1/15. death due to microvascular occlusion in sickle-cell trait following physical exertion.The heterozygous condition characterized by the presence of hemoglobin AS (sickle-cell trait) occurs in approximately 8% of the American black population. Unlike the homozygous state (sickle-cell disease), sickle-cell trait is not widely recognized as a cause of life-threatening illness or death despite over 30 case reports describing fatal or serious complications of exercise in young black males with this condition. These reports identify heat stress, dehydration, viral illness, and poor physical conditioning as factors which may contribute to exertional rhabdomyolysis and sudden death, suggesting multifactorial etiology. However, since sickling is known to occur postmortem, it remains controversial as to whether the pathogenesis of these exercise related deaths involves microvascular obstruction by sickled erythrocytes. We describe three young black individuals with no significant past medical history who died following physical exertion. In all three cases, postmortem hemoglobin electrophoresis demonstrated hemoglobin AS. In none of the cases was the body temperature found to be elevated. These cases serve to remind the forensic community that, in the proper setting, sickle-cell trait must be viewed as a potentially fatal disorder.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. A 14-year-old girl with recumbent proteinuria.We describe a 14-year-old female who presented with persistently elevated nighttime urinary protein excretion without additional clinical symptoms. She had no evidence of intrinsic renal disease on physical examination or laboratory studies. Ultrasound examination of the abdomen revealed a large cyst arising from the spleen. CT scan showed compression of the left renal vein by the splenic cyst. Removal of the cyst resulted in resolution of her proteinuria. Entrapment of the left renal vein (nutcracker syndrome) remains a rare but important cause of elevated protein excretion.- - - - - - - - - - ranking = 1.532859053702keywords = physical examination, physical (Clic here for more details about this article) |
3/15. Pseudomalignant myositis ossificans of the wrist causing compression of the ulnar nerve and artery. A case report.myositis ossificans (MO) is a condition characterised by focal, benign and self-limited idiopathic heterotopic bone formation. It is extremely rare in the hand and wrist and may lead to concomitant nerve compression. Because of the rare incidence of pseudomalignant MO at the wrist and hand, we found it of interest to report a case of this condition localised to the wrist. A 31-year-old female patient presented with swelling and pain of her left wrist. The physical examination findings, magnetic resonance imaging and Tc-99m bone scan suggested acute osteomyelitis or a tumoral condition. Incisional biopsy and pathological examination was done. The microscopic findings confirmed that the lesion was pseudomalignant MO. The lesion was removed totally and decompression of the ulnar nerve and artery was achieved. The patient regained full asymptomatic range of motion of all digits and wrist and the numbness of the fourth and fifth digits had subsided at follow-up five months later.- - - - - - - - - - ranking = 1.532859053702keywords = physical examination, physical (Clic here for more details about this article) |
4/15. leiomyosarcoma of the femoral vein in a marathon runner.leiomyosarcoma of the femoral vein is a rare tumor. physicians involved in the care of athletic patients must not be cavalier in evaluating overuse injuries and should endeavor to make a specific diagnosis. If atypical findings, such as generalized extremity swelling, are present, the physician must consider systemic illness including malignancy in apparently healthy, physically active individuals.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
5/15. Primary hyperparathyroidism mimicking vaso-occlusive crises in sickle cell disease.We report a case of bone pain associated with primary hyperparathyroidism in a patient with sickle cell disease. A 17-year-old girl with sickle cell disease (SS phenotype) was seen for bilateral knee and back pain. She had had recurrent severe vaso-occlusive crises and acute chest syndrome in the course of her disease. In the last 2 years, she had frequent visits to the emergency department for severe bone pain. She complained of long-standing fatigue and lethargy. Her physical examination was normal. hydroxyurea treatment, as well as and long- and short-acting narcotics were given, with little improvement in symptoms. Poor compliance with medication, family dysfunction, and potential narcotic addiction were felt to be significant contributors to the patient's symptoms. She was incidentally found to have an extremely elevated total calcium level of 3.19 mmol/L (range: 2.25-2.76) with an ionized calcium level of 1.9 mmol/L (range: 1.15-1.35). phosphorus level was 0.82 mmol/L (range: 0.90-1.50), alkaline phosphatase level was elevated at 519 U/L (range: 10-170), and parathyroid hormone level was extremely high at 1645 pg/mL (range: 10-60). Her renal function was normal. ultrasonography of the neck and a Sestamibi scan revealed a single left inferior parathyroid adenoma adjacent to the thyroid lobe. There was no evidence of an underlying multiple endocrine neoplasia. The patient was diagnosed with primary hyperparathyroidism. Fluid hydration, hydrocortisone, calcitonin, and bisphosphonates were initiated for acute hypercalcemia management before surgical excision of the left parathyroid adenoma. On review of previous blood work, a borderline calcium level of 2.72 was present 18 months before this admission. Two years postsurgery, she has normal renal function, calcium, and parathyroid hormone levels. The weekly visits to the emergency department for pain episodes decreased to 1 every 2 months within the first few months after her surgery. The decrease in pain episodes, even if it coincided with the treatment of primary hyperparathyroidism, may still reflect the natural evolution of sickle cell disease in this patient. However, the high morbidity associated with primary hyperparathyroidism was successfully prevented in this patient. Primary hyperparathyroidism is rare in childhood. In a recent study, it occurred more commonly in female adolescents and was because of a single adenoma, as in our patient. Significant morbidity, mainly secondary to renal dysfunction, was because of the delay in diagnosis after the onset of symptoms (2.0-4.2 years), emphasizing the need for a rapid diagnosis. Sickle cell disease affects approximately 1 of every 600 blacks in north america. Acute episodes of severe vaso-occlusive crisis account for > 90% of sickle cell-related hospitalizations and are a significant cause of morbidity in patients. There is no known association between sickle cell disease and primary hyperparathyroidism, and this case is most probably a random occurrence. However, as emphasized by this case report, pain may also be a harbinger of other disease processes in sickle cell disease. Because management may vary, we suggest that care providers consider the diagnosis of vaso-occlusive crisis as the diagnosis of exclusion and that other etiologies for pain be envisaged in this patient population, especially in the presence of prolonged pain or unusual clinical, radiologic, or biological findings.- - - - - - - - - - ranking = 1.532859053702keywords = physical examination, physical (Clic here for more details about this article) |
6/15. Endocrine function in a case of beta-adrenergic hyperdynamic circulatory state.Endocrine functions were investigated in a case of "beta-adrenergic hyperdynamic circulatory state". This state was diagnosed by (1) typical symptoms of cardiac awareness, (2) physical findings (increments of pulse rate and blood pressure by changing positions or walking), (3) increase in cardiac output (5.25 l/min leads to 14.03 l/min) and decrease in circulatory time (10.8 sec leads to 5.5 sec) by isoproterenol infusion (0.02 mug/min/kg body weight), (4) rapid loss of symptoms and above findings by propranolol treatment (30 mg per os daily) and reappearance by discontinuing medication. The mechanism of insulin response to glucose has been a controversy as to whether the secretion is transmitted by beta-receptor or independent glucose receptor. And in this physiologic beta-adrenergic state, it was found that insulin responses in IVGTT and OGTT were within normal limit. When beta-adrenergic condition was corrected by propranolol treatment, insulin responses were shown lowered, though in the normal range. This could be reproduced by discontinuing medication. insulin, glucagon and growth hormone secretions caused by arginine were also found normal, but during the period the patient was on propranolol therapy, all responses were decreased, within the normal range. These results do not positively support the idea that glucose receptor is linked to beta-receptor. They do not either agree with the contention that secretions of insulin, glucagon and growth hormone induced by arginine are mediated through beta-receptors.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
7/15. Radiating leg pain in the older patient.Failure to recognize the presentation frequently leads to misdiagnoses and treatment errors. To avoid such pitfalls, guidelines on seven prominent etiologies are provided. With careful attention to the history and physical examination, an understanding of how those etiologies present will lead to accurate diagnosis and appropriate treatment.- - - - - - - - - - ranking = 1.532859053702keywords = physical examination, physical (Clic here for more details about this article) |
8/15. Paradoxical ventricular septal motion with right ventricular dilatation as a manifestation of pure pressure overload due to pulmonary veno-occlusive disease.Paradoxical interventricular septal motion with right ventricular dilatation has been considered the hallmark of right ventricular volume overload. We report a 43-year-old woman with severe pulmonary hypertension due to pulmonary veno-occlusive disease who exhibited these echocardiographic abnormalities. Right ventricular volume overload was excluded by physical examination, echocardiography with saline contrast study and by cardiac catheterization, angiography, and shunt study. These echocardiographic findings are thus not pathognomonic of right ventricular volume overload and can be seen with pressure overload as well.- - - - - - - - - - ranking = 1.532859053702keywords = physical examination, physical (Clic here for more details about this article) |
9/15. Bilateral upper extremity ischemia after administration of dihydroergotamine-heparin for prophylaxis of deep venous thrombosis.Prolonged arterial spasm as a complication of ergot-containing medications has been reported since antiquity. This article describes our experience with a patient who had severe bilateral arterial spasm in the upper extremities 6 days after the initiation of a regimen of dihydroergotamine and heparin for prophylaxis against deep venous thrombosis. The spasm was refractory to oral calcium channel blocking agents and direct intraarterial infusion of tolazoline (Priscoline). However, intraarterial nitroglycerin produced a prompt and dramatic improvement in symptoms and in physical and arteriographic findings. This experience suggests that intraarterial nitroglycerin may be an appropriate first choice for ergot-induced arterial spasm.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
10/15. popliteal artery entrapment syndrome. A report of two cases.Two cases of popliteal artery entrapment syndrome are added to the previously reported three cases from china. The details of the history, physical findings, and treatment of these two cases are presented, with a general discussion of the syndrome.- - - - - - - - - - ranking = 0.16666666666667keywords = physical (Clic here for more details about this article) |
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