Examination Findings In Patients Research Articles

A Case Report of a New Variant Associated with Vici Syndrome in a Turkish Infant; EPG5 Frameshift Variant

Introduction: Vici syndrome is a congenital multisystem disorder characterized primarily by callosal agenesis, cataracts, cardiomyopathy, combined immunodeficiency, and oculocutaneous hypopigmentation, along with additional newly recognized findings. Autosomal recessive variants in the EPG5 gene, which encodes ectopic P-granules autophagy protein 5 (EPG5), a key regulator of autophagy, are known genetic causes of this syndrome. The aim of this case report is to present a novel disease-causing variant identified through EPG5 gene sequence analysis. Case Presentation: We report on a 2-month-old Turkish girl who presented with developmental delay, bilateral congenital cataracts, microcephaly, hypotonia, hypertrophic cardiomyopathy, hypopigmented skin lesions, and agenesis of the corpus callosum. Genetic analysis revealed a homozygous c.7504delC (p.Gln2502Argfs*4) frameshift variant in the EPG5 gene, which has not been previously documented. Conclusions: Adding a new variant to the literature is crucial, as it highlights the feasibility of reaching an accurate diagnosis through well-conducted physical examination findings in patients with early developmental delay. This case also raises awareness about such rare diseases. Moreover, recognizing new mutations is critical for understanding atypical findings, prognosis, treatment responses, and the genetic risks for other family members.

Testicular Pain – Not Always What it Seems: A Cross-Sectional Assessment of Patients Presenting for Chronic Scrotal Content Pain at a Tertiary Care Center

ObjectiveTo review historical and examination findings in patients presenting to a tertiary care center for evaluation of Chronic Scrotal Content Pain (CSCP) defined by persistent/bothersome pain present for > 3-months. MethodsWe performed a retrospective chart review of all patients presenting to our medical center for evaluation of CSCP. Pertinent information collected included historical data, physical examination findings, laboratory and imaging results, and treatments recommended by the assessing physician. The data was summarized to present a cross-sectional representation of patients presenting for CSCP. Results110 patients were identified. 80 patients (73%) had seen at least one prior urologist. 26 patients (24%) had undergone a prior unsuccessful surgical intervention for CSCP. Reproducible tenderness was present in 67% of patients including testicular tenderness in 50 (45%), epididymal tenderness in 60 (55%), and spermatic cord tenderness in 31 patients (28%). 33% of patients did not have any reproductible scrotal content tenderness on physical examination. Surgery was recommended in 57/110 patients (52%), including microdenervation in 22%. Musculoskeletal etiologies were suspected based on specific aspects of the history and physical examination in 43 patients (39%), prompting additional evaluation and/or referrals. ConclusionCSCP presents with a wide array of symptoms and many patients do not have reproducible findings on examination, suggesting alternative sources of pain such as referred pain from musculoskeletal causes. The history and physical examination should include assessments for concurrent abdominal, back, hip, and other genital/pelvic pain that may suggest alternative diagnoses and referrals for appropriate treatment.

Efficacy of intravenous alpha lipoic acid in the treatment of neuropatic pain due to carpal tunnel syndrome.

<p>In this study, we analyzed the effect of oral and oral + intravenous Alpha-lipoic acid (ALA) treatment on pain level and physical examination findings in patients diagnosed with carpal tunnel syndrome (CTS).</p>. <p>A total of 115 patients patricipa&shy;ted in the study. Physiotherapy and wrist splint were first applied to all patients diag&shy;nosed with CTS in the study. 40 patients were treated with oral ALA after iv. ALA the&shy;rapy, 35 patients received only oral ALA treatment and 40 patients did not receive any medication. The patients were divided into 3 groups as those who received only splint treatment and physiotherapy, those who received oral ALA treatment, and those who received oral ALA treatment after iv. treat&shy;ment. All patients were assessed be&shy;fore the treatment, and at the 1st and 3rd months of the treatment. In clinical assessment, visual analog scale (VAS) forms were filled to define the pain severity, the Boston symptom severity scale (BSSS) and Boston functional status scale (BFDS) were filled for evaluating symptoms and functional status.&nbsp;</p>. <p>VAS, BSSS and BFDS scores of the patients who were treated with intravenous and then oral ALA were found to be significantly lower at the end of both the 1st and 3rd months compared to the patients who received only oral ALA or no medication (p=0.001; p&lt;0.001), (p=0.001; p&lt;0.001), (p=0.006; p&lt;0.001).</p>. <p>We think that iv. ALA is effective in the treatment of symptoms associated with CTS.</p> <p>&nbsp;</p>.

