1/157. Spontaneous remission in myelodysplastic syndrome.A 73-year-old man was admitted for investigation of pancytopenia. His physical examination was unremarkable and the bone marrow aspirate was compatible with myelodysplastic syndrome (RAEB). cytogenetic analysis of the bone marrow revealed a trisomy 21. The patient received transfusions of packed red cells, and his condition remained stable for the next 7 months. He was then admitted with a chest infection and was treated with broad-spectrum antibiotics with satisfactory response. During his hospitalization there was a gradual increase in his complete blood count values, which persisted, resulting in a normal peripheral blood after 3 months. A bone marrow aspirate performed at that time revealed normal findings with no karyotypic abnormalities, indicating a spontaneous remission. The patient remained stable for the next 6 months; then he recurred with 20% blasts in his bone marrow and reappearance of trisomy 21 in 42% of the metaphases examined. Several hematologic malignancies with spontaneous remissions have been described to date, but they have generally been short and recurrence is the rule, as in the case described. The role of endogenous cytokines in triggering these spontaneous remissions is under question, as the exact mechanism is unknown.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/157. Successful treatment of adolescent pemphigus vulgaris by immunoadsorption method.A 15-year-old girl with pemphigus vulgaris did not respond to oral administration of prednisolone at 45 mg/day. The skin and oral mucous membrane lesions recurred after effective treatments with methylprednisolone pulse therapy and combination therapy with prednisolone and cyclosporine. The finally successful treatment involved eleven cycles of immunoadsorption using a tryptophan column and administration of a moderate dose of prednisolone. serum gamma-globulin level and anti-intercellular antibody titer decreased from 1.08 g/dl to 0.5 g/dl and 1:320 to 1:20, respectively. She has been well controlled with 21.5 mg/day prednisolone for 8 months after the final adsorption. Considering the physical, mental and social situation of adolescent student patients, immunoadsorption is a highly preferable choice among a variety of treatment modalities for pemphigus vulgaris because it makes the term of hospitalization shorter and avoids undesirable side effects from initial high dose corticosteroids.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
3/157. Chronic eosinophilic pneumonia.Chronic eosinophilic pneumonia (CEP) belongs to a group of syndromes manifested by pulmonary infiltrates with peripheral eosinophilia (PIE syndromes). The role of the eosinophil as a destructive agent in CEP is discussed. The degree of manifested eosinophilia at the time of diagnosis, the frequency of relapses of pneumonia, the response to steroid therapy, the status of current physical and x-ray findings, and especially the trend in pulmonary function data, all appear to be critical factors in determining the potential mortality risk of CEP cases.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
4/157. nicotine dependence and withdrawal in an oncology setting: a risk factor for psychiatric comorbidity and treatment non-adherence.Highly nicotine dependent oncology patients are at high risk for psychiatric morbidity when they enter the medical care setting where smoking restrictions apply. nicotine withdrawal symptoms exacerbate cancer-related distress as well as common physical side effects of cancer treatment. This case report illustrates the management of a patient whose ongoing treatment for bladder cancer was jeopardized as a result of nicotine dependence and withdrawal. Several associated complications are described, the most serious of which were his acute anxiety and non-adherence to medical recommendations. A short-term management approach that included anxiolytics and nicotine replacement was effectively used to reduce this patient's excessive anxiety and thus facilitate compliance with stressful treatments. The severity of complications that can result from untreated nicotine dependence and withdrawal underscores the importance of assessing and monitoring smoking status in every patient. Greater staff awareness of the clinical practice guidelines regarding the diagnosis and treatment of nicotine dependence will likely result in improved patient care and compliance.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
5/157. Hyperhomocysteinaemia and upper extremity deep venous thrombosis: a case report.A case is presented of a 24 yr old military aircrew applicant who developed a right axillary subclavian deep venous thrombosis following physical exertion. Investigations revealed damage to the right axillary subclavian venous system and limitation to flow. Coagulation studies also showed an elevated plasma homocysteine level. hyperhomocysteinemia has recently been recognized as a risk factor for venous thromboembolic disease. Damage caused by the thrombosis, the hyperhomocysteinemia and environmental factors encountered in flight, may predispose him to recurrent episodes of thrombosis. This complex case involves aspects of hematology and the nature of coagulation which are only just being elucidated and as yet are poorly understood, and highlights some serious aeromedical implications for pilots afflicted with these conditions.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
