Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach

Idiopathic cyclic edema is a type of generalized edema that mainly affects women. Diagnosis is made by the patient’s clinical history and an evaluation of the accumulation of weight during the day. The objective of this study is to report the clinical control of lymphedema associated with idiopathic cyclic edema using calcium dobesilate. A 55-year-old female patient reported generalized edema for years in that she woke up in the morning with her legs swollen and the edema worsened during the day. The physical examination revealed generalized edema. After four days of treatment with calcium dobesilate, the patient returned to the Clínica Godoy, Brazil, with less edema and reductions in body weight and the amount of extracellular and intracellular fluid. With further treatment, there was a total reduction of the edema. It is concluded that calcium dobesilate helps to control lymphedema secondary to idiopathic cyclic edema.

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Midthoracic Punctate Midline Myelotomy for Treatment of Chronic, Intractable, Nonmalignant, Abdominal Visceral Pain: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa034 ◽

2020 ◽

Vol 19 (2) ◽

pp. E183-E183 ◽

Cited By ~ 1

Author(s):

Tyler Ball ◽

Zaid Aljuboori ◽

Haring Nauta

Keyword(s):

Abdominal Pain ◽

Physical Examination ◽

Surgical Procedure ◽

Visceral Pain ◽

Lower Abdominal Pain ◽

Clinical History ◽

Dorsal Column ◽

Complete Relief ◽

Patient Reported

Abstract Punctate midline myelotomy (PMM) is a surgical procedure that damages the ascending fibers of the postsynaptic dorsal column (PSDC) pathway to interrupt visceral pain transmission.1-3 It can offer relief to patients with chronic visceral pain conditions that are refractory to other treatments. Here, we present a surgical video of midthoracic PMM in a patient with chronic, intractable, nonmalignant visceral abdominal pain that failed over a decade of medical treatment. We choose T7-8 as the level for laminectomy in patients with pelvic or lower abdominal pain, because the postsynaptic pain fibers transmitting visceral pain sensation from the lower abdominal organs will invariably be caudal to this level. The patient developed immediate and complete relief of her visceral pain after the procedure, which was sustained through the 11-wk follow-up period to date and was able to be weaned off narcotics. Postoperatively, she remained full strength and had no impairment of light touch or proprioception of her lower extremities. Detailed physical examination showed a reduced vibratory sensation on the glabrous skin of her great toes. Regarding patient-reported sensory changes (not detected on physical examination), she reported some numbness on the insides of her feet that had resolved by 11-wk follow-up. She also reported some numbness of the vulva, but not of the vagina. However, by 11-wk follow-up, she reported this had resolved and she had normal sexual function. The only persistent sensation at 11-wk follow-up was slight tingling in her toes that was not bothersome to her.4 The patient presented in the following video consented to both the surgical procedure and the publication of her clinical history and operative video.

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Ovarian cancer recurrence detection may not require in-person physical examination: an MSK team ovary study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002885 ◽

2021 ◽

pp. ijgc-2021-002885

Author(s):

Jacqueline Feinberg ◽

Karen Carthew ◽

Emily Webster ◽

Kaity Chang ◽

Nita McNeil ◽

...

Keyword(s):

