1/12. Leukaemia presenting as respiratory distress in a child with asthma.asthma is the most common reason for children to present to an emergency department complaining of shortness of breath. The diagnosis, based on one or more of a positive history of atopy, physical examination findings consistent with reactive airways disease, and a clinical response to bronchodilator therapy is usually straightforward. It is important however, to consider other diagnoses, particularly when patients present differently from that which has previously been documented and/or have unexplained physical findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. Trans-metatarsal amputation as a complication of child sexual abuse.A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/12. Systemic lupus erythematosus complicated by hellp syndrome.We describe a pregnant woman with systemic lupus erythematosus, complicated by severe pre-eclampsia (the hellp syndrome) and adult respiratory distress syndrome, who died in the intensive care unit. A 33-year-old multigravid woman was referred to our university hospital at 17 weeks' gestation because of an exacerbation of systemic lupus erythematosus with elevated liver enzymes and thrombocytopenia. At the time of admission, on physical examination she had revealed a butterfly rash over the cheeks, purpura, acute synovitis and oedema of the legs. Her blood pressure was 180/100 mmHg. The initial laboratory tests and immunological evaluation confirmed active systemic lupus erythematosus complicated by severe pre-eclampsia. One week after admission, she became suddenly confused and had a convulsion with Glascow coma Score 10 (3 3 4). Therapeutic abortion was induced in the Obstetric Department. She was transferred to the intensive care unit with a diagnosis of respiratory failure, probably due to acute respiratory distress syndrome, and was intubated and ventilated. dialysis was instituted on two consecutive days from the eighth day. In total she received over 20 units of red blood cells and large quantities of fresh frozen plasma and platelets. On the 24th day her Glascow coma Score was 2 (1 1 E) and severe hypotension developed. She died from worsening acute respiratory distress syndrome on the 25th day. women with systemic lupus erythematosus should be advised to become pregnant when the disease is inactive and should be observed at an appropriate centre using a multidisciplinary approach. Therapeutic abortion is an acceptable option if active nephropathy and severe pre-eclampsia are present in early pregnancy.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/12. Respiratory failure and hypercoagulability in a toddler with Lemierre's syndrome.A 3.5-year-old healthy boy with 4 days of fever was referred to the emergency department for respiratory distress. The physical examination was remarkable for stupor, tachycardia, tachypnea, and dyspnea. Initial blood tests showed pancytopenia. He rapidly developed torticollis. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. A presumptive diagnosis of Lemierre's syndrome was made and he was started on antibiotics and anticoagulation. He subsequently developed adult respiratory distress syndrome and required high frequency oscillatory ventilation for 9 days. Blood cultures were positive for fusobacterium necrophorum. Screening for hypercoagulability revealed 2 known risk factors: a mutation in the prothrombin gene and elevated lipoprotein a.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/12. Intravenous use of glycopyrrolate in acute respiratory distress due to bronchospastic pulmonary disease.A patient with acute respiratory distress secondary to emphysema and reactive airway disease had inadequate tidal volumes with and without endotracheal intubation. Because of the patient's failure to respond to maximal standard bronchodilator therapy and the physical inability to ventilate the patient by manual positive pressure, he received IV glycopyrrolate (0.2 mg) approximately 50 minutes after admission to the ED. The patient's condition immediately improved, as evidenced by the ability to manually ventilate the patient; he developed increased tidal volumes; and he began responding to inhalation therapy. This is the first reported case of IV glycopyrrolate administration for chronic obstructive pulmonary disease or asthma in the literature and demonstrates an instance in which inhalation therapy was ineffective due to low tidal volumes.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/12. adult respiratory distress syndrome associated with miliary tuberculosis.Three patients with respiratory failure resulting from miliary tuberculosis had a characteristic clinical presentation that included a long history of a prominent cough, dyspnea, weight loss, tachycardia, tachypnea, pulmonary adventitious sounds, and hepatomegaly. Hematologic investigation showed a normal white cell count with marked left shift in the morphology of white cells in all three patients, and evidence of disseminated intravascular coagulation in one patient. In only one patient was the initial sputum positive for acid-fast bacilli; in the others, invasive diagnostic procedures including lumbar puncture, bone marrow trephine, and open-lung biopsy were necessary for diagnosis. Miliary tuberculosis should be suspected in patients with adult respiratory distress syndrome of unknown etiology. Simple diagnostic procedures such as sputum, bronchial brushings, and urine examination should be followed by bone marrow trephine, liver biopsy, transbronchial lung biopsy, and lumbar puncture if physical signs of meningitis are present.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/12. The adult respiratory distress syndrome bronchogenic pulmonary tuberculosis.In three cases of pulmonary tuberculosis associated with the adult respiratory distress syndrome the clinical features, which were similar to those of patients with miliary tuberculosis and adult respiratory distress syndrome, included a history of cough, fever, and dyspnoea on effort, and the physical signs of fever, tachypnoea, pulmonary adventitious sounds, tachycardia, and hepatomegaly. In these cases the radiological features, though suggestive of diffuse pulmonary oedema, were more prominent on the side in which the cavitatory lesion appeared. The diagnosis of tuberculosis was made easily from direct examination of sputum. Despite early ventilatory support and antituberculous therapy, two of the three patients died. Postmortem examination of the lungs in these cases showed evidence of acute alveolar damage (loss of type 1 pneumocytes and the presence of hyaline membranes within alveolar ducts) and of chronic alveolar damage (interstitial and alveolar fibrosis).- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/12. Chest physical therapy to the patient with multiple trauma. Two case studies.Chest physical therapy is the preferred treatment in the MIEMSS for both preventing and treating pulmonary complications caused by retained secretions. The beneficial results of chest physical therapy in our facility, including improvement in chest roentgenogram appearance, arterial blood gases, and lung compliance, have been documented. The cases presented illustrate the successful use of chest physical therapy despite the presence of severe trauma and possible contraindications. The potential benefits of chest physical therapy may outweigh the existing possible contraindications.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
9/12. Use of Denver shunt in recurrent hepatic hydrothorax.A 49-year-old woman with alcoholic cirrhosis was hospitalized for severe respiratory distress. A moderate amount of ascites was noted on physical examination, and the right hemithorax was completely opacified on the chest x-ray film. Thoracentesis was performed, and a follow-up chest x-ray film showed marked reduction of pleural effusion. Two days later the patient again was in respiratory distress, and a chest tube was inserted. On the tenth hospital day, a peritoneovenous (Denver) shunt was inserted and the chest tube was removed. Follow-up chest x-ray films showed almost complete resolution of pleural effusion, and the patient has remained free of symptoms. When hepatic hydrothorax does not respond to conventional therapy, we believe aggressive treatment with a Denver shunt may be successful. To our knowledge this procedure has been performed successfully in only one other patient. Further study is needed to assess its value as a possible alternative method of treatment.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/12. Successful lung transplantation in a long-term ventilator-dependent patient.Ventilator dependence has been postulated to be a major contraindication for successful lung transplantation. We describe the case of a 44-year-old female patient mechanically ventilated for 10 months after adult respiratory distress syndrome. After a program of physical training the patient underwent successful bilateral sequential lung transplantation. Six months postoperatively she is in good physical condition and is able to carry out the activities of normal daily living. We conclude that in selected patients long-term mechanical ventilatory support is not a contraindication for lung transplantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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