1/6. Painful pectoralis major myospasm as a result of sternal wound reconstruction: complete resolution with bilateral pectoral neurectomies.We report a patient with a highly unusual and previously unreported complication with the use of the pectoralis major muscle to treat the infected median sternotomy. The diagnosis of painful myospasm was made by a combination of physical findings and exclusion of other conditions such as recurrent infection. Treatment by pectoral denervation was relatively simple and highly successful. patients with chest-wall pain after sternal wound reconstruction should have myospasm entertained as a possible cause.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Alternative management of complex wounds and fistulae.The management of complex wounds and fistulae can often prove challenging to even the most skilled clinician. The incidence and complexity of fistulae vary considerably from centre to centre, however they often lead to prolonged hospital stays. Routine admissions for 4-5 days may lead to 4-5 months in the event of fistulae formation. Thus, many patients experience not only compromised physical health, but also complex psychological problems. This article provides a brief overview of the challenges and developments of managing a complex wound with multiple fistulae and a pictorial illustration of an innovative alternative wound management system.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. paper clip stab wounds: four case reports.Four prisoners recently evaluated at a county hospital sustained self-inflicted paper clip stab wounds of the abdomen on 22 occasions. Guidelines for management based on physical examination, abdominal films and wound exploration with paper clip extraction and short-term admission for observation have been successful in avoiding laparotomy in most instances. Evaluation and surgical treatment of penetrating abdominal injuries are controversial. Some authors propose mandatory laparotomy for all stab wounds violating the peritoneum, while others recommend selective management based on physical findings, local exploration of the wound and subsequent peritoneal lavage. Recently, four prisoners have inserted sharpened paper clips into and through the abdominal wall on 22 occasions, raising questions about the appropriate treatment of these injuries. These wounds differ from other stab wounds in several respects: 1) underlying psychiatric disturbances and the self-inflicted nature of the wound increase the difficulty of patient management; 2) attempts are often multiple, precluding repeated peritoneal lavage for evaluation; 3) the foreign body may be completely intraperitoneal; and 4) peritoneal penetration is similar to that incurred during a peritoneal tap with an 18-gauge needle. The differing presentations of these patients are reported, and a plan for management of these injuries is proposed.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/6. pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma.Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
5/6. Severe jaundice as presenting symptom of generalized peritonitis following cesarean section.jaundice complicating severe bacterial infection has already been described; much less common is its occurrence as the presenting symptom of severe sepsis. A case is presented describing a patient who developed rapid increasing jaundice on the 4th day after an elective cesarean section, accompanied by deterioration in her general status. Various diagnostic means (abdominal CT, ultrasound investigation and hepatosplenic scanning) were performed in order to confirm or rule out the possibility of intraabdominal sepsis and the only finding on physical examination, being the absence of peristaltics. In spite of negative results of all the image processing techniques the patient underwent an explorative laparotomy on the 6th day, which revealed a generalized purulent peritonitis. It should be emphasized that: Severe jaundice maybe the presenting symptom of sepsis. False negative results of several modern image processing procedures may mislead the diagnostic approach and the subsequent therapeutic methods.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Cervical spine infections.Cervical spine infections arise from a variety of etiologies including postsurgical, iatrogenic, and hematogenous routes. Clinical history, physical examinations, and diagnostic studies all play an integral role in the diagnosis and treatment of these infections. Successful treatment depends on a proper and timely diagnosis, understanding the etiology, and defining the extent to which the infectious process involves the spinal supporting and neurologic elements. Surgical treatment is required when there is abscess formation, instability, progressive kyphosis secondary to vertebral body collapse, or canal compromise with neurologic deficits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |