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Initial Signs (initial + sign)

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Medical Sciences	100%

Selected Abstracts

Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A

HAEMOPHILIA, Issue 6 2006
G. D. E. CUVELIER
Summary., We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis. [source]

Mycosis fungoides presenting with extensive pyoderma gangrenosum-like ulcers

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2002
SG Carbia
Abstract Mycosis fungoides (MF) may present with atypical clinical manifestations. Usually it mimics various chronic dermatoses, with the appearance of ulcers during the tumour stage. Infrequently, cutaneous ulcers are the main or initial sign of lymphoma. We report the case of a man who presented multiple skin lesions that clinically appeared to be pyoderma gangrenosum (PG). However, histological and immunohistochemical examination revealed MF. This case illustrates that PG-like ulcers may be atypical cutaneous manifestations of MF and exceptionally the presenting sign of this disease. [source]

Meanings of being a supervisor for care providers suffering from burnout: from initial signs to recuperation

JOURNAL OF NURSING MANAGEMENT, Issue 3 2009
EVA ERICSON-LIDMAN RNT
Aim, To illuminate meanings of being a supervisor for care providers suffering from burnout: from initial signs to recuperation. Background, Supervisors in health care, i.e. supervisors with first-line responsibilities for a work unit, are exposed to heavy demands, especially in times of downsizing and restructuring of the healthcare system. When care providers show signs of developing burnout, these demands are even greater. Methods, Interviews with 12 supervisors in health care were interpreted using a phenomenological-hermeneutic method. Results, Being a supervisor when someone in the work team shows signs of burnout means struggling to help them to continue working. In this predicament and being responsible for the unit, the supervisors are torn between focusing on relations and on production. When the care provider reports sick, they are left with feelings of hopelessness and self-blame. Conclusions and implications for nursing management, Supervisors face almost unmanageable strain, caught between conflicting demands. It seems important that supervisors are offered opportunities to share their feelings about this predicament as well as gaining increased knowledge about burnout. This is important if the supervisors are to give proper support, but it will also help to turn supervisory failure into development and to protect the health of the supervisors. [source]

Coexistence of movement disorders and epilepsia partialis continua as the initial signs in probable Creutzfeldt,Jakob disease

MOVEMENT DISORDERS, Issue 9 2005
Berril Donmez MD
Abstract Movement disorders and epilepsy rarely occur in the early stage of Creutzfeldt,Jakob disease (CJD) but have not been reported concurrently. We report on a 47-year-old patient with probable CJD who presented with generalized chorea and focal dystonia with myoclonic jerks on the right hand. Myoclonic jerks progressed to epilepsia partialis continua within 5 days of admission to the hospital. The diagnosis of our patient was compatible with probable CJD on the basis of clinical course, electroencephalogram, and diffusion-weighted magnetic resonance imaging findings, and presence of 14-3-3 protein in cerebrospinal fluid. To our knowledge, this is the first report of a case developing both movement disorders and epilepsia partialis continua in the early stage of the disease. © 2005 Movement Disorder Society [source]

Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion

CANCER, Issue 1 2002
Sebastiano Mercadante M.D.
Abstract BACKGROUND Cancer pain emergencies presenting with severe excruciating pain require a rapid application of powerful analgesic strategies. The aim of the current study was to evaluate a method of rapid titration with intravenous morphine to achieve relief of cancer pain of severe intensity. METHODS Forty-nine consecutive patients admitted to a Pain Relief and Palliative Care Unit for severe and prolonged pain were enrolled in the study. Pain was evaluated on a numeric scale of 0,10 (0 indicated no pain and 10 indicated excruciating pain). After the initial assessment (T0), an intravenous line was inserted and boluses of morphine (2 mg every 2 minutes) were given until the initial signs of significant analgesia were detected or severe adverse effects occurred (T1). A continuous reassessment was warranted and the effective total dose administrated intravenously was assumed to last approximately 4 hours and was calculated for 24 hours. The dose immediately was converted to oral morphine (a 1:3 ratio for low doses and a 1:2 ratio for high doses). RESULTS Data from 45 patients was analyzed. A significant decrease in pain intensity was achieved in a mean of 9.7 minutes (95% confidence interval [95% CI], 7.4,12.1 minutes), using a mean dose of intravenous morphine of 8.5 mg (95% CI, 6.5,10.5 mg). The doses administered rapidly were converted to oral morphine and pain control was mantained until the patient's discharge, which occurred in a mean of 4.6 days (95% CI, 4.1,5.2 days). The incidence of adverse effects was minimal. CONCLUSIONS The results of the current study demonstrate that cancer pain emergencies can be treated rapidly in the majority of cancer patients with an acceptable level of adverse effects. Intravenous administration of morphine requires initial close supervision and continuity of medical and nursing care. Cancer 2002;95:203,8. © 2002 American Cancer Society. DOI 10.1002/cncr.10636 [source]