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Physical exam signs

Danny Mangual, Luis A Bisbal-Matos, Ricardo Jiménez-Lee, Román Vélez, Miguel Noy
The case of a 27-year-old Hispanic female who presented with an occipito-parietal tumor after suffering trauma to the area. A physical examination revealed no tenderness to palpation and with evidence of healing ulcerations. The biopsy was consistent with a synovial sarcoma. A wide excision of the mass (15cm x 14cm x 6cm) followed by a pericranial flap was performed. A follow-up CT showed recurrence involving the parietal sagittal sinus. After a second biopsy the mass was determined to be a small-cell sarcoma, consistent with Ewing's sarcoma...
March 2018: Puerto Rico Health Sciences Journal
Cornelia Nitipir, Octav Ginghina, Liliana Popa, Florin Andrei, Nicolaie Tudor, Irina Radu, Cristian Iaciu, Cristina Orlov, Florina Vasilescu, Cristian Balalau, Grigoris Leon, Carolina Negrei, Maria Alexandra Barbu
Although gastric metastases have been estimated to occur in less than 2% of cancer patients, an increased use of upper digestive tract endoscopy allows for a higher detection of secondary gastric tumors. We describe the case of a 66-year-old male patient presenting with mild pain in the sternum and upper abdominal area. Physical examination revealed a right parietal skull tumor, with no other significant clinical changes. Upon exclusion of an acute coronary syndrome, upper digestive tract endoscopy was performed, showing the presence of an ulcerated tumor located in the gastric fundus...
April 2018: Molecular and Clinical Oncology
Orrin Devinsky, Anup D Patel, Elizabeth A Thiele, Matthew H Wong, Richard Appleton, Cynthia L Harden, Sam Greenwood, Gilmour Morrison, Kenneth Sommerville
OBJECTIVE: To evaluate the safety and preliminary pharmacokinetics of a pharmaceutical formulation of purified cannabidiol (CBD) in children with Dravet syndrome. METHODS: Patients aged 4-10 years were randomized 4:1 to CBD (5, 10, or 20 mg/kg/d) or placebo taken twice daily. The double-blind trial comprised 4-week baseline, 3-week treatment (including titration), 10-day taper, and 4-week follow-up periods. Completers could continue in an open-label extension. Multiple pharmacokinetic blood samples were taken on the first day of dosing and at end of treatment for measurement of CBD, its metabolites 6-OH-CBD, 7-OH-CBD, and 7-COOH-CBD, and antiepileptic drugs (AEDs; clobazam and metabolite N -desmethylclobazam [N-CLB], valproate, levetiracetam, topiramate, and stiripentol)...
March 14, 2018: Neurology
James J Leyden, Vilma Sniukiene, David R Berk, Alexandre Kaoukhov
BACKGROUND: There is a need for new oral antibiotics for acne with improved safety profiles and targeted antibacterial spectra. Sarecycline is a novel, tetracycline-class antibiotic specifically designed for acne, offering a narrow spectrum of activity compared with currently available tetracyclines, including less activity against enteric Gram-negative bacteria. This phase 2 study evaluated the efficacy and safety of three doses of sarecycline for moderate to severe facial acne vulgaris...
March 1, 2018: Journal of Drugs in Dermatology: JDD
A Phillips, E R Kulendra, R Lam, N J Kulendra, D J Brockman
A 9-month-old domestic short-haired cat presented with stunted growth and chronic gastrointestinal signs. Tachypnoea, a heart murmur and cranial abdominal bruit were detected on physical examination. Echocardiography revealed volume overload in all heart chambers. CT angiography identified an abnormal communication between the hepatic arterial circulation and the portal vein, along with multiple acquired shunts. The abnormal vascular communication was surgically ligated. Echocardiography documented improvement in cardiac parameters following surgery and the cat continues to have no clinical signs 39 months after surgery...
March 14, 2018: Journal of Small Animal Practice
Steven M Dean
In the contemporary era of medical diagnosis via sophisticated radiographic imaging and/or comprehensive serological testing, a focused physical examination remains paramount in recognizing the cutaneous manifestations of chronic vascular disease. Recognition of the unique cutaneous signs of lymphatic and venous hypertension assists in the diagnosis as well as the staging and classification of both lymphedema and chronic venous insufficiency. Awareness of explicit dermatologic vasomotor manifestations aids not only in the identification of acrocyanosis, Raynaud phenomenon, pernio, and erythromelalgia but also mitigates confusion related to their clinical overlap...
