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Sample records for case series bcs

  1. BCS condensate as a special case of the Bose-Einstein condensate

    NASA Astrophysics Data System (ADS)

    Batle, J.; Casas, M.; Fortes, M.; Solís, M. A.; de Llano, M.; Salazar, A.; Valladares, A. A.; Rojo, O.

    2001-03-01

    Rather general separable interfermionic interactions with sufficient attraction to bind fermions into (bosonic) Cooper pairs (CPs) give [1], in 2D or 3D, a center-of-mass-momentum(CMM)-dependent CP binding energy that is quadratic for any coupling strictly only in the limit of zero Fermi energy, i.e., when the Fermi sea disappears and one is in vacuum. Otherwise, this "dispersion relation" is linear to good approximation---and perfectly so in weak to moderate coupling. Moreover, the CPs break up beyond a certain CMM which vanishes in the zero coupling limit. As a result, the condensate of BCS theory (which generally neglects nonzero CMM CPs) appears to be a special case of the Bose-Einstein condensate of a boson-fermion binary mixture. Chemical and thermal equilibrium in the mixture gives rise [2] to a boson number which is strongly coupling- and temperature-dependent, and generally leads to transition temperatures substantially greater than those predicted by BCS theory. [1] S.K. Adhikari et al., Physica C (in press) and Phys. Rev. B 62 (2000) 8671; M. Casas et al., Physica C 295 (1998) 93; M. Casas et al., Phys. Letters A 245 (1998) 55. [2] M. Casas et al., http://xxx.lanl.gov/abs/cond-mat/0003499.

  2. Nonketotic hyperglycinemia case series

    PubMed Central

    Iqbal, Mehtab; Prasad, Manish; Mordekar, Santosh R.

    2015-01-01

    To present three cases who presented with neonatal hiccups and who were later diagnosed with nonketotic hyperglycinemia (NKH). Case series. We present three babies who presented in neonatal life with hiccups who later were diagnosed with NKH. Two babies presented on the 2nd day of life with hypotonia, poor feeding, and abnormal movements including jitteriness, hiccups, and twitching. The third baby only had transient hiccups lasting for a couple of days in the 1st week of life but later presented at 3 months of age with poor feeding, drowsiness, and jerky movements. All three cases needed extensive investigations before reaching the diagnosis including metabolic screen, lumbar puncture, electroencephalography, and computed tomography/magnetic resonance imaging. The first two babies needed intubation on their 2nd day of life because of apneas in whom later, the care was withdrawn after reaching the diagnosis of NKH because of poor prognosis. The third baby was discharged home on oral dextromethorphan and ketogenic diet. We discuss the importance of early recognition of symptoms (frequent hiccups) and investigation needed to reach the diagnosis early as it helps in making decision to either carry on treatment or withdraw care because of poor prognosis. It also helps in genetic counseling and prenatal diagnosis can be offered at the subsequent pregnancy. PMID:26962342

  3. Kleptomania: a case series

    PubMed Central

    Saluja, Bharat; Chan, Lai Gwen; Dhaval, Dani

    2014-01-01

    Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 2010 at the Institute of Mental Health, Singapore, we found three patients who were diagnosed with kleptomania. In this report, we describe the pertinent clinical and sociodemographic characteristics, as well as the diagnostic issues of kleptomania in relation to the three cases. PMID:25630329

  4. Ameloblastic carcinoma: A case series

    PubMed Central

    Kumaran, P. Satish; Anuradha, V.; Gokkulakrishnan, S.; Thambiah, Lalita; Jagadish, Ajay Kumar; Satheesh, G.

    2014-01-01

    Ameloblastic carcinoma is a rare odontogenic tumor exhibiting not only features of ameloblastoma, but also features of carcinoma. Clinical dissemination of this lesion is more aggressive and rapid than that of ameloblastoma and it can metastasize to the lung or regional lymph node. Histologically, there are features of both ameloblastoma and carcinoma. <50 cases have been reported until 2011. We report a series of six cases with our treatment modalities. PMID:25210376

  5. Cutaneous macroglobulinosis: a case series.

    PubMed

    Camp, Brendan J; Magro, Cynthia M

    2012-10-01

    Cutaneous macroglobulinosis is a rare skin manifestation of Waldenstrom macroglobulinemia. It is characterized by the deposition of eosinophilic, immunoglobulin-derived material in the dermis. It typically presents as pink or skin-colored papules favoring the extensor surfaces of the extremities. There are 11 reported cases of cutaneous macroglobulinosis in the literature. In our consultative dermatopathology practice we encountered three additional cases. In Case 1, a 41-year-old female with a monoclonal immunoglobulin M (IgM)-kappa gammopathy developed skin-colored papules on her extensor extremities, forehead and back. Histopathologic and immunohistochemical analyses revealed periodic acid-Schiff (PAS)-positive pink material in the dermis that stained with IgM. In Case 2, an 83-year-old female with a monoclonal IgM-lambda paraproteinemia developed non-blanching papules and plaques on the lower extremities and cheeks. Skin biopsies showed a striking occlusion of the vessels with a PAS-positive eosinophilic precipitate, which was also found in the extravascular spaces and stained with IgM using direct immunofluorescence (DIF) and immunohistochemical stains. In Case 3, an 80-year-old male with Waldenstrom macroglobulinemia developed ulcerated papules and nodules on the lower extremities. The biopsy findings were similar to those of Case 2. We present a series of three patients with cutaneous macroglobulinosis and explore variations in the clinical and histopathological findings of this uncommon entity. PMID:22882527

  6. Case Citations 1991. Eleventh Series.

    ERIC Educational Resources Information Center

    Sharp, Linda A., Ed.

    Case citations from five legal areas--college students, liability on campus, sport law, employment, and employment discrimination--are presented in this document. Each section offers brief summaries of cases and concludes with a table of cases. The first section on college students examines litigation involving student finances, disciplinary…

  7. pH-Dependent Solubility and Dissolution Behavior of Carvedilol--Case Example of a Weakly Basic BCS Class II Drug.

    PubMed

    Hamed, Rania; Awadallah, Areeg; Sunoqrot, Suhair; Tarawneh, Ola; Nazzal, Sami; AlBaraghthi, Tamadur; Al Sayyad, Jihan; Abbas, Aiman

    2016-04-01

    The objective of this study was to investigate the pH-dependent solubility and dissolution of weakly basic Biopharmaceutical Classification Systems (BCS) class II drugs, characterized by low solubility and high permeability, using carvedilol, a weak base with a pK a value of 7.8, as a model drug. A series of solubility and in vitro dissolution studies was carried out using media that simulate the gastric and intestinal fluids and cover the physiological pH range of the GI from 1.2 to 7.8. The effect of ionic strength, buffer capacity, and buffer species of the dissolution media on the solubility and dissolution behavior of carvedilol was also investigated. The study revealed that carvedilol exhibited a typical weak base pH-dependent solubility profile with a high solubility at low pH (545.1-2591.4 μg/mL within the pH range 1.2-5.0) and low solubility at high pH (5.8-51.9 μg/mL within the pH range 6.5-7.8). The dissolution behavior of carvedilol was consistent with the solubility results, where carvedilol release was complete (95.8-98.2% released within 60 min) in media simulating the gastric fluid (pH 1.2-5.0) and relatively low (15.9-86.2% released within 240 min) in media simulating the intestinal fluid (pH 6.5-7.8). It was found that the buffer species of the dissolution media may influence the solubility and consequently the percentage of carvedilol released by forming carvedilol salts of varying solubilities. Carvedilol solubility and dissolution decreased with increasing ionic strength, while lowering the buffer capacity resulted in a decrease in carvedilol solubility and dissolution rate. PMID:26202065

  8. Profilin desensitization: A case series.

    PubMed

    Nucera, Eleonora; Aruanno, Arianna; Rizzi, Angela; Pecora, Valentina; Patriarca, Giampiero; Buonomo, Alessandro; Mezzacappa, Simona; Schiavino, Domenico

    2016-09-01

    The role of profilin as an allergen has long been questioned. The capacity of profilin to induce respiratory symptoms has recently been demonstrated; moreover, over 50% of patients sensitized to profilin experienced symptoms after the ingestion of plant-derived foods, suggesting that profilin should be considered as a clinically relevant food allergen.We describe the cases of seven allergic patients with oral allergy syndrome and other adverse reactions after eating plant-derived food, that have been undergone to profilin desensitization treatment.The protocol started with a drop of profilin solution (50 µg/mL) diluted 1:10(18) in water until the highest dose of 10 drops of undiluted solution three times a week. At the end of the treatment we observed a decreased mean diameter of profilin wheal in skin prick test (SPT) in five of the seven participants and in profilin specific IgE values in six patients that repeated the test. Regarding basophil activation test (BAT) and the detection of IgG4, we do not have significant results because the tests have to be repeated in some patients. Regarding the double-blind placebo-controlled challenges, after about 10 months of induction phase all the patients showed tolerance to several foods that they previously did not tolerate.Moreover, the immunotherapy with profilin has proved to be safe because no serious adverse events have been reported in our patients.In summary, the results of this exploratory study of sublingual immunotherapy (SLIT) for profilin allergy show that it can be a promising therapeutic option that could modify the clinical reactivity of the patients to the intake of plant-derived food. PMID:26684620

  9. Kaposi's varicelliform eruption: A case series

    PubMed Central

    Ferrari, Bruno; Taliercio, Vanina; Luna, Paula; Abad, María Eugenia; Larralde, Margarita

    2015-01-01

    Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options. PMID:26753139

  10. Translational research in cancer complementary and alternative medicine: the National Cancer Institute's Best Case Series Program.

    PubMed

    Lee, Colleen O

    2004-04-01

    Public interest in CAM for cancer care likely will influence the need for continued scientific evaluation. The NCI BCS program evaluates case studies involving novel alternative therapies for cancer treatment. Through the NCI BCS program, meaningful data are generated that may lead to NCI-supported research projects, including prospective studies, clinical trials, and advances in scientific knowledge. Individuals interested in obtaining a submission packet for the NCI BCS program may access the official OCCAM Web site at http://www3.cancer.gov/occam/ or call 301-435-7980. PMID:15108425

  11. Transvestism as a Symptom: A Case Series

    PubMed Central

    Anupama, M.; Gangadhar, K. H.; Shetty, Vandana B.; Dip, P. Bhadja

    2016-01-01

    Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD) and had good response to selective serotonin reuptake inhibitor (SSRI). PMID:27011411

  12. Scrub typhus in pregnancy: a case series.

    PubMed

    Meena, Monika; Rohilla, Minakshi; Jain, Vanita; Kalra, Jaswinder; Prasad, Grv

    2016-07-01

    Scrub typhus, an acute febrile illness caused by Rickettsia and transmitted by mites, is a re-emerging endemic zoonosis in the Asia Pacific region. It is an uncommon entity and very few cases of this disease in pregnant women have been reported. We present a series of six such cases collected over 1 year with poor feto-maternal outcome in 50%. PMID:26519136

  13. Commonality between BCS and TCS.

    PubMed

    Shah, Vinod P; Rădulescu, Flavian Ştefan; Miron, Dalia Simona; Yacobi, Avraham

    2016-07-25

    Both biopharmaceutics classification system (BCS) and topical drug classification system (TCS) are based on sound scientific principles with the aim of providing biowaiver and reducing regulatory burden without lowering the quality requirements and standards of approval for the drug products. BCS is based on the solubility and permeability properties of the active pharmaceutical ingredient (API, or drug substance) whereas the TCS is based on the qualitative and quantitative composition of the dosage form and the in vitro release rate of the active ingredient as key decision tools. Both BCS and TCS take drug release and dissolution as their guiding principle for providing biowaiver, increasing the availability and affordability of safe and effective medicines to the consumers and at the same time maintaining the drug product quality. PMID:27208656

  14. Inducible urticaria: Case series and literature review.

    PubMed

    Amaya, Daniel; Sánchez, Andrés; Sánchez, Jorge

    2016-01-01

    Inducible urticaria is a heterogeneous group of skin disorders characterized by the appearance of wheals, pruritus and/or angioedema, sometimes accompanied by systemic symptoms caused by innocuous stimuli (cold, heat, pressure, etc.). This group of disorders compromises people's quality of life and most of the literature in this regard comes from case reports and case series since its epidemiology has been poorly studied and some cases are very rare. The aim of this review is to show an up-to-date overview of the available literature for various types of inducible urticarias, always beginning with an illustrative case and then describing their pathophysiological mechanisms, clinical manifestations, and treatment. PMID:27622434

  15. Lee-Yang cluster expansion approach to the BCS-BEC crossover: BCS and BEC limits

    NASA Astrophysics Data System (ADS)

    Sakumichi, Naoyuki; Nishida, Yusuke; Ueda, Masahito

    2014-03-01

    It is shown that a cluster expansion technique, which is usually applied in the high-temperature regime to calcutate virial coefficients, can be applied to evaluate the superfluid transition temperature of the Bardeen-Cooper-Schrieffer (BCS)-Bose-Einstein condensation (BEC) crossover à la Lee and Yang. The transition temperature is identified with the emergence of the singularity in the sum of a certain infinite series of cluster functions. In the weak-coupling limit, we reproduce the Thouless criterion and the number equation of Nozières and Schmitt-Rink, and hence the transition temperature of the BCS theory. In the strong-coupling limit, we reproduce the transition temperature of BEC of noninteracting tightly bound dimers.

  16. The BCS-BEC Crossover

    NASA Astrophysics Data System (ADS)

    Parish, Meera M.

    2015-09-01

    This chapter presents the crossover from the Bardeen-Cooper-Schrieffer (BCS) state of weakly correlated pairs of fermions to the Bose-Einstein condensation (BEC) of diatomic molecules in the atomic Fermi gas. Our aim is to provide a pedagogical review of the BCS-BEC crossover, with an emphasis on the basic concepts, particularly those that are not generally known or are difficult to find in the literature. We shall not attempt to give an exhaustive survey of current research in the limited space here; where possible, we will direct the reader to more extensive reviews.

  17. Effect of Gastric Fluid Volume on the In Vitro Dissolution and In Vivo Absorption of BCS Class II Drugs: a Case Study with Nifedipine.

    PubMed

    Nader, Ahmed M; Quinney, Sara K; Fadda, Hala M; Foster, David R

    2016-07-01

    Nifedipine is a BCS Class II drug used for treatment of hypertension and preterm labor. Large inter-patient variability in nifedipine absorption results in variable exposure among different patients. We conducted in vitro dissolution studies to compare nifedipine dissolution from immediate release (IR) capsules with different volumes of dissolution media. Results from dissolution studies were used to design a crossover study in healthy volunteers to evaluate the effect of coadministered water volume with nifedipine 10 mg IR capsules on nifedipine pharmacokinetics, especially absorption (C max, t max, and AUC0-6). Dissolution studies demonstrated that larger gastric fluid volumes result in enhanced nifedipine dissolution from 10 mg IR cosolvent capsules (73 vs. 17% in 200 and 100 mL simulated gastric fluid, respectively, at 30 min). The pharmacokinetic crossover study in healthy volunteers (N = 6) did not show a significant effect of the water volume administered with the capsule (50 vs. 250 mL) on C max, t max, or AUC0-6 of orally administered nifedipine IR capsules (10 mg). However, administration of large water volumes resulted in lower variability in nifedipine C max (47 vs. 70% for 250 and 50 mL, respectively). Administration of large water volumes with nifedipine 10 mg IR cosolvent capsules may reduce inter-individual variability in plasma exposure. Evaluation of similar effects in other BCS Class II drugs is recommended. PMID:27106837

  18. Ictal swearing: a case series and review.

    PubMed

    Birca, Veronica; Tayah, Tania; Saint-Hilaire, Jean-Marc; Nguyen, Dang Khoa

    2013-12-01

    Seizures can manifest with ictal swearing but few studies have investigated the localising value of this epileptic manifestation. In this case series and review of the literature, we attempted to determine whether ictal swearing could help localise the epileptic focus. We review two previously published cases and report eight additional epileptic patients with ictal swearing for whom the epileptic focus was determined based on clinical, structural, electrophysiological, and surgical outcome data. Results indicated that ictal swearing occurs more commonly in male subjects and lateralises to the non-dominant hemisphere, but has poor localisation value, arising either from the frontal, parietal, temporal or occipital lobes in different patients. We discuss the significance of these findings. [Published with video sequences]. PMID:24317202

  19. Vitamin D and depression: A case series

    PubMed Central

    Odejayi, Gbolahan

    2014-01-01

    Introduction: Over two-thirds of Canadians are deficient in vitamin D. Clinical overlap can compound diagnosis of depression in vitamin D deficient individuals. Citing high costs, the Ministry of Health has restricted routine vitamin D screening and hence is not feasible. Objectives: The current case series is an attempt to recognise the clinical overlap between depression and vitamin D deficiency in order to avoid unnecessary antidepressant prescriptions and to demonstrate the role of collaborative care in such patients. Method: After appropriate ethics approval 62 patients from an outpatient clinic were screened for the diagnosis of treatment resistant depression. Those who had predominant somatic complaints were further screened for organic factors and those with inadequate vitamin D levels were referred to family physicians for supplementation with vitamin D. Results: More than 50% were detected deficient in vitamin D after our evaluation. They showed subjective improvement with vitamin D supplements. No modification of antidepressants was needed. Conclusion: Vitamin D deficiency should be suspected in depressed patients with prominent somatic symptoms and their treatment resistance should be reconsidered to avoid unnecessary exposure to mood stabilisers. Collaborating with primary care is advocated. Limitation: Co-prescription of an antidepressant is a confounder in our case series, and we propose more organised studies with objective rating scales. PMID:27489667

  20. Strong coupling BCS superconductivity and holography

    NASA Astrophysics Data System (ADS)

    Kalyana Rama, S.; Sarkar, Swarnendu; Sathiapalan, B.; Sircar, Nilanjan

    2011-11-01

    We attempt to give a holographic description of the microscopic theory of a BCS superconductor. Exploiting the analogy with chiral symmetry breaking in QCD we use the Sakai-Sugimoto model of two D8 branes in a D4 brane background with finite baryon number. In this case there is a new tachyonic instability which is plausibly the bulk analog of the Cooper pairing instability. We analyze the Yang-Mills approximation to the non-Abelian Dirac-Born-Infeld action. We give some exact solutions of the non-linear Yang-Mills equations in flat space and also give a stability analysis, showing that the instability disappears in the presence of an electric field. The holographic picture also suggests a dependence of T on the number density which is different from the usual (weak coupling) BCS. The flat space solutions are then generalized to curved space numerically and also, in an approximate way, analytically. This configuration should then correspond to the ground state of the boundary superconducting (superfluid) ground state. We also give some preliminary results on Green functions computations in the Sakai-Sugimoto model without any chemical potential.

  1. Dance-related concussion: a case series.

    PubMed

    Stein, Cynthia J; Kinney, Susan A; McCrystal, Tara; Carew, Elizabeth A; Bottino, Nicole M; Meehan Iii, William P; Micheli, Lyle J

    2014-01-01

    Sport-related concussion is a topic of increasing public and media attention; the medical literature on this topic is growing rapidly. However, to our knowledge no published papers have described concussion specifically in the dancer. This case series involved a retrospective chart review at a large teaching hospital over a 5.5-year period. Eleven dancers (10 female, 1 male) were identified who experienced concussions while in dance class, rehearsal, or performance: 2 in classical ballet, 2 in modern dance, 2 in acro dance, 1 in hip hop, 1 in musical theater, and 3 were unspecified. Dancers were between 12 and 20 years old at the time of presentation. Three concussions occurred during stunting, diving, or flipping. Three resulted from unintentional drops while partnering. Two followed slips and falls. Two were due to direct blows to the head, and one dancer developed symptoms after repeatedly whipping her head and neck in a choreographed movement. Time to presentation in the sports medicine clinic ranged from the day of injury to 3 months. Duration of symptoms ranged from less than 3 weeks to greater than 2 years at last documented follow-up appointment. It is concluded that dancers do suffer dance-related concussions that can result in severe symptoms, limitations in dance participation, and difficulty with activities of daily living. Future studies are needed to evaluate dancers' recognition of concussion symptoms and care-seeking behaviors. Additional work is also necessary to tailor existing guidelines for gradual, progressive, safe return to dance. PMID:24844421

  2. Facial Firework Injury: A Case Series

    PubMed Central

    Tadisina, Kashyap Komarraju; Abcarian, Ariane; Omi, Ellen

    2014-01-01

    Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future. PMID:25035740

  3. Facial firework injury: a case series.

    PubMed

    Tadisina, Kashyap K; Abcarian, Ariane; Omi, Ellen

    2014-07-01

    Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future. PMID:25035740

  4. Disorder effects in the evolution from BCS to BEC superfluidity

    NASA Astrophysics Data System (ADS)

    Han, Li; de Melo, Carlos A. R. Sa

    2009-03-01

    We discuss the effects of disorder on the critical temperature of superfluids during the evolution from BCS to BEC. For s-wave superfluids we find that the critical temperature is weakly affected by disorder in the BCS regime as described in Anderson’s theorem, even less affected by disorder at zero chemical potential (near unitarity), but strongly affected by disorder in the BEC regime, where Anderson's theorem does not apply. This suggests that the superfluid is more robust to the effects of disorder at the interaction parameter where the chemical potential vanishes (close to unitarity). We construct a three dimensional phase diagram of critical temperature, disorder and interaction parameter [1], and show that there are regions of localized superfluidity, as well as insulating regions due to Anderson localization of fermions (BCS regime) and molecular bosons (BEC regime). The phase diagram for higher angular momentum (e.g. p-wave and d-wave) is also analyzed, where the effects of disorder are much more dramatic in the BCS regime in comparison to the s-wave case because pair breaking is strong, while the disorder effects in BEC regime are similar to what occurs in the s-wave case. [1] Li Han, C. A. R. Sa de Melo, arXiv:0812.xxxx

  5. Case Citations 1992. Thirteenth Series: Pupils.

    ERIC Educational Resources Information Center

    Hartmeister, Fred, Ed.

    Court case citations are organized in six major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows: (1) "Extended School Year (ESY) Services and Disabled Students" (Susan S. Schermerhorn); (2) "Recent Developments in Related Services under the IDEA" (Kathleen S.…

  6. Case Citations 1992, Twelfth Series: Employment.

    ERIC Educational Resources Information Center

    Cambron-McCabe, Nelda H., Ed.

    Collected case citations are organized in five major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows: (1) "Employment in General" (William Gordon); (2) "Termination of Employment" (Alan Robertson); (3) "Staff evaluation" (Virginia Helm); (4) "Tort Liability"…

  7. Case Citations 1996. Eighteenth Series (School Administrators).

    ERIC Educational Resources Information Center

    Evans, William J., Jr., Ed.

    This document contains case citations for 1996 in areas pertaining to school administration. The cases are categorized according to the topics of negligence, workers' compensation, administrator due process, discrimination against school administrators, and discrimination in hiring teachers for administrative positions. Negligence cases cover…

  8. Discrimination. Case Citations, 1992, Fourteenth Series.

    ERIC Educational Resources Information Center

    Russo, Charles J., Ed.

    Case citations regarding discrimination in education are provided in this document. The first section deals with civil rights remedies, specifically, employment and student discrimination. The second section describes cases involving employment discrimination on the basis of race, religion, national origin, age, and disabilities. Gender-related…

  9. Sudden Death Following Exercise; a Case Series

    PubMed Central

    Najari, Fares; Alimohammadi, Alimohammad; Ghodrati, Parisa

    2016-01-01

    Introduction: Natural and unexpected death that happens within less than one hour of first symptom occurrence is called sudden death. Cardiovascular diseases are the main known reason of sudden death and more than 75% of sudden deaths in athletes are assigned to it. Here we reported the autopsy results of all cases with sudden death following exercise that were referred to forensic center of Tehran, Iran, from 2009 to 2014. Methods: In this cross sectional study all subjects who were registered to forensic medicine center of Tehran, Iran, from 2009 to 2014, as a case of sudden death following exercise were evaluated. Demographic data and medical history as well as autopsy and toxicology findings were retrospectively gathered using profiles of the deceased. Results were reported using descriptive analysis. Results: 14 cases were registered as sudden death following exercise in forensic medicine profiles during the study period. Exploring the files of the mentioned deceased, revealed five non-compatible cases in this regard. Finally, 9 eligible cases were enrolled (88.9% male). The mean age of the deceased was 28.66 ± 10.86 years (range: 7 – 40). Toxicological tests were available for 7 cases, one of which was positive for tramadol. Sudden death following football was reported most frequently (44.4%). Only 3 (33.3%) cases had herald signs such as chest pain, syncope, or loss of consciousness. 1 case (11.11%) had a positive history of sudden death in relatives. Conclusion: Although most sudden death victims are asymptomatic until the event, all those who suffer from symptoms such as chest pain, shortness of breath, dizziness, fatigue and irregular heart rate during physical activities, should be screened regarding common probable causes of sudden death. PMID:27274521

  10. Fatal anorectal injuries: a series of four cases.

    PubMed

    Orr, C J; Clark, M A; Hawley, D A; Pless, J E; Tate, L R; Fardal, P M

    1995-03-01

    Anorectal injuries associated with sexual practices have become more frequently reported in the last decade. Although anorectal injuries are commonly reported in cases of sexual abuse of children, fatalities are very rare. In this series of cases, we report a case of fatal child abuse resulting from anal intercourse. In addition, there are two cases of death in females as a result of heterosexual "fisting" or "handballing." The fourth case of the series is that of a homicidal injury produced by rectal impalement with a 31 inch length of threaded pipe. PMID:7602281

  11. Pneumothorax, music and balloons: A case series.

    PubMed

    Dejene, Shiferaw; Ahmed, Fahim; Jack, Kastelik; Anthony, Arnorld

    2013-07-01

    We describe two cases of spontaneous pneumothorax in young healthy adults with no underlying structural lung disease. The onset of pneumothorax was following physical activity including playing musical instruments and blowing of balloons. There is sparse data evaluating the pathophysiology of primary spontaneous pneumothorax in relation to increased mouth pressures. These cases highlight the possible physical effect of valsalva manoeuvre on transpulmonary pressures, and the potential risk of developing pneumothorax in otherwise healthy individuals. This aspect of pneumothorax development is worthy of further exploration, to better elucidate the mechanism and enhance our understanding of this common respiratory presentation. PMID:23922614

  12. Rare Mimickers of Exostosis: A Case Series

    PubMed Central

    Perubhotla, Lakshmi Manasa

    2016-01-01

    Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora’s lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas.

  13. On a Particular Case of Series

    ERIC Educational Resources Information Center

    de Oliveira, E. Capelas

    2008-01-01

    We present a general formula for a triple product involving four real numbers. As a particular case, we get the sum of a triple product of four odd integers. Some interesting results are recovered. We derive a general formula for more than four odd numbers.

  14. Case Citations, 1993: Fifteenth Series (School Governance).

    ERIC Educational Resources Information Center

    Russo, Charles J., Ed.

    This guide provides summaries and citations of federal and state court decisions covering five important areas of school governance in education. A one-paragraph summary and a full citation of each court decision are offered. An alphabetical listing of cases with page references is included at the end of each of the sections. The first section…

  15. Acute eclipse retinopathy: a small case series.

    PubMed

    Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime

    2014-01-01

    We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14-29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen. PMID:25323644

  16. Oral syphilis: a series of 5 cases.

    PubMed

    Hertel, Moritz; Matter, Daniel; Schmidt-Westhausen, Andrea M; Bornstein, Michael M

    2014-02-01

    Syphilis is an infectious, usually sexually transmitted, disease caused by Treponema pallidum, subspecies pallidum. Because of the increasing prevalence in Europe during the past few years, dentists could be confronted with patients with oral manifestations of syphilis. Because oral lesions are highly contagious, it is vital to make the correct diagnosis quickly to initiate the proper therapy and to interrupt the chain of infection. We present the cases of 5 patients with syphilis-related oral lesions. These cases are representative because of their clinical presentation, age, and gender distribution and the diagnostic approach. The aim of the present report is to emphasize the importance of the dentist knowing and identifying syphilis in different stages to diagnose the disease and institute treatment at an early stage. PMID:24045192

  17. Mycobacterium heraklionense sp. nov.: A case series

    PubMed Central

    NEONAKIS, IOANNIS K.; SPANDIDOS, DEMETRIOS A.; GITTI, ZOE

    2015-01-01

    Mycobacterium heraklionense sp. nov. (M. heraklionense) is a novel non-tuberculous mycobacterium belonging to the Mycobacterium terrae complex that has recently been described. It has a world-wide distribution. Recently, a case of tenosynovitis in an immunocompetent individual caused by M. heraklionense was reported, indicating that it has the ability to cause diseases. In the present study, in order to provide a more detailed profile of this mycobacterium and to obtain a more complete overall picture of its clinical significance, we report all available data regarding the initial 12 cases of its isolation. Of the 12 patients, 5 (42%) eventually died within a period of 3 months following the isolation of the mycobacterium. However, any connection between the presence of M. heraklionense and these deaths could not be documented. These 5 patients were all males with a mean age of 74.6 years suffering from serious underlying diseases, which most probably were the cause of death. Additional data from possible new cases of M. heraklionense isolation are anticipated. PMID:26622497

  18. Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series

    PubMed Central

    Jena, Saubhagya Kumar; Naik, Monalisha; Ray, Lipsa; Behera, Satyanarayan

    2016-01-01

    Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options. PMID:27190903

  19. Case series on tropical diabetic hand syndrome.

    PubMed

    Ezeani, I U; Edo, A E

    2014-01-01

    Tropical diabetic hand syndrome is a term used to describe diabetes complication of the hand affecting people in the tropics. It consists of localized cellulitis with variable swelling and ulceration of the hands, progressive, fulminant hand sepsis and gangrene in extreme cases. This syndrome is not well-recognized and is therefore less frequently reported. The authors describe three different female patients who were known diabetics of varying duration presenting with this syndrome at our tertiary health center and who were successfully managed by both the surgical and medical units. The need for early diagnosis and aggressive management is emphasized. PMID:24909485

  20. Orbital apex disorders: a case series.

    PubMed

    Warburton, R E; Brookes, C C D; Golden, B A; Turvey, T A

    2016-04-01

    Orbital apex syndrome is an uncommon disorder characterized by ophthalmoplegia, proptosis, ptosis, hypoesthesia of the forehead, and vision loss. It may be classified as part of a group of orbital apex disorders that includes superior orbital fissure syndrome and cavernous sinus syndrome. Superior orbital fissure syndrome presents similarly to orbital apex syndrome without optic nerve impairment. Cavernous sinus syndrome includes hypoesthesia of the cheek and lower eyelid in addition to the signs seen in orbital apex syndrome. While historically described separately, these three disorders share similar causes, diagnostic course, and management strategies. The purpose of this study was to report three cases of orbital apex disorders treated recently and to review the literature related to these conditions. Inflammatory and vascular disorders, neoplasm, infection, and trauma are potential causes of orbital apex disorders. Management is directed at the causative process. The cases described represent a rare but important group of conditions seen by the maxillofacial surgeon. A review of the clinical presentation, etiology, and management of these conditions may prompt timely recognition and treatment. PMID:26725107

  1. Takotsubo Cardiomyopathy: Case Series and Literature Review

    PubMed Central

    Cavayero, Chase; Kar, Pran; Kar, Sunny

    2016-01-01

    Although originally considered to be uncommon, Takotsubo cardiomyopathy is becoming increasingly visible, annually comprising an increasing portion of suspected diagnoses of acute coronary syndrome. This condition is characterized by reversible left ventricular akinesis without significant coronary artery obstruction. This case study presents five patients diagnosed with Takotsubo cardiomyopathy, as confirmed by echocardiogram and angiography. All of the patients presented with classic myocardial chest pain and elevated troponins. Following diagnosis, they were treated with supportive measures, particularly angiotensin-converting enzyme inhibitors, and beta-blockers. All patients made a full recovery. Though the mechanism of Takotsubo has not been fully elucidated, hypotheses suggest it may be related to excessive catecholamine levels causing either myocardial stunning or coronary vasospasm. Recognition and understanding of this unusual pathology are essential because it can lead to improved clinical management. PMID:27446769

  2. PLATEAU IRIS SYNDROME--CASE SERIES.

    PubMed

    Feraru, Crenguta Ioana; Pantalon, Anca Delia; Chiselita, Dorin; Branisteanu, Daniel

    2015-01-01

    Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris periphery in respect to the trabecular meshwork. There are two aspects that need to be differentiated: plateau iris configuration and plateau iris syndrome. The first describes a situation when the iris root is flat and the anterior chamber is not shallow, the latter refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Isolated plateau iris syndrome is rare compared to plateau iris configuration. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance. PMID:26978890

  3. Chemotherapy-induced Spontaneous Pneumothorax: Case Series.

    PubMed

    Hendarsih, Een; Fadjari, Trinugroho H; Oehadian, Amaylia

    2016-04-01

    We present 2 patients who developed spontaneous pneumothorax (SP) following rapid regression of lymphoma and rhabdomyosarcoma with lung metastases. Case 1, a 43-year old man was admitted to our hospital with dyspnea 10 days before admission. He denied any recent trauma or previous treatment for lung tuberculosis. Three weeks prior to admission, he received first cycle of CHOP for non-Hodgkin's lymphoma stage II BE. Chest X-ray consistent with right pneumothorax. After treatment with chest tube drainage for about 1 month, the patient recovered and chemotherapy could be continued without further complications. Case 2, a 35- year old man was admitted to other hospital with dyspnea and chest pain on day 4 after second cycle of systemic combined chemotherapy for rhabdomyosarcoma stage IV (lung metastases) with doxorubicin, ifosfamide, mesna, and dacarbazine. Chest X-ray showed hydropneumothorax on right and left lung. After treatment with chest tube drainage about 2 weeks, the patient recovered and chemotherapy could be continued without further complications. The mechanism of pneumothorax following chemotherapy is not clearly understood yet, however, several hypotheses have been considered: 1) the rupture of a subpleural bulla after chemotherapy; 2) the rupture of an emphysematous bulla in an over expanded portion of the lung which is partially obstructed by a neoplasm; 3) tumor lyses or necrosis due to cytotoxic chemotherapy directly induces the formation of fistula. Dyspnea and chest pain suddenly appear during successful chemotherapy for metastatic chemosensitive tumors should alert the physician to the possibility of SP. The treatment is directed toward lung re-expansion. Chemotherapy induced pneumothorax should be considered as oncologic emergency. PMID:27550883

  4. Etiologies of Autism in a Case-Series from Tanzania

    ERIC Educational Resources Information Center

    Mankoski, Raymond E.; Collins, Martha; Ndosi, Noah K.; Mgalla, Ella H.; Sarwatt, Veronica V.; Folstein, Susan E.

    2006-01-01

    Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case…

  5. Varieties of Misdiagnosis in ASD: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Van Schalkwyk, Gerrit I.; Peluso, Francesco; Qayyum, Zheala; McPartland, James C.; Volkmar, Fred R.

    2015-01-01

    The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also…

  6. Finite case series or infinite single-case studies? Comments on "Case series investigations in cognitive neuropsychology" by Schwartz and Dell (2010).

    PubMed

    Lambon Ralph, Matthew A; Patterson, Karalyn; Plaut, David C

    2011-10-01

    In this commentary, though acknowledging that a case-series approach in neuropsychology is not always possible, we set out a series of considerations that in our view make this approach generally superior to single-case study. We argue that case-series designs are crucial for theory-testing, assessment of computational models, evaluation of inter-patient variation (including selection criteria, patient homogeneity/heterogeneity, premorbid individual differences, etc.) and to establish solid foundations for the interpretation of behavioural dissociations and associations. We conclude by suggesting that, alongside other neuroscience techniques, case-series cognitive neuropsychology provides a crucial contribution to the future of clinical and cognitive neuroscience. PMID:22746688

  7. Rare Hernias Presenting as Acute Abdomen- A Case Series

    PubMed Central

    Ulahannan, Sansho Elavumkal; Kurien, John S; Joseph, Aneesh; Kurien, Annie Sandhya; Varghese, Sandeep Abraham; Thomas, Bindhya; Varghese, Fobin

    2016-01-01

    Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. It can be divided into internal, external and diaphragmatic hernias. Most of them can be asymptomatic. If they become symptomatic they can present with features of intestinal obstruction, incarceration or strangulation. In this case series we compare the incidence of these rare presentations of hernias with world literature and to warn surgeons not to cut the obstructing band in cases of internal hernias. In this case series, we review the clinical details of 7 rare presentations of hernia, who presented with various types of hernias to a tertiary care centre in Kerala over a period of one year. Of these 7 cases 6 cases were internal hernias (3 left paraduodenal hernias, 2 transmesentric hernias, and 1 pericaecal hernia) and a case of spigelian hernia above the level of umbilicus. All of them presented as acute abdomen in the emergency department. Among these 7 cases, only one case was diagnosed preoperatively. Three patients had bowel gangrene and had to undergo resection- anastomosis of the bowel. The survival rate among these cases was 100% as compared to 50% in the world literature if they had been left untreated. Even though internal hernias are a rare entity, we need to have it as a differential diagnosis in case of intestinal obstruction, in a previously non-operated abdomen. PMID:27134943

  8. Spontaneous pneumoperitoneum in pediatric patients: A case series

    PubMed Central

    Tallant, Caitlin; Tallant, Aaron; Nirgiotis, Jason; Meller, Janet

    2016-01-01

    Introduction Pneumoperitoneum frequently results in emergent surgery because it typically indicates an abdominal viscus perforation. However, this may not always be the case. There have been few recent reports in the pediatric population that document cases of pneumoperitoneum which could be considered for non-surgical management. Presentation of case This case series presents three different instances of pediatric patients with radiographic evidence of pneumoperitoneum who were subsequently found to have no perforated viscus following surgical intervention. Conclusion We recommend that in the absence of peritoneal signs, fever, leukocytosis, significant abdominal pain, distension, or clinical deterioration, non-operative management be considered in pediatric patients with radiographic signs of pneumoperitoneum. PMID:27058151

  9. Quantifying the Chasm: Exploring the Impact of the BCS on Total Football Revenues for Division One Football Programs from 2002-2012

    ERIC Educational Resources Information Center

    Caro, Cary A.

    2014-01-01

    The Bowl Championship Series served as a collection of bowl games that were designed to crown the national champion in Division One football. The BCS created two classifications of institutions in Division football, those that were granted automatic access (AQ) to the post-season games, and those that were not (non-AQ). The BCS also generated…

  10. Isolated gingival overgrowths: A review of case series.

    PubMed

    Raizada, Shruti; Varghese, Jothi M; Bhat, K M; Gupta, Kanishk

    2016-01-01

    Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation. PMID:27307683

  11. Isolated gingival overgrowths: A review of case series

    PubMed Central

    Raizada, Shruti; Varghese, Jothi M.; Bhat, K. M.; Gupta, Kanishk

    2016-01-01

    Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation. PMID:27307683

  12. Pulmonary Nocardiosis in the Immunocompetent Host: Case Series

    PubMed Central

    Singh, Inderjit; West, Frances Mae; Sanders, Abraham; Hartman, Barry; Zappetti, Dana

    2015-01-01

    Pulmonary nocardiosis is commonly recognized as an opportunistic infection in patients with predisposing immunosuppressive conditions. However, reports of pulmonary nocardiosis in the immunocompetent host are rare. Here, we report a case series of four patients with pulmonary nocardiosis without a predisposing condition. PMID:26491594

  13. Use of Cantilever Mechanics for Impacted Teeth: Case Series

    PubMed Central

    Paduano, Sergio; Spagnuolo, Gianrico; Franzese, Gerardo; Pellegrino, Gioacchino; Valletta, Rosa; Cioffi, Iacopo

    2013-01-01

    This paper describes the orthodontic treatment, and the biomechanics of cantilevers for the impaction of permanent teeth in youngs, adolescents, and adults. In these case series, multibracket straightwire fixed appliances, together with cantilever mechanics, were used to treat the impaired occlusion. PMID:24511332

  14. Primary oral malignant melanoma: Clinicopathological series of four cases

    PubMed Central

    Kumar, Ajay; Bindal, Ruchi; Shetty, Devi C.; Singh, Harkanwal P.

    2012-01-01

    Melanoma of the oral cavity is a rare malignant disease. On account of the presence at relatively obscure areas in the oral cavity, most of oral malignant melanomas are diagnosed at a late stage. Early diagnosis is essential for successful treatment and perhaps is the key factor in improving the prognosis of oral malignant melanoma. However, no large clinical series exist, and in fact, clinical cases are the sole key source of information. We hereby present a series of four cases of primary oral malignant melanoma of South-East Asian ethnic origin, with long-term, regular follow-up. The age of the patients ranged between 40 and 70 years, with equal sex predilection, and the gingiva was found to be the most common site of its occurrence. Based on clinical and histological parameters, all the cases were diagnosed as primary malignant melanoma, which were further confirmed by using immunohistochemical markers. PMID:23087742

  15. Cosmological BCS mechanism and the big bang singularity

    SciTech Connect

    Alexander, Stephon; Biswas, Tirthabir

    2009-07-15

    We provide a novel mechanism that resolves the big bang singularity present in Friedman-Lemaitre-Robertson-Walker space-times without the need for ghost fields. Building on the fact that a four-fermion interaction arises in general relativity when fermions are covariantly coupled, we show that at early times the decrease in scale factor enhances the correlation between pairs of fermions. This enhancement leads to a BCS-like condensation of the fermions and opens a gap dynamically driving the Hubble parameter H to zero and results in a nonsingular bounce, at least in some special cases.

  16. Indications and Case Series of Intentional Replantation of Teeth

    PubMed Central

    Asgary, Saeed; Alim Marvasti, Laleh; Kolahdouzan, Alireza

    2014-01-01

    This case series aims to comprehensively introduce intentional replantation with a focus on its indications and case selection in endodontics. In all represented cases, calcium enriched mixture (CEM) cement is used for root-end filling. This case series demonstrates twenty cases of IR and extraoral root-end resection and filling with CEM cement. All the selected teeth had a failed endodontic treatment and required surgical/nonsurgical endodontic (re)treatment or extraction. Subsequent to gentle tooth extraction, an appropriate root-end cavity was prepared and filled with CEM cement. Then the tooth was replanted; maximun procedure time was 15 min. A total of 18 cases (90%) were successful over a mean follow-up period of 15.5 months. It can be concluded that intentional replantation with careful case selection can have a high success rate over 2 years. Intentional replantation may be a suitable treatment option for both trained general practitioners and specialists provided that the extraction is simple and straightforward. PMID:24396380

  17. Treatment of subclavian artery stenosis: A case series

    PubMed Central

    Salman, Reem; Hornsby, Jane; Wright, Lucie J.; Elsaid, Tarek; Timmons, Grace; Mudawi, Ahmed; Bhattacharya, Vish

    2015-01-01

    Introduction In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Presentation Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. Discussion and conclusion This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities. PMID:26722712

  18. Pregnancy in patients with mucopolysaccharidosis: a case series.

    PubMed

    Stewart, Fiona J; Bentley, Andrew; Burton, Barbara K; Guffon, Nathalie; Hale, Susan L; Harmatz, Paul R; Kircher, Susanne G; Kochhar, Pavan K; Mitchell, John J; Plöckinger, Ursula; Graham, Sue; Sande, Stephen; Sisic, Zlatko; Johnston, Tracey A

    2016-09-01

    The mucopolysaccharidoses (MPS disorders) are rare inherited diseases associated with multi-organ accumulation of glycosaminoglycans, leading to musculoskeletal, respiratory, cardiac, neurological, ophthalmological, otolaryngological, and gastrointestinal abnormalities. As a result of improvements in diagnosis, multi-disciplinary care, and therapies such as enzyme replacement therapy and hematopoietic stem cell transplantation, an increasing number of patients with MPS are reaching adulthood and are involved in family planning. Data on fertility and pregnancy outcome in MPS is sparse and comprises primarily isolated case reports. To address this evidence gap, we present a case series on fertility and pregnancy in eight mothers and five fathers with MPS. This case series demonstrates that women with MPS have high-risk pregnancies and deliveries secondary to their underlying disease. However, with appropriate pre-conceptual multi-disciplinary evaluation, optimization and discussion regarding potential risks, combined with regular multi-disciplinary maternal and fetal surveillance in a tertiary center, the outcome of most pregnancies in this case series seems to be favorable with all babies developing normally. Partners of fathers with MPS had uncomplicated pregnancies and deliveries. All children were healthy, with normal growth and development. PMID:27622143

  19. Case series: non vascular considerations in trigeminal neuralgia.

    PubMed

    Balasundram, Sathesh; Cotrufo, Stefano; Liew, Colin

    2012-02-01

    An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia. PMID:21210165

  20. Hereditary Nonsyndromic Gingival Fibromatosis: Report of Family Case Series

    PubMed Central

    Peeran, Syed Wali; Ramalingam, Karthikeyan; Peeran, Syed Ali; Mugrabi, Marei Hamed; Abdulla, Khaled Awidat

    2013-01-01

    Hereditary gingival fibromatosis (HGF) is a rare, benign disorder with slowly progressive enlargement of maxillary and mandibular gingiva. Herewith, we report the first case series of HGF presenting among mother and all of her 3 children. Their complaints included unaesthetic appearance due to gingival growth, malocclusion, and difficulty in mastication. Conventional gingivectomy with oral hygiene measures and regular followup is the treatment of choice for such presentation. PMID:24191204

  1. Hereditary nonsyndromic gingival fibromatosis: report of family case series.

    PubMed

    Peeran, Syed Wali; Ramalingam, Karthikeyan; Peeran, Syed Ali; Mugrabi, Marei Hamed; Abdulla, Khaled Awidat

    2013-01-01

    Hereditary gingival fibromatosis (HGF) is a rare, benign disorder with slowly progressive enlargement of maxillary and mandibular gingiva. Herewith, we report the first case series of HGF presenting among mother and all of her 3 children. Their complaints included unaesthetic appearance due to gingival growth, malocclusion, and difficulty in mastication. Conventional gingivectomy with oral hygiene measures and regular followup is the treatment of choice for such presentation. PMID:24191204

  2. Trends in Energy Management Technology: BCS Integration Technologies - Open Communications Networking

    SciTech Connect

    Webster, Tom

    2002-09-18

    Our overall purpose in writing this series of articles is to provide Federal energy managers some basic informational tools to assist their decision making process relative to energy management systems design, specification, procurement, and energy savings potential. Since Federal buildings rely on energy management systems more than their commercial counterparts, it is important for energy practitioners to have a high level of knowledge and understanding of these complex systems. This is the second article in a series and will focus on building control system (BCS) networking fundamentals and an assessment of current approaches to open communications protocols. This is important because networking is a complex subject and the networks form the basic infrastructure for energy management functions and for integrating a wide variety of OEM equipment into a complete EMCIS. The first article [1] covered enabling technologies for emerging energy management systems. Future topics will concentrate on more practical aspects including applications software, product offerings, networking strategies, and case studies of actual installations. Please refer to the first article for a more complete overview of the purpose and background for this series.

  3. Evolution from BCS to BEC Superfluidity in Dilute Fermi Gases

    NASA Astrophysics Data System (ADS)

    de Melo, Carlos A. R. Sa

    2006-03-01

    I will review briefly some old results [1,2] of the evolution from BCS to BEC superfluidity in dilute Fermi gases, including critical temperature, order parameter amplitude, chemical potential and time dependent Ginzburg-Landau theory for the s-wave channel in three dimensions. Following this discussion, I will present new results for the BCS to BEC evolution of Fermi gases in the p-wave channel [3]. I will make comparisons between s-wave and p-wave superfluidity and point out the main differences between the two cases. Lastly, I will discuss supefluidity of s-wave and p-wave Fermi gases in a restricted two-dimensional geometry (one dimensional optical lattice), where a Berezinkii-Kosterlitz-Thouless-type transition is proposed as the system evolves from the weak to the strong attraction limit. In this case, I will show that spontaneous vortex-antivortex pairs form and that they can condense into a vortex-antivortex lattice at lower temperatures [4]. [1] C. A. R. Sa de Melo, M. Randeria, and J. R. Engelbrecht, PRL 71, 3202 (1993). [2] J. R. Engelbrecht, M. Randeria, and C. A. R. Sa de Melo, PRB 55, 15153 (1997). [3] M. Iskin, and C. A. R. Sa de Melo, cond-mat/0510300 (2005). [4] S. S. Botelho, and C. A. R. Sa de Melo, cond-mat/0509387 (2005).

  4. Distinguishing between the Permeability Relationships with Absorption and Metabolism To Improve BCS and BDDCS Predictions in Early Drug Discovery

    PubMed Central

    2015-01-01

    The biopharmaceutics classification system (BCS) and biopharmaceutics drug distribution classification system (BDDCS) are complementary classification systems that can improve, simplify, and accelerate drug discovery, development, and regulatory processes. Drug permeability has been widely accepted as a screening tool for determining intestinal absorption via the BCS during the drug development and regulatory approval processes. Currently, predicting clinically significant drug interactions during drug development is a known challenge for industry and regulatory agencies. The BDDCS, a modification of BCS that utilizes drug metabolism instead of intestinal permeability, predicts drug disposition and potential drug–drug interactions in the intestine, the liver, and most recently the brain. Although correlations between BCS and BDDCS have been observed with drug permeability rates, discrepancies have been noted in drug classifications between the two systems utilizing different permeability models, which are accepted as surrogate models for demonstrating human intestinal permeability by the FDA. Here, we recommend the most applicable permeability models for improving the prediction of BCS and BDDCS classifications. We demonstrate that the passive transcellular permeability rate, characterized by means of permeability models that are deficient in transporter expression and paracellular junctions (e.g., PAMPA and Caco-2), will most accurately predict BDDCS metabolism. These systems will inaccurately predict BCS classifications for drugs that particularly are substrates of highly expressed intestinal transporters. Moreover, in this latter case, a system more representative of complete human intestinal permeability is needed to accurately predict BCS absorption. PMID:24628254

  5. Gastric foregut cystic developmental malformation: Case series and literature review

    PubMed Central

    Geng, Yan-Hua; Wang, Chang-Xing; Li, Jiang-Tao; Chen, Qing-Yu; Li, Xiu-Zhen; Pan, Hao

    2015-01-01

    Foregut cystic developmental malformation (FCDM) is a very rare lesion of the alimentary tract, especially in the stomach. We discuss the concepts of gastric duplication cyst, bronchogenic cysts, and FCDM. Nomenclature has been inconsistent and confusing, but, by some definitions, gastric duplication cysts involve gastric mucosa and submucosal glands, bronchogenic cysts involve respiratory mucosa with underlying cartilage and glands, and FCDM lacks gastric mucosa or underlying glands or cartilage but has pseudostratified ciliated columnar epithelium (PCCE). We searched our departmental case files from the past 15 years and identified 12 cases of FCDM in the alimentary tract. We summarize the features of these 12 cases including a report in detail on a 52-year-old man with a submucosal cyst lined with simple PCCE and irregular and stratified circular muscle layers that merged with gastric smooth muscle bundles near the lesser curvature of the gastric cardia. A literature review of cases with this histology yielded 25 cases. We propose the term gastric-FCDM for such cases. Our own series of 12 cases confirms that preoperative recognition of the entity is infrequent and problematic. The rarity of this developmental disorder, as well as a lack of understanding of its embryologic origins, may contribute to missing the diagnosis. Not appreciating the diagnosis preoperatively can lead to an inappropriate surgical approach. In contrast, presurgical recognition of the entity will contribute to a good outcome and reduced risk of complications. PMID:25593458

  6. Ocular Dirofilariasis: A Case Series of 8 Patients

    PubMed Central

    Kalogeropoulos, Chris D.; Stefaniotou, Maria I.; Gorgoli, Konstantina E.; Papadopoulou, Chrissanthy V.; Pappa, Chrysavgi N.; Paschidis, Costas A.

    2014-01-01

    Purpose: Dirofilaria repens is an endemic parasite in Mediterranean countries that mostly affects animals. Rarely, however, it can infect humans. This case series presents patients with ocular infections due to D. repens. Materials and Methods: A chart review was performed of patients with ocular dirofilariasis after the year 2000, treated at a tertiary referral centre in Greece. Data were collected on the ocular, microbiological, or/and histopathological aspects and treatment. Results: Eight cases of unilateral ocular dirofilariasis were identified, of which 5 were subconjunctival (1 masquerading as nodular scleritis) and were removed through a conjunctival incision, 2 cases were intravitreal and were removed with vitrectomy, and 1 was intraorbital (adjacent to the roof of the orbit). The latter appeared as an encapsulated mass and subsequent histological examination revealed the presence of the parasite. Of the 8 cases recorded after the year 2000, 7 appeared within the last 6 years (4 cases within the last 3 years). The majority of cases involved residents of the Ionian Islands (7 of 8 cases). Conclusions: D. repens can affect various ocular and periocular tissues. A progressive increase in the incidence of dirofilariasis was observed, which is potentially associated with climate changes in warm and moist areas where this parasite is endemic. PMID:25371636

  7. A modified physiological BCS for prediction of intestinal absorption in drug discovery.

    PubMed

    Zaki, Noha M; Artursson, Per; Bergström, Christel A S

    2010-10-01

    In this study, the influence of physiologically relevant media on the compound position in a biopharmaceutical classification system (BCS) which resembled the intestinal absorption was investigated. Both solubility and permeability limited compounds (n = 22) were included to analyze the importance of each of these on the final absorption. Solubility was determined in three different dissolution media, phosphate buffer pH 6.5 (PhB 6.5), fasted state simulated intestinal fluid (FaSSIF), and fed state simulated intestinal fluid (FeSSIF) at 37 °C, and permeability values were determined using the 2/4/A1 cell line. The solubility data and membrane permeability values were used for sorting the compounds into a BCS modified to reflect the fasted and fed state. Three of the seven compounds sorted as BCS II in PhB 6.5 (high permeability, low solubility) changed their position to BCS I when dissolved in FaSSIF and/or FeSSIF (high permeability, high solubility). These were low dosed (20 mg or less) lipophilic molecules displaying solvation limited solubility. In contrast, compounds having solid-state limited solubility had a minor increase in solubility when dissolved in FaSSIF and/or FeSSIF. Although further studies are needed to enable general cutoff values, our study indicates that low dosed BCS Class II compounds which have solubility normally restricted by poor solvation may behave as BCS Class I compounds in vivo. The large series of compounds investigated herein reveals the importance of investigating solubility and dissolution under physiologically relevant conditions in all stages of the drug discovery process to push suitable compounds forward, to select proper formulations, and to reduce the risk of food effects. PMID:20734997

  8. Cannabis-related stroke: case series and review of literature.

    PubMed

    Singh, Niranjan N; Pan, Yi; Muengtaweeponsa, Sombat; Geller, Thomas J; Cruz-Flores, Salvador

    2012-10-01

    Marijuana, or cannabis, is one of the most commonly used illicit drugs worldwide. Although there are some case reports of stroke associated with cannabis use, there is no information on a causal role of cannabis in stroke. We identified 14 patients admitted to St Louis University Hospital between January 2004 and July 2007 with ischemic stroke who had documented clear exposure to cannabis during or before symptom onset and a positive urine screen for cannabis. We report this series, along with 3 cases previously reported by our group, for a total of 17 patients (13 men and 4 women), with a mean age of 41 years (range, 15-63 years). Nine patients were under age 45 years, 4 had a history of hypertension, and 10 sustained stroke in the posterior circulation. Headache, dysarthria, and ataxia were the most common presenting symptoms. Five patients had recurrent stroke with reexposure to cannabis. No patient had a prothrombotic state or cardiac source of embolism. Autopsy performed in 2 patients revealed hemorrhagic infarct with no evidence of vasculitis or embolus. The absence of other vascular risk factors in most of our patients, the temporal relation of symptom onset to cannabis exposure, and the recurrence of symptoms in a few patients with reexposure suggest a causal role of cannabis in these cases of ischemic stroke. However, this causal association cannot be definitely ascertained, given the descriptive nature of our series. More research is needed to explore this possible causal association. PMID:21367621

  9. Shoshin Beriberi in Critically-Ill patients: case series.

    PubMed

    Dabar, George; Harmouche, Carine; Habr, Bassem; Riachi, Moussa; Jaber, Bertrand

    2015-01-01

    Thiamine plays a fundamental role in cellular metabolism. The classical syndrome caused by thiamine deficiency is beriberi, and its fulminant variant, once considered an uncommon finding, is now encountered among the critically ill.We present a case series of four critically ill non-septic non-alcoholic patients with severe lactic acidosis and refractory cardio-circulatory collapse caused by acute fulminant beriberi, which drastically responded to thiamine administration.In critical care settings, increased awareness of this life-threatening but reversible condition is a requirement, especially among patients receiving parenteral nutrition and those with unexplained recalcitrant lactic acidosis. PMID:25982313

  10. Management of Ectopically Erupting Maxillary Incisors: A Case Series.

    PubMed

    Suresh, Kotumachagi Sangappa; Uma, H L; Nagarathna, J; Kumar, Pravin

    2015-01-01

    Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  11. Management of Ectopically Erupting Maxillary Incisors: A Case Series

    PubMed Central

    Suresh, Kotumachagi Sangappa; Uma, HL; Nagarathna, J

    2015-01-01

    ABSTRACT Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  12. Pulmonary alveolar proteinosis in children: a case series

    PubMed Central

    Tabatabaei, Seyyed Ahmad; Karimi, Abdollah; Tabatabaei, Sedigheh Rafiee; Radpay, Badiozzaman; Jadali, Farzaneh; Shiva, Farideh; Jahromy, Mana Hadipour

    2010-01-01

    Pulmonary alveolar proteinosis, (PAP) is a rare disease of unknown etiology, characterized by accumulation of intraalveolar proteinaceous material which is rich in lipid and positive on periodic acid-Schiff stain. Two clinically different pediatric types have been defined as congenital PAP which is fulminant and fatal, and a late-onset PAP which is similar to the adult form and less severe. Eight children with late-onset PAP were hospitalized from 1998 to 2005 in Mofid Children Hospital. Characteristics of these patients and the methods of diagnosis and treatment are presented in this case series. PMID:21526069

  13. Fabry's Disease: Case Series and Review of Literature

    PubMed Central

    Wani, Muzaffar Maqsood; Khan, Imran; Bhat, Riyaz Ahmad; Ahmad, Muzaffar

    2016-01-01

    Fabry's disease is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme with the progressive accumulation of globotriaosylceramide in vascular endothelial cells leading to cardiovascular, renal, gastrointestinal, neuropathic, lenticular, and dermatological manifestations. It is a rare cause of end-stage renal disease. It classically affects males whereas 10–15% of female heterozygote carriers are affected depending on localization. Both the FD and its association with ESRD is rare. With this background, this case series of five patient's along with the review of literature is presented here. PMID:27398254

  14. Anterior Segment Findings in Vitamin A Deficiency: A Case Series

    PubMed Central

    Rubino, Pierangela; Mora, Paolo; Ungaro, Nicola; Gandolfi, Stefano A.; Orsoni, Jelka G.