Ovarian Cancer ◽

Physical Examination ◽

Tumor Marker ◽

Financial Burden ◽

Cancer Recurrence ◽

Cancer Surveillance ◽

Detection Methods ◽

Surveillance Program ◽

Patient Reported ◽

Primary Means

ObjectiveGiven the inconvenience and financial burden of frequent ovarian cancer surveillance and the risks of in-person visits due to COVID-19, which have led to the acceleration of telehealth adaptation, we sought to assess the role of in-person physical examination for the detection of ovarian cancer recurrence among patients enrolled in a routine surveillance program.MethodsThis was a retrospective study of patients initially seen from January 2015 to December 2017 who experienced ovarian cancer recurrence during first clinical remission. Descriptive statistics and bivariate analyses were performed to compare differences in detection methods and in patient and disease characteristics.ResultsAmong 147 patients who met our inclusion criteria, there were no recurrences detected by physical examination alone. Forty-six (31%) patients had recurrence first detected by tumor marker, 81 (55%) by radiographic scan, 17 (12%) by presentation of new symptoms, and 3 (2%) by biopsies taken during non-oncological surgery. One hundred and eleven patients (75%) had multiple positive findings at the time of recurrence. Of all 147 patients, 48 (33%) had symptoms, 21 (14%) had physical examination findings, 106 (72%) had increases in tumor markers, and 141 (96%) had changes on imaging.ConclusionsIn-person physical examination was not a primary means of detection for ovarian cancer recurrence for any patient. Substituting in-person visits for virtual visits that include patient-reported symptoms, alongside a regular surveillance protocol that includes tumor marker testing and imaging, may be a suitable approach for the detection of ovarian cancer recurrence while also reducing patient inconvenience and risks to health.

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Intestinal Obstruction following Ingestion of Metallic Instruments in a Psychiatric Patient

Case Reports in Surgery ◽

10.1155/2018/2469462 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Oscar Kivike ◽

Israel Soko ◽

David Mgaya ◽

Frank Sandi

Keyword(s):

Physical Examination ◽

Intestinal Obstruction ◽

Female Patient ◽

Psychiatric Patient ◽

Psychiatric Patients ◽

Abdominal Distension ◽

History Taking ◽

Proximal Intestine ◽

Psychotic Features

Pica among psychiatric patients has been well documented. We report a 25-year-old female patient who presented with abdominal distension for one week. She is a known psychiatric patient for 5 years. Through history taking, physical examination, and investigations, the patient was found to have psychotic features and features of intestinal obstruction. Surgery was done by opening the abdomen and then the stomach. The stomach, together with the proximal intestine, was found to be filled with metallic instruments weighing 780 mg. The diagnosis of a metalophagia type of pica was reached. All instruments were removed and the patient did well postoperatively.

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Comparison of Chief Complaints and Patient-Reported Symptoms of Treatment-Naive Lung Cancer Patients Before Surgery

10.21203/rs.3.rs-173687/v1 ◽

2021 ◽

Author(s):

Yaqian Feng ◽

Wei Dai ◽

Yaqin Wang ◽

Jia Liao ◽

Xing Wei ◽

...

Keyword(s):

Lung Cancer ◽

Physical Examination ◽

Cancer Patients ◽

Patient Reported Outcome ◽

Prospective Longitudinal Study ◽

Lung Cancer Patients ◽

Outcome Instrument ◽

Patient Reported ◽

Chief Complaints ◽

Prospective Longitudinal

Abstract BackgroundLung cancer patients without chief complaints have been increasingly identified by physical examination. This study aimed to profile and compare chief complaints with patient-reported symptoms of lung cancer patients before surgery.MethodsData was extracted from a multicenter, prospective longitudinal study (CN-PRO-Lung 1) in China from November 2017 and January 2020. A comparison between chief complaints and patient-reported symptoms was analyzed using the Chi-squared test.ResultsA total of 201 (50.8%) lung cancer patients without chief complaints were found by physical examination at admission, and 195(49.2%) patients had chief complaints. The top 5 chief complaints were coughing (38.1%), expectoration (25.5%), chest pain (13.6%), hemoptysis (10.6%), and shortness of breath (5.1%). There were significantly more patients with chief complaints of coughing (38.1% vs. 15.0 %, P <0.001) and pain (20.5% vs. 6.9%, P<0.001) than those with the same symptoms rated ≥4 via MDASI-LC. There were less patients with chief complaints of fatigue (1.8% vs. 10.9%, P<0.001), nausea (0.3% vs. 2.5%, P=0.006), and vomiting (0.3% vs. 1.8%, p=0.032) than those with the same symptoms rated ≥4 via MDASI-LC. In patients without chief complaints, the five most common moderate to severe patient-reported symptoms were disturbed sleep (19.5%), distress (13.5%), dry mouth (13%), sadness (12%), and difficulty remembering (11.1%).ConclusionsSymptoms of lung cancer patients not included in the chief complaint could be identified via a patient-reported outcome instrument, suggesting the necessity of implementing the patient-reported outcome assessment before lung cancer surgery for better patient care.

