scholarly journals Relapsing Polychondritis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Beata Sosada ◽  
Katarzyna Loza ◽  
Ewelina Bialo-Wojcicka
Keyword(s):  
Physical Examination ◽  
Clinical Response ◽  
Clinical Features ◽  
Systemic Disease ◽  
Correct Diagnosis ◽  
Relapsing Polychondritis ◽  
Oral Prednisolone ◽  
Clinical History ◽  
History Of ◽  
Laboratory Examinations

Relapsing polychondritis (RP) is a rare systemic disease characterized by recurrent, widespread chondritis of the auricular, nasal, and tracheal cartilages. Additional clinical features include audiovestibular dysfunction, ocular inflammation, vasculitis, myocarditis, and nonerosive arthritis. Although the cause remains unknown, the etiology is suspected to be autoimmune. We describe a case of a 31-year-old woman with a four-month history of bilateral auricular and nasal chondritis. Infectious and neoplastic diseases were excluded by imaging and laboratory examinations. RP was diagnosed based on three McAdam’s criteria. The patient was medicated with oral prednisolone and methotrexate with positive clinical response. In this case clinical history and detailed physical examination were fundamental in concluding the correct diagnosis and administrating the appropriate medication.

scholarly journals Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

2017 ◽  
Vol 19 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Michael J. Ellis ◽  
Dean M. Cordingley ◽  
Sara Vis ◽  
Karen M. Reimer ◽  
Jeff Leiter ◽  
...  
Keyword(s):  
Physical Examination ◽  
Clinical History ◽  
International Classification Of Diseases ◽  
Initial Assessment ◽  
Clinical Predictors ◽  
Blurred Vision ◽  
Posttraumatic Amnesia ◽  
Potential Risk Factors ◽  
History Of ◽  
History Of Depression

OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

2018 ◽  
Vol 22 (01) ◽  
pp. 046-056 ◽  
Author(s):  
Usa Cain ◽  
Andrey Rupasov ◽  
Apeksha Chaturvedi
Keyword(s):  
Physical Examination ◽  
Correct Diagnosis ◽  
Clinical History ◽  
Review Article ◽  
Clinical Deterioration ◽  
School Age ◽  
Imaging Appearance ◽  
Imaging Perspective

AbstractAcute limp in a child presents a diagnostic conundrum and can result from a variety of causes. The underlying etiology is often referable to the hip, but the spine, abdomen, pelvis, or knee can be alternatively implicated. An adequate clinical history and satisfactory physical examination are often difficult in younger children. Consequently, there is disproportionate reliance on imaging to arrive at the correct diagnosis. The potential for rapid clinical deterioration and long-term sequelae is a risk with some of the conditions presenting with acute hip (septic hip, osteomyelitis). This review article describes the imaging appearance of common etiologies for acute limp in the ambulatory preschool (1–5 years) and school-age child (5–12 years). The ultimate goal is to familiarize the interpreting radiologist with the imaging appearance of specific clinical entities that lead to acute limp while providing a readily accessible resource on how to image the patient most appropriately and judiciously.

Appendiceal Rupture: A Continuing Diagnostic Problem

PEDIATRICS ◽  
1979 ◽  
Vol 63 (1) ◽  
pp. 37-43
Author(s):  
Ronald A. Savrin ◽  
H. William Clatworthy
Keyword(s):  
Mortality Rate ◽  
Natural History ◽  
Physical Examination ◽  
Early Recognition ◽  
Correct Diagnosis ◽  
Diagnostic Problem ◽  
Children's Hospital ◽  
Primary Physician ◽  
History Of ◽  
Physical Findings

The mortality rate for appendicitis in children has remained relatively unchanged since the 1940s, when antibiotics were introduced in the treatment of appendiceal peritonitis. However, since this time the incidence of appendiceal rupture has increased appreciably, presumably owing to a failure of early recognition and treatment. At Columbus Children's Hospital, one half of all patients undergoing appendectomy for ruptured appendix in 1975 had been seen by another physician before admission, but the correct diagnosis had not been made. The history obtained by the primary physician and that given on admission were similar, yet differed from the histories given by patients whose disease had been correctly diagnosed. Findings on in-hospital physical examination of incorrectly diagnosed patients differed from those recorded by the primary physician, but were similar to those of patients whose disease had been correctly diagnosed. Since it is unlikely that the natural history of the disease has changed, the increased incidence of rupture must result either from early misinterpretation of physical findings or from greater delay by parents in responding to the child's illness. Physicians and parents must share the responsibility equally for the increasing incidence of appendiceal rupture in children.