    2015-01-01

    Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed. PMID:26509090

  15. Brachiocephalic vein stent fracture: case series and literature review.

    PubMed

    Kapoor, Baljendra; Lockhart, Mark; Sharma, Deepak; Maya, Ivan D

    2010-01-01

    Stent fractures are commonly seen in the arterial circulation and there is paucity of literature describing venous stent fractures particularly in the central venous circulation. In this case series, we describe three patients on hemodialysis who underwent right brachiocephalic vein (BCV) stent placement for severe stenosis in two patients and occlusion in one patient. Over the course of time, these patients clinically presented with arm swelling, pain, and difficulty in dialysis because of stenosis related to stent fracture and intimal hyperplasia. Two of these patients were successfully treated by restenting. PMID:20331828

  16. Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center

    PubMed Central

    Katz, Kenneth D.; Leonetti, Adam L.; Bailey, Blake C.; Surmaitis, Ryan M.; Eustice, Eric R.; Kacinko, Sherri; Wheatley, Scott M.

    2016-01-01

    Synthetic cannabinoid use has risen at alarming rates. This case series describes 11 patients exposed to the synthetic cannabinoid, MAB-CHMINACA who presented to an emergency department with life-threatening toxicity including obtundation, severe agitation, seizures and death. All patients required sedatives for agitation, nine required endotracheal intubation, three experienced seizures, and one developed hyperthermia. One developed anoxic brain injury, rhabdomyolysis and died. A significant number were pediatric patients. The mainstay of treatment was aggressive sedation and respiratory support. Synthetic cannabinoids pose a major public health risk. Emergency physicians must be aware of their clinical presentation, diagnosis and treatment. PMID:27330661

  17. Particle-hole duality, integrability, and Russian doll BCS model

    NASA Astrophysics Data System (ADS)

    Bork, L. V.; Pogosov, W. V.

    2015-08-01

    We address a generalized Richardson model (Russian doll BCS model), which is characterized by the breaking of time-reversal symmetry. This model is known to be exactly solvable and integrable. We point out that the Russian doll BCS model, on the level of Hamiltonian, is also particle-hole symmetric. This implies that the same state can be expressed both in the particle and hole representations with two different sets of Bethe roots. We then derive exact relations between Bethe roots in the two representations, which can hardly be obtained staying on the level of Bethe equations. In a quasi-classical limit, similar identities for usual Richardson model, known from literature, are recovered from our results. We also show that these relations for Richardson roots take a remarkably simple form at half-filling and for a symmetric with respect to the middle of the interaction band distribution of one-body energy levels, since, in this special case, the rapidities in the particle and hole representations up to the translation satisfy the same system of equations.

  18. Subdeltoid lipomas: a consecutive series of 13 cases.

    PubMed

    Carbone, Stefano; Candela, Vittorio; Passaretti, Daniele; Cinotti, Gianluca; Della Rocca, Carlo; Giannicola, Giuseppe; Gumina, Stefano

    2012-05-01

    We describe 13 consecutive cases of patients presenting with shoulder mass and limited function, and to whom we formulated a diagnosis of subdeltoid lipoma. Between 2002 and 2010, 14 patients had a diagnosis of subdeltoid lipoma. Of these, one was excluded from this review because of a concomitant cuff tear. Shoulder was evaluated with X-ray, MRI, EMG and pre-/post-operatively with constant score (CS) and subjective shoulder value (SSV). All patients had complete excision of the mass. Minimum follow-up was 12 months. In 14 cases, the lipoma was causing slight pain or discomfort, and in four cases (28.57 %), it was causing limitation of joint movement. EMG showed axillary nerve neuro apraxia in two cases (14.28 %). Preoperative CS and SSV were on average 80 and 80, respectively. At one-year follow-up, CS and SSV were meanly 92 and 95, respectively (p = 0.034). No recurrence of the lesion was noted. Subdeltoid lipomas quickly grow up and may cause compression of axillary nerve. Surgery is the treatment of these lesions if symptomatic. After complete excision, subdeltoid lipomas do not recur, and clinical signs disappear. Level of evidence Case series, Level IV. PMID:22528845

  19. LEIOMYOMA CUTIS: A CLINICOPATHOLOGICAL SERIES OF 37 CASES

    PubMed Central

    Malhotra, Purnima; Walia, Harpreet; Singh, Avninder; Ramesh, V

    2010-01-01

    Background: Cutaneous leiomyomas are benign smooth muscle tumors that comprise three distinct types such as piloleimyoma, angioleiomyoma, and genital leiomyoma. Aim: The objective of this study was to report a series of cases seen in last 8 years in a tertiary care hospital in north India and to discuss their clinicopathologic findings. Material and Methods: Paraffin-embedded blocks of cases reported as cutaneous leiomyoma from 1999 to 2007 were retrieved from the Institute of Pathology, New Delhi, and their clinical parameters were noted. Their histopathological features were reviewed on hematoxylin-eosin stained slides. Immunohistochemistry was performed where necessary. Results: Twenty-seven cases of piloleiomyoma, three cases of angioleiomyoma, five breast leiomyomas, and two scrotal leiomyomas were seen in patients ranging from 21 to 65 years of age, with an average of 38.2 years at presentation. There was a male predominance with 26 males and 11 females (M:F = 2.2:1). Solitary lesions (n = 21) were more common than multiple ( n = 16). The trunk and upper limbs were involved most commonly, comprising 23 of 37 (62.2%) cases. This was followed by lower limb, face, breast, and scrotum. Conclusion: Cutaneous leiomyomas are rare lesions and form an important clinical differential diagnosis of painful papulonodules. These must be biopsied in order to differentiate them from other spindle cell lesions. PMID:21430885

  20. Hepatotoxicity Due To Hydroxycut®: A Case Series

    PubMed Central

    Fong, Tse-Ling; Klontz, Karl C.; Canas-Coto, Alejandro; Casper, Steven J.; Durazo, Francisco A.; Davern, Timothy J.; Hayashi, Paul; Lee, William M.; Seeff, Leonard B.

    2013-01-01

    Background Muscletech Hydroxycut® (Iovate Health Sciences Research, Oakville, Ontario) was a popular weight loss supplement that was recalled by the manufacturer in May 2009 based on reports of hepatotoxicity associated with this supplement. Objective To characterize the clinical presentation of Hydroxycut®-associated liver injury and to adjudicate these cases for causal association with Hydroxycut®. Design Case series. Setting Academic tertiary care hospitals and FDA databases. Measurements Assessment of causality and grading of severity of liver injury using methodology developed by the Drug-Induced Liver Injury Network (DILIN) study. Results Eight patients who developed liver injury after taking Hydroxycut treated at different medical centers were identified. All were hospitalized and 3 of 8 patients required liver transplantation. Nine other cases with adequate clinical information were obtained from the FDA MedWatch database including one fatal case of acute liver failure. Usual symptoms were jaundice, fatigue, nausea, vomiting and abdominal pain. Most patients exhibited a hepatocellular pattern of injury. Adjudication for causality revealed 8 cases as definite, 5 highly likely, 2 probable and 2 were considered as possible. Conclusions Hydroxycut® has been clearly implicated as a cause for severe liver injury that may lead to acute liver failure and death. Weight loss supplements represent a class of dietary supplements that should be regarded as capable of causing severe hepatic toxicity when the usual causes of identified liver injury cannot be otherwise elucidated. PMID:20104221

  1. Case series of buprenorphine injectors in Kuala Lumpur, Malaysia.

    PubMed

    Bruce, R Douglas; Govindasamy, Sumathi; Sylla, Laurie; Haddad, Marwan S; Kamarulzaman, Adeeba; Altice, Frederick L

    2008-01-01

    Diversion of buprenorphine has been described in settings where it is legally prescribed and has become an increasing concern in Malaysia; it resulted in banning of buprenorphine in Singapore where unsubstantiated case reports suggested that buprenorphine injection was associated with particularly poor outcomes. We therefore conducted a case series of qualitative interviews with buprenorphine injectors in Kuala Lumpur, Malaysia to examine further the issues surrounding buprenorphine injection as well as the abuse of midazolam in combination with buprenorphine. Interviews with 19 men do not suggest significant adverse health consequences from buprenorphine injection alone and injectors have adapted diverted buprenorphine as a treatment modality. A subset of these injectors, however, combined buprenorphine and midazolam for euphoric effects with resultant symptoms of a possible pharmacological interaction. Prospective cohort studies, rather than hospital-derived samples, are needed to better understand the safety of buprenorphine injection. PMID:18584580

  2. Optic Neuropathy in Thyroid Eye Disease: A Case Series

    PubMed Central

    Seng, Wong Hon; Isa, Hazlita Dato' Mohd

    2016-01-01

    In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient's vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians. PMID:27274392

  3. Can Masturbatory Guilt Lead to Severe Psychopathology: A Case Series

    PubMed Central

    Aneja, Jitender; Grover, Sandeep; Avasthi, Ajit; Mahajan, Sudhir; Pokhrel, Prabhakar; Triveni, Davuluri

    2015-01-01

    Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder. PMID:25722518

  4. Can masturbatory guilt lead to severe psychopathology: a case series.

    PubMed

    Aneja, Jitender; Grover, Sandeep; Avasthi, Ajit; Mahajan, Sudhir; Pokhrel, Prabhakar; Triveni, Davuluri

    2015-01-01

    Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder. PMID:25722518

  5. Chediak-Higashi Syndrome: A Case Series from Karnataka, India.

    PubMed

    Rudramurthy, Pradeep; Lokanatha, Hemalata

    2015-01-01

    Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disease, characterized by partial oculocutaneous albinism, frequent pyogenic infections, and the presence of abnormal large granules in leukocytes and other granulecontaining cells. The abnormal granules are readily seen in blood and marrow granulocytes. Other clinical features include silvery hair, photophobia, nystagmus and hepatosplenomegaly. However, the presence of abnormal giant intracytoplasmic granules in neutrophils and their precursors are diagnostic of CHS. Here, we present a series of five cases, out of which four presented in the accelerated phase. In all the five cases, the giant granules were noted predominantly in the cytoplasm of lymphocytes, which is a rare occurrence compared to those present in the granulocytes. PMID:26538743

  6. Acute sterile endophthalmitis following intravitreal bevacizumab: case series

    PubMed Central

    Orozco-Hernández, Axel; Ortega-Larrocea, Ximena; Sánchez-Bermúdez, Gustavo; García-Aguirre, Gerardo; Cantón, Virgilio Morales; Velez-Montoya, Raul

    2014-01-01

    Background Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. Conclusion The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast

  7. Congenital asymptomatic diaphragmatic hernias in adults: a case series

    PubMed Central

    2013-01-01

    Introduction Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. Case presentations In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Conclusions Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease. PMID:23668793

  8. Intensive outpatient comprehensive behavioral intervention for tics: A case series

    PubMed Central

    Blount, Tabatha H; Lockhart, Ann-Louise T; Garcia, Rocio V; Raj, Jeslina J; Peterson, Alan L

    2014-01-01

    Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients’ treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation. PMID:25325069

  9. Asthma caused by potassium aluminium tetrafluoride: a case series.

    PubMed

    Laštovková, Andrea; Klusáčková, Pavlina; Fenclová, Zdenka; Bonneterre, Vincent; Pelclová, Daniela

    2015-01-01

    The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF(4))-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF(4) - with fluorides' workplace air concentrations ranging between 1.7 and 2.8 mg/m(3). No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients' exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation. PMID:26212411

  10. Chiropractic Treatment of Temporomandibular Dysfunction: A Retrospective Case Series

    PubMed Central

    Pavia, Steven; Fischer, Rebecca; Roy, Richard

    2015-01-01

    Objective The purpose of this study is to describe chiropractic treatment of 14 patients who presented with signs and symptoms of temporomandibular joint dysfunction (TMD). Methods This is a retrospective case series of 14 patients, including 13 adults and 1 child. The majority of these patients were undergoing chiropractic care for spine-related conditions when they presented with additional TMD signs and symptoms. They were evaluated and treated with Activator Methods International published protocols relative to the temporomandibular joint before the addition of treatment to the suprahyoid muscles. Results All pre- and postadjustment assessments were recorded using a numeric pain scale. The resulting average showed a reduction in the patients’ pain scores from the initial visit of 8.3 ± 1.6 to the last visit at 1.4 ± 1.1 with an 80.9% ± 15.4% improvement. The average number of visits was 13.6 ± 8.2. Conclusion All patients selected for this case series showed a reduction of temporomandibular dysfunction symptoms. PMID:26793040

  11. K-Sign in retrocaecal appendicitis: a case series

    PubMed Central

    2009-01-01

    Background Variations in position of the vermiform appendix considerably changes clinical findings. Retrocaecal appendicitis presents with slightly different clinical features from those of classical appendicitis associated with a normally sited appendix. K-sign looks for the presence of tenderness on posterior abdominal wall in the retrocaecal and paracolic appendicitis. This is the first case report of this kind in the literature. The K-sign has been named, as a mark of respect, after the region of origin of this sign, Kashmir, so called as "Kashmir Sign". The sign being present in view of inflamed appendix crossing above its non palpable position above iliac crest on the posterior abdominal wall and the tenderness is by irritation of posterior peritoneum Case presentation The author is reporting a case series of four patients in whom a K-sign, a clinical sign, was elicited and found positive on the posterior abdominal wall for presence of tenderness in a specific area bound by the 12th rib superiorly, spine medially, lateral margin of posterior abdominal wall laterally and iliac crest inferiorly and was found to be present in three retrocaecal and one paracolic appendicitis. Each case had tenderness in this specific area on posterior abdominal wall. All had appendectomy and having histopathological evidence of appendicitis. Conclusion K-sign can be useful in diagnosis of retrocaecal and paracolic appendicitis. Significance of K-sign being in view of difficulty in diagnosis of retrocaecal appendicitis and its subsequent complications. PMID:19946528

  12. BCG-related renal granulomas managed conservatively: A case series

    PubMed Central

    Al-Qaoud, Talal; Brimo, Fadi; Aprikian, Armen G.; Andonian, Sero

    2015-01-01

    Introduction: The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. Case reports: The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without anti-tuberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. Conclusions: While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without anti-tuberculous medications. PMID:26085879

  13. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery – A case series

    PubMed Central

    Rassu, Pier Carlo

    2015-01-01

    Background Oxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP. Patients and methods 18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred. Results Below the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications. Conclusion During 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients. PMID:26865976

  14. Segmentation of cartridge cases based on illumination and focus series

    NASA Astrophysics Data System (ADS)

    Brein, Christoph

    2005-03-01

    Cartridge cases are important forensic specimen for the identification of weapons. The illumination conditions in the area of the firing pin marks and the breech face marks are very different and have to be treated separately to achieve an appropriate image quality for a visual inspection. Furthermore, not only the comparison but also the detection of the different and independent forensic marks should be automated. Both problems lead to the task of segmenting the different parts of the cartridge case bottom. In this paper, two automated approaches for the segmentation of cartridge cases are investigated and compared. The aim of the segmentation is the detection of the cartridge case border, the primer, the firing pin mark and additionally the letters around the primer. The first approach uses images obtained under systematically varied illumination conditions. After a preprocessing step a circle detection is applied to find the circular structures. The analysis of illumination series combined with a the connected components labeling method detect the letters. In a second approach, the depth-from-focus method is used to obtain 2½ D-data. This data is segmented applying a plane estimation technique. This results directly in the detection of the letters. Afterwards a circle detection algorithm identifies the parameters of the circular structures. With the introduced methods it is possible to optimize the illumination in order to realize a higher contrast of both the striation marks on the cartridge case surface and of the indentation of the firing pin independently. The improved image quality helps the examiner in identifying weapons and will help to improve the automated comparison strategies.

  15. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    PubMed Central

    Ali, Rehan; Ahmed, Shakeel; Qadir, Maqbool; Maheshwari, Prem; Khan, Rehan

    2013-01-01

    Objective Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies. Methods A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit. Results Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%), hyaline membrane disease (20%), meconium aspiration syndrome (20%) and congenital diaphragmatic hernia (10%). Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions. Conclusion The study showed a higher number of mortality cases (60%). Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces. PMID:23386951

  16. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review

    PubMed Central

    Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S.; Moster, Marlene R.

    2016-01-01

    Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594

  17. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review.

    PubMed

    Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S; Moster, Marlene R

    2016-09-01

    Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594

  18. Microincision cataract surgery combined with vitrectomy: a case series

    PubMed Central

    Jalil, A; Steeples, L; Subramani, S; Bindra, M S; Dhawahir-Scala, F; Patton, N

    2014-01-01

    Aim The objective of this study was to present the results of combined phacovitrectomy using 1.8 mm microincision cataract surgery (MICS) with special emphasis on the anterior segment complications in this group. Methods Retrospective, single-centre case series involving consecutive patients undergoing phacovitrectomy in a single centre in the United Kingdom during a 6-month period. Results A total of 52 eyes underwent combined MICS and pars plana vitrectomy. Intraoperative complications included posterior capsule rupture (n=2), minor iris trauma during phacoemulsification (n=1), iatrogenic retinal tears (n=2), and entry site break (n=1). Postoperatively two cases had significant inflammation, one of which resulted in 360° posterior synaechiea, iris bombe, and raised intraocular pressure. Other complications included mild posterior synaechiae (n=2), posterior capsular opacification (n=3), cystoid macular oedema (n=1), and hyphaema (n=1), which spontaneously resolved. There were no cases of intraocular lens decentration. Two patients who underwent surgery for retinal detachment repair subsequently redetached. Among those having surgery for macular hole, non-closure was seen in one patient and one patient developed a retinal detachment. Conclusion In conclusion, sub-2 mm MICS is a safe and effective technique in dealing with vitreoretinal disorders necessitating cataract surgery at the same time. PMID:24406418

  19. The laparoscopic management of Swyer syndrome: Case series

    PubMed Central

    Malhotra, Neena; Dadhwal, Vatsla; Sharma, Kandala Aparna; Gupta, Deepika; Agarwal, Sumita; Deka, Dipika

    2015-01-01

    Swyer syndrome, also known as 46 XY pure gonadal dysgenesis, is a rare endocrine disorder. Affected individuals are phenotypically female with female genitalia, normal Mullerian structures, absent testicular tissue, and a 46 XY chromosomal constitution. We report a series of eight cases of Swyer syndrome, of which six were managed by laparoscopic gonadectomy. The two other cases had to undergo an exploratory laparotomy in view of their presentation with adnexal masses. Two of the girls were siblings. The chief presenting complaint was primary amenorrhea. Four girls also presented with a history of poor development of secondary sexual characters. The average age at presentation was 16.19±2.85 years. The average height was 158.33 ±4.63 cm, and the average weight was 49.33±8.44 kg. Breast development was either Tanner 2 or 3 in four girls, whereas three girls had a Tanner 1 underdeveloped breasts. Axillary and pelvic hair was sparse in all the girls. The vagina was well canalized in all the girls. Hormonal evaluation revealed hypergonadotropic hypogonadism with a mean follicle-stimulating hormone (FSH) level of 95.81 mIU/L and a mean luteinizing (LH) level of 24.15 mIU/L. Imaging analysis revealed the presence of a small uterus in all the cases, except one. Bilateral ovaries were either not visualized or streak gonads were present. Adnexal mass was detected in two of the six cases with raised carcinoembryonic antigen (CA) 125 levels in one case. Genetic analysis revealed a karyotype of 46 XY in six girls, 46 XY/45 X in one, and the culture repeatedly failed in one girl. Because of the risk of malignancy, bilateral gonadectomy was performed in all cases. Histopathological analysis revealed that three of the six cases had dysgerminoma. The patients have been started on hormone replacement therapy. Laparoscopy is a minimally invasive modality for the definitive diagnosis and treatment of cases with Swyer syndrome. An early diagnosis of Swyer syndrome is possible

  20. Serous endometrial intraepithelial carcinoma: a case series and literature review

    PubMed Central

    Pathiraja, P; Dhar, S; Haldar, K

    2013-01-01

    Background Minimal uterine serous cancer (MUSC) or serous endometrial intraepithelial carcinoma (EIC) has been described by many different names since 1998. There have been very few cases reported in literature since EIC/MUSC was recognized as a separate entity. The World health Organization (WHO) Classification favors the term serous EIC. Although serous EIC is confined to the uterine endometrium at initial histology diagnosis, a significant number of patients could have distal metastasis at diagnosis, without symptoms. Serous EIC is considered as being the precursor of uterine serous cancer (USC), but pure serous EIC also has an aggressive behavior similar to USC. It is therefore prudent to have an accurate diagnosis and appropriate surgical staging. There are very few published articles in literature that discuss the pure form of serous EIC. The aim of this series is to share our experience and review evidence for optimum management of serous EIC. Patients and methods We report a series of five women treated in our institute in the last 3 years. We reviewed the relevant literature on serous EIC and various management strategies, to recommend best clinical practice. Conclusion Pure serous EIC is a difficult histopathological diagnosis, which requires ancillary immunohistochemical staining. It can have an aggressive clinical behavior with early recurrence and poor survival. Optimum surgical staging, with appropriate adjuvant treatment, should be discussed when treating these patients. PMID:23861597

  1. Toward Optimal Outcome Following Pivotal Response Treatment: A Case Series

    PubMed Central

    Ventola, Pamela E.; Oosting, Devon R.; Keifer, Cara M.; Friedman, Hannah E.

    2015-01-01

    There is a growing literature on children with autism spectrum disorder (ASD) who respond favorably to behavioral treatment, which is often termed “optimal outcome.” Rates and definitions of optimal outcome vary widely. The current case series describes an empirically validated behavioral treatment approach called Pivotal Response Treatment (PRT). We present two preschool-aged children who received an intensive course of PRT and seem to be on a trajectory toward potential optimal outcome. Understanding response to treatment and predictors of response is crucial, not necessarily to predict who may succeed, but to individualize medicine and match children with customized treatment programs that will be best tailored to their unique and varied needs. PMID:25745373

  2. [Type IIb primary hyperlipoproteinemia. An homogenous series of 412 cases].

    PubMed

    Rouffy, J; Loeper, J; Dreux, C; Lemogne, M; Loeper, J; Pestel, M; Dakkak, R

    1976-03-20

    On the basis of a homogeneous series of 412 cases of type IIb primary hyperlipoproteinaemia, the authors compare their experience with findings in the literature. The prevalence of this type of hyperlipoproteinaemia in the general population has been underestimated at 3%. Biological diagnosis remains simple (identification of a double and distinct excess in beta and pre beta lipoproteins). Extravascular lipid deposits (gerontoxon, xanthelasma, tendon xanthomata) are not type specific. Hyperlipidaemic syndrome is rare. Above all, the importance of type IIb in atheromatous disease in the young subject now seems obvious. The mode of hereditary transmission of the familial anomaly is not certain but would appear to be often associated with a double heterozygote condition. PMID:1264609

  3. Unusual Thyroid Carcinoma Metastases: a Case Series and Literature Review.

    PubMed

    Farina, Eleonora; Monari, Fabio; Tallini, Giovanni; Repaci, Andrea; Mazzarotto, Renzo; Giunchi, Francesca; Panzacchi, Riccardo; Cammelli, Silvia; Padula, Gilbert D A; Deodato, Francesco; Pasquali, Renato; Fanti, Stefano; Fiorentino, Michelangelo; Morganti, Alessio G

    2016-03-01

    The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission. PMID:26662609

  4. Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series

    PubMed Central

    Cramer, Holger; Krucoff, Carol; Dobos, Gustav

    2013-01-01

    While yoga is gaining increased popularity in North America and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga. Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder stand, lotus position, and forceful breathing were the most common yoga postures and breathing techniques cited. Twenty-seven adverse events (35.5%) affected the musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case (1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice, yoga should be practiced carefully under the guidance of a qualified instructor. Beginners should avoid extreme practices such as headstand, lotus position and forceful breathing. Individuals with medical preconditions should work with their physician and yoga teacher to appropriately adapt postures; patients with glaucoma should avoid inversions and patients with compromised bone should avoid forceful yoga practices. PMID:24146758

  5. Rapid Levothyroxine Absorption Testing: A Case Series of Nonadherent Patients

    PubMed Central

    Balla, Mamtha; Jhingan, Ram M.; Rubin, Daniel J.

    2015-01-01

    Background: Nonadherence to levothyroxine therapy is one cause of persistent hypothyroidism. To distinguish nonadherence from malabsorption, a levothyroxine absorption test is required. Typically, this test measures the serum free thyroxine (FT4) response to 1000 mcg of oral levothyroxine over 4 to 24 hours. Published data indicate that serum levels of FT4 are at or near their peak 2 hours after levothyroxine ingestion. Objectives: We present the successful completion of 2-hour levothyroxine absorption testing in 3 patients as a retrospective case series. Patients and Methods: Serum levels of thyroid stimulating hormone (TSH), FT4, and free triiodothyronine (FT3) were drawn at 0, 60, and 120 minutes after 1000 mcg of oral levothyroxine. Results: In all 3 cases, baseline thyroid function indicated the patients had taken their prescribed doses of levothyroxine prior to the absorption test. Despite high baseline levels both FT3 and FT4 increased during each absorption test, providing more evidence of adequate levothyroxine absorption. Subsequently, patients achieved normal TSH levels on lower doses of levothyroxine. Conclusions: Levothyroxine absorption testing over 2 hours may offer a more rapid alternative to the commonly used longer protocols to rule out malabsorption. Scheduling a levothyroxine absorption test may induce some patients to start adhering to levothyroxine therapy. PMID:26633982

  6. Harlequin Color Change: Neonatal Case Series and Brief Literature Review

    PubMed Central

    Valerio, Enrico; Barlotta, Alessia; Lorenzon, Eleonora; Antonazzo, Livio; Cutrone, Mario

    2015-01-01

    First clinical report of Harlequin color change (HCC) phenomenon came in 1952 from Neligan and Strang. Since then, HCC has been described in a fairly broad number of clinical reports involving neonates, infants, children, and adult patients. We here present a small case series of HCC occurring in neonates, pointing out three of the different possible presentations (hemifacial, patchy scattered across the whole body, and hemiscrotal) of this phenomenon. A brief discussion and literature review encompassing epidemiology, clinical features, physiopathology, associated conditions, and differential diagnoses of HCC is then presented. In most cases, HCC represents a benign, idiopathic, and rapidly autoresolutive phenomenon, with no need for treatment. Some drugs (especially anesthetics and prostaglandin E) are thought to enhance HCC expression through their influence on the capillary tone in the peripheral vascular bed; this effect is anyway promptly reversible with drug withdrawal. Only in rare circumstances, HCC may act as a clue for serious central nervous system disorders (e.g., meningitis; hypothalamic, brain stem, or sympathetic nervous system lesions); anyway, in these rare occurrences HCC always represents an epiphenomenon of the disease, never acting as the sole sign of the underlying disorder. PMID:26199804

  7. The Histopathological Spectrum of Pyogenic Granuloma: A Case Series

    PubMed Central

    Shrestha, Sajeev

    2016-01-01

    Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH). Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification. PMID:27382492

  8. Case series of feline panleukopenia virus in an animal shelter.

    PubMed

    Litster, Annette; Benjanirut, Chutamas

    2014-04-01

    The aim of this study was to describe a series of confirmed and suspected cases of feline panleukopenia virus (FPV) and in-contact cats in an adoption-guarantee shelter in an FPV-endemic area by reviewing shelter records over a 10-month period (January-October 2010). Cats were divided into three groups: in-contact group - asymptomatic cats that were housed with a FPV fecal antigen (Ag)-positive cat/kitten as part of a litter group (n = 66); FPV-survivors group (FPV-infected survivors) - tested FPV fecal Ag-positive and showed clinical signs of FPV, but survived (n = 27); FPV-non-survivors group (FPV-infected non-survivors) - showed clinical signs of FPV and either tested FPV fecal Ag-positive or were housed with an Ag-positive family member, but did not survive (n = 52). Ages ranged from 3 weeks to 3 years, but most were <6 months old (in-contact group: 79%; FPV-survivors group: 70%; FPV-non-survivors group: 85%). A seasonal peak occurred over summer, but cases occurred year-round. Anorexia, dehydration, fever and diarrhea predominated in the FPV-survivors group, and death was preceded by clinical signs of circulatory shock in the FPV-non-survivors group. Housing litters of kittens with their mother was not associated with improved outcome, perhaps because in this population clinical FPV infection was relatively common in queens arriving at the shelter with susceptible litters. PMID:23873047

  9. Face and object imagery in congenital prosopagnosia: a case series.

    PubMed

    Tree, Jeremy J; Wilkie, Jaimie

    2010-10-01

    It has been reported that congenital prosopagnosics may have a general imagery deficit or an imagery deficit specific to faces. However, much of this evidence is based on self-report questionnaires, rather than experimentally based testing (Grüter et al., 2007, 2009). This study tested face and non-face based imagery in a case series of congenital prosopagnosics, utilising both questionnaire based and forced choice accuracy measures. Our findings indicate that all the prosopagnosics showed impaired face based imagery, which contrasted with normal performance on imagery of objects and colours - a pattern that is consistent with reports of acquired prosopagnosia (Barton, 2008; Michelon and Biederman, 2003). Given all our experimentally based testing indicated face imagery impairments, despite no such problems being seen on self-report questionnaires, we would argue that testing based only on the latter must be interpreted with some caution. Overall, we would advocate that our findings demonstrate a category specific visual imagery impairment in congenital prosopagnosia, such that general imagery skill can be intact in such cases. PMID:20434142

  10. Are Staphylococcus intermedius Infections in Humans Cases of Mistaken Identity? A Case Series and Literature Review

    PubMed Central

    Viau, Roberto; Hujer, Andrea M.; Hujer, Kristine M.; Bonomo, Robert A.; Jump, Robin L.P.

    2015-01-01

    Staphylococcus intermedius and Staphylococcus pseudintermedius are difficult to distinguish using conventional microbiological methods. Molecular diagnostic tools change our understanding of the epidemiology of these 2 organisms. In this study, we present (1) a detailed review of the current literature on molecular diagnostics and (2) a case series in which misidentification was proven in 1 case. We conclude that S pseudintermedius is a more common human pathogen than previously recognized. PMID:26509181

  11. Competition between BCS-pairing and “moth-eaten effect” in BEC-BCS crossover

    NASA Astrophysics Data System (ADS)

    Zhu, Guojun; Combescot, Monique

    2012-01-01

    We study the change in condensation energy from a single pair of fermionic atoms to a large number of pairs interacting via the reduced BCS potential. We find that the energy-saving due to correlations decreases when the pair number increases because the number of empty states available for pairing gets smaller ("moth-eaten effect"). However, this decrease dominates the 3D kinetic energy increase of the same amount of noninteracting atoms only when the pair number is a sizable fraction of the number of states available for pairing. As a result, in BEC-BCS crossover of 3D systems, the condensation energy per pair first increases and then decreases with pair number while in 2D, it always is controlled by the "moth-eaten effect" and thus simply decreases.

  12. Case series: toxicity from 25B-NBOMe--a cluster of N-bomb cases.

    PubMed

    Gee, Paul; Schep, Leo J; Jensen, Berit P; Moore, Grant; Barrington, Stuart

    2016-01-01

    Background A new class of hallucinogens called NBOMes has emerged. This class includes analogues 25I-NBOMe, 25C-NBOMe and 25B-NBOMe. Case reports and judicial seizures indicate that 25I-NBOMe and 25C-NBOMe are more prevalently abused. There have been a few confirmed reports of 25B-NBOMe use or toxicity. Report Observational case series. This report describes a series of 10 patients who suffered adverse effects from 25B-NBOMe. Hallucinations and violent agitation predominate along with serotonergic/stimulant signs such as mydriasis, tachycardia, hypertension and hyperthermia. The majority (7/10) required sedation with benzodiazepines. Analytical method 25B-NBOMe concentrations in plasma and urine were quantified in all patients using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Peak plasma levels were measured between 0.7-10.1 ng/ml. Discussion The NBOMes are desired by users because of their hallucinogenic and stimulant effects. They are often sold as LSD or synthetic LSD. Reported cases of 25B- NBOMe toxicity are reviewed and compared to our series. Seizures and one pharmacological death have been described but neither were observed in our series. Based on our experience with cases of mild to moderate toxicity, we suggest that management should be supportive and focused on preventing further (self) harm. High doses of benzodiazepines may be required to control agitation. Patients who develop significant hyperthermia need to be actively managed. Conclusions Effects from 25B-NBOMe in our series were similar to previous individual case reports. The clinical features were also similar to effects from other analogues in the class (25I-NBOMe, 25C-NBOMe). Violent agitation frequently present along with signs of serotonergic stimulation. Hyperthermia, rhabdomyolysis and kidney injury were also observed. PMID:26621342

  13. BCS-BEC crossover and phase structure of relativistic systems: A variational approach

    SciTech Connect

    Chatterjee, Bhaswar; Mishra, Hiranmaya; Mishra, Amruta

    2009-01-01

    We investigate here the BCS-BEC crossover in relativistic systems using a variational construct for the ground state and the minimization of the thermodynamic potential. This is first studied in a four-fermion point interaction model and with a BCS type ansatz for the ground state with fermion pairs. It is shown that the antiparticle degrees of freedom play an important role in the BCS-BEC crossover physics, even when the ratio of Fermi momentum to the mass of the fermion is small. We also consider the phase structure for the case of fermion pairing with imbalanced populations. Within the ansatz, thermodynamically stable gapless modes for both fermions and antifermions are seen for strong coupling in the Bose-Einstein condensation (BEC) regime. We further investigate the effect of fluctuations of the condensate field by treating it as a dynamical field and generalize the BCS ansatz to include quanta of the condensate field also in a boson-fermion model with quartic self-interaction of the condensate field. It is seen that the critical temperature decreases with inclusion of fluctuations.

  14. Relativistic BEC-BCS Crossover in a magnetized Nambu-Jona-Lasinio Model

    NASA Astrophysics Data System (ADS)

    Duarte, Dyana C.; Farias, R. L. S.; Manso, Pedro H. A.; Ramos, Rudnei O.

    2016-04-01

    The BEC-BCS crossover in the NJL model is studied in the presence of an external magnetic field. Particular attention is given to two different regularization schemes used in the literature and we show how they compare to each other. The comparison is made for the case of a cold and magnetized two color NJL model. We also make a brief discussion about the Nc = 3 case without magnetic fields, as an extension of this work in the future.

  15. Double tibial osteotomy for bow leg patients: A case series

    PubMed Central

    Nazem, Khalilollah; Fouladi, Arash; Chinigarzadeh, Mozhdeh

    2013-01-01

    Background: High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO). Materials and Methods: A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009–2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery. Results: The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 ± 3.05° vs. 3.93 ± 0.66°, 79.13 ± 3.4° vs. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM) near knee and ankle was not observed. Conclusion: DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time. PMID:24523802

  16. Liquid Nitrogen Cryotherapy for Conjunctival Lymphangiectasia: A Case Series

    PubMed Central

    Fraunfelder, Frederick W.

    2009-01-01

    Purpose: To report a case series of conjunctival lymphangiectasia treated with liquid nitrogen cryotherapy. Methods: A 1.5-mm Brymill cryoprobe was applied in a double freeze-thaw method after an incisional biopsy of a portion of the conjunctiva in patients with conjunctival lymphangiectasia. Freeze times were 1 to 2 seconds with thawing of 5 to 10 seconds between treatments. Patients were reexamined at 1 day, 2 weeks, 3 months, 6 months, and yearly following cryotherapy. Results: Five eyes of 4 patients (3 male and 1 female) with biopsy-proven conjunctival lymphangiectasia underwent liquid nitrogen cryotherapy. The average patient age was 53 years. Ocular examination revealed large lymphatic vessels that were translucent and without conjunctival injection. Subjective symptoms included epiphora, ocular irritation, eye redness, and occasional blurred vision. After treatment with liquid nitrogen cryotherapy, the patients’ symptoms and signs resolved within 2 weeks. Lymphangiectasia recurred twice in one patient, at 1 and 3 years postoperatively. In another patient, lymphangiectasia recurred at 6 months. The average time to recurrence in these 3 eyes was 18 months. Average length of follow-up was 24.5 months for all subjects. Conclusion: Liquid nitrogen cryotherapy may be an effective surgical alternative in the treatment of conjunctival lymphangiectasia. Cryotherapy may need to be repeated in some instances. PMID:20126499

  17. Hypomagnesemia and hypocalcemia in mycosis fungoides: a retrospective case series.

    PubMed

    Morgan, Matt; Maloney, Denise; Duvic, Madeleine

    2002-06-01

    The most common variant of cutaneous T-cell lymphomas (CTCLs) is mycosis fungoides (MF), a malignant proliferation of atypical CD4+ CD45Ro+ T-cells that initially proliferate in the skin and later invades lymph nodes and other organs including the blood (Sezary syndrome). The pathogenesis of CTCL is largely unknown. We present definitive data showing a correlation between degree and prevalence of hypomagnesemia and hypocalcemia and clinical stage of MF. Hypomagnesemia was present in 22.2% of MF patients with early stage (n = 27), 38.5% of intermediate stage (n = 13), and 67.5% of advanced stage disease (n = 40). Hypocalcemia was present in 8.3% of MF patients with early stage (n = 24), 54.5% with intermediate stage (n = 11), and 61.0% with advanced stage disease (n = 41). The odds ratios for having hypomagnesemia and hypocalcemia in patients with stage II or higher MF compared with stage I patients were 5.33 and 16.24, respectively. Hypomagnesemia has been associated with immune function abnormalities including the development of T-cell leukemia-lymphoma in rats. We hypothesize that the hypomagnesemia may play a role in the progression or pathogenesis of MF or the Sezary syndrome (SS). This retrospective case series is the first study ever to report a relationship between serum cations and CTCL in humans. PMID:12152999

  18. Adverse clinical sequelae after skin branding: a case series

    PubMed Central

    2009-01-01

    Introduction Branding refers to a process whereby third degree burns are inflicted on the skin with a hot iron rod or metallic object. Branding employs the phenomenon of "counter irritation," and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment. Case presentation Four Pakistani patients, three male and one female, ranging from 25 to 60 years of age "branded" with a red hot iron rod for various medical reasons presented with severe medical complications to our tertiary care hospital. The mean duration between the procedure and presentation to the hospital was 6 days. At the time of admission, two patients had septic shock, one patient had cavernous sinus thrombosis and one patient had multiple splenic abscesses. All patients received standard care for wound management and systemic infections. Two patients eventually died during the course of treatment. Conclusion Severe complications from branding are troublesome and the potential risks of this treatment outweigh its benefits. Globally, there is a great need for heightened awareness about the dangers of branding among patients and physicians, as this will have an important effect on patients who seek branding for various medical conditions. PMID:19166615

  19. Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

    PubMed Central

    Hawasli, Ammar H.; Ray, Wilson Z.; Wright, Neill M.

    2014-01-01

    Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair. PMID:24871148

  20. Descemet's membrane detachment in horses; case series and literature review.

    PubMed

    Matas Riera, Màrian; Donaldson, David; Priestnall, Simon Lawrence

    2015-09-01

    The aim of this article was to describe Descemet's membrane detachment (DMD) following phacoemulsification in five equine eyes and to review the human literature on this topic. In the last decade, there has been increased reporting of DMD in the human literature, in particular following cataract surgery. The natural history of DMD remains unknown and although various medical and surgical treatments have been advocated there is no recognized 'gold standard' treatment for DMD. This case series reports the diagnosis of DMD in four horses (5 eyes) in association with phacoemulsification surgery. The diagnosis of DMD in these patients was made intra-operatively, postoperatively or on subsequent histopathological examination. The surgical reports, photographic or video recordings, and ultrasound data were evaluated and possible factors associated with the pathophysiology of DMD are discussed. This is the first description of DMD in the veterinary literature, and the authors believe that DMD might hitherto have been overlooked in veterinary ophthalmology due to a lack of awareness of the condition. The possible causes, clinical signs, and treatment of DMD as described in the human literature are also reviewed. PMID:25180582

  1. Monocular Elevation Deficiency: A Case Series of Surgical Outcome

    PubMed Central

    Talebnejad, Mohammad Reza; Roustaei, Gholam Abbas; Khalili, Mohammad Reza

    2014-01-01

    Background: Inferior rectus recession, Knapp procedure, partial tendon transposition, and combined procedure are different surgical procedures in the management of monocular elevation deficiency (MED). Only a few studies have been published on the management of this problem. In this study, we report our experience with patients with MED focusing on the indications and types of surgery in the south of Iran. Methods: In this case series, a computerized database review on 4773 patients with strabismus was performed and 18 patients diagnosed as having MED who had undergone strabismus surgery were enrolled. Results: Of the 18 patients, 13 had only hypotropia and 5 had horizontal deviation as well. Preoperative vertical deviation was between 15 and 60 prism diopter (mean±SD=25.8±10.7 PD). Fourteen patients had positive forced duction test on elevation. Seventeen patients had ptosis twelve of them had true ptosis and the remaining 5 had pseudoptosis). The mean postoperative follow-up was 24.4 months. Four patients underwent Knapp procedure, 12 patients underwent inferior rectus recession, and for 2 patients a combined procedure was performed. The mean postoperative hypotropia was 6.1±7.9 PD. Twelve out of the 18 patients were corrected to within five PD of orthophoria and no one was found with overcorrection. Conclusion: Although MED is etiologically multifactorial, satisfactory surgical results can be achieved by judicious selection of the surgical technique based on the results of the forced duction test. PMID:24644378

  2. Liver Damage Associated with Polygonum multiflorum Thunb.: A Systematic Review of Case Reports and Case Series.

    PubMed

    Lei, Xiang; Chen, Jing; Ren, Jingtian; Li, Yan; Zhai, Jingbo; Mu, Wei; Zhang, Li; Zheng, Wenke; Tian, Guihua; Shang, Hongcai

    2015-01-01

    Objective. To summarize the characteristics and analysis of relevant factors and to give references for prevention and further study of liver damage associated with Polygonum multiflorum Thunb. (HSW), we provide a systematic review of case reports and case series about liver damage associated with HSW. Methods. An extensive search of 6 medical databases was performed up to June 2014. Case reports and case series involving liver damage associated with HSW were included. Results. This review covers a total of 450 cases in 76 articles. HSW types included raw and processed HSW decoction pieces and many Chinese patent medicines that contain HSW. Symptoms of liver damage occur mostly a month or so after taking the medicine, mainly including jaundice, fatigue, anorexia, and yellow or tawny urine. Of the 450 patients, two cases who received liver transplantation and seven who died, the remaining 441 cases recovered or had liver function improvement after discontinuing HSW products and conservative care. Conclusion. HSW causes liver toxicity and may cause liver damage in different degrees and even lead to death; most of them are much related to long-term and overdose of drugs. Liver damage associated with HSW is reversible, and, after active treatment, the majority can be cured. People should be alert to liver damage when taking HSW preparations. PMID:25648693

  3. Liver Damage Associated with Polygonum multiflorum Thunb.: A Systematic Review of Case Reports and Case Series

    PubMed Central

    Lei, Xiang; Chen, Jing; Ren, Jingtian; Li, Yan; Zhai, Jingbo; Mu, Wei; Zhang, Li; Zheng, Wenke; Tian, Guihua; Shang, Hongcai

    2015-01-01

    Objective. To summarize the characteristics and analysis of relevant factors and to give references for prevention and further study of liver damage associated with Polygonum multiflorum Thunb. (HSW), we provide a systematic review of case reports and case series about liver damage associated with HSW. Methods. An extensive search of 6 medical databases was performed up to June 2014. Case reports and case series involving liver damage associated with HSW were included. Results. This review covers a total of 450 cases in 76 articles. HSW types included raw and processed HSW decoction pieces and many Chinese patent medicines that contain HSW. Symptoms of liver damage occur mostly a month or so after taking the medicine, mainly including jaundice, fatigue, anorexia, and yellow or tawny urine. Of the 450 patients, two cases who received liver transplantation and seven who died, the remaining 441 cases recovered or had liver function improvement after discontinuing HSW products and conservative care. Conclusion. HSW causes liver toxicity and may cause liver damage in different degrees and even lead to death; most of them are much related to long-term and overdose of drugs. Liver damage associated with HSW is reversible, and, after active treatment, the majority can be cured. People should be alert to liver damage when taking HSW preparations. PMID:25648693

  4. Congenital Zika syndrome with arthrogryposis: retrospective case series study

    PubMed Central

    Filho, Epitacio Leite Rolim; Lins, Otavio Gomes; Aragão, Maria de Fátima Viana Vasco; Brainer-Lima, Alessandra Mertens; Cruz, Danielle Di Cavalcanti Sousa; Rocha, Maria Angela Wanderley; Sobral da Silva, Paula Fabiana; Carvalho, Maria Durce Costa Gomes; do Amaral, Fernando José; Gomes, Joelma Arruda; Ribeiro de Medeiros, Igor Colaço; Ventura, Camila V; Ramos, Regina Coeli

    2016-01-01

    Objective To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Design Retrospective case series study. Setting Association for Assistance of Disabled Children, Pernambuco state, Brazil. Participants Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. Results The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Conclusions Congenital Zika syndrome should be added to the differential diagnosis of congenital

  5. Effect of Intrathecal Baclofen Concentration on Spasticity Control: Case Series

    PubMed Central

    Saval, April; Chiodo, Anthony E

    2008-01-01

    Background/Objective: Intrathecal baclofen (ITB) has been shown to be an effective treatment for severe spasticity of spinal or cerebral origin. Although most patients respond well to an ITB trial, there are often difficulties in achieving and/or maintaining such effectiveness with ITB pump treatment. There are few published guidelines for dosing efficacy and no studies looking at the effect of concentration of ITB on spasticity management. Methods: Case series of 3 adults with severe spasticity treated with ITB pump: a 44-year-old man with C7 tetraplegia using a 40-mL Medtronic SynchroMed II pump with 500-μg/mL concentration; a 35-year-old woman with traumatic brain injury with right spastic hemiplegia using a 18-mL Medtronic SynchroMed EL pump with 2,000-μg/mL concentration; and a 43-year-old woman with spastic diplegic cerebral palsy using a 40-mL Medtronic SynchroMed II pump with 2,000-μg/mL concentration. Results: After reducing ITB concentrations in the pump, either as part of a standard protocol for dye study to assess the integrity of pump and catheter system or secondary to plateau in therapeutic efficacy, patients experienced temporary, significant reduction in spasticity based on range of motion, Modified Ashworth scores, and verbal feedback. Conclusions: Decreasing the concentration of ITB seems to affect spasticity control. Further research in this area is needed for those patients with refractory spasticity to optimize efficacy of ITB therapy. PMID:18959357

  6. Temporary Diverting Ileostomy via the Umbilicus: a Small Case Series

    PubMed Central

    Mushaya, C. D.; Chandra, Raaj; Sansom, Wendy; Keck, James

    2015-01-01

    The umbilicus, a natural orifice, which is used as an access port during laparoscopic surgery, can be used as a stoma site with potential superior cosmetic results as one less incision is then required. Our objective was to assess the efficacy and safety of the umbilical stoma in a selected group of patients. This is a prospective case series in hospital patients admitted as emergency or elective. Patients who underwent laparoscopic colorectal surgery with a planned ileostomy at Box Hill Hospital were approached and invited to participate in the study, with the stoma being fashioned on the umbilicus. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital related outcomes, postoperative bowel related complications, and other surgical and medical complications. Outcomes of a total of 10 (5 males) patients who underwent umbilical covering ileostomy during the study period were analyzed. Two patients with ulcerative colitis had the second stage of their operation converting their end stomas to loop stoma. These were counted twice, totaling 12 stomas in 10 patients. Three patients had their umbistomas after receiving neoadjuvant treatment for rectal cancer. The median period patients have had umbistomas is 113 days. Overall morbidity during the initial operation was low, except for 1 patient who had a small bowel injury. There was no mortality. Minor peristomal skin changes were the most common postoperative complication. Three patients had their stomas reversed with excellent cosmesis. Umbistomas appear to be a safe and effective way to fashion covering stomas post laparoscopic surgery and save the patient an added incision with excellent cosmetic results. PMID:25785324

  7. Extra-articular ankle stabilization: a case series.

    PubMed

    Roukis, Thomas S

    2010-06-01

    Maintenance of the foot at 90 degrees to the lower leg following posterior calf lengthening or to prevent an equinus contracture in situations in which splint, cast, or external fixation is deemed inappropriate is a challenge. The author presents an observational case series involving 9 extra-articular ankle stabilizations performed in 9 consecutive patients. Each patient underwent his or her index surgery followed by percutaneous placement of 2 smooth 2.8-mm or larger diameter Steinmann pins extra-articular to the ankle joint. There were 6 men and 3 women with a mean age of 56.1 years (range, 31-73 years). Five patients had diabetes with peripheral neuropathy, 2 had critical limb ischemia, 1 had alcohol-induced neuropathy, 1 had lupus, and 1 was an active smoker. Eight patients had posterior calf lengthening, and 1 had open metatarsal fractures with severe soft-tissue disruption with an inability to use splint immobilization. Three patients had a transmetatarsal amputation, 2 patients had Chopart amputations, 2 patients had forefoot plastic surgery reconstructive procedures, 1 had a complex Charcot reconstruction, and 1 had a splittibialis anterior tendon transfer. Extra-articular ankle stabilization fixation was retained for a mean of 5.5 weeks (range, 2-10 weeks). Mean follow-up was 12 months (range, 1-17 months). All extra-articular stabilization procedures were deemed successful. When properly performed, extra-articular stabilization to maintain the foot at 90 degrees to the lower leg represents a safe, simple, reliable, and minimally invasive technique useful in situations in which traditional splint or cast immobilization is not possible and when external fixation is deemed inappropriate. PMID:20508012

  8. Analysis of the cellulose synthase operon genes, bcsA, bcsB, and bcsC in Cronobacter species: Prevalence among species and their roles in biofilm formation and cell-cell aggregation.

    PubMed

    Hu, Lan; Grim, Christopher J; Franco, Augusto A; Jarvis, Karen G; Sathyamoorthy, Vengopal; Kothary, Mahendra H; McCardell, Barbara A; Tall, Ben D

    2015-12-01

    Cronobacter species are emerging food-borne pathogens that cause severe sepsis, meningitis, and necrotizing entercolitis in neonates and infants. Bacterial pathogens such as Escherichia coli and Salmonella species produce extracellular cellulose which has been shown to be involved in rugosity, biofilm formation, and host colonization. In this study the distribution and prevalence of cellulose synthase operon genes (bcsABZC) were determined by polymerase chain reaction (PCR) analysis in 231 Cronobacter strains isolated from clinical, food, environmental, and unknown sources. Furthermore, bcsA and bcsB isogenic mutants were constructed in Cronobacter sakazakii BAA894 to determine their roles. In calcofluor binding assays bcsA and bcsB mutants did not produce cellulose, and their colonial morphotypes were different to that of the parent strain. Biofilm formation and bacterial cell-cell aggregation were significantly reduced in bcsA and bcsB mutants compared to the parental strain. bcsA or bcsAB PCR-negative strains of C. sakazakii did not bind calcofluor, and produced less biofilm and cell-cell aggregation compared to strains possessing bcsAB genes. These data indicated that Cronobacter bcsABZC were present in all clinical isolates and most of food and environmental isolates. bcsA and bcsB genes of Cronobacter were necessary to produce cellulose, and were involved in biofilm formation and cell-cell aggregation. PMID:26338122

  9. Atypical BCS-BEC crossover induced by quantum-size effects

    NASA Astrophysics Data System (ADS)

    Shanenko, A. A.; Croitoru, M. D.; Vagov, A. V.; Axt, V. M.; Perali, A.; Peeters, F. M.

    2012-09-01

    Quantum-size oscillations of the basic physical characteristics of a confined fermionic condensate are a well-known phenomenon. Its conventional understanding is based on the single-particle physics, whereby the oscillations follow variations in the single-particle density of states driven by the size quantization. Here we present a study of a cigar-shaped ultracold superfluid Fermi gas, which demonstrates an important many-body aspect of the quantum-size coherent effects, overlooked previously. The many-body physics is revealed here in the atypical crossover from the Bardeen-Cooper-Schrieffer (BCS) superfluid to the Bose-Einstein condensate (BEC) induced by the size quantization of the particle motion. The single-particle energy spectrum for the transverse dimensions is tightly bound, whereas for the longitudinal direction it resembles a quasi-free dispersion. This results in the formation of a series of single-particle subbands (shells) so that the aggregate fermionic condensate becomes a coherent mixture of subband condensates. Each time when the lower edge of a subband crosses the chemical potential, the BCS-BEC crossover is approached in this subband, and the aggregate condensate contains both BCS and BEC-like components.

  10. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    PubMed Central

    Esene, Ignatius Ngene; Ashour, Ahmed M; Marvin, Eric; Nosseir, Mohamed; Fayed, Zeiad Y; Seoud, Khaled; El Bahy, Khaled

    2016-01-01

    Introduction: Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome. Materials and Methods: We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients’ sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed. Results: The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1–144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up. Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

  11. Case Citations 1994. Seventeenth Series (Violence and School Safety).

    ERIC Educational Resources Information Center

    Russo, Charles J., Ed.

    Case citations from federal and state court decisions concerning violence and school safety are organized in five major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows (1) "Assaults on School Personnel" (Michael L. Yates); (2) "The Fourth Amendment: Search and…

  12. BEC-BCS crossover in a cold and magnetized two color NJL model

    NASA Astrophysics Data System (ADS)

    Duarte, Dyana C.; Allen, P. G.; Farias, R. L. S.; Manso, Pedro H. A.; Ramos, Rudnei O.; Scoccola, N. N.

    2016-01-01

    The BEC-BCS crossover for a Nambu-Jona-Lasinio (NJL) model with diquark interactions is studied in the presence of an external magnetic field. Particular attention is paid to different regularization schemes used in the literature. A thorough comparison of results is performed for the case of a cold and magnetized two-color NJL model. According to our results, the critical chemical potential for the BEC transition exhibits a clear inverse magnetic catalysis effect for magnetic fields in the range 1 ≲e B /mπ2≲20 . As for the BEC-BCS crossover, the corresponding critical chemical potential is very weakly sensitive to magnetic fields up to e B ˜9 mπ2, showing a much smaller inverse magnetic catalysis as compared to the BEC transition, and displays a strong magnetic catalysis from this point on.

  13. Authors@UF Campus Conversation Series: A Case Study

    ERIC Educational Resources Information Center

    Silver, Isabel

    2014-01-01

    The Authors@UF program series emerged to showcase the scholarship and creativity of faculty, creating an intellectual forum within the academic library, and providing informal, extra-curriculum, academic engagement between students and faculty outside the classroom. This article identifies steps to launch an author program, and considerations in…

  14. Case-Control Study and Case Series of Pseudohyperphosphatemia during Exposure to Liposomal Amphotericin B

    PubMed Central

    Hoover, Katherine C.; Wahlquist, Amy E.; Zhu, Yusheng; Velez, Juan Carlos Q.

    2015-01-01

    Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval {CI}, 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously. PMID:26282423

  15. Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B.

    PubMed

    Bohm, Nicole M; Hoover, Katherine C; Wahlquist, Amy E; Zhu, Yusheng; Velez, Juan Carlos Q

    2015-11-01

    Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval {CI}, 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously. PMID:26282423

  16. Difficult Cases of Pain and Nonpain Symptoms in Intractable Spinal Infections: A Case Series

    PubMed Central

    Olsen, Molly L.; Havyer, Rachel D. A.; Smith, Thomas J.; Swetz, Keith M.

    2014-01-01

    In the modern age of advanced surgical techniques and pharmacologic management, bacterial spinal infections (SIs) can be managed (either eradicated or suppressed) in many hosts. However, the optimal management of SIs may be limited by patient comorbidities, which do not allow for surgical management, or limited by antimicrobial options due to side effects, toxicities, or emerging drug resistance. In these settings, frank and honest discussion regarding risks and benefits of treatment should be pursued, including that the SI may be a terminal illness. In this case series, we present 3 patients who had bacterial SIs whose treatments were limited by the above-mentioned factors. Furthermore, each case presented challenges regarding optimal medical management of somatic and neuropathic pain associated with the SI. PMID:22144661

  17. [Adult Still's disease: study of a series of 11 cases].