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Clinical history-taking and physical examination in medical practice in Africa: still relevant?

Croatian Medical Journal ◽

10.3325/cmj.2016.57.605 ◽

2016 ◽

Vol 57 (6) ◽

pp. 605-607 ◽

Cited By ~ 3

Author(s):

Ayo Oyedokun ◽

Davies Adeloye ◽

Olanrewaju Balogun

Keyword(s):

Physical Examination ◽

Medical Practice ◽

Clinical History ◽

History Taking

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Oral Melanotic Macule – An Unusual Occurrence In Gingiva

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708744 ◽

2018 ◽

Vol 08 (01) ◽

pp. 48-51

Author(s):

Sajna H. R. ◽

Biju Thomas ◽

Amitha Ramesh ◽

Rahul Bhandary ◽

Madhurya N. Kedlaya

Keyword(s):

Oral Cavity ◽

Female Patient ◽

Excisional Biopsy ◽

Chief Complaint ◽

Pathological Examination ◽

Pigmented Lesion ◽

Patient Reported ◽

Unusual Occurrence ◽

One Year ◽

Black Pigmentation

AbstractMelanotic macule is the most common benign pigmented lesion of the oral cavity characterised by a focal increase in the melanin deposition. A 34 year old female patient reported with a chief complaint of black pigmentation with respect to maxillary gingiva between the central incisors since one year. An excisional biopsy was done for histo pathological examination, which revealed the lesion as melanotic macule.

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Diabetes Barriers and Self-Care Management

Clinical Nursing Research ◽

10.1177/1054773813507948 ◽

2014 ◽

Vol 23 (6) ◽

pp. 601-626 ◽

Cited By ~ 10

Author(s):

Deborah Stiffler ◽

Deborah Cullen ◽

Gaye Luna

Keyword(s):

Therapeutic Approach ◽

Care Management ◽

Self Care ◽

Self Management ◽

Qualitative Synthesis ◽

Clinical Control ◽

The Many ◽

Research Studies

For those individuals diagnosed with diabetes, the challenge is how to cope and manage the many aspects of their lives. The aim of this qualitative synthesis was to evaluate research studies for findings and then synthesize patients’ experiences within the context of diabetes self-care while facing daily barriers. A total of 95 findings from 21 studies were categorized via like themes. These themes were further analyzed and aggregated to represent an interpretive meta-synthesis via a rigorous methodological protocol as described by Pearson, Robertson-Malt, and Rittinmeyer and the Joanna Briggs Institute. Meta-synthesized findings suggest that patients “avoid and hinder self-management” as well as “desire self-care and living life.” Clinicians can improve interactions and potentiate understanding when the therapeutic approach is about the person living with diabetes as opposed to clinical control.

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Pneumonia byListeria monocytogenes: A Common Infection by an Uncommon Pathogen

Case Reports in Infectious Diseases ◽

10.1155/2015/627073 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Theocharis Koufakis ◽

Marianneta Chatzopoulou ◽

Anastasios Margaritis ◽

Maria Tsiakalou ◽

Ioannis Gabranis

Keyword(s):

Listeria Monocytogenes ◽

Pregnant Women ◽

Female Patient ◽

Respiratory System ◽

Therapeutic Approach ◽

The Elderly ◽

Pulmonary Infections ◽

Immunosuppressed Patients ◽

Common Infection

Infections byListeria monocytogenestypically occur in infants, the elderly, pregnant women, and immunosuppressed subjects. Pulmonary infections in adults are extremely uncommon and only few reports can be found in the literature. We here report a case ofListeriapneumonia in an 85-year-old female patient and we discuss our diagnostic and therapeutic approach. Despite being rare and in most cases difficult to be identified,Listeriapneumonia should always be considered in immunosuppressed patients, presenting with fever and symptoms from the lower respiratory system.

