1/11. budd-chiari syndrome complicating restorative proctocolectomy for ulcerative colitis: report of a case.PURPOSE: This is a case of hepatic vein thrombosis presenting in a delayed fashion after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Search for a causative thrombotic condition resulted in the diagnosis of polycythemia vera, a myeloproliferative disorder associated with hypercoagulability. The polycythemia was masked by an iron deficiency associated with the ulcerative colitis. methods: The history, physical, diagnostic modalities, and treatment for this patient are described, and the literature of budd-chiari syndrome associated with ulcerative colitis is reviewed. RESULTS: Six cases of budd-chiari syndrome in the setting of ulcerative colitis are reported in the literature from 1945 to 1997. CONCLUSIONS: Hepatic vein thrombosis is a rare complication of ulcerative colitis. The diagnosis of budd-chiari syndrome demands a thorough search for a hematologic condition predisposing to thrombosis. Our patient had a myeloproliferative disorder, polycythemia vera, that is associated with a hypercoagulable state. The disorder was masked by an iron deficiency associated with the ulcerative colitis. Recognition of the entity will permit successful treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Amebic colitis mistaken for inflammatory bowel disease.In ten patients, amebic colitis was mistakenly diagnosed as ulcerative colitis or crohn disease of the colon because of the similarity of history, physical examination, and routine laboratory studies as well as findings on proctoscopic and barium enema examination. Multiple stool examinations failed to demonstrate ova or trophozoites of entamoeba histolytica. Routine examinations of stools for ova and parasites are inadequate and even a meticulous search for amebas in fresh stool, in scrapings from bowel ulcer, or in biopsy material may give negative results. The indirect hemagglutination test was shown to be a reliable diagnostic test in the evaluation of these cases. Because corticosteroid treatment of patients with amebic colitis may lead to undesirable complications the indirect hemagglutination test results should be obtained in patients in whom such diagnostic confusion is likely.- - - - - - - - - - ranking = 9.123371583013keywords = physical examination, physical (Clic here for more details about this article) |
3/11. psychophysiologic disorders in children and adolescents.Psychosomatic disorders in children and and adolescents is a topic that covers a wide variety of illnesses and one which is difficult if not impossible to define accurately. In general, chronic emotional states, often nonspecific, serve as strong contributors to the development of a physical illness. The particular illness is often dictated by varying degrees of biological predisposition in one physiological system-i.e., such a predisposition in the respiratory system may lead to asthma or in the gastrointestinal system to ulcerative colitis. In some cases the biological factor is large and the emotional factor minimal, while in other cases the reverse is true. In the early days of research in psychosomatic disorders it was widely believed that each disorder was accompanied by certain specific emotional problems. Further study has shown this is not true. It was also felt that many, if not most of these disorders could be cured by psychotherapy, and this also has proven to be a fallacy. we have moved more and more to the team approach. Since both psyche and soma are involved, more than one specialist is usually required. In children and adolescents this may involve a child psychiatrist, a pediatrician, an allergist or gastroenterologist, a social worker and a psychologist. It requires time and patience to form an effective and smoothly functioning team in which all members respect one another's potential contribution. Some examples of team operation are presented and some of the problems outlined. In addition, there is attention given to the special problems of the adolescent and also the child with chronic nonspecific physical complaints as well as the child who requires hospitalization.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/11. psychosomatic medicine: the divergent legacies of Freud and Janet.A series of differing explanations of a puzzling case of psychosomatic illness introduces some reflections on a century's history of psychoanalytic interest in the mind-body problem. Freud and Janet explained the physical symptoms of hysteria using radically different models of the mind. Since then Janet's model, banished early on, has returned to haunt the castle of psychoanalysis. The enduring influence of Janet's model on subsequent thought in this field, especially that of Marty and de M'Uzan, Sifneos, LeDoux, and others, is traced, as is the influence of Freud's model on Groddeck, Alexander, McDougall, Fonagy, and others. It is argued that although these models are vastly different at one level of abstraction, at a higher level they share an important set of assumptions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. Non-cardiogenic pulmonary oedema induced by salazosulfapyridine.A 25-year-old woman received oral salazosulfapyridine, 4 g/day, for treatment of ulcerative colitis. At 10 days later, she presented with fever and respiratory symptoms. Based on physical, laboratory and radiological findings, bacterial pneumonia and non-cardiogenic pulmonary oedema was suspected. Salazosulfapyridine was immediately halted and antibiotic therapy started. Two days later, her symptoms and abnormal findings had improved rapidly. Bacteriological studies were negative. Salazosulfapyridine-induced non-cardiogenic pulmonary oedema was diagnosed. Non-cardiogenic pulmonary oedema should be considered as one of several salazosulfapyridine- induced pulmonary diseases in patients who are receiving salazosulfapyridine and who develop respiratory symptoms and an abnormal CXR.