    PubMed

    Ben Taarit, C; Turki, S; Ben Maïz, H

    2002-02-01

    Adult Still's disease is a systemic disease of unknown etiology. We report a retrospective study of 11 cases (9 females and 2 males) of adult Still's disease collected during 25 years. The mean age was 36 years. Fever, arthritis and skin rash was constant. Adenopathies and splenomegaly were observed in 2 patients. The laboratory findings was characterized by a constant inflammatory syndrome and leucocytosis. Hypertransaminasemia and hyperferritinemia were observed respectively in 7 cases and 3 cases. Corticosteroids were prescribed in all patients. Methotrexate was administered in 3 patients. Outcome was favorable in 10 cases, death incurred in one patient, secondary to acute hepatitis. PMID:12070839

  18. Design considerations for case series models with exposure onset measurement error

    PubMed Central

    Mohammed, Sandra M.; Dalrymple, Lorien S.; Şentürk, Damla; Nguyen, Danh V.

    2014-01-01

    Summary The case series model allows for estimation of the relative incidence of events, such as cardiovascular events, within a pre-specified time window after an exposure, such as an infection. The method requires only cases (individuals with events) and controls for all fixed/time-invariant confounders. The measurement error case series model extends the original case series model to handle imperfect data, where the timing of an infection (exposure) is not known precisely. In this work, we propose a method for power/sample size determination for the measurement error case series model. Extensive simulation studies are used to assess the accuracy of the proposed sample size formulas. We also examine the magnitude of the relative loss of power due to exposure onset measurement error, compared to the ideal situation where the time of exposure is measured precisely. To facilitate the design of case series studies, we provide publicly available web-based tools for determining power/sample size for both the measurement error case series model as well as the standard case series model. PMID:22911898

  19. Dyschromias: A Series of Five Interesting Cases from India

    PubMed Central

    Namitha, Prabhu; Sacchidanand, S

    2015-01-01

    Dyschromatosis is a pigmentary genodermatosis which presents with hyper and hypopigmented skin lesions giving a mottled appearance. It is a rare entity in India reported mainly in the East Asian population. Classically, two forms have been described; dyschromatosis universalis hereditaria (DUH) and dyschromatosis symmetrica hereditaria. Here we report four cases of DUH and one case of dyschromatosis symmetrica hereditaria from India. PMID:26677297

  20. Methodology Series Module 2: Case-control Studies.

    PubMed

    Setia, Maninder Singh

    2016-01-01

    Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias. PMID:27057012

  1. Kasabach-Merritt phenomenon and prenatal counseling: a case series.

    PubMed

    Beissel, Anne; Riou, Stéphanie; Fischer Fumeaux, Céline Julie; Cassart, Marie; Blanc, Sébastien; Claris, Olivier; Guibaud, Laurent

    2016-07-01

    Kasabach-Merritt phenomenon can be encountered in the perinatal period. No consensus exists regarding prenatal management. We report one prenatal case leading to therapeutic abortion and one neonatal case, successfully treated by a multimodal therapy. Prenatal counseling should include the possibility of neonatal multimodal treatment that can lead to favorable outcomes. PMID:27386131

  2. Methodology Series Module 2: Case-control Studies

    PubMed Central

    Setia, Maninder Singh

    2016-01-01

    Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same ‘study base’ as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive – particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases – selection bias and recall bias. PMID:27057012

  3. Case Series: Outbreak of Conversion Disorder among Amish Adolescent Girls.

    ERIC Educational Resources Information Center

    Cassady, Joslyn D.; Kirschke, David L.; Jones, Timothy F.; Craig, Allen S.; Bermudez, Ovidio B.; Schaffner, William

    2005-01-01

    Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding,…

  4. Filicide-Suicide: Case Series and Review of the Literature.

    PubMed

    Shields, Lisa B E; Rolf, Cristin M; Goolsby, Mary E; Hunsaker, John C

    2015-09-01

    Homicide-suicides or "dyadic deaths" refer to a homicide followed by the suicide of the perpetrator within 1 week of the homicide. A unique subset is filicide-suicide: a parent kills his/her child before committing suicide. Shooting is the preferred method for both the homicide and suicide. The perpetrator has depression in most cases.We present 3 cases of filicide-suicide. In case 1, a divorced mother with schizophrenia and bipolar disorder shot her son and herself. In case 2, a father shot his son and himself while involved in a child-custody dispute. In case 3, a father, experiencing a divorce and financial difficulties, and his daughter with Angelman syndrome succumbed to carbon monoxide poisoning.The forensic pathologist should be aware of the psychosocial dynamics that interplay in filicide-suicide. Diligent attention to a parent's life stressors may aid in determining risk factors for filicide-suicide. PMID:26087315

  5. Surgical augmentation of interdental papilla - A case series

    PubMed Central

    Muthukumar, Santhanakrishnan; Rangarao, Suresh

    2015-01-01

    Formation of black triangles between teeth due to loss of interdental palpilla is one of the common problems encountered in routine clinical practice, as extreme importance is given to esthetics. This paper discusses two different surgical approaches in treating three cases with papillary loss in the first case the reconstruction of papilla was achieved by using a semilunar coronally repositioned papilla technique and in second and the third case reconstruction of the papilla was achieved by modification of Nodland's microsurgical technique. In all the three cases a free connective tissue graft was used to reconstruct the lost volume of interdental papilla. Complete reconstruction of the lost papilla was achieved in all the three cases 6 months postoperatively. PMID:26604592

  6. Mandibular First Premolars with One Root and Three Canals: A Case Series.

    PubMed

    Daneshvar, Farzaneh; Baziar, Hani; Karkehabadi, Hamed; Jafarzadeh, Hamid; Bhandi, Shilpa; Patil, Shankargouda

    2015-06-01

    The possibility of extra canals in mandibular premolars is quite low; however, it must be taken into account in clinical and radiographic evaluations during root canal treatment. This case series describes the presence of one root and three canals in mandibular premolars in three patients. The case series underlines the importance of complete knowledge about root canal morphology and possible variations to increase the ability of clinicians to treat difficult cases. PMID:26323457

  7. Streptococcus acidominimus causing invasive disease in humans: a case series

    PubMed Central

    2014-01-01

    Introduction Streptococcus acidominimus is a member of the viridans group streptococci and is rarely pathogenic in humans, making it difficult to assess its epidemiologic and clinical significance. Case presentation We report the cases of five Han Chinese patients with invasive diseases caused by S. acidominimus over a one-year time frame. Three of the patients developed continuous fever after surgery, consisting of a successful elective laparoscopic cholecystectomy (case 1), a laparoscopic esophageal resection and gastroesophageal anastomosis (case 2), and a liver transplant in a patient with liver cancer (case 3). For these three patients, cultures of the purulent drainage material grew S. acidominimus. Case 4 concerns a 52-year-old man who developed sepsis 48 hours after hospitalization for hepatitis, liver cirrhosis and hepatitis-related glomerulonephritis. Case 5 concerns a 55-year-old woman receiving regular hemodialysis who had low-grade fever for one month. For these two patients, blood cultures grew S. acidominimus. An antimicrobial susceptibility test revealed that S. acidominimus was resistant to clindamycin and, to some degree, beta-lactam or macrolides. The S. acidominimus from the patient on hemodialysis was resistant to multiple antibiotics. Conclusion S. acidominimus is an ever-increasing cause of disease, especially in patients who are critically ill. It is showing increased resistance to antimicrobial agents, so in patients with viridans group streptococci infections, it is necessary to identify the species to improve the clinical management of S. acidominimus. PMID:24529345

  8. [Spiegelian hernia. Apropos of a series of 31 cases].

    PubMed

    Ondo N'Dong, F; Lorofi, R; Comes, G; Bellamy, J; Diané, C

    1992-04-01

    31 cases of spiegelian hernias are reported. It is one of the world biggest statistics of this affection. The patients were divided in 18 women and 13 men, with an average of 45 years old. The hernia was located on the right side of the abdomen in 16 cases and on the left side in 13 cases. In two cases, the affection was bilateral. In 14 cases, there was an incarceration. No strangulation was observed. The rare forms can be divided in massive form, tumoral, crawling (in the old man), spread (in the infant and the woman). The spiegelian hernia can be associated with one or more other kinds of hernias. 27 patients underwent an operation. In all the cases, an direct approach was used. There was no post operative complications. We want to emphazise the high frequence of this affection in Gabon, and the fact that most of the cases have been observed within the same area, in the south of the country. A study researching predictive factors could be interesting to be realised in this area. PMID:1527192

  9. Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

    PubMed Central

    Srinivasan, Uddanapalli Sreeramulu; Lawrence, Radhi

    2015-01-01

    Introduction and Aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. Materials and Methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years. Results: In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making. Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst. PMID:25767579

  10. Tonsillitis with acute myeloid leukemia: a case series for caution.

    PubMed

    Thakur, Jagdeep S; Mohindroo, N K; Sharma, D R; Mohindroo, Shobha; Thakur, Anamika

    2013-01-01

    Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy. PMID:23599112

  11. Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2016-01-01

    Introduction The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned. Case Presentation Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects. Conclusions The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss. PMID:27148497

  12. Massive subchorionic thrombohematoma: a series of 10 cases.

    PubMed

    Fung, Tak Yuen; To, Ka Fai; Sahota, Daljit Singh; Chan, Lin Wai; Leung, Tak Yeung; Lau, Tze Kin

    2010-10-01

    A retrospective audit identified 10 cases of massive idiopathic subchorionic thrombohematoma. The incidence was 1:3,133. Only six of these pregnancies resulted in a livebirth and only two reached term. In eight cases there were ultrasound abnormalities, including two cases of placentomegaly both of which resulted in a pregnancy loss. There was one placental abruption. Seven of the women were nulliparous. Massive subchorionic thrombohematoma is associated with poor pregnancy outcome. Ultrasound findings of placentomegaly might be a bad prognostic sign. PMID:20846069

  13. Gynecologic findings in Goltz syndrome: A case series.

    PubMed

    Adeyemi-Fowode, Oluyemisi A; Mansouri, Roshanak; Dietrich, Jennifer E

    2016-03-01

    There is limited information available related to the gynecologic findings in Goltz syndrome. We report exclusively on external genitalia findings in 17 girls with a known diagnosis of focal dermal hypoplasia. This is the largest series to date. Some of our findings have been reported previously; however, some novel features including short perineum body not previously mentioned are noted as well. We recommend referral to a pediatric gynecologist for early evaluation of the reproductive tract as this can have an impact on the future fertility of these girls. © 2016 Wiley Periodicals, Inc. PMID:27001927

  14. BACLOFEN IN THE TREATMENT OF PERSISTENT HICCUP: A CASE SERIES

    PubMed Central

    Mirijello, Antonio; Addolorato, Giovanni; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Leggio, Lorenzo; Landolfi, Raffaele

    2016-01-01

    Background Persistent hiccup is a worrying symptom both for patients, because of reduced quality of life, and for physicians, because of frustration for unsuccessful treatments. Aim To test baclofen administration for the treatment of persistent hiccup. Methods We report a series of seven patients affected by persistent hiccup successfully treated with baclofen. Results Hiccup stopped in all patients after a single administration of the drug. Conclusions Baclofen is a GABAB receptor agonist. It is conceivable that the reduction of dopamine release by GABAB receptor stimulation is able to interrupt hiccup's reflex arc. PMID:23834241

  15. Breast Cancer in Transgender Veterans: A Ten-Case Series.

    PubMed

    Brown, George R

    2015-03-01

    All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female). PMID:26790021

  16. Postintubation tracheal injuries--case series and literature review.

    PubMed

    Misak, Vilka Bekavac; Beraković, Andrea Persin; Vukusić, Ivana; Kogler, Jana; Pazanin, Leo; Ozegović, Slavica Orehovec

    2012-09-01

    SUMMARY - Post-intubation tracheal injury is a rare and potentially fatal complication. The most common causes are overinflation ofendotracheal tube cuffs and multiple intubation attempts in emergency cases. The diagnosis is based on clinical and radiological suspicion of tracheal injury confirmed by fiberoptic bronchoscopy. Decision between conservative and surgical management of the injury depends on clinical presentation (respiratory instability, concomitant diseases), lesion characteristics (lesion site, size, and number), and time elapsed from injury to diagnosis. We present three cases ofpost-intubation tracheal injury. In two cases, the patients were treated conservatively; in the third case, the patient died from asphyxia caused by thrombus occlusion of the trachea after a longitudinal tracheal lesion. Pre-anesthetic examination did not indicate any possibility of difficult intubation in any of the patients; however, in one of the patients admitted through the emergency department, emergency intubation was performed. PMID:23330416

  17. Sentinel lymph node biopsy in paediatric melanoma. A case series.

    PubMed

    Sánchez Aguilar, M; Álvarez Pérez, R M; García Gómez, F J; Fernández Ortega, P; Borrego Dorado, I

    2015-01-01

    The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity. PMID:25595513

  18. Proximal Interruption of the Pulmonary Artery: A Case Series

    PubMed Central

    Anand, S.H.; Mani, Sunithi Elizabeth; Joseph, Elizabeth; Mathai, John

    2015-01-01

    We present a few cases of Proximal Interruption of the Pulmonary Artery, an uncommon developmental anomaly associated with congenital heart disease. The cases had varied clinical presentations. Chest radiograph showed a hypoplastic lung with an ipsilateral small hilum on the side of the interruption and hyperinflation of the contralateral lung. Contrast CT confirmed the diagnosis, demonstrating non-visualization of the left or right pulmonary artery, and other related findings. PMID:26816968

  19. Proximal Interruption of the Pulmonary Artery: A Case Series.

    PubMed

    Anand, S H; Jasper, Anitha; Mani, Sunithi Elizabeth; Joseph, Elizabeth; Mathai, John

    2015-12-01

    We present a few cases of Proximal Interruption of the Pulmonary Artery, an uncommon developmental anomaly associated with congenital heart disease. The cases had varied clinical presentations. Chest radiograph showed a hypoplastic lung with an ipsilateral small hilum on the side of the interruption and hyperinflation of the contralateral lung. Contrast CT confirmed the diagnosis, demonstrating non-visualization of the left or right pulmonary artery, and other related findings. PMID:26816968

  20. Treatment of epidermoid tumors with gamma knife radiosurgery: Case series

    PubMed Central

    Vasquez, Javier A. Jacobo; Fonnegra, Julio R.; Diez, Juan C.; Fonnegra, Andres

    2016-01-01

    Background: Epidermoid tumors (ETs) are benign lesions that are treated mainly by means of surgical resection, with overall good results. External beam radiotherapy is an alternative treatment for those recurrent tumors, in which a second surgery might not be the best choice for the patient. A little information exists about the effectiveness of gamma knife radiosurgery for the treatment of newly diagnosed and recurrent ETs. We present three cases of ETs treated with gamma knife radiosurgery. Case Description: Case 1 is a 21-year-old female with an ET located in the left cerebellopontine angle (CPA) with symptoms related to VIII cranial nerve dysfunction. Symptom control was achieved and maintained after single session radiosurgery with gamma knife. Case 2 is a 59-year-old female patient with the history of trigeminal neuralgia secondary to a recurrent ET located in the left CPA. Significant pain improvement was achieved after treatment with gamma knife radiosurgery. Case 3 is a 29-year-old male patient with a CPA ET causing long lasting trigeminal neuralgia, pain relief was achieved in this patient after gamma knife radiosurgery. Conclusion: Long-term symptom relief was achieved in all three cases proving that gamma knife radiosurgery is a good and safe alternative for patients with recurrent or nonsurgically treated ETs. PMID:26958427

  1. [Mixed gonadal dysgenesis. Apropos of a series of 21 cases].

    PubMed

    Lalau Keraly, J; Chaussain, J L; Job, J C

    1985-03-01

    Twenty-one cases of mixed gonadal dysgenesis referred at age 1 to 16 years are studied. External genitalia were in most cases of types III-IV, with a small penis and posterior hypospadias, asymmetrical genital folds containing an externalized testis on one side. The internal genitalia varied according to the degree of dysgenesis of the gonads, and included an uterus and/or a vagina in 18 among the 21 cases. A chromosomal mosaicism XO/XY or XX/XY was found in 11 patients, the other 10 having a normal 46 XY caryotype. Pubertal follow-up was obtained in 10 cases, and showed always a male sexual development, without possibility to exactly evaluate the function of the testis. Choosing the sex assignment is relatively easy in newborns or infants with mixed gonadal dysgenesis. It relies more on anatomy (size of corpora cavernosa, feasibility of urethroplasty or vaginoplasty) than on the results of hormonal measurements. The presence of an Y chromosome is not by itself an argument to choose the male sex. In most cases, the choice of the female sex is the easiest and relies on strong clinical arguments, but it leads unavoidably to suppress both the testis and the dysgenetic gonad. PMID:4004479

  2. Penile cancer: a local case series and literature review

    PubMed Central

    Lau, Wei Da; Ong, Chin Hu; Lim, Tow Poh; Teo, Colin

    2015-01-01

    INTRODUCTION Penile cancer is an uncommon disease affecting only about one in 100,000 men worldwide in a year. The diagnosis of the condition is frequently delayed, and the disease and its treatment frequently result in significant morbidity in patients. METHODS We herein describe seven cases of penile tumours: six cases of squamous cell carcinomas and one case of B-cell lymphoma that presented to our hospital’s urology department between March 2011 and October 2012. We reviewed the literature to discuss the clinical presentation, natural history and current management of penile cancer. RESULTS The patients were followed up for 1–24 months. They were managed according to their disease stage and lymph node status. Four out of seven patients showed disease progression during the follow-up period. CONCLUSION The accurate staging of inguinal nodes in cases of low-risk disease is important to prescribe appropriate surgery for the inguinal nodes. Aggressive management of inguinal and pelvic lymph nodes remains the cornerstone in the treatment of high-risk disease cases. PMID:26668410

  3. Case series of rhinocerebral mucormycosis occurring in diabetic patients

    PubMed Central

    Mohammadi, Rasoul; Meidani, Mohsen; Mostafavizadeh, Kamyar; Iraj, Bijan; Hamedani, Pooria; Sayedain, Sayed Mohammad Amin; Mokhtari, Mojgan

    2015-01-01

    Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%). Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database. Conclusion: In patients with mucoreosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection. PMID:26644901

  4. Neuroinfection as a Mask of Lung Cancer: A Case Series

    PubMed Central

    Kuklińska, Beata; Moniuszko-Malinowska, Anna; Mróz, Robert; Pancewicz, Sławomir; Zajkowska, Joanna

    2016-01-01

    Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer. PMID:27239354

  5. Laryngeal myofibroblastic tumor: case series and literature review

    PubMed Central

    Alhumaid, Humaid; Bukhari, Manal; Rikabi, Ammar; Farahat, Mohamad; Mesallam, Tamer A.; Malki, Khalid H.; Aldkhyyal, Ahmed

    2011-01-01

    Inflammatory myofibroblastic tumor (IMT) or (plasma cell granuloma) of the larynx is a rare benign lesion that usually involves the lungs and broncopulmonary tree, as well as abdominal viscera. Overall this kind of tumor represents less than 1% of all tumors in the lung and respiratory tract with only 31 cases reported to date in the English language literature of laryngeal IMT. We report the first 2 cases in Saudia Arabia of IMT of the larynx treated at King Abdulaziz University Hospital (KAUH) with literature review. PMID:23267296

  6. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study.

    PubMed

    McClure, Philip; Booy, David; Katarincic, Julia; Eberson, Craig

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. PMID:26977161

  7. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study

    PubMed Central

    McClure, Philip; Booy, David; Katarincic, Julia; Eberson, Craig

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. PMID:26977161

  8. Bethanechol for buprenorphine-related urinary hesitancy: a case series.

    PubMed

    Varma, Anjali; Smigiel, Joseph; Eck, Nancy; Brooks, Stephanie

    2011-09-01

    Constipation is a well-known side effect of buprenorphine, but urinary hesitancy is less frequently discussed and may go unrecognized. Reported are the 2 cases of men older than 50 years who experienced disabling urinary hesitancy with buprenorphine and naloxone combination (suboxone) and were successfully treated with bethanechol, a cholinergic medication. PMID:21844838

  9. Spontaneous coronary artery dissection: a case series and literature review

    PubMed Central

    Garcia, Nelson A. Telles; Khan, Abul N.; Boppana, Ratna C.; Smith, Hayden L.

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare and often lethal cause of acute coronary syndrome, which typically affects young women and otherwise healthy individuals. SCAD can be diagnosed in patients undergoing coronary angiography and can be underestimated. Special techniques such as optical coherence tomography (OCT) and intravascular ultrasound should be used when there is suspicion of the condition. In the majority of cases, the left anterior descending (LAD) artery is involved; however, a few cases of the right coronary artery (RCA) involvement have been reported. This article describes three cases of SCAD in women of different ages, all presenting with chest pain. Coronary angiography in conjunction with OCT was used for diagnosis in two of the cases. One of the patients had involvement of the proximal RCA and underwent percutaneous coronary intervention, whereas the other two patients had mid-LAD disease and were treated conservatively with medical therapy. Presently, there are no specific guidelines for the treatment of SCAD, and therapy is individualized according to extent and severity of the condition. PMID:25317273

  10. Patchy alopecia areata sparing gray hairs: a case series

    PubMed Central

    Jia, Wei-Xue; Mao, Qiu-Xia; Xiao, Xue-Min; Li, Zhi-Liang; Yu, Rui-Xing

    2014-01-01

    Alopecia areata is an unpredictable, non-scarring hair loss condition. Patchy alopecia areata sparing gray hairs is rare. Here we present 4 cases with patchy non-scarring hair loss, which attacked pigmented hairs only and spared gray hairs. It should be differentiated from vitiligo, colocalization of vitiligo and alopecia areata, and depigmented hair regrowth after alopecia areata. PMID:25097478

  11. Looking for Childhood Schizophrenia: Case Series of False Positives.

    ERIC Educational Resources Information Center

    Stayer, Catherine; Sporn, Alexandra; Gogtay, Nitin; Tossell, Julia; Lenane, Marge; Gochman, Peter; Rapoport, Judith L.

    2004-01-01

    Extensive experience with the diagnosis of childhood-onset schizophrenia indicates a high rate of false positives. Most mislabeled patients have chronic disabling, affective, or behavioral disorders. The authors report the cases of three children who passed stringent initial childhood-onset schizophrenia "screens" but had no chronic psychotic…

  12. Distance-Learning Programs. Case Studies in TESOL Practice Series.

    ERIC Educational Resources Information Center

    Henrichsen, Lynn E., Ed.

    The 14 cases in this book show how distance learning takes a variety of forms in teaching English to speakers of other languages (TESOL). The 15 chapters include the following: (1) "Beyond Adding Telecommunications to a Traditional Course: Insights into Human and Instructional Factors Affecting Distance Learning in TESOL" (Lynn E. Hendrichsen);…

  13. Opening a New Catholic School: A Series of Case Studies.

    ERIC Educational Resources Information Center

    Kealey, Robert J., Ed.

    During the last 10 years, almost 200 new Catholic schools have opened across the United States. This booklet presents nine case studies that provide ideas about how to open new Catholic schools. The schools include: (1) Diocese of Arlington, Virginia; (2) St. John Neuman Regional Catholic School, Archdiocese of Atlanta, Georgia; (3) Charlotte…

  14. Diagnostic Dilemma in Ovarian Pregnancy: A Case Series

    PubMed Central

    Pallavee, P.; Samal, Sunita

    2015-01-01

    Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg’s criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality. PMID:26023609

  15. [Misuse of substances theoretically without abuse potential--case series].

    PubMed

    Anand, Jacek Sein; Habrat, Bogusław; Sut, Michał; Korolkiewicz, Roman

    2009-01-01

    The aim of our study was to present cases of misuse of different substances theoretically without abuse potential. In the last few years such behavior became an increasing problem in toxicological and emergency units. Lack of typical signs of intoxication with psychoactive substances, and negative results of standard toxicological tests may be a challenge for toxicologists and emergency medicine practitioners. PMID:19788132

  16. Single-incision laparoscopic sigmoidectomy and rectopexy case series.

    PubMed

    Adair, James; Gromski, Mark A; Nagle, Deborah

    2011-08-01

    Single-incision laparoscopic surgery has recently been investigated as a novel approach to colorectal pathology. This article describes 3 cases of single-incision laparoscopic sigmoidectomy with rectopexy for the treatment of rectal prolapse. We demonstrate our surgical approach and results from these initial patients treated with this novel technique. PMID:21810504

  17. Diagnostic dilemma in ovarian pregnancy: a case series.

    PubMed

    Begum, Jasmina; Pallavee, P; Samal, Sunita

    2015-04-01

    Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg's criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality. PMID:26023609

  18. BCS to Bose crossover: Broken-symmetry state

    SciTech Connect

    Engelbrecht, J.R. |; Randeria, M. |; Sa de Melo, C.A.

    1997-06-01

    A functional integral formulation, used previously to calculate T{sub c} and describe normal state properties of the BCS-Bose crossover, is extended to T{lt}T{sub c}. The saddle point approximation is shown to be qualitatively correct for T{lt}T{sub c} for {ital all} couplings, in contrast to the situation above T{sub c}. Several features of the crossover are described. The difference between the T=0 {open_quotes}pair size{close_quotes} and the (prefactor of the T dependent) Ginzburg-Landau coherence length is pointed out: the two quantities are the same only in the BCS limit. The evolution of the collective modes from the BCS to the Bose regime is discussed together with the mixing of the amplitude and phase in the absence of a particle-hole symmetry. {copyright} {ital 1997} {ital The American Physical Society}

  19. Cases Series of Malignant Lymphohematopoietic Disorder in Korean Semiconductor Industry

    PubMed Central

    Lee, Hye-Eun; Ryu, Hyung-Woo; Park, Seung-Hyun; Kang, Seong-Kyu

    2011-01-01

    Objectives Seven cases of malignant lymphohematopoietic (LHP) disorder were claimed to have developed from occupational exposure at two plants of a semiconductor company from 2007 to 2010. This study evaluated the possibility of exposure to carcinogenic agents for the cases. Methods Clinical courses were reviewed with assessing possible exposure to carcinogenic agents related to LHP cancers. Chemicals used at six major semiconductor companies in Korea were reviewed. Airborne monitoring for chemicals, including benzene, was conducted and the ionizing radiation dose was measured from 2008 to 2010. Results The latency of seven cases (five leukemiae, a Non-Hodgkin's lymphoma, and an aplastic anemia) ranged from 16 months to 15 years and 5 months. Most chemical measurements were at levels of less than 10% of the Korean Occupational Exposure Limit value. No carcinogens related to LHP cancers were used or detected. Complete-shielded radiation-generating devices were used, but the ionizing radiation doses were 0.20-0.22 uSv/hr (background level: 0.21 µSv/hr). Airborne benzene was detected at 0.31 ppb when the detection limit was lowered as low as possible. Ethylene oxide and formaldehyde were not found in the cases' processes, while these two were determined to be among the 263 chemicals in the list that was used at the six semiconductor companies at levels lower than 0.1%. Exposures occurring before 2002 could not be assessed because of the lack of information. Conclusion Considering the possibility of exposure to carcinogenic agents, we could not find any convincing evidence for occupational exposure in all investigated cases. However, further study is needed because the semiconductor industry is a newly developing one. PMID:22953195

  20. Simple resection of truncal desmoid tumors: A case series

    PubMed Central

    Nishida, Yoshihiro; Tsukushi, Satoshi; Urakawa, Hiroshi; Hamada, Shunsuke; Kozawa, Eiji; Ikuta, Kunihiro; Ishiguro, Naoki

    2016-01-01

    Desmoid tumors of the extra-abdominal and abdominal wall have been associated with morbidity due to the aggressive nature of the surgery and high recurrence rates. Surgery that does not cause functional impairment is desired for patients with desmoid tumors. In the present study, among patients with desmoid tumors who were prospectively and consecutively treated with identical conservative treatment with meloxicam, a selected patients of patients were treated with less invasive surgery than wide-resection. Out of 60 patients pathologically diagnosed with desmoid tumors, 9 patients with tumors refractory to conservative treatment and 4 patients who refused to receive this type of treatment were treated with planned simple resection. Subsequently, the clinical outcome of the patients and the mutational status of the catenin β-1 (CTNNB1) gene in the tumors were analyzed. The mean age of the 13 patients that underwent planned simple resection was 39 years, and the tumors were located in the abdominal wall in 6 cases, the chest wall in 4 cases and the neck in 3 cases. All excised specimens were evaluated and positive microscopic margins were identified; however, during the mean follow-up period of 30 months, 12/13 cases, 7 of which had T41A mutations and 5 of which had no mutations (wild-type), did not develop recurrence. Only 1 initial case with an S45F mutation in the CTNNB1 gene developed recurrence. The results of the present prospectively treated with simple resection and retrospectively analyzed study suggest that planned simple resection could serve as a therapeutic modality for extraperitoneal desmoid tumors, particularly truncal ones with a wild-type or T41A mutational status. PMID:27446472

  1. Case series in drug safety: a review to determine characteristics and quality.

    PubMed

    Abou Chakra, Claire Nour; Pariente, Antoine; Pinet, Marion; Nkeng, Lenhangmbong; Moore, Nicholas; Moride, Yola

    2010-12-01

    Case series and case reports are a cornerstone of drug safety research; however, the characteristics of case series published in the literature remain poorly examined. A narrative review of case series addressing drug safety, published in the literature between 1 January 2003 and 15 July 2009, and identified through a PubMed search, was conducted in order to determine their characteristics and quality according to the criteria found in the US FDA Pharmacovigilance Guidance 2005. Of 130 publications that met the search criteria, 11.5% included an analytical component and 88.5% were descriptive. The median number of cases included in a given case series was 7 (range 2-2195) and the median time period for recruitment of the cases was 23 months (range 0.5-96). Overall, 43.1% of case series consisted of individual case reports, while 24.6% originated from cohorts and 21% from pharmacovigilance databases. Of the case series, 65.1% concerned adults (age ≥18 years), 11.6% elderly (age ≥65 years) and 8.5% youth (<18 years). Adverse effects involved mainly the skin (18.5%) and the circulatory system (13.8%). The main suspected drug classes (Anatomical Therapeutic Chemical classification) were nervous system drugs (23.1%) and antineoplastic and immunomodulating agents (20.0%). On average, six out of the possible nine US FDA Pharmacovigilance Guidance Criteria were fulfilled, with 27% of publications fulfilling at least seven criteria. Only 10% reported data on co-morbidity. In conclusion, this review highlights the reporting gaps and heterogeneity in published case series with respect to size, recruitment period and quality. PMID:21077699

  2. [Experience in thyroglossal duct pathology: clinical case series].

    PubMed

    Cieri, Patricio; Udaquiola, Julia E; Calello, Santiago E; Libero, Daniel H

    2016-10-01

    The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45). PMID:27606652

  3. Split median raphe: case series and brief literature review.

    PubMed

    Valerio, Enrico; Cutrone, Mario

    2014-01-01

    We describe three cases of split median raphe of the penis (SMR) from our hospital newborn records from 2004 to 2013. One case was associated with median raphe cyst, one with skin hypochromia, and one with a scar-like aspect of the region of interest. SMR is thought to be the result of defective fusion of ectodermal tissue in the urethra and scrotum area or of defective growth of the perineal mesoderm around the urethra during gestation. Although SMR associated with other major penile congenital defects (epispadias, hypospadias, penile torsion, bifid scrotum, chordee) is common, isolated SMR is probably an underdiagnosed (although not rare) malformative condition. Recognizing SMR in a newborn may be of educational value to neonatologists because it leads to the search for and exclusion of the above-mentioned pathologic conditions. PMID:25236772

  4. Probable Nootropicinduced Psychiatric Adverse Effects: A Series of Four Cases

    PubMed Central

    Ajaltouni, Jean

    2015-01-01

    The misuse of nootropics—any substance that may alter, improve, or augment cognitive performance, mainly through the stimulation or inhibition of certain neurotransmitters—may potentially be dangerous and deleterious to the human brain, and certain individuals with a history of mental or substance use disorders might be particularly vulnerable to their adverse effects. We describe four cases of probable nootropic-induced psychiatric adverse effects to illustrate this theory. To the best of our knowledge this has not been previously reported in the formal medical literature. We briefly describe the most common classes of nootropics, including their postulated or proven methods of actions, their desired effects, and their adverse side effects, and provide a brief discussion of the cases. Our objective is to raise awareness among physicians in general and psychiatrists and addiction specialists in particular of the potentially dangerous phenomenon of unsupervised nootropic use among young adults who may be especially vulnerable to nootropics’ negative effects. PMID:27222762

  5. Clinical Use of Laser-Microtextured Abutments: A Case Series.

    PubMed

    Shapoff, Cary A; Babushkin, Jeffrey A; Wohl, David J

    2016-01-01

    This article discusses the clinical use of laser-microtextured abutments on dental implant restorations. Four cases are presented, each using one of the four commercially available laser-microtextured abutment styles. Numerous preclinical and clinical studies have shown the positive effects of laser microtexturing on the implant platform in limiting crestal bone loss and benefiting soft tissue stability. Other histologic studies of laser microtexturing on the implant abutment have demonstrated the ability of this specific feature to block epithelial downgrowth and provide a functional connective tissue attachment to the abutment surface. Other abutment designs, styles, and materials have only demonstrated a soft tissue seal with epithelial adhesion and a circular ring of connective tissue fibers around the abutment without direct contact. This article presents clinical and radiographic case examples from a private practice perspective on the longterm successful use of microtextured abutments with respect to crestal bone levels, exceptional soft tissue health, and stability with minimal sulcular depth. PMID:27560683

  6. Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series

    PubMed Central

    Pattnaik, Naina; Satpathy, Anurag; Mohanty, Rinkee; Nayak, Rashmita; Sahoo, Surjeet

    2015-01-01

    Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions. PMID:26664762

  7. Probable Nootropicinduced Psychiatric Adverse Effects: A Series of Four Cases.

    PubMed

    Talih, Farid; Ajaltouni, Jean

    2015-01-01

    The misuse of nootropics-any substance that may alter, improve, or augment cognitive performance, mainly through the stimulation or inhibition of certain neurotransmitters-may potentially be dangerous and deleterious to the human brain, and certain individuals with a history of mental or substance use disorders might be particularly vulnerable to their adverse effects. We describe four cases of probable nootropic-induced psychiatric adverse effects to illustrate this theory. To the best of our knowledge this has not been previously reported in the formal medical literature. We briefly describe the most common classes of nootropics, including their postulated or proven methods of actions, their desired effects, and their adverse side effects, and provide a brief discussion of the cases. Our objective is to raise awareness among physicians in general and psychiatrists and addiction specialists in particular of the potentially dangerous phenomenon of unsupervised nootropic use among young adults who may be especially vulnerable to nootropics' negative effects. PMID:27222762

  8. Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series.

    PubMed

    Pattnaik, Naina; Satpathy, Anurag; Mohanty, Rinkee; Nayak, Rashmita; Sahoo, Surjeet

    2015-01-01

    Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions. PMID:26664762

  9. Micafungin in the treatment of candiduria: A case series

    PubMed Central

    Kane, Lauren E.; Muzevich, Katie M.

    2016-01-01

    Echinocandin antifungal agents are not routinely recommended for the treatment of candiduria due to low urine concentrations and a paucity of clinical data supporting this indication. This report presents five cases describing the use of micafungin for the treatment of candiduria. Each patient received parenteral micafungin for a minimum of 6 days and had resolution of baseline fungal within 30 days of treatment completion. PMID:26937340

  10. Dyke-Davidoff-Masson Syndrome: Time to Revisit Case Series.

    PubMed

    Shubhakaran; Bhushan, Bharat

    2015-09-01

    We read a case report by Manghera et al (JAPI, Vol 62 page No. 76-67), which was in response to an earlier case report by Ola et al.1 Here we would like to share our experience and views as under- The authors in the correspondence have said that crossed cerebellar atrophy is an unusual and rare finding. We in our study of 28 patients of DDMS, have found cerebellar atrophy in nine patients along with cerebral atrophy.2 Out of nine patients with cerebellar atrophy three patients had diffuse bilateral atrophy, only one patient had unilateral cerebellar atrophy which was controlateral to left cerebral hemiatrophy (CHA). This is similar to the findings of the authors and the patho-physiology quoted by authors is worth appreciation. Other parenchymal changes observed in our study were cerebral peduncle atrophy in three patients, and thalamic atrophy with lentiform nucleus hypoplasia in 11 patients. Seven cases of CHA were associated with ipsilateral large schizencephalic cleft with absence of the septum pellucidum whereas two had porencephaly. Five patients had left-sided hippocampal sclerosis (HS), four were concordant and one was discordant. PMID:27608884

  11. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    PubMed Central

    2016-01-01

    Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL); postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes); no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n = 1), 41–60 (n = 1), and >60 (n = 55); scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy. PMID:27144170

  12. Kissing molars extraction: Case series and review of the literature

    PubMed Central

    Arjona-Amo, Manuel; Torres-Carranza, Eusebio; Batista-Cruzado, Antonio; Serrera-Figallo, Maria-Angeles; Crespo-Torres, Santos; Belmonte-Caro, Rodolfo; Albisu-Andrade, Claudio; Gutiérrez-Pérez, José-Luis

    2016-01-01

    Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. Key words:Impacted molar, kissing molar, surgical extraction. PMID:26855716

  13. Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series

    PubMed Central

    Senthil, Sirisha; Garudadri, Chandrasekhar; Rao, Harsha B L; Maheshwari, Rajat

    2010-01-01

    The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management. PMID:20413935

  14. Bisphosphonates in Langerhans Cell Histiocytosis: An International Retrospective Case Series

    PubMed Central

    Chellapandian, Deepak; Makras, Polyzois; Kaltsas, Gregory; van den Bos, Cor; Naccache, Lamia; Rampal, Raajit; Carret, Anne-Sophie; Weitzman, Sheila; Egeler, R. Maarten; Abla, Oussama

    2016-01-01

    Background Bone is the most common organ of involvement in patients with Langerhans cell histiocytosis (LCH), which is often painful and associated with significant morbidity from pathological fractures. Current first-line treatments include chemotherapy and steroids that are effective but often associated with adverse effects, whereas the disease may reactivate despite an initial response to first-line agents. Bisphosphonates are osteoclast inhibitors that have shown to be helpful in treating bone lesions of LCH. To date, there are no large international studies to describe their role in treating bone lesions of LCH. Method We conducted a multicenter retrospective review of 13 patients with histologically proven LCH, who had received bisphosphonates either at diagnosis or at disease reactivation. Results Ten patients (77%) had a single system bone disease, and 3 (23%) had bone lesions as part of multisystem disease. Median follow-up time post-bisphosphonate therapy was 4.6 years (range, 0.8 to 8.2 years). Treatment with bisphosphonates was associated with significant pain relief in almost all patients. Twelve (92%) achieved resolution of active bone lesions, and 10 out of them had no active disease for a median of 3.5 years (range, 0.8 to 5 years). One patient did not respond. No major adverse effects were reported in this series. Conclusion Bisphosphonates are well-tolerated drugs that can significantly improve bone pain and induce remission in active bone LCH. Future prospective studies evaluating the role of bisphosphonates in LCH are warranted. PMID:27413525

  15. Crisponi/CISS1 syndrome: A case series.

    PubMed

    Alhashem, Amal M; Majeed-Saidan, Muhammad Ali; Ammari, Amer N; Alrakaf, Maha S; Nojoom, Maha; Maddirevula, Sateesh; Faqeih, Eissa; Alkuraya, Fowzan S; Garne, Ester; Kurdi, Ahmad M

    2016-05-01

    Crisponi/CISS1 syndrome (MIM#272430) is a rare autosomal recessive disease characterized by major feeding difficulties, camptodactyly, and anhidrosis in early childhood; and the subsequent development of paradoxical cold-induced sweating and scoliosis later in life. The syndrome is caused by biallelic mutations in CRLF1 or, much less commonly, CLCF1. Although genotype/phenotype correlation has been elusive, it has been suggested that the level of the mutant protein may correlate with the phenotypic severity. However, we show in this series of 12 patients from four families, all previously unpublished, that the homogeneity of the recently described c.983dupG (p.Ser328Argfs∗2) mutation in CRLF1 was associated with a highly variable degree of severity, and that the phenotype significantly overlaps with the recently described COG6-related anhidrosis syndrome (MIM#615328). Another fifth previously unpublished family is also described with a novel mutation in CRLF1, c.605delC (p.Ala202Valfs*32). In Saudi Arabia the prevalence of the syndrome is probably underestimated due to the difficulty in making the diagnosis considering the complex phenotype with typical neonatal and evolutive features. © 2016 Wiley Periodicals, Inc. PMID:26804344

  16. Dental implants inserted in native bone: Cases series analyses

    PubMed Central

    Guidi, Riccardo; Viscioni, Alessandro; Dattola, Frencesco; Carinci, Francesco

    2012-01-01

    Background: The concept of osseointegration, i.e., the direct anchorage of endosseous implants made of commercially pure or titanium alloy to the bone caused a breakthrough in oral rehabilitation. The identification of factors for long-term survival and success rate are the main goal of the recent literature. Several variables can influence the final result, and in general they are grouped in surgery-, host-, implant-, and occlusion-related factors. Materials and Methods: A retrospective analysis on a large series of dental implants was performed to detect those variables influencing the clinical outcome. In the period between January 2007 and December 2009, 157 patients were operated. A total of 429 implants were inserted. Dental implants are reliable devices to be used in oral rehabilitation. Results: Globally, very few implants were lost at the end of the follow-up period. Slight but significant differences existed among different implants types with regard to peri-implant bone resorption. Conclusion: A better clinical outcome was revealed for Sweden and Martina global implant. PMID:23814579

  17. Hypophosphatemic rickets and craniosynostosis: a multicenter case series.

    PubMed

    Vega, Rafael A; Opalak, Charles; Harshbarger, Raymond J; Fearon, Jeffrey A; Ritter, Ann M; Collins, John J; Rhodes, Jennifer L

    2016-06-01

    OBJECTIVE This study examines a series of patients with hypophosphatemic rickets and craniosynostosis to characterize the clinical course and associated craniofacial anomalies. METHODS A 20-year retrospective review identified patients with hypophosphatemic rickets and secondary craniosynostosis at 3 major craniofacial centers. Parameters examined included sex, age at diagnosis of head shape anomaly, affected sutures, etiology of rickets, presenting symptoms, number and type of surgical interventions, and associated diagnoses. A review of the literature was performed to optimize treatment recommendations. RESULTS Ten patients were identified (8 males, 2 females). Age at presentation ranged from 1 to 9 years. The most commonly affected suture was the sagittal (6/10 patients). Etiologies included antacid-induced rickets, autosomal dominant hypophosphatemic rickets, and X-linked hypophosphatemic (XLH) rickets. Nine patients had undergone at least 1 cranial vault remodeling (CVR) surgery. Three patients underwent subsequent surgeries in later years. Four patients underwent formal intracranial pressure (ICP) monitoring, 3 of which revealed elevated ICP. Three patients were diagnosed with a Chiari Type I malformation. CONCLUSIONS Secondary craniosynostosis develops postnatally due to metabolic or mechanical factors. The most common metabolic cause is hypophosphatemic rickets, which has a variety of etiologies. Head shape changes occur later and with a more heterogeneous presentation compared with that of primary craniosynostosis. CVR may be required to prevent or relieve elevated ICP and abnormalities of the cranial vault. Children with hypophosphatemic rickets who develop head shape abnormalities should be promptly referred to a craniofacial specialist. PMID:26824597

  18. Anaphylaxis to Patent Blue V: a case series

    PubMed Central

    Manson, Ania L.; Juneja, Rohit; Self, Robert; Farquhar-Smith, Paul; MacNeill, Fiona

    2012-01-01

    Blue dyes such as Patent Blue V (PBV) have been used in medical procedures for decades, and in the United Kingdom they are routinely utilised in sentinel lymph node biopsy (SLNB) for staging the axilla in early breast cancer. However, it has long been recognised that such dyes are associated with anaphylaxis. It has recently been estimated in a prospective study that allergy to PBV occurs with a frequency of 0.9%. Since repeated SLNB (and therefore further exposure to PBV) is increasingly being advocated for the small proportion of patients who develop a local (in-breast) recurrence, and because anaphylaxis can be life-threatening, it is important that those individuals that are allergic to PBV are recognised on their first medical exposure. The measurement of serum mast-cell tryptase (MCT) and skin prick test (SPT) are used in the investigation of suspected anaphylaxis because positive results are supportive of type-1 mediated hypersensitivity. Here we report the clinical features, MCT results and SPT results that pertain to a series of four patients referred to our drug allergy clinic with suspected anaphylaxis following SLNB. We recommend that all patients that show clinical evidence of allergy following exposure to PBV are referred to a specialist drug allergy service for further evaluation to investigate the cause. PMID:22348211

  19. Epithelioid Angiosarcoma of the Bladder: A Series of 9 Cases.

    PubMed

    Matoso, Andres; Epstein, Jonathan I

    2015-10-01

    Primary angiosarcoma of the bladder is very rare, with approximately 30 cases reported in the literature. Those with epithelioid morphology are even rarer, with only single-case reports published. We describe the histopathologic features and clinical follow-up of 9 patients with epithelioid angiosarcoma (EA) of the bladder retrieved from our Surgical Pathology files from 1998 to 2014. Eight cases were consults. The mean age at presentation was 65 years (range, 39 to 85 y). The M:F ratio was 8:1. The clinical presentation was hematuria and bladder mass in all cases. Six patients had a history of radiotherapy to the pelvis, 5 to treat prostate cancer and 1 to treat uterine cervical cancer. The time from radiotherapy to the diagnosis of EA ranged from 6 to 15 years. The average size of the tumor was 4 cm. (range, 1 to 8 cm.). The submitting diagnoses were poorly differentiated carcinoma (n=5), high-grade invasive urothelial carcinoma (n=3), and atypical vascular proliferation (n=1). Morphologically, the tumors were composed of nests and sheets of highly atypical cells with high nuclear to cytoplasmic ratio, occasional intracytoplasmic lumens, and a hemorrhagic background. None of the cases showed any urothelial carcinoma component. Three patients showed in addition usual angiosarcoma in the resection specimen. By immunohistochemistry, 5/9 cases were positive for cytokeratins, including CK7 (n=3), AE1/AE3 (n=3), and Cam5.2 (n=1). All cases were positive for at least 1 endothelial marker, including CD31 (n=7), CD34 (n=2), FVIII (n=3), and ERG (n=2). Urothelial markers (p63 and GATA3) were consistently negative. Surgical treatment included transurethral resection of the bladder (TURB) only (n=5), TURB followed by cystoprostatectomy (n=2), TURB followed by partial cystectomy (n=1), and cystoprostatectomy only (n=1). The tumor involved the muscularis propria in 5/9 patients, the periureteric adipose tissue in 1 patient, and the prostate and seminal vesicles in 1 patient

  20. Neonates presenting with severe complications of frenotomy: a case series

    PubMed Central

    2012-01-01

    Introduction Tongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia. Case presentation Case 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later. Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later. Conclusion Treatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated. PMID:22394653

  1. Rupture of the triceps tendon - A case series.

    PubMed

    Jaiswal, Atin; Kacchap, Naiman-Deep; Tanwar, Yashwant-Singh; Kumar, Devendra; Kumar, Birendra

    2016-08-01

    Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed. PMID:27578383

  2. Metformin-induced lactic acidosis: a case series

    PubMed Central

    Silvestre, Joana; Carvalho, Susana; Mendes, Vitor; Coelho, Luis; Tapadinhas, Camila; Ferreira, Pedro; Povoa, Pedro; Ceia, Fatima

    2007-01-01

    Introduction Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. Case presentation We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A progressive recovery was observed

  3. Guillain-Barré syndrome following chickenpox: a case series.

    PubMed

    Tatarelli, P; Garnero, M; Del Bono, V; Camera, M; Schenone, A; Grandis, M; Benedetti, L; Viscoli, C

    2016-01-01

    Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, usually triggered by an infectious episode, mostly of viral origin. Varicella zoster virus (VZV) is a rare cause of GBS, mainly in the case of latent infection reactivation. We report on three adult patients who developed GBS following chickenpox, after a short period of latency. They were promptly treated with intravenous immunoglobulin, and the first one with plasma exchange additionally. All the patients experienced almost complete clinical recovery. Our experience suggests that primary VZV infection constitutes a GBS triggering event. PMID:26000930

  4. Superhero‐related injuries in paediatrics: a case series

    PubMed Central

    Davies, Patrick; Surridge, Julia; Hole, Laura; Munro‐Davies, Lisa

    2007-01-01

    Five cases of serious injuries to children wearing superhero costumes, involving extreme risk‐taking behaviour, are presented here. Although children have always displayed behaviour seemingly unwise to the adult eye, the advent of superhero role models can give unrealistic expectations to the child, which may lead to serious injury. The children we saw have all had to contemplate on their way to hospital that they do not in fact possess superpowers. The inbuilt injury protection which some costumes possess is also discussed. PMID:17337680

  5. Case series: Pregnancy Outcome in Patients with Uterine Fibroids

    PubMed Central

    Naik, Kusuma; Shreelatha, S.; Vana, Harshini

    2015-01-01

    Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy. PMID:26557577

  6. Case series: Pregnancy Outcome in Patients with Uterine Fibroids.

    PubMed

    Radhika, B H; Naik, Kusuma; Shreelatha, S; Vana, Harshini

    2015-10-01

    Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy. PMID:26557577

  7. Bipolar disorder and antithyroid antibodies: review and case series.

    PubMed

    Bocchetta, Alberto; Traccis, Francesco; Mosca, Enrica; Serra, Alessandra; Tamburini, Giorgio; Loviselli, Andrea

    2016-12-01

    Mood disorders and circulating thyroid antibodies are very prevalent in the population and their concomitant occurrence may be due to chance. However, thyroid antibodies have been repeatedly hypothesized to play a role in specific forms of mood disorders. Potentially related forms include treatment-refractory cases, severe or atypical depression, and depression at specific phases of a woman's life (early gestation, postpartum depression, perimenopausal). With regard to bipolar disorder, studies of specific subgroups (rapid cycling, mixed, or depressive bipolar) have reported associations with thyroid antibodies. Offspring of bipolar subjects were found more vulnerable to develop thyroid antibodies independently from the vulnerability to develop psychiatric disorders. A twin study suggested thyroid antibodies among possible endophenotypes for bipolar disorder. Severe encephalopathies have been reported in association with Hashimoto's thyroiditis. Cases with pure psychiatric presentation are being reported, the antithyroid antibodies being probably markers of some other autoimmune disorders affecting the brain. Vasculitis resulting in abnormalities in cortical perfusion is one of the possible mechanisms. PMID:26869176

  8. Pleuroperitoneal leak complicating peritoneal dialysis: a case series.

    PubMed

    Kennedy, C; McCarthy, C; Alken, S; McWilliams, J; Morgan, R K; Denton, M; Conlon, P J; Magee, C

    2011-01-01

    Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis. PMID:21876802

  9. A case series of scrub typhus in obstetrics.

    PubMed

    G K, Poomalar; R, Rekha

    2014-12-01

    Scrub typhus is endemic and re-emerging in eastern and southern Asia. Illness varies from mild and self-limiting to fatal. Only few studies were published about its effect in maternal and neonatal outcome. A retrospective analysis was done in six prenatal and two postnatal women with scrub typhus. Details about clinical presentation, investigations, treatment given, response to treatment and pregnancy outcome were collected. The common symptoms were fever with chills, vomiting, myalgia, headache and abdominal pain. Typical features of eschar and lymphadenopathy were noted in only two cases. Two patients presented with jaundice and altered liver function test. Two patients presented with breathlessness. One patient developed oligohydramnios. Two postnatal women developed scrub typhus following blood transfusion for postpartum haemorrhage. Because of its high prevalence, scrub typhus should be included in fever investigations in endemic areas, even in the absence of eschar. Early diagnosis of cases will help in less severe organ damage and easy recovery with antibiotics. Few evidences state that scrub typhus can spread through blood transfusion. Correlation between blood transfusion and scrub typhus has to be further evaluated. PMID:25653996

  10. Bipolar Disorder and Multiple Sclerosis: A Case Series

    PubMed Central

    Sidhom, Youssef; Ben Djebara, Mouna; Hizem, Yosr; Abdelkefi, Istabrak; Kacem, Imen; Gargouri, Amina; Gouider, Riadh

    2014-01-01

    Background. The prevalence of psychiatric disturbance for patients with multiple sclerosis (MS) is higher than that observed in other chronic health conditions. We report three cases of MS and bipolar disorder and we discuss the possible etiological hypothesis and treatment options. Observations. All patients fulfilled the McDonald criteria for MS. Two patients were followed up in psychiatry for manic or depressive symptoms before developing MS. A third patient was diagnosed with MS and developed deferred psychotic symptoms. Some clinical and radiological features are highlighted in our patients: one manic episode induced by high dose corticosteroids and one case of a new orbitofrontal MRI lesion concomitant with the emergence of psychiatric symptoms. All patients needed antipsychotic treatment with almost good tolerance for high dose corticosteroids and interferon beta treatment. Conclusions. MRI lesions suggest the possible implication of local MS-related brain damage in development of pure “psychiatric fits” in MS. Genetic susceptibility is another hypothesis for this association. We have noticed that interferon beta treatments were well tolerated while high dose corticosteroids may induce manic fits. PMID:24825960

  11. The Novel Transvestibule Approach for Endoscopic Thyroidectomy: A Case Series

    PubMed Central

    Yang, Kai; Ding, Boni; Lin, Changwei; Li, Wanwan

    2016-01-01

    Object: To evaluate the feasibility of NOTES for thyroid by the transvestibule approach. Methods: Six patients diagnosed with benign thyroid diseases were enrolled and underwent transvestibule endoscopic thyroidectomy in our hospital from October 2013 to September 2014. Results: All 6 patients completed transvestibule endoscopic thyroidectomy successfully with no conversion to open surgery. The mean operation time was 122 minutes (100 to 150 min). The average blood loss during surgery was 30 mL (10 to 40 mL). The pathologic diagnosis coincided with the preoperative diagnosis, which was 1 case of thyroid adenoma and 5 cases of thyroid goiters. The mean length of hospital stay was 8.2 days (8 to 10 d). No severe complications were reported during the 3 to 13 months’ follow-up. Conclusions: Transvestibule endoscopic thyroidectomy is feasible, with a satisfactory cosmetic effect; yet, further improvement of surgical techniques are required on account of the complexity of the surgical procedure and the prolonged operation time. PMID:26813240

  12. Zolpidem dependence case series: possible neurobiological mechanisms and clinical management.

    PubMed

    Liappas, I A; Malitas, P N; Dimopoulos, N P; Gitsa, O E; Liappas, A I; Nikolaou, Ch K; Christodoulou, G N

    2003-03-01

    Zolpidem is a short-acting imidazopyridine hypnotic that is an agonist at the gamma-aminobutyric acid A type (GABAA) receptor. It has been suggested that it acts selectively on alpha1 subunit-containing GABAA benzodiazepine (BZ1) receptors presenting (contrary to classic benzodiazepines) low or no affinity for other subtypes. Therefore, it has been proposed that it lacks the benzodiazepines-like side-effects, having minimal abuse and dependence potential. Nevertheless, there is a considerable number of zolpidem dependence case reports in the literature. We present eight cases of zolpidem abuse and dependence without criminal record, without history of substance abuse (except for one alcohol abuser), with minor psychiatric disorders, who took zolpidem after physicians prescription in order to deal with their insomnia. However, they became zolpidem abusers not craving its sedative, but its anxiolytic and stimulating action, which helped them to cope with everyday activities. It is possible that, in the high doses that our patients used, zolpidem abandons its selectivity for BZ1 receptors and demonstrates all the actions of classic benzodiazepines. Molecular biology, via possible mutations on GABA receptors, may provide some answers as to why our eight patients (who did not differ much from the thousands of insomniacs who use zolpidem) and other zolpidem abusers, raised the dose progressively, and sought something from the drug other than hypnotic action. PMID:12680751

  13. Cecal bascule after spinal cord injury: A case series report

    PubMed Central

    Ishida, Yuichi; McLean, Susan F.; Tyroch, Alan H.

