Cases reported "Chronic Disease"

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1/59. Phase II therapy for a chronic pain patient: a clinical report.

    One of the roadblocks to success in treating temporomandibular joint dysfunction (TMD) patients is an accurate diagnosis. The terms "TMJ" or "TMD" are not specific enough to provide definitive treatment. Initially the disorder must be classified as a muscular or an internal derangement problem. Once accomplished, the further diagnostic breakdown of the problem will prepare the patient and the doctor for the scope of treatment necessary and the prognosis. This lack of a specific diagnosis can lead to inappropriate treatment and inadequate communication among clinical dentists, academia and patients. Our patients and the profession will continue to suffer until a single diagnostic system is universally agreed upon and utilized.
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keywords = communication
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2/59. Bronchoperitoneal fistula secondary to chronic klebsiella pneumoniae subphrenic abscess.

    We treated a case of bronchoperitoneal fistula secondary to a klebsiella pneumoniae subphrenic abscess. This fistulous communication and the surgical procedure used to treat it are described.
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3/59. Patient management and decision making in complete denture fabrication using a duplicate denture procedure: a clinical report.

    A patient may have difficulty adapting to a new prosthesis for either physical or psychological reasons. This article describes a procedure for duplicating an existing denture and gives the practitioner an alternative to the traditional denture fabrication techniques. The duplicated denture fabrication technique minimizes the changes to the new denture, making it easier for the patient to adapt to new dentures. However, in-depth communication with the patient is necessary for successful denture therapy.
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4/59. Cerebral herniation after lumbar puncture in sarcoid meningitis.

    A patient with chronic meningitis due to neurosarcoidosis became comatose within minutes of a lumbar puncture and died 24 h later. The diagnosis of neurosarcoidosis was made post mortem. Development of cerebral herniation may have been exacerbated by lumbar puncture. It was proposed that arachnoid villi dysfunction may have contributed to very high intracranial pressures in this patient, since post mortem examination revealed communication between the ventricles and outlet foramina of the fourth ventricle, and that herniation was in part due to an acute pressure differential caused by lumbar puncture.
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5/59. Duodenal web causing gastric outlet obstruction in an adult.

    Congenital duodenal web is a rare cause of gastric outlet obstruction in the adult. In this communication, we report a case in whom a preoperative diagnosis of chronic duodenal ulcer had been made. A review of diagnosis was forced by the finding of a normal pylorus at surgery.
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6/59. Training agrammatic subjects on passive sentences: implications for syntactic deficit theories.

    We trained two subjects with chronic agrammatic aphasia on production of passive sentences using a computerized, iconic-based communication system. After training, one of the subjects demonstrated significant improvements in his abilities to comprehend and verbally produce English passive voiced sentences, including sentences with conjoined subjects and objects. These results suggest that agrammatism does not represent a fixed syntactic deficit.
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7/59. "Wireless" laser recanalization of chronic total coronary occlusions.

    Chronic total occlusions in particular, completely obstructed aorto-ostial lesions are among the most challenging targets in interventional cardiology. Excimer laser is a debulking technology for revascularization of complex lesions. Treatment of total occlusions with laser angioplasty can be applied providing that a guidewire traverses the entire length of the occlusion prior to device activation. In many patients with total occlusions, a guidewire is unable to penetrate the target stenosis. This communication presents a new technique termed "wireless" laser recanalization. This approach entails recanalization of a total occlusion with a laser catheter without a leading guidewire.
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8/59. High-dose oral magnesium treatment of chronic, intractable erythromelalgia.

    BACKGROUND: Previous studies with magnesium have shown beneficial effects in pain syndromes and in vascular disorders (hypertension, migraines, Raynaud's phenomenon). However, results have been variable, possibly because of the limited oral doses achievable due to frequent diarrhea. OBJECTIVE: To describe the case of a 53-year-old white man (the author) with disabling erythromelalgia (EM) who achieved modest improvement limited by adverse effects with calcium antagonists and then obtained remission with the use of magnesium. Intolerant of several standard magnesium products, he attained high doses of magnesium by taking intravenous-grade magnesium sulfate diluted in water orally (up to 24 mL/d of MgSO4 50% = 1166 mg/d of magnesium). methods: After 12 months of continued improvement, patient 1, a board member of The erythromelalgia association, notified other members of the success of this therapy via an internet communication channel. He encouraged those interested in high-dose magnesium therapy to consult their physicians and to report their results to the association. Twelve patients responded to this request, describing several standard oral magnesium products. RESULTS: overall, 8 of 13 patients (61.5%) reported improvement (1, remission; 3, major improvement; 2, moderate improvement; 2, mild improvement). Four patients (30.8%) reported no response to magnesium therapy, and 1 patient's symptoms worsened. Two patients' magnesium dose was limited because of diarrhea. CONCLUSIONS: Despite recent progress in understanding and treating EM, this vascular disorder remains painful and life-altering for many patients. In this informal survey, the use of high oral doses of magnesium produced good and sometimes dramatic results in 8 of 13 patients who had been unresponsive to many other treatments. These results suggest a possible role for high-dose oral magnesium in the treatment of EM and, perhaps, other vascular disorders.
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9/59. Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.

    The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days. On postoperative day 8, hand therapy was initiated. Many challenges were encountered. insurance constraints required the patient to change therapists. The device frame cracked. The patient developed a PIP joint contracture with extensor lag. Despite these obstacles, the patient achieved a successful outcome, returning to normal pain-free use with grip strength at 87% of that of the uninvolved hand. At discharge, active range of motion was 12 degrees/100 degrees at the PIP joint and 0 degrees/40 degrees at the DIP joint. Passive extension was 0 degrees. At 6 months postoperatively, active range of motion was 0 degrees/105 degrees at the PIP joint and 0 degrees/60 degrees at the DIP joint. This case demonstrates the need for closely supervised postoperative therapy that includes good communication between providers, ongoing patient education, and close monitoring of range of motion.
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keywords = communication
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10/59. Implementing transitions for youth with complex chronic conditions using the medical home model.

    The concept of a medical home is endorsed as an effective model for implementing successful transitions for youth with complex chronic conditions. The U Special Kids program at the University of minnesota is described as a medical home designed to improve service delivery for children and youth with complex medical conditions to help them achieve optimal health and functioning. Two case studies depict effective communication methods, including a concise written health history summary, that promote shared understanding of the adolescent's and family's strengths and their skills. Specific components of a transition plan are detailed with the recommendation that a formal assessment occur to develop an individualized transition plan. The individualized plan incorporates goals for the adolescent to gain independence and to obtain support in required areas.
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