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Tibial Neuropathy—Tarsal Tunnel Syndrome

10.1093/med/9780190617127.003.0010 ◽

2018 ◽

Author(s):

Daniel A. Lyons ◽

David L. Brown

Keyword(s):

Physical Examination ◽

Surgical Intervention ◽

Tibial Nerve ◽

Clinical History ◽

Surgical Decompression ◽

Tarsal Tunnel ◽

Success Rates ◽

Tarsal Tunnel Syndrome ◽

Tunnel Syndrome ◽

Space Occupying Lesion

Tarsal tunnel syndrome (TTS) is caused by compression of the tibial nerve and its branches within the tarsal tunnel at the ankle. The diagnosis of TTS is often made clinically, but imaging and electrodiagnostic studies should be considered when the diagnosis cannot be ascertained from the clinical history and physical examination. Surgical decompression of the tarsal tunnels should be pursued only after conservative measures have failed or when a space-occupying lesion or point of tibial nerve compression has been identified. Surgical intervention requires complete release of the flexor retinaculum at the medial ankle, as well as release of the three distinct tunnels enveloping the medial and lateral plantar nerves and the calcaneal branch. Success rates for tibial nerve decompression vary widely in the literature, ranging from 44% to 96%.

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Clinical reasoning in feline spinal disease: which combination of clinical information is useful?

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19858447 ◽

2019 ◽

Vol 22 (6) ◽

pp. 521-530 ◽

Cited By ~ 2

Author(s):

Stephanie L Mella ◽

Thomas JA Cardy ◽

Holger A Volk ◽

Steven De Decker

Keyword(s):

Logistic Regression ◽

Physical Examination ◽

Clinical History ◽

Spinal Disease ◽

Multivariate Logistic Regression ◽

Intervertebral Disc Disease ◽

Disc Disease ◽

Feline Infectious Peritonitis ◽

General Physical Examination ◽

General Physical

Objectives The aim of this study was to evaluate if a combination of discrete clinical characteristics can be used to identify the most likely differential diagnoses in cats with spinal disease. Methods Two hundred and twenty-one cats referred for further evaluation of spinal disease were included and categorised as follows: non-lymphoid neoplasia (n = 44); intervertebral disc disease (n = 42); fracture/luxation (n = 34); ischaemic myelopathy (n = 22); feline infectious peritonitis virus myelitis (n = 18); lymphoma (n = 16); thoracic vertebral canal stenosis (n = 11); acute non-compressive nucleus pulposus extrusion (n = 11); traumatic spinal cord contusion (n = 8); spinal arachnoid diverticula (n = 7); lumbosacral stenosis (n = 5); and spinal empyema (n = 3). Information retrieved from the medical records included signalment, clinical history and clinical presentation. Univariate analyses of variables (clinical history, breed, age, sex, general physical examination findings, onset, progression, spinal hyperaesthesia, asymmetry, ambulatory status and neuroanatomical location) were performed, and variables were retained in a multivariate logistic regression model if P <0.05. Results Multivariate logistic regression revealed that intervertebral disc disease most often occurred in middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs. Ischaemic myelopathy occurred most often in older cats with a stable or improving, non-painful, lateralising, C6–T2 myelopathy. Spinal fracture/luxation occurred most often in younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status. Concurrent systemic abnormalities or abnormal findings detected on general physical examination were significantly associated with feline infectious peritonitis virus myelitis, spinal lymphoma or spinal empyema. Conclusions and relevance This study suggests that using easily identifiable characteristics from the history and clinical examination can assist in obtaining a preliminary differential diagnosis when evaluating cats with spinal disease. This information could aid veterinary practitioners in clinical decision-making.

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