    2016-01-01

    Introduction Cecal bascule is a rare cause of intestinal obstruction associated with upward and anterior folding of the ascending colon. We report three patients who presented with spinal cord injury complicated with a cecal bascule. Diagnosis and management of cecal bascule is discussed. Presentation of cases Patient 1: 59-year-old male sustained a traumatic brain injury and cervical spinal cord injury after a motorcycle crash. He had abdominal distension and the diagnosis of cecal bascule was made. Cecopexy was performed. Patient 2: 51-year-old male sustained an unstable C7 vertebral fracture with a cord contusion and quadriplegia after a diving incident. After an unsuccessful medical management of the colonic distension, the patient was taken for a laparotomy and cecal bascule was found. A cecostomy and a cecopexy were performed. Patient 3: 63-year-old male was transferred after a fall. He had diffuse degenerative changes in the thoracic and lumbar spine. He was found to have a perforated cecal bascule. He had a right hemicolectomy with an ileocolic anastomosis. Discussion We suggest the possibility of spinal cord injury being a risk factor for cecal bascule. Currently, right hemicolectomy is recommended for the treatment of cecal bascule. Cecopexy is also acceptable treatment option for a case in which the patient will be undergoing an operation with an insertion of hardware. Conclusion The diagnosis of cecal bascule should be considered for trauma patients with cecal distention without delay in order to prevent disastrous complications. PMID:27077698

  14. Peripheral hemangioblastoma: clinicopathologic characterization in a series of 22 cases.

    PubMed

    Doyle, Leona A; Fletcher, Christopher D M

    2014-01-01

    Hemangioblastoma is a rare tumor of uncertain histotype that typically arises in the cerebellum, quite often in the setting of Von Hippel-Lindau syndrome (VHL). Exceptional cases of hemangioblastoma arising outside the central nervous system have been reported, but little is known about their clinicopathologic and immunohistochemical features. Twenty-two cases of hemangioblastoma arising at peripheral sites were identified in consultation files. Clinical, morphologic, and immunohistochemical features were evaluated. Outcome data were obtained from referring pathologists. Twelve patients were female and 10 male; the median age was 58 years (range, 27 to 79 y). All the tumors were solitary (except 1) and arose in spinal nerve roots (12), kidney (3), intestine (2), orbit (1), forearm (1), peritoneum (1), periadrenal soft tissue (1), and flank (1). Five patients had VHL; another 5 had lesions suggestive of VHL. One patient had tuberous sclerosis. The median tumor size was 4 cm (range, 1.3 to 15 cm). Most tumors were well circumscribed; 6 were poorly marginated-3 eroded the adjacent bone and 1 extended into the pleura. All tumors were composed of an admixed population of plump spindle cells and microvacuolated cells with palely eosinophilic or clear cytoplasm, which often mimicked lipoblasts or renal cell carcinoma. In 5 cases the microvacuolated cells were scant. Spindle cell nuclei were hyperchromatic or vesicular with inconspicuous nucleoli. Four tumors showed marked nuclear pleomorphism. Mitotic activity was low (range, 0 to 2/10 HPF). All tumors had a complex capillary network, with admixed larger thin-walled or thick-walled vessels in a solid and often lobular growth pattern, similar to central nervous system hemangioblastoma. In 9 cases the larger vessels showed a branching hemangiopericytoma-like pattern. No necrosis or lymphovascular invasion was identified. Tumor cells expressed inhibin in 95% (20/21), neuron-specific enolase in 79% (15/19), and S100 protein

  15. Intracranial Pressure Monitoring in Acute Liver Failure: Institutional Case Series.

    PubMed

    Maloney, Patrick R; Mallory, Grant W; Atkinson, John L D; Wijdicks, Eelco F; Rabinstein, Alejandro A; Van Gompel, Jamie J

    2016-08-01

    Acute liver failure (ALF) has been associated with cerebral edema and elevated intracranial pressure (ICP), which may be managed utilizing an ICP monitor. The most feared complication of placement is catastrophic intracranial hemorrhage in the setting of severe coagulopathy. Previous studies reported hemorrhage rates between 3.8-22 % among various devices, with epidural catheters having lower hemorrhage rates and precision relative to subdural bolts and intraparenchymal catheters. We sought to identify institutional hemorrhagic rates of ICP monitoring in ALF and its associated factors in a modern series guided by protocol implantation. Patient records treated for ALF with ICP monitoring at Mayo Clinic in Rochester, MN from 1995 to 2014 were reviewed. Protocalized since 1995, epidural (EP) ICP monitors were first used followed by intraparenchymal (IP) for stage III-IV hepatic encephalopathy. The following variables and outcomes were collected: patient demographics, ICPs and treatment methods, laboratory data, imaging studies, number of days for ICP monitoring, radiographic and symptomatic hemorrhage rates, orthotopic liver transplantation rates, and death. A total of 20 ICP monitors were placed for ALF, 7 EP, and 13 IP. International normalized ratio (INR) at placement of an EP monitor was 2.4 (1.7-3.2) with maximum of 2.7 (2.0-3.6) over the following 2.3 (1-3) days. Mean EP ICP at placement was 36.3 (11-55) and maximum of 43.1 (20-70) mm Hg. INR at placement of an IP monitor was 1.3 (<0.8-3.0) with maximum value of 2.9 (1.6-5.4) over the following 4.2 (2-6) days. Mean IP ICP at placement was 9.9 (2-19) and maximum was 39.8 (11-100) mm Hg. There was one asymptomatic hemorrhage in the EP group (14.3 % hemorrhage rate) and two hemorrhages in the IP group (hemorrhage rate was 15.4 %), both of which were fatal. Overall mortality rate in the EP group was 71.4 % (5/7) with two patients receiving transplantation, and one death in the transplant group. Overall mortality

  16. Acute Calcific Tendinitis of the Rectus Femoris: A Case Series

    PubMed Central

    IKobayashi, Hideo; Kaneko, Haruka; Homma, Yasuhiro; Baba, Tomonori; Kaneko, Kazuo

    2015-01-01

    Introduction: Periarticular calcific tendinitis is a common cause of Orthopedic outpatient referral. Calcific tendinitis of the rectus femoris, however, is very rare and not well known. Due to its rarity, correct diagnosis and prompt treatment are not fully understood. Case Report: Two females (38 and 40 years old) of acute calcific tendinitis of the rectus femoris with the good clinical course without any operative treatment were presented. The pain was managed with oral non-steroidal antiinflammatory drugs and/or local steroid injection. Interval radiographic assessment showed complete resorption of the calcification. Conclusion: Establishing the correct diagnosis and initiating prompt treatment are shown to be important in achieving resolution of symptoms and in avoiding unnecessary investigations. PMID:27299063

  17. The female athlete triad: a case series and narrative overview

    PubMed Central

    Laframboise, Michelle A.; Borody, Cameron; Stern, Paula

    2013-01-01

    Objective: To illustrate the varying presentations of the female athlete triad and to inform the practitioner of the potential sequelae of this common condition. Clinical Features: Four patients presented with a variety of signs and symptoms of the female athlete triad including low caloric intake, osteoporosis, amenorrhea and/or endothelial dysfunction. Intervention and Outcome: A conservative treatment approach was utilized in each case including education on the female athlete triad, education on increased caloric intake and a referral to the family physician. Conclusion: Health care practitioners should be aware of the different clinical presentations of the female athlete triad. A narrative review of the literature is provided to educate practitioners on the components of the female athlete triad, proper diagnosis and appropriate management. PMID:24302779

  18. Metronidazole Toxicity in Cockayne Syndrome: A Case Series.

    PubMed

    Wilson, Brian T; Strong, Andrew; O'Kelly, Sean; Munkley, Jennifer; Stark, Zornitza

    2015-09-01

    Cockayne syndrome (CS) is a rare genetic disorder characterized by small stature, intellectual disability, and accelerated pathologic aging. Through the Cockayne Syndrome Natural History Study, we have identified 8 cases of acute hepatic failure after metronidazole administration (8% of our cohort), 3 of which were fatal. The interval between initial administration and death was 6 to 11 days. Two of these patients also experienced acute neurologic deficit. Both hepatotoxicity and acute neurologic deficit have been reported previously as extremely rare adverse events after metronidazole administration. However, we have not identified any patients with CS who have received metronidazole without serious adverse effects. We recommend that a diagnosis of CS be considered an absolute contraindication to the use of metronidazole. PMID:26304821

  19. Purpura fulminans secondary to rickettsial infections: A case series

    PubMed Central

    Katoch, Saloni; Kallappa, Ravindra; Shamanur, Murugesh B.; Gandhi, Sneha

    2016-01-01

    Purpura fulminans (PF) is a descriptive term used to describe a heterogeneous group of disorders characterized by rapidly progressive purpuric lesions that may develop into extensive areas of skin necrosis, and peripheral gangrene. This rare disorder is associated with laboratory evidence of consumptive coagulopathy and is often fatal. PF is usually associated with many infections, most notably with meningococcal, staphylococcal, and streptococcal infections. However, there are very few reports of this entity with spotted fever and scrub typhus from India. Rickettsial infections are an underdiagnosed group of diseases presenting as acute febrile illness, with high mortality in untreated cases. Of the available tests, Weil–Felix is a handy and economical tool for early diagnosis of this fatal disease especially in resource poor settings. We present four infants with PF secondary to rickettsial fever diagnosed by the Weil–Felix test. PMID:26955583

  20. Purpura fulminans secondary to rickettsial infections: A case series.

    PubMed

    Katoch, Saloni; Kallappa, Ravindra; Shamanur, Murugesh B; Gandhi, Sneha

    2016-01-01

    Purpura fulminans (PF) is a descriptive term used to describe a heterogeneous group of disorders characterized by rapidly progressive purpuric lesions that may develop into extensive areas of skin necrosis, and peripheral gangrene. This rare disorder is associated with laboratory evidence of consumptive coagulopathy and is often fatal. PF is usually associated with many infections, most notably with meningococcal, staphylococcal, and streptococcal infections. However, there are very few reports of this entity with spotted fever and scrub typhus from India. Rickettsial infections are an underdiagnosed group of diseases presenting as acute febrile illness, with high mortality in untreated cases. Of the available tests, Weil-Felix is a handy and economical tool for early diagnosis of this fatal disease especially in resource poor settings. We present four infants with PF secondary to rickettsial fever diagnosed by the Weil-Felix test. PMID:26955583

  1. Pediatric non-Helicobacter pylori atrophic gastritis: a case series.

    PubMed

    Pogoriler, Jennifer; Kamin, Daniel; Goldsmith, Jeffrey D

    2015-06-01

    Although autoimmune atrophic gastritis is classically a disease of elderly adults, recent studies have described the disease in younger adults, particularly in those with other autoimmune diseases and iron-deficiency anemia. Atrophic gastritis in pediatrics is a rare and possibly underdiagnosed entity that has been primarily reported as single-case reports. This retrospective study of atrophic gastritis not associated with Helicobacter pylori infection was performed to further expand the knowledge of clinical presentation, pathologic findings, and natural history of this disease in the pediatric population. Twelve patients with a histologic diagnosis of atrophic gastritis were identified, with an age range of 8 months to 18 years. Seven had other autoimmune diseases and/or immunodeficiency. Atrophy was confined to the oxyntic mucosa in 10 patients, with intramucosal inflammation in a diffuse or basal-predominant pattern. Active inflammation was present in 7 patients. Pseudopyloric, intestinal, or squamous/mucinous metaplasia was seen at initial biopsy or on follow-up in 8 patients, and enterochromaffin-like cell hyperplasia was seen in 5. One patient developed an adenocarcinoma during the follow-up period of 10 years. Two false-negative diagnoses were retrospectively identified. In the majority of cases, the possibility of atrophic gastritis was not raised by the submitting physician, and the endoscopic findings were not specific. Therefore, accurate diagnosis requires a high degree of suspicion on the part of the pathologist, and the diagnosis should be considered particularly in patients with a clinical history of other autoimmune diseases or iron-deficiency anemia. PMID:25602795

  2. Squamous neoplasia of the scrotum: a series of 29 cases.

    PubMed

    Matoso, Andres; Ross, Hillary M; Chen, Sonja; Allbritton, Jill; Epstein, Jonathan I

    2014-07-01

    The current epidemiology and clinicopathologic features of squamous cell carcinoma (SCC) of the scrotum are largely unknown because of its low incidence. We describe the histopathologic features, immunohistochemistry, and human papillomavirus (HPV) status of 29 patients with scrotal SCC. The mean age at presentation was 55 years (range, 30 to 74 y). White to black ratio was 1.9:1. There was no predominant occupation, with the majority being white-collar professionals. Clinical history of condylomas was present in 5 patients, and 7 patients had a history of multiple skin cancers including melanoma, basal cell carcinoma, and other SCCs. Other comorbidities included human immunodeficiency virus infection (n=2), kidney transplant (n=1), leukemia/lymphoma (n=2), hidradenitis suppurativa (n=1), chronic scrotal infections with abscess (n=1), inflamed epidermal inclusion cyst (n=1), and lichen planus (n=1). One patient had a history of regular tanning bed use. Morphologically, the majority was usual type (n=17), followed by basaloid (n=7) and warty (n=5). Nineteen cases were in situ, and 10 were invasive. Three patients had inguinal lymphadenopathy; in 1, metastasis was confirmed. Suprabasal nuclear staining for Ki67 was considered positive. For p16, a continuous band of nuclear and cytoplasmic staining was considered positive, and a noncontinuous or absence of staining was considered negative. p16 was positive in 10 cases; high-risk HPV was confirmed in 7 cases. Ki67 was positive in 8/17 (47%) usual, 6/7 (85.7%) basaloid, and 3/5 (60%) warty type. p53 was positive in 5/17 (29.4%) usual, 2/7 (28.6%) basaloid, and 1/5 (20%) warty type. All patients were treated with local excision only; 13 had positive margins. Three patients were treated with imiquimod after local excision. The median follow-up was 30 months. Three patients recurred and were treated with re-excision; 1 patient received radiotherapy. Overall, the morphologic, immunohistochemical, and HPV studies show that

  3. Driving under the influence of synthetic phenethylamines: a case series.

    PubMed

    Maas, Alexandra; Wippich, Cornelia; Madea, Burkhard; Hess, Cornelius

    2015-09-01

    New psychoactive drugs, so-called legal highs, have gained more and more popularity during the last years. One of the most important groups of these legal high substances are the synthetic phenethylamines that share a common phenethylamine moiety. Based on certain structural characteristics, these synthetic phenethylamines can be divided into further subclasses, among which the synthetic cathinones ('bath salts') are particularly noteworthy. Synthetic cathinones are characterized by an additional carbonyl group attached at the beta position on the amino alkyl chain. Consumption of synthetic phenethylamines can lead to impairments similar to those observed after the use of, for instance, amphetamine or 3,4-methylenedioxy-N-methylamphetamine (MDMA, 'ecstasy'). These impairments include diverse neurological and psychological symptoms which can affect a safe driving behaviour. Although several reports on clinical symptoms and poisonings due to these substances have been published, most of these publications do not contain any analytical data. Additionally, there is still a lack of information concerning pharmacological and toxicological effects of these rather new psychoactive substances. In particular, the knowledge of the impact on the ability to drive following consumption of synthetic phenethylamines is relevant for the police as well as for forensic toxicologists. In this publication, several cases of individuals driving under the influence (DUI) of synthetic phenethylamines (4-fluoroamphetamine, mephedrone (4-methylmethcathinone, 4-MMC), 2-DPMP (desoxypipradol), methylenedioxypyrovalerone (MDPV), benzedrone, N-ethylamphetamine (etilamfetamine), 3-methylmethcathinone (3-MMC)) are presented, focusing on analytical results and signs of impairment. PMID:25618172

  4. Fatal Cerebral Air Embolism: A Case Series and Literature Review

    PubMed Central

    Reddy, Pavithra; Khaja, Misbahuddin

    2016-01-01

    Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

  5. Khat chewing and cirrhosis in Somaliland: Case series

    PubMed Central

    Mahamoud, Hawa D.; Muse, Sabah Mohammed; Roberts, Lewis R.; Torbenson, Michael S.; Fader, Tim

    2016-01-01

    Background Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. Aim To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. Settings A university-affiliated teaching hospital in Somaliland. Methods Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. Results Eight Somali men aged 27–70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15–128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. Conclusion Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis. PMID:27543281

  6. Cognitive behavior therapy for stuttering: a case series.

    PubMed

    Reddy, R P; Sharma, M P; Shivashankar, N

    2010-01-01

    The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. PMID:21799560

  7. Transverse sacral fractures: case series and literature review

    PubMed Central

    Kim, Miriam Y.; Reidy, Declan P.; Nolan, Paul C.; Finkelstein, Joel A.

    2001-01-01

    Objectives To report experience with transverse sacral fracture, an uncommon injury frequently associated with neurologic deficit, and to perform a meta-analysis of the literature in order to define the role of decompression for the management of sacral fractures. Design A review of 7 cases. Setting A university-affiliated tertiary care centre. Patients Seven patients with transverse fractures of the sacrum. The mean follow-up was 13 months. Interventions A review of the clinical data and a search of the literature for studies that reported on 4 or more patients with a transverse sacral fracture. Main outcome measures Mechanism of injury, type of neurologic deficit and its management. Results The most common mechanism in the 7 study patients was a fall from a height. Six patients had neurologic deficits, mostly in the form of bowel or bladder disturbance. Five of these were treated with surgical decompression, and 4 of them had an improvement in neurologic function. The 7 original studies from the literature dealt with a total of 55 patients. As in the study patients, falls from a height and motor vehicle accidents predominated as the mechanisms of injury. In contrast to patients in this study, 20 of 48 patients in the literature review with neurologic deficits were treated conservatively. Conclusions The outcomes in this study are similar to those reported in the literature. The place of surgical decompression for patients with neurologic deficit cannot be clearly determined from the evidence currently available. PMID:11603749

  8. AUTOLOGOUS CHONDROCYTE TRANSPLANTATION-SERIES OF 3 CASES

    PubMed Central

    Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Barreto, Ronald Bispo; Pécora, José Ricardo; Rezende, Múrcia Uchõa de; Filho, Tarcisio E.P Barros; Lombello, Christiane Bertachini

    2015-01-01

    Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases. PMID:27022579

  9. Lassa fever presenting as acute abdomen: a case series.

    PubMed

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  10. Lassa fever presenting as acute abdomen: a case series

    PubMed Central

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  11. RT-12OUTCOMES IN MEDULLOBLASTOMA: SINGLE INSTITUTION CASE SERIES

    PubMed Central

    Kannan, V.; Bajpai, Ranjeet; Anand, Vivek; Deshpande, Sudesh; Misra, Basant K.; Kapadia, Asha; Almel, Sachin; Sankhe, Milind; Desai, Ketan; Kannan, Aarthi; Dubey, Sandhya; Ashok, P.P.; Shinde, Sandip

    2014-01-01

    BACKGROUND: We have seen a paradigm shift in terms of use of radiation technology for the treatment of patients with medulloblastoma, from conventional 2-D shifting fields to 3-D CRT, IMRT and proton therapy. Similarly from prone to supine position and reduced dose to the cranio-spinal axis with an intent to have equivalent outcomes with reduced probability of late sequelae including second malignancies. METHODS: We have analysed data of 21 consecutive patients in May 2014, registered and treated in our hospital between 2002 and 2011. The cohort consisted of 14 male and 7 female patients with a median age of 8 (Range 3-30) Years. With no known co-morbidities and median KPS of 70 they all had tumors mostly in the IV ventricle(43%) and cerebellum(38%), for which they underwent surgery including decompression(72%) subtotal excision(9%), near total or total excision(19%). All patients were histologically grade IV medulloblastoma who underwent adjuvant radiation alone (40%) or followed by chemotherapy (60%) based on the risk stratification. 57% received 3D CRT in supine position while rest are treated with conventional techniques, median dose given to cranio-spinal axis was 23.4 Gy, posterior fossa was 36 Gy and to the tumor bed was 55.8 Gy at 1.8Gy per fraction. Chemotherapy was usually procarbazine/cisplatin/vincristine based regimen. Regular IQ, endocrine, ophthalmic and auditory evaluation was done in all the patients on follow-up. RESULT: Overall survival at 5 year was documented at 45% and 10 year survival at 35% for the entire cohort taking worst case scenario.3/13 patients developed IQ problems, 7/13 developed endocrine dysfunction, 3/12 developed auditory abnormality. CONCLUSION: Outcome of this cohort is comparable to the literature on risk group stratification. More importantly, risk adapted strategy for the treatment was found to be technically and logistically feasible and effective for a comparatively rare tumor in our setup.

  12. A Case Series: Herpes Simplex Virus as an Occupational Hazard

    PubMed Central

    Browning, William D; McCarthy, James P

    2012-01-01

    Statement of the Problem Herpes labialis infections are common and present a serious risk to the dental team. Purpose of the Study The purpose is to make dentists aware of the risks involved with treatment of patients with active herpes labialis. In addition, evidence-based risk-management strategies are presented. Methods and Materials The incidence and natural history of herpes simplex virus type 1 (HSV-1) are reviewed. Four previously unreported case histories are presented to illustrate the impact common sequelae of HSV-1 can have on the dental team. The differences between HSV-1 and the blood-borne diseases which are the focus of universal precautions are discussed. In particular, the highly contagious, highly transmissible nature of HSV-1 and its transmission through aerosols are highlighted. Finally, the need to include protection against aerosols in the profession's understanding of universal precautions is noted. Results The authors suggest limiting the treatment of patients with active lesions to urgent care only, and treating active HSV-1 lesions to reduce time of healing. For four common clinical situations involving HSV-1 infections, evidence-based methods for protecting the dental team and the patient from cross-contamination are also presented. Conclusion While it is clear that the treatment of patients with active herpes labialis lesions increases risk of cross-infection, there are good protocols for controlling this risk. CLINICAL SIGNIFICANCE By bringing common vectors of cross-infection to light and providing evidence-based protocols for preventing them, this article provides practitioners with positive steps that can be taken for controlling the risk of spreading herpes infections to the dental team. (J Esthet Restor Dent 24:61–67, 2012) PMID:22296698

  13. Mechanical Thrombectomy for Ischaemic Stroke: The First UK Case Series

    PubMed Central

    Ahmad, Nasar; Nayak, Sanjeev; Jadun, Changez; Natarajan, Indira; Jain, Palbha; Roffe, Christine

    2013-01-01

    Background and Purpose Endovascular treatments have the potential to accelerate reperfusion in acute ischaemic stroke with large vessel occlusion. In the UK only a few stroke centres offer this interventional option. The University Hospital of North Staffordshire (UHNS) has treated the largest number of cases in the UK. Results of the first 106 endovascular treatments (EVT) are presented here. Methods All patients treated with EVT (intra-arterial thrombolysis (IAT), mechanical thrombectomy (MT) or both, or an attempt at intervention) for acute stroke at UHNS, Stoke-on-Trent, UK, were entered into a prospective register. Baseline demographic and clinical data, the National Institutes for Health Stroke Scale (NIHSS), imaging results including Thrombolysis in Cerebral Infarction (TICI) score, and complications were recorded. Mortality, and modified Rankin score (mRS) were assessed at 90 days. Results From December 2009 to January 2013 106 patients (mean age 64 years, median baseline NIHSS 18) were treated with EVT (thrombectomy ± IAT 83%, IAT alone 13%, neither 4%). Seventy-eight per cent of occlusions were in the anterior circulation. Intravenous bridging thrombolysis was performed in 81%. Revascularization was successful (TICI 2b/3) in 84%. The median time from stroke onset to the end of the procedure was 6 h 03 min. A good outcome (mRS≤2) at 90 days was achieved in 48% with a mortality of 15%. Fatal or nonfatal symptomatic intracranial haemorrhage (sICH) within 10 days occurred in 9%. The median length of stay was 14 days (31% discharged home ≤7 days). Conclusions EVT led to good clinical outcomes in almost 50% of patients with severe strokes. PMID:24386090

  14. Osteoradionecrosis of the Temporal Bone: A Case Series

    PubMed Central

    Sharon, Jeffrey D; Khwaja, Shariq S.; Drescher, Andrew; Gay, Hiram; Chole, Richard A

    2014-01-01

    Objective To study osteoradionecrosis (ORN) of the temporal bone Study Design Retrospective case review Setting Academic medical center Patients Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least three months Intervention(s) Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy and surgery. Main Outcome Measure(s) To describe the presentation and management of patients with temporal bone osteoradionecrosis. Results 33 patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n=11), followed by the nasopharynx (n=7). The time to development of ORN varied between 1 and 22 years, with mean 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n=15), hearing loss (n=13), and otalgia (n=12). 15 patients had bacterial superinfection, most commonly S. aureus (n=9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications. Conclusions Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss. PMID:24914789

  15. Morgellons disease, illuminating an undefined illness: a case series

    PubMed Central

    2009-01-01

    Introduction This review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes. Case presentation Clinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions. Conclusions These data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with

  16. A systematic review protocol for reporting deficiencies within surgical case series

    PubMed Central

    Agha, Riaz; Fowler, Alexander J; Lee, Seon-Young; Gundogan, Buket; Whitehurst, Katharine; Sagoo, Hakiran; Jeong, Kyung Jin Lee; Altman, Douglas G; Orgill, Dennis P

    2015-01-01

    Introduction Case series are an important and common study type in surgical literature. There is evidence that key data are excluded from published case series, and currently no reporting guideline exists for case series. There is, therefore, the potential to change practices and improve the reporting of case series. Reporting guidelines have been shown to be efficacious in raising the bar for reporting quality. We present our protocol for the first stage of guideline development—a systematic review of previously identified deficiencies in how surgical case series are reported. Methods and analysis Electronic searches will be conducted on MEDLINE, EMBASE, Cochrane Methods Register, Science Citation Index and Conference Proceedings Citation Index, from the start of indexing until 5 November 2014. The electronic search strategy was developed with an information specialist. Two independent researchers will identify articles for inclusion, specifically those that describe reporting deficiencies within surgical case series. Data will be extracted to specifically focus on the deficiencies of reporting. These will be categorised according to their type, and other identified issues will also be presented. Data will be presented with descriptive statistics to determine frequently missing types of data, and the commonest reporting issues tabulated. Ethics and dissemination The authors hope to disseminate the findings as widely as possible, irrespective of results, as these will add to the wider corpora of information on this subject. The systematic review will be published in a peer-reviewed journal and will be presented at a wide range of national and international conferences. Ultimately, this will inform a Delphi process for the development of a surgical case series reporting guideline. Protocol registration CRD42015016145. PMID:26438134

  17. Obsessive Compulsive Disorder Treatment in Patients with Down Syndrome: A Case Series

    ERIC Educational Resources Information Center

    Sutor, Bruce; Hansen, Mark R.; Black, John L.

    2006-01-01

    In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side…

  18. Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

    ERIC Educational Resources Information Center

    Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

    2009-01-01

    The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

  19. Aortic complications following pediatric heart transplantation: A case series and review

    PubMed Central

    Lang, Sean M; Frazier, Elizabeth A; Collins, R Thomas

    2016-01-01

    Aortic complications occur rarely after pediatric orthotopic heart transplantation, but are typically accompanied by catastrophic events. We describe the three cases of major aortic complications in our experience of 329 pediatric heart transplants. This case series and review highlight the important risk factors for aortic complications after heart transplantation. PMID:27011691

  20. BCS theory has to be overhauled: Reassurance from numerical survival rate

    NASA Astrophysics Data System (ADS)

    Zheng, X. H.; Walmsley, D. G.

    2016-07-01

    The BCS theory has conceptual and numerical difficulties. We have previously overhauled it with a new scheme of phonon-mediated electron pairing that can be expressed analytically in terms of an empirical pairing survival rate factor, S(q) = 0 or 1/2, depending on phonon momentum, q. Now we evaluate S(q) numerically entirely from experimental data on normal state electrical resistivity and on superconducting tunnelling conductance. The empirical and numerical S(q) are reassuringly close in aluminium and lead and particularly so in two other cases, niobium and tantalum.

  1. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.

    PubMed

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-01

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP

  2. Congenital Malformations of the Inner Ear: Case Series and Review of the Literature.

    PubMed

    Piromchai, Patorn; Kasemsiri, Pornthep; Thanawirattananit, Panida; Yimtae, Kwanchanok

    2015-08-01

    Patients with craniofacial anomalies often present to doctors due to their noticeable disfigurement and are routinely assessed by otolaryngologists for hearing evaluation. However, small percentage of craniofacial anomaly patients may present with delayed speech though they may not have initial obvious external deformation. The objective of case series is to identify the congenital inner ear malformation. The series of clinical presentation, physical examination, investigations, treatments and follow-up results were demonstrated followed by the discussion. PMID:26742393

  3. EPIDEMIOLOGY AND TREATMENT OF MONTEGGIA LESION IN ADULTS: SERIES OF 44 CASES

    PubMed Central

    Suarez, Roberto; Barquet, Antonio; Fresco, Rodrigo

    2016-01-01

    ABSTRACT Objective: To analyze the epidemiology, treatment and outcome of a series of adult patients with Monteggia lesion treated in Uruguayan institutions. Methods: This is a retrospective article, we retrospectively identified from two Uruguayan institutions 44 adult patients with Monteggia lesion and analyzed their characteristics including Bado classification, associated injuries, treatment modality and outcome (Morrey score). Results: Using Bado classification, 23 cases (52%) were type II, 12 (27%) type I, seven (16%) type IV and two cases (5%) type III. Associated lesions were radial head fractures, found in 15 patients, coronoid ipsilateral fractures in seven patients, and neurological injuries in four. Radial head dislocation was reduced in 93% of the cases with closed maneuvers. Ulna fractures underwent open reduction and internal fixation in all 30 cases using 3.5 mm DCP plates. Complications after surgery occurred in 21 cases. Revision surgery was done in 15 cases. Outcomes after primary and revision surgery were good or excellent in 37 cases. Conclusions: In our series we observed that Monteggia lesion in adults is a serious injury with a high number of complications that often require revision surgeries. Level of Evidence IV, Retrospective Study, Case Series. PMID:26997915

  4. Virtual reality hypnosis pain control in the treatment of multiple fractures: a case series.

    PubMed

    Teeley, Aubriana M; Soltani, Maryam; Wiechman, Shelley A; Jensen, Mark P; Sharar, Sam R; Patterson, David R

    2012-01-01

    This case series evaluated the use of virtual reality hypnosis (VRH) for the treatment of pain associated with multiple fractures from traumatic injuries. VRH treatment was administered on 2 consecutive days, and pain and anxiety were assessed each day before and after VRH treatment as well as on Day 3, which was 24 hours after the second treatment session. Pain reduction from baseline to Day 3 was from 70% to 30%, despite opioid analgesic use remaining stable. The subjective pain reduction reported by patients was encouraging, and the results of this case series suggest the importance of further study of VRH with larger samples using randomized controlled trials. PMID:22443021

  5. Description of C isotopes within RMF+BCS approach

    NASA Astrophysics Data System (ADS)

    Saxena, G.; Singh, D.; Kaushik, M.

    2013-06-01

    In the present investigations we have employed relativistic mean-field plus BCS (RMF + BCS) approach to carry out a systematic study for the ground state properties of even-even C Isotopes. One of the prime reason of this study has been to look into the role of low lying states in neutron rich reason near neutron drip line. It is found that irrespective of whether any resonant state exists or not, the occupancy of weakly bound neutron single particle states having low orbital angular momentum, (l = 0 or 1), with a well spread wave function due to the absence or very small strength of centrifugal barrier, helps to cause the occurrence of nuclei with widely extended neutron density. Such nuclei are found to have characteristically very small two-neutron separation energy and large neutron rms radius akin to that observed in weakly bound systems.

  6. Description of C isotopes within RMF+BCS approach

    SciTech Connect

    Saxena, G.; Singh, D.; Kaushik, M.

    2013-06-03

    In the present investigations we have employed relativistic mean-field plus BCS (RMF + BCS) approach to carry out a systematic study for the ground state properties of even-even C Isotopes. One of the prime reason of this study has been to look into the role of low lying states in neutron rich reason near neutron drip line. It is found that irrespective of whether any resonant state exists or not, the occupancy of weakly bound neutron single particle states having low orbital angular momentum, (l = 0 or 1), with a well spread wave function due to the absence or very small strength of centrifugal barrier, helps to cause the occurrence of nuclei with widely extended neutron density. Such nuclei are found to have characteristically very small two-neutron separation energy and large neutron rms radius akin to that observed in weakly bound systems.

  7. Particle-hole fluctuations in BCS-BEC crossover

    SciTech Connect

    Floerchinger, S.; Scherer, M.; Wetterich, C.; Diehl, S.

    2008-11-01

    The effect of particle-hole fluctuations for the BCS-BEC crossover is investigated by use of functional renormalization. We compute the Gorkov effect and the critical temperature for the whole range in the scattering length a. On the BCS side for small negative a we recover the Gorkov approximation, while on the BEC side of small positive a the particle-hole fluctuations play no important role, and we find a system of interacting bosons. In the unitarity limit of infinite scattering length our quantitative estimate yields T{sub c}/T{sub F}=0.264. We also investigate the crossover from broad to narrow Feshbach resonances - for the latter we obtain T{sub c}/T{sub F}=0.204 for a{sup -1}=0. A key ingredient for our treatment is the computation of the momentum dependent four-fermion vertex and its bosonization in terms of an effective bound-state exchange.

  8. Isospin Dependent Pairing Interactions and BCS-BEC crossover

    SciTech Connect

    Sagawa, H.; Margueron, J.; Hagino, K.

    2008-11-11

    We propose new types of density dependent contact pairing interaction which reproduce the pairing gaps in symmetric and neutron matters obtained by a microscopic treatment based on the realistic nucleon-nucleon interaction. The BCS-BEC crossover of neutrons pairs in symmetric and asymmetric nuclear matters is studied by using these contact interactions. It is shown that the bare and screened pairing interactions lead to different features of the BCS-BEC crossover in symmetric nuclear matter. We perform Hartree-Fock-Bogoliubov (HFB) calculations for semi-magic Calcium, Nickel, Tin and Lead isotopes and N = 20, 28, 50 and 82 isotones using these density-dependent pairing interactions. Our calculations well account for the experimental data for the neutron number dependence of binding energy, two neutrons separation energy, and odd-even mass staggering of these isotopes. Especially the interaction IS+IV Bare without the medium polarization effect gives satisfactory results for all the isotopes.

  9. Continuum discretised BCS approach for weakly bound nuclei

    NASA Astrophysics Data System (ADS)

    Lay, J. A.; Alonso, C. E.; Fortunato, L.; Vitturi, A.

    2016-08-01

    The Bardeen–Cooper–Schrieffer (BCS) formalism is extended by including the single-particle continuum in order to analyse the evolution of pairing in an isotopic chain from stability up to the drip-line. We propose a continuum discretised generalised BCS based on single-particle pseudostates (PS). These PS are generated from the diagonalisation of the single-particle Hamiltonian within a transformed harmonic oscillator basis. The consistency of the results versus the size of the basis is studied. The method is applied to neutron rich oxygen and carbon isotopes and compared with similar previous works and available experimental data. We make use of the flexibility of the proposed model in order to study the evolution of the occupation of the low-energy continuum when the system becomes weakly bound. We find an increasing influence of the non-resonant continuum as long as the Fermi level approaches the neutron separation threshold.

  10. Amyotrophic lateral sclerosis in Brazil: Case series and review of the Brazilian literature.

    PubMed

    Prado, Laura de Godoy Rousseff; Bicalho, Isabella Carolina Santos; Vidigal-Lopes, Mauro; Ferreira, Carla Juliana Araújo; Mageste Barbosa, Luiz Sérgio; Gomez, Rodrigo Santiago; De Souza, Leonardo Cruz; Teixeira, Antônio Lúcio

    2016-01-01

    Our objective was to systematically analyse the first series of cases of amyotrophic lateral sclerosis (ALS) in Minas Gerais and to review the Brazilian literature about clinical studies in ALS. This was a cross-sectional and descriptive study of a consecutive series of patients with probable or defined sporadic ALS according to the Awaji criteria, followed at two referral centres of Belo Horizonte (South-east Brazil). Patients underwent full clinical assessment. Comparisons of patient subgroups according to disease duration and initial presentation were performed. A systematic review was performed about Brazilian clinical studies in ALS. Results showed that of the 61 enrolled patients the male/female ratio was 1.6:1. The mean age at onset of symptoms was 54.9 years (SD ± 11.4). Mean age at diagnosis was 56.3 years (SD ± 11.1). Regarding the initial form of presentation, 43 cases (70.5%) were spinal, 12 cases (19.7%) were generalized and six cases (9.8%) were bulbar. Eight studies were found in the systematic review. In conclusion, the profile of our sample was similar to other national and international series, except for fewer cases of bulbar ALS in our series. There are few clinical studies of ALS in Brazil. The national data of prevalence and incidence are still uncertain. PMID:26854959

  11. Flow equations for the BCS-BEC crossover

    SciTech Connect

    Diehl, S.; Gies, H.; Pawlowski, J. M.; Wetterich, C.

    2007-08-15

    The functional renormalization group is used for the BCS-BEC crossover in gases of ultracold fermionic atoms. In a simple truncation, we see how universality and an effective theory with composite bosonic diatom states emerge. We obtain a unified picture of the whole phase diagram. The flow reflects different effective physics at different scales. In the BEC limit as well as near the critical temperature, it describes an interacting bosonic theory.

  12. Structure of the number-projected BCS wave function

    NASA Astrophysics Data System (ADS)

    Dukelsky, J.; Pittel, S.; Esebbag, C.

    2016-03-01

    We study the structure of the number-projected BCS (PBCS) wave function in the particle-hole basis, displaying its similarities with coupled clusters theory (CCT). The analysis of PBCS together with several modifications suggested by the CCT wave function is carried out for the exactly solvable Richardson model involving a pure pairing Hamiltonian acting in a space of equally spaced, doubly degenerate levels. We point out the limitations of PBCS to describe the nonsuperconducting regime and suggest possible avenues for improvement.

  13. Polymorphous Low-grade Adenocarcinoma: A Case Series and Determination of Recurrence

    PubMed Central

    Kimple, Adam J.; Austin, Grace K.; Shah, Rupali N.; Welch, Chris M.; Funkhouser, William K.; Zanation, Adam M.; Shockley, William W.

    2015-01-01

    Objective Information on polymorphous low-grade adenocarcinoma (PLGA) consists primarily of case reports and small institutional series with varying recurrence rates. In this report, we describe our institutional experience and conduct a review of the literature to assess the overall incidence of PLGA among oral salivary gland tumors and determine recurrence rates. Study Design A retrospective case series and literature based review was performed. Methods Retrospective case series at an academic tertiary referral center. Review of clinical records and pathological analysis of tissue specimens from 20 patients treated for PLGA from July 1, 1990 to July 1, 2011. A literature-based review on PLGA was also performed. Results Twenty patients (mean age 54 years, 8 males) with PLGA based on pathologic diagnosis were included. The most common initial presentation was an asymptomatic mass (45%) and the most frequent site was the palate (60%). Our literature review identified 54 case reports, 8 case series, and 17 large series. In total 456 cases of PLGA were identified with an overall recurrence rate of 19%. Half of the recurrences occurred by 36 months; however, recurrences were reported up to 24 years after initial resection. Conclusion PLGA arises from minor salivary glands and is characteristically slow growing and indolent. While these tumors may be histologically low-grade, our review highlights the high rates of recurrence of these tumors as well as the ability to metastasis to local lymph nodes and distant organs. The mainstay of treatment should be wide surgical excision with long-term oncologic follow up. PMID:25229805

  14. Primary Synovial Sarcoma of the Pharynx: A Series of Five Cases and Literature Review.

    PubMed

    Fatima, Syeda Samia; Din, Nasir Ud; Ahmad, Zubair

    2015-12-01

    Synovial sarcoma comprises approximately 10 % of all soft tissue sarcomas. Although synovial sarcoma has been reported in practically every organ, the extremities are the commonest site of occurrence followed by the head and neck. Primary synovial sarcoma of the pharynx is rare and only case reports have been published. We report a series of five cases of primary synovial sarcoma involving the pharynx. PMID:26022274

  15. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  16. Laparoscopic Surgery in Nonparasitic Cysts of the Liver: Results Observed in a Series of Consecutive Cases.

    PubMed

    Manterola, Carlos; Otzen, Tamara

    2016-08-01

    The purpose of this study was to report the results of laparoscopic treatment of nonparasitic cysts of the liver (NPCL) in terms of postoperative morbidity (POM) and recurrence. Prospective case series of patients operated on for NPCL at the Clínica Mayor in Temuco, Chile (2008 to 2015). The preoperative study consisted of general examinations, abdominal ultrasound or computed tomographic scan. The outcome variable was POM. Other variables of interest were surgical time, need for conversion, hospital stay, mortality, and recurrence. In the study period, 41 patients with NPCL underwent surgery. Median age of the series was 58 years, and 75.6% of the cases were female. The median ultrasound diameter of the lesions was 10 cm and surgical time was 50 minutes. All patients underwent a cystectomy. There was no conversion, no record of POM, mortality or recurrence. The treatment applied in this series of NPCL is associated with an adequate postoperative evolution. PMID:27403620

  17. Neurosis Meets Psychosis: Case Series from a Tertiary Care Center in South India

    PubMed Central

    Dholakia, Saumil Y.; Susmita, Chandramouleeswaran; Ranjit, Krishna Das; Singh, Yogendra; Braganza, Deepa

    2015-01-01

    The utility of the terms psychosis and neurosis in psychiatry have maintained their dichotomous stance since ages. Clinical observations and etiological hypothesis of psychiatric disorders have kept this polarity intact since the times of Freud and Jung. This case series attempts to revisit this perennial psychiatric controversy. PMID:26664092

  18. Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

    ERIC Educational Resources Information Center

    Litynsky, Walter; And Others

    A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that volume…

  19. REHABILITATION OF SUBACROMIAL PAIN SYNDROME EMPHASIZING SCAPULAR DYSKINESIS IN AMATEUR ATHLETES: A CASE SERIES

    PubMed Central

    Moura, Katherinne F.; Monteiro, Renan L.; Lucareli, Paulo R.G.

    2016-01-01

    ABSTRACT Study design Case series Background and Purpose Scapular dyskinesis has been associated with several shoulder injuries. Recent literature has suggested that a greater activation of the scapular muscles can play an important role in reducing subacromial impingement in patients with shoulder pain. Thus, the purpose of this case series was to describe a rehabilitation program that emphasizes scapular dyskinesis correction for those with clinical evidence of subacromial pain syndrome. Case Descriptions The four amateur athletes in this series showed clinical evidence of subacromial pain syndrome and scapular dyskinesis and each underwent a treatment protocol consisting of three phases. Phase 1 emphasized pain relief, scapular control, and recovery of normal range of motion (ROM), Phase 2 focused on muscular strengthening, and Phase 3 emphasized sensory motor training. Outcomes All subjects demonstrated decreased pain, improved sports performance and function, increased muscular strength for shoulder elevation and external rotation, and increased ROM for internal rotation. Improvement in serratus anterior (SA) activation was also noted. Discussion The results of this case series suggest that subjects with clinical tests positive for subacromial pain syndrome can show significant improvement with an intervention focused on scapular dyskinesis correction. SA activation can play an important role in this process given that all subjects presented with better recruitment after rehabilitation, as measured by electromyography. Levels of Evidence Level 4 PMID:27525180

  20. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  1. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  2. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

  3. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  4. Intervention for Infants at Risk of Developing Autism: A Case Series

    ERIC Educational Resources Information Center

    Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

    2013-01-01

    Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base…

  5. Outcomes of laparoscopic removal of the Essure sterilization device for pelvic pain: a case series.

    PubMed

    Casey, James; Aguirre, Francisco; Yunker, Amanda

    2016-08-01

    The following presents a case series of 29 referral patients who underwent laparoscopic Essure removal for the indication of suspected Essure-related pelvic pain and to describe patient characteristics, intraoperative findings and postoperative pain outcomes. Laparoscopic removal for Essure-associated pelvic pain is a safe and effective treatment. PMID:27063056

  6. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  7. Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

    2013-01-01

    We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

  8. The Understanding Words Reading Intervention: Evidence from a Case Series Design

    ERIC Educational Resources Information Center

    Wright, Craig; Conlon, Elizabeth G.; Wright, Michalle

    2012-01-01

    Using a case-series design with double baseline and 10-week maintenance phase, 5 struggling readers from middle- to high-income families (age range 6.4-7.9 years) completed a 5-times-weekly intervention (96 sessions) administered by a parent. All participants completed the intervention with phonological decoding, text-reading accuracy and reading…

  9. Efficacy and safety of the “mother’s kiss” technique: a systematic review of case reports and case series

    PubMed Central

    Cook, Stephanie; Burton, Martin; Glasziou, Paul

    2012-01-01

    Background: Foreign bodies lodged in the nasal cavity are a common problem in children, and their removal can be challenging. The published studies relating to the “mother’s kiss” all take the form of case reports and case series. We sought to assess the efficacy and safety of this technique. Methods: We performed a comprehensive search of the Cochrane library, MEDLINE, CINAHL, Embase, AMED Complementary and Allied Medicine and the British Nursing Index for relevant articles. We restricted the results to only those studies involving humans. In addition, we checked the references of relevant studies to identify further possibly relevant studies. We also checked current controlled trials registers and the World Health Organization search portal. Our primary outcome measures were the successful extraction of the foreign object from the nasal cavity and any reported adverse effects. We assessed the included studies for factors that might predict the chance of success of the technique. We assessed the validity of each study using the Newcastle–Ottawa scale. Results: Eight relevant published articles met our inclusion criteria. The overall success rate for all of the case series was 59.9% (91/152). No adverse effects were reported. Interpretation: Evidence from case reports and case series suggests that the mother’s kiss technique is a useful and safe first-line option for the removal of foreign bodies from the nasal cavities of children. PMID:23071371

  10. Applying data mining techniques to medical time series: an empirical case study in electroencephalography and stabilometry.

    PubMed

    Anguera, A; Barreiro, J M; Lara, J A; Lizcano, D

    2016-01-01

    One of the major challenges in the medical domain today is how to exploit the huge amount of data that this field generates. To do this, approaches are required that are capable of discovering knowledge that is useful for decision making in the medical field. Time series are data types that are common in the medical domain and require specialized analysis techniques and tools, especially if the information of interest to specialists is concentrated within particular time series regions, known as events. This research followed the steps specified by the so-called knowledge discovery in databases (KDD) process to discover knowledge from medical time series derived from stabilometric (396 series) and electroencephalographic (200) patient electronic health records (EHR). The view offered in the paper is based on the experience gathered as part of the VIIP project. Knowledge discovery in medical time series has a number of difficulties and implications that are highlighted by illustrating the application of several techniques that cover the entire KDD process through two case studies. This paper illustrates the application of different knowledge discovery techniques for the purposes of classification within the above domains. The accuracy of this application for the two classes considered in each case is 99.86% and 98.11% for epilepsy diagnosis in the electroencephalography (EEG) domain and 99.4% and 99.1% for early-age sports talent classification in the stabilometry domain. The KDD techniques achieve better results than other traditional neural network-based classification techniques. PMID:27293535

  11. Modern Spirometry Supports Anesthetic Management in Small Animal Clinical Practice: A Case Series.

    PubMed

    Calice, Ivana; Moens, Yves

    2016-01-01

    Modern spirometry, like no other monitoring technique, allows insight into breath-to-breath respiratory mechanics. Spirometers continuously measure volume, airway pressure, and flow while calculating and continuously displaying respiratory system compliance and resistance in the form of loops. The aim of this case series is to show how observation of spirometric loops, similar to electrocardiogram or CO2 curve monitoring, can improve safety of anesthetic management in small animals. Spirometric monitoring cases described in this case series are based on use of the anaesthesia monitor Capnomac Ultima with a side stream spirometry sensor. The cases illustrate how recognition and understanding of spirometric loops allows for easy diagnosis of iatrogenic pneumothorax, incorrect ventilator settings, leaks in the system, kinked or partially obstructed endotracheal tube, and spontaneous breathing interfering with intermittent positive-pressure ventilation. The case series demonstrates the potential of spirometry to improve the quality and safety of anesthetic management, and, hence, its use can be recommended during intermittent positive-pressure ventilation and procedures in which interference with ventilation can be expected. PMID:27487353

  12. Propagation of sound and supersonic bright solitons in superfluid Fermi gases in BCS-BEC crossover

    NASA Astrophysics Data System (ADS)

    Wen, Wen; Shen, Shun-Qing; Huang, Guoxiang

    2010-01-01

    We investigate the linear and nonlinear sound propagations in a cigar-shaped superfluid Fermi gas with a large particle number. We first solve analytically the eigenvalue problem of linear collective excitations and provide explicit expressions of all eigenvalues and eigenfunctions, which are valid for all superfluid regimes in the Bardeen-Cooper-Schrieffer-Bose-Einstein condensation (BCS-BEC) crossover. The linear sound speed obtained agrees well with that of a recent experimental measurement. We then consider a weak nonlinear excitation and show that the time evolution of the excitation obeys a Korteweg de Vries equation. Different from the result obtained in quasi-one-dimensional case studied previously, where subsonic dark solitons are obtained via the balance between quantum pressure and nonlinear effect, we demonstrate that bright solitons with supersonic propagating velocity can be generated in the present three-dimensional system through the balance between a waveguidelike dispersion and the interparticle interaction. The supersonic bright solitons obtained display different physical properties in different superfluid regimes and hence can be used to characterize superfluid features of the BCS-BEC crossover.

  13. Dengue virus infection in renal allograft recipients: a case series during 2010 outbreak.

    PubMed

    Prasad, N; Bhadauria, D; Sharma, R K; Gupta, A; Kaul, A; Srivastava, A

    2012-04-01

    Dengue virus infection is an emerging global threat caused by Arbovirus, a virus from Flaviridiae family, which is transmitted by mosquitoes, Aedes aegypti and Aedes albopictus. Renal transplant recipients who live in the endemic zones of dengue infection or who travel to an endemic zone could be at risk of this infection. Despite multiple epidemics and a high case fatality rate in the Southeast Asian region, only a few cases of dengue infection in renal transplant recipients have been reported. Here, we report a case series of 8 dengue viral infection in renal transplant recipients. Of the 8 patients, 3 developed dengue hemorrhagic shock syndrome and died. PMID:22212524

  14. Leptomeningeal carcinomatosis in esophageal cancer: a case series and systematic review of the literature.

    PubMed

    Lukas, R V; Mata-Machado, N A; Nicholas, M K; Salgia, R; Antic, T; Villaflor, V M

    2015-01-01

    The aim of this study was to more clearly define the clinical course of leptomeningeal carcinomatosis due to esophageal cancer. A single institution retrospective case series was conducted. Additionally, a systematic review of the literature was performed. We present a large case series (n = 7) of leptomeningeal carcinomatosis due to esophageal cancer. Our case series and systematic review of the literature report similar findings. In our series, we report a predominance of male patients (86%) with adenocarcinoma histology (77%). Variable onset of leptomeningeal involvement of esophageal cancer in relation to the original diagnosis of the primary disease (5 months to 3 years and 11 weeks) was noted. Disease progresses quickly and overall survival is poor, measured in weeks (2.5-16 weeks) from the diagnosis of leptomeningeal involvement. Four of our patients initiated whole-brain radiation therapy with only two completing the course prior to clinical deterioration. Our patient with the longest survival (16 weeks) received intrathecal topotecan and oral temozolomide. Leptomeningeal carcinomatosis secondary to esophageal cancer has a poor prognosis. A clearly beneficial treatment modality is lacking. PMID:25142531

  15. Plasma cell leukemia: A case series from South India with emphasis on rarer variants

    PubMed Central

    Rajeswari, G.; Paul, T. Roshni; Uppin, Megha S.; Uppin, Shantveer G.; Rao, D. Raghunadha; Raju D, D. Sree Bhushan; Sadashindu, G.

    2014-01-01

    Plasma cell leukemia (PCL) is a rare and aggressive variant of plasma cell dyscrasia. They occur de novo (primary) or as a late manifestation of multiple myeloma (secondary). Patients present with anemia, thrombocytopenia, renal failure, organomegaly and extramedullary manifestations. We are presenting this series as it is the second largest series from India (16) with 4 young cases (under 40 years of age), more number of female patients and two having ‘hairy cell’ morphology. It is recommended that techniques like immunophenotyping and protein electrophoresis be performed, whenever the morphology is not characteristic of plasma cells. PMID:25336792

  16. BCS-BEC crossover and quantum hydrodynamics in p-wave superfluids with a symmetry of the A1 phase

    SciTech Connect

    Kagan, M. Yu. Efremov, D. V.

    2010-03-15

    We solve the Leggett equations for the BCS-BEC crossover in a three dimensional resonance p-wave superfluid with the symmetry of the A1 phase. We calculate the sound velocity, the normal density, and the specific heat for the BCS domain ({mu} > 0), for the BEC domain ({mu} < 0), and close to the important point {mu} = 0 in the 100% polarized case. We find the indications of a quantum phase transition close to the point {mu}(T = 0) = 0. Deep in the BCS and BEC domains, the crossover ideas of Leggett, Nozieres, and Schmitt-Rink work quite well. We discuss the spectrum of orbital waves, the paradox of intrinsic angular momentum and the complicated problem of chiral anomaly in the BCS A1 phase at T = 0. We present two different approaches to the chiral anomaly, based on supersymmetric hydrodynamics and on the formal analogy with the Dirac equation in quantum electrodynamics. We evaluate the damping of nodal fermions due to different decay processes in the superclean case at T = 0 and find that a ballistic regime {omega}{tau} >> 1 occurs. We propose to use aerogel or nonmagnetic impurities to reach the hydrodynamic regime {omega}{tau} << 1 at T = 0. We discuss the concept of the spectral flow and exact cancelations between time derivatives of anomalous and quasiparticle currents in the equation for the total linear momentum conservation. We propose to derive and solve the kinetic equation for the nodal quasiparticles in both the hydrodynamic and ballistic regimes to demonstrate this cancelation explicitly. We briefly discuss the role of the other residual interactions different from damping and invite experimentalists to measure the spectrum and damping of orbital waves in the A phase of {sup 3}He at low temperatures.

  17. Orifice-assisted small-incision surgery: case series in benign and oncologic gynecology.

    PubMed

    Einarsson, Jon I; Cohen, Sarah L; Puntambekar, Shailesh

    2012-01-01

    This case series describes the feasibility of orifice-assisted small-incision surgery (OASIS), a novel technique that may incorporate benefits of single-incision and natural-orifice surgery while minimizing issues such as instrument crowding and interaction of optical access with operative instrumentation. In our multiple-site series, we included patients from a large academic medical center in the northeastern United States and a private gynecology clinic in India. Between the 2 centers, a total of 14 patients (5 with benign disease and 9 with oncologic disease) underwent the following procedures: OASIS total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic myomectomy, or laparoscopic radical hysterectomy with pelvic lymph node dissection. The initial 14 cases were safely completed. Oncologic clearance was consistent with specialty norms. Operating time ranged from 60 to 150 minutes, and estimated blood loss ranged from 10 to 500 mL. Detailed procedure descriptions and videos are provided. Based on preliminary case series experience, OASIS seems to be a safe and feasible addition to the advanced minimally invasive surgeons' armamentarium for both benign and oncologic cases. PMID:22417906

  18. Tubercular Uveitis with Ocular Manifestation as the First Presentation of Tuberculosis: A Case Series.

    PubMed

    Shah, Jayashree S; Shetty, Niharika; Shah, Sharath Kumar D; Shah, Neelesh Kumar S

    2016-03-01

    Tuberculosis is very common disease in India. It is one of the most common causes of Granulomatous Uveitis in our Country even today. So the strongest suspicion in our mind when we are treating a case of Uveitis, should be TB. We reviewed all the cases of clinically suspected ocular tuberculosis attending the Ophthalmology OPD of Sri Siddhartha Medical College between December 2012 and December 2014 who were refractory to routine uveitis management and later on responded to anti-Tubercular treatment. History of TB contact, Ocular manifestation, Demographic Profile of the patients, Diagnostic test, Treatment regime were looked into. Here by we present a case series of 15 cases of refractory uveitis that later were detected to be of tuberculous origin. We studied the characteristic features, complications and correlation of mantoux test, ESR and Koch's contact with these cases. PMID:27134908

  19. Late-life homicide-suicide: a national case series in New Zealand.

    PubMed

    Cheung, Gary; Hatters Friedman, Susan; Sundram, Frederick

    2016-01-01

    Homicide-suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late-life homicide-suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late-life homicide-suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five-year period (July 2007-December 2012). Of the 225 suicides, 4 cases of homicide-suicide were identified (an estimated incidence of 0.12 per 100,000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide-suicide, and one case as siblicide-suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide-suicide. Age-related biopsychosocial issues were highlighted in this case series of late-life homicide-suicide. Additionally, evaluating firearm licences in high-risk groups may represent a prevention strategy. PMID:25735608

  20. Sound modes at the BCS-BEC crossover

    SciTech Connect

    Heiselberg, H.

    2006-01-15

    First and second sound speeds are calculated for a uniform superfluid gas of Fermi atoms as a function of temperature, density, and interaction strength. The second sound speed is of particular interest as it is a clear signal of a superfluid component and it determines the critical temperature. The sound modes and their dependence on density, scattering length, and temperature are calculated in the BCS, molecular Bose-Einstein condensate (BEC), and unitarity limits and a smooth crossover is extrapolated. It is found that first and second sounds undergo avoided crossing on the BEC side due to mixing. Consequently, they are detectable at crossover both as density and thermal waves in traps.

  1. Buprenorphine/naloxone therapy for opioid refractory neuropathic pain following traumatic amputation: a case series.

    PubMed

    Licina, Lauren; Hamsher, Carlyle; Lautenschager, Karl; Dhanjal, Sandeep; Williams, Necia; Spevak, Christopher

    2013-07-01

    Phantom limb pain is a common consequence of limb amputation and is prevalent among the service members sustaining traumatic battlefield limb injuries during the conflicts in Iraq and Afghanistan. Current treatment to relieve phantom limb pain consists of physical, behavioral, and medical modalities including opioids and adjunct medications. Treatment failure resulting in persistent pain and disability may result. This case series describes four previously healthy service members who developed phantom limb pain following traumatic amputation successfully treated with buprenorphine/naloxone after failing traditional treatment. This is the first reported case series of patients expressing improved pain control with decreased frequency of phantom limb pain with the use of buprenorphine/naloxone instead of traditional opioid agonists. PMID:23820366

  2. The bone lamina technique: a novel approach for lateral ridge augmentation--a case series.

    PubMed

    Wachtel, Hannes; Fickl, Stefan; Hinze, Marc; Bolz, Wolfgang; Thalmair, Tobias

    2013-01-01

    The goal of this case series is to present a novel treatment approach for lateral ridge augmentation. Four systemically healthy patients (aged 48 to 59 years) with inadequate dental alveolar ridge widths were selected for inclusion. All ridge defects were augmented using a xenogeneic cortical bone shield in combination with particulated bone substitutes and a thin collagen barrier. At baseline and after 6 months, digital cone beam computed tomography scans were performed. Biopsy specimens were harvested at reentry surgery and processed for histologic analysis. The results revealed a sufficient amount of bone structure for implant placement without additional augmentation procedures. The histologic analysis demonstrated that new bone formation had taken place and the bone shield had resorbed entirely. This case series indicates that the bone lamina technique has the biologic and mechanical properties to successfully achieve hard tissue augmentation of deficient ridges. PMID:23820709

  3. Disulfiram-Induced Reversible Hypertension: A Prospective Case Series and Review of The Literature

    PubMed Central

    Kulkarni, Ranganath R.; Ramdurg, Santosh I.; Bairy, Bhavya K.

