1/10. First place winner. Recurrent febrile seizures: an unusual presentation of nutritional rickets.Nutritional rickets is a serious disease that is infrequently encountered in the united states today because of the fortification of infant formulas and dairy products with vitamin d. We report a case of undiagnosed nutritional rickets presenting with recurrent febrile seizures. Febrile seizures, a common and usually benign presenting complaint, are not among the symptoms generally known to be associated with rickets. Therefore, the disease was uncovered only after a careful history and physical examination prompted a more thorough investigation into an underlying cause for recurrent seizures. The diagnosis was subsequently confirmed by quantitative laboratory testing. We review the historical and cultural factors, symptoms, and physical findings suggestive of this potentially serious yet easily treatable disease.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/10. Retrorectal cyst: a rare tumor frequently misdiagnosed.BACKGROUND: The rarity of retrorectal cysts and their nonspecific clinical presentations often lead to misdiagnoses and inappropriate operations. In recent years, several such patients have been referred to our institutions for evaluation and treatment of misdiagnosed retrorectal cysts. A review of these patients is presented. STUDY DESIGN: medical records of the colorectal surgery divisions at two institutions were reviewed. patients found to have previously misdiagnosed retrorectal cysts were identified. Preliminary diagnoses, radiologic examinations, operative procedures, and final diagnoses were obtained. RESULTS: Seven patients with retrorectal cysts who had been misdiagnosed before referral were identified. These patients had been treated for fistulae in ano, pilonidal cysts, perianal abscesses; psychogenic, lower back, posttraumatic, or postpartum pain, and proctalgia fugax before the correct diagnosis was made. patients underwent an average of 4.1 operative procedures. physical examination in combination with CT scanning made the correct diagnosis in all patients. All patients underwent successful resection through a parasacrococcygeal approach, and six of seven did not require coccygectomy. The resected tumors included four hamartomas, two epidermoid cysts, and one enteric duplication cyst. CONCLUSIONS: Retrorectal cysts are a rare entity that can be difficult to diagnose without a high index of clinical suspicion. A history of multiple unsuccessful procedures should alert the clinician to the diagnosis of retrorectal cyst. Once suspected, the correct diagnosis can be made with physical examination and a CT scan before a definitive surgical procedure.- - - - - - - - - - ranking = 0.93900498161123keywords = physical examination, physical (Clic here for more details about this article) |
3/10. Ruptured aneurysm of the sinus of valsalva into the right atrium. An uncommon congenital heart defect.rupture of an aneurysm of the sinus of valsalva is an uncommon heart defect. A continuous murmur may be the first clinical sign of this rupture. Additional imaging techniques, and in the first place echocardiography, can be used to confirm the diagnosis. We present a case where, at the age 53 years, the diagnosis was made of a ruptured sinus of valsalva into the right atrium, with a typical windsock image on echocardiogram. Although several cases of a ruptured sinus of valsalva are reported in the literature, it is still an underdiagnosed condition because it is frequently missed during physical examination.- - - - - - - - - - ranking = 0.93900498161123keywords = physical examination, physical (Clic here for more details about this article) |
4/10. chondroblastoma of the distal femur. A case report.The authors report a case of chondroblastoma which was localised in the distal femoral epiphysis in a 16-year-old boy. The lesion was large, rapidly expanding and extended into the knee joint. After diagnostic evaluation including tru-cut biopsy, the lesion was treated surgically with curettage and grafting with coralline hydroxyapatite. Four months after surgery the patient had no pain and had nearly full range of motion of the left knee. He was followed up for thirty-five months with routine radiographs and physical examination. He had no recurrence, no pain, and regained full range of motion of his knee. Most chondroblastomas involve the medullary cavity; they may rarely involve the cortex but to the best of our knowledge, no cases with soft tissue involvement have been reported in the literature.- - - - - - - - - - ranking = 0.93900498161123keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Dercum's disease (adiposis dolorosa): a new case-report.Dercum's disease, or adiposa dolorosa, is a rare condition characterized by the development of multiple painful subcutaneous lipomas. Postmenopausal women are selectively affected. The ankle area is an uncommon site of involvement. We report a case with lipomas about the ankle, and we review the relevant literature. CASE-REPORT: This 46-year-old perimenopausal woman receiving follow-up for depression presented in December 1997 for swelling and mechanical pain in the right ankle. Lumps behind and under the malleoli were removed surgically and found to have the typical histological features of lipomas. In January 2000, a lump developed behind and under the malleoli of the left ankle, and the lumps on the right recurred. The physical examination showed obesity, with a body mass index of 32.04 kg/m(2). Firm, mobile, painless lumps were felt under and behind the malleoli on both sides. The ankles were painful, although range of motion was normal. Examination of the back found two similar lumps. The erythrocyte sedimentation rate was 10 mm/h and the c-reactive protein level was 6 mg/l. serum lipid levels were normal. Findings were normal from plain radiographs of the ankles. Ultrasound scanning of the ankles confirmed that the lumps were composed of adipose tissue. magnetic resonance imaging visualized an arc-shaped lipomatous mass on the left. Whole-body bone density measurement found an increase in fat mass of the lower limbs with normal bone mass. The ankle lipomas were removed surgically. At last follow-up 18 months later, she was free of recurrence. DISCUSSION: Dercum's disease is a rare condition of unknown etiology characterized by multiple, often painful lipomas. paresthesia in the overlying skin is common. Lipomas about the joints cause mechanical arthralgia. The diagnosis, which is often delayed, rests on ultrasonography and, above all, magnetic resonance imaging. A combination of medications, surgery, and psychiatric care is usually needed. The treatment aims at relieving the pain and restoring a normal appearance.