a full stomach. The management of patients with guillain-barre syndrome and their special needs are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/14. guillain-barre syndrome leading to a conversion reaction in a teenage girl. Case report.conversion disorder can sometimes simulate guillain-barre syndrome (GBS). This often involves the mimicry of organic symptoms similar to those experienced by a relative or acquaintance. The patient with the conversion unconsciously adopts these symptoms to convert their psychologic stress to a physical phenomenon. This case is of 15-yr-old girl who had a documented case of GBS and who subsequently had recurrent episodes of a conversion disorder that simulated her original GBS presentation. The methods for diagnostically separating recurrent GBS from conversion reaction are noted.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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