    2014-01-01

    Disulfiram (DSF) is one of the recommended aids in the management of selected patients with alcohol dependence. Hypertension (HTN) as an adverse effect of DSF therapy is less understood. In our prospective case series of 7 subjects with co-morbid alcohol and nicotine dependence, a temporal, dose-dependent, and reversible grade 1-3 HTN within 1-6 weeks of initiation of DSF therapy (125-500 mg/day) with no other detectable causes of HTN was noted. Challenges and strategies surrounding diagnosis and treatment along with mean change and percentage rise in blood pressure are described. Literature review and clinical description of case series may suggest neurobiological role in its causation. HTN may be a clinically significant, dose-dependent, and reversible adverse effect of DSF therapy, especially in co-morbid alcohol and nicotine-dependent patients. Awareness amongst clinicians may render better health care delivery to subjects with alcohol dependence. PMID:25336781

  4. A case-series study of cerebral venous thrombosis in women using short course oral contraceptive

    PubMed Central

    Khomand, Payam; Hassanzadeh, Kambiz

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month. Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015. Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. They did not have other possible risk factors for CVT. A headache was the most common in 9/9 patients (100%) followed by vomiting and vertigo. Conclusion: We found that high rate of CVT in female population during Ramadan indicates that it needs be considered as a specific risk factor and should be considered by healthcare system. PMID:27326364

  5. Vortex lattices in a rotating Fermi superfluid in the BCS-BEC crossover with many Landau levels

    SciTech Connect

    Song, Tie-ling; Ma, C.R.; Ma, Yong-li

    2012-08-15

    We present an explicit analytical analysis of the ground state of vortex lattice structure, based on a minimization of the generalized Gross-Pitaevskii energy functional in a trapped rotating Fermi superfluid gas. By a Bogoliubov-like transformation we find that the coarse-grained average of the atomic density varies as inverted parabola in three dimensional cases; the Fermi superfluid in the BEC regime enters into the lowest Landau level at fast rotation, in which the vortices form an almost regular triangular lattice over a central region and the vortex lattice is expanded along the radial direction in the outer region; the fluid in the unitarity and BCS regimes occupies many low-lying Landau levels, in which a trapped gas with a triangular vortex lattice has a superfluid core surrounded by a normal gas. The calculation is qualitatively consistent with recent numerical and experimental data both in the vortex lattice structure and vortex numbers and in the density profiles versus the stirring frequency in the whole BCS-BEC crossover. - Highlights: Black-Right-Pointing-Pointer We present an analysis of vortex lattice in an interacting trapped rotating Fermi superfluid gas. Black-Right-Pointing-Pointer Decomposing the vortex from the condensate, we can explain the vortex lattice. Black-Right-Pointing-Pointer The calculation is consistent with numerical and experimental data. Black-Right-Pointing-Pointer It can characterize experimentally properties in different regimes of the BCS-BEC crossover.

  6. Excessive sweepstakes participation in patients with dementia in Hawai'i: a case series.

    PubMed

    Tamura, Bruce K; Wong, Warren F; Sezginsoy, Banu; Masaki, Kamal H

    2006-12-01

    We report a case series of 11 patients with excessive sweepstakes participation on initial geriatric consultation in Honolulu. Ten of these patients had dementia, mostly Alzheimer's disease, with Folstein MiniMental Status Exam scores ranging from 17-29/30. Money lost ranged from 6,600 dollars to 200,000-400,000 dollars. Physicians need to have a high index of suspicion and the public needs to be educated about simple preventive strategies. PMID:17319475

  7. Management of Lower Extremity and Pelvic Tumors Using Computer Assisted Modeling (CAM) A Case Series.

    PubMed

    Haskoor, John; Sinno, Sammy; Blank, Alan; Saadeh, Pierre; Rapp, Timothy

    2016-06-01

    Computer assisted modeling (CAM) has become an important tool in surgical oncology and reconstructive surgery. The preservation of the limb is an important consideration when approaching the treatment of lower extremity and pelvic tumors. The use of cutting guides allows for optimal conservation of disease-free bone and maintenance of function. We present a small case series that illustrates the use of CAM in patients with lower extremity and pelvic bone tumors. PMID:27281326

  8. Treatment of rosacea with topical ivermectin cream: a series of 34 cases.

    PubMed

    Mendieta Eckert, Marta; Landa Gundin, Nerea

    2016-01-01

    Rosacea is a highly prevalent, chronic inflammatory disease. The use of topical ivermectin cream has recently been described in the treatment of rosacea in three clinical trials. We report our experience in a series of 34 patients treated with topical ivermectin cream. The results are a reflection of the reality of clinical practice and the perception of patients of the treatment. We also evaluate the efficacy in cases of mild rosacea and erythematotelangiectatic rosacea which have not been studied in trials. PMID:27617938

  9. Grape Cells (Multinucleated Keratinocytes) in Noninfectious Dermatoses: Case Series and Review of the Literature

    PubMed Central

    Sulit, Daryl J.; Adams, Erin G.; Shvartsman, Katerina R.; Rapini, Ronald P.

    2015-01-01

    Abstract: Multinucleated keratinocytes (also known as multinucleated epidermal giant cells) are a frequently overlooked histological finding in noninfectious inflammatory dermatoses. They are sometimes found in conditions characterized by chronic rubbing and pruritus, such as lichen simplex chronicus or prurigo nodularis, and may be a helpful clue in making the clinical diagnosis. This finding must be differentiated from other conditions characterized by multinucleated keratinocytes on histopathology, specifically herpes simplex, varicella zoster, or measles viral infections. The authors present a case series of 2 patients with unique clinical noninfectious diagnoses but similar histopathologic findings on biopsy. The histopathologic findings on both cases demonstrated multinucleated keratinocytes, which were related to manipulation of the epidermis. PMID:26588345

  10. Eosinophilic meningitis: a case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum.

    PubMed

    Shah, I; Barot, S; Madvariya, M

    2015-01-01

    Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents. PMID:25560024

  11. Treatment of ranula using carbon dioxide laser--case series report.

    PubMed

    Lai, J B; Poon, C Y

    2009-10-01

    Ranulas are mucus extravasation phenomenon formed after trauma to the sublingual gland or mucus retention from the obstruction of the sublingual ducts. There are various methods for treating ranulas, including marsupialization with or without open packing, excision of ranula with or without removal of sublingual gland, and laser excision and vaporization of ranula. The authors present a case series report on the use of carbon dioxide laser treatment for ranula and a literature review of cases treated using carbon dioxide laser. The authors' experience and reports in the literature indicate that carbon dioxide laser excision of ranula is safe with minimal or no recurrence. PMID:19481422

  12. [Nerve sonography of intraneural ganglia as cause painful peroneal palsies: a case series].

    PubMed

    Schilg, Lenka; Hägele-Link, Stefan; Felbecker, Ansgar; Gers, Bettina; Weber, Johannes; Tettenborn, Barbara; Hundsberger, Thomas

    2014-11-26

    In selected cases acquired peroneal palsy is caused by intraneural ganglia. In contrast to the much more frequent "loco typico" lesion which is caused by external pressure, intraneural ganglia can be treated by microscopic nerve surgery as part of primary treatment strategy. A careful clinical history as well as a profound clinical and electrophysiological examination is required to disclose unusual findings. These are common in non-typical peroneal palsy. In this situation high resolution nerve sonography is a fast and sensitive method to detect intraneural ganglia. We report a case series of three patients with peroneal palsy caused by intraneural ganglia and give a review of the literature. PMID:25446682

  13. Preamputation mirror therapy may prevent development of phantom limb pain: a case series.

    PubMed

    Hanling, Steven R; Wallace, Scott C; Hollenbeck, Kerry J; Belnap, Brian D; Tulis, Matthew R

    2010-02-01

    We report the cases of 4 patients who performed daily mirror therapy for 2 wk before undergoing elective limb amputation. One patient experienced no phantom limb pain (PLP). Two patients experienced rare episodes of mild PLP without effect on their participation in physical therapy (PT) or their quality of life. One patient reported daily, brief episodes of moderate PLP without effect on his participation in PT or his stated quality of life. These results indicate that preoperative mirror therapy may improve postamputation PT compliance and decrease the incidence of PLP. Future prospective studies are needed to confirm the results of this case series. PMID:19917622

  14. Elaboration of the alpha-model derived from the BCS theory of superconductivity

    SciTech Connect

    Johnston, David C.

    2013-10-14

    The single-band α-model of superconductivity (Padamsee et al 1973 J. Low Temp. Phys. 12 387) is a popular model that was adapted from the single-band Bardeen–Cooper–Schrieffer (BCS) theory of superconductivity mainly to allow fits to electronic heat capacity versus temperature T data that deviate from the BCS prediction. The model assumes that the normalized superconducting order parameter Δ(T)/Δ(0) and therefore the normalized London penetration depth λL(T)/λL(0) are the same as in BCS theory, calculated using the BCS value αBCS ≈ 1.764 of α ≡ Δ(0)/kBTc, where kB is The single-band α-model of superconductivity (Padamsee et al 1973 J. Low Temp. Phys. 12 387) is a popular model that was adapted from the single-band Bardeen–Cooper–Schrieffer (BCS) theory of superconductivity mainly to allow fits to electronic heat capacity versus temperature T data that deviate from the BCS prediction. The model assumes that the normalized superconducting order parameter Δ(T)/Δ(0) and therefore the normalized London penetration depth λL(T)/λL(0) are the same as in BCS theory, calculated using the BCS value αBCS ≈ 1.764 of α ≡ Δ(0)/kBTc, where kB is Boltzmann's constant and Tc is the superconducting transition temperature. On the other hand, to calculate the electronic free energy, entropy, heat capacity and thermodynamic critical field versus T, the α-model takes α to be an adjustable parameter. Here we write the BCS equations and limiting behaviors for the superconducting state thermodynamic properties explicitly in terms of α, as needed for calculations within the α-model, and present plots of the results versus T and α that are compared with the respective BCS predictions. Mechanisms such as gap anisotropy and strong coupling that can cause deviations of the thermodynamics from the BCS predictions, especially the heat capacity jump at Tc, are considered. Extensions of the α-model that have appeared in the literature, such as the two-band model

  15. Evaluation of Streptococcus pneumoniae in bile samples: A case series review.

    PubMed

    Itoh, Naoya; Kawamura, Ichiro; Tsukahara, Mika; Mori, Keita; Kurai, Hanako

    2016-06-01

    Although Streptococcus pneumoniae is an important pathogen of humans, pneumococcal cholangitis is rare because of the rapid autolysis of S. pneumoniae. The aim of this case series was to review patients with bile cultures positive for S. pneumoniae. This study was a single center retrospective case series review of patients with S. pneumoniae in their bile at a tertiary-care cancer center between September 2002 and August 2015. Subjects consisted of all patients in whom S. pneumoniae was isolated in their bile during the study period. Bile specimens for culture were obtained from biliary drainage procedures such as endoscopic retrograde biliary drainage, endoscopic nasobiliary drainage, and percutaneous transhepatic biliary drainage. There were 20 patients with bile cultures positive for S. pneumoniae during the study period. All patients presented with extrahepatic obstructive jaundice due to hepatopancreatobiliary tumors. Nineteen of 20 patients underwent the placement of plastic intrabiliary tubes. The mean time between the first-time drainage and the positive culture was 26 days (range 0-313 days). Although 12 of 20 patients met our definition of cholangitis, 5 were clinically treated with antibiotics based on a physician's assessment of whether there was a true infection. The present study is the largest case series of patients with S. pneumoniae in their bile. Based on our findings, the isolation of S. pneumoniae from bile may be attributed to the placement of biliary drainage devices. PMID:27025902

  16. Regression of advanced melanoma upon withdrawal of immunosuppression: case series and literature review

    PubMed Central

    Thomas, N.; Sharpless, N.; Collichio, F.

    2013-01-01

    We report two cases of stage IV malignant melanoma arising in patients treated with azathioprine for myasthenia gravis. In both cases, the melanoma metastases regressed upon withdrawal of immunosuppression. One patient remains melanoma free at 10 years, and the second patient experienced an 18-month disease free period. There is one prior case report in the medical literature to support full immune reconstitution for treatment in advanced immunosuppression-related melanoma, and one case series suggesting that transplant patients developing melanoma may benefit from a switch to sirolimus. Virtually, no data exist for the medical management of early stage melanoma in the immunosuppressed patients. We review the limited preclinical data in support of immune reconstitution and the data on immunosuppression as a risk factor for melanoma. We conclude that reduction or withdrawal of immunosuppression may be beneficial in patients with advanced stage melanoma and warrants further consideration in patients with early stage melanoma. PMID:19890737

  17. Management of cervical cancer and surgical-pathological staging (SPS). Report of our clinical case series.

    PubMed

    Onnis, A; Marchetti, M; Maggino, T; Cascio, A; Cerri, G; Dipasquale, C; Meneghello, E; Romagnolo, C; Rozzo, M L

    1988-01-01

    FIGO staging is imprecise in a relevant number of cases of cervical cancer, especially in advanced stages, when the prognosis and the choice of the therapy are most delicate. The Authors examine their case series about the index of correction of FIGO staging after Surgical Pathological Staging (SPS). Surgical Pathological Staging was applied systematically in 788 cases and revealed errors in FIGO staging in 16% of cases at stage I; 77% at stage II; and 96% at stage III. SPS allows a more precise knowledge of neoplastic diffusion and consequently to the elimination of many false advanced stages and to adequate the treatment. Furthermore 5 year survival rate confirms the role of SPS and Surgical therapy alone or combined with Radiotherapy and Chemotherapy in every stages of diffusion of cervical cancer. PMID:3383889

  18. Bleaching teeth treated endodontically: long-term evaluation of a case series.

    PubMed

    Amato, Massimo; Scaravilli, Maria Serena; Farella, Mauro; Riccitiello, Francesco

    2006-04-01

    The chromatic stability of nonvital discolored teeth, subjected to the combined intracoronal bleaching technique and to endodontic treatment, was evaluated at a distance of 16 yr (1989-2005). The series comprised 50 patients (age range 7-30 yr) selected from among those attending the Dental Clinic at "Federico II" University, Naples, between 1987 and 1989. After 16 yr, only 35 cases could be evaluated: in 22 of these cases (62.9%) the color had remained stable and was similar to that of adjacent teeth, indicating a successful outcome of the combined bleaching technique. There were 13 cases (37.1%) classified as failures because of marked color relapse. Radiology showed none of the cases re-examined to have undergone internal or external root resorption. These results confirm the validity of the combined intracoronal bleaching technique in terms of efficacy, rapid esthetic result, and safety. PMID:16554217

  19. Epilepsy and violence: case series concerning physical trauma in children of persons with epilepsy

    PubMed Central

    Gauffin, Helena; Landtblom, Anne-Marie

    2014-01-01

    Historically, epilepsy has been associated with violence, but more recent studies have emphasized genetic and psychosocial factors as more important. The case series presented here aim to highlight the difficult situation the affected children are in. We report on three cases when children have been traumatized and, in one case, even been killed by their parent who was diagnosed with epilepsy. In the first case, we describe a woman with juvenile myoclonic epilepsy who was sentenced to forensic psychiatry care for killing her child. She lived under difficult psychosocial circumstances and a suicide attempt contributed to what happened. The second case describes a man with post-traumatic seizures who was sentenced for child abuse. Ictal or postictal violence was considered in these two cases but a causal link between the violence and epilepsy has not been established. In the third case, we describe a woman with focal epilepsy and psychogenic non-epileptic seizures (PNESs). Her child was hurt and frightened in relation to violent seizures, which were regarded as PNESs. This case series demonstrates that children of parents with epilepsy can be in a vulnerable situation. No causality has been established between the seizures and these events, so consequently other factors such as psychosocial stress, low cognitive function, and a suicide attempt must also be considered as important. When a child is hurt by a parent with epilepsy the patient must be closely examined to determine the role of the seizures. Children can also be affected by PNESs. It is essential to notice especially those children of parents with epilepsy who live under difficult psychosocial circumstances and offer extra support when necessary. PMID:25484586

  20. Epilepsy and violence: case series concerning physical trauma in children of persons with epilepsy.

    PubMed

    Gauffin, Helena; Landtblom, Anne-Marie

    2014-01-01

    Historically, epilepsy has been associated with violence, but more recent studies have emphasized genetic and psychosocial factors as more important. The case series presented here aim to highlight the difficult situation the affected children are in. We report on three cases when children have been traumatized and, in one case, even been killed by their parent who was diagnosed with epilepsy. In the first case, we describe a woman with juvenile myoclonic epilepsy who was sentenced to forensic psychiatry care for killing her child. She lived under difficult psychosocial circumstances and a suicide attempt contributed to what happened. The second case describes a man with post-traumatic seizures who was sentenced for child abuse. Ictal or postictal violence was considered in these two cases but a causal link between the violence and epilepsy has not been established. In the third case, we describe a woman with focal epilepsy and psychogenic non-epileptic seizures (PNESs). Her child was hurt and frightened in relation to violent seizures, which were regarded as PNESs. This case series demonstrates that children of parents with epilepsy can be in a vulnerable situation. No causality has been established between the seizures and these events, so consequently other factors such as psychosocial stress, low cognitive function, and a suicide attempt must also be considered as important. When a child is hurt by a parent with epilepsy the patient must be closely examined to determine the role of the seizures. Children can also be affected by PNESs. It is essential to notice especially those children of parents with epilepsy who live under difficult psychosocial circumstances and offer extra support when necessary. PMID:25484586

  1. Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports

    PubMed Central

    2012-01-01

    The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001–2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%). The most common site of infection was blood (52%), followed by respiratory (30%), and urine (10%). Forty-nine (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01). Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p= 0.03). Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02); similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p= 0.03). Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29%, and 25

  2. Case series of familial frontal fibrosing alopecia and a review of the literature.

    PubMed

    Navarro-Belmonte, María Rogelia; Navarro-López, Vicente; Ramírez-Boscà, Ana; Martínez-Andrés, Ma Asunción; Molina-Gil, Consuelo; González-Nebreda, Miguel; Asín-Llorca, Manuel

    2015-03-01

    Frontal fibrosing alopecia (FFA) is a distinctive form of scarring alopecia presenting with partial eyebrow loss and frontal temporal parietal recession of the hairline. Its etiology remains unknown, and there is no definitive treatment. Information in familial cases of FFA is scarce. We conducted a retrospective cohort study describing the mean clinical findings, treatment, and also the mean differences between premenopausal and postmenopausal cases of familiar FFA. Data analysis from case was performed on eight patients with a familiar history and diagnosis of FFA seen at the Alicante Aesthetic Dermatology Centre between January 2009 and June 2014. All patients in this cohort were females. Mean age at onset was 65 year (range 60-75) in the postmenopausal patients and 39 year (range 33-47) in the premenopausal women. All menopausal patients were in an advanced stage when the disease had already developed in the frontal and/or temporal parietal hairline region. However, the daughters, all of them premenopausal age, attended the consultation with mild involvement of the eyebrows in all four cases and mild impairment of the frontal hairline in three of them. Specific clinical findings in familial FFA are poorly communicated until nowadays although the number of familial cases arises until 8% in the main case series published in recent years. Early diagnosis in premenopausal stage is frequent in our case series and allows us to begin the protocol treatment in the first stage of the disease, but long-term progression will remain uncertain until a definitive treatment could be established by multicenter randomized controlled trials. PMID:25614294

  3. Paracetamol serum concentrations in preterm infants treated with paracetamol intravenously: a case series

    PubMed Central

    2012-01-01

    Introduction Until now, studies on paracetamol given intravenously have mainly been performed with the pro-drug propacetamol or with paracetamol in preterm babies above 32 weeks of gestation. Studies in these babies indicate that intravenous paracetamol is tolerated well, however studies on the efficacy of intravenous paracetamol are lacking. There are no pharmacokinetic data on the administration of multiple doses of paracetamol in preterm babies with a gestational age below 32 weeks. Case presentation We present a case series of nine Caucasian preterm babies, six boys and three girls, with a mean gestational age of 28.6 weeks (range 25.9 to 31.6 weeks). Case one, a girl with a gestational age of 25 weeks and six days, presented with necrotizing enterocolitis. In the second case, a female baby with a gestational age of 26 weeks and two days presented with hematoma. In case three, a female baby with a gestation of 26 weeks and one day developed intraventricular hemorrhage. In case four, a male baby with a gestational age of 31 weeks and four days presented with pain after vacuum delivery. Case five, a female baby born after a gestation of 29 weeks and six days presented with hematoma. In case six, a male baby with a gestation of 30 weeks and six days presented with hematoma. In case seven, a male baby, born with a gestational age of 30 weeks and six days, presented with caput succedaneum and hematoma. In case eight, a male baby, born after a gestation of 28 weeks and four days, developed abdominal distention. Case nine, a female baby, born with a gestational age of 27 weeks and three days presented with hematoma. These babies were treated with intravenous paracetamol 15 mg/kg every six hours. Serum concentrations and aspartate transaminase were determined after prolonged administration. Pain scores were assessed using the Premature Infant Pain Profile. Conclusion Paracetamol serum concentrations ranged from 8 to 64 mg/L after eight to 12 doses of intravenous

  4. Conservative Nonsurgical Treatment of Class 4 Invasive Cervical Resorption: A Case Series.

    PubMed

    Salzano, Stefano; Tirone, Federico

    2015-11-01

    External cervical resorption, also called invasive cervical resorption (ICR), is a pathological process difficult to diagnose that causes a progressive replacement of dentin by granulation tissue and results in complete tooth destruction. According to the literature, class 4 ICR can be expected to have success rates of 12.5% if treated. In this case series, we show nonsurgical conservative treatment of 4 patients affected by class 4 ICR. In 4 patients affected by class 4 ICRs, granulomatous tissue was orthograde removed with the help of an operating microscope and cone-beam computed tomographic imaging. The teeth were devitalized, the granulomatous tissue was mechanically removed, and the defects were filled with either mineral trioxide aggregate or Biodentine (Septodont, Saint-Maur-des-Fossés, France). After a follow-up period varying from 18 months for case 1 to 4 months for case 4, neither signs of periradicular bone rarefaction nor recurrence of resorption were observed. The teeth were asymptomatic, and conservative restorations appeared to be in excellent condition. Given the results achieved in this case series, it may be assumed that many class 4 ICRs could be successfully treated with the help of an operating microscope and cone-beam computed tomographic imaging. PMID:26395913

  5. Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series

    PubMed Central

    Noriega, Luis Miguel; Verdugo, Renato J.; Araos, Rafael; Munita, José Manuel; Díaz, Violeta; Marcotti, Alejandra; Perez, Jorge; Gonzalez, Patricia; Thompson, Luis; Canals, Magdalena; Hoppe, Arnold; Mounts, Anthony W.; Vial, Pablo A.

    2010-01-01

    Please cite this paper as: Noriega et al. (2010) Pandemic influenza a (H1N1) 2009 with neurological manifestations, a case series. Influenza and Other Respiratory Viruses 4(3), 117–120. Objectives  Describe a series of atypical presentations of pandemic influenza A (H1N1) 2009. Methods  Description of case series using hospital records. Results  Six patients aged 1 to 65 years with confirmed pandemic influenza A (H1N1) 2009 infection presented with neurological complications within 2 to 5 days after the first signs of influenza‐like illness. All six were admitted with seizures or altered mental status. No abnormalities were found in brain scans or cerebral spinal fluid studies of any of the six. All were discharged without sequelae within days of admission. Conclusions  This is only the second report of pandemic influenza presenting with neurological manifestations. Clinicians caring for patients when pandemic influenza is prevalent in their communities should maintain a high level of awareness of the potential atypical presentations with which this disease can appear. PMID:20409207

  6. More is Different:. 50 Years of Nuclear BCS

    NASA Astrophysics Data System (ADS)

    Broglia, R. A.

    2013-01-01

    At the basis of BCS theory, and associated symmetry breaking phenomena in gauge space, one finds Cooper pair binding. A major question in the nuclear case concerning this issue, regards the relative role played by the bare nucleon-nucleon force and by the interaction induced by the exchange of vibrations between members of Cooper pairs. The exotic nucleus 113Li8 in which two neutrons forming an extended halo, bind weakly to the 9Li core, provides an excellent testing ground to try to shed light on this issue. Theory finds that, in this case, the exchange of collective vibrations associated with the core and with the halo fields, provides an important fraction of the glue binding the pair. Inverse kinematics and active detector based experiments, combined with a quantitative description (based on absolute differential cross sections) of single Cooper pair tunneling, the specific probe of pairing in nuclei, which forces the virtual phonon into a real final state, have tested these predictions with positive results. The extension of structure and reaction studies to open shell (superfluid) nuclei (Sn-isotopes), displaying a strong alignment of quasispin in gauge space, and associated domain wall, as testified by pairing rotational bands excited in terms of single Cooper pair tunneling, provides an overall description of the data within experimental errors. This is also true in connection with pairing vibrations as observed in closed shell nuclei. Many of the concepts which are at the basis of the development associated with a quantitative treatment of the variety of phenomena associated with the spontaneous breaking of gauge symmetry in nuclei have been instrumental in connection with novel studies of soft matter, namely of protein evolution and protein folding. Although the route to these subjects and associated development does not necessarily imply the nuclear physics connection, such a connection has proven qualitatively and quantitatively inspiring. In particular

  7. BCS to BEC evolution for mixtures of fermions with unequal masses

    NASA Astrophysics Data System (ADS)

    de Melo, Carlos A. R. Sa

    2009-03-01

    I discuss the zero and finite temperature phase diagrams of a mixture of fermions with unequal masses with and without population imbalance, which may correspond for example to mixtures of ^6Li and ^40K, ^6Li and ^87Sr, or ^40K and ^87Sr in the context of ultracold atoms. At zero temperature and when excess fermions are present, at least three phases may occur as the interaction parameter is changed from the BCS to the BEC regime. These phases correspond to normal, phase separation, or superfluid with coexistence between paired and excess fermions. The zero temperature phase diagram of population imbalance versus interaction parameter presents a remarkable asymmetry between the cases involving excess lighter or heavier fermions [1, 2], in sharp contrast with the symmetric phase diagram corresponding to the case of equal masses. At finite temperatures, the phase separation region of the phase diagram competes with superfluid regions possessing gapless elementary excitations [3] for certain ranges of the interaction parameter depending on the mass ratio. Furthermore, a phase transition may take place between two superfluid phases which are topologically distinct. The precise location of such transition is sensitive to the mass ratio between the two species of fermions. Signatures of this possible topological transition are present in the momentum distribution or structure factor, which may be measured experimentally in time-of-flight or through Bragg scattering, respectively. Lastly, throughout the evolution from BCS to BEC, I discuss the critical current and sound velocity for unequal mass systems as a function of interaction parameter and mass ratio. These quantities may also be measured via the same techniques already used in mixtures of fermions with equal masses. [1] M. Iskin, and C. A. R. Sa de Melo, Phys. Rev. Lett. 97, 100404 (2006). [2] M. Iskin and C. A. R. Sa de Melo, Phys. Rev. A 76, 013601 (2007). [3] Li Han, and C. A. R. Sa de Melo, arXiv:0812.xxxx

  8. Identification and management of tardive dyskinesia: A case series and literature review.

    PubMed

    Khouzam, Hani Raoul

    2015-01-01

    Tardive dyskinesia (TD) is a serious, disabling and potentially permanent, neurological hyperkinetic movement disorder that occurs after months or years of taking dopamine receptor-blocking agents. The pathophysiology of TD is complex, multifactorial and still not fully understood. Although there is no identified effective and standard treatment for TD, several agents have been tried for the management of this motor disturbance. The aim of this case series is to review the literature in regard to the identification, diagnosis and the treatment of TD with anticholinergics, anticholinergic medication withdrawal, cholinergic agents, botulinum toxin intramuscular injections, tetrabenazine, levetiracetam, propranolol and zolpidem, and to describe one case of TD that responded favorably to clonazepam and two cases of TD that responded favorably to Ginkgo biloba. PMID:26216578

  9. Surrogacy as a good option for treatment of repeated implantation failure: a case series

    PubMed Central

    Aflatoonian, Nastaran; Eftekhar, Maryam; Aflatoonian, Behrooz; Rahmani, Elham; Aflatoonian, Abass

    2013-01-01

    Background: Repeated implantation failure (RIF) is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found. Cases: In these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy (pregnancy rate=66.66%). Conclusion: This study showed that surrogacy is a good option for treatment of RIF. PMID:24639697

  10. Direct Cranial Nerve Involvement by Gliomas: Case Series and Review of the Literature.

    PubMed

    Mabray, M C; Glastonbury, C M; Mamlouk, M D; Punch, G E; Solomon, D A; Cha, S

    2015-07-01

    Malignant gliomas are characterized by infiltrative growth of tumor cells, including along white matter tracts. This may result in clinical cranial neuropathy due to direct involvement of a cranial nerve rather than by leptomeningeal spread along cranial nerves. Gliomas directly involving cranial nerves III-XII are rare, with only 11 cases reported in the literature before 2014, including 8 with imaging. We present 8 additional cases demonstrating direct infiltration of a cranial nerve by a glioma. Asymmetric cisternal nerve expansion compared with the contralateral nerve was noted with a mean length of involvement of 9.4 mm. Based on our case series, the key imaging feature for recognizing direct cranial nerve involvement by a glioma is the detection of an intra-axial mass in the pons or midbrain that is directly associated with expansion, signal abnormality, and/or enhancement of the adjacent cranial nerves. PMID:25857757

  11. Pulmonary Cryptococcosis in HIV- sero-negative patients: case series from India.

    PubMed

    Chopra, Shimpi; Capoor, Malini R; Mallik, Rupali; Gupta, Sonal; Ray, Animesh; Khanna, Geetika; Suri, J C; Bhattacharya, D; Raghavan, Samudrala

    2015-05-01

    Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse. PMID:25817989

  12. Epidermoid carcinoma of the anal canal. A series of 276 cases

    SciTech Connect

    Papillon, J.; Montbarbon, J.F.

    1987-05-01

    During the past ten years, substantial progress has been made in the knowledge of the natural history of epidermoid carcinoma of the anal canal and of the response of the disease to radiotherapy alone or combined with chemotherapy. At the present time, the main problem in the management of this tumor concerns identification of the best modalities to achieve local control and preservation of anal function. From a series of 276 cases, followed for more than three years, the necessity for a careful pretreatment evaluation was stressed. This included a systematic search for pelvic metastatic lymph nodes by palpation and CT scan. All patients were treated initially by irradiation except those who underwent groin dissection for inguinal node metastasis or colostomy for complete anal obstruction. Three groups of patients have been identified: unresectable or disseminated tumors (33 cases), resectable tumors but not suitable for sphincter conservation (21 cases) treated by radiochemotherapy and delayed surgery, and resectable tumors suitable for sphincter conservation (222 cases) which were treated by a split-course regimen combining a short course of carefully planned external beam irradiation (19 days) followed by an iridium 192 implant after a two-month rest. In this group, which represents 80 percent of the whole series, 80 percent of patients have had their cancer controlled and 90 percent of controlled patients have retained normal anal function. The use of chemotherapy during the first days of irradiation is advisable in all cases to reinforce the efficacy of treatment and increase the chance of anal preservation. Results of the split-course regimen, combining external beam and interstitial irradiation, demonstrate a clear superiority over external beam irradiation alone, especially for large infiltrating tumors, which represent the majority of cases.

  13. Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series

    PubMed Central

    Poceta, J. Steven

    2011-01-01

    Study Objectives: To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias. Methods: A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Results: Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Conclusions: Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors. Citation: Poceta JS. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series. J Clin Sleep Med 2011;7(6):632-638. PMID:22171202

  14. Hypnosis delivered through immersive virtual reality for burn pain: A clinical case series.

    PubMed

    Patterson, David R; Wiechman, Shelley A; Jensen, Mark; Sharar, Sam R

    2006-04-01

    This study is the first to use virtual-reality technology on a series of clinical patients to make hypnotic analgesia less effortful for patients and to increase the efficiency of hypnosis by eliminating the need for the presence of a trained clinician. This technologically based hypnotic induction was used to deliver hypnotic analgesia to burn-injury patients undergoing painful wound-care procedures. Pre- and postprocedure measures were collected on 13 patients with burn injuries across 3 days. In an uncontrolled series of cases, there was a decrease in reported pain and anxiety, and the need for opioid medication was cut in half. The results support additional research on the utility and efficacy of hypnotic analgesia provided by virtual reality hypnosis. PMID:16581687

  15. Series solutions of the Sitnikov restricted N+1-body problem: elliptic case

    NASA Astrophysics Data System (ADS)

    Shahbaz Ullah, M.; Majda, B.; Ullah, M. Zafar; Shahnawaz Ullah, M.

    2015-06-01

    Following Giacaglia (1967), in Sect. 2 we have developed equation of motion of the Sitnikov restricted N+1-body problem in elliptic case. We assumed that the primaries are at the vertices of a regular N-gon so the distances of the primaries from center of mass are time depending. In Sect. 3 we have linearized the equation of motion to obtain the Hill's type equation and then find the approximate solution. In Sects. 4 and 5 the series solutions of the Sitnikov restricted N+1-body problem have been developed by the method of Lindstedt-Poincaré and iteration of Green's function respectively. In Sect. 6 the two series solutions have been compared graphically by putting N=2, 3 and 4 for different eccentricity.

  16. History of Soil Survey and Evolution of the Brazilian Soil Classification System - SiBCS

    NASA Astrophysics Data System (ADS)

    Cunha dos Anjos, Lúcia Helena; Csekö Nolasco de Carvalho, Claudia; Homem Antunes, Mauro Antonio; Muggler, Cristine Carole

    2014-05-01

    national soil classification was presented by Marcelo Camargo (Embrapa Soils) and Jacob Bennema (FAO adviser). When Soil Taxonomy was first published in 1975, a field workshop was held in Brazil, and the system was not accepted by the country scientists; one main reason was the usage of climate as a main attribute for suborders. In 1978, the first national soil field correlation meeting was held with the goal of developing the national system, giving origin to the Brazilian Soil Classification System (SiBCS). In 1980, a working group was created by Embrapa Soils and other institutes resulting in four approximations of the system. In 1999, the first edition of the SiBCS was released, followed by a second edition in 2006 and the third in 2013. The SiBCS is a hierarchic system, based on morphogenetic soil attributes, with six categorical levels: order, suborder, great group, subgroup, family, and series. It has 13 soil orders, and it is structured as a key down to subgroup level. Many soil attributes are based on concepts adopted by the Soil Taxonomy (United States) and by the World Reference Base for Soil Resources (WRB - FAO). The development of the SiBCS is supervised by a national executive committee, and information is available at http://www.cnps.embrapa.br/sibcs (in Portuguese).

  17. Acquired Factor XIII Inhibitor in Hospitalized and Perioperative Patients: A Systematic Review of Case Reports and Case Series.

    PubMed

    Tone, Kira J; James, Tyler E; Fergusson, Dean A; Tinmouth, Alan; Tay, Jason; Avey, Marc T; Kilty, Shaun; Lalu, Manoj M

    2016-07-01

    Factor XIII (FXIII) cross-links fibrin monomers to support clot stabilization and wound healing. Acquired FXIII deficiency is caused by autoantibodies that inhibit FXIII and can result in bleeding despite normal routine coagulation test results. Given the rarity of this disease, large clinical studies are not feasible. We therefore conducted a systematic review of case reports and case series of acquired FXIII inhibitor to evaluate potential management and treatment strategies for acquired FXIII inhibitor in hospitalized and/or perioperative patients. A systematic search of MEDLINE, Embase, and Web of Science identified reports of hospitalized and perioperative patients with acquired FXIII deficiency. No restrictions were placed on language or publication type. Article screening and data extraction were performed independently by 2 abstractors. Completeness of reporting was evaluated according to modified elements from the CAse REport (CARE) guidelines. A total of 1028 citations were reviewed, with 36 case reports and 3 case series meeting eligibility criteria (63 patients total). The mean age was 60 (range, 9-87) years with balanced sex representation. At presentation, 48 patients (76%) had intramuscular or subcutaneous bleeding, and 34 patients (54%) had external or surgical bleeding. All cases were diagnosed by initially detecting a FXIII deficiency and then identifying the inhibitor. Clinical improvement in bleeding was seen in patients receiving FXIII concentrate (13/17 patients), cryoprecipitate (5/8), and plasma (10/18). Inhibitor reduction was seen in patients who received rituximab (6/6 patients), plasma exchange (2/2), intravenous immunoglobulin (4/5), steroid (15/20), and cyclophosphamide (10/15). Concurrent initiation of multiple therapies and obvious lack of control comparisons made direct association to outcomes difficult to establish. Outcomes were reported for 55 patients, with 25 patients (45%) having complete inhibitor eradication and 15 patients

  18. Molecular phylogenetics of the Anolis onca series: a case history in retrograde evolution revisited.

    PubMed

    Nicholson, Kirsten E; Mijares-Urrutia, Abraham; Larson, Allan

    2006-09-15

    Anoles of the Anolis onca series represent a dramatic case of retrograde evolution, exhibiting great reduction (A. annectens) and loss (A. onca) of the subdigital pads considered a key innovation for the evolutionary radiation of anoles in arboreal environments. We present a molecular phylogenetic analysis of these anoles and their closest known relatives (A. auratus, A. lineatus, A. meridionalis, and A. nitens) using new mitochondrial DNA sequence data from the ND2 gene, five tRNA genes (tRNA(Trp), tRNA(Ala), tRNA(Asn), tRNA(Cys), tRNA(Tyr)), the origin of light-strand replication, and a portion of the CO1 gene (1,446 aligned base positions, 612 parsimony informative). Our results confirm monophyly of the A. onca series and suggest an evolutionary separation of approximately 10 million years between A. annectens and A. onca. Evolution of subdigital structure in this series illustrates ectopic expression of developmental programs that replace flexible subdigital lamellae of the toepad with rigid, keeled scales resembling dorsal digital scales. Our phylogenetic results indicate that narrowing of the toepad in A. auratus evolved separately from toepad reduction in the A. onca series. Expansion of the subdigital lamellae along the phalanges in A. auratus appears to compensate constriction of lamellae by digital narrowing, maintaining greater climbing capability in this species. Toepad evolution in the lineage ancestral to A. auratus features changes of the same developmental modules as the A. onca series but in the opposite direction. Large molecular distances between geographic populations of A. auratus indicate that its derived toepad structure is at least 9 million years old. PMID:16506231

  19. Arthroscopic management of proximal tibial fractures: technical note and case series presentation

    PubMed Central

    BENEA, HOREA; TOMOAIA, GHEORGHE; MARTIN, ARTUR; BARDAS, CIPRIAN

    2015-01-01

    Background and aims The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly. Patients and method Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture. Results The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted. Conclusions Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures. PMID:26528076

  20. Use of CT Angiogram in Interventions Involving Coronary Artery Anomalies: A Case Series

    PubMed Central

    Ramesh, Dwarakanath; Setty Natraj Setty, Huliyurdurga S.; Patil, Veeresh; Swamy, Kumar; Kumar, Sunil; Guruprasad, Guruprasad; Manjunath, Cholenahalli Nanjappa

    2015-01-01

    Case series Patient: — Final Diagnosis: Coronary anamolies Symptoms: Chest pain Medication: None Clinical Procedure: PTCA with stent/CABG Specialty: Cardiology Objective: Challenging differential diagnosis Background: Coronary artery anomalies are rare, accounting for about 0.3–1.3% of patients undergoing diagnostic coronary angiography. Interventions in these cases are still rare, and therefore pose technical challenges during intervention. CT Angiography provides a non-invasive means of assessment of coronary artery disease and also shows the anatomy of the coronary tree. This helps in knowing the origin of the coronaries and also to plan selection of hardware. There are no specific guidelines for use of guiding catheters and guide wires in anomalous coronary artery intervention. Case Report: We report a series of 5 patients presenting with effort angina who had anomalous coronary arteries with coronary stenosis diagnosed by CT angiography. Three patients received percutaneous intervention, 1 patient underwent CABG, and 1 patient received medical management. Conclusions: CT Angiography provides a useful tool for showing the coronary anatomy and for selecting the guiding catheter and the guide wire that remain the mainstay of interventions in coronary artery anomalies. PMID:26637639

  1. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series

    PubMed Central

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-01-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near—anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  2. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series.

    PubMed

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-07-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near-anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  3. Endoscopic ear surgery: A case series and first United Kingdom experience

    PubMed Central

    Kanona, Hala; Virk, Jagdeep Singh; Owa, Anthony

    2015-01-01

    AIM: To present the United Kingdom’s first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries. METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery. RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps (P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications. CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed. PMID:25789304

  4. Four cases of echogenic breast lesions: a case series and review

    PubMed Central

    Goh, Lin Wah; Wong, Su Lin Jill; Tan, Puay Hoon

    2016-01-01

    Echogenic breast lesions are generally thought to be benign. We herein report four cases of echogenic breast lesions that were seen at our centre over 38 months. One patient had a prior history of wide excision and radiotherapy for breast cancer and was imaged as part of routine cancer surveillance, while the other three were recalled for further assessment following an abnormal screening mammogram. All four patients were assessed on ultrasonography, which demonstrated an echogenic lesion in each patient. All four lesions underwent ultrasonography-guided core biopsy, followed by excision biopsy. The indications for biopsy were interval increase in the size of lesion or indeterminate features demonstrated in the lesion. Three lesions were benign, while the lesion from the patient who had received previous radiotherapy was angiosarcoma. Not all echogenic lesions are benign and lesions with suspicious features on ultrasonography should undergo biopsy. PMID:26891743

  5. Collaborative case conferences in rectal cancer: case series in a tertiary care centre

    PubMed Central

    Eskicioglu, C.; Forbes, S.; Tsai, S.; Francescutti, V.; Coates, A.; Grubac, V.; Sonnadara, R.; Simunovic, M.

    2016-01-01

    Background In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers. Methods We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as “major” (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as “minor” (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information. Results Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation. Conclusions Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review. PMID:27122982

  6. BCS coupling in a 1D Luttinger liquid

    NASA Astrophysics Data System (ADS)

    Eneias, R.; Ferraz, A.

    2015-12-01

    In this work we investigate the effect produced by the BCS coupling in spinless fermions in one spatial dimension. Using bosonization techniques our initial model is rewritten in terms of a sine-Gordon field and a free massless scalar field. As a result the Cooper pair in our scenario is made up of soliton and antisoliton particles. We calculate the single particle Green’s function, the pair correlation function and the optical conductivity associated with the physical fermions and we show how they differ from their conventional quasiparticle analogues. Finally, we compare our results with related experimental findings for high temperature superconductors and we display how they fit qualitatively well the related observed effects produced by the anti-nodal quasiparticles in those materials.

  7. Resonant electronic Raman scattering: A BCS-like system

    NASA Astrophysics Data System (ADS)

    Rodrigues, Leonarde N.; Arantes, A.; Schüller, C.; Bell, M. J. V.; Anjos, V.

    2016-05-01

    In this paper we investigate the resonant intersubband Raman scattering of two-dimensional electron systems in GaAs-AlGaAs single quantum wells. Self-consistent calculations of the polarized and depolarized Raman cross sections show that the appearance of excitations at the unrenormalized single-particle energy are related to three factors: the extreme resonance regime, the existence of degeneracy in intersubband excitations of the electron gas, and, finally, degeneracy in the interactions between pairs of excitations. It is demonstrated that the physics that governs the problem is similar to the one that gives rise to the formation of the superconducting state in the BCS theory of normal metals. Comparison between experiment and theory shows an excellent agreement.

  8. BCS Superconductivity of Dirac Electrons in Graphene Layers

    NASA Astrophysics Data System (ADS)

    Kopnin, N. B.; Sonin, E. B.

    2008-06-01

    Possible superconductivity of electrons with the Dirac spectrum is analyzed using the BCS model. We calculate the critical temperature, the superconducting energy gap, and the supercurrent as functions of the doping level and of the pairing interaction strength. Zero doping is characterized by the existence of a quantum critical point such that the critical temperature vanishes below some finite value of the interaction strength. However, the critical temperature remains finite for any nonzero electron or hole doping level when the Fermi energy is shifted away from the Dirac point. As distinct from usual superconductors, the supercurrent density is not proportional to the number of electrons but is strongly decreased due to the presence of the Dirac point.

  9. BCS Superconductivity of Dirac electrons in graphene layers.

    PubMed

    Kopnin, N B; Sonin, E B

    2008-06-20

    Possible superconductivity of electrons with the Dirac spectrum is analyzed using the BCS model. We calculate the critical temperature, the superconducting energy gap, and the supercurrent as functions of the doping level and of the pairing interaction strength. Zero doping is characterized by the existence of a quantum critical point such that the critical temperature vanishes below some finite value of the interaction strength. However, the critical temperature remains finite for any nonzero electron or hole doping level when the Fermi energy is shifted away from the Dirac point. As distinct from usual superconductors, the supercurrent density is not proportional to the number of electrons but is strongly decreased due to the presence of the Dirac point. PMID:18643614

  10. Immediate Effect of Therapeutic Massage on Pain Sensation and Unpleasantness: A Consecutive Case Series

    PubMed Central

    2015-01-01

    Background: Musculoskeletal pain is a common condition that poses a significant burden to its sufferers and costs the US economy billions of dollars each year in lost productivity. Individuals complaining of musculoskeletal pain make up a large proportion of clients treated by massage therapists in community practices, yet few studies have examined the immediate effect of therapeutic massage on this type of pain in the practice setting. Purpose: To assess the immediate effect of therapeutic massage on musculoskeletal pain sensation and unpleasantness in a community setting. Setting: Solo private practice in central Virginia, United States. Participants: One hundred sixteen first-time clients who complained of musculoskeletal pain as a presenting symptom. Research design: Prospective, consecutive practice-based case series. Intervention: A single 60-minute session of individualized therapeutic massage; techniques used included Swedish massage employing effleurage, petrissage, and friction,;deep tissue; myofascial; positional release; passive and resisted joint mobilization; and biofield modalities. Main Outcome Measures: Visual Analog Scales for pain sensation and unpleasantness. Results: Both pain sensation and unpleasantness were significantly reduced by a single session of therapeutic massage. Mean pain sensation decreased from 3.76 (SD=1.87) prior to massage to .89 (SD=1.35) following massage, with t=18.87, P<.001. Mean pain unpleasantness decreased from 5.21 (SD=2.48) prior to massage to .64 (SD=1.23) following massage, with t =20.45, P<.001. Effect sizes were 1.76 and 1.90, respectively. Conclusions: In this case series, therapeutic massage appeared to be an effective intervention for common musculoskeletal pain that influenced both the physical and affective dimension of the pain experience. Although care was taken to reduce potential bias through limiting eligibility to first time clients and use of a standardized script, practice-based case series have

  11. Analysis of time series of cattle rabies cases in Minas Gerais, Brazil, 2006-2013.

    PubMed

    Lopes, Edna; Sáfadi, Thelma; Da Rocha, Christiane Maria Barcellos Magalhaes; Cardoso, Denis Lucio

    2015-04-01

    Vampire bats are potential transmitters of rabies in rural areas. Cattle rabies is relevant in the state of Minas Gerais due to the increasing cattle herds and geographical features of the area, which are favorable to bat populations. This study evaluated the occurrence of rabies in state cattle by analyzing the time series of monthly values, 2006-2012, describing some aspects of the areas and species affected. The study also pointed out the disease prediction for January-December 2013. We used monthly data of cases reported to the Continental Epidemiological Surveillance System (SIVCONT) of the Ministry of Agriculture, Livestock, and Supply (MAPA), January 2006-March 2013. We also collected data on municipalities and other animal species affected by rabies for a descriptive analysis of the disease. The results indicate that cattle rabies is endemic in the State, with different intensities in different regions. The variables frequency of notifications and bat shelters had a positive and regular correlation (P = 0.035; r = 0.567) between them. With respect to data series, there was a fluctuation of the number of cases (5 to 29 cases per month) over 2006 and 2013, without trend or seasonality, although there would visually appear to be a downward trend. The results also suggest that the forecasting method is suitable for predicting future cases. Bovine species had the highest number of reporting, with 1007 cases (88.88 %), followed by equine species with 112 (9.89 %). The information provided by this study may help understand disease occurrence and find the most effective measures for rabies control in endemic areas. PMID:25698529

  12. Case Series of First Metatarsophalangeal Joint Injuries in Division 1 College Athletes

    PubMed Central

    Faltus, John; Mullenix, Kerry; Moorman, Claude T.; Beatty, Kyle; Easley, Mark E.

    2014-01-01

    Context: Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries. Evidence Acquisition: A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used. Study Design: Case series. Level of Evidence: Level 4. Results: Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities. Conclusion: Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision

  13. A Possible Path from BCS through HTS to VHTS

    NASA Astrophysics Data System (ADS)

    Chu, C. W.

    2010-03-01

    Three years after celebrating the 50th anniversary of the BCS theory and the 20th anniversary of the discovery of high temperature superconductivity (HTS), it appears to be most fitting for us to contemplate the possibility of very high temperature superconductivity (VHTS). VHTS, preferably at room temperature, if achieved, could change the world both scientifically and technologically. Unfortunately, it has long been considered by some to belong to the domain of science fiction and to occur only ``at an astronomical distance and under an astronomical pressure.'' With the advent of liquid nitrogen superconductivity in 1987, the outlook has become much brighter. Currently, there appears to be no reason, either theoretical or experimental, why VHTS would be impossible, in spite of the 2006 prediction of the death of HTS by 2010-2015 through the so-called scientometric analysis of the publication record of the previous 20 years. The recent discovery of the new class of Fe-pnictide HTSs fuels more cautious optimism. Since its inception, BCS theory has provided the basic framework for the occurrence and understanding of superconductivity, but it has failed to show where and how to find superconductivity at a higher temperature. This may be attributed to the small energy scale of superconductivity in comparison with those of other excitations in the solids. After examining existing data, we believe that a holistic multidisciplinary enlightened empirical approach appears to be the most effective way to discover novel superconductors with higher transition temperatures. In this talk, I shall present several possible approaches toward VHTS that we are currently pursuing, after briefly summarizing what has happened in the long search for HTS and VHTS.

  14. Order parameter, correlation functions, and fidelity susceptibility for the BCS model in the thermodynamic limit

    NASA Astrophysics Data System (ADS)

    El Araby, Omar; Baeriswyl, Dionys

    2014-04-01

    The exact ground state of the reduced BCS Hamiltonian is investigated numerically for large system sizes and compared with the BCS ansatz. A "canonical" order parameter is found to be equal to the largest eigenvalue of Yang's reduced density matrix in the thermodynamic limit. Moreover, the limiting values of the exact analysis agree with those obtained for the BCS ground state. Exact results for the ground-state energy, level occupations, and a pseudospin-pseudospin correlation function are also found to converge to the BCS values already for relatively small system sizes. However, discrepancies persist for a pair-pair correlation function, for interlevel correlations of occupancies and for the fidelity susceptibility, even for large system sizes where these quantities have visibly converged to well-defined limits. Our results indicate that there exist nonperturbative corrections to the BCS predictions in the thermodynamic limit.

  15. Hypnobehavioral approaches for school-age children with dysphagia and food aversion: a case series.

    PubMed

    Culbert, T P; Kajander, R L; Kohen, D P; Reaney, J B

    1996-10-01

    The purpose of this article is to describe hypnobehavioral treatment of five school-age children with maladaptive eating behaviors, including functional dysphagia, food aversion, globus hystericus, and conditioned fear of eating (phagophobia). The unique treatment approach described emphasizes the successful use of self-management techniques, particularly hypnosis, by all five children. Common etiological factors, treatment strategies, and proposed mechanisms of change are discussed. To the authors' knowledge, this is the first such case series in the mainstream pediatric literature describing the use of a hypnobehavioral approach for children with these maladaptive eating problems. PMID:8897222

  16. The versatility of intraosseous vascular access in perioperative medicine: a case series.

    PubMed

    Anson, Jonathan A; Sinz, Elizabeth H; Swick, John T

    2015-02-01

    Intraosseous vascular access is a time-tested procedure that is reemerging in popularity. This is primarily a result of the emphasis on intraosseous access in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Advanced Cardiac Life Support. Modern intraosseous insertion devices are easy to learn and use, suggesting the possibility of use beyond the resuscitation setting. We present a case series of recent intraosseous insertions for a variety of indications by anesthesiologists at our institution to demonstrate the potential utility of this alternative access technique. PMID:25547826

  17. Spinal cord ependymoma: a review of the literature and case series of ten patients.

    PubMed

    Celano, Emma; Salehani, Arsalaan; Malcolm, James G; Reinertsen, Erik; Hadjipanayis, Constantinos G

    2016-07-01

    Spinal cord ependymoma (SCE) is a rare tumor that is most commonly low-grade. Complete surgical resection has been established as first-line treatment and can be curative. However, SCEs tend to recur when complete tumor resection is not possible. Evidence supporting the use of adjuvant radiation and chemotherapy is not definitive. We review the most recent literature on SCE covering a comprehensive range of topics spanning the biology, presentation, clinical management, and outcomes. In addition, we present a case series of ten SCE patients with the goal of contributing to existing knowledge of this rare disease. PMID:27154165

  18. Clinical experience with Leptospermum honey use for treatment of hard to heal neonatal wounds: case series.

    PubMed

    Boyar, V; Handa, D; Clemens, K; Shimborske, D

    2014-02-01

    Preterm, critically ill neonates represent a challenge in wound healing. Many factors predispose infants to skin injuries, including decreased epidermal-dermal cohesion, deficient stratum corneum, relatively alkaline pH of skin surface, impaired nutrition and presence of multiple devices on the skin. We present a case series describing the use of medical-grade honey-Leptospermum honey (Medihoney), for successful treatment of slowly healing neonatal wounds, specifically stage 3 pressure ulcer, dehiscent and infected sternal wound, and full-thickness wound from an extravasation injury. PMID:24476663

  19. Myasthenia gravis mimicking stroke: a case series with sudden onset dysarthria.

    PubMed

    Tremolizzo, Lucio; Giopato, Federico; Piatti, Maria Luisa; Rigamonti, Andrea; Ferrarese, Carlo; Appollonio, Ildebrando

    2015-06-01

    Myasthenia gravis (MG) is an immune-mediated disorder characterized by fluctuating fatigue of skeletal muscles, often involving extrinsic ocular or bulbar districts. Myasthenia gravis in the elderly is an under-recognized condition, sometimes confused with cerebrovascular disease. Here we present a case series of myasthenia patients which onset was characterized by sudden dysarthria, clearly raising this diagnostic dilemma. In the workout of sudden onset isolated dysarthria, MG should be always considered. In fact, even if myasthenia is a rare condition, lacunar stroke only with this clinical presentation is also unusual, and significant risks may arise (e.g., unexpected myasthenic crisis). PMID:25648108

  20. A Unique Incidental Finding in Two Young Dancers: A Case Series.

    PubMed

    Miller, Marshal N; Close, Jeremy D

    2015-01-01

    Dancers frequently present to the sports medicine clinic with a variety of lower extremity complaints ranging from acute and traumatic injuries to more chronic, overuse injuries. This case series depicts a similar and unique incidental radiographic finding found in 2 young dancers seen at the same sports medicine clinic. While the findings are likely benign and unrelated to both patients' initial presentation, the finding of acroosteolysis can be found in more serious systemic and genetic processes as well an early finding in repetitive trauma. PMID:26502417

  1. Case series on anesthesia for video-assisted thoracoscopic surgery for congenital diaphragmatic hernia in children

    PubMed Central

    Aggarwal, Anurag; Lohani, Rohit; Suresh, Varun

    2016-01-01

    Video-assisted thoracoscopic surgery (VATS) in the pediatric population is a challenging task for any anesthesiologist, moreover considering the high incidence of associated congenital anomalies which are individual predictors of poor prognosis. A thorough preoperative evaluation, knowledge of the physiology of one lung ventilation - pertaining to various methods of lung isolation, individualized meticulous planning, and continuous vigilance to detect any untoward event at the earliest with good communication between the anesthesiology and surgical teams contributes to a safe and successful surgery. We present a case series of anesthetic management of congenital diaphragmatic hernia with VATS. PMID:26957707

  2. BCS Biowaivers: Similarities and Differences Among EMA, FDA, and WHO Requirements.

    PubMed

    Davit, Barbara M; Kanfer, Isadore; Tsang, Yu Chung; Cardot, Jean-Michel

    2016-05-01

    The Biopharmaceutics Classification System (BCS), based on aqueous solubility and intestinal permeability, has enjoyed wide use since 1995 as a mechanism for waiving in vivo bioavailability and bioequivalence studies. In 2000, the US-FDA was the first regulatory agency to publish guidance for industry describing how to meet criteria for requesting a waiver of in vivo bioavailability and bioequivalence studies for highly soluble, highly permeable (BCS Class I) drugs. Subsequently, the World Health Organization (WHO) and European Medicines Agency (EMA) published guidelines recommending how to obtain BCS biowaivers for BCS Class III drugs (high solubility, low permeability), in addition to Class I drugs. In 2015, the US-FDA became better harmonized with the EMA and WHO following publication of two guidances for industry outlining criteria for obtaining BCS biowaivers for both Class I and Class III drugs. A detailed review and comparison of the BCS Class I and Class III criteria currently recommended by the US-FDA, EMA, and WHO revealed good convergence of the three agencies with respect to BCS biowaiver criteria. The comparison also suggested that, by applying the most conservative of the three jurisdictional approaches, it should be possible for a sponsor to design the same set of BCS biowaiver studies in preparing a submission for worldwide filing to satisfy US, European, and emerging market regulators. It is hoped that the availability of BCS Class I and Class III biowaivers in multiple jurisdictions will encourage more sponsors to request waivers of in vivo bioavailability/bioequivalence testing using the BCS approach. PMID:26943914

  3. Small-cell lung cancer in never-smokers: A case series.

    PubMed

    Tavares e Castro, Ana; Clemente, Joana; Carvalho, L; Freitas, Sara; Cemlyn-Jones, Jessica

    2016-03-01

    Small-cell lung cancer (SCLC) is closely correlated with smoking and only sporadic cases have been reported in non-smoking patients. Environmental tobacco smoke and/or occupational risk factors have been suggested as possible causes of lung cancer in this subset of patients. However, particularly in relation to SCLC there is not enough reliable information. All patients with lung cancer in follow-up for a period of three-months at the Pulmonology Unit of Coimbra University Hospital were retrospectively assessed. From a total of 303 patients, 35 had SCLC, 4 of which were never-smokers and their clinical cases are hereby presented. A detailed questionnaire was given to all patients, which excluded second-hand smoking or occupational hazards. They were all female with a mean age of 63.0 ± 15.7 years. The most frequent complaints were cough, dyspnoea, anorexia and significant weight loss. Diagnosis was obtained by transbronchial biopsies in all cases. Two patients had locally advanced disease and the other two had extensive-disease due to distant metastases. Treatment approaches included first-line chemotherapy with platin and etoposide duplet and partial remission was achieved in half the cases. All patients died; mean survival was 15.8 ± 3.8 months. Further studies are needed for a better understanding of the pathogenicity of non-smoking related SCLC and we hope that this case series with its meticulous exclusion of potential risk factors will be a useful contribution. PMID:26898619

  4. Treatment of Myositis Ossificans with acetic acid phonophoresis: a case series

    PubMed Central

    Bagnulo, Angela; Gringmuth, Robert

    2014-01-01

    Objective To create awareness of myositis ossificans (MO) as a potential complication of muscle contusion by presenting its clinical presentation and diagnostic features. An effective method of treatment is offered for those patients who develop traumatic MO. Management: Patients in this case series developed traumatic MO, confirmed on diagnostic ultrasound. Patients participated in a treatment regimen consisting of phonophoresis of acetic acid with ultrasound. Outcome: In all cases, a trial of phonophoresis therapy significantly decreased patient signs, symptoms and the size of the calcification on diagnostic ultrasound in most at a 4-week post diagnosis mark. Discussion: Due to the potential damage to the muscle and its function, that surgical excision carries; safe effective methods of conservative treatment for MO are crucial. MO deserves more attention in the literature due to its common presentation in athletes. PMID:25550659

  5. SNAKE BITE: CASE SERIES OF PATIENTS PRESENTED TO GONDAR UNIVERSITY HOSPITAL, NORTH WEST ETHIOPIA.

    PubMed

    Mekonnen, Desalew; Mitiku, Tadesse; Tamir, Yenesew; Azazh, Aklilu

    2016-04-01

    Snakebite is an important public health challenge. Venomous snake bites cause significant morbidity and mortality if treatment measures, especially antivenom therapy, are delayed. We did a case series of 27 adult patients admitted after snakebite to the medical wards of Gondar University Hospital (GUH) from September 2013 to August 2014. The age range was from 15 to 74 years. The male to female ratio was 8:1. The majority (25) of patients presented after 12 hours of being bitten. Most of the bites occurred on the legs. Hematologic complications, including prolonged bedside whole blood clotting test, bleeding complications and Disseminated Intravascular Coagulation, were the common complications detected. The case fatality rate was 4/27 (14.8%). Availability of affordable snake specific antivenom is recommended. A large population study is needed to address the burden in Ethiopia. PMID:27476228

  6. Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature

    PubMed Central

    Luchsinger, Isabelle; Bosshard, Philipp Peter; Kasper, Romano Silvio; Reinhardt, Dominic; Lautenschlager, Stephan

    2015-01-01

    Objective Investigation on recent cases of tinea genitalis after travelling to South East Asia. Methods Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. Results The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. Conclusions Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory. PMID:26071391

  7. Case Series: Fractional Anisotropy Profiles of the Cerebellar Peduncles in Adolescents Born Preterm With Ventricular Dilation.