Diagnostic Competence of Creatine Kinase BB, in Mild Traumatic Brain Injury and its Prognostic Value.

Due to the very high and increasing prevalence, essential complications, and risk factors for psychiatric disorders, it is necessary to introduce screening tests for diagnosing and predicting mild traumatic brain injury (mTBI) prognosis. After completing the consent form and recording information and examination findings of patients with mild trauma, venous blood samples were taken from these patients. The samples were measured by observing the cold chain. After 3 months from mTBI, the post concussion symptoms questionnaire (PCSQ) and the short form 36 (SF-36) questionnaire for physical and mental evaluations were performed. Statistical tests analyzed the relationship between different variables and serum Creatine kinase BB (CKBB) levels. Statistic analyses showed no relation between CKBB level of serum and age, gender, level of consciousness, PCSQ, and SF 36 scale, and the interval between trauma and arrival to the hospital. Further, there is a significant correlation between CK-BB levels and intracranial damage based on Fisher's exact test. This study and following more significant considerations can introduce a serum-based biomarker panel that can accurately differentiate patients with complicated mTBI from those with uncomplicated.

Ultrasonographic Findings of Periarthritis of Shoulder Joint in the Out Patients Department

Background: To detect periarticular lesions around the shoulder, musculoskeletal ultrasonography is very much useful. Recent improvements in Ultrasonographic technology have led to a higher sensitivity and accuracy of musculoskeletal sonography. Objective: To present the distribution and representation of shoulder ultrasonographic (US) examination findings in patients with clinical diagnosis of shoulder periarthritis. Materials and Methods: A cross sectional descriptive type of study at Single center setting conducted in OPD of department of Physical Medicine&amp; Rehabilitation, BSMMU, Dhaka on thirty-five patients with the clinical diagnosis of periarthritis of shoulder. Data was collected using an interview- administered questionnaire. All baseline investigations were done. Ultrasonogram was done by experienced Sonologists who were unaware about clinical data. Results: The primary end point was reached in 85 percent of patient presented sonographic alteration suffering from periathritis of shoulder. The structure most frequently involved was bicipital tendinitis (32%) and Supraspinatus tendinitis (28%). Sub acromial Bursitis (14%) and Acromioclavicular Osteoathritis (11%) were also involved. About 15% individual presents no abnormalities. Different varieties of changes in the various structures had been detected. Conclusion: Proper identification and assessment of the alteration of periarticular structure helps to approach for management and rehabilitation of Periarthritis of shoulder thus disability can be reduced. KYAMC Journal Vol. 13, No. 03, October 2022: 134-138

The Effects of Nasal Septum Deviation on Ocular Examination Findings: Does Deviated Nasal Septum Cause Impaired Vision?

Aim: Nasal obstruction due to nasal septum deviation is associated with systemic diseases such as cardiopulmonary disease, neurological and vascular problems. But the effect of pure nasal deviation on the ocular system has not been precisely investigated. The aim of this study was to analyze the association of nasal septal deviation with ocular examination findings. Material and Methods: Twenty-seven adult patients underwent septoplasty and 31 controls were included in the study. The study group was conducted on patients with pure nasal septum deviation which is significantly obstructing the nasal airway (&amp;gt;50%). In ophthalmological examination; peripapillary retinal nerve fiber layer, macular and choroidal thickness measurements were obtained. The examination findings were compared between the study and control groups. Results: The mean macular thicknesses at nasal-500μm were 305.89±32.79 and 287.87±25.00 in the study and control groups, respectively (p=0.021). The mean macular thicknesses at nasal-1000μm were 353.04±21.28 and 341.16±17.97 in the study and control groups, respectively (p=0.025). The mean thickness of choroid was statistically significantly different at central (p=0.036) and peripheral measurements; nasal-500μm (p=0.020); nasal-1000μm (p=0.001); nasal-1500μm (p&amp;lt;0.001); temporal-500μm (p=0.023) and temporal-1000μm (p=0.045). No statistically significant difference was found between the two groups according to ocular tension, thickness of cornea, keratometry, anterior chamber depth, axial length of cornea, and retinal nerve fiber layer thickness. Conclusion: This is one of the pioneer studies evaluating the ocular examination findings in patients with nasal septum deviation. Our results indicate the increased thickness of both macula and choroid in patients with nasal septum deviation.