- - - - - - - - - - ranking = 0.93900498161123keywords = physical examination, physical (Clic here for more details about this article) |
6/10. Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report.Isolated fracture of the lesser tuberosity is an unusual phenomenon in children and adolescents. These injuries are difficult to diagnose acutely and often present as chronic shoulder pain. In this study, we report on 1 case of a displaced lesser tuberosity apophysis avulsion fracture in an adolescent treated with open reduction and internal fixation, as well as a review of the literature. A 14-year-old adolescent male presented to the senior surgeon complaining of left shoulder pain and weakness 10 days after a wrestling injury. He was diagnosed with a displaced, isolated fracture of the lesser tuberosity apophysis for which he underwent open reduction and internal fixation. A combination of sutures passed through drill holes in the proximal humerus and bioabsorbable suture tacks were used to anatomically fix the lesser tuberosity fragment and subscapularis tendon. Postoperatively, he underwent a progressive physical therapy regimen. At 4 months follow-up, he had full range of motion, complete return of strength, and returned to competitive athletics. We report here on the successful surgical treatment of a fracture of the lesser tuberosity apophysis in an adolescent.- - - - - - - - - - ranking = 0.060995018388771keywords = physical (Clic here for more details about this article) |
7/10. An unusual localization of thymoma.A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.- - - - - - - - - - ranking = 0.93900498161123keywords = physical examination, physical (Clic here for more details about this article) |
8/10. Primary extracranial meningioma of the sinonasal tract.Meningiomas occurring outside the cerebrospinal axis can be primary at an extracranial site (nasal cavity, paranasal sinuses, and nasopharynx) or secondary extending from an intracranial lesion. magnetic resonance imaging findings of an 8-year-old child with primary meningioma before and after surgery have been reviewed and compared to computed tomography and histological evaluation. The child had difficulty breathing through the left nostril and tearing of the left eye. After physical and radiological examination, a tumor comprising the left lower, middle turbinate, and ethmoidal cells was found and radically extirpated. On histological examination, the tumor was identified as meningothelial meningioma. On the basis of the clinical, radiological, and histological features, the tumor was diagnosed as extracranial meningioma of the sinonasal tract. A follow-up examination 6 months later revealed no evidence of recurrence of the tumor.- - - - - - - - - - ranking = 0.060995018388771keywords = physical (Clic here for more details about this article) |
9/10. hypereosinophilic syndrome associated with acute necrotizing myocarditis and cardiomyopathy.We report the rare case of a 55-year-old female with massive eosinophilic myocarditis and severe, however reversible, impairment of left ventricular function. The patient presented with reduced physical condition, progressive dyspnea on exertion and peripheral edema. The white blood count revealed a leukocytosis and markedly elevated peripheral blood eosinophilics (48.8%). An endomyocardial biopsy demonstrated massive myocardial infiltration with eosinophilic granulocytes and necrosis. The symptoms and laboratory parameters indicate the presence of a hypereosinophilic syndrome. The differential diagnosis of a churg-strauss syndrome is discussed. Medical heart failure treatment according to international guidelines and an immunosuppressive treatment with prednisolone (Decortin H) 1.5 mg/kgBW) were initiated. This therapy led to a dramatic reduction of the eosinophilic granulocyte count and normalization of the peripheral blood count, which correlated with a significant improvement of clinical symptoms. Consistently, an increase of left-ventricular function was observed. Upon successive dose reduction to a maintenance dosage of 10 mg prednisolone, the patient's clinical status and peripheral blood count remained stable.- - - - - - - - - - ranking = 0.060995018388771keywords = physical (Clic here for more details about this article) |
10/10. sturge-weber syndrome: A case study.sturge-weber syndrome (SWS) is a rare, sporadic, progressive, congenital syndrome. In its complete trisymptomatic form, SWS is physically characterized by port-wine stains over the trigeminal area, leptomeningeal angiomas usually over the parieto-occipital region, and eye abnormalities. Clinical manifestation for infants with SWS depends on the affected organs, but can include seizures, mental retardation, and glaucoma. This article begins with a case presentation of an infant with SWS and then presents the etiology, embryology, pathophysiology, clinical presentation, management, and prognosis of SWS.- - - - - - - - - - ranking = 0.060995018388771keywords = physical (Clic here for more details about this article) |
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