    PubMed

    Travis, Katherine E; Leitner, Yael; Ben-Shachar, Michal; Yeom, Kristen W; Feldman, Heidi M

    2016-03-01

    This case series assesses white matter microstructure of the cerebellar peduncles in 4 adolescents born preterm with enlarged ventricles and reduced white matter volume in the cerebrum but no apparent injury to the cerebellum. Subjects (ages 12-17 years, gestational age 26-32 weeks, birth weight 825-2211 g) were compared to a normative sample of 19 full-term controls (9-17 years, mean gestational age 39 weeks, mean birth weight 3154 g). Tract profiles for each of the cerebellar peduncles were generated by calculating fractional anisotropy at 30 points along the central portion of each tract. One or more case subjects exhibited higher fractional anisotropy beyond the 90th percentile in the inferior, middle, and superior cerebellar peduncles. Findings demonstrate that differences in cerebellar white matter microstructure can be detected in the absence of macrostructural cerebellar abnormalities. PMID:26116381

  8. The Emergence of Zoonotic Onchocerca lupi Infection in the United States--A Case-Series.

    PubMed

    Cantey, Paul T; Weeks, Jessica; Edwards, Morven; Rao, Suchitra; Ostovar, G Amin; Dehority, Walter; Alzona, Maria; Swoboda, Sara; Christiaens, Brooke; Ballan, Wassim; Hartley, John; Terranella, Andrew; Weatherhead, Jill; Dunn, James J; Marx, Douglas P; Hicks, M John; Rauch, Ronald A; Smith, Christiana; Dishop, Megan K; Handler, Michael H; Dudley, Roy W R; Chundu, Kote; Hobohm, Dan; Feiz-Erfan, Iman; Hakes, Joseph; Berry, Ryan S; Stepensaski, Shelly; Greenfield, Benjamin; Shroeder, Laura; Bishop, Henry; de Almeida, Marcos; Mathison, Blaine; Eberhard, Mark

    2016-03-15

    This case-series describes the 6 human infections with Onchocerca lupi, a parasite known to infect cats and dogs, that have been identified in the United States since 2013. Unlike cases reported outside the country, the American patients have not had subconjunctival nodules but have manifested more invasive disease (eg, spinal, orbital, and subdermal nodules). Diagnosis remains challenging in the absence of a serologic test. Treatment should be guided by what is done for Onchocerca volvulus as there are no data for O. lupi. Available evidence suggests that there may be transmission in southwestern United States, but the risk of transmission to humans is not known. Research is needed to better define the burden of disease in the United States and develop appropriately-targeted prevention strategies. PMID:26611778

  9. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series.

    PubMed

    Thiruvenkatarajan, V; Van Wijk, R M; Rajbhoj, A

    2015-03-01

    Cranial nerve injuries are unusual complications of supraglottic airway use. Branches of the trigeminal, glossopharyngeal, vagus and the hypoglossal nerve may all be injured. We performed a systematic review of published case reports and case series of cranial nerve injury from the use of supraglottic airway devices. Lingual nerve injury was the most commonly reported (22 patients), followed by recurrent laryngeal (17 patients), hypoglossal (11 patients), glossopharyngeal (three patients), inferior alveolar (two patients) and infra-orbital (one patient). Injury is generally thought to result from pressure neuropraxia. Contributing factors may include: an inappropriate size or misplacement of the device; patient position; overinflation of the device cuff; and poor technique. Injuries other than to the recurrent laryngeal nerve are usually mild and self-limiting. Understanding the diverse presentation of cranial nerve injuries helps to distinguish them from other complications and assists in their management. PMID:25376257

  10. Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series.

    PubMed

    Medeiros, Rui; Silva, Igor Henrique; Carvalho, Alessandra Tavares; Leão, Jair Carneiro; Gueiros, Luiz Alcino

    2015-11-01

    Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions. PMID:25962368

  11. Colorectal Disorders in Acute Human Immunodeficiency Virus Infection: A Case Series

    PubMed Central

    Panichsillapakit, Theppharit; Patel, Derek; Santangelo, Joanne; Richman, Douglas D.; Little, Susan J.; Smith, Davey M.

    2016-01-01

    Background. The gastrointestinal (GI) tract is important in the pathogenesis of human immunodeficiency virus (HIV) infection. We report a case series of lower GI endoscopic and histopathologic findings of HIV-infected individuals after presentation with acute infection. Methods. We performed a retrospective case review of individuals infected with HIV who enrolled between August 2010 and April 2013 in a primary infection treatment trial. All participants started the trial during acute infection and underwent colonoscopy with biopsies at baseline and after the start of antiretroviral treatment. Results. Twenty acutely infected individuals were included in the study (mean age, 33 years; range, 20–54 years). All participants were male who reported having receptive anal sex as an HIV risk factor. Nine individuals (45%) had at least 1 finding by colorectal pathology; 1 person had 2 diagnoses (diverticulosis and focal active proctitis). The histopathological findings revealed anal dysplasia in 3 cases: 2 had high-grade anal intraepithelial neoplasia (AIN) and 1 had low-grade AIN. Two persons had a colorectal polyp, 1 hyperplastic and 1 adenomatous. Three persons were diagnosed with diverticulosis, and 2 persons were diagnosed with proctitis, including 1 with focal active proctitis and 1 with cytomegalovirus proctitis. Conclusions. To our knowledge, this is the first case series report of lower GI disorders in acute HIV-infected individuals. Although the causal relationship remains uncertain, we describe the endoscopic findings that were observed during acute HIV infection among men who have sex with men. Understanding the prevalence of these pathologies may likely shed light on how acute HIV infection damages the lower GI tract. PMID:26925432

  12. Photodynamic Therapy as Novel Treatment for Halitosis in Adolescents: A Case Series Study

    PubMed Central

    Lopes, Rubia Garcia; de Santi, Maria Eugenia Simões Onofre; Franco, Bruno Edin; Deana, Alessandro Melo; Prates, Renato Araujo; França, Cristiane Miranda; Fernandes, Kristianne Porta Santos; Ferrari, Raquel Agnelli Mesquita; Bussadori, Sandra Kalil

    2014-01-01

    Introduction: Halitosis is a common problem that affects a large portion of the population worldwide. The origin of this condition is oral in 90% of cases and systemic in 10% of cases. The foul odor is caused mainly by volatile sulfur compounds produced by Gram-negative bacteria. However, it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide (H2S) in the presence of amino acids, such as cysteine. Light with and without the combination of chemical agents has been used to induce therapeutic and antimicrobial effects. In photodynamic therapy, the antimicrobial effect is confined to areas covered by the photosensitizing dye. The aim of the present case series study was to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using a sulfide meter (Halimeter®). Methods: Five adolescents aged 14 to 16 years were evaluated using a sulfide meter before and one hour after photodynamic therapy, which involved the use of methylene blue 0.005% on the middle third and posterior thirds of the dorsum of the tongue and nine points of laser irradiation in the red band (660 nm) with an energy dose of 9 J, power output of 100 mW and 90-seconds exposure time. Results: A 31.8% reduction in the concentration of volatile sulfur compounds was found in the comparison of the initial and final readings. The statistically significant reduction (p = 0.0091) led to an absence of halitosis following treatment (mean: 58.2 ppb). Conclusion: Photodynamic therapy seems to be effective on reduction the concentration of volatile sulfur compounds.Considering the positive effects of photodynamic therapy in this case series, further studies involving microbiological analyses should be conducted to allow comparisons of the results. PMID:25653814

  13. Alemtuzumab use in neuromyelitis optica spectrum disorders: a brief case series.

    PubMed

    Azzopardi, Laura; Cox, Amanda L; McCarthy, Claire L; Jones, Joanne L; Coles, Alasdair J

    2016-01-01

    Alemtuzumab is an anti-CD52 monoclonal antibody recently licensed for use in relapsing-remitting multiple sclerosis. Here, we report our experience of its use in neuromyelitis optica (NMO) spectrum disorders. A retrospective case review of patients treated with alemtuzumab in Cambridge, UK, was conducted to identify those who fulfil the criteria for NMO spectrum disorder. Three cases were identified. Case 1, 9-year-old female, presented with transverse myelitis and bilateral optic neuritis,with one lower medullary and several longitudinally extensive cord lesions. Despite immunosuppression including two courses of alemtuzumab, she continued to relapse, was wheelchair bound and registered blind by age 12, and died at age 18. Case 2, 41-year-old female, presented with bilateral optic neuritis and transverse myelitis with longitudinally extensive cervical cord lesions. Despite three courses of alemtuzumab, she had five relapses with visual impairment and new cord lesions. She later developed tumefactive white matter lesions and died aged 51.Case 3, 31-year-old female, presented with transverse myelitis with longitudinally extensive cervical cord lesions and positive aquaporin-4 antibody. After one course of alemtuzumab, she relapsed with 4 episodes of myelitis with new enhancing lesions and accumulating disability. She became relapse free after rituximab and mycophenolate mofetil. From this case series, we conclude that alemtuzumab failed to prevent disabling relapses and poor outcome in NMO. We hypothesise that rituximab is more effective, as in case 3, because it causes much more prolonged B lymphocyte depletion than alemtuzumab. We therefore caution against the use of alemtuzumab in NMO. PMID:26477020

  14. The spread of drug-resistant tuberculosis in children: an Italian case series.

    PubMed

    Mignone, F; Codecasa, L R; Scolfaro, C; Raffaldi, I; Lancella, L; Ferrarese, M; Garazzino, S; Marabotto, C; Esposito, S; Gabiano, C; Lipreri, R; Tovo, P-A

    2014-10-01

    Drug-resistant paediatric tuberculosis (TB) is an overlooked global problem. In Italy, the epidemiology of TB has recently changed and data regarding drug-resistant forms in the paediatric setting is scanty. The aim of this case series was to report the cases of drug-resistant TB, diagnosed between June 2006 and July 2010 in four Italian tertiary centres for paediatric infectious diseases, in children and adolescents living in Italy. Twenty-two children were enrolled, of these 17 were resistant to one or more drugs and five had multidrug-resistant TB. All but one child were either foreign born or had at least one foreign parent. Twenty-one patients completed their treatment without clinical or radiological signs of activity at the end of treatment, and one patient was lost to follow up. The outcomes were good, with few adverse effects using second-line anti-TB drugs. Although this series is limited, it might already reflect the worrisome increase of drug-resistant TB, even in childhood. PMID:24480079

  15. Pinna abscesses: can we manage them better? A case series and review of the literature.

    PubMed

    Mitchell, Scott; Ditta, Kashif; Minhas, Satvir; Dezso, Attila

    2015-11-01

    Suppurative perichondritis of the pinna is a serious condition with potentially long-term cosmetic sequelae. Literature regarding the optimal treatment of these abscesses is scarce with most case series containing low numbers. This work reports the largest series from the UK to date; along with a review of recent literature. A 10-year retrospective review of case notes was undertaken. Demographic data, interventions and microbiology results were recorded along with outpatient descriptions of cosmetic outcomes. 20 patients were identified with male:female ratio of 4:1. Average patient age was 25.3 years (range 8-65). Average duration of symptoms prior to being seen by the ENT department was 9.95 days with an average length of stay in hospital of 2.5 days. 80% of patients had a surgical intervention performed. The commonest organism grown on microbiological culture was pseudomonas (33%). Of patients who attended follow-up, 28.6% had residual deformity. All of these had undergone surgical drainage of the abscess. Residual deformity was associated with longer time before presentation, piercing of the cartilage and a growth of pseudomonas. Prompt surgical management and appropriate antibiotic regimens to cover pseudomonas are the cornerstones of treatment in the event of pinna abscess formation. PMID:25348338

  16. Possible Association of Cutaneous Rosai-Dorfman Disease and Chronic Crohn Disease A Case Series Report

    PubMed Central

    Salva, Katrin A.; Stenstrom, Melissa; Breadon, Jonith Y.; Odland, Paul Blair; Bennett, Daniel; Longley, Jack; Wood, Gary S.

    2014-01-01

    IMPORTANCE Cutaneous Rosai-Dorfman disease (CRDD), a variant of Rosai-Dorfman disease limited to the skin, has a wide range of clinical presentations. Rosai-Dorfman disease is believed to result from an aberrant response to antigens, caused by immunosuppressive macrophages. Macrophage-mediated immunosuppression is also implicated in the pathogenesis of Crohn disease, linking these otherwise unrelated entities. To our knowledge, the coexistence of these disorders has been described in only 2 cases, 1 of them confined to the skin and soft tissue. OBSERVATIONS We present a series of 3 patients who developed purely CRDD in the context of long-standing Crohn disease. Statistical estimates suggested that the association of these 2 disorders is not due to chance (P < .001). CONCLUSIONS AND RELEVANCE Our case series provides the clinical correlate to the pathogenetic parallels between CRDD and Crohn disease. Crohn disease is frequently complicated by various skin manifestations, which may be mimicked by CRDD. Therefore, it may be prudent for clinicians to include CRDD in the list of differential diagnoses when examining skin lesions in patients with Crohn disease. PMID:24305684

  17. [Therapeutic local anesthesia for the management of atypical odontalgia. A clinical case series].

    PubMed

    Türp, Jens Christoph

    2005-01-01

    The management of patients diagnosed with atypical odontalgia (AO) is a challenging task. The aim of this longitudinal clinical case series was to document the effect of a 4% carticaine solution without epinephrine among ten patients with AO. Once or on two successive days, 1.7 ml of the local anesthetics was injected buccally in the area of the perceived pain. Pain intensity was recorded four times daily by each participant, beginning at least two weeks prior to the treatment and ending at least four weeks thereafter. The main outcome parameter was pain reduction (in percent) four weeks after treatment compared to the average pain intensity before the injection(s). In addition, study participants were asked to rate their satisfaction with the treatment. Four weeks after treatment, seven of the ten patients experienced significantly less pain than before. Among five individuals, there was a significant pain decrease (about 30% or more). Patient satisfaction was not significantly associated with the amount of pain reduction. Considering the limited treatment options and their side effects, injections with epinephrine-free carticaine seem to be a measure worth to be taken into consideration. Although results gained from uncontrolled case series have to be interpreted with caution, the findings of this observational study sound promising. PMID:16342641

  18. Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series

    PubMed Central

    Mosier, Jarrod; Roper, Grant; Hays, Daniel; Guisto, John

    2013-01-01

    Introduction: Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux. Methods: Case series of 4 patients presenting to an urban academic medical center with migraine headache failing outpatient therapy. Each patient was given a sedation dose (1 mg/kg) of propofol under standard procedural sedation precautions. Results: Each of the 4 patients experienced dramatic reductions or complete resolution of headache severity. LOS for 3 of the 4 patients was 50% less than the average LOS for patients with similar chief complaints to our emergency department. 1 patient required further treatment with standard therapy but had a significant reduction in pain and a shorter LOS. There were no episodes of hypotension, hypoxia, or apnea during the sedations. Conclusion: In this small case series, sedation dose propofol appears to be effective and safe for the treatment of refractory migraines, and may result in a reduced LOS. PMID:24381692

  19. Successful treatment of rare-earth magnet ingestion via minimally invasive techniques: a case series.

    PubMed

    Kosut, Jessica S; Johnson, Sidney M; King, Jeremy L; Garnett, Gwendolyn; Woo, Russell K

    2013-04-01

    Cases of rare-earth magnet ingestions have been increasingly reported in the literature. However, these descriptions have focused on the severity of the injuries, rather than the clinical presentation and/or therapeutic approach. We report a series of eight children, ranging in age from 2 to 10 years, who ingested powerful rare-earth magnets. The rare-earth magnets were marketed in 2009 under the trade name Buckyballs(®) (Maxfield & Oberton, New York, NY). They are about 5 mm in size, spherical, and brightly colored, making them appealing for young children to play with and place in their mouths. Three children presented within hours of ingestion, and the magnets were successfully removed via endoscopy in two, whereas the third child required laparoscopy. No fistulas were found in these children. A fourth child presented 2 days after ingestion with evidence of bowel wall erosion, but without fistula formation; the magnets were removed via laparoscopy. A fifth child ingested nine magnets in a ring formation, which were removed via colonoscopy without evidence of injury or fistula formation. The three remaining children presented late (5-8 days after ingestion) and were found to have associated fistulas. They were treated successfully with a combination of endoscopy and laparoscopy with fluoroscopy. None of the children in our series required an open surgical procedure. All children were discharged home without complications. This case series highlights the potential dangers of rare-earth magnet ingestion in children. Our experience suggests that prompt intervention using minimally invasive approaches can lead to successful outcomes. PMID:23573888

  20. Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

    PubMed Central

    Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-woo; Yin, Chang Shik; Lee, Young Jin

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy. PMID:23935655

  1. Endoscopic Endonasal Transclival Approaches: Case Series and Outcomes for Different Clival Regions

    PubMed Central

    Little, Ryan E.; Taylor, Robert J.; Miller, Justin D.; Ambrose, Emily C.; Germanwala, Anand V.; Sasaki-Adams, Deanna M.; Ewend, Matthew G.; Zanation, Adam M.

    2014-01-01

    Objective Transclival endoscopic endonasal approaches to the skull base are novel with few published cases. We report our institution's experience with this technique and discuss outcomes according to the clival region involved. Design Retrospective case series. Setting Tertiary care academic medical center Participants All patients who underwent endoscopic endonasal transclival approaches for skull base lesions from 2008 to 2012. Main Outcome Measures Pathologies encountered, mean intraoperative time, intraoperative complications, gross total resection, intraoperative cerebrospinal fluid (CSF) leak, postoperative CSF leak, postoperative complications, and postoperative clinical course. Results A total of 49 patients underwent 55 endoscopic endonasal transclival approaches. Pathology included 43 benign and 12 malignant lesions. Mean follow-up was 15.4 months. Mean operative time was 167.9 minutes, with one patient experiencing an intraoperative internal carotid artery injury. Of the 15 cases with intraoperative cerebrospinal fluid (CSF) leaks, 1 developed postoperative CSF leak (6.7%). There were six other postoperative complications: four systemic complications, one case of meningitis, and one retropharyngeal abscess. Gross total resection was achieved for all malignancies approached with curative intent. Conclusions This study provides evidence that endoscopic endonasal transclival approaches are a safe and effective strategy for the surgical management of a variety of benign and malignant lesions. Level of Evidence 4. PMID:25093148

  2. Determining Financial Capability of SSI/SSDI Beneficiaries with Psychiatric Disabilities: A Case Series

    PubMed Central

    Lazar, Christina M.; Black, Anne C.; McMahon, Thomas J; O’Shea, Kevin; Rosen, Marc I.

    2015-01-01

    Objective Social Security beneficiaries’ liberty is constrained if they are judged incapable of managing their disability payments and are assigned a fiduciary to manage benefit payments on their behalf. Conversely, beneficiaries’ well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and capability guidelines appear to be applied inconsistently in practice. This case series describes the ambiguities remaining for a small number of individuals even after published criteria for capability— failing to meet basic needs and/or harmful spending on drugs— are applied. Methods Trained, experienced assessors rated the financial capability of 119 individuals in intensive outpatient or inpatient psychiatric facilities who received SSI or SSDI payments. Ten individuals’ cases were determined difficult to judge. Results Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending needed to be considered incapable, the amount of spending on harmful things needed to be considered incapable, how intermittent periods of capability and incapability should be considered, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information. Conclusion The cases raise fundamental questions about what financial incapability is, but also illustrate how detailed consideration of beneficiaries’ living situations and decision making can inform the difficult dichotomous decision about capability. PMID:25727116

  3. Nasopharyngeal Masses Arising from Embryologic Remnants of the Clivus: A Case Series.

    PubMed

    Sajisevi, Mirabelle; Hoang, Jenny K; Eapen, Rose; Jang, David W

    2015-11-01

    Objectives This study aims to (1) discuss rare nasopharyngeal masses originating from embryologic remnants of the clivus, and (2) discuss the embryology of the clivus and understand its importance in the diagnosis and treatment of these masses. Design and Participants This is a case series of three patients. We discuss the clinical and imaging characteristics of infrasellar craniopharyngioma, intranasal extraosseous chordoma, and canalis basilaris medianus. Results Case 1: A 16-year-old male patient with a history of craniopharyngioma resection, who presented with nasal obstruction. A nasopharyngeal cystic mass was noted to be communicating with a patent craniopharyngeal canal. Histology revealed adamantinomatous craniopharyngioma. Case 2: A 43-year-old male patient who presented with nasal obstruction and headache. Computed tomography (CT) and magnetic resonance imaging revealed an enhancing polypoid mass in the posterior nasal cavity abutting the clivus. Histopathology revealed chondroid chordoma. Case 3: A 4-year-old female patient with a recurrent nasopharyngeal polyp. CT cisternogram showed that this mass may have risen from a bony defect of the middle clivus suggestive of canalis basilaris medianus. Conclusions Understanding the embryology of the clivus is crucial when considering the differential diagnosis of a nasopharyngeal mass. Identification of characteristic findings on imaging is critical in the diagnosis and treatment of these lesions. PMID:26623237

  4. Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series

    PubMed Central

    Jaeger, Marie; Harats, Moti; Kornhaber, Rachel; Aviv, Uri; Zerach, Amir; Haik, Josef

    2016-01-01

    Hypergranulation tissue (or also known as overgranulation) may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal®. All five cases underwent surgical debridement and split-skin grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3–41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds. PMID:27570466

  5. Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series.

    PubMed

    Jaeger, Marie; Harats, Moti; Kornhaber, Rachel; Aviv, Uri; Zerach, Amir; Haik, Josef

    2016-01-01

    Hypergranulation tissue (or also known as overgranulation) may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal(®). All five cases underwent surgical debridement and split-skin grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3-41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds. PMID:27570466

  6. Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series

    PubMed Central

    Archer, Kristin R.

    2015-01-01

    Background and Purpose Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Case Description Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements. Outcomes Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention. Discussion The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD. PMID:25256740

  7. Ophthalmologic manifestations of focal dermal hypoplasia (Goltz syndrome): A case series of 18 patients.

    PubMed

    Gisseman, Jordan D; Herce, Honey H

    2016-03-01

    Focal Dermal Hypoplasia (FDH) or Goltz syndrome is a rare multi-system disorder with cutaneous, ocular, dental, and skeletal anomalies due to dysplasia of mesoectodermal derived tissues. It is an X-linked inheritance syndrome caused by mutations in the PORCN gene. This study is aimed to investigate the ocular findings in patients with Goltz syndrome. To date, there have been a limited number of case reports on the ocular manifestations of FDH. This is a prospective, non-consecutive, observational case series. Prospective ophthalmologic evaluation was performed on 18 patients with confirmed genetic testing for FDH, Goltz Syndrome, as a component of a larger multi-subspecialty study to better characterize the findings of this condition. Special attention was placed on evaluating the incidence of anophthalmia, microphthalmia, colobomas (iris, optic nerve, and/or retinal), cataracts, nystagmus, and strabismus. A complete ophthalmologic exam was done on all the patients. The mean patient age was 12.8 years (1-55 years). Eighty-nine percent were female and 77% (14/18) of patients had some form of an ophthalmologic manifestation of the condition. Ophthalmological findings included chorioretinal colobomas (61%), iris colobomas (50%), microphthalmia (44%), anophthalmia (11%), cataracts (11%), and conjunctival and eyelid papillomas (5%). Nystagmus was present in 33% and strabismus in 22% of the patients. Visual acuity ranged from 20/20 to no light perception. This study demonstrates a higher incidence of ophthalmologic manifestations as previously reported (77% vs. 40%). To our knowledge, this is the largest case series reported in the literature with 18 patients. © 2016 Wiley Periodicals, Inc. PMID:27001926

  8. Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series*

    PubMed Central

    Gomes, Vivianne Calheiros Chaves; Silva, Mara Cristina Coelho; Maia, José Holanda; Daltro, Pedro; Ramos, Simone Gusmão; Brody, Alan S.; Marchiori, Edson

    2013-01-01

    OBJECTIVE: Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. CONCLUSIONS: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment. PMID:24310630

  9. Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series

    PubMed Central

    Pereira, João Pedro Tavares; Romão, Vera; Eulálio, Margarida; Jorge, Rita; Breda, Filipe; Calretas, Suzana; Leitão, Sara; Eugénio, Gisela; Santos, Rui; Carvalho, Armando

    2016-01-01

    Case series Patient: Male, 51 • Male, 70 • Male, 63 • Male, 67 • Female, 76 Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain Medication: — Clinical Procedure: Colcicine Specialty: Metabolic Disorders and Diabetics Objective: Rare co-existance of disease or pathology Background: Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. Case Report: Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65±9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. Conclusions: Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community

  10. Retrospective testing and case series study of porcine delta coronavirus in U.S. swine herds.

    PubMed

    McCluskey, Brian J; Haley, Charles; Rovira, Albert; Main, Rodger; Zhang, Yan; Barder, Sunny

    2016-01-01

    Porcine deltacoronavirus (PDCoV) was first reported in the United States (US) in February 2014. This was the second novel swine enteric coronavirus detected in the US since May 2013. In this study, we conducted retrospective testing of samples submitted to three veterinary diagnostic laboratories where qualifying biological samples were derived from previously submitted diagnostic case submissions from US commercial swine farms with a clinical history of enteric disease or from cases that had been previously tested for transmissible gastroenteritis virus, PEDV, or rotavirus. Overall, 2286 banked samples were tested from 27 States. Samples were collected in 3 separate years and in 17 different months. Test results revealed 4 positive samples, 3 collected in August 2013 and 1 collected in October 2013. In addition, a case series including 42 operations in 10 States was conducted through administration of a survey. Survey data collected included information on characteristics of swine operations that had experienced PDCoV clinical signs. Special emphasis was placed on obtaining descriptive estimates of biosecurity practices and disease status over time of each operation. Clinical signs of PDCoV were reported to be similar to those of PEDV. The average number of animals on each operation exhibiting clinical signs (morbidity) and the average number of case fatalities was greatest for suckling and weaned pigs. Average operation-level weaned pig morbidity was greatest in the first week of the outbreak while average operation-level suckling pig case fatality was greatest in the second week of the outbreak. The survey included questions regarding biosecurity practices for visitors and operation employees; trucks, equipment and drivers; and feed sources. These questions attempted to identify a likely pathway of introduction of PDCoV onto the operations surveyed. PMID:26603048

  11. Evaluation of the North American Guidelines for Children's Agricultural Tasks using a case series of injuries

    PubMed Central

    Marlenga, B; Brison, R; Berg, R; Zentner, J; Linneman, J; Pickett, W

    2004-01-01

    Objective: To evaluate the potential for the North American Guidelines for Children's Agricultural Tasks (NAGCAT) to prevent the occurrence of pediatric farm injuries. This evaluation focuses upon farm injuries experienced when children were engaged in farm work. Design: Novel outcome evaluation involving primary review of three retrospective case series. Setting: Fatal, hospitalized, and restricted activity injuries from the United States and Canada. Subjects: Nine hundred and thirty four pediatric farm injury cases. Methods: The applicability of NAGCAT to each case was rated. For injuries where NAGCAT were applicable, recurrent injury patterns were described and the potential for NAGCAT to prevent their occurrence was assessed. Results: A total of 283 (30.3%) cases involved children engaged in farm work. There was an applicable NAGCAT guideline in 64.9% of the work related cases. Leading individual guidelines applicable to the injury events were: (1) working with large animals; (2) driving a farm tractor; and (3) farm work with an all-terrain vehicle. In the judgment of the research team, 59.6% of these injuries were totally preventable if the principles espoused by NAGCAT had been applied. Conclusions: NAGCAT are a set of consensus guidelines aimed at the prevention of pediatric farm injuries. The findings suggest that NAGCAT, if applied, would be efficacious in preventing many of the most serious injuries experienced by children engaged in farm work. However, work related injuries represent only a modest portion of pediatric farm injuries. This new information assists in the refinement of NAGCAT as an injury control resource and puts its potential efficacy into context. PMID:15583256

  12. Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases

    PubMed Central

    Yeh, Shih-Bin; Schenck, Carlos H.

    2014-01-01

    Objective To present findings on a series of cases of sporadic nocturnal frontal lobe epilepsy (NFLE), a form of NFLE that is infrequently reported, in contrast to familial (autosomal dominant) NFLE. Both forms of NFLE need to be distinguished from parasomnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders. Methods Eight consecutive cases of sporadic NFLE were evaluated at a sleep clinic in Taiwan. All patients had clinical evaluations, daytime waking and sleeping EEGs, brain MRIs, and overnight video-polysomnography (vPSG) with seizure montage. Results Gender was equal (four males, four females); mean age was 18.4 yrs (range, 7–41 yrs). Age of NFLE onset was by puberty. Premorbid history was negative for any neurologic, medical or psychiatric disorder. NFLE subtypes: nocturnal paroxysmal dystonia, n=6; paroxysmal arousals, n=2. MRI brain scan abnormalities with clinical correlates were found in one patient. Daytime awake EEGs were negative for ictal/interictal activity in all patients, but two patients had daytime sleep EEGs with interictal epileptiform EEG activity. During vPSG studies, three of eight patients with NFLE seizure events had concurrent epileptiform EEG activity, and two patients had interictal epileptiform EEG activity during their vPSG studies. No case had a spontaneous remission. Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency). Discussion These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America. PMID:26483923

  13. Hypothermia associated with antipsychotic drug use: a clinical case series and review of current literature.

    PubMed

    Kreuzer, Peter; Landgrebe, Michael; Wittmann, Markus; Schecklmann, Martin; Poeppl, Timm B; Hajak, Goeran; Langguth, Berthold

    2012-07-01

    Hypothermia as an adverse reaction of antipsychotic drug use represents a potentially life-threatening complication. However, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are far from being fully understood. Here we present a case series of 5 patients developing severe hypothermia after administration of olanzapine and benperidol. Controlled by a network of neural structures, body temperature is physiologically regulated in far more narrow boundaries than are other vital functions, and its homeostasis is critical for survival. The preoptic region in the ventral hypothalamus is assumed to act as a coordinating center that is endowed with thermosensory units that constantly compare actual body temperature with target values and initiate regulatory and compensatory mechanisms in case of mismatch. Hypothermia risk seems to increase in the first days after initiation of antipsychotic drug therapy or increases in the daily dose. Schizophrenic patients bear a higher risk than nonschizophrenic patients treated with antipsychotic drugs (such as patients with dementia or depression). Antipsychotic drugs with strong 5-HT2 antagonism seem to be more frequently associated with hypothermia. These cases demonstrate the clinical relevance of hypothermia as an adverse reaction to antipsychotic treatment and the importance of careful monitoring of body temperature. PMID:21956608

  14. Head and neck solitary infantile myofibroma: Clinicopathological and immunohistochemical features of a case series.

    PubMed

    Lopes, Rodrigo Nascimento; Alves, Fábio de Abreu; Rocha, André Caroli; Suassuna, Thales M; Kowalski, Luiz Paulo; de Castro, Jurema Freire Lisboa; Perez, Danyel Elias da Cruz

    2015-01-01

    Infantile myofibroma is a rare mesenchymal benign tumor mostly found in the head and neck region. The aim of this study was to describe a small case series of head and neck solitary infantile myofibroma, emphasizing the importance of the histopathological and immunohistochemical features, and the potential diagnostic challenges. For the study, clinical and imaging data were obtained from the medical records. All cases were histologically reviewed, and immunohistochemical analyses were performed to confirm the diagnosis. Four cases of head and neck solitary infantile myofibroma were identified. All patients were females and presented a mean age of 3 years old (ranging from 2 to 6 years). The site of the tumors were the mandible, right cheek, subcutaneous tissue adjacent to basal cortical of the mandible and upper anterior gingiva. No symptoms, such as pain or paresthesia, were reported. Computerized tomography revealed well-delimited tumors. All tumors were positive for vimentin and alpha-smooth muscle actin. All patients underwent surgical excision and no signs of recurrence were observed after long-term follow-up. In summary, head and neck solitary infantile myofibromas are rare and present excellent prognosis. The correlation between clinical, histopathological and immunohistochemical features are essential for a correct diagnosis. PMID:25744090

  15. Rarely Seen Nasal Congenital Problems Causing Neonatal Upper Respiratory Obstruction: A Case Series

    PubMed Central

    Başal, Yeşim; Akcan, Abdullah Bariş; Polat, Yasemin Durum; Günel, Ceren; Eryilmaz, Aylin; Başak, Sema

    2016-01-01

    Since newborns are obligatory nasal breathers, upper respiratory tract problems may sometimes be life threatening. The most common pathology causing dyspnea and stridor in newborns is laryngomalacia. Nasal cavity pathologies that risk the neonatal airway are more rarely met. These anomalies may be seen either as solitary anomalies or as a part of a syndrome. While choanal atresia is one of the best-known nasal cavity anomalies, choanal stenosis, congenital nasal mid-line masses, congenital nasal pyriform aperture stenosis, and nasal tip anomalies are more rarely seen structural pathologies. Choanal atresia may be present either as an isolated congenital anomaly or as a part of CHARGE syndrome. Some rare chromosome anomalies may also cause significant problems during nasal respiration in newborns. With this study, we presented a case series of newborns with pathologies that affected nasal respiration. Although the diagnosis and treatment of choanal atresia and congenital dacryocystocele are well known, the information on the diagnosis and treatment of the other two uncommon cases are limited. With this study, we aimed to contribute to the literature by presenting our approach in six cases having congenital pathologies that cause nasal respiratory obstruction. PMID:27114819

  16. [Aspects of the tuberculosis of the child: a series of 153 cases].

    PubMed

    Barchiche, N A; Berkani, A; Chernai, M; Aitabdeslam, S; Meguenni, W

    2010-04-01

    Known as White Plague xvii and xviii centuries. It is a present disease with 1.7 billions inhabitants who are touched (OMS). Disease of future with eight to 10 millions of new cases per year (99% of countries underdeveloped are touched). It kills more than other infectious disease: with three millions of death (deaths) among which 3105 children per year. Twenty-four thousand one hundred and three new cases a day and 7103 deaths in the daytime, because of the epidemic of the AIDS and the resistance of the BK. The authors report a series of 153 cases of tuberculosis at old children of some months of life in 15 and a half year follow-up and took care at the level of various services of the CHU of Tizi-Ouzou brought together in one and a half decade (15 years). Whole preference of the male achievement, touching quite sectors of society especially the most deprived one third of the children are schooled, little complicated and three deaths recorded. PMID:19892476

  17. Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series

    PubMed Central

    Garcia, Alvaro; Baldoni, Anthony

    2015-01-01

    We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm2. Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) – one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes. Conclusion Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach. PMID:26288732

  18. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    PubMed Central

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  19. An Alternative Approach to Atopic Dermatitis: Part I—Case-Series Presentation

    PubMed Central

    2004-01-01

    Atopic dermatitis (AD) is a complex disease of obscure pathogenesis. A substantial portion of AD patients treated with conventional therapy become intractable after several cycles of recurrence. Over the last 20 years we have developed an alternative approach to treat many of these patients by diet and Kampo herbal medicine. However, as our approach is highly individualized and the Kampo formulae sometimes complicated, it is not easy to provide evidence to establish usefulness of this approach. In this Review, to demonstrate the effectiveness of the method of individualized Kampo therapy, results are presented for a series of patients who had failed with conventional therapy but were treated afterwards in our institution. Based on these data, we contend that there exist a definite subgroup of AD patients in whom conventional therapy fails, but the ‘Diet and Kampo’ approach succeeds, to heal. Therefore, this approach should be considered seriously as a second-line treatment for AD patients. In the Discussion, we review the evidential status of the current conventional strategies for AD treatment in general, and then specifically discuss the possibility of integrating Kampo regimens into it, taking our case-series presented here as evidential basis. We emphasize that Kampo therapy for AD is more ‘art’ than technology, for which expertise is an essential pre-requisite. PMID:15257326

  20. A case series of laparoscopic components separation and rectus medialization with laparoscopic ventral hernia repair.

    PubMed

    Malik, Kashif; Bowers, Steven P; Smith, C Daniel; Asbun, Horacio; Preissler, Susanne

    2009-10-01

    Laparoscopic ventral hernia repair has been shown to offer improved patient recovery, when compared to open repair. It has also been shown to offer a lower complication rate. However, in patients with high body-mass index and large defects, the intraperitoneal on-lay technique of laparoscopic repair is criticized for an increased incidence of failure. In 1990, a study introduced the technique of open-component separation, hence enabling the medialization of the rectus muscle and decreasing the incidence of recurrence associated with primary repair. Open-component separation is associated with increased wound problems due to extensive dissection. Different laparoscopic and endoscopic modifications to the open-component-separation technique have been tried to minimize wound problems. In this article, we present our case series of 4 patients involving the laparoscopic component-separation technique of rectus medialization and, laparoscopic ventral hernia combined. This is one of the first series ever reported to involve both modalities of hernia repair in using an exclusive laparoscopic technique. PMID:19694565

  1. Syndrome of remitting seronegative symmetrical synovitis with pitting edema: A case series

    PubMed Central

    Varshney, AN; Singh, NK

    2015-01-01

    Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) is a rare clinical entity that is easily missed due to lack of knowledge. It was formerly considered as a subset of rheumatoid arthritis (RA), but is now regarded as a distinct disease/syndrome. The diagnosis of RS3PE is not easy, as it is always hindered by the lack of definite diagnostic criteria and presence of other much common rheumatological disorders that mimic it. We report a series of seven cases that attended our clinic in the last year, which highlight the salient features of the disease. The disease was found to have a heterogeneous presentation. Immunogenetic, clinical, laboratory, radiological, and possible etiological factors and associations with the neoplasm are described, as also other peculiar presentations. Finally, a comparison with other common rheumatological disorders is made to alert the clinician about this rare, but easily treatable disease. PMID:25511217

  2. Eosinophilic esophagitis that develops during therapy with proton pump inhibitors : case series and possible mechanisms.

    PubMed

    Orel, R; Murch, S; Amil Dias, J; Vandenplas, Y; Homan, M

    2016-01-01

    Therapy with proton-pump inhibitors (PPIs) results in remission in at least one third of patients with esophageal eosinophilia, presumably because of both their acid-related and anti-inflammatory mechanisms of action. However, eosinophilic esophagitis (EoE) may also develop during therapy with PPIs. We present a case series of four children who were initially diagnosed with infectious esophagitis, gastroesophageal reflux disease or gastric ulcer, who had no eosinophilic infiltration of the esophagus, but subsequently developed symptoms, endoscopic features and histological picture of typical EoE. We discuss mechanisms of action of PPIs of likely relevance to an increased risk of development of EoE in some patients, such as their influence on mucosal barrier function, interference with pH-related protein digestion by pepsin, and antigen processing by immune cells. PMID:27382946

  3. The androgen receptor and genetic susceptibility to ovarian cancer: results from a case series.

    PubMed

    Levine, D A; Boyd, J

    2001-02-01

    Our objectives were to test whether polymorphic variation in the (CAG)n repeat of the androgen receptor (AR) gene affects penetrance of germ-line BRCA mutations for ovarian cancer or age of diagnosis for ovarian cancer. Using a case-series study design, 179 consecutive Ashkenazi Jewish ovarian cancer patients were genotyped for AR repeat length and BRCA mutation status. There was no association between AR repeat length and presence of a BRCA mutation. However, ovarian cancer patients from both groups (with or without BRCA mutation) who carried a short AR allele were diagnosed an average of 7.2 (95% confidence interval, 2.3-12.1) years earlier than patients who did not carry a short allele (P = 0.004). These data suggest that AR allele length affects age of diagnosis of ovarian cancer, irrespective of BRCA mutation status. PMID:11221880

  4. Fatal Honey Poisoning Caused by Tripterygium wilfordii Hook F in Southwest China: A Case Series.

    PubMed

    Zhang, Qiang; Chen, Xinguang; Chen, Shunan; Liu, Zhitao; Wan, Rong; Li, Juanjuan

    2016-06-01

    Mad honey poisoning has been reported in many countries, and it seldom results in death. We describe a rare case series of fatal honey poisoning caused by Tripterygium wilfordii Hook F (TwHF) in Southwest China. Three male construction workers were delivered to the emergency department with symptoms of food poisoning after ingestion of wild raw honey. Laboratory results showed that the 3 patients were at different degrees of renal damage, and 1 patient with severe symptoms died of acute renal failure 1 day after admission. Pollen analysis indicated that the suspected honey was heavily contaminated with TwHF pollen. Early diagnosis and prompt treatment are crucial for such poisoning. Pollen analysis is a practical approach to help diagnosis in remote areas where such honey poisoning occurs. PMID:27132027

  5. Tracheobronchial Mycosis in a Retrospective Case-Series Study of Five Status Asthmaticus Patients

    PubMed Central

    Mak, Garbo; Porter, Paul C.; Bandi, Venkata; Kheradmand, Farrah; Corry, David B.

    2013-01-01

    The aetiology of status asthmaticus (SA), a complication of severe asthma, is unknown. Fungal exposure, as measured by fungal atopy, is a major risk factor for developing asthma, but the relationship of fungi in SA per se has not previously been reported. In this five patient retrospective case series study, lower respiratory tract cultures were performed on bronchoalveolar lavage or tracheal aspirate fluid, comparing standard clinical laboratory cultures with a specialized technique in which respiratory mucus was removed prior to culture. We show mucolytic treatment allows increased detection of fungal growth, especially yeast, from the lower airways of all SA patients. We also demonstrate that the yeast Candida albicans inhalation readily induces asthma-like disease in mice. Our observations suggest, SA may represent a fungal infectious process, and supports additional prospective studies utilizing anti-fungal therapy to supplement conventional therapy, broad-spectrum antibiotics and high-dose glucocorticoids, which can promote fungal overgrowth. PMID:23280490

  6. Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.

    PubMed

    Bell, David; Marasco, Silvana; Almeida, Aubrey; Rowland, Michael

    2010-08-01

    With the recent withdrawal of the antifibrinolytic aprotinin from the market, tranexamic acid (TxA) has become more widely used. This change has led to increasing concern about the side-effect profile of TxA, particularly the incidence of postoperative seizures. In this case series, we describe 7 patients over an 18-month period who had open-chamber cardiac surgery and developed seizures in the postoperative period. This incidence is increased compared with that of a cohort of patients in the previous 36 months who did not receive TxA (0.66% versus 0%; P < .05). The exact mechanism of TxA-induced seizures is thought to be via inhibition of gamma-aminobutyric acid receptors in neurons. Data from the neurosurgical literature show a well-established link between this antifibrinolytic and seizures. There is now increasing awareness of this association in cardiac surgery, particularly when high TxA doses are used. PMID:20719731

  7. Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series

    PubMed Central

    Hauser, Ross A.; Orlofsky, Amos

    2013-01-01

    Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation. PMID:24046512

  8. Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series.

    PubMed

    Urban, Istvan A; Monje, Alberto; Wang, Hom-Lay

    2015-01-01

    Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained. PMID:26357691

  9. Case series of cerebral infarction with Trousseau's syndrome associated with malignant gynecological tumors

    PubMed Central

    ISHIKAWA, MASAKO; NAKAYAMA, KENTARO; ISHIBASHI, TOMOKA; SATO, EMI; NAKAMURA, KOHEI; KATAGIRI, HIROSHI; KYO, SATORU

    2016-01-01

    The association between neoplastic disease and thromboembolic disorders was first recognized by Trousseau in 1865. Blood coagulation abnormalities have been reported in the majority of patients with cancer, including those with ovarian carcinoma. However, Trousseau's syndrome (TS) has rarely been reported in women with ovarian carcinoma. We herein report a case series of TS, notably in the brain, in association with gynecological malignant disease, and emphasize the difficulties associated with the management of these thromboembolic effects. The aim of this study was to present our experience with 5 TS patients whose condition was effectively controlled through treatment of the primary malignant disease. Therefore, we suggest that patients with TS may be cured by tumor resection, even if they have severe thromboembolic disease, such as cerebral or pulmonary infarction. PMID:27330786

  10. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations

    PubMed Central

    Woitzik, Erin; deGraauw, Chris; Easter, Brock

    2014-01-01

    Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns. PMID:25550665

  11. Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review.

    PubMed

    Yu, JiaDe; Brandling-Bennett, Heather; Co, Dominic O; Nocton, James J; Stevens, Anne M; Chiu, Yvonne E

    2016-06-01

    Bullous eruptions in patients with underlying systemic lupus erythematosus (LE) can mimic toxic-epidermal necrolysis (TEN), a rapidly progressive mucocutaneous reaction usually associated with medication use. Differentiating between classic drug-induced TEN and TEN-like cutaneous LE is important but difficult. We report a series of 3 patients with pediatric systemic LE who were admitted with severe worsening of skin disease resembling TEN. However, the initial photo-distribution of the eruption, subacute progression, limited mucosal involvement, mild systemic symptoms, supportive biopsy and laboratory results, and lack of culprit drugs was more suggestive of a TEN-like cutaneous LE. These patients recovered with various systemic immunosuppressive medications including methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Our cases are rare and demonstrate key clinical and histologic features of TEN-like cutaneous LE in young patients and the importance of differentiating this entity from drug-induced TEN. PMID:27245834

  12. Surgical techniques for the treatment of ankyloglossia in children: a case series

    PubMed Central

    JUNQUEIRA, Marina Azevedo; CUNHA, Nayara Nery Oliveira; SILVA, Lidiane Lucas Costa e; ARAÚJO, Leandro Borges; MORETTI, Ana Beatriz Silveira; COUTO FILHO, Carlos Eduardo Gomes; SAKAI, Vivien Thiemy

    2014-01-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort. PMID:25025566

  13. The use of hemospray in portal hypertensive bleeding; a case series.

    PubMed

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray. PMID:24140803

  14. Sacroiliac joint radiofrequency ablation with a multilesion probe: a case series of 60 patients.

    PubMed

    Schmidt, Peter C; Pino, Carlos A; Vorenkamp, Kevin E

    2014-08-01

    This retrospective case series of patients with refractory sacroiliac joint (SIJ) pain presents our first 77 SIJ radiofrequency ablation (RFA) procedures performed with a multilesion probe. Of these, 16 (20.8%) provided no relief; 55 (71.4%) provided >50% pain relief at 6 weeks; 42 (54.5%, 95% confidence interval, 42.8%-65.8%) provided >50% pain relief at 6 months; and 12 (15.6%) continued to provide >50% pain relief at 1 year. These results compare favorably to those published using other RFA techniques. In conclusion, more than half of our patients with refractory SIJ pain received some pain relief for at least 6 months after RFA. PMID:25046790

  15. Desensitization of triggers and urge reprocessing for pathological gambling: a case series.

    PubMed

    Bae, Hwallip; Han, Changwoo; Kim, Daeho

    2015-03-01

    This case series introduces the desensitization of triggers and urge reprocessing (DeTUR), as a promising adjunctive therapy in addition to comprehensive treatment package for pathological gambling. This addiction protocol of eye movement desensitization and reprocessing was delivered to four male inpatients admitted to a 10-week inpatient program for pathological gambling. The therapist gave three 60-min weekly sessions of the DeTUR using bilateral stimulation (horizontal eye movements or alternative tactile stimuli) focusing on the hierarchy of triggering situations and the urge to initiate gambling behaviors. After treatment, self-reported gambling symptoms, depression, anxiety, and impulsiveness were all improved, and all the participants reported satisfaction with the therapy. They were followed up for 6 months and all maintained their abstinence from gambling and their symptomatic improvements. Given the efficiency (i.e., brevity and efficacy) of the treatment, a controlled study to confirm the effects of the DeTUR on pathological gambling would be justified. PMID:24293014

  16. Sleep-Related Infant Deaths in Victoria: A Retrospective Case Series Study.

    PubMed

    Bugeja, Lyndal; Dwyer, Jeremy; McIntyre, Sara-Jane; Young, Jeanine; Stephan, Karen Lesley; McClure, Roderick John

    2016-05-01

    Background There is general agreement that in some circumstances, sharing a sleep surface of any kind with an infant increases the risk of sudden unexpected death in infancy. There is a paucity of research conducted in Australia examining this issue. This study examines the frequency and distribution of sleep-related infant deaths in a defined population, and reports the proportion that occurred in the context of bed-sharing. Methods A retrospective population-based case series study was conducted of infants (≤365 days) who died in a sleeping context during the period 1 January 2008 to 31 December 2010 in the state of Victoria, Australia. Information about the infant, caregiver, sleeping environment and bed-sharing was collected from a review of the coroner's death investigation record. Results During the 3-year study period, 72 infant deaths occurred in a sleeping context. Of these, 33 (45.8 %) occurred in the context of bed-sharing: n = 7 in 2008; n = 11 in 2009; and n = 15 in 2010. Further analysis of the 33 deaths occurring in the context of bed-sharing showed that in this group, bed-sharing was largely intentional, habitual and most often involved the mother as one of the parties. Conclusions Given the case series nature of the study design, a causal relationship between bed-sharing and infant death could not be inferred. However the fact that nearly half of all sleep-related deaths occurred in the context of bed-sharing, provides strong support for the need to undertake definitive analytic studies in Australia so that evidence-based advice can be provided to families regarding the safety of bed-sharing practices. PMID:26649875

  17. Diagnostic challenges of early Lyme disease: Lessons from a community case series

    PubMed Central

    2009-01-01

    Background Lyme disease, the most common vector-borne infection in North America, is increasingly reported. When the characteristic rash, erythema migrans, is not recognized and treated, delayed manifestations of disseminated infection may occur. The accuracy of diagnosis and treatment of early Lyme disease in the community is unknown. Methods A retrospective, consecutive case series of 165 patients presenting for possible early Lyme disease between August 1, 2002 and August 1, 2007 to a community-based Lyme referral practice in Maryland. All patients had acute symptoms of less than or equal to 12 weeks duration. Patients were categorized according to the Centers for Disease Control and Prevention criteria and data were collected on presenting history, physical findings, laboratory serology, prior diagnoses and prior treatments. Results The majority (61%) of patients in this case series were diagnosed with early Lyme disease. Of those diagnosed with early Lyme disease, 13% did not present with erythema migrans; of those not presenting with a rash, 54% had been previously misdiagnosed. Among those with a rash, the diagnosis of erythema migrans was initially missed in 23% of patients whose rash was subsequently confirmed. Of all patients previously misdiagnosed, 41% had received initial antibiotics likely to be ineffective against Lyme disease. Conclusion For community physicians practicing in high-risk geographic areas, the diagnosis of Lyme disease remains a challenge. Failure to recognize erythema migrans or alternatively, viral-like presentations without a rash, can lead to missed or delayed diagnosis of Lyme disease, ineffective antibiotic treatment, and the potential for late manifestations. PMID:19486523

  18. The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series

    PubMed Central

    Louw, Adriaan; Diener, Ina

    2015-01-01

    Background Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. Methods A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. Results Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. Conclusions The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS. PMID:26056626

  19. Internet-Delivered, Family-Based Treatment for Early-Onset OCD: A Preliminary Case Series

    PubMed Central

    Comer, Jonathan S.; Furr, Jami M.; Cooper-Vince, Christine E.; Kerns, Caroline E.; Chan, Priscilla T.; Edson, Aubrey L.; Khanna, Muniya; Franklin, Martin E.; Garcia, Abbe M.; Freeman, Jennifer B.

    2014-01-01

    Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormous promise. This article presents the rationale, key considerations, and a preliminary case series for a promising behavioral telehealth innovation in the evidence-based treatment of early-onset OCD. We developed an Internet-based format for the delivery of family-based treatment for early-onset OCD directly to families in their homes, regardless of their geographic proximity to a mental health facility. Videoteleconferencing (VTC) methods were used to deliver real-time cognitive-behavioral therapy centering on exposure and response prevention to affected families. Participants in the preliminary case series included 5 children between the ages of 4 and 8 (MAge = 6.5) who received the Internet-delivered treatment format. All youth completed a full treatment course, all showed OCD symptom improvements and global severity improvements from pre- to posttreatment, all showed at least partial diagnostic response, and 60% no longer met diagnostic criteria for OCD at posttreatment. No participants got worse, and all mothers characterized the quality of services received as “excellent.” The present work adds to a growing literature supporting the potential of VTC and related computer technology for meaningfully expanding the reach of supported treatments for OCD and lays the foundation for subsequent controlled evaluations to evaluate matters of efficacy and engagement relative to standard in-office evidence-based care. PMID:24295036

  20. New findings for phenotype-genotype correlations in a large European series of holoprosencephaly cases

    PubMed Central

    Mercier, Sandra; Dubourg, Christèle; Garcelon, Nicolas; Campillo-Gimenez, Boris; Gicquel, Isabelle; Belleguic, Marion; Ratié, Leslie; Pasquier, Laurent; Loget, Philippe; Bendavid, Claude; Jaillard, Sylvie; Rochard, Lucie; Quélin, Chloé; Dupé, Valérie; David, Véronique; Odent, Sylvie

    2011-01-01

    Background Holoprosencephaly (HPE) is the most common forebrain defect in humans. It results from incomplete midline cleavage of the prosencephalon. Methods We report a large European series of 645 HPE probands (and 699 relatives), consisting of 51% foetuses and 49% liveborn children. Results Mutations in the four main genes involved in HPE (SHH, ZIC2, SIX3, TGIF) were identified in 25% of cases. The SHH, SIX3 and TGIF mutations were inherited in more than 70% of these cases, whereas 70% of the mutations in ZIC2 occurred de novo. Moreover, rearrangements were detected in 22% of the 260 patients screened by array-CGH. Fifteen probands had two mutations providing additional support for the “multiple-hit process” in HPE. There was a positive correlation between the severity of the brain malformation and facial features for SHH, SIX3 and TGIF, but no such correlation was found for ZIC2 mutations. The most severe HPE types were associated with SIX3 and ZIC2 mutations, whereas microforms were associated with SHH mutations. We focused on the associated brain malformations, including neuronal migration defects, which predominated in individuals with ZIC2 mutations, and neural tube defects, which were frequently associated with ZIC2 (rachischisis) and TGIF mutations. Extra-craniofacial features were observed in 27% of the individuals in this series (up to 40% of those with ZIC2 mutations) and a significant correlation was found between renal/urinary defects and mutations of SHH and ZIC2. Conclusions We propose an algorithm based on these new phenotype-genotype correlations, to facilitate molecular analysis and genetic counselling for HPE. PMID:21940735

  1. Non-BCS thermodynamic properties of H2 S superconductor

    NASA Astrophysics Data System (ADS)

    Durajski, Artur P.; Szcze&şacute; niak, Radosław; Li, Yinwei

    2015-08-01

    The present paper determines the thermodynamic properties of the superconducting state in the H2S compound. The values of the pressure from 130 GPa to 180 GPa were taken into consideration. The calculations were performed in the framework of the Eliashberg formalism. In the first step, the experimental course of the dependence of the critical temperature on the pressure was reproduced: TC ∈ < 31, 88 > K, whereas the Coulomb pseudopotential equal to 0.15 was adopted. Next, the following quantities were calculated: the order parameter at the temperature of zero Kelvin (Δ (0)), the specific heat jump at the critical temperature (ΔC (TC) ≡CS (TC) -CN (TC)), and the thermodynamic critical field (HC (0)). It was found that the values of the dimensionless ratios: RΔ ≡ 2 Δ (0) /kBTC , RC ≡ ΔC(TC) /CN (TC) , and RH ≡TCCN (TC) / HC2(0) deviate from the predictions of the BCS theory: RΔ ∈ < 3.64, 4.16 > , RC ∈ < 1.59, 2.24 > , and RH ∈ < 0.144, 0.163 > . Generalizing the results on the whole family of the HnS -type compounds, it was shown that the maximum value of the critical temperature can be equal to ˜290 K, while RΔ,RC and RH adopt the following values: 6.53, 3.99, and 0.093, respectively.