6/157. Abdominal aortic aneurysm compression is probably responsible for the recurrent episodes of acute pancreatitis: case report.An aged male with a known history of abdominal aortic aneurysm suffered from epigastralgia, vomiting and cold sweating for one day. According to the physical examination, serum amylase level and computed tomographic examination, acute pancreatitis was diagnosed. Surgical intervention for the abdominal aortic aneurysm was not performed because of his age, and finally this patient died after three recurrent episodes. Acute pancreatitis co-existing with an intact abdominal aortic aneurysm has never been reported before. The possible pathogenesis of this recurrent acute pancreatitis was discussed.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
7/157. low back pain and its relation to the hip and foot.STUDY DESIGN: Case study. OBJECTIVE: To describe a treatment approach for a patient with recurrent low back pain who also had asymmetry in hip rotation between the left and right sides. BACKGROUND: The patient's chief complaint was dull, intermittent unilateral low back pain during the past 3 years. methods AND MEASURES: The patients was a 35-year-old man with recurrent unilateral low back pain. The findings of the physical therapy examination suggested sacroiliac joint dysfunction. Also, evaluation later showed evidence of unilateral excessive foot pronation on the same side of the excessive hip lateral rotation. The finding of excessive hip lateral rotation and excessive foot pronation on the same side of the unilateral low back pain suggested a possible connection between low back symptoms, hip, and lower extremity dysfunction. RESULTS: The treatment of the hip and the subtalar joint of the foot eliminated the reoccurrence of the patients signs and symptoms of sacroiliac joint dysfunction. CONCLUSIONS: This case report demonstrates the successful treatment of a patient with low back pain who exhibited multiple impairments in the sacroiliac, hip, and subtalar joints.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
8/157. Synchronically performed laparoscopic cholecystectomy and hernioplasty.Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
9/157. Idiopathic ileoileal intussusception in an adult with spontaneous reduction during enteroclysis: a case report.We report a rare case of recurring idiopathic ileoileal intussusception in an adult. diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination. After a short period of physical improvement, a follow-up CT showed a recurrence. Surgery proved the diagnosis, but no predisposing factor was found.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
10/157. Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus.STUDY DESIGN: Case report with repeated measures. OBJECTIVES: To describe the effects of a tendo-Achilles lengthening (TAL) and total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, neuropathic ulcer, and limited dorsiflexion range of motion (DFROM). BACKGROUND: Limited DFROM has been associated with increased forefoot pressures and skin breakdown. A TAL was expected to increase DFROM and reduce forefoot pressures during walking, but the influence on muscle performance and function was unknown. methods AND MEASURES: The patient was a 42-year-old man with a 20-year history of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. Outcome measures were DFROM, isokinetic plantar flexor muscle peak torque, in-shoe and barefoot peak plantar pressure, physical performance test (PPT) score, and peak ankle and hip moments during walking obtained from an automated gait analysis. All tests were completed pre-TAL, 8 weeks post-TAL (after immobilization in a TCC), and 7 months post-TAL. RESULTS: The wound healed in 40 days. The TAL resulted in a sustained increase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 21% 8 weeks after the TAL compared with the torque before surgery but recovered fully at 7 months. Seven months following TAL, in-shoe forefoot peak plantar pressure was reduced by 55%, barefoot pressure decreased by 14%, PPT score increased by 24%, peak ankle plantar flexor moment remained decreased by 30%, and the peak hip flexor moment increased by 41% during walking. CONCLUSION: For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankle DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar pressure.- - - - - - - - - - ranking = 0.16419991295185keywords = physical (Clic here for more details about this article) |
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