1/18. Migration of a K-wire from the distal radius to the heart.K-wires and Steinmann pins are used to provide internal fixation for fractures or osteotomies. In some instances, removal of the implant is planned and the implant is left long to facilitate its removal. In other instances, implant removal is not planned and the implant is cut off at the level of the bone. Migration of these implants to solid organs or body cavities has been reported. Extravascular migration may occur along tissue planes assisted by muscle motion. Large vessel penetration can occur and has been reported with subsequent migration of the implant to the heart. This case report documents the loosening of a K-wire used in the distal radius to supplement the fixation of a complex intra-articular fracture, migration of the implant along tissue planes, penetration into a peripheral vein, and continued migration of the implant to the heart. There are multiple reports documenting wandering bullets, venous catheter tips, and invasive monitoring devices in the extremities. This is only the second case report that the authors are aware of that confirms migration of an implant from the distal extremity to the heart.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/18. Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain.OBJECTIVE: To describe the sonographic appearance of a poorly recognized cause of low thoracic or upper abdominal pain. methods: Three sonographic descriptions of slipping rib syndrome are presented. RESULTS: The 3 patients had abnormal mobility of a cartilaginous rib, which could slip over an adjacent rib during abdominal muscle contraction. CONCLUSIONS: Slipping rib syndrome should be considered in patients with histories of upper abdominal or low thoracic pain of unknown origin. We suggest that high-resolution sonography of the costal margin should be added to abdominal sonography in cases of nonspecific abdominal pain.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/18. chest pain during stenting of a native aortic coarctation: a case for acute intercostal muscle ischemia and rhabdomyolysis.An adult male experienced severe chest pain during stenting of a native aortic coarctation. He also developed the postcoarctectomy syndrome with paradoxical hypertension and abdominal pain. Our hypothesis suggests that sudden interruption of large collateral blood flow caused acute chest wall muscle ischemia, rhabdomyolysis, and severe chest pain.- - - - - - - - - - ranking = 5keywords = muscle (Clic here for more details about this article) |
4/18. Rhabdomyomatous multilocular thymic cyst.The thymus is the seat of a diverse array of pathologic conditions given its embryologic roots. Multilocular thymic cysts, although well described, are uncommon, and one associated with rhabdomyomatous elements has not been described previously. A 15-year-old boy complained of sudden-onset chest pain of a month's duration, but was otherwise well. Chest radiographs localized the mass to the anterior mediastinum, arising from the thymus. A computed tomography scan demonstrated the lesion to be a multilocular fluid-containing cyst. A large, 15-cm cyst contiguous with the thymus was removed. Histologic evaluation confirmed a multilocular cyst lined mainly by mucinous epithelium with focal areas of ciliated and squamous lining. A prominent finding was skeletal muscle elements in the form of spider cells, strap-like cells, and foci reminiscent of fetal-type muscle with cross-striations. At the periphery of the cyst, thymic tissue with branching ducts and Hassall corpuscles were noted. No evidence of skin and/or its appendage structures, cartilage, or other differentiated tissue was seen despite generous sampling of the specimen. The muscle elements, most likely, were derived from thymic myoid cells, while the multilocular cyst arose from remnants of the thymomedullary system.- - - - - - - - - - ranking = 3keywords = muscle (Clic here for more details about this article) |
5/18. Malignant mesothelioma presenting as stroke--a case report.A case of a 64-year-old man with metastatic malignant mesothelioma is described in detail. When he presented to us he gave a history suggestive of transient ischaemic attack (TIA) 2 weeks before and 3 days after admission he developed weakness of the left upper limb. Computed tomographic scan of the brain revealed a solitary metastasis in the right cerebrum. A few days later, he developed subcutaneous metastasis in the chin. Malignant mesothelioma is considered to metastasize rarely and to spread locally. We suggest that distant metastasis in malignant mesothelioma is not uncommon and may be considered to behave like other forms of lung cancer. Treatment modalities should be studied in such patients.- - - - - - - - - - ranking = 0.5373354353924keywords = limb (Clic here for more details about this article) |
6/18. guillain-barre syndrome coexisting with pericarditis or nephrotic syndrome after influenza vaccination.A 68-year-old woman and a 72-year-old man presented with distal weakness of the limbs and numbness following an influenza vaccination within 2 weeks. Moreover, guillain-barre syndrome (GBS) was diagnosed in two patients. pericarditis was diagnosed in the first patient who also had precordial chest pain with referral to trapezius ridge, and nephrotic syndrome, was observed in the second patient who had leg edema and proteinuria. The relationship among GBS, pericarditis and nephrotic syndrome after an influenza vaccination is discussed.- - - - - - - - - - ranking = 0.5373354353924keywords = limb (Clic here for more details about this article) |
7/18. Sometimes (what seems to be) a heart attack is (really) a pain in the neck.A 31-year-old patient complained of severe crushing chest pain that radiated to his left arm and jaw. After admission to the hospital, tests revealed a normal electrocardiogram, normal treadmill, normal coronary arteriogram, and normal cardiac enzymes. However, the patient continued to have pain, which was relieved by sublingual and intravenous nitroglycerine. He was discharged from the hospital with a diagnosis of "musculoskeletal" chest pain, taking nonsteroidal anti-inflammatory drugs, muscle relaxants, and narcotics. Two weeks later, the patient returned with worsening symptoms. Cardiac work-up was again negative. Thoracic and cervical spine radiographs were ordered for possible discogenic pain. After abnormalities were found on cervical radiographs, magnetic resonance imaging (MRI) was ordered, and the patient was referred to an orthopedic surgeon. Further work-up revealed a herniated disk at C6-C7, with radicular pain. Surgery on the suspect disk totally relieved the patient's pain.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
8/18. Diffuse pulmonary hamartoma: a case report.Pulmonary hamartoma usually occurs as a benign, well-circumscribed single nodule in the lung parenchyma. We report on a unique case of hamartoma that extended along the bronchial tree, formed endobronchial polypoid lesions, and expanded into the lung parenchyma. The patient, a 48-year-old man, was admitted with dyspnea and chest pain. A transbronchial biopsy was performed on a tumorous lesion that was diagnosed histologically as a hamartoma. As this lesion was found to be growing diffusely along the bronchial tree, a left pneumonectomy was performed. Gross examination showed that yellowish soft tissue had surrounded the bronchial tree and extended into the lung parenchyma. Histologically, the lesion contained mainly mature adipose tissue, cartilage, and muscle tissue with a minor component of short spindle cells in a myxomatous matrix. The patient was diagnosed as having diffuse pulmonary hamartoma.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
9/18. Determining functional significance of subclavian artery stenosis using exercise thallium-201 stress imaging.subclavian artery stenosis (SAS) is a rare lesion accounting for nearly 2.5% of all extracranial arterial occlusions. Symptoms from SAS usually relate to subclavian steal, and include syncope, vertigo, ataxia, and, rarely, upper limb paralysis or hemipareses. upper extremity ischemia may result in intermittent or constant arm pain. The majority of patients with SAS are asymptomatic. upper extremity ischemia is particularly unusual. More commonly, patients with significant SAS have symptoms of cerebral ischemia, which are usually triggered by vigorous motion of the arm on the side of the severe proximal subclavian obstruction. Stress exercise radionuclide imaging appears to be a valuable modality in determining the functional significance of SAS. We describe a case in which radionuclide imaging with thallium-201 after stress of the upper extremities was used for risk stratification of subclavian stenosis, and to help decide treatment options.- - - - - - - - - - ranking = 0.5373354353924keywords = limb (Clic here for more details about this article) |
10/18. Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl.In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
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