  2. Miltefosine for Mucosal and Complicated Cutaneous Old World Leishmaniasis: A Case Series and Review of the Literature

    PubMed Central

    Mosimann, Vincent; Blazek, Claudia; Grob, Heini; Chaney, Matthew; Neumayr, Andreas; Blum, Johannes

    2016-01-01

    Complicated Old World cutaneous leishmaniasis (OWCL) and Old World mucosal leishmaniasis (OWML) constitute an indication for systemic treatment. To date, there no controlled clinical studies that compare treatment options for these diseases. We compiled a case series of 24 cases successfully treated with miltefosine. We conclude that oral miltefosine is an effective treatment option for both OWCL and OWML. PMID:27042675

  3. Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series

    PubMed Central

    Revuelta-Gutiérrez, Rogelio; Morales-Martínez, Andres Humberto; Mejías-Soto, Carolina; Martínez-Anda, Jaime Jesús; Ortega-Porcayo, Luis Alberto

    2016-01-01

    Background: Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. It is characterized by a sudden onset lancinating pain usually localized in the sensory distribution of the IX cranial nerve associated with excessive vagal outflow, which leads to bradycardia, hypotension, syncope, or cardiac arrest. This study aims to review our surgical experience performing microvascular decompression (MVD) in patients with GPN. Methods: Over the last 20 years, 14 consecutive cases were diagnosed with GPN. MVD using a microasterional approach was performed in all patients. Demographic data, clinical presentation, surgical findings, clinical outcome, complications, and long-term follow-up were reviewed. Results: The median age of onset was 58.7 years. The mean time from onset of symptoms to treatment was 8.8 years. Glossopharyngeal and vagus nerve compression was from the posterior inferior cerebellar artery in eleven cases (78.5%), vertebral artery in two cases (14.2%), and choroid plexus in one case (7.1%). Postoperative mean follow-up was 26 months (3–180 months). Pain analysis demonstrated long-term pain improvement of 114 ± 27.1 months and pain remission in 13 patients (92.9%) (P = 0.0001) two complications were documented, one patient had a cerebrospinal fluid leak, and another had bacterial meningitis. There was no surgical mortality. Conclusions: GPN is a rare entity, and secondary causes should be discarded. MVD through a retractorless microasterional approach is a safe and effective technique. Our series demonstrated an excellent clinical outcome with pain remission in 92.9%. PMID:27213105

  4. Mitotically active microglandular hyperplasia of the cervix: a case series with implications for the differential diagnosis.

    PubMed

    Abi-Raad, Rita; Alomari, Ahmed; Hui, Pei; Buza, Natalia

    2014-09-01

    Microglandular hyperplasia (MGH) is a benign proliferation of endocervical glands with relatively uniform columnar or cuboidal nuclei, and rare to absent mitoses. Endometrial adenocarcinomas with mucinous differentiation or a microglandular pattern can closely mimic MGH, often resulting in a diagnostic dilemma in small biopsy specimens. Rare unusual morphologic features-mild to moderate nuclear atypia, solid or reticular growth pattern, hobnail and signet ring cells-have been previously reported in MGH. We present 9 cases of unusual, mitotically active-between 5 and 11 mitotic figures per 10 HPF-MGH, all of which presented as endocervical polyps and had morphologic features otherwise typical of MGH. The patients' age ranged between 35 and 56 yr, 2 patients were postmenopausal. High-risk human papillomavirus status was available in 7 patients, all of which were negative. The Ki-67 proliferation index ranged between 1% and 15%, and all cases were negative for p16, carcinoembryonic antigen, and vimentin immunostains. The clinical follow-up ranged from 3 to 76.2 mo, with a median of 40.7 mo, all patients were doing well without evidence of endocervical or endometrial malignancy. In summary, this case series documents the presence of rare cases of MGH demonstrating significant mitotic activity (up to 11/10 HPF) without a negative impact on the clinical prognosis. Mitotic activity alone should be interpreted with caution in small biopsy specimens with microglandular growth pattern. Immunohistochemical stains, especially p16, carcinoembryonic antigen, and vimentin, may be helpful-in addition to the patient's clinical history and human papillomavirus status to rule out endocervical or endometrial malignancy. PMID:25083971

  5. Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

    PubMed Central

    Vezakis, Antonios I.; Pantiora, Eirini V.; Kontis, Elissaios A.; Sakellariou, Vasileios; Theodorou, Dimitrios; Gkiokas, Georgios; Polydorou, Andreas A.; Fragulidis, Georgios P.

    2016-01-01

    Case series Patient: Fenale, 77 • Female, 46 • Female, 33 Final Diagnosis: Caustic injury Symptoms: — Medication: — Clinical Procedure: Surgery Specialty: Surgery Objective: Unusual clinical course Background: Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae. Case Report: The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies. Conclusions: Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to

  6. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

    PubMed

    Mustafi, N; Engels, P

    2016-04-01

    Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery. PMID:27064368

  7. Shrinking lung syndrome in systemic lupus erythematosus: A case series and review of the literature.

    PubMed

    Borrell, Helena; Narváez, Javier; Alegre, Juan José; Castellví, Ivan; Mitjavila, Francesca; Aparicio, María; Armengol, Eulàlia; Molina-Molina, María; Nolla, Joan M

    2016-08-01

    Shrinking lung syndrome (SLS) is a rare and less known complication mainly associated with systemic lupus erythematosus (SLE). In this study, we analyze the clinical features, investigation findings, approaches to management, and outcome in a case series of 9 adult patients with SLE and SLS diagnosed during a 35-year period in 3 referral tertiary care hospitals in Spain. Additionally, we reviewed 80 additional cases previously reported (PubMed 1965-2015). These 80 cases, together with our 9 patients, form the basis of the present analysis.The overall SLS prevalence in our SLE population was 1.1% (9/829). SLS may complicate SLE at any time over its course, and it usually occurs in patients without previous or concomitant major organ involvement. More than half of the patients had inactive lupus according to SELENA-systemic lupus erythematosus disease activity index (SLEDAI) scores. Typically, it presents with progressive exertional dyspnea of variable severity, accompanied by pleuritic chest pain in 76% of the cases.An important diagnostic delay is common. The diagnostic tools that showed better yield for SLS detection are the imaging techniques (chest x-ray and high-resolution computed tomography) along with pulmonary and diaphragmatic function tests. Evaluation of diaphragm dome motion by M-mode ultrasonography and phrenic nerve conduction studies are less useful.There are no standardized guidelines for the treatment of SLS in SLE. The majority of patients were treated with medium or high doses of glucocorticoids. Several immunosuppressive agents have been used in conjunction with steroids either if the patient fails to improve or since the beginning of the treatment. Theophylline and beta-agonists, alone or in combination with glucocorticoids, have been suggested with the intent to increase diaphragmatic strength.The overall long-term prognosis was good. The great majority of patients had significant clinical improvement and stabilization, or mild to moderate

  8. Potential utility of precision medicine for older adults with polypharmacy: a case series study

    PubMed Central

    Finkelstein, Joseph; Friedman, Carol; Hripcsak, George; Cabrera, Manuel

    2016-01-01

    Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as “CYP3A4/CYP3A5 poor metabolizer”, which affected metabolism of eleven prescribed drugs. The second case had “CYP2D6 rapid metabolizer” status affecting three prescribed medications, two of which were key drugs for managing this patient’s chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug–drug interactions. Both patients with significant drug–gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides

  9. Potential utility of precision medicine for older adults with polypharmacy: a case series study.

    PubMed

    Finkelstein, Joseph; Friedman, Carol; Hripcsak, George; Cabrera, Manuel

    2016-01-01

    Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as "CYP3A4/CYP3A5 poor metabolizer", which affected metabolism of eleven prescribed drugs. The second case had "CYP2D6 rapid metabolizer" status affecting three prescribed medications, two of which were key drugs for managing this patient's chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug-drug interactions. Both patients with significant drug-gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides providing

  10. Hemophagocytic Lymphohistiocytosis: Single-Center Series of 12 Cases from Saudi Arabia.

    PubMed

    Elyamany, Ghaleb; Alzahrani, Azzah; Elfaraidi, Huda; Alsuhaibani, Omar; Othman, Nada; Al Mussaed, Eman; Alabbas, Fahad

    2016-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease that commonly appears in infancy, although it has been reported in adults. Chemoimmunotherapy-based treatments have improved the survival of patients with HLH; however, overall survival is still poor. We retrospectively analyzed the data of 12 HLH patients who were admitted between 2005 and 2014. All patients were Saudi Arabia in origin with a female predominance (75%) and a median age of onset of 9.5 months. The consanguinity rates were significantly high (75%) with a positive family history in 41% of cases. Of the 12 patients, nine were defined as primary HLH patients and three were confirmed to be secondary HLH patients. All patients fulfilled the 2004 diagnostic criteria for HLH and received HLH-2004 treatment. Six of these patients showed a good response to chemotherapy, while the remainder of the patients showed partial or no response to chemotherapy. Five patients in this cohort received stem cell transplant, and these patients are currently in remission. The mortality rate of this cohort is currently 50%. Genetic mutational analysis showed a positive STX11 mutation in five patients and a PRF1 (perforin) mutation in two patients. To the best of our knowledge, this is the first case series of HLH from Saudi Arabia. PMID:27081327

  11. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

    PubMed Central

    Kajekar, Payal; Mendonca, Cyprian; Danha, Rati; Hillermann, Carl

    2014-01-01

    Background and Aims: Pentax airway scope (AWS) has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade), total dose of local anaesthetic used, anaesthetists rating and patient's tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%). The mean (standard deviation) intubation time and total time to complete the tracheal intubation was 5.4 (2.4) and 13.9 (3.7) min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS). Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route. PMID:25197114

  12. Clinical Effect of Acupotomy Combined with Korean Medicine: A Case Series of a Herniated Intervertebral Disc.

    PubMed

    Kim, Hyun-ji; Jeon, Ju-hyun; Kim, Young-il

    2016-02-01

    The aim of this study is to evaluate the effect of acupotomy for treating patients with a herniated intervertebral disc (HIVD). This case series includes five HIVD patients who were treated at the Department of Acupuncture and Moxibustion, Daejeon University Dunsan Korean Hospital, Daejeon, Korea, from January 2015 to April 2015. Acupotomy was performed three times over a 2-week period, along with Korean medical treatment. The outcomes were evaluated by using a numeric rating scale (NRS), physical examination, the Oswestry Low Back Pain Disability Index (ODI), the Short-Form 36-Item Health Survey (SF-36), and the Surgical Safety Checklist. The NRS and physical examination results, as well as the ODI scores, were improved in all cases. No significant differences were noted on the SF-36. No patients had any adverse effects. This study, with its findings of encouraging responses in reducing low back pain and radiating pain and in recovering the kinetic state of soft tissue, supports the potential use of acupotomy for the treatment of patients suffering from HIVD. PMID:26896075

  13. Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma.

    PubMed

    Zvosec, Deborah L; Smith, Stephen W; Porrata, Trinka; Strobl, A Quinn; Dyer, Jo Ellen

    2011-03-01

    γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention. PMID:20825811

  14. Steroid-responsive Encephalopathy Subsequently Associated with Alzheimer Disease Pathology: A Case Series

    PubMed Central

    Mateen, Farrah J.; Josephs, Keith A.; Parisi, Joseph E.; Drubach, Daniel A.; Caselli, Richard J.; Kantarci, Kejal; Lennon, Vanda; Jack, Clifford; Boeve, Bradley F.

    2011-01-01

    Background Steroid-responsive encephalopathies can considered vasculitic or nonvasculitic. Clinicopathological studies of nonvasculitic steroid-responsive encephalopathy are unusual, but can explain the range of diagnoses consistent with a steroid responsive presentation in life. Objective To extend the range of clinical features and pathological findings consistent with steroid-responsive encephalopathy. Design, Methods, and Patients A clinicopathological case series of four patients (ages 54–71 years, 2 women) with steroid-responsive encephalopathy followed at this institution until the time of death. Results Clinical features were suggestive of Creutzfeld-Jakob disease, dementia with Lewy Bodies, and parkinsonism, but pathological examination revealed only Alzheimer’s Disease-related findings without evidence of Lewy bodies or prion disease in all cases. All patients demonstrated marked, sustained improvement following steroid treatment, based on clinical, magnetic resonance imaging, and/or electroencephalogram studiesAlzheimer’s Disease was not diagnosed in life due to a lack of hippocampal atrophy on brain imaging and a dramatic symptomatic response to steroids. Conclusions Steroid-responsive encephalopathy is the clinical presentation of some patients with Alzheimer’s Disease related pathology at autopsy, and can be consistent with the clinical diagnoses of parkisonism, dementia with Lewy Bodies, or Creutzfeld-Jakob Disease in life. PMID:21714739

  15. Spontaneous coronary artery dissection: Case series from two institutions with literature review.

    PubMed

    Uribe, Carlos Esteban; Ramirez-Barrera, Juan David; Rubio, Carlos; Gallegos, Cesia; Ocampo, Luz Adriana; Saldarriaga, Clara; Eusse, Carlos; Tenorio, Carlos; Lopez, Nilson; Moreno, Andres; Jaramillo, Natalia Gonzalez; Chehrazi-Raffle, Alexander Morteza; Singh, Vikas; Martinez-Clark, Pedro

    2015-05-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Consequently, its presentation and optimal treatment are yet to be clearly defined. In the current literature, all case series report less than 50 patients, most of whom are either young peripartum women or women who have used oral contraceptives over long periods. All information in this study was compiled by the database service from two hospitals, the first one between 2003 and 2012 and the second one between 2007 and 2012, to include the clinical characteristics, angiography. and treatment approaches in the study population. The study population consisted in four women (50%) and four men (50%) whose ages ranged between 28 and 57 years. Two women had a history of oral contraceptive use and three women presented during peripartum. None of the patients had traditional cardiovascular risk factors or previous heart disease. In 88% of the cases, the principal diagnoses were non-ST segment elevation myocardial infarction and unstable angina. All patients underwent emergency coronary angiography and percutaneous coronary intervention. Half of them were treated with drug-eluting stents and the other half with bare metal stents. The most frequent type of dissection was NIHBL Type E, and the right coronary artery was the most frequently compromised. SCAD is a rare cause of ACS; however, its identification has improved due to the availability of angiography and new complementary techniques. Regarding treatment, PCI seems effective with adequate long-term results. PMID:25993713

  16. Hemophagocytic Lymphohistiocytosis: Single-Center Series of 12 Cases from Saudi Arabia

    PubMed Central

    Elyamany, Ghaleb; Alzahrani, Azzah; Elfaraidi, Huda; Alsuhaibani, Omar; Othman, Nada; Al Mussaed, Eman; Alabbas, Fahad

    2016-01-01

    BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease that commonly appears in infancy, although it has been reported in adults. Chemoimmunotherapy-based treatments have improved the survival of patients with HLH; however, overall survival is still poor. We retrospectively analyzed the data of 12 HLH patients who were admitted between 2005 and 2014. All patients were Saudi Arabia in origin with a female predominance (75%) and a median age of onset of 9.5 months. The consanguinity rates were significantly high (75%) with a positive family history in 41% of cases. Of the 12 patients, nine were defined as primary HLH patients and three were confirmed to be secondary HLH patients. All patients fulfilled the 2004 diagnostic criteria for HLH and received HLH-2004 treatment. Six of these patients showed a good response to chemotherapy, while the remainder of the patients showed partial or no response to chemotherapy. Five patients in this cohort received stem cell transplant, and these patients are currently in remission. The mortality rate of this cohort is currently 50%. Genetic mutational analysis showed a positive STX11 mutation in five patients and a PRF1 (perforin) mutation in two patients. To the best of our knowledge, this is the first case series of HLH from Saudi Arabia. PMID:27081327

  17. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study

    PubMed Central

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D.

    2013-01-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including establishing a safe therapeutic environment, reprocessing the trauma, constructing a new narrative, and managing emotional dysregulation. Therapeutic Assessment (TA) is a semistructured, brief intervention that uses psychological testing to promote positive change. The case study of Kelly, a middle-aged woman with a history of repeated interpersonal trauma, illustrates delivery of the TA model for CPTSD. Results of this single-case time-series experiment indicate statistically significant symptom improvement as a result of participating in TA. We discuss the implications of these findings for assessing and treating trauma-related concerns, such as CPTSD. PMID:24159267

  18. Free Flap Donor Site Reconstruction: A Prospective Case Series Using an Optimized Polyurethane Biodegradable Temporizing Matrix

    PubMed Central

    Wagstaff, Marcus J. D.; Schmitt, Bradley J.; Caplash, Yugesh

    2015-01-01

    Introduction: We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal. Objective: This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material. Methods: The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft. Results: Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis. Conclusion: This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated. PMID:26171099

  19. Flexible modelling of vaccine effect in self-controlled case series models.

    PubMed

    Ghebremichael-Weldeselassie, Yonas; Whitaker, Heather J; Farrington, C Paddy

    2016-05-01

    The self-controlled case series (SCCS) method, commonly used to investigate the safety of vaccines, requires information on cases only and automatically controls all age-independent multiplicative confounders, while allowing for an age-dependent baseline incidence. Currently, the SCCS method represents the time-varying exposures using step functions with pre-determined cut points. A less prescriptive approach may be beneficial when the shape of the relative risk function associated with exposure is not known a priori, especially when exposure effects can be long-lasting. We therefore propose to model exposure effects using flexible smooth functions. Specifically, we used a linear combination of cubic M-splines which, in addition to giving plausible shapes, avoids the integral in the log-likelihood function of the SCCS model. The methods, though developed specifically for vaccines, are applicable more widely. Simulations showed that the new approach generally performs better than the step function method. We applied the new method to two data sets, on febrile convulsion and exposure to MMR vaccine, and on fractures and thiazolidinedione use. PMID:26494534

  20. Cryptococcosis in non-HIV/non-transplant patients: A Brazilian case series.

    PubMed

    Lomes, Naiane Ribeiro; Melhem, Marcia Souza de Carvalho; Szeszs, Maria Walderez; Martins, Marilena Dos Anjos; Buccheri, Renata

    2016-10-01

    Cryptococcosis is a classical systemic opportunistic mycosis, primarily occurring among patients with significant immunologic impairment. However, this disease could also affect patients without any recognized immunologic defects, that is, phenotypically normal patients. The medical records of 29 non-HIV/nontransplant patients with cryptococcal disease during the period 2007-2014 were retrospectively reviewed. The most common site of infection was the central nervous system (n = 25, 86.2%), followed by the pulmonary system (n = 11, 37.9%) and blood (n = 2, 6.8%). Thoracic- and brain-computed tomography demonstrated abnormalities of 81.2% (n = 13) and 62.5% (n = 15), respectively. In sum, 22% (n = 6) of the patients experienced a significant underlying condition. More than one therapeutic regimen was used in 77.8% (n = 21) of the patients. The isolates were identified as being Cryptococcus neoformans species complex (n = 4, 36.4%) and Cryptococcus gattii species complex (n = 7, 63.6%). The overall mortality was 20.7% (n = 6). Herein, we presented the first case series of cryptococcosis in this specific population in São Paulo City, Brazil. The incidence of cryptococcosis in our hospital has not increased in recent years, and 77.8% (n = 21) of cases had no obvious predisposing factor. However, this disease remains associated with high mortality. PMID:27118805

  1. Subcutaneous Fungal Cyst Masquerading as Benign Lesions – A Series of Eight Cases

    PubMed Central

    Varghese, Renu G’Boy; Phansalkar, Manjiri; Ramdas, Anita; K, Authy; G, Thangiah

    2015-01-01

    Background Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and are usually localised. We present a series of eight cases with subcutaneous fungal cystic lesions masquerading as benign lesions. Materials and Methods A retrospective study was conducted on subcutaneous fungal infections seen between January 2007 to July 2014 in the Department of Pathology. Eight patients with biopsy proven subcutaneous fungal infection were included. We collected and analysed their demographic, clinical and histopathological details. Results Among eight patients, six were male and two were female. The mean age was 47 years (Range: 21-70). All the eight patients presented with non-tender cystic swelling. The size of the swellings varied from a minimum of 3x3 cm to maximum of 10x4 cm. Out of eight, hand was involved in three, forearm in one, elbow in two, leg in one and foot in one. On H&E staining, all the cases showed fibro collagenous cyst wall, lined by histiocytes, granulomatous reaction, foreign body type of giant cells with acute and chronic inflammatory infiltrate containing fungal elements. Six were identified as hyalohyphomycosis and two were identified as phaeohyphomycotic cysts based on pigmentation of hyphae. Conclusion Fungal infection should be suspected in all subcutaneous cystic lesions. Excised tissue should always be sent for culture and histopathology. PMID:26557537

  2. Triceps fascial tongue exposure for total elbow arthroplasty: surgical technique and case series.

    PubMed

    Marinello, Patrick G; Peers, Sebastian; Styron, Joseph; Pervaiz, Khurram; Evans, Peter J

    2015-06-01

    During a posterior approach to the elbow, the triceps muscle body and tendon insertion must be addressed during exposure. Several methods exist including performing an olecranon osteotomy. The triceps fascial tongue exposure, originally described by Van Gorder in 1940, provides an excellent view of the joint while causing minimal trauma to the extensor mechanism facilitating tendon healing, and easy intraoperative conversion from fracture fixation to a total elbow arthroplasty if a fracture is not able to be reconstructed. Using a standard posterior approach to the elbow, a triceps tongue is created. A distally based flap of the triceps tendon approximately 10 cm long and 2 to 3 cm wide is created and a remnant of the tendon is kept on all sides to secure a meticulous repair with nonabsorbable figure-of-eight sutures at the conclusion of the case. In our case series, 29 patients underwent 30 total elbow arthroplasties. There were no triceps-related failures. This surgical technique is a useful alternative surgical exposure to the posterior elbow for fractures and arthroplasty. PMID:25929418

  3. The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review.

    PubMed

    Foreman, Paul M; Naftel, Robert P; Moore, Thomas A; Hadley, Mark N

    2016-04-01

    OBJECT Since its introduction in 1976, the lateral extracavitary approach (LECA) has been used to access ventral and ventrolateral pathology affecting the thoracolumbar spine. Reporting of outcomes and complications has been inconsistent. A case series and systematic review are presented to summarize the available data. METHODS A retrospective review of medical records was performed, which identified 65 consecutive patients who underwent LECA for the treatment of thoracolumbar spine and spinal cord pathology. Cases were divided according to the presenting pathology. Neurological outcomes and complications were detailed. In addition, a systematic review of outcomes and complications in patients treated with the LECA as reported in the literature was completed. RESULTS Sixty-five patients underwent the LECA to the spine for the treatment of thoracic spine and spinal cord pathology. The most common indication for surgery was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were worse. Two patients (3.1%) experienced a complication. The systematic review revealed comparable neurological outcomes (74.9% improved) but a notably higher complication rate (32.2%). CONCLUSIONS The LECA provides dorsal and unilateral ventrolateral access to and exposure of the thoracolumbar spine and spinal cord while allowing for posterior instrumentation through the same incision. Although excellent neurological results can be expected, the risk of pulmonary complications should be considered. PMID:26682602

  4. Labour exploitation and health: a case series of men and women seeking post-trafficking services.

    PubMed

    Turner-Moss, Eleanor; Zimmerman, Cathy; Howard, Louise M; Oram, Siân

    2014-06-01

    Research on the health of trafficked men and on the health problems associated with trafficking for labor exploitation are extremely limited. This study analysed data from a case series of anonymised case records of a consecutive sample of 35 men and women who had been trafficked for labor exploitation in the UK and who were receiving support from a non-governmental service between June 2009 and July 2010. Over three-quarters of our sample was male (77 %) and two-thirds aged between 18 and 35 years (mean 32.9 years, SD 10.2). Forty percent reported experiencing physical violence while they were trafficked. Eighty-one percent (25/31) reported one or more physical health symptoms. Fifty-seven percent (17/30) reported one or more post-traumatic stress symptoms. A substantial proportion of men and women who are trafficked for labor exploitation may experience violence and abuse, and have physical and mental health symptoms. People who have been trafficked for forced labor need access to medical assessment and treatment. PMID:23649665

  5. Polynomial similarity transformation theory: A smooth interpolation between coupled cluster doubles and projected BCS applied to the reduced BCS Hamiltonian

    NASA Astrophysics Data System (ADS)

    Degroote, Matthias; Henderson, Thomas M.; Zhao, Jinmo; Dukelsky, Jorge; Scuseria, Gustavo E.

    2016-03-01

    We present a similarity transformation theory based on a polynomial form of a particle-hole pair excitation operator. In the weakly correlated limit, this polynomial becomes an exponential, leading to coupled cluster doubles. In the opposite strongly correlated limit, the polynomial becomes an extended Bessel expansion and yields the projected BCS wave function. In between, we interpolate using a single parameter. The effective Hamiltonian is non-Hermitian and this polynomial similarity transformation theory follows the philosophy of traditional coupled cluster, left projecting the transformed Hamiltonian onto subspaces of the Hilbert space in which the wave function variance is forced to be zero. Similarly, the interpolation parameter is obtained through minimizing the next residual in the projective hierarchy. We rationalize and demonstrate how and why coupled cluster doubles is ill suited to the strongly correlated limit, whereas the Bessel expansion remains well behaved. The model provides accurate wave functions with energy errors that in its best variant are smaller than 1% across all interaction strengths. The numerical cost is polynomial in system size and the theory can be straightforwardly applied to any realistic Hamiltonian.

  6. Confirmation of BCS Theory and Its Impact on Applications Past and Future

    NASA Astrophysics Data System (ADS)

    Beasley, Malcolm

    2011-03-01

    The experimental confirmation of BCS theory established it as the correct microscopic theory of superconductivity. It also led to applications of superconductivity distinct from those based on the Josephson effect and the magnetic properties of superconductors. The most prominent of these are SIS mixers for astronomy and high-Q filters for the cellular phone industry. In this talk we trace these historical developments and consider where today's more novel (beyond simple BCS) superconductors might be useful looking forward.

  7. A PARAMETRIC STUDY OF BCS RF SURFACE IMPEDANCE WITH MAGNETIC FIELD USING THE XIAO CODE

    SciTech Connect

    Reece, Charles E.; Xiao, Binping

    2013-09-01

    A recent new analysis of field-dependent BCS rf surface impedance based on moving Cooper pairs has been presented.[1] Using this analysis coded in Mathematica TM, survey calculations have been completed which examine the sensitivities of this surface impedance to variation of the BCS material parameters and temperature. The results present a refined description of the "best theoretical" performance available to potential applications with corresponding materials.

  8. Motor cortex stimulation for neuropathic pain syndromes: a case series experience.

    PubMed

    Buchanan, Robert J; Darrow, David; Monsivais, Daniel; Nadasdy, Zoltan; Gjini, Klevest

    2014-06-18

    Neuropathic pain is a chronic condition lacking effective management and responding poorly to standard treatment protocols. Motor cortex stimulation has emerged as a new and promising therapeutic tool with outcomes potentially affected by the specific causes and location. In this study we report a series of eight cases in the neurosurgery practice of one of the authors (R.J.B.), including neuropathic pain syndromes of trigeminal or thalamic origin with or without anesthesia dolorosa. Pain relief was evaluated on the basis of comparison of Visual Analog scores at baseline and at 3 months after surgery. In addition, we assessed differences in pain relief outcomes between cases with trigeminal neuralgia and thalamic stroke, as well as cases with or without anesthesia dolorosa (i.e. pain with numbness of the affected area). Visual Analog Scale scores showed a statistically significant decrease of 4.19 (P=0.002) at 3 months follow-up compared with baseline. Pain relief levels in four of five patients in the subgroup with facial pain were higher than 50%, and none of the patients in the subgroup with thalamic and phantom limb pain showed such a good outcome. Furthermore, we found larger pain relief levels in facial pain conditions with versus without anesthesia dolorosa. These results point to utility of motor cortex stimulation in relieving neuropathic pain, as well as better outcomes for patients with facial pain and anesthesia dolorosa. Future studies should incorporate methods to noninvasively trial those patients who may benefit from surgical implantation to predict the outcomes and maximize their negative predictive value. PMID:24780896

  9. Delayed posthypoxic leukoencephalopathy: a case series and review of the literature

    PubMed Central

    Zamora, Carlos A; Nauen, David; Hynecek, Robert; Ilica, Ahmet T; Izbudak, Izlem; Sair, Haris I; Gujar, Sachin K; Pillai, Jay J

    2015-01-01

    Background Delayed posthypoxic leukoencephalopathy (DPHL) is a rare and underrecognized entity where patients manifest a neurological relapse after initial recovery from an acute hypoxic episode. We sought to describe the magnetic resonance imaging (MRI) findings in a group of patients with DPHL and review the available literature. Methods Retrospective case series including patients who presented with neurological and/or psychiatric symptoms after recovery from an acute hypoxic episode. The history and clinical presentation were reviewed from the electronic medical records. MRI scans were evaluated from the picture archiving and communication system. We performed a comprehensive review of the English medical literature for prior published cases of DPHL and describe the key imaging findings that have been reported related to this condition. Results A total of five patients were identified, including four patients with respiratory failure due to drug overdoses from benzodiazepines, opioids, and/or barbiturates, and one patient who presented after cardiopulmonary arrest due to pulmonary embolism. All patients showed diffuse, extensive, and confluent white matter signal abnormalities including prominent restricted diffusion, extending to the subcortical white matter and respecting the U-fibers. There was no gyral edema or contrast enhancement. In one case histopathology was available, which highlighted patchy subcortical myelin loss with sparing of U-fibers and demonstrated prominent macrophage/microglial inflammation with extensive axonal damage. Of the other four patients, two were at their neurological baselines and two had persistent neurological deficits at the time of discharge. Conclusions The described constellation of MRI findings is highly suggestive of DPHL in the appropriate clinical setting. PMID:26357591

  10. Bartonella and intraocular inflammation: a series of cases and review of literature

    PubMed Central

    Kalogeropoulos, Chris; Koumpoulis, Ioannis; Mentis, Andreas; Pappa, Chrisavgi; Zafeiropoulos, Paraskevas; Aspiotis, Miltiadis

    2011-01-01

    Purpose: To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis. Methods: Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature. Results: Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis. Conclusion: Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis. PMID:21750616

  11. Pituitary hyperplasia: case series and literature review of an under-recognised and heterogeneous condition

    PubMed Central

    Earls, Peter; McCormack, Ann I

    2015-01-01

    Summary Pituitary hyperplasia (PH) occurs in heterogeneous settings and remains under-recognised. Increased awareness of this condition and its natural history should circumvent unnecessary trans-sphenoidal surgery. We performed an observational case series of patients referred to a single endocrinologist over a 3-year period. Four young women were identified with PH manifesting as diffuse, symmetrical pituitary enlargement near or touching the optic apparatus on MRI. The first woman presented with primary hypothyroidism and likely had thyrotroph hyperplasia given prompt resolution with thyroxine. The second and third women were diagnosed with pathological gonadotroph hyperplasia due to primary gonadal insufficiency, with histopathological confirmation including gonadal-deficiency cells in the third case where surgery could have been avoided. The fourth woman likely had idiopathic PH, though she had concomitant polycystic ovary syndrome which is a debated cause of PH. Patients suspected of PH should undergo comprehensive hormonal, radiological and sometimes ophthalmological evaluation. This is best conducted by a specialised multidisciplinary team with preference for treatment of underlying conditions and close monitoring over surgical intervention. Learning points Normal pituitary dimensions are influenced by age and gender with the greatest pituitary heights seen in young adults and perimenopausal women.Pituitary enlargement may be seen in the settings of pregnancy, end-organ insufficiency with loss of negative feedback, and excess trophic hormone from the hypothalamus or neuroendocrine tumours.PH may be caused or exacerbated by medications including oestrogen, GNRH analogues and antipsychotics.Management involves identification of cases of idiopathic PH suitable for simple surveillance and reversal of pathological or iatrogenic causes where they exist.Surgery should be avoided in PH as it rarely progresses. PMID:26124954

  12. Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

    PubMed Central

    Srivastava, Sudhir Kumar; Aggarwal, Rishi Anil; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment

  13. Critical Current, Vortices and Fermionic Bound States in the BEC to BCS Crossover

    NASA Astrophysics Data System (ADS)

    Sensarma, Rajdeep; Randeria, Mohit; Lun Ho, Tin

    2006-03-01

    We have analyzed a single vortex at T=0 in a 3D superfluid atomic Fermi gas across a Feshbach resonance[1] using a fully self-consistent Bogoliubov-deGennes approach. From the current flow around a vortex we conclude that unitarity (as= ∞) is the most robust superfluid state in the entire BCS-BEC crossover, with the highest critical velocity vc of about 0.1vF. On either side of unitarity, vc decreases. It is determined by pair breaking on the BCS side and by collective excitations in the BEC regime. In the BCS limit, the order parameter near the vortex core shows a variation on both the scale of kF-1 and of the coherence length ξ, while away from the BCS limit only a variation on the scale of ξ is seen. The density in the core rises quadratically with radial distance and is progressively depleted as one moves from BCS to BEC. The number of fermionic bound states in the core decreases as we move from the BCS to BEC regime. Remarkably, a bound state branch persists even on the BEC side reflecting the composite nature of bosonic molecules.[1] R. Sensarma, M. Randeria and T.L. Ho, cond-mat/0510761

  14. The complexity of intestinal permeability: Assigning the correct BCS classification through careful data interpretation.

    PubMed

    Zur, Moran; Hanson, Allison S; Dahan, Arik

    2014-09-30

    While the solubility parameter is fairly straightforward when assigning BCS classification, the intestinal permeability (Peff) is more complex than generally recognized. In this paper we emphasize this complexity through the analysis of codeine, a commonly used antitussive/analgesic drug. Codeine was previously classified as a low-permeability compound, based on its lower LogP compared to metoprolol, a marker for the low-high permeability class boundary. In contrast, high fraction of dose absorbed (Fabs) was reported for codeine, which challenges the generally recognized Peff-Fabs correlation. The purpose of this study was to clarify this ambiguity through elucidation of codeine's BCS solubility/permeability class membership. Codeine's BCS solubility class was determined, and its intestinal permeability throughout the small intestine was investigated, both in vitro and in vivo in rats. Codeine was found to be unequivocally a high-solubility compound. All in vitro studies indicated that codeine's permeability is higher than metoprolol's. In vivo studies in rats showed similar permeability for both drugs throughout the entire small-intestine. In conclusion, codeine was found to be a BCS Class I compound. No Peff-Fabs discrepancy is involved in its absorption; rather, it reflects the risk of assigning BCS classification based on merely limited physicochemical characteristics. A thorough investigation using multiple experimental methods is prudent before assigning a BCS classification, to avoid misjudgment in various settings, e.g., drug discovery, formulation design, drug development and regulation. PMID:24262076

  15. Impaired complex III assembly associated with BCS1L gene mutations in isolated mitochondrial encephalopathy.

    PubMed

    Fernandez-Vizarra, Erika; Bugiani, Marianna; Goffrini, Paola; Carrara, Franco; Farina, Laura; Procopio, Elena; Donati, Alice; Uziel, Graziella; Ferrero, Iliana; Zeviani, Massimo

    2007-05-15

    We investigated two unrelated children with an isolated defect of mitochondrial complex III activity. The clinical picture was characterized by a progressive encephalopathy featuring early-onset developmental delay, spasticity, seizures, lactic acidosis, brain atrophy and MRI signal changes in the basal ganglia. Both children were compound heterozygotes for novel mutations in the human bc1 synthesis like (BCS1L) gene, which encodes an AAA mitochondrial protein putatively involved in both iron homeostasis and complex III assembly. The pathogenic role of the mutations was confirmed by complementation assays, using a DeltaBcs1 strain of Saccharomyces cerevisiae. By investigating complex III assembly and the structural features of the BCS1L gene product in skeletal muscle, cultured fibroblasts and lymphoblastoid cell lines from our patients, we have demonstrated, for the first time in a mammalian system, that a major function of BCS1L is to promote the maturation of complex III and, more specifically, the incorporation of the Rieske iron-sulfur protein into the nascent complex. Defective BCS1L leads to the formation of a catalytically inactive, structurally unstable complex III. We have also shown that BCS1L is contained within a high-molecular-weight supramolecular complex which is clearly distinct from complex III intermediates. PMID:17403714

  16. Goal-Setting: Guidelines for Diagnosis and Rehabilitation Program Development: Melinda Bracken's Case File. Advanced Facilitative Case Management Series, Training Package II.

    ERIC Educational Resources Information Center

    Roessler, Richard T.; Rubin, Stanford E.

    This paper is a sample case study for the second in a series of instructor-assisted training modules for rehabilitation counselors, supervisors, and graduate students. This case file for the second module focuses on the counseling skills needed for rehabilitation of the severely disabled and provides an illustration of the…

  17. Pitfalls in Fractal Time Series Analysis: fMRI BOLD as an Exemplary Case

    PubMed Central

    Eke, Andras; Herman, Peter; Sanganahalli, Basavaraju G.; Hyder, Fahmeed; Mukli, Peter; Nagy, Zoltan

    2012-01-01

    This article will be positioned on our previous work demonstrating the importance of adhering to a carefully selected set of criteria when choosing the suitable method from those available ensuring its adequate performance when applied to real temporal signals, such as fMRI BOLD, to evaluate one important facet of their behavior, fractality. Earlier, we have reviewed on a range of monofractal tools and evaluated their performance. Given the advance in the fractal field, in this article we will discuss the most widely used implementations of multifractal analyses, too. Our recommended flowchart for the fractal characterization of spontaneous, low frequency fluctuations in fMRI BOLD will be used as the framework for this article to make certain that it will provide a hands-on experience for the reader in handling the perplexed issues of fractal analysis. The reason why this particular signal modality and its fractal analysis has been chosen was due to its high impact on today’s neuroscience given it had powerfully emerged as a new way of interpreting the complex functioning of the brain (see “intrinsic activity”). The reader will first be presented with the basic concepts of mono and multifractal time series analyses, followed by some of the most relevant implementations, characterization by numerical approaches. The notion of the dichotomy of fractional Gaussian noise and fractional Brownian motion signal classes and their impact on fractal time series analyses will be thoroughly discussed as the central theme of our application strategy. Sources of pitfalls and way how to avoid them will be identified followed by a demonstration on fractal studies of fMRI BOLD taken from the literature and that of our own in an attempt to consolidate the best practice in fractal analysis of empirical fMRI BOLD signals mapped throughout the brain as an exemplary case of potentially wide interest. PMID:23227008

  18. Ovulation induction with minimal dose of follitropin alfa: a case series study

    PubMed Central

    2011-01-01

    Background Gonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Pharmacologic OI is associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. Treatment protocols that minimize these risks by promoting monofollicular development are required. A starting dose of 37.5 IU/day follitropin alfa has been used in OI, particularly among women at high risk of multifollicular development and multiple pregnancy. A retrospective case series study was performed to evaluate rates of monofollicular development and singleton pregnancy following standard treatment with 37.5 IU/day follitropin alfa. Methods Spanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses. Results Thirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle ≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations. Conclusions Monofollicular growth rate was comparable with

  19. Convergence in spectral forward modelling: Binominal series solutions vs. direct integral solutions at high degrees - spherical and ellipsoidal case

    NASA Astrophysics Data System (ADS)

    Rexer, Moritz; Claessens, Sten; Hirt, Christian

    2016-04-01

    The number of relevant terms of binominal series expansions used in spectral forward modelling of the gravitational potential is known to rise substantially as the resolution of the models increases. Here, we investigate and compare the binominal series expansions in forward modelling w.r.t. a sphere and w.r.t. an ellipsoid (Claessens and Hirt, 2013) in view of high degree forward modelling (d/o 10800). The series in each case depend on different parameters - such as elevation of the topographic function or ellipsoidal radius/co-latitude - and reveal different maximum orders of truncation for a 1% convergence level (=relative error). The results are verified in a real data scenario up to d/o 5400 by spot-checks using direct integral solutions that do not depend on binomial series expansions. As a conclusion, our study demonstrates that for d/o 10800 modelling up to 30 terms of the binominal series accounting for the radial integral are needed within the spherical and the ellipsoidal case, while up to 60 terms are needed for the binominal series accounting for the oblateness of Earth in the ellipsoidal case for a convergence at the 1% level. References: Claessens, S.J.; Hirt, C.: Ellipsoidal topographic potential - new solutions for spectral forward gravity modelling of topography with respect to a reference ellipsoid; Journal of Geophysical Research (JGR) - Solid Earth, Vol. 118, DOI: 10.1002/2013JB010457, 2013.

  20. CASE/A - COMPUTER AIDED SYSTEM ENGINEERING AND ANALYSIS, ECLSS/ATCS SERIES

    NASA Technical Reports Server (NTRS)

    Bacskay, A.

    1994-01-01

    , specific heat, density, and viscosity) is generated at user-selected output intervals and stored for reference. The Integrated Plot Utility (IPU) provides plotting capability for all data output. System utility commands are provided to enable the user to operate more efficiently in the CASE/A environment. The user is able to customize a simulation through optional operations FORTRAN logic. This user-developed code is compiled and linked with a CASE/A model and enables the user to control and timeline component operating parameters during various phases of the iterative solution process. CASE/A provides for transient tracking of the flow stream constituents and determination of their thermodynamic state throughout an ECLSS/ATCS simulation, performing heat transfer, chemical reaction, mass/energy balance, and system pressure drop analysis based on user-specified operating conditions. The program tracks each constituent through all combination and decomposition states while maintaining a mass and energy balance on the overall system. This allows rapid assessment of ECLSS designs, the impact of alternate technologies, and impacts due to changes in metabolic forcing functions, consumables usage, and system control considerations. CASE/A is written in FORTRAN 77 for the DEC VAX/VMS computer series, and requires 12Mb of disk storage and a minimum paging file quota of 20,000 pages. The program operates on the Tektronix 4014 graphics standard and VT100 text standard. The program requires a Tektronix 4014 or later graphics terminal, third party composite graphics/text terminal, or personal computer loaded with appropriate VT100/TEK 4014 emulator software. The use of composite terminals or personal computers with popular emulation software is recommended for enhanced CASE/A operations and general ease of use. The program is available on an unlabeled 9-track 6250 BPI DEC VAX BACKUP format magnetic tape. CASE/A development began in 1985 under contract to NASA/Marshall Space Flight

  1. AB082. Phenotype and genotype of Vietnamese patients with mucopolysaccharidosis II: first case series report

    PubMed Central

    Hang, Le Thi Thuy; Dung, Vu Chi; Tomatsu, Shunji; Yen, Nguyen Thi; Hung, Trinh Thanh; Ngoc, Can Thi Bich; Nguyen, Ngoc Khanh; Hwu, Wuh-Liang; Ki, Gu-Hwan; Yoo, Han-Wook

    2015-01-01

    Background and objective Mucopolysaccharidosis II (MPS II, Hunter syndrome, OMIM 309900) is an X-linked lysosomal storage disorder. MPS II is caused by a deficiency in the enzyme iduronate-2 sulfatase (I2S), leading to the accumulation of the glycosaminoglycans (GAGs) dermatan sulfate and heparan sulfate in lysosomes. Excessive storage of these GAGs causes a variety of clinical manifestations: coarse facies, hearing loss, cardiac valve disease, restrictive and obstructive airway disease, hepatosplenomegaly, skeletal abnormalities, joint contractures, short stature. The study aims to describe clinical characteristics and to identify mutations in the IDS gene in Vietnamese patients with MPS II. Methods This case series report including 18 cases with MPS II diagnosed and treated at the National Hospital of Pediatric, Vietnam from December 2012 to May 2015. We describe clinical manifestations, radiological, biochemical evaluations and identified mutations of IDS gene of the patients confirmed by enzyme assay. Nine exons and their intronic boundaries of the IDS gene were sequenced using genomic DNA from the patient. Subsequently, to identify the recombination event with pseudogene, PCR analysis was carried out. Results Mean age of diagnosis was 8.2±5.9 years. The clinical symptoms included coarsened facial features (100%); mental retardation and joint stiffness (88.89%); bone deformation (66.67%); hepatomegaly (33.33%); valvular heart disease (22.22%); hearing loss (16.67%); obstructive airway disease (100%). Mutations of IDS gene were identified in 14/18 of cases (77.8%) including six cases (33.33%) had recombination event. Three reported causative mutations were identified: c.120-122del (p.L41del); c.1001A > G (p.D334G); c.879G > C (p.Q293H); and five novel one were identified in this study: c.166dup (p.D56Gfs*2); c.1124-1128dup (p.L377Gfs*10); c.473del (p.Y158fs); c.814C > T (p.Q272*) and c.1048A > T (p.N350Y). Conclusions Description of clinical characteristics to

  2. Osteoradionecrosis of the mandible: a case series at a single institution

    PubMed Central

    2013-01-01

    Background Osteoradionecrosis (ORN) defines exposed irradiated bone, which fails to heal over a period of 3–6 months without evidence of residual or recurrent tumor. In the previous decades, a staging and treatment protocol suggested by Marx, has dominated the approach to ORN. However, recently this paradigm is shifting. The purpose of this study was to evaluate our institutional experience in managing ORN through a retrospective review of case series from a large urban academic cancer centre. Methods A retrospective chart review was conducted to include all ORN cases from 2003 to 2009 diagnosed at the Department of Otolaryngology – Head and Neck Surgery and the Department of Dentistry. The staging of ORN was assessed as affected by tumor site, tumor stage, radiotherapy modality and dose, chemotherapy, dental work, and time to diagnosis. The effectiveness of hyperbaric oxygen therapy (HBO) and surgery in the management of ORN was evaluated. Results Fourteen cases of ORN were documented (incidence 0.84%). Primary subsites included tonsils, tongue, retromolar trigone, parotid gland, soft palate and buccal mucosa. There were 5 (35.7%) stage 1, 3 (21.4%) stage 2, and 6 (42.9%) stage 3 cases. ORN severity was not significantly associated with gender, smoking, alcohol use, tumor site, T stage, N stage, AJCC stage, or treatment modality (radiation alone, surgery with adjuvant radiation or adjuvant chemoradiation). Patients treated with intensity-modulated radiotherapy developed less severe ORN compared to those treated with conventional radiotherapy (p < 0.015). ORN stage did not correlate with radiation dose. In one patient only dental procedures were performed following radiation and could be implicated as the cause of ORN. HBO therapy failed to prevent ORN progression. Surgical treatment was required for most stage 2 (partial resections and free tissue transfers) and stage 3 patients (mandibulectomies and free tissue transfers, including two flaps in one

  3. Solution of the Skyrme HF + BCS equation on a 3D mesh

    NASA Astrophysics Data System (ADS)

    Bonche, P.; Flocard, H.; Heenen, P. H.

    2005-09-01

    imaginary time step method. A quadratic constraint is used to obtain states corresponding to given values of the quadrupole tensor. Unusual features:The pairing correlations being included with the BCS method, a physically correct solution must not have any occupied single particle state in the continuum. This requires the Fermi energy of both nucleon species to be negative and their absolute value to be typically larger than twice the pairing gap. Running time:For the test case, which starts from Nilsson wave-functions, a deformed configuration of 84Zr is obtained with an accuracy better than 0.1 keV in 157 s on a HP-RX4640. Starting from this solution, other deformed configurations are obtained in less than 1 min.

  4. Comparison of different pairing fluctuation approaches to BCS-BEC crossover

    SciTech Connect

    Levin, Kathryn Chen Qijin Chien, C.-C. He Yan

    2010-02-15

    The subject of BCS-Bose-Einstein condensation (BEC) crossover is particularly exciting because of its realization in ultracold atomic Fermi gases and its possible relevance to high temperature superconductors. In this paper we review the body of theoretical work on this subject, which represents a natural extension of the seminal papers by Leggett and by Nozieres and Schmitt-Rink (NSR). The former addressed only the ground state, now known as the 'BCS-Leggett' wave-function, and the key contributions of the latter pertain to calculations of the superfluid transition temperature T{sub c}. These two papers have given rise to two main and, importantly, distinct, theoretical schools in the BCS-BEC crossover literature. The first of these extends the BCS-Leggett ground state to finite temperature and the second extends the NSR scheme away from T{sub c} both in the superfluid and normal phases. It is now rather widely accepted that these extensions of NSR produce a different ground state than that first introduced by Leggett. This observation provides a central motivation for the present paper which seeks to clarify the distinctions in the two approaches. Our analysis shows how the NSR-based approach views the bosonic contributions more completely but treats the fermions as 'quasi-free'. By contrast, the BCS-Leggett based approach treats the fermionic contributions more completely but treats the bosons as 'quasi-free'. In a related fashion, the NSR-based schemes approach the crossover between BCS and BEC by starting from the BEC limit and the BCS-Leggett based scheme approaches this crossover by starting from the BCS limit. Ultimately, one would like to combine these two schemes. There are, however, many difficult problems to surmount in any attempt to bridge the gap in the two theory classes. In this paper we review the strengths and weaknesses of both approaches. The flexibility of the BCS-Leggett based approach and its ease of handling make it widely used in T=0

  5. Ascending aortitis: a clinicopathological study of 21 cases in a series of 300 aortic repairs.

    PubMed

    Xu, Lauren; Heath, Jonathon; Burke, Allen

    2014-06-01

    There are few single-institution clinicopathological series of aortitis. In this study, all ascending aneurysms were prospectively evaluated pathologically with ≥6 aortic sections over a 6-year period.Of 300 ascending aortic resections, there were 21 cases of aortitis (7%), in 11 women and 10 men (mean 67, range 41-88 years). There were 19 patients with aneurysms, and two patients with sclerosing periaortitis, clinically suspected to have intramural haematoma. Of the 19 patients with aneurysms (11 women), two had prior temporal arteritis, one ankylosing spondylitis, one IgA nephropathy, one undifferentiated autoimmune disease, one Lyme disease, and one fibromyalgia. In only two patients was aortitis suspected before surgery as the cause of aneurysm. Four patients developed distal aortic aneurysm requiring repeat surgery. Valve replacement or repair was necessary in nine patients, and two patients died after surgery. There were no significant differences between patients with and without autoimmune disease. The histological features were necrotising aortitis in 18 of 19 patients with aneurysmal aortitis, and there was one case of non-necrotising aortitis. One valve showed autoimmune valvulitis, congenitally bicuspid associated with ankylosing spondylitis. Necrotising aortitis was classified as acute (n = 5), healing (n = 9), and healed (n = 4). Acute necrotising aortitis was associated with need for valve replacement (p = 0.01) and younger age (p = 0.01). The healed phase had subtle histological features, sparse medial inflammation, marked medial attenuation, and chronic adventitial inflammation. Two patients with periaortitis demonstrated marked fibroinflammatory thickening of the adventitia with histological features typical of IgG4-related disease; neither had systemic symptoms. Ascending aortitis is histologically diverse, most frequently of the medial necrotising type, and is usually not suspected pre-operatively. Awareness of the

  6. Long ureteric stricture replacement by buccal mucosa graft: an Armenian experience case series report

    PubMed Central

    Akopyan, Kristina; Levonyan, Arthur; Tsaturyan, Ashot

    2016-01-01

    Introduction The aim of this study is to demonstrate the results of a case series concerning the replacement of long ureteric strictures using buccal mucosa grafts. Material and methods Five patients (3 men, 2 women), with a mean age of 35 years old, underwent reconstructive ureteral surgery using buccal mucosa graft with omental wrapping during the period of 2010–2013. In all cases, the location of strictures was in the proximal ureters with the length of strictures varying from 2.5 to 5.0 cm. Results We did not observe any major complications postoperatively. Two patients complained of constipation, which was resolved on the second day without any special treatment. Only one patient experienced fever (39°C) on the seventh day after the surgery due to inadequate drainage of the nephrostomic tube. Mean follow-up time was 39.6 months (range 26–52 months), mean hospital stay length was 10.6 days. Intravenous and antegrade urography were performed after removing JJ stents. Results were favorable without any signs of stricture. Repetitive ultrasound and radiologic imaging was performed at month 3, 6, 12 in the first year and every half-year thereafter. Intravenous urography showed no signs of strictures. Hydronephrosis was resolved in all patients by the sixth month following the surgery. Conclusions Postoperatively, we observed favorable results in all patients in terms of absence of short term-surgical complications. This technique could be considered for patients with long ureteric strictures in whom ureteral replacement with bowel interposition or kidney auto-transplantation is contraindicated. PMID:27551561

  7. Amniotic membrane - A Novel material for the root coverage: A case series

    PubMed Central

    Sharma, Anamika; Yadav, Komal

    2015-01-01

    Background: Periodontal plastic surgical procedures aimed at coverage of exposed root surface. Owing to the second surgical donor site and difficulty in procuring a sufficient graft for the treatment of root coverage procedures, various alternative additive membranes have been used. A recent resorbable amniotic membrane, not only maintains the structural and anatomical configuration of regenerated tissues, but also enhances gingival wound healing, provides a rich source of stem cells. Therefore, amniotic membrane is choice of material these days in augmenting the better results in various periodontal procedures. Aim: The aim of this observational case series was to evaluate the effectiveness, predictability and the use of a novel material, amniotic membrane in the treatment of shallow-to-moderate isolated recession defects. Materials and Methods: A total of three cases, showing Miller's Class I or Class II gingival recession, participated in this study. Recession depth, recession width, keratinized gingiva (KG) tissue width, clinical attachment level (CAL) were recorded at baseline, 3 and 6 months postoperatively. Results: Six months following root coverage procedures, the mean root coverage was found to be 70.2 ± 6.8%. CAL significantly decreased from 6.4 ± 0.54 mm preoperatively to 3.5 ± 0.9 mm postoperatively at 6 months while KG showed significant improvement from 3.2 ± 0.28 mm preoperatively to 5.9 ± 0.74 mm postoperatively at 6 months. Conclusion: Autogenous graft tissue procurement significantly increases patient morbidity while also lengthening the duration of surgery in placing the graft, while self-adherent nature of amniotic membrane significantly reduces surgical time and made the procedure easier to perform, making it membrane of choice. PMID:26392696

  8. Diffuse dermal angiomatosis of the breast: a series of 22 cases from a single institution

    PubMed Central

    Reusche, Ryan; Winocour, Sebastian; Degnim, Amy

    2015-01-01

    Background Diffuse dermal angiomatosis (DDA) is a rare cutaneous disorder that can affect the breast. A total of nine cases of breast involvement have been described in the literature, but there is currently no consensus in the best therapeutic approach. The objective of this study was to examine patient outcomes with such therapies in women diagnosed with DDA of the breast. Methods Consecutive cases of DDA of the breast were retrospectively reviewed including patient demographic variables, diagnostic criteria and type of therapies. A successful outcome was defined as complete healing of chronic open breast wounds and absence of disease recurrence after cessation of therapy. Results Twenty-two women (mean age, 48.4 years) diagnosed with DDA of the breast were identified between 2004 and 2012. The diagnosis was confirmed with skin biopsy in 12 patients and clinical diagnosis in the remaining ten patients. The majority of patients were obese [68.2% (15/22), average body mass index (BMI), 36.9 kg/m2] and at the time of diagnosis, 27.3% of patients were active smokers (6/22). Only two patients (9.1%) received isotretinoin, neither had full recovery and both patients showed recurrence when taken off of therapy. Other medical therapies showed less to no improvement. Two patients underwent successful surgical treatment. One patient had a successful outcome following breast reduction, although her postoperative course was complicated with delayed wound healing. The other patient presented with recurrence of DDA following breast reduction, and was successfully managed with bilateral simple mastectomies. Conclusions Our findings suggest that DDA of the breast is associated with macromastia, obesity and tobacco use. Isotretinoin therapy is published as having favorable outcomes to other therapies, but in this series only appears to reduce symptoms rather than eradicate DDA. Our findings indicate that other medical therapies have been attempted with limited success. Surgical

  9. Validation of a home safety questionnaire used in a series of case-control studies

    PubMed Central

    Watson, Michael; Benford, Penny; Coupland, Carol; Clacy, Rose; Hindmarch, Paul; Majsak-Newman, Gosia; Deave, Toity; Kendrick, Denise

    2014-01-01

    Objective To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies. Methods The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses. Results In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value

  10. Pediatric seizure-related posttraumatic stress and anxiety symptoms treated with EMDR: a case series

    PubMed Central

    Dautovic, Elmedina; de Roos, Carlijn; van Rood, Yanda; Dommerholt, Agnes; Rodenburg, Roos

    2016-01-01

    Purpose To examine the potential effects of eye movement desensitization and reprocessing (EMDR) in children with epilepsy-related posttraumatic stress and/or anxiety symptoms, using a case series design. Methods Five children (aged 8–18) with epilepsy identified for seizure-related posttraumatic stress and/or anxiety symptoms were treated with EMDR. To examine potential treatment effects, posttraumatic stress and anxiety symptoms were assessed (CRTI and SCARED) pre- and post-EMDR and at 3-month follow-up. Normative deviation scores were calculated to examine the severity of seizure-related posttraumatic stress and anxiety symptoms over time. The reliable change index was calculated for pre- to posttreatment change of seizure-related posttraumatic stress and/or anxiety symptoms. Results Before EMDR, overall or subscale scores indicated that all children had (sub)clinical seizure-related posttraumatic stress symptoms and/or anxiety symptoms. Directly after EMDR, most children showed significant and/or clinical individual improvement, and these beneficial effects were maintained or reached at follow-up. The mean number of sessions was 2 (range 1–3, 45 min per session). Conclusions In case of seizure-related posttraumatic stress and/or anxiety, this study indicates that EMDR is a potentially successful quick and safe psychological treatment for children with epilepsy. Highlights of the article The first study to examine the potential effects of EMDR to reduce clinical seizure-related posttraumatic stress symptoms and/or anxiety symptoms in children with epilepsy. After 1–3 EMDR (45 min) sessions, positive treatment effects were found on a range of seizure-related PTSD symptoms and/or anxiety symptoms. During treatment, no seizures, absences, or any other adverse events were observed; the seizure diaries showed that none of the children experienced more seizures (or an unusual pattern) after treatment. At the reevaluation of EMDR, all children and parents

  11. Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series

    PubMed Central

    Stojkovic, M; Mickan, C; Weber, TF; Junghanss, T

    2015-01-01

    Background Alveolar echinococcosis (AE) is a neglected zoonosis presenting with focal liver lesions (FLL) with a wide range of imaging patterns resembling benign as well as malignant FLLs. Complementary serology and histopathology may be misleading. Objective The objective of our study is to highlight pitfalls leading to wrong diagnoses and harmful interventions in patients with AE. Design This retrospective sentinel case series analyses diagnostic and treatment data of patients with confirmed AE. Results 80 patients treated between 1999 and 2014 were included in the study. In 26/80 patients treatment decisions were based on a wrong diagnosis. AE was mistaken for cystic echinococcosis (CE) in 12/26 patients followed by cholangiocellular carcinoma (CCA) in 5/26 patients; 61/80 patients had predominantly infiltrative liver lesions and 19/80 patients had a predominantly pseudocystic radiological presentation. Serology correctly differentiated between Echinococcus multilocularis and Echinococcus granulosus in 53/80 patients. Histopathology reports attributed the right Echinococcus species in 25/58 patients but failed to differentiate E. multilocularis from E. granulosus in 25/58 patients. Although contraindicated in AE 8/25 patients treated surgically had instillation of a protoscolicidal agent intraoperatively. One of the eight patients developed toxic cholangitis and liver failure and died 1 year after liver transplantation. Conclusions Misclassification of AE leads to a critical delay in growth inhibiting benzimidazole treatment, surgical overtreatment and bares the risk of liver failure if protoscolicidal agents are instilled in AE pseudocysts. PMID:26462284

  12. Correction of Tear Trough Deformity With a Cohesive Polydensified Matrix Hyaluronic Acid: A Case Series.

    PubMed

    Huber-Vorländer, Jürgen; Kürten, Martin

    2015-01-01

    The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM®) technology hyaluronic acid gel (Belotero® Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects' satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area. PMID:26605822

  13. Correction of tear trough deformity with a cohesive polydensified matrix hyaluronic acid: a case series.

    PubMed

    Huber-Vorländer, Jürgen; Kürten, Martin

    2015-01-01

    The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM(®)) technology hyaluronic acid gel (Belotero(®) Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects' satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area. PMID:26170706

  14. Correction of tear trough deformity with a cohesive polydensified matrix hyaluronic acid: a case series

    PubMed Central

    Huber-Vorländer, Jürgen; Kürten, Martin

    2015-01-01

    The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM®) technology hyaluronic acid gel (Belotero® Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects’ satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area. PMID:26170706

  15. A case series of buprenorphine/naloxone treatment in a primary care practice.

    PubMed

    Doolittle, Benjamin; Becker, William

    2011-10-01

    Physicians' adoption of buprenorphine/naloxone treatment is hindered by concerns over feasibility, cost, and lack of comfort treating patients with addiction. We examined the use of buprenorphine/naloxone in a community practice by two generalist physicians without addiction training, employing a retrospective chart review. From 2006-2010, 228 patients with opiate abuse/dependence were treated with buprenorphine/naloxone using a home-induction protocol. Multiple co-morbidities including diabetes (23% of patients), hypertension (36%), Hepatitis C (43%), and depression (74%) were concurrently managed. In this diverse sample, 1/228 experienced precipitated withdrawal during induction. Of the convenience subsample analyzed (n = 28), 82% (+/-10%) had negative urine drug tests for opioids; 92% (+/-11%) were negative for cocaine; 88% (+/-12%) were positive for buprenorphine. This case series demonstrated feasibility and safety of a low-cost buprenorphine/naloxone home induction protocol employed by generalists. Concurrent treatment of multiple comorbidities conforms with the patient-centered medical home ideal. Randomized trials of this promising approach are needed. PMID:22014257

  16. Is mindfulness-based therapy an effective intervention for obsessive-intrusive thoughts: a case series.

    PubMed

    Wilkinson-Tough, Megan; Bocci, Laura; Thorne, Kirsty; Herlihy, Jane

    2010-01-01

    Despite the efficacy of cognitive-behavioural interventions in improving the experience of obsessions and compulsions, some people do not benefit from this approach. The present research uses a case series design to establish whether mindfulness-based therapy could benefit those experiencing obsessive-intrusive thoughts by targeting thought-action fusion and thought suppression. Three participants received a relaxation control intervention followed by a six-session mindfulness-based intervention which emphasized daily practice. Following therapy all participants demonstrated reductions in Yale-Brown Obsessive-Compulsive Scale scores to below clinical levels, with two participants maintaining this at follow-up. Qualitative analysis of post-therapy feedback suggested that mindfulness skills such as observation, awareness and acceptance were seen as helpful in managing thought-action fusion and suppression. Despite being limited by small participant numbers, these results suggest that mindfulness may be beneficial to some people experiencing intrusive unwanted thoughts and that further research could establish the possible efficacy of this approach in larger samples. PMID:20041421

  17. Weightlifting's risky new trend: a case series of 41 insulin users.

    PubMed

    Ip, Eric J; Barnett, Mitchell J; Tenerowicz, Michael J; Perry, Paul J

    2012-01-01

    Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 ± 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a "recreational exerciser" (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 ± 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it "easy" to acquire their insulin. Strategies aimed to prevent insulin misuse are needed. PMID:22777326

  18. Disulfiram-Induced De Novo Convulsions without Alcohol Challenge: Case Series and Review of Literature.

    PubMed

    Kulkarni, Ranganath Ramarao; Bairy, Bhavya K

    2015-01-01

    Seizure induction by disulfiram (DSF) an adverse effect of therapeutic dosages of DSF is less understood. In our prospective case series of eight subjects with alcohol dependence a temporal, dose-dependent, and reversible epileptogenic potential due to DSF was noted. Mean duration of onset of first seizure was 2.13 ± 1.13 weeks after initiation of DSF therapy (125-500 mg/day) with no other detectable causes of seizures. Presence of alcohol withdrawal seizures (50%), DSF-induced hypertension (HTN) (37.5%), psychosis (12.5%) were noted, that may suggest common neurobiological underpinnings like dopamine-beta-hydroxylase inhibition. Various types of DSF-induced generalized seizures (tonic-clonic, 62.5%; myoclonic and tonic-clonic, 25%; myoclonic, 12.5%) were effectively managed by halving initial DSF dose (37.5%) even after cessation of antiepileptics, or stopping DSF (37.5%). Presence of alcohol withdrawal seizures, DSF-induced HTN/psychosis during DSF therapy may be early risk factors for dose-dependent and reversible adverse effect of DSF therapy - seizure induction, emphasizing caution. PMID:26664087

  19. Childhood Onset Diagnoses in a Case Series of Teens at Clinical High Risk for Psychosis

    PubMed Central

    Mazzoni, Paola; Kimhy, David; Khan, Shamir; Posner, Kelly; Maayan, Lawrence; Eilenberg, Mara; Messinger, Julie; Kestenbaum, Clarice

    2009-01-01

    Abstract Reasons Schizophrenia is typically an adult neurodevelopmental disorder that has its antecedents in childhood and adolescence. Little is known about disorders “usually first diagnosed in infancy, childhood and adolescence” (e.g., childhood-onset disorders) in “prodromal” teens at heightened clinical risk for psychotic disorder. Main Findings Childhood-onset disorders were prevalent in putatively prodromal teens, including anxiety and disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), and, surprisingly, elimination disorders. These may reflect developmental antecedents in psychotic disorders such as schizophrenia. Key Data and Statistics A case series of 9 teens (ages 13–17) identified as prodromal to psychosis were evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version (K-SADS-PL). Childhood-onset diagnoses commonly endorsed (threshold or subthreshold) included ADHD (5/9), oppositional defiant disorder (5/9), enuresis or encopresis (4/9), conduct disorder (2/9), separation anxiety (3/9), and transient tic disorder (2/9). Enuresis was identified in 3 of the 4 older teens (ages 15–17). Major Conclusions An understanding of the childhood-onset disorders that occur in teens at risk for psychotic illnesses, such as schizophrenia, can shed light on the pathophysiology of schizophrenia and potentially inform early identification and intervention. PMID:20035596

  20. Disulfiram-Induced De Novo Convulsions without Alcohol Challenge: Case Series and Review of Literature

    PubMed Central

    Kulkarni, Ranganath Ramarao; Bairy, Bhavya K.

    2015-01-01

    Seizure induction by disulfiram (DSF) an adverse effect of therapeutic dosages of DSF is less understood. In our prospective case series of eight subjects with alcohol dependence a temporal, dose-dependent, and reversible epileptogenic potential due to DSF was noted. Mean duration of onset of first seizure was 2.13 ± 1.13 weeks after initiation of DSF therapy (125-500 mg/day) with no other detectable causes of seizures. Presence of alcohol withdrawal seizures (50%), DSF-induced hypertension (HTN) (37.5%), psychosis (12.5%) were noted, that may suggest common neurobiological underpinnings like dopamine-beta-hydroxylase inhibition. Various types of DSF-induced generalized seizures (tonic-clonic, 62.5%; myoclonic and tonic-clonic, 25%; myoclonic, 12.5%) were effectively managed by halving initial DSF dose (37.5%) even after cessation of antiepileptics, or stopping DSF (37.5%). Presence of alcohol withdrawal seizures, DSF-induced HTN/psychosis during DSF therapy may be early risk factors for dose-dependent and reversible adverse effect of DSF therapy — seizure induction, emphasizing caution. PMID:26664087

  1. Nonoperative Korean Medicine Combination Therapy for Lumbar Spinal Stenosis: A Retrospective Case-Series Study

    PubMed Central

    Kim, Kiok; Jeong, Yongjae; Youn, Yousuk; Choi, Jeongcheol; Kim, Jaehong; Chung, Wonseok; Kim, Tae-Hun

    2015-01-01

    This is a retrospective case series exploring the therapeutic benefits and harm of nonoperative Korean medicine combination therapy for lumbar spinal stenosis (LSS). The medical records of a total of 33 LSS patients, who were treated as inpatients at Mokhuri Neck and Back Hospital, Republic of Korea, from November 2010 to January 2012, were reviewed first and telephone survey on these patients was conducted after one year. Body acupuncture, pharmacoacupuncture, Chuna, and oral administration of herbal medicines were offered to all patients. A Visual analogue scale (VAS) of pain and the walking duration without pain were used to assess the patients during the approximately 1-month treatment period. The average VAS score of pain and the walking duration improved significantly; the VAS score decreased from 9 (SD, 1.15) to 2.75 (2.22) (p < 0.01), and the walking duration increased from 5.5 (6.66) to 16.75 (13.00) minutes (p < 0.01). No adverse event was reported during the treatment. In addition, the decreased pain level and improved function continued for over one year. Although we did not find definitive evidence, the study results suggest that KM combination therapy may be beneficial for decreasing pain and improving function in LSS patients and may produce comparatively few adverse events. PMID:26543486

  2. Effects of a Dynamic Progressive Orthotic Intervention for Chronic Hemiplegia: A Case Series

    PubMed Central

    Doucet, Barbara M.; Mettler, Joni A.

    2014-01-01

    Study Design: Case series design on a single subgroup of participants Introduction: Management of hypertonicity and resistance to passive movement (RTPM) in the upper extremity is an intractable problem for persons with stroke and the therapists who provide their care. Therapists have limited options for assessment and treatment of this condition which can profoundly limit functional performance and quality of life. Purpose of the Study: To evaluate the effect of a 12-week dynamic progressive orthotic intervention in persons with chronic stroke exhibiting wrist flexion contracture who are residents of a long term skilled nursing facility. Methods: A custom fitted dynamic progressive wrist extension orthotic was applied to 6 residents with chronic stroke. The orthotic was worn for 4 hours daily, 4X/week for 12 weeks. Wrist passive range of motion (PROM) and RTPM were measured weekly and after discontinuation of the orthotics using the Modified Ashworth Scale and the Tardieu Scale of Spasticity. Signal analysis of electromyographical (EMG) flexor response to extensor stretching was also measured before and after orthotic intervention using maximal root mean square (RMS) values and EMG burst onset time. Results: A moderate effect was found for changes in PROM with the orthotic intervention. Progress made diminished following discontinuation. Moderate effects were also seen in EMG measures which indicated increases in amount of resistive-free movement following intervention. Conclusions: A dynamic progressive orthotic intervention can be an effective option for increasing wrist PROM and reducing RTPM in persons with chronic stroke. Level of Evidence: 4 PMID:23149271

  3. Unintentional root fragment retention in proximity to dental implants: a series of six human case reports.

    PubMed

    Langer, Laureen; Langer, Burton; Salem, Daliah

    2015-01-01

    There has been renewed interest in intentionally placing dental implants in proximity to or in contact with tooth root fragments. In clinical practice, human teeth are usually extracted due to nonrestorable caries, vertical or horizontal root fractures, periodontal disease, or endodontic failure, which is commonly accompanied by inflammation and bacterial contamination. The aim of this case series is to present the adverse effects in humans of clinically undetected root-to-implant contact (CURIC), where implants were unintentionally placed in proximity to undetected retained root fragments. The adverse effects of small (3 to 5 mm) root fragments were detectible 6 to 48 months post implant placement. Three out of seven implants in six patients were removed due to severe coronal bone loss. This differs from retrograde peri-implantitis, where only the apical area of the implant is affected and the coronal portion remains integrated. The detrimental effect of root fragment-to-implant contact is described along with its clinical management. Based on the review of currently relevant data, mixed results have been documented regarding the success of dental implants in proximity to tooth-root fragments. Careful evaluation of long-term, postloading results in humans where hopeless teeth have been extracted due to infection and significant bone loss are required before intentional root fragment retention is considered a safe and reliable clinical option for implant placement. PMID:25909518

  4. Paucity of Intrahepatic Bile Ducts in Neonates: the First Case Series from Iran

    PubMed Central

    Zahmatkeshan, Mozhgan; Geramizadeh, Bita; Haghighat, Mahmood; Enteshari, Hajar

    2013-01-01

    Objective Paucity of interlobular bile ducts (PIBD), defined as absence or marked decrease in the number of interlobular bile ducts, is one of the causes of neonatal cholestasis. Treatment includes treating the intractable pruritus caused by persistent cholestasis. PIBD can be part of a familial syndrome of cholestasis named Alagille syndrome (AGS). We report clinical status of a case series of Iranian patients with PIBD. Methods In this retrospective study, patients with cholestasis admitted to the pediatric gastroenterology ward in a referral hospital in Shiraz from January 2006 to January 2010 and underwent liver biopsy were evaluated. Clinical and paraclinical status of children with the pathologic diagnosis of PIBD was assessed. Findings Disease was presented in all jaundiced patients with aged in average 3 days at presentation. Seven patients had the criteria of AGS. Despite medical treatment, cholestasis was not controlled in 6 (28.6%) patients. Liver transplantation led to the survival of 5 patients while the other patient who did not undergo liver transplantation died at 2 months of age. One patient underwent peritoneal dialysis due to renal insufficiency and died at 9 months of age. After 1-5 years of follow-up, the mortality rate was 9.5%. Conclusion In patients with intractable cholestasis, only patients that underwent liver transplantation survived. Thus, the most important criterion for liver transplantation in neonatal PIBD is intractable cholestasis. This is the first report that shows AGS can result in neonatal-onset renal insufficiency. PMID:23550220

  5. Tetrodotoxin poisoning caused by Goby fish consumption in southeast China: a retrospective case series analysis

    PubMed Central

    You, Jie; Yue, YaJun; Xing, Feng; Xia, Wei; Lai, ShaoYang; Zhang, FengLei

    2015-01-01

    OBJECTIVES: To investigate an unusual outbreak of tetrodotoxin poisoning in Leizhou, southeast China, a case series analysis was conducted to identify the source of illness. METHODS: A total of 22 individuals experienced symptoms of poisoning, including tongue numbness, dizziness, nausea and limb numbness and weakness. Two toxic species, Amoya caninus and Yongeichthys nebulosus, were morphologically identified from the batches of gobies consumed by the patients. Tetrodotoxin levels in the blood and Goby fish samples were detected using liquid chromatography-tandem mass spectrometry. RESULTS: The tetrodotoxin levels in the remaining cooked Goby fish were determined to be 2090.12 µg/kg. For Amoya caninus, the toxicity levels were 1858.29 µg/kg in the muscle and 1997.19 µg/kg in the viscera and for Yongeichthys nebulosus, they were 2783.00 µg/kg in the muscle and 2966.21 µg/kg in the viscera. CONCLUSION: This outbreak demonstrates an underestimation of the risk of Goby fish poisoning. Furthermore, the relationships among the toxic species, climates and marine algae present should be clarified in the future. PMID:25672425

  6. Clinical Phenotype of Adult Fragile X Gray Zone Allele Carriers: a Case Series.

    PubMed

    Debrey, Sarah M; Leehey, Maureen A; Klepitskaya, Olga; Filley, Christopher M; Shah, Raj C; Kluger, Benzi; Berry-Kravis, Elizabeth; Spector, Elaine; Tassone, Flora; Hall, Deborah A

    2016-10-01

    Considerable research has focused on patients with trinucleotide (CGG) repeat expansions in the fragile X mental retardation 1 (FMR1) gene that fall within either the full mutation (>200 repeats) or premutation range (55-200 repeats). Recent interest in individuals with gray zone expansions (41-54 CGG repeats) has grown due to reported phenotypes that are similar to those observed in premutation carriers, including neurological, molecular, and cognitive signs. The purpose of this manuscript is to describe a series of adults with FMR1 alleles in the gray zone presenting with movement disorders or memory loss. Gray zone carriers ascertained in large FMR1 screening studies were identified and their clinical phenotypes studied. Thirty-one gray zone allele carriers were included, with mean age of symptom onset of 53 years in patients with movement disorders and 57 years in those with memory loss. Four patients were chosen for illustrative case reports and had the following diagnoses: early-onset Parkinson disease (PD), atypical parkinsonism, dementia, and atypical essential tremor. Some gray zone carriers presenting with parkinsonism had typical features, including bradykinesia, rigidity, and a positive response to dopaminergic medication. These patients had a higher prevalence of peripheral neuropathy and psychiatric complaints than would be expected. The patients seen in memory clinics had standard presentations of cognitive impairment with no apparent differences. Further studies are necessary to determine the associations between FMR1 expansions in the gray zone and various phenotypes of neurological dysfunction. PMID:27372099

  7. Postoperative respiratory depression associated with pregabalin: A case series and a preoperative decision algorithm

    PubMed Central

    Eipe, Naveen; Penning, John

    2011-01-01

    Pregabalin is gaining popularity in the perioperative period for its usefulness in treating neuropathic pain and its apparent opioid-sparing effect. The present report describes the perioperative course of three patients who received pregabalin and experienced significant respiratory depression in the postoperative period. All three patients consented to the report and publication of the present case series. The first patient was elderly with borderline renal dysfunction. She experienced respiratory arrest in the immediate postoperative period following a craniotomy for tumour excision. The second patient presented with severe respiratory depression 12 h after receiving a spinal anesthetic for joint replacement, and was later found to have clinically significant obstructive sleep apnea. The third patient, who was an otherwise healthy elderly individual on benzodiazepines for anxiety, experienced respiratory arrest in the postanesthesia care unit after an uneventful anesthesia for lumbar spine decompression. All of these patients were treated successfully with standard resuscitation measures. Although other causes of respiratory depression in these patients were considered, there appears to be an association between pregabalin and this complication. The present article briefly reviews the evidence regarding the perioperative use of pregabalin. Based on the authors’ experience and the available evidence, they believe that pregabalin may be useful in the management of acute pain in carefully selected patients undergoing certain surgeries. A clinical algorithm has been developed to guide the perioperative use of pregabalin. This algorithm may be helpful in increasing the safety of perioperative pregabalin use. PMID:22059207

  8. Outcomes of myringoplasty in Australian Aboriginal children and factors associated with success: a prospective case series.

    PubMed

    Mak, D; MacKendrick, A; Bulsara, M; Coates, H; Lannigan, F; Lehmann, D; Leidwinger, L; Weeks, S

    2004-12-01

    The objective of this study was to assess the outcomes of myringoplasties in Aboriginal children and to identify factors associated with a successful outcome with the use of prospective case series from primary health care clinics and hospitals in four rural and remote regions of Western Australia. All 58 Aboriginal children, aged 5-15 years, who underwent 78 myringoplasties between 1 January 2000 and 30 June 2001 were included in the study. Complete postoperative (post-op) follow-up was achieved following 78% of myringoplasties. The main outcome measures were (a) success, i.e. an intact tympanic membrane and normal hearing six or more months post-op in the operated ear, (b) closure of the perforation, (c) Post-op hearing improvement. Forty-nine per cent of myringoplasties were successful, 72% resulted in closure or reduction in the size of the perforation and 51% resulted in hearing improvement. After controlling for age, sex, clustering and number of previous myringoplasties, no association was observed between success or hearing improvement and perforation size, or the presence of serous aural discharge at the time of surgery. Myringoplasty resulted in hearing improvement and/or perforation closure in a significant proportion of children. Thus, primary school-aged Aboriginal children in whom conservative management of chronic suppurative otitis media has been unsuccessful should have access to myringoplasty because of the positive impact on their socialization, language and learning that results from improved hearing. PMID:15533146

  9. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series.

    PubMed

    Tanaka, Eriko; Murata, Hiroaki; Minami, Hitomi; Sumikawa, Koji

    2014-06-01

    Peroral endoscopic myotomy (POEM) is a newly developed, less invasive treatment for esophageal achalasia that requires general anesthesia under positive pressure ventilation. In this retrospective case series, we describe the anesthetic management of 28 consecutive patients who underwent POEM for esophageal achalasia. Anesthesia was maintained with sevoflurane and remifentanil under positive pressure ventilation through a tracheal tube. Retained contents in the esophagus were evacuated just before anesthesia induction to prevent regurgitation into the trachea. The POEM procedure was performed using an orally inserted flexible fiberscope. Elevation of end-tidal carbon dioxide after initiating esophageal carbon dioxide insufflation was observed in all patients and was treated by minute adjustments to the ventilation volume. Scopolamine butylbromide-induced tachycardia in one patient was treated with landiolol hydrochloride, which is a short-acting beta 1-selective blocker. Minor subcutaneous emphysema around the neck was observed in one patient. POEM was successfully completed, and tracheas were extubated immediately after the procedure in all patients. Our findings suggest that prevention of aspiration pneumonia during anesthesia induction, preparation for carbon dioxide insufflation-related complications, and treatment of scopolamine butylbromide-induced tachycardia play important roles in safe anesthesia management of POEM for esophageal achalasia. PMID:24185834

  10. Hand injuries due to firework devices: a series of 58 cases.

    PubMed

    Matheron, A-S; Hendriks, S; Facca, S; Liverneaux, P A

    2014-04-01

    Fireworks or firecrackers can cause serious accidents. They are classified from K1 to K4 according to the amount of powder they contain. In Alsace (France), a type-K1 firecracker is available on the free market and the K2 and K3 ones are prohibited. The aim of this study was to reveal the effects of measures taken in order to prevent repercussions related to hand injuries caused by fireworks. Patients who fell victim to firework incidents have been recorded since 2006, starting date of the prevention campaign. Records have been taken on the circumstances, the group of firecracker, the level of injury and the severity of the injury in four stages. Our series included 62 hands from 58 patients (average age: 25 years), including two women. Most of them sustained their injury during the night of New Year's Eve. The study dealt with 21 K1, and 35 K2 or K3. We registered 29 cases of grade I, 2 grades II, 21 grades III and 9 grades IV. One patient died. The numbers of consultations, K2/K3 injuries and number of surgeries increased from 2006 to 2012. Our results show that firework-related injuries to the hand are serious, pluridigital, multistage and/or bilateral. Prevention was ineffective but should be improved and strengthened, as a total ban on fireworks is a counterproductive measure. PMID:24674696

  11. Time-series microarray data simulation modeled with a case-control label.

    PubMed

    Liu, Y J; Zhang, J Y

    2016-01-01

    With advances in molecular biology, microarray data have become an important resource in the exploration of complex human diseases. Although gene chip technology continues to grow, there are still many barriers to overcome, such as high costs, small sample sizes, complex procedures, poor repeatability, and the dependence on data analysis methods. To avoid these problems, simulation data have a vital role in the study of complex diseases. A simulation method of microarray data is introduced in this study to model the occurrence and development of general diseases. Using classic statistics and control theory, five risk models are proposed. One or more models can be introduced into the baseline simulation dataset with a case-control label. In addition, time-series gene expression data can be generated to model the dynamic evolutionary process of a disease. The prevalence of each model is estimated and disease-associated genes are tested by significance analysis of microarrays. The source code, written in MATLAB, is freely and publicly available at http://sourceforge.net/projects/genesimulation/files/. PMID:27323009

  12. Exertional rhabdomyolysis: attrition through exercise, a case series and review of the literature.

    PubMed

    Reese, Jason M; Fisher, Scott D; Robbins, David P

    2012-01-01

    Rhabdomyolysis is a common syndrome that can range from asymptomatic to a severe life-threatening condition. It is the result of acute muscle fiber necrosis leading to cell lysis and subsequent transfer of those byproducts into the circulatory system.1-3 The most significant constituent of these byproducts is myoglobin, which has been known to cause renal failure in 10?50% of patients that develop rhabdomyolysis.4,5 In addition, the electrolytes contained within these cells are leached into the blood stream, which can lead to significant electrolyte abnormalities. The etiology of rhabdomyolysis is broad and includes inherited diseases, drugs, toxins, muscle compression or overexertion, infections, and more. This syndrome may carry a mortality rate ranging from 7?80%.3,6 We describe five patients assigned to various companies within 160th Special Operations Aviation Regiment (Airborne) that developed exertional rhabdomyolysis of the bilateral upper extremities between June 2011 and January 2012. In this case series we will describe the events leading up to the diagnosis, lack of risk factors or family history, diagnostic criteria, treatment, and future concerns related to the condition. PMID:23032321

  13. Lesser toe salvage with external fixation and autogenous bone grafting: a case series.

    PubMed

    Roukis, Thomas S

    2010-06-01

    Lesser toe salvage secondary to soft tissue ulceration and underlying osteomyelitis is a challenge, and amputation is frequently the primary procedure recommended. The author presents an observational case series involving retrospective review of prospectively collected data of 4 lesser toe salvage procedures with external fixation and delayed autogenous bone grafting for the treatment of osteomyelitis in 4 consecutive patients. Each patient underwent initial resection of involved soft tissue ulceration and underlying osseous components of the lesser toe with application of external fixation and polymethylmethacrylate antibiotic-loaded bone cement spacer. Once eradication of osteomyelitis was confirmed clinically, the patient underwent delayed insertion of autogenous bone graft harvested from the ipsilateral calcaneus or osteocutaneous flap transfer from the fibular border of the ipsilateral great toe. There were 2 men and 2 women with a mean age of 56.5 years. Three patients had diabetes mellitus, and 1 had previous history of open fracture. There were 2 right feet and 2 left feet involved and 2 second, 1 third, and 1 fourth toe salvage procedures performed with a mean follow-up of 12 months. The external fixation device was maintained until complete osseous integration was verified, which occurred at a mean of 7.5 weeks. All procedures were deemed successful with complete osseous incorporation of the proximal and distal graft-host bone interfaces and no recurrent soft tissue ulcerations, osteomyelitis, toe deformity, or fracture about the bone graft sites. PMID:20508009

  14. Pulsed radiofrequency ablation for residual and phantom limb pain: a case series.

    PubMed

    West, Matt; Wu, Hong

    2010-01-01

    Residual limb pain (RLP) and phantom limb pain (PLP) can be debilitating and can prevent functional gains following amputation. High correlations have been reported between RLP and the stump neuromas following amputation. Many treatment methods including physical therapy, medications, and interventions, have been used with limited success. Pulsed radiofrequency ablation (PRFA) has shown promise in treating neuropathic pain because of the inhibition of evoked synaptic activity. We present 4 amputees who were treated with PRFA after failing conservative management for their RLP and PLP. All 4 patients underwent PRFA and demonstrated at least 80% relief of RLP for over 6 months. One patient reported a complete resolution of phantom sensation while another patient had significantly decreased frequency of spontaneous PLP and resolution of evoked PLP. In addition, all patients reported improved overall function including increased prosthetic tolerance and decreased oral pain medications. This case series suggests that PRFA is a viable treatment option which might be used for long-term relief of intractable RLP and/or PLP. PMID:20230449

  15. Chlorinated pesticides and cancer of the head and neck: a retrospective case series.

    PubMed

    Govett, Gregg; Genuis, Stephen John; Govett, Hannah E; Beesoon, Sanjay

    2011-07-01

    Cancer of the head and neck is a pervasive problem with recognized determinants including tobacco use, alcohol consumption, and earlier radiation exposure. Organochlorine pesticides (OCPs) have been shown to have carcinogenic potential in both animals and humans. OCPs have previously been widely used in the agricultural industry of rural Oklahoma. Seven patients from rural Oklahoma with head and neck cancer and without any of the usual risk factors were tested for the presence of OCPs in their adipose tissue. Clinical and toxicological data on each of these patients are presented for consideration. Results were compared with (i) levels from five individuals not experiencing cancer but who lived in the same area, and (ii) adipose tissue OCP levels in other population groups. Each of the seven patients tested had markedly elevated levels of some OCPs in their adipose tissue compared with the cohort of noncancer patients. Further research is required to confirm whether there is a causative link between OCP bioaccumulation and head and neck cancer as suggested by this case series. PMID:21633202

  16. Intravenous thiotepa for treatment of breast cancer-related leptomeningeal carcinomatosis: case series.

    PubMed

    Chahal, Jaspreet; Stopeck, Alison; Clarke, Kathryn; Livingston, Robert B; Chalasani, Pavani

    2015-09-01

    Leptomeningeal carcinomatosis (LMC) secondary to metastatic breast cancer (MBC) has increased in incidence with improved systemic disease control. Current treatment options include radiation therapy (to symptomatic sites) and systemic treatment [intrathecal (IT) or intravenous (IV) chemotherapy]. Methotrexate (MTX), thiotepa and cytarabine are the most commonly used IT agents, while high-dose MTX is the most common IV regimen. While IT treatments are generally well tolerated, complications like chemical meningitis, leukoencephalopathy, etc. occur. LMC may cause a breakdown in the blood-brain barrier and thus allow systemic agents to penetrate; however, efficacy is reported only for agents administered at high doses (MTX). We report our institution's experience in using IV thiotepa as treatment for LMC secondary to MBC. We conducted a retrospective chart review of 13 patients with MBC who developed LMC and treated with IV thiotepa at our institution. It was administered at 40 mg/m(2) every 21 days; median number of thiotepa cycles administered was 5 with the major dose-limiting toxicity being myelosuppression. Four had partial response, 3 had stable disease and 6 had progressive disease. The 6-month survival rate was 69 % and 1-year survival rate was 31 %. Despite retrospective nature of our case series, we found the use of IV thiotepa as sole treatment for LMC in patients with MBC to be well tolerated, easily administered in the ambulatory setting, and with efficacy comparable to the other chemotherapeutic agents commonly used in the treatment of LMC. This regimen warrants further investigation in prospective studies. PMID:25990104

  17. Association between Beckwith-Wiedemann syndrome and assisted reproductive technology: a case series of 19 patients

    PubMed Central

    Chang, Aimee S.; Moley, Kelle H.; Wangler, Michael; Feinberg, Andrew P.; DeBaun, Michael R.

    2016-01-01

    Objective An association between assisted reproductive technique (ART) and specific imprinting mutations, such as Beckwith-Wiedemann syndrome (BWS), has recently been documented. Based on experiments in farm animals that demonstrated an association between alterations in culture media during ART and large offspring syndrome, we hypothesized that the culture media could be implicated as a common factor among the children with BWS conceived after ART. Design Retrospective case series. Setting Registry from Academic Medical Center. Patient(s) Nineteen children born after ART were identified within the registry. Main Outcome Measure(s) Demographics of patients, type of ART, culture media, IVF parameters. Result(s) Twelve of the 19 medical records from the reproductive endocrine centers were successfully obtained. Ten of 12 mothers of children with BWS had IVF, but no single, consistent culture media was used in this group. Half of the patients underwent IVF with intracytoplasmic sperm injection (ICSI; n = 5), whereas the other half had routine IVF. One child was conceived through clomiphene citrate (CC) stimulation and artificial insemination, whereas another patient conceived through gonadotropin stimulation with intrauterine insemination (IUI). The gonadotropin dosage and quantity of embryos transferred also varied significantly. The only consistent finding was that all 12 women received some type of ovarian stimulation medication. Conclusion(s) Large epidemiologic studies are needed to further study the association between BWS and ART. PMID:15705373

  18. Recovery of brachial plexus lesions resulting from heavy backpack use: A follow-up case series

    PubMed Central

    2011-01-01

    Background Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP) in a large series of patients. Methods Thirty-eight consecutive patients with idiopathic BPP were identified from our population of 193,450 Finnish conscripts by means of computerised register. A physiotherapist provided instructions for proper hand use and rehabilitative exercises at disease onset. The patients were followed up for 2 to 8 years from the diagnosis. We also searched for genetic markers of hereditary neuropathy with pressure palsies. Mann-Whitney U-test was used to analyze continuous data. The Fischer's exact test was used to assess two-way tables. Results Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies. Conclusions The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided. PMID:21429232

  19. Medication-free Alternatives for Long-term Maintenance of Bipolar Disorder: A Case Series

    PubMed Central

    Robinson, Cassandra L.

    2015-01-01

    Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness. PMID:25984407

  20. Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series

    PubMed Central

    Carames, Joao; Yu, Yung Cheng Paul; Pérez, Alejandro; Kang, Mary

    2015-01-01

    Purpose. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion. Materials and Methods. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants. Results. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months. Conclusions. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction. PMID:26124835

  1. The value of histopathological diagnosis in the elderly patients with granulomatous dermatoses. Case series.

    PubMed

    Badea, Mihail Alexandru; Buicu, Corneliu Florin; Sin, Anca Ileana; Cotoi, Ovidiu Simion; Badea, Iudita Maria; Chiotoroiu, Andreea Luciana; Morariu, Silviu Horia

    2016-01-01

    Granulomatous inflammations are a particular type of chronic septic or aseptic inflammation, in which infectious or non-infectious agents are difficult to eliminate by the immune system. These are type IV hypersensitivity reactions mediated by pre-sensitized T-lymphocytes cells CD4+ and CD8+ lymphocytes. Disorders included in this category are: tuberculosis, leprosy, syphilis, sarcoidosis, type I diabetes, multiple sclerosis, Crohn's disease and rheumatoid arthritis. At cutaneous level, this pattern of granulomatous reaction is characterized by a chronic inflammation with formation of granulomas consisting of a variable number of histiocytes, multinucleated giant cells and lymphocytes. Granulomatous dermatoses should be differentiated from other primary or secondary lesions affecting the skin such as inflammation or tumors. Often granulomatous dermatoses can be confused with other skin disorders, both clinically and histological. Histopathology examination can add important information and clarify the diagnosis. This paper presents a series of three clinical cases of granulomatous skin occurring in the elderly patients confirmed at histology examination. Clinical and histology criteria were analyzed, along with specific differential diagnosis, based on data from the literature. PMID:27516029

  2. The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites

    PubMed Central

    Doolan, David F.; Bates, David W.; James, Brent C.

    2003-01-01

    Objective: To describe advanced clinical information systems in the context in which they have been implemented and are being used. Design: Case series of five U.S. hospitals, including inpatient, ambulatory and emergency units. Descriptive study with data collected from interviews, observations, and document analysis. Measurements: The use of computerized results, notes, orders, and event monitors and the type of decision support; data capture mechanisms and data form; impact on clinician satisfaction and clinical processes and outcomes; and the organizational factors associated with successful implementation. Results: All sites have implemented a wide range of clinical information systems with extensive decision support. The systems had been well accepted by clinicians and have improved clinical processes. Successful implementation required leadership and long-term commitment, a focus on improving clinical processes, and gaining clinician involvement and maintaining productivity. Conclusion: Despite differences in approach there are many similarities between sites in the clinical information systems in use and the factors important to successful implementation. The experience of these sites may provide a valuable guide for others who are yet to start, or are just beginning, the implementation of clinical information systems. PMID:12509360

  3. Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

    PubMed Central

    2012-01-01

    Background Alcohol withdrawal delirium (AWD) is associated with significant morbidity and mortality. Pellagra (niacin deficiency) can be a cause of delirium during alcohol withdrawal that may often be overlooked. Objectives We present a three-patient case series of pellagrous encephalopathy (delirium due to pellagra) presenting as AWD. Methods We provide a brief review of pellagra’s history, data on pellagra’s epidemiology, and discuss pellagra’s various manifestations, particularly as related to alcohol withdrawal. We conclude by providing a review of existing guidelines on the management of alcohol withdrawal, highlighting that they do not include pellagrous encephalopathy in the differential diagnosis for AWD. Results Though pellagra has been historically described as the triad of dementia, dermatitis, and diarrhea, it seldom presents with all three findings. The neurocognitive disturbance associated with pellagra is better characterized by delirium rather than dementia, and pellagra may present as an isolated delirium without any other aspects of the triad. Discussion Although endemic pellagra is virtually eradicated in Western countries, it continues to present as pellagrous encephalopathy in patients with risk factors for malnutrition such as chronic alcohol intake, homelessness, or AIDS. It may often be mistaken for AWD. Whenever pellagra is suspected, treatment with oral nicotinamide (100 mg three times daily for 3–4 weeks) prior to laboratory confirmation is recommended as an inexpensive, safe, and potentially life-saving intervention. PMID:23186222

  4. Scaling symmetry, renormalization, and time series modeling: The case of financial assets dynamics

    NASA Astrophysics Data System (ADS)

    Zamparo, Marco; Baldovin, Fulvio; Caraglio, Michele; Stella, Attilio L.

    2013-12-01

    We present and discuss a stochastic model of financial assets dynamics based on the idea of an inverse renormalization group strategy. With this strategy we construct the multivariate distributions of elementary returns based on the scaling with time of the probability density of their aggregates. In its simplest version the model is the product of an endogenous autoregressive component and a random rescaling factor designed to embody also exogenous influences. Mathematical properties like increments’ stationarity and ergodicity can be proven. Thanks to the relatively low number of parameters, model calibration can be conveniently based on a method of moments, as exemplified in the case of historical data of the S&P500 index. The calibrated model accounts very well for many stylized facts, like volatility clustering, power-law decay of the volatility autocorrelation function, and multiscaling with time of the aggregated return distribution. In agreement with empirical evidence in finance, the dynamics is not invariant under time reversal, and, with suitable generalizations, skewness of the return distribution and leverage effects can be included. The analytical tractability of the model opens interesting perspectives for applications, for instance, in terms of obtaining closed formulas for derivative pricing. Further important features are the possibility of making contact, in certain limits, with autoregressive models widely used in finance and the possibility of partially resolving the long- and short-memory components of the volatility, with consistent results when applied to historical series.

  5. Thrombotic events in patients with antiphospholipid syndrome treated with rivaroxaban: a series of eight cases.

    PubMed

    Signorelli, Flavio; Nogueira, Felipe; Domingues, Vinicius; Mariz, Henrique Ataide; Levy, Roger A

    2016-03-01

    The current treatment for antiphospholipid syndrome (APS) with thrombotic manifestation is long-term anticoagulation. Vitamin K antagonists (VKA) are usually the agents of choice. However, VKA limitations, such as unpredictable anticoagulation effects due to interaction with diet and other drugs, require regular monitoring. This may impact on patients' quality of life. Since the approval of new oral anticoagulants (NOAC) for non-valvular atrial fibrillation and deep vein thrombosis prevention, much has been speculated about its use in APS patients. We report here a series of eight APS patients with failure of thrombotic prevention during rivaroxaban use. All patients had venous thrombosis as the initial manifestation of APS, and two of them also had arterial manifestations. Three patients had triple antibody positivity. Five patients developed arterial events during the treatment with rivaroxaban. Until the results of ongoing trials of rivaroxaban for APS are presented, NOAC should not be recommended to APS patients. Our preliminary experience as well cases previously reported in the literature suggest that there is a high-risk group that is less protected with rivaroxaban, namely those with previous arterial thrombosis or triple positivity. VKA remains to be the mainstay treatment for thrombotic APS. PMID:26219490

  6. Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series

    PubMed Central

    Brantingham, James W.; Cassa, Tammy Kay

    2015-01-01

    Objective The objective of this case series is to describe manual manipulative therapy with exercise for 3 patients with mild to moderate osteoarthritis of the great toe. Clinical Features Three patients, a 32-year-old man, a 55-year-old woman, and a 49-year-old woman, had great toe pain of 8, 1, and 2 years, respectively. Each had a palpable exostosis, a benign outgrowth of bone projecting outward from the bone surface, and decreased dorsiflexion with a hard end-feel. Intervention and Outcome Manual manipulative therapy with exercise, the Brantingham protocol, was used with patients receiving 6, 9, and 12 treatments over 6 weeks. Specific outcome measures for hallux rigidus and the foot were chosen to document the effects of this intervention including digital inclinometry, the lower extremity functional scale, the foot functional index, overall therapy effectiveness and Visual Analogue Scale (VAS). Each patient had an increase in range of motion that surpassed the minimal clinically important change, an increase in the overall therapy effectiveness and a decrease in the foot functional index that surpassed the minimally clinically important difference. Most importantly for the patients, each reported a decrease in both usual and worst pain on the VAS that exceeded the minimally clinically important difference of 20 to 30 mm. Conclusion The 3 patients reported decreased pain measured by the VAS, increased range of motion and minimally clinically important difference in 3 other outcome measures. PMID:26793039

  7. Rumination-focused cognitive behaviour therapy for residual depression: a case series.

    PubMed

    Watkins, Ed; Scott, Jan; Wingrove, Janet; Rimes, Katharine; Bathurst, Neil; Steiner, Herbert; Kennell-Webb, Sandra; Moulds, Michelle; Malliaris, Yanni

    2007-09-01

    The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression. PMID:17367751

  8. Ex Vivo Liver Resection and Autotransplantation for End-Stage Alveolar Echinococcosis: A Case Series.

    PubMed

    Wen, H; Dong, J-H; Zhang, J-H; Duan, W-D; Zhao, J-M; Liang, Y-R; Shao, Y-M; Ji, X-W; Tai, Q-W; Li, T; Gu, H; Tuxun, T; He, Y-B; Huang, J-F

    2016-02-01

    The role of autotransplantation in end-stage hepatic alveolar echinococcosis (AE) is unclear. We aimed to present our 15-case experience and propose selection criteria for autotransplantation. All patients were considered to have unresectable hepatic AE by conventional resection due to critical invasion to retrohepatic vena cava, hepatocaval region along with three hepatic veins, and the tertiary portal and arterial branches. All patients successfully underwent ex vivo extended right hepatectomy and autotransplantation without intraoperative mortality. The median autograft weight was 706 g (380-1000 g); operative time was 15.5 hours (11.5-20.5 hours); and anhepatic time was 283.8 minutes (180-435 min). Postoperative hospital stay was 32.3 days (12-60 days). Postoperative complication Clavien-Dindo grade IIIa or higher occurred in three patients including one death that occurred 12 days after the surgery due to acute liver failure. One patient was lost to follow-up after the sixth month. Thirteen patients were followed for a median of 21.6 months with no relapse. This is the largest reported series of patients with end-stage hepatic AE treated with liver autotransplantation. The technique requires neither organ donor nor postoperative immunosuppressant. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment and strict patient selection are of utmost importance. PMID:26460900

  9. Surgical treatment of physeal injuries of the lateral aspect of the clavicle: a case series.

    PubMed

    Rashid, A; Christofi, T; Thomas, M

    2013-05-01

    Lateral clavicular physeal injuries in adolescents are frequently misinterpreted as acromioclavicular dislocations. There are currently no clear guidelines for the management of these relatively rare injuries. Non-operative treatment can result in a cosmetic deformity, warranting resection of the non-remodelled original lateral clavicle. However, fixation with Kirschner (K)-wires may be associated with infection and/or prominent metalwork. We report our experience with a small series of such cases. Between October 2008 and October 2011 five patients with lateral clavicular physeal fractures (types III, IV and V) presented to our unit. There were four boys and one girl with a mean age of 12.8 years (9 to 14). Four fractures were significantly displaced and treated operatively using a tension band suture technique. One grade III fracture was treated conservatively. The mean follow-up was 26 months (6 to 42). All patients made an uncomplicated recovery. The mean time to discharge was three months. The QuickDASH score at follow-up was 0 for each patient. No patient developed subsequent growth disturbances. We advocate the surgical treatment of significantly displaced Grade IV and V fractures to avoid cosmetic deformity. A tension band suture technique avoids the problems of retained metalwork and the need for a secondary procedure. Excellent clinical and radiological results were seen in all our patients. PMID:23632678

  10. Tuberculosis Case Finding in Benin, 2000-2014 and Beyond: A Retrospective Cohort and Time Series Study.

    PubMed

    Ade, Serge; Békou, Wilfried; Adjobimey, Mênonli; Adjibode, Omer; Ade, Gabriel; Harries, Anthony D; Anagonou, Séverin

    2016-01-01

    Objective. To determine any changes in tuberculosis epidemiology in the last 15 years in Benin, seasonal variations, and forecasted numbers of tuberculosis cases in the next five years. Materials and Methods. Retrospective cohort and time series study of all tuberculosis cases notified between 2000 and 2014. The "R" software version 3.2.1 (Institute for Statistics and Mathematics Vienna Austria) and the Box-Jenkins 1976 modeling approach were used for time series analysis. Results. Of 246943 presumptive cases, 54303 (22%) were diagnosed with tuberculosis. Annual notified case numbers increased, with the highest reported in 2011. New pulmonary bacteriologically confirmed tuberculosis (NPBCT) represented 78%  ± SD 2%. Retreatment cases decreased from 10% to 6% and new pulmonary clinically diagnosed cases increased from 2% to 8%. NPBCT notification rates decreased in males from 2012, in young people aged 15-34 years and in Borgou-Alibori region. There was a seasonal pattern in tuberculosis cases. Over 90% of NPBCT were HIV-tested with a stable HIV prevalence of 13%. The ARIMA best fit model predicted a decrease in tuberculosis cases finding in the next five years. Conclusion. Tuberculosis case notifications are predicted to decrease in the next five years if current passive case finding is used. Additional strategies are needed in the country. PMID:27293887

  11. Tuberculosis Case Finding in Benin, 2000–2014 and Beyond: A Retrospective Cohort and Time Series Study

    PubMed Central

    Ade, Serge; Békou, Wilfried; Adjobimey, Mênonli; Adjibode, Omer; Ade, Gabriel; Harries, Anthony D.; Anagonou, Séverin

    2016-01-01

    Objective. To determine any changes in tuberculosis epidemiology in the last 15 years in Benin, seasonal variations, and forecasted numbers of tuberculosis cases in the next five years. Materials and Methods. Retrospective cohort and time series study of all tuberculosis cases notified between 2000 and 2014. The “R” software version 3.2.1 (Institute for Statistics and Mathematics Vienna Austria) and the Box-Jenkins 1976 modeling approach were used for time series analysis. Results. Of 246943 presumptive cases, 54303 (22%) were diagnosed with tuberculosis. Annual notified case numbers increased, with the highest reported in 2011. New pulmonary bacteriologically confirmed tuberculosis (NPBCT) represented 78%  ± SD 2%. Retreatment cases decreased from 10% to 6% and new pulmonary clinically diagnosed cases increased from 2% to 8%. NPBCT notification rates decreased in males from 2012, in young people aged 15–34 years and in Borgou-Alibori region. There was a seasonal pattern in tuberculosis cases. Over 90% of NPBCT were HIV-tested with a stable HIV prevalence of 13%. The ARIMA best fit model predicted a decrease in tuberculosis cases finding in the next five years. Conclusion. Tuberculosis case notifications are predicted to decrease in the next five years if current passive case finding is used. Additional strategies are needed in the country. PMID:27293887

  12. Cooper pairing and BCS-BEC evolution in mixed-dimensional Fermi gases

    SciTech Connect

    Iskin, M.; Subasi, A. L.

    2010-12-15

    Similar to what has recently been achieved with Bose-Bose mixtures [G. Lamporesi, J. Catani, G. Barontini, Y. Nishida, M. Inguscio, and F. Minardi, Phys. Rev. Lett. 104, 153202 (2010)], mixed-dimensional Fermi-Fermi mixtures can be created by applying a species-selective one-dimensional optical lattice to a two-species Fermi gas ({sigma}{identical_to}({up_arrow},{down_arrow})), in such a way that both species are confined to quasi-two-dimensional geometries determined by their hoppings along the lattice direction. We investigated the ground-state phase diagram of superfluidity for such mixtures in the BCS-BEC evolution, and found normal, gapped superfluid, gapless superfluid, and phase separated regions. In particular, we found a stable gapless superfluid phase where the unpaired {up_arrow} and {down_arrow} fermions coexist with the paired (or superfluid) ones in different momentum space regions. This phase is in some ways similar to the Sarma state found in mixtures with densities, but in our case, the gapless superfluid phase is unpolarized and most importantly it is stable against phase separation.

  13. Apo- and Cellopentaose-bound Structures of the Bacterial Cellulose Synthase Subunit BcsZ

    SciTech Connect

    Mazur, Olga; Zimmer, Jochen

    2012-10-25

    Cellulose, a very abundant extracellular polysaccharide, is synthesized in a finely tuned process that involves the activity of glycosyl-transferases and hydrolases. The cellulose microfibril consists of bundles of linear {beta}-1,4-glucan chains that are synthesized inside the cell; however, the mechanism by which these polymers traverse the cell membrane is currently unknown. In Gram-negative bacteria, the cellulose synthase complex forms a trans-envelope complex consisting of at least four subunits. Although three of these subunits account for the synthesis and translocation of the polysaccharide, the fourth subunit, BcsZ, is a periplasmic protein with endo-{beta}-1,4-glucanase activity. BcsZ belongs to family eight of glycosyl-hydrolases, and its activity is required for optimal synthesis and membrane translocation of cellulose. In this study we report two crystal structures of BcsZ from Escherichia coli. One structure shows the wild-type enzyme in its apo form, and the second structure is for a catalytically inactive mutant of BcsZ in complex with the substrate cellopentaose. The structures demonstrate that BcsZ adopts an ({alpha}/{alpha}){sub 6}-barrel fold and that it binds four glucan moieties of cellopentaose via highly conserved residues exclusively on the nonreducing side of its catalytic center. Thus, the BcsZ-cellopentaose structure most likely represents a posthydrolysis state in which the newly formed nonreducing end has already left the substrate binding pocket while the enzyme remains attached to the truncated polysaccharide chain. We further show that BcsZ efficiently degrades {beta}-1,4-glucans in in vitro cellulase assays with carboxymethyl-cellulose as substrate.

  14. Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

    PubMed Central

    Toda, Karla Sawada; Kikuchi, Luciana; Chagas, Aline Lopes; Tanigawa, Ryan Yukimatsu; Paranaguá-Vezozzo, Denise Cerqueira; Pfiffer, Túlio; Rocha, Manoel de Souza; Alves, Venâncio Avancini Ferreira; Carrilho, Flair José

    2015-01-01

    Background and Aims: Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic. Methods: From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil. Results: Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died. Conclusions: It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the

  15. Invasive Complete Hydatidiform Moles: Analysis of a Case Series With Genotyping.

    PubMed

    Bynum, Jennifer; Murphy, Kathleen M; DeScipio, Cheryl; Beierl, Katie; Adams, Emily; Anderson, Derek; Vang, Russell; Ronnett, Brigitte M

    2016-03-01

    Complete hydatidiform moles (CHM) are purely androgenetic conceptions, with most (∼85%) arising from fertilization of an egg lacking maternal DNA by a single sperm that duplicates (homozygous/monospermic 46,XX) and a small subset arising via fertilization by 2 sperms (heterozygous/dispermic 46,XY or 46,XX). It remains controversial if heterozygous/dispermic CHMs have a significantly greater risk of persistent gestational trophoblastic disease. Analysis of zygosity of CHMs with and without invasion at presentation, including invasive CHMs with concurrent atypical trophoblastic proliferations concerning for or consistent with choriocarcinoma, has not been specifically addressed. In a prospective series of 1024 products of conception specimens subjected to immunohistochemical analysis of p57 expression and molecular genotyping with short tandem-repeat markers, 288 CHMs were diagnosed, of which 126 were genotyped, including 16 invasive CHMs. Zygosity was compared between those with and without invasion. Of the 16 study cases, 12 (75%) were homozygous/monospermic XX and 4 (25%) were heterozygous/dispermic (3 XY and 1 XX). Of the 110 genotyped noninvasive CHMs, 96 (87%) were homozygous/monospermic XX and 14 (13%) were heterozygous/dispermic (12 XY, 2 XX). Comparison of the zygosity results for the invasive CHMs (study group) with the noninvasive CHMs in the database did not demonstrate a statistically significant difference (P=0.24, Fisher exact test). In addition, of the 3 cases associated with metastatic gestational trophoblastic disease (pulmonary nodules) at presentation, 2 were homozygous/monospermic XX, indicating that this form is not without risk of significant gestational trophoblastic disease. Thus, the current study has demonstrated a higher frequency of heterozygous/dispermic CHMs among invasive cases compared with those lacking invasion, but does not support the use of zygosity data for risk assessment of CHMs. A persistent, unresolved diagnostic challenge

  16. Time Series Analysis OF SAR Image Fractal Maps: The Somma-Vesuvio Volcanic Complex Case Study

    NASA Astrophysics Data System (ADS)

    Pepe, Antonio; De Luca, Claudio; Di Martino, Gerardo; Iodice, Antonio; Manzo, Mariarosaria; Pepe, Susi; Riccio, Daniele; Ruello, Giuseppe; Sansosti, Eugenio; Zinno, Ivana

    2016-04-01

    The fractal dimension is a significant geophysical parameter describing natural surfaces representing the distribution of the roughness over different spatial scale; in case of volcanic structures, it has been related to the specific nature of materials and to the effects of active geodynamic processes. In this work, we present the analysis of the temporal behavior of the fractal dimension estimates generated from multi-pass SAR images relevant to the Somma-Vesuvio volcanic complex (South Italy). To this aim, we consider a Cosmo-SkyMed data-set of 42 stripmap images acquired from ascending orbits between October 2009 and December 2012. Starting from these images, we generate a three-dimensional stack composed by the corresponding fractal maps (ordered according to the acquisition dates), after a proper co-registration. The time-series of the pixel-by-pixel estimated fractal dimension values show that, over invariant natural areas, the fractal dimension values do not reveal significant changes; on the contrary, over urban areas, it correctly assumes values outside the natural surfaces fractality range and show strong fluctuations. As a final result of our analysis, we generate a fractal map that includes only the areas where the fractal dimension is considered reliable and stable (i.e., whose standard deviation computed over the time series is reasonably small). The so-obtained fractal dimension map is then used to identify areas that are homogeneous from a fractal viewpoint. Indeed, the analysis of this map reveals the presence of two distinctive landscape units corresponding to the Mt. