1/24. 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 = 1keywords = physical (Clic here for more details about this article) |
2/24. Tuberculous infection of the gracilis muscle and tendon clinically mimicking deep venous thrombosis: sonographic findings.Musculoskeletal tuberculosis usually involves the spine. Tuberculous infection of muscles and tendons is rare. A patient with tuberculous infection of the gracilis muscle and tendon is reported. lower extremity Doppler ultrasound was initially performed, as the physical examination mimicked deep vein thrombosis. Sonography identified the abnormal muscle and tendon and was then used to guide aspiration. The sonographic appearance of the gracilis muscle and tendon is described and compared with correlative MR images.- - - - - - - - - - ranking = 8.1659171597633keywords = physical examination, physical (Clic here for more details about this article) |
3/24. Deep venous thrombosis and pulmonary embolism as a complication of bed rest for low back pain.A case of bilateral lower extremity deep venous thrombosis and pulmonary embolism as a complication of bed rest prescribed for an acute low back pain episode is presented. A 29-year-old woman with low back pain was prescribed more than 2 weeks of bed rest, during which she developed progressive bilateral lower extremity complaints that were ascribed to nerve root irritation. Her symptoms were initially treated with physical therapy and epidural steroid injections. A Doppler examination and ventilation-perfusion scan revealed extensive deep venous thromboses and mismatches consistent with pulmonary embolism. This case illustrates an unusual extraspinal source of lower extremity symptoms associated with low back pain and further supports the role of early mobilization in the treatment of back pain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/24. Mesenteric venous thrombosis: a diagnosis not to be missed!Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/24. portal vein thrombosis and liver disease.portal vein thrombosis can occur secondary to infection, surgical intervention, or as a result of liver dysfunction. Its development can precipitate the need for emergency interventions including endoscopy, transjugular intrahepatic portosystemic stents (TIPS), portacaval shunts, or even liver transplantation. portal vein thrombosis occurs slowly and silently. portal vein thrombosis is not discovered until gastrointestinal hemorrhage develops in the patient unless the thrombosis is diagnosed on routine surveillance diagnostic testing. portal vein thrombosis can be diagnosed by Doppler ultrasonography, computed tomography scan, or magnetic resonance imaging. Late identification of portal vein thrombosis can lead to increased morbidity and mortality of the patient population. patients with portal vein thrombosis can be successfully managed with early identification and collaboration between the patient and the health care team for ongoing monitoring and treatment. Patient education involves assisting the patient in the understanding of esophageal varices, the various treatment modalities, their physical limitations, and the need for monitoring and management of the portal hypertension.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/24. Thrombosis associated with physical restraints.OBJECTIVE: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. METHOD: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. RESULTS: To our knowledge, we are the first to report thrombosis associated with physical restraint. CONCLUSION: immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.- - - - - - - - - - ranking = 8keywords = physical (Clic here for more details about this article) |
7/24. Caval thrombosis in a young athlete.We here describe a clinical case of caval thrombosis of sudden and unexpected onset, in an athlete without signs of venous insufficiency. Pre-existing caval hypoplasia was observed through imaging examinations. Following a review of the literature, the authors interpret the pathophysiological mechanism of thrombosis as such: a combination of intense physical activity and the malformation led to an overwhelming venous flow and a consequent congestion. Caval thrombosis distal to the malformation is an absolute indication to lifelong oral anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/24. Catheter-related deep venous thrombosis in children with hemophilia.central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms. Five of 15 patients had clinical problems related to the CVC, all of whom had DVT. Four of 15 patients had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For patients with DVT, the mean duration was 66.6 /- 7.5 months, compared to 49.5 /- 7.2 months for patients without DVT (P =.06). No patient whose CVC was in place fewer than 48 months had an abnormal venogram. Many hemophilia patients with CVCs develop DVT of the upper venous system, and the risk increases with duration of catheter placement.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/24. Group A streptococcal sepsis and ovarian vein thrombosis after an uncomplicated vaginal delivery.BACKGROUND: Group A streptococcal puerperal sepsis is an uncommon peripartum infection that can quickly progress to a fulminant, multisystemic infection and life-threatening toxin-mediated shock. This infection can be asymptomatic during a short hospital stay after a routine delivery. Early treatment with antibiotics might not alter the course of tissue destruction caused by the exotoxin A. methods: literature searches were performed using the key words "puerperal infections," "streptococcal infections," "septic sacroiliitis," "postpartum septic arthritis," and "postpartum ovarian vein thrombosis." After patient consent was obtained, a report was prepared documenting the disease course, diagnosis, and treatment of a case of puerperal sepsis with multiple serious complications. RESULTS AND CONCLUSION: Puerperal sepsis occurs when streptococci colonizing the genital tract or acquired nosocomially invade the endometrium, adjacent structures, lymphatics, and bloodstream. A lack of symptoms early in the course of infection is common; later, minor somatic complaints can quickly progress to septic shock as effects of the exotoxin A are manifest. women who complain of fever, pelvic pain, or unexplained systemic symptoms in the early postpartum period should have a detailed history and physical examination. All sites of suspected infection should be cultured. If sepsis is suspected, diagnostic imaging includes chest radiographs, contrast-enhanced computed tomographic scans, or magnetic resonance imaging to rule out ovarian vein thrombosis, pelvic abscess, or sacroiliac septic arthritis. Broad-spectrum antibiotic coverage must be initiated immediately after collection of cultures. clindamycin plus a beta-lactam antibiotic is preferred for streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 8.1659171597633keywords = physical examination, physical (Clic here for more details about this article) |
10/24. Effect of stress on international normalized ratio during warfarin therapy.OBJECTIVE: To discuss the effect of stress on the international normalized ratio (INR) when patients are taking warfarin. CASE SUMMARY: Two patients at a pharmacist-managed anticoagulation clinic who were stable with anticoagulation developed elevated INR values after a stressful event occurred. All other factors known to elevate the INR were unchanged; furthermore, the INR values returned to the prior level of control after resolution of the stressful events. DISCUSSION: Management of anticoagulation with warfarin requires the knowledge of factors that may alter an INR. Many of these factors, such as dietary changes, illnesses, drug interactions, patient compliance, and physical activity, have been described. In spite of this understanding, many patients continue to experience variability in their INR values, suggesting there are other factors that can alter the INR that have not been fully described. The cases presented here demonstrate that stressful events, physical or psychological, can elevate the INR. The mechanism for this occurrence is unknown, but may be related to decreased metabolism of warfarin during stress. CONCLUSIONS: When an unexplained INR value exists, a stressor should be evaluated as a potential cause.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
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