March 10, 2018: Progress in Cardiovascular Diseases
João Ferreira, Ana Franco, Tiago Teodoro, Miguel Coelho, Luísa Albuquerque
Vernet syndrome is a unilateral palsy of glossopharyngeal, vagus, and accessory nerves. Varicella zoster virus (VZV) infection has rarely been described as a possible cause. A 76-year-old man presented with 1-week-long symptoms of dysphonia, dysphagia, and weakness of the right shoulder elevation, accompanied by a mild right temporal parietal headache with radiation to the ipsilateral ear. Physical examination showed signs compatible with a right XI, X, and XI cranial nerves involvement and also several vesicular lesions in the right ear's concha...
March 12, 2018: Journal of Neurovirology
Malo Le Hanneur, Andres A Maldonado, Benjamin M Howe, Michelle L Mauermann, Robert J Spinner
BACKGROUND: Several hypotheses have been proposed for the pathophysiology of suprascapular nerve (SSN) palsy, including compression, traction, and nerve inflammation. OBJECTIVE: To provide insight into the pathophysiology of isolated nontraumatic SSN palsy by performing critical reinterpretations of electrodiagnostic (EDX) studies and magnetic resonance (MR) images of patients with such diagnosis. METHODS: We retrospectively reviewed all patients referred to our institution for the past 20 yr with a diagnosis of nontraumatic isolated suprascapular neuropathy who had an upper extremity EDX study and a shoulder or brachial plexus MR scan...
February 26, 2018: Neurosurgery
Abdul Waheed, Michael Malone, Samiullah Samiullah
Functional gastrointestinal disorders (FGIDs) are common among children and cause tremendous distress for patients and families. Family physicians should know how to diagnose and manage some of the more common childhood FGIDs. These include infant regurgitation, infant colic, infant dyschezia, cyclic vomiting syndrome, functional nausea and vomiting, functional diarrhea and constipation, abdominal migraine, and nonspecific functional abdominal pain. Diagnosis requires a thorough history and physical examination to rule out red flag signs and symptoms for structural or organic etiologies...
March 2018: FP Essentials
Michael Malone, Abdul Waheed, Samiullah Samiullah
Functional upper gastrointestinal disorders are common and cause significant patient distress and health care cost. These disorders typically are classified as either esophageal or gastroduodenal. Functional esophageal disorders include functional heartburn, reflux hypersensitivity, and functional dysphagia. Functional gastroduodenal disorders include functional dyspepsia and cyclic vomiting syndrome. Cyclic vomiting syndrome should be suspected in any patient with multiple episodes of vomiting with no apparent cause that completely resolve between episodes...
March 2018: FP Essentials
Amy C Arnold, Jessica Ng, Satish R Raj
Postural tachycardia syndrome (POTS) is a heterogeneous clinical syndrome that has gained increasing interest over the past few decades due to its increasing prevalence and clinical impact on health-related quality of life. POTS is clinically characterized by sustained excessive tachycardia upon standing that occurs in the absence of significant orthostatic hypotension and other medical conditions and or medications, and with chronic symptoms of orthostatic intolerance. POTS represents one of the most common presentations of syncope and presyncope secondary to autonomic dysfunction in emergency rooms and in cardiology, neurology, and primary care clinics...
February 28, 2018: Autonomic Neuroscience: Basic & Clinical
Anna Sojka, Marcin Żarowski, Barbara Steinborn, Wiesław Hedzelek, Beata Wiśniewska-Spychała, Barbara Dorocka-Bobkowska
BACKGROUND: Headache is a common complaint in all age groups and is a frequent cause of medical consultations and hospitalization. OBJECTIVES: The aim of this study was to evaluate the prevalence of bite and non-bite parafunctions as well as the signs and symptoms of temporomandibular disorder (TMD) in adolescents presenting with primary headaches. MATERIAL AND METHODS: Parents of adolescents presented with headaches to the Department of Developmental Neurology within a 12-month period were asked to complete a questionnaire developed by the authors of this study...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
J Zhang, M Liu, L Zhou, Z B Zhang, J M Wang, Y W Jiang, Y Wu
Objective: To analyze the clinical and imaging features of hypomyelination with brain stem and spinal cord involvement and leg spasticity (HBSL) due to mutations in DARS, and to identify DARS mutations responsible for HBSL. Methods: Data on 2 HBSL patients who were admitted to the pediatric department of Peking University First Hospital from January 2009 through December 2016 were reviewed and the 2 patients were followed up. Targeted next generation sequencing, whole exome sequencing and Sanger sequencing were employed to identify potential genetic variations of the children and their parents...
