1/46. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = physical, physical examination (Clic here for more details about this article) |
2/46. Late onset startle induced tics.Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor tics were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The tics developed after physical trauma or a period of undue emotional stress. reflex tics may occur in Gilles de la Tourette's syndrome, but have not been described in late onset Tourette's syndrome. Such tics must be distinguished from psychogenic myoclonus and the culture bound startle syndromes.- - - - - - - - - - ranking = 0.52707918122902keywords = physical (Clic here for more details about this article) |
3/46. chronic pain disorder following physical injury.Pain disorders that are primarily associated with psychological factors are of great clinical concern, but they are difficult to study because of the inability to make valid or reliable diagnoses by structured interview alone. The authors confront this difficulty by using an injured subject population that had extensive psychiatric and medical evaluations. Those who developed somatoform pain disorder (SPD) were compared with a control group who did not. The SPD group had distinctive associated factors: more sites of pain, spread of pain beyond area of original injury, and substantially more opiate and benzodiazepine use. Compensation/litigation influenced symptoms more in the SPD group. Psychotherapists often supported the patient's viewpoint that the pain was physical and to be endured.- - - - - - - - - - ranking = 2.6353959061451keywords = physical (Clic here for more details about this article) |
4/46. Physical injury as a provoking factor in three patients with scleroderma.A 51-year-old female developed linear-like scleroderma in the left thigh following a linear wound caused by a car accident. 27 years later she also developed a typical diffuse cutaneous systemic sclerosis with extensive skin involvement and bibasilar pulmonary fibrosis. The second case is a 39-year-old female who had a history of Raynaud's phenomenon since early childhood. She developed a morphea following a burning injury of the left thigh. 17 years later she also developed a typical limited cutaneous systemic sclerosis with sclerodactyly, skin ulcers and subcutaneous calcinosis. The third case is a 43-year-old female who developed a typical morphea of the right elbow around the site of a previous local corticosteroid injection. The two remarkable points of these 3 cases are the possible role of physical injury in the provocation of localized scleroderma and in the first 2 cases the unusual later development of a systemic form of scleroderma.- - - - - - - - - - ranking = 0.52707918122902keywords = physical (Clic here for more details about this article) |
5/46. Physical restraint and subcutaneous hematoma in an anticoagulated patient.A large subcutaneous hematoma extending from the breastbone region to the left axillary region and left flank developed in a 86-year-old anticoagulated man because of repeated microtrauma from a physical restraint used to prevent his rising from a chair. physicians, nurses, and physiotherapists should recognize that physical restraints causing pressure on the skin increase hemorrhagic risk in patients who take low molecular weight heparin. Accordingly, they should systematically check for hemorrhagic complications and attempt to limit the use of such devices.- - - - - - - - - - ranking = 1.054158362458keywords = physical (Clic here for more details about this article) |
6/46. Management of post-traumatic pain syndromes (causalgia).A number of post-traumatic pain syndromes may be grouped under the two headings: causalgia and mimocausalgia states. Our concern is the early recognition of patients whose complaints have a real organic basis but whose physical signs are not of sufficient degree to make this fact readily apparent. These patients are all too often mismanaged or neglected for sufficiently long periods of time to permit the underlying pathologic physiology to secure supremacy over normal function. Recognized and treated properly by means of sympathetic ablation, either medical or surgical, the vast majority can be relieved of their symptoms. The extremities can then be rehabilitated by appropriate measures.- - - - - - - - - - ranking = 0.52707918122902keywords = physical (Clic here for more details about this article) |
7/46. Using quality of life assessment in wound care.This article considers the role of the nurse in caring for patients who have wounds, drawing particular attention to the quality of life of these patients. For the purpose of this article a wound is defined as any break in skin integrity, caused by injury, infection or operation, which requires some form of nursing intervention to promote healing. A nursing approach is suggested that focuses nursing on the psychosocial and physical factors affecting wound care. The impact of the wound on quality of life is examined from the perspective of the patient.- - - - - - - - - - ranking = 0.52707918122902keywords = physical (Clic here for more details about this article) |
8/46. Injuries experienced by infant children: a population-based epidemiological analysis.OBJECTIVE: Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern ontario. methods: Epidemiologic analysis of emergency-based surveillance data (1994-2000) for infants (<12 months old) from the Kingston sites of the Canadian hospitals Injury Reporting and Prevention Program. RESULTS: A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries). CONCLUSION: The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.- - - - - - - - - - ranking = 0.52707918122902keywords = physical (Clic here for more details about this article) |
9/46. A case of blunt abdominal trauma and posttraumatic acute appendicitis.Acute appendicitis and blunt abdominal trauma are common surgical emergencies. Whether there is a causative relationship between these two entities has long been a subject of debate. A twenty-one-year-old male Japanese tourist presented with vague abdominal pain and dysuria that began after he had been beaten and robbed. No signs of trauma were detected on physical examination; however, there were diffuse abdominal sensitivity with maximal tenderness in the hypogastrium and rebound tenderness in the right lower quadrant. Upon no improvement with medications within 24 hours, laparotomy was performed, which revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, and free peritoneal fluid that was found to be sterile. Following appendectomy, the diagnosis was confirmed by pathologic examination and the enlargement of the lymph node was attributed to non-specific reactive hyperplasia. The patient had an uneventful postoperative course, with relief of pain and fever.- - - - - - - - - - ranking = 1keywords = physical, physical examination (Clic here for more details about this article) |
10/46. Handlebar hernia in children: two cases and review of the literature.Localised traumatic abdominal hernias are rare. Most such hernias are due to the direct impact of the handlebars of a bicycle or motorcycle, with 20 cases reported to date in the English language literature, 12 in children. We report two new cases of handlebar hernia, in children aged 6 and 10 years. In both cases, physical examination revealed an area of contusion and bruising in the lower abdomen. However, the muscle defect was detected during the first examination in only one of the patients, and not until several days later in the other patient. Abdominal ultrasonography proved useful for diagnosis in both patients. Early surgical correction is necessary to prevent possible complications. This type of hernia should be borne in mind when evaluating children who have suffered abdominal trauma in a bicycle accident.- - - - - - - - - - ranking = 1keywords = physical, physical examination (Clic here for more details about this article) |
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