The Recurrent Nevus Phenomenon: A History of Challenge, Controversy, and Discovery

2011 ◽  
Vol 135 (7) ◽  
pp. 842-846 ◽  
Author(s):  
John C. Fox ◽  
Jon A. Reed ◽  
Christopher R. Shea
Keyword(s):  
Personal Experience ◽  
Correct Diagnosis ◽  
Clinical History ◽  
Melanocytic Nevi ◽  
History Of ◽  
Immunohistochemical Studies ◽  
Recurrent Nevus ◽  
Potential Challenge ◽  
Microscopic Findings ◽  
Histopathologic Features

Abstract Context.—The diagnosis of recurrent nevus poses a potential challenge to practicing pathologists. Although most recurrent nevi show uniform microscopic findings and pose no great diagnostic difficulty, a few cases exhibit some histopathologic features similar to, and in some cases indistinguishable from, melanoma. Historically, the term pseudomelanoma has been used in the literature to describe such recurrent nevi, although this label has the potential for confusion and is no longer the favored term for recurrent pigmented melanocytic nevi. Objective.—To describe historical, histopathologic, and immunohistochemical features of recurrent pigmented melanocytic nevi and to review briefly the literature surrounding the mechanism of recurrence. Data Sources.—Published peer-reviewed literature and the authors' personal experience. Conclusions.—Recognition of the histopathologic pattern of recurrent nevi leads the pathologist to the correct diagnosis in most cases; however, in particularly challenging specimens or in circumstances in which there is insufficient clinical history, immunohistochemical studies have proved helpful in distinguishing recurrent nevi from melanoma.

scholarly journals (Doctor…My child keeps falling over) unexpected MRI findings in children with history of frequent falls and dizziness: a case series

2019 ◽  
Vol 12 (7) ◽  
pp. e229849 ◽  
Author(s):  
Ashraf Nabeel Mahmood ◽  
Osama Abulaban ◽  
Arshad Janjua
Keyword(s):  
Physical Examination ◽  
Case Series ◽  
Clinical History ◽  
Brain Stem Glioma ◽  
Mri Findings ◽  
Group Management ◽  
Wide Range ◽  
Detailed Clinical History ◽  
History Of ◽  
Low Threshold

Frequent falls and dizziness are common complaints in children. These symptoms can be caused by wide range of underlying pathologies including peripheral vestibular deficits, cardiac disease, central lesions, motor skills delay and psychogenic disorders. We report three paediatric cases who presented with complaints of repeated falls and imbalance. MRI scan revealed underlying brain lesions (frontal lobe arteriovenous malformation, exophytic brain stem glioma and cerebellomedullary angle arachnoid cyst with cerebellar tonsillar ectopia). By reporting these cases, we would like to emphasise the importance of a thorough assessment of children with similar symptoms by detailed clinical history, physical examination and maintaining low threshold for investigations, including radiological imaging. Taking in consideration, the wide range of differential diagnosis, the challenge of obtaining detailed history and difficulty of performing reliable physical examination in this age group. Management of underlying disorders can be medical, surgical or just observational.

Relapsing polychondritis presented as inner ear involvement

1996 ◽  
Vol 110 (2) ◽  
pp. 154-157 ◽  
Author(s):  
Yasuyuki Kimura ◽  
Hiroko Miwa ◽  
Mitsuru Furukawa ◽  
Yuji Mizukami
Keyword(s):  
Inner Ear ◽  
Steroid Therapy ◽  
Correct Diagnosis ◽  
Herbal Medicines ◽  
Relapsing Polychondritis ◽  
Oral Prednisolone ◽  
Sudden Onset ◽  
Initial Symptom ◽  
Old Japanese ◽  
Dose Oral

AbstractWe report a rare case of relapsing polychondritis with an initial symptom of inner ear involvement. This 53-year-old Japanese man experienced a hearing difficulty, tinnitus in both ears, and dizziness of sudden onset, but lacked auricular chondritis at that time, which is the most frequent finding in relapsing polychondritis. Thus it was difficult to reach a correct diagnosis. Steroid therapy, with oral prednisolone 15 mg daily, was effective. Almost two months after we began the steroid therapy, the patient complained of losing interest in his work and reported a hallucination vision on the TV screen, so the dose of prednisolone was decreased to 10 mg. The hallucinations then disappeared, but the serum level of C-reactive protein increased highly. To reduce the dose of prednisolone, we tried low-dose oral methotrexate. However, we had to discontinue it when the patient experienced severe vomiting and diarrhoea. As adjuvant therapy, we then administered Sho-saiko-to, Chinese herbal medicines with few side effects. Symptoms and laboratory abnormalities then improved markedly.

scholarly journals Unusual Clinical Manifestations of Chronic Discoid Lupus Erythematosus

2014 ◽  
Vol 6 (2) ◽  
pp. 69-72
Author(s):  
Ljubka Miteva ◽  
Valentina Broshtilova ◽  
Robert A. Schwartz
Keyword(s):  
Physical Examination ◽  
Alopecia Areata ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Discoid Lupus Erythematosus ◽  
Histopathological Analysis ◽  
Scarring Alopecia ◽  
History Of ◽  
Scalp Lesions