March 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Christiaan H Koster, Annelieke Mk Harmsen, Miranda C Lichtenberg, Frank W Bloemers
Three physical examination tests are most commonly used to evaluate cruciate ligament injury. The best known and most frequently used technique is the anterior drawer test. The other 2 tests, the Lachman test and the pivot shift test, are more difficult to perform and are used less often, especially by physicians untrained in their use. In addition, there is a relatively new diagnostic test: the lever sign test. The aim of our article is to provide a short, clinically relevant overview of the literature and to assess the diagnostic value of physical examination for the primary care physician...
March 2018: Journal of Family Practice
Gilad Segev, Alicia Rojas, Eran Lavy, Marganit Yaffe, Itamar Aroch, Gad Baneth
BACKGROUND: Dogs are the definitive hosts of Spirocerca lupi. Spirocercosis is treated by prolonged avermectin administration by injection or daily oral doses. In this prospective, double-blinded, placebo-controlled, clinical trial, the efficacy of imidacloprid and moxidectin spot-on formulation (Advocate®) was compared to injectable doramectin (Dectomax®). Dogs diagnosed with benign esophageal spirocercosis were divided randomly into doramectin (400 μg/kg IM) or moxidectin and imidacloprid spot-on (2...
March 5, 2018: Parasites & Vectors
Kotaro Matsumoto, Jun Kikuchi, Yuko Kaneko, Hidekata Yasuoka, Kazuko Suzuki, Hirobumi Tokuyama, Kaori Kameyama, Kunihiro Yamaoka, Tsutomu Takeuchi
RATIONALE: Dialysis-related amyloidosis (DRA) can present rheumatic manifestations in patients on long-term hemodialysis. Typical articular symptoms with DRA involve carpal-tunnel syndrome, effusion in large joints, spondyloarthropathy, or cystic bone lesions, which are usually with non-inflammatory processes. PATIENT CONCERNS: A 64-year-old man on hemodialysis for >30 years was admitted because of intermittent fever, polyarthritis, and elevated serum C-reactive protein (CRP) level, which was continuous for 2 years...
January 2018: Medicine (Baltimore)
Erin Sweet, Christine S Shusterman, Marina S Nedeljkovic, Jean C Solodiuk
Pain is a complex physical and emotional experience. Therefore, assessment of acute pain requires self-report when possible, observations of emotional and behavioral responses and changes in vital signs. Peripheral nerve and epidural catheters often provide postoperative analgesia in children. Administration of chloroprocaine (a short acting local anesthetic) via a peripheral nerve or epidural catheter allows for a comparison of pain scores, observations of emotional and behavioral responses and changes in vital signs to determine catheter function...
March 1, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Shawn M Varney, Patrick C Ng, Crystal A Perez, Allyson A Araña, Edwin R Austin, Rosemarie G Ramos, Vikhyat S Bebarta
BACKGROUND: Dietary supplement use (protein/amino acids, weight-loss supplements, performance enhancers) is common among U.S. military members. Reported dietary supplement use in deployed troops is limited and is of concern in settings where troops are exposed to high ambient temperatures, increased physical demands, and dehydration. Our objective was to describe dietary supplement use and adverse events (AEs) among deployed U.S. service members compared with their pre-deployment use...
October 26, 2017: Military Medical Research
Elise Harder, Kirsten E Juul, Signe M Jensen, Louise T Thomsen, Kirsten Frederiksen, Susanne K Kjaer
Cervical cancer occurs most often in under-screened women. In this nationwide register study, we described differences in sociodemographic characteristics between passive and active non-participants and examined socio-demographic characteristics, reproductive history, and mental and physical health as potential determinants for passive non-participation compared with participation in the Danish cervical cancer screening program. Screening history in women aged 23-49 years invited for cervical cancer screening in 2008-2009 was retrieved from the Danish Pathology Databank with information about dates of invitation and unsubscription...
March 6, 2018: Preventive Medicine
Niccolò Parri, Bradley J Crosby, Lisa Mills, Zachary Soucy, Anna Maria Musolino, Liviana Da Dalt, Angela Cirilli, Laura Grisotto, Nathan Kuppermann
OBJECTIVES: To determine the accuracy of skull point-of-care ultrasound (POCUS) for identifying fractures in children younger than 2 years of age with signs of head trauma, and the ability of POCUS to identify the type and depth of fracture depression. STUDY DESIGN: This was a multicenter, prospective, observational study of children younger than 2 years of age with nontrivial mechanisms of injury and signs of scalp/skull trauma. Patients were enrolled if they underwent computed tomography (CT)...
February 28, 2018: Journal of Pediatrics
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