Testicular Pain – Not Always What it Seems: A Cross-sectional Assessment of Patients Presenting for Chronic Scrotal Content Pain at a Tertiary Care Center

ABSTRACT Introduction Introduction:: Chronic scrotal content pain (CSCP) is generally defined by persistent and bothersome pain present for &amp;gt; 3-months. This symptom complex leads to frustration for patients and providers alike, as the underlying etiology varies and in many instances is unknown. Scrotal pain may arise from outside the scrotal contents, as is seen with musculoskeletal conditions involving the hips, lower back, and pelvic musculature. Identifying those patients who have signs or symptoms of a musculoskeletal etiology earlier in their clinical course will allow for a more streamlined treatment pathway and minimize the need for unnecessary referrals. Objective To review historical and examination findings in patients presenting to a tertiary care center for evaluation of chronic testicular pain. Methods We reviewed our clinical experience with referrals for surgical intervention for “chronic testicular pain” at a tertiary care medical center between July 2019 and October 2020. Prior to scheduling an appointment, patients are queried via a list of questions to gather additional information in order to determine whether specialist consultation is indicated. Pertinent information was collected including historical patient data, physical examination findings, laboratory and imaging results, and treatment as recommended by the assessing physician. In addition, we gathered data on the number of prior consults and interventions performed by outside clinicians. The data was summarized to present a cross-sectional representation of patients presenting for CSCP. Results In total, 126 patients were seen for a primary chief complaint of CSCP. Mean patient age was 45 years [standard deviation (SD) 15]. 31 (24%), 55 (44%), and 40 (32%) were self-referred or referred by their primary care provider or a urologist, respectively. 88 patients (70%) had seen at least one prior urologist. 22/126 (17%) reported bilateral testicular pain. 29 patients (24%) had undergone a prior unsuccessful surgical intervention for their pain. On examination, reproducible testicular tenderness was present in only 57 patients (45%), despite 109 patients (87%) stating testicular pain as their primary chief complaint. Digital rectal examination of the pelvic floor musculature was positive for tenderness in 31/126 patients (25%), suggesting a possible pelvic floor contribution. After thorough assessment, musculoskeletal etiologies were suspected to underlie CSCP in 49 patients (39%), prompting additional evaluation and/or referrals. This included 35 patients (28%) who were specifically referred to a pelvic floor physical therapy specialist. Surgery was recommended in 68/126 patients (54%), including microdenervation of the spermatic cord in 22% (after successful diagnostic spermatic cord block), and epididymectomy in 13%. Conclusions CSCP presents with a wide array of concurrent symptoms. The history and physical examination must include assessments for concurrent abdominal, back, hip, and other genital/pelvic pain that may lend towards an alternative non-urologic treatment pathway. Disclosure No

Temporal Trends and Prognosis of Physical Examination Findings in Patients With Acute Decompensated Heart Failure: The ARIC Study Community Surveillance.

Bedside evaluation of congestion is a mainstay of heart failure (HF) management. Whether detected physical examination signs have changed over time as obesity prevalence has increased in HF populations, or if the associated prognosis differs for HF with reduced or preserved ejection fraction (HFrEF or HFpEF) is uncertain. From 2005 to 2014, the ARIC study (Atherosclerosis Risk in Communities) conducted adjudicated hospital surveillance of acute decompensated HF. We analyzed trends in physical examination findings, imaging signs, and symptoms related to congestion, both over time and by obesity class, and associated 28-day mortality risks. Of 24 937 weighted hospitalizations for acute decompensated HF (mean age 75 years, 53% women, 32% Black), 47% had HFpEF. The prevalence of obesity increased from 2005 to 2014 for both HF types. With increasing obesity category, detected edema increased, while jugular venous distension decreased, and rales remained stable. Detected edema also increased over time, for both HF types. Associations between 28-day mortality and individual signs and symptoms of congestion were similar for HFpEF and HFrEF; however, the adjusted mortality risk with all 3 (edema, rales, and jugular venous distension) versus <3 physical examination findings was higher for patients with HFpEF (odds ratio, 2.41 [95% CI, 1.53-3.79]) than HFrEF (odds ratio, 1.30 [95% CI, 0.87-1.93]); P for interaction by HF type =0.02. In patients hospitalized with acute decompensated HF, detected physical examination findings differ both temporally and by obesity. Combined findings from the physical examination are more prognostic of 28-day mortality for patients with HFpEF than HFrEF.