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/11. Localized giant pseudopolyposis in ulcerative colitis.A case of localized giant pseudopolyposis in ulcertative colitis is discussed in which a mass effect mimicked tumor. The fulminant collection of pseudopolyps was palable in the epigastrium on physical exam and caused a partial obstruction to the retrograde flow of barium. carcinoma is a worrisome possibility in ulcerative colitis, but localized giant pseudopolyposis may also present as a mass.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. Diagnostic approach to the patient with a chronic diarrheal disorder.Chronic diarrhea is a common problem facing the practitioner of medicine. Despite impressive advances in diagnostic technology, many patients continue to have chronic diarrhea without a firm diagnosis being established. Most important, the history and physical examination are often perfunctory and the patient undergoes a number of contrast and imaging studies, endoscopic procedures, and laboratory investigations which may still be non-diagnostic. In all patients with chronic diarrhea, which I will arbitrarily define as diarrhea that has persisted over at least 2 months, there is a need for a careful orderly approach to the differential diagnosis. In this paper I will detail a method that I have used in evaluating such patients. The method emphasizes a careful history and physical examination, judicious and sequential use of laboratory investigations, contrast studies, and endoscopic procedures, and calls attention to special situations where more detailed investigations are required. I have found that unless I go through this detailed diagnostic approach, I will miss disorders that can be readily diagnosed and, more importantly, such patients may not be given appropriate treatment.- - - - - - - - - - ranking = 18.246743166026keywords = physical examination, physical (Clic here for more details about this article) |
8/11. A patient's view of ileostomy.What is it like to have a stoma? There are many implications--physical and psychological, good and bad. This is one woman's account of her illness, operation and life post-ileostomy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Toxic megacolon in ulcerative colitis. early diagnosis and management.The diagnosis of toxic megacolon is based on a thorough history and physical examination, simple laboratory tests, and careful examination of plain abdominal films. As with other uncommon conditions, making the correct diagnosis requires a high index of suspicion. This is especially true when toxic megacolon is the initial manifestation of ulcerative colitis. In this setting, a previous history of chronic diarrhea may be lacking. patients with toxic megacolon are usually first seen in the emergency room, so the diagnosis must be entertained in all patients presenting with abdominal distention and acute or chronic diarrhea. The diagnosis of toxic megacolon does not require CT scans, ultrasound examinations, radionuclide scans, colonoscopy, or barium enema. In fact, reliance on those nonessential diagnostic procedures may delay diagnosis while the patient continues to deteriorate. Once toxic megacolon is diagnosed, the patient should be admitted immediately to an intensive care unit for careful monitoring by both medical and surgical staff.- - - - - - - - - - ranking = 9.123371583013keywords = physical examination, physical (Clic here for more details about this article) |
10/11. Infantile factors in two cases of ulcer colitis.In a third investigation of psychological factors in the etiology of ulcerative colitis the author again utilizes selected cases in which the variables preceding illness are limited. A first and second investigation had utilized patients who were afflicted with partial deafness and organic brain damage respectively in addition to ulcerative colitis. All patients displayed a marked trend to ojbectlessness in the prodromal period. The patients with organic brain damage displayed an intense rage reaction as well. The present investigation focuses upon two patients with ulcerative colitis who had been traumatically separated from their mother at age six months. The prodromal period of illness in both cases was initiated by an event which possessed a strong associative link with the primal loss. During the prodromal period both patients displayed an intense rage reaction and a trend to objectlessness which were similar to the reactions of the patients with organic brain damage. This particular emotional configuration appears to represent the revival of the emotional configuration which had prevailed following the loss in infancy. Some tentative ideas regarding the role played by the revival of the archaic emotional configuration in the production of physical changes are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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