Hip pain in the elderly: evaluation and diagnosis

Hip pain in the elderly can result in severe disability with compromise of independence. The causes of hip pain include many intrinsic and extrinsic disorders. Evaluation of the geriatric patient with pain in the vicinity of the hip requires a complete history and physical, radiographic evaluation and appropriate laboratory studies in order for proper management to be instituted.     

Chest pain in the adolescent and young adult

Pediatric cardiologists and cardiologists who examine adults frequently receive referrals of adolescents and young adults with chest pain. Chest pain in this age group is most likely noncardiac in origin, which often creates a diagnostic dilemma for the consultant in terms of the etiology and extent of evaluation. This review presents the noncardiac and cardiac etiologies of chest pain in adolescents and young adults, as well as the key features of a patient's history and physical examination that help delineate cardiac from noncardiac chest pain. In addition, we present recommendations for the cardiac consultant regarding the evaluation and management of adolescents and young adults referred with the complaint of chest pain.     

Hip and knee pain: role of occupational factors

Many people rely economically on occupations involving high loading of the hip or knee joints for lengthy periods, possibly placing them at increased risk of developing chronic pain in these joints. There is a growing body of evidence from large longitudinal cohort studies, case-control studies and population-based surveys that certain occupations, or having work involving considerable heavy lifting, kneeling or squatting, may be associated with increased risk of symptomatic hip or knee osteoarthritis and joint replacement surgery. Only a few studies have evaluated the effectiveness of specific workplace strategies to reduce this risk. Identifying modifiable workplace risk factors and implementing feasible and accessible preventative strategies will be of great public health significance in the next decade.     

Hypertension in an adolescent boy

We report the case of an adolescent boy who presented with hypertension and hypokalemia. A systematic work-up revealed hyperreninemic hyperaldosteronism. Further study revealed Page kidney caused by trauma-associated renal hematoma. The evaluation and management of hyperaldosteronism and Page kidney are discussed.     

Hyperthyroidism and steatorrhea in an adolescent

Summary A case of hyperthyroidism and steatorrhea in an adolescent mentally retarded girl is reported. It is suggested that the hyperthyroidism was a major contributing factor in causing the steatorrhea.Supported in part by Clinical Research Center Grant 3 MO 1 FR-40, from the Division of Research Facilities and Resources, National Institutes of Health, Bethesda, Md.Dr. John Helwig reviewed the patient's cardiac status.     

Isolated granulomatous gastritis in an adolescent

Summary This is a case of a 14 1/2-year-old black male with isolated granulomatous gastritis. The case is unusual in several aspects. For the first time this disorder has been seen in the pediatric age group. The symptoms and signs were more acute and severe than previously reported, and the inflammatory process involved the entire gastric mucosa. Several findings suggested an (auto)immune pathogenesis. The patient had a good clinical and histologic response to prednisone therapy, but the disease recurred after two years when therapy was discontinued.     

Primary hypertrophic osteoarthropathy in an adolescent

Hypertrophic osteoarthropathy is a rare syndrome characterized by dysacromelia and periostosis with digital clubbing. Primary form is called pachydermoperiostosis. A case of a primary hypertrophic osteoarthropathy without pachydermia is reported in a 13-year-old boy, which was born of a consanguineous marriage. This case suggested an incomplete form of pachydermoperiostosis with a recessive inheritance. Pachydermoperiostosis is often familial and occurs predominantly in men. This affection is believed to be inherited in an autosomal dominant pattern but some autosomal recessive forms have also been reported.     

Amiodarone-induced pulmonary toxicity in an adolescent.

We report amiodarone-induced pulmonary toxicity in an 18-year-old boy who had undergone corrective surgery for tetralogy of Fallot 4 years earlier, and was treated with amiodarone because of recurrent malignant postoperative ventricular tachyarrhythmias. Toxicity was recognized on the basis of clinical features, chest X-ray, high-resolution contrast enhanced computerized tomography, and resolution of the findings subsequent to withdrawal of amiodarone and treatment with steroids. Pulmonary toxicity due to amiodarone, as far as we know, has not been reported in children and young adults, and its occurence even in young adults requires wider appreciation.