Physical Examination for the Detection of Pulmonary Hypertension: A Systematic Review.

We performed a systematic review to determine whether the physical examination can reliably assist in the diagnostic approach for patients suspected of having pulmonary hypertension (PH). Using dual extraction, two investigators independently searched PubMed, Ovid MEDLINE, Cochrane Library, and Embase for studies that compared physical examination findings with a right heart catheterization, from inception until July 10, 2021. We obtained data from four studies that evaluated physical examination findings in patients receiving a right heart catheterization to diagnose PH. Pooled diagnostic odds ratios (DOR) were calculated for right ventricular heave, a loud pulmonic component of the second heart sound (P2), jugular venous pressure (JVP) 3 cm above sternal angle, and a palpable P2.Three physical examination findings had DOR that supports the diagnosis of PH: the JVP > 3 cm above the sternal angle (5.90, 95% CI 2.57, 13.57), a loud P2 (2.91, 95% CI 1.38, 6.10), and a right ventricular heave (2.78, 95% CI 1.12, 6.89). The palpable P2 had a DOR less than one and was not able to be conclusive in diagnosing PH.Our systematic review found a small body of evidence supporting the use of physical examination tests in the diagnostic evaluation of pulmonary hypertension. The JVP > 3 cm above the sternal angle was the most accurate physical examination sign for the diagnosis of PH. Larger cohort studies using a combination of tests may shed more light on the role of the physical examination in the diagnosis and early detection of pulmonary hypertension.

Predictors of critical illness and mortality based on symptoms and initial physical examination for patients with SARS-CoV-2: A retrospective cohort study

IntroductionAn unidentified cluster of pneumonia was identified in Wuhan city of China in the last week of December 2019, named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2). The current study explored the predictors associated with critical illness and mortality based on symptoms at the time of admission and initial physical examination findings in patients with SARS-CoV-2. Material and methodsA total of 249 records of laboratory-confirmed SARS-COV-2 patients were analyzed. Demographic profile and findings of initial physical examination were collected and analyzed. Bivariate logistic and multivariable stepwise forward regression analysis was used to identify the predictors of critical illness and mortality. ResultsA total of 249 records of SARS-COV-2 patients were retrospectively studied, of whom 66 (26.5%) developed a critical illness, and 58 (23.29%) died. The mean age of patients was 45.15 (16.34) years; 171 (68.71%) were men. From 27 potential predictors for developing a critical illness, 15 were reported independent predictors for critical illness, and 13 were for increased risk of mortality. Stepwise forward regression reported dyspnea as a single strongest predictor (OR, 5.800, 95% CI-2.724−12.346; p = 0.001, R2 = 0.272) to develop critical illness. Likewise, the respiratory rate was alone reported as a strong predictor (OR, 1.381, 95% CI- 1.251−1.525; p = 0.000, R2 = 0.329) for mortality. ConclusionsCoronavirus disease is a new challenge to the medical fraternity, leading to significant morbidity and mortality. Knowledge of potential risk factors could help clinicians assess patients' risk with unfavourable outcomes and improve hospitalization decisions in the early stage.

Evaluation of Patients with Post-Traumatic Hearing Loss: A Retrospective Review of 506 Cases.

Objectives: The purpose of the study is to evaluate the audiological, radiological, and examination findings of patients who have been treated for hearing loss (HL) due to head trauma and evaluated in terms of causality to reveal current data, and to highlight the steps to be taken.Methods: We retrospectively reviewed the reports of cases that had applied for disability with HL due to head injury and had been evaluated by the Forensic Medicine Institute between January 01, 2009 and January 01, 2019.Results: Of the total cases of head trauma, 52.42% were not vehicle-related, and cases were observed to be concentrated in the age range of 19-40 (55.92%; n = 283). Although otorrhagia/otorrhea was the most common finding in all types of trauma, TM perforation was the most common finding in blast-type injuries. While the rate of newly developed unilateral HL was 84.2%, 72.7% of the patients had sensorineural hearing loss (SNHL) . Temporal bone fractures were detected in 59.3% of the cases, and 60.2% of them were of the longitudinal type. Facial paralysis (FP) was detected in 28.6% of the cases, and there was no statistically significant difference between the groups in terms of HL compared to those without FP. Other nerve palsy was detected in 4.9% of the cases, and N. Abducens paralysis was the most common.Conclusion: Accompanying intracranial nerve injury, temporal fracture, and intracranial pathologies are considerably high in patients who develop HL following head trauma. The first examination requires a multidisciplinary approach to guide future disability applications.

Spontaneous cerebrospinal fluid leaks of the temporal bone – clinical features and management outcomes

Objective:1.To characterise the clinical profile, symptoms and examination findings of patients with spontaneous cerebrospinal fluid otorrhoea.2.To evaluate the management outcomes of patients with spontaneous cerebrospinal fluid otorrhoea. MethodsA retrospective cohort study over seven-years from 2013 to 2020 was conducted at five tertiary referral centres. Patients identified with biochemically confirmed spontaneous cerebrospinal fluid leaks of the temporal bone manifesting as middle ear fluid with no other obvious cause were included. Demographics (age, gender, body-mass-index), symptomatology, past medical history, examination, investigation (biochemical and radiological), management and outcomes were recorded. Results90 adult patients with spontaneous cerebrospinal fluid otorrhoea were identified. Right sided leaks were most common (58%), and a majority of the cohort overweight (mean body-mass-index = 29.2 kg/m2). Unilateral hearing loss was the commonest presenting symptom (81%). Two patients presented to hospital with meningitis presumed secondary to spontaneous cerebrospinal fluid otorrhoea. Over half (54%) of patients were observed who tended to be older (mean age of 71 years vs 62 years) whilst the remainder underwent surgical repair with middle-fossa craniotomy the most common approach (87%). Eight patients managed surgically had recurrent leaks (21%). ConclusionsThis is one of the largest cohorts of spontaneous cerebrospinal fluid otorrhoea reported in the literature and reiterates the importance for clinicians to have a high index of suspicion for this condition in patients presenting with a unilateral middle ear effusion, especially in those who are overweight. Surgical intervention carries a risk of recurrence and further studies are needed to determine the risk of intra-cranial infection in order to guide management.

Physical Examination Findings in Patients with Protracted Concussion and the Impact of an Integrative Concussion Rehabilitation Protocol

Purpose: To describe physical examination (PE) findings of individuals with protracted concussion recovery and evaluate an integrated primitive reflex (PR) disinhibition, vision, and vestibular rehabilitation intervention. Method: Retrospective study of 82 patients with protracted concussion (60.98% female) who received ≥ 2 phases of treatment. Following a baseline PE, patients completed the Post-Concussion Symptom Survey (PCSS), Activities-Based Balance Confidence Questionnaire (ABC), Dizziness Handicap Index (DHI), and Acquired Traumatic Brain Injury (aTBI) Vision Questionnaire. A subset of patients (Group 1), completed a final PE and second questionnaire administration. Descriptive statistics characterized the sample. T-tests and Wilcoxon rank sum tests compared characteristics of Group 1 vs Group 2. Wilcoxon sign rank tests assessed changes in patient-reported outcomes. Results: Patients in Groups 1 (median age=23.5) and 2 (median age=17.5) were similar regarding demographic and PE findings. Statistically and clinically significant improvements were seen for Group 1: PCSS (-21 points, MCID 6.8), DHI (-27 points, MDC 17.8, MCID 19), ABC (+ 8.5 points, MDC 9)and aTBI Vision Questionnaire (-16.5 points). Conclusion: Patients with protracted concussion recovery can benefit from a multitude of interventions ranging from orthopedic to vision and vestibular interventions in order to address objective deficits and subjective complaints such as headache, dizziness, or blurry vision following a concussion. Patients who completed the full intervention demonstrated clinically significant improvements in function, including return to school/work and recreational activities. These data suggest there is a potential positive benefit to a structured, integrative concussion rehabilitation approach for individuals with protracted concussion recovery.

Investigating the Biochemical Parameters Derangement and Physical Examination Findings in Patients with Non-Alcoholic Fatty Liver Disease

Investigating the Biochemical Parameters Derangement and Physical Examination Findings in Patients with Non-Alcoholic Fatty Liver Disease

Trigeminal Hyperexcitability in Idiopathic Intracranial Hypertension: A Blink Reflex Study.

To compare blink reflex examination findings in patients with idiopathic intracranial hypertension (IIH) with migraineurs and controls and to investigate the role of blink reflex data in the follow-up by evaluating their relationship with clinical symptoms. We included 23 patients with IIH, 15 migraineurs, and 16 controls. Blink reflex was studied with bilateral paired stimulations, and the 2R2/1R2 and 2R2c/1R2c area ratios, 1R2, 2R2, 1R2c, and 2R2c latencies were compared (R2:ipsilateral R2 response, R2c:contralateral R2 response). 2R2/1R2 area ratios at 200, 300, and 500 ms interstimulus intervals were significantly higher in the IIH group compared with the controls, and significantly higher 2R2/1R2 area ratio at 200 ms interstimulus interval was also detected in the IIH group compared with the migraine group. Significantly shorter 2R2 latencies were found at 500 and 800 ms interstimulus intervals in IIH group compared with the migraine group and controls. Significantly higher 2R2/1R2 area ratios at 500, 800 ms, and 2R2c/1R2c area ratios at 300, 500, and 800 ms were detected in patients with IIH in remission compared with patients with attacks. The significant increase in R2 recovery rates in patients with IIH in remission suggests that there is an increased excitability in the trigeminal pathways. Our findings may provide a new perspective for IIH mechanism related to trigeminal hyperexcitability and evaluating new management strategies.

Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis

ObjectivesThe aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs).Materials and methodsPubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for the diagnosis of DD, using Magnetic resonance imaging (MRI) as the reference standard. Meta-analyses were performed with Metadisc 1.4 and RevMan 5.3.ResultsA total of 16 studies qualified for meta-analyses. For the diagnosis of DD at closed mouth position (DD-CM) and DD at maximum mouth-opening position (DD-MMO), the added values of a positive result with US for ruling in DD-CM and DD-MMO were 22 and 41%, while those of a negative result with US for ruling out DD-CM and DD-MMO were 30 and 20%. For the diagnosis of DD with reduction (DDWR) and DD without reduction (DDWoR), the added values of a positive result in US for ruling in DDWR and DDWoR were 35 and 41%, while those of a negative result in US for ruling out DDWR and DDWoR were 21 and 27%.ConclusionsUsing MRI as reference standard, the added values of both positive predictive values and negative predictive values of US for ruling in and ruling out DDs are sufficient in the decision-making in dental practice.Clinical relevanceUS can be a good imaging tool to supplement clinical examination findings in patients with suspected DDs. Combined static and dynamic examinations using high-resolution US should be preferred.

Correlation of Cord Signal Change With Physical Examination Findings in Patients With Cervical Myelopathy

Retrospective case series. To determine whether cord signal change (CSC) visualized on magnetic resonance imaging (MRI) correlates with level-specific physical examination findings as well as other signs of cervical myelopathy. Although CSC is often used as a marker for severe cervical spine pathology, it is not known whether CSC detected on MRI actually translates clinically into level-specific findings detected on physical examination. A consecutive series of patients with CSC evident on MRI operated on by a single surgeon from 2010 to 2012 were retrospectively analyzed. Patients' preoperative reflex examination (biceps, brachioradialis, and triceps) including abnormal reflexes (Hoffman sign, inverted radial reflex, clonus, and Babinski) were recorded. Patients were deemed to have an examination consistent with the level of CSC if they had normal reflexes cranial to the level of CSC, were hypo-reflexic at the affected level, and hyper-reflexic caudal to the level of CSC. Forty-three patients with CSC were identified during the study period (Table 1). Isolated T2 CSC was present in 35 patients, and concomitant T1 and T2 CSC was present in 8 patients. Interestingly, the reflex examination correlated poorly with the cranio-caudad level of CSC, with only 11 of 43 patients (26%) having a concordant examination. In patients with CSC, 16% had clonus, 67% had Hoffman sign, 44% had Romberg sign, and 60% had a gait abnormality. CSC visualized on MRI correlates poorly with the upper extremity reflex examination in patients with cervical myelopathy. Of the pathological reflexes, Hoffman sign has the strongest association with CSC, but still was only positive in 67% of cases. More sensitive clinical measures need to be developed to more accurately associate CSC detected on MRI to the clinical severity of cervical spondylotic myelopathy.

Retrospective Analysis of Nasal Fractures in the Emergency Clinic

Objective: The aim of this study is to analyze the demographic and diagnostic characteristics of patients presenting to the emergency clinic with nasal trauma. Material and Methods: Data analysis was performed with imaging tests on the files of 77 patients presented to the emergency clinic between 2012 and 2013. Results: In order of prevalence, nasal fractures were caused by falls from heights, violence, trauma, sports injuries and traffic accidents. Physical examination findings in patients with nasal fracture were sensitivity, nose swelling, nasal mucosal hemorrhage and septal deviation. Fracture was also determined at physical examination in 26 (86.6%) of the 30 patients with fracture detected at tomography. In the analysis, approximately 26% were multiple depressed fractures, while linear fracture along a single line was determined in 31%, with fissure-type fracture in the remaining 43%. Pathologies such as septal edema or hemorrhage were present in 30 of the 77 patients, while the septum was mobile and dislocated in approximately 16 of these patients (33.7%). Conclusion: Falls from heights were the most common cause in patients with nasal fracture, and although the most common imaging technique employed was x-ray, tomography provided more detailed information concerning rhinorrhea, smell perception disorders, maxillofacial traumas and multiple nasal fractures. (JAEM 2014; 13: 139-42)

Ocular manifestations in Korean patients with transbronchial lung biopsy‐proven sarcoidosis

AbstractPurpose To evaluate the characteristic ocular signs and systemic examination findings in patients with transbronchial lung biopsy (TBLB)‐proven sarcoidosis.Methods A total of 28 patients with TBLB‐proven sarcoidosis were evaluated between January 2011 and December 2012. The medical records of patients were retrospectively reviewed. We evaluated the following five characteristic ocular signs that are suggestive for the diagnosis of sarcoidosis: (1) mutton‐fat keratic precipitates and iris nodules; (2) nodules at the trabecular meshwork and tent‐shaped peripheral anterior synechia; (3) snowball or string‐of‐pearls vitreous opacities; (4) nodular periphlebitis; (5) multiple chorioretinal lesions. The results of systemic examination, including serum angiotensin converting enzyme (ACE) assay, chest radiography or computed tomography of the chest, pulmonary function tests (PFT), tuberculin skin test and bronchoalveolar lavage (BAL), were considered for each patient.Results Eighteen patients (64.2%) showed ocular signs, which are suggestive of ocular sarcoidosis. Thirteen (72.2%) of these 18 patients presented with ocular signs as the initial manifestation of the disease. The typical findings of chest CT, such as bilateral hilar lymphadenopathy (BHL), were observed in all of the 28 patients.Conclusion It can be suggested that intraocular lesions could be the sole clinical manifestation of the disease. Therefore, it is important to perform pulmonary examination including chest CT in patients with suspicious ocular sarcoidosis.

Augmenting glial cell-line derived neurotrophic factor signaling to treat painful neuropathies

Peripheral neuropathies are a group of disorders affecting peripheral nerves, characterized by either distal axonal degeneration or dysfunction of the ensheathing Schwann cells. Depending on the type of peripheral nerve involvement, there are many different symptoms and examination findings in patients with peripheral neuropathy. However, neuropathic pain is probably the single most prevalent complaint that results in consultation with a doctor. Although symptomatic therapies exist for treating pain in peripheral neuropathies (1), none are very effective or specific to the underlying pathogenic mechanisms, often resulting in too many side effects. There is a desperate need in the field to develop pathogenesis-based specific treatments to treat painful symptoms in patients with peripheral neuropathies. In PNAS, Hedstrom et al. present convincing preclinical data to show that enhancement of glial cell-line derived neurotrophic factor (GDNF) signaling with a small molecule agonist offers such a hope (2).