Abstract A 22-year-old woman with a 3-year history of discoid lupus erythematosus presented with two circumscribed patches of non-scarring alopecia, clinically simulating alopecia areata. Histopathological analysis of scalp lesions revealed discoid lupus erythematosus. Based on the clinical history, physical examination, and histological and immunological findings, we distinguished our case from a true combination of alopecia areata and typical chronic discoid lupus erythematosus.

scholarly journals Oral Manifestations of Celiac Disease and Wheat Allergy: Report of Three Cases and Review of Literature

2018 ◽  
pp. 33-45
Author(s):  
Yadira V. Boza Oreamuno DDS, MSc ◽  
María F. Rugama Flores BSND
Keyword(s):  
Celiac Disease ◽  
Systemic Disease ◽  
Clinical Manifestations ◽  
Abdominal Distension ◽  
Clinical History ◽  
Recurrent Abdominal Pain ◽  
Oral Manifestations ◽  
Wheat Allergy ◽  
Immune Mediated ◽  
History Of

Celiac Disease (CD) is an immune-mediated systemic disease, caused by gluten and related prolamins, in genetically susceptible individuals. It is characterized by gluten-dependent clinical manifestations, CD-specific antibodies, HLA DQ2 or DQ8 haplotypes, and enteropathy. Most patients are asymptomatic or with mild manifestations. It mainly affects the gastrointestinal system causing symptoms and signs such as diarrhea, recurrent abdominal pain and abdominal distension; also extradigestive manifestations. Patients with CD may have oral manifestations that include recurrent aphthous stomatitis (RAS), enamel hypoplasia, atrophic glossitis, among others. The diagnosis of CD is based on clinical history, serology, endoscopy and histology. There are other entities that should be differentiated from CD, such as non-celiac gluten sensitivity and wheat allergy. The aim of this study is to present three patients with a history of RAS and other clinical manifestations associated with the early diagnosis of CD and food allergy.

Cholangiocarcinoma in a young bitch – case report

2017 ◽  
Vol XXII (128) ◽  
pp. 44-52
Author(s):  
Ricardo Henrique Miziara ◽  
Bruna Maria Pereira Coelho Silva ◽  
Vera Assunta B. Fortunato Wirthl ◽  
Demétrio Ian Carvalho de Godoy ◽  
Tatiane Ribeiro Melo ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Clinical History ◽  
Abdominal Ultrasound ◽  
Atypical Case ◽  
History Of ◽  
Laboratory Examinations ◽  
Hepatobiliary Tumors ◽  
Low Prevalence

Primary hepatobiliary tumors have low prevalence in dogs and are usually observed in nine to 12-year-old animals. This article reports a case of acute clinical cholangiocarcinoma in a three-year-old Labrador Retriever bitch. The animal had a clinical history of emesis and hyporexia. Physical and laboratory examinations disclosed hyperthermia, jaundice, hypoglycemia, leukocytosis, anemia, thrombocytopenia and coagulopathy. Abdominal ultrasound revealed an enlarged liver of heterogeneous echotexture with hyperechoic and hypoechoic irregular areas. The animal developed severe hemolysis and came to die. Necropsy revealed hepatomegaly and irregular appearance of the liver; metastasis were found in the bone marrow, kidneys and spleen, and neoplastic pulmonary embolism was also observed. Cholangiocarcinoma was identified microscopically. The aim of this report was to describe an atypical case of cholangiocarcinoma because of the precocity of its occurrence.

Cutaneous Rosai–Dorfman disease: a challenging diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e239244
Author(s):  
Rita Sampaio ◽  
Leandro Silva ◽  
Goreti Catorze ◽  
Isabel Viana
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Physical Examination ◽  
Plasma Cells ◽  
Oral Prednisolone ◽  
Inflammatory Cells ◽  
Rosai Dorfman Disease ◽  
History Of ◽  
Nodular Lesions ◽  
Proliferative Disease

Rosai–Dorfman disease is a rare benign histiocytic proliferative disease of unknown cause that, in exceptional cases, presents with lesions confined to the skin. Clinically variable types of lesions such as papules, nodules and plaques have been reported. We present a case of a 27-year-old woman with a 1-year history of erythematous papular and nodular lesions on the malar and right axillary regions, previously misdiagnosed as acne. She reported no fever, malaise or weight loss, while physical examination and laboratory workup were normal. Bacteriological and mycobacteriological cultures were negative. Histopathological findings showed dense infiltration of inflammatory cells involving the entire dermis, consisting of large macrophages with emperipolesis, S100 and CD68 positive, neutrophils, eosinophils, lymphocytes and plasma cells. The patient was treated with oral prednisolone without improvement. Dapsone was subsequently initiated with favourable clinical response. The present article aimed to emphasise the clinical and histological differential diagnosis and share the treatment experience.

Sign in / Sign up

Export Citation Format

Share Document