1/9. The efficacy of therapeutic plasmapheresis for the treatment of fatal hemophagocytic syndrome: two case reports.A potentially fatal hemophagocytic syndrome (HPS) has been noted in patients with reactive HPS. We describe 2 patients with reactive HPS treated with a regimen of therapeutic plasmapheresis and evaluate the efficacy of plasmapheresis for fatal HPS. Case 1 was a 31 year-old woman who had been treated for systemic lupus erythematosus (SLE) with corticosteroid hormones and immunosuppressants. She presented with persistent leukopenia and thrombocytopenia with spiking fever. She had an elevated level of serum ferritin, liver dysfunction, coagulopathy, and plasma inflammatory cytokines. Her bone marrow smear disclosed numerous hemophagocytosis of histiocytes. She was administered therapeutic plasmapheresis with total plasma exchange by fresh frozen plasma. There was an immediate and prominent decrease of cytokines, and she completely recovered. Case 2 was a 34 year-old woman who had been receiving high doses of corticosteroids and plasmapheresis for severe Stevens-Johnson's syndrome. After 18 months, she presented with physical and laboratory findings resembling lupus-like conditions and was administered high doses of corticosteroids and immunosuppressants. Human parvovirus B19 infection was detected by IgM and IgG antibodies and viral dna from a bone marrow sample; moreover, a bone marrow smear disclosed findings of HPS. Repeated therapeutic plasmapheresis was effective for improving her symptoms and laboratory abnormalities; however, she suffered from septic methicilline resistant staphylococcus aureus infection and finally died of a brain hemorrhage resulting from disseminated intravascular coagulation (DIC).- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Episodes of severe metabolic acidosis in a patient with 3-methylglutaconic aciduria.Persistent excretion of 3-methylglutaconic acid was found in a 6-month-old infant with multiple minor physical malformations and delayed development. During two episodes of intercurrent viral illness, the patient developed severe metabolic acidosis and excreted large amounts of lactate, 3-hydroxybutyrate and acetoacetate. The excretion of 3-methylglutaconic acid did not change during these episodes, nor did it increase following leucine loading. in vitro studies suggest that in this patient, as in the majority of other patients with 3-methylglutaconic aciduria, a primary defect in leucine metabolism is not responsible for the biochemical abnormality.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. Sudden onset of slow gastric emptying of food.Three healthy, young adults suddenly experienced the onset of slow gastric emptying. Their symptoms began in February, 1975 in association with a brief illness consistent with a viral gastroenteritis. They complained of early satiety, nausea, and vomiting when they ate solid food and they had lost 11-25 kg in body weight in 8-12 mo. On admission, their physical examinations and laboratory studies were within normal limits. Their stomachs emptied a barium mixture normally, and fiberoptic endoscopy did not detect any abnormalities. The slowed gastric emptying of food was documented with radioisotopic gastric emptying studies. The prolonged emptying rates of 2 patients were reduced 90% with metoclopramide. In association with metoclopramide therapy, the patients were able to eat more food, and they regained 8-10 kg of body weight in 4-6 mo. Their histories raise the possibility that their initial illness may have damaged the mechanisms which control the gastric emptying of food.- - - - - - - - - - ranking = 6.1248905701045keywords = physical examination, physical (Clic here for more details about this article) |
5/9. Acute viral encephalitis complicating a first manic episode.The diagnosis of viral encephalitis in a patient with acute mania was difficult because of symptom overlap and inconclusive laboratory evaluations. Final differentiation was made clinically. Despite the generally assumed usefulness of diagnostic tests for encephalitis, only the electroencephalogram showed consistent sensitivity in this patient and in similar previously reported cases. diagnosis was further complicated by the potential side effects of neuroleptic medications, which may mimic infection through extrapyramidal symptoms, fever, or altered blood counts. In addition, legitimate physical complaints were discounted as a result of the patient's psychiatric status.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. teratogens associated with congenital contractures in humans and in animals.An evaluation of over 350 patients in a study of congenital contractures of the joints (arthrogryposis) included a review of family, pregnancy, and delivery histories for teratogenic exposures. Fifteen out of the total 350 patients studied had a possible teratogenic exposure: an infectious agent (viral or bacterial), maternal drug or toxin ingestion, chronic maternal neurologic or muscular illness, or a direct physical insult such as a structural uterine anomaly. literature was reviewed for all human and animal cases reported with congenital contractures of the joints with an associated teratogenic insult. Those findings are discussed here.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Intensification of relative myocardial T2-weighted magnetic resonance signals in patients with acute viral myocarditis: report of one case.A 10-year-old girl was admitted to our hospital because of frequent attacks of syncope over a period of two days. A physical examination, electrocardiogram, echocardiograms and a cardiac enzyme study concluded that the girl was likely to be suffering from acute viral myocarditis. Intensities of the T2-Weighted magnetic resonance signals between the myocardium and the trapezius muscle of this patient on the first, the eighth, and the twenty-eighth hospital day were 5.1, 7.8, and 3.6 respectively. These values were significantly higher than the values of seven other patients without a history of acute viral myocarditis. Therefore, we concluded that the myocardial T2-weighted signal did intensify in patients with acute viral myocarditis.- - - - - - - - - - ranking = 6.1248905701045keywords = physical examination, physical (Clic here for more details about this article) |
8/9. diagnosis, surveillance, and epidemiologic evaluation of viral infections in pediatric cardiac transplant recipients with the use of the polymerase chain reaction.BACKGROUND: Viral infections, particularly those caused by cytomegalovirus, are a major cause of postoperative morbidity and mortality in heart transplant recipients. These infections have classically been diagnosed by history, physical examination, peripheral viral cultures, and serologic studies. These methods are often time-consuming and lack sensitivity. Positive viral cultures from the heart are rarely obtained, and viral myocarditis and acute cellular rejection are unable to be differentiated histologically. We have therefore used the polymerse chain reaction to diagnose possible viral infection in pediatric heart transplant recipients with findings consistent with acute unexplained rejection. methods: polymerase chain reaction was used as an aid to diagnose cytomegalovirus infection of cardiac tissue obtained by right ventricular endomyocardial biopsy and follow its long-term course. In addition, polymerase chain reaction was used to diagnose infection of the heart by other viruses in patients with clinical and histologic evidence of rejection, especially those with unexplained late rejection or chronic rejection. polymerase chain reaction primers were designed to amplify nucleic acid sequences from cytomegalovirus, parvovirus, adenovirus, herpes simplex virus, Epstein-Barr virus, and the rna viruses of the enterovirus family. RESULTS: Forty patients underwent serial right ventricular endomyocardial biopsy (129 samples) for rejection surveillance with positive results obtained in 41 samples (32%) from 21 patients. Viral genome amplified included cytomegalovirus in 16 samples, adenovirus in 14, enterovirus in 6, parvovirus in 3, and herpes simplex virus in 2. In 13 of the 21 patients positive for viral genome (62%), endomyocardial biopsy histologic scores were consistent with multifocal moderate to severe rejection (Internal Society for heart and lung transplantation scores of 3A or greater). CONCLUSIONS: Polymerase chain reactions may be used as a rapid and sensitive method to evaluate postoperative viral infections in heart transplant recipients, especially in those with late-onset rejection or chronic rejection. polymerase chain reaction may also be useful in the serial analysis of cytomegalovirus status in transplant recipients. The use of multiple viral primers improves the diagnostic evaluation of these patients and may lead to a better understanding of the epidemiologic characteristics of posttransplantation viral infections and the cause of late or chronic rejection.- - - - - - - - - - ranking = 6.1248905701045keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Differential diagnosis of common causes of pediatric pharyngitis.pharyngitis or sore throat is a common result of illness in pediatric and adolescent populations. Sore throat can signal either nonsystemic or systemic disease processes. Clinicians in ambulatory settings are often faced with deriving a differential diagnosis based on this symptom. Prompt and appropriate treatment depends on identification of the underlying causative agent or illness. This article examines common causes of sore throat in the pediatric and adolescent populations. These diagnoses are: (1) group A beta-hemolytic streptococcal pharyngitis; (2) non-group A beta-hemolytic streptococcal bacterial pharyngitis; (3) viral pharyngitis; (4) infectious mononucleosis; and (5) chronic conditions. Less common causes are also considered. Differential diagnosis is dependent on complete and accurate history, distinct physical finding, and interpretation of adjunct diagnostic tests. The value of critical data sources is essential in arriving at a differential diagnosis of pharyngitis. Once a diagnosis is established, an appropriate treatment plan can be initiated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |