1/6. Functioning adrenal black adenoma with pulmonary and cutaneous cryptococcosis: a case report and review of English literature.A 53-year-old woman experienced progressive general weakness and lumbago in the 2 years prior to a physical examination which disclosed cushingoid manifestations and a skin ulcer on the back of her right knee joint. Her plasma cortisol concentration ranged from 24.7 to 31.1 microg/dl, with an ACTH level <5 pg/ml. Urinary excretions of 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) were 20.5 mg/day and 5.1 mg/day, respectively, and urinary cortisol was also increased (421 microg/day). Cortisol was not suppressed after the administration of 8 mg dexamethasone. Abdominal ultrasound sonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) studies demonstrated a left adrenal tumor and further, a chest X-ray examination showed a cavitary lesion containing a fungus ball-like mass in the left lower lung field. The serum cryptococcal antigen titer was positive at 1:128 and a bronchoalveolar lavage fluid culture yielded a growth of cryptococcus neoformans. A biopsy specimen of the skin ulcer also suggested cryptococcosis. As a result, a left adrenectomy was performed, and the excised specimen was shown to be an adenoma consisting of compact cells with abundant pigmentation (black adenoma). A diagnosis of functioning black adenoma of the adrenal gland, complicated with pulmonary and cutaneous cryptococcosis was made.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Use of differential reinforcement to treat medical non-compliance in a paediatric patient with leukocyte adhesion deficiency.Leukocyte Adhesion Deficiency (LAD) is a rare immuno-deficiency disorder which results in chronic infections, such as gingivitis, necrotic skin infections and gastrointestinal ulcers. This case describes an 18-year-old male who was non-compliant during an inpatient hospitalization with several aspects of his complex medical regimen, particularly his wound care, physical therapy and use of his crutches. The patient's dressing change protocol was task analysed in order to create a structured, predictable routine by having the subject complete small, discrete steps. A differential reinforcement programme was implemented to provide the patient with tangible reinforcement for general compliance with his treatment, including compliance with dressing changes and physical therapy. Over a 1-month period, the subject's overall compliance with his medical regimen achieved an average of approximately 87%. His compliance with physical therapy and dressing changes both improved to 87 and 80%, respectively, by the end of his hospitalization. During the last week of his hospitalization, the use of his crutches was task analysed and included in his reinforcement programme using a changing criterion design. His average use of his crutches also improved to 80%.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
3/6. psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient.A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Perianal orf.The parapox viral infection orf is usually diagnosed without difficulty when the lesions have the characteristic morphology and there is an appropriate history of contact with sheep. Two cases of orf in a perineal location in young children are presented to illustrate modification of the physical signs by flexural occluded sites. Electron microscopy of scrapings from the lesions established the diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Peripheral gangrene in childhood: further observations on its aetiology and psycho-social sequelae in nigeria.Nine children, aged one day to 10 years, presented with gangrene at the Paediatrics Department, University College Hospital, Ibadan. The aetiological factors included septic skin spots (4 cases), snake bite (1 case), femoral vein thrombosis (1 case), and congenital arterial block by embolized placental tissue (1 case). One patient had polyarteritis of undetermined aetiology, and another probably had vasculitis complicating a staphylococcal septicaemia. Two of the nine patients died. Five of the seven survivors had a significant physical handicap subsequently.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Complications of cutaneous laser resurfacing: a nursing guide.Laser use for various cutaneous conditions has advanced rapidly in the past several years. Initial background and physical history is important when determining if a patient is a candidate for laser resurfacing. nurses must be able not only to identify appropriate candidates preoperatively, but to discuss the risks associated with the procedure. Because proper postoperative management is critical to the healing process, nurses must identify complications early in their course to provide appropriate intervention and, thus, reduce long-term side effects.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |