1/29. Fatal child abuse by forced water intoxication.BACKGROUND: Although water intoxication leading to brain damage is common in children, fatal child abuse by forced water intoxication is virtually unknown. methods: During the prosecution of the homicide of an abused child by forced water intoxication, we reviewed all similar cases in the united states where the perpetrators were found guilty of homicide. In 3 children punished by forced water intoxication who died, we evaluated: the types of child abuse, clinical presentation, electrolytes, blood gases, autopsy findings, and the fate of the perpetrators. FINDINGS: Three children were forced to drink copious amounts of water (over 6 L). All had seizures, emesis, and coma, presenting to hospitals with hypoxemia (PO2 = 44 /- 8 mm Hg) and hyponatremia (plasma Na = 112 /- 2 mmol/L). Although all showed evidence of extensive physical abuse, the history of forced water intoxication was not revealed to medical personnel, thus none of the 3 children were treated for their hyponatremia. All 3 patients died and at autopsy had cerebral edema and aspiration pneumonia. The perpetrators of all three deaths by forced water intoxication were eventually tried and convicted. INTERPRETATION: Forced water intoxication is a new generally fatal syndrome of child abuse that occurs in children previously subjected to other types of physical abuse. patients present with coma, hyponatraemia, and hypoxemia of unknown etiology. If health providers were made aware of the association, the hyponatremia is potentially treatable.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/29. Paraesophageal hernia in an elderly woman with vomiting.We describe the case of a 79-year-old woman who presented with resolved episodes of vomiting and was found to have a paraesophageal hernia. Her initial evaluation was unremarkable, and the diagnosis was established only by the use of screening chest radiography. Once the diagnosis was confirmed, the patient required urgent surgical repair. Paraesophageal hernia is a rare clinical entity with the potential for life-threatening complications, making the diagnosis itself an indication for surgery. This case illustrates the fact that significant pathology may be present with few, if any, physical findings in the elderly patient, and thorough evaluations are required for the diagnosis of such occult pathology.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/29. Desensitization of the gag reflex in an adult with cerebral palsy: a case report.Severe oral hypersensitivity and aversive oral behaviors present a significant barrier to dental treatment and compromise oral health status. Although several authors have addressed the reduction of oral hypersensitivity and aversive behaviors (such as gagging, retching, and vomiting) in the otherwise well dental patient, treatment for patients with severe disability has not been explored. The successful management of oral hypersensitivity and aversive behavior can have significant health benefits. These can be described via an outcomes paradigm as physical and social benefits for the patient, psychological benefits for the patient, carer, and practitioner, and organizational benefits for the institutions providing dental care and medical management. This paper summarizes the management of a severely disabled patient whose aversive behaviors were eliminated with non-invasive therapy techniques. oral hygiene was facilitated and health benefits were identified across a number of domains following successful multi-disciplinary management.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/29. A case study of neurosis secondary to trauma in an eight-year-old girl. Comments on the tendency for psychogenic illness to become chronic.This case study deals with an eight-year-old girl who developed persistent abdominal pain and vomiting for which no physiological cause could be discovered. After two months of unsuccessful treatment for her illness, the girl was referred for a psychiatric consultation. During the psychiatric interview, the psychogenic nature of the girl's illness became readily apparent, as did the nature of the conflict which had produced it. The tendency is strong for psychogenic illness, such as this, to become chronic without psychiatric treatment. Many physicians are reluctant to apply clinically basic psychiatric techniques to the treatment of physical illness. A suggestion is made that closer collaboration between psychiatry and other medical specialties could be of great value in preventive medicine.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/29. Abdominal cancer, nausea, and vomiting.nausea and vomiting in abdominal cancer is perhaps one of the most difficult symptom complexes to manage, especially when complicated by bowel obstruction. There are many mechanisms of nausea in advanced abdominal cancer with a number of therapeutic interventions that can significantly enhance symptom control and overall quality of life. As with pain, the ideal approach should include a mechanistic analysis of the causes of nausea beginning with a thorough history, followed by a directed physical examination, and selected laboratory studies. The symptom history, in conjunction with a physical examination and directed tests should direct appropriate pharmacologic and nonpharmacologic interventions. The result is often the amelioration of significant suffering and enhanced quality of living.- - - - - - - - - - ranking = 6.6184650090844keywords = physical examination, physical (Clic here for more details about this article) |
6/29. Intractable vomiting in diabetic patients.Intractable nausea and vomiting have been described in individuals without any underlying physical etiology explaining these complaints. Physical or emotional abuse has been described in individuals suffering from these symptoms and associated with somatoform disorders manifesting primarily as gastrointestinal complaints. We present five patients with long-standing Type 1 diabetes who suffered from intractable vomiting. personality disorders, profound depression and emotional abuse dramatically influenced the course of these patients' illness. In most of the patients, physical symptoms remarkably improved after identification and removal of the triggering factors. Therefore, psychogenic vomiting must be considered among the differential diagnoses of intractable nausea and vomiting, especially in individuals with chronic illnesses. A careful search for a physical etiology and medical treatment that does not cause relief of symptoms should suggest that there is almost certainly a psychological issue at the root of the problem.- - - - - - - - - - ranking = 1.5keywords = physical (Clic here for more details about this article) |
7/29. Partial seizure: an unusual cause of recurrent vomiting.Partial seizure is a rare cause of nausea and vomiting. We report an adult patient with abdominal discomfort lasting 15 years accompanied by nausea and vomiting at least twice a week. On admission, physical examination and detailed laboratory tests were normal. Abdominal ultrasound examination, upper gastrointestinal endoscopy and CT scanning of the brain did not reveal any evidence of disease. electroencephalography revealed bilateral synchronous sharp wave discharges and spike wave activities. The diagnosis of partial seizure was considered and the patient was administered sodium valproate. The patient's symptoms subsided and he has been asymptomatic for the past 20 months. We conclude that partial seizure should be considered in patients suffering from abdominal complaints who do not have any underlying gastrointestinal disorder.- - - - - - - - - - ranking = 3.3092325045422keywords = physical examination, physical (Clic here for more details about this article) |
8/29. Spontaneous retroperitoneal hemorrhage localized by blood pool scintigraphy.A healthy 17-year-old girl presented to the emergency department with a 1-day history of left upper quadrant abdominal pain associated with nausea and vomiting. Her hematocrit was 22. On physical examination, she had left upper quadrant fullness and tenderness. Initial computed tomography revealed a large, loculated, left-sided retroperitoneal hematoma. blood pool scintigraphy with labeled red cells revealed a very large photon-deficient area with 3 areas of active bleeding in the upper margin of the cold area. An angiogram showed active extravasation from the left inferior phrenic artery. The patient was felt to have had spontaneous adrenal hemorrhage, likely within a preexisting, large adrenal cyst. Spontaneous hemorrhage into an adrenal cyst is a rare entity that can be life-threatening if not treated early in its course.- - - - - - - - - - ranking = 3.3092325045422keywords = physical examination, physical (Clic here for more details about this article) |
9/29. Herniated nucleus pulposus as a result of emesis in a 20-yr-old man.The causes of herniated disc in vivo vary, and recent studies stress the role of intradiscal pressure as an important factor. Identifying causes of increased intradiscal pressure is difficult. This case report describes the diagnosis of a herniated nucleus pulposus in a 20-yr-old healthy man, with sudden onset of emesis. The diagnosis was made by a complete history, physical examination, electrodiagnostic studies, and magnetic resonance imaging. This etiology of herniated nucleus pulposus has not been described in the medical literature, and the severity of the symptoms, clinical examination, electrodiagnostic findings, and radiologic findings are discussed. Intradiscal pressures and their role in herniated nucleus pulposus are discussed, with a review of the medical literature on the measurement of intradiscal pressure. The amount of force required to produce a herniated nucleus pulposus is also discussed.- - - - - - - - - - ranking = 3.3092325045422keywords = physical examination, physical (Clic here for more details about this article) |
10/29. Spontaneous rupture of adrenal pheochromocytoma with capsular invasion.A 67-year-old Japanese man developed a sudden onset of severe right-side upper abdominal pain, nausea and vomiting. On hospitalization, physical examination revealed sweating, tachycardia, hypertension and the appearance of peripheral vasoconstriction. An urgent computed tomography scan with contrast demonstrated a large hematoma in the right retroperitoneal space. A phentolamine test and an 131iodine metaiodobenzylguanidine scan suggested pheochromocytoma. An elective right adrenalectomy was successfully performed after pretreatment for sufficient volume replacement with continuous administration of alpha- and beta-adrenergic blocking agents. Pathological diagnosis was an adrenal pheochromocytoma 9.0 x 6.5 cm in diameter with evidence of capsular invasion, which could be associated with a tear in the capsule.- - - - - - - - - - ranking = 3.3092325045422keywords = physical examination, physical (Clic here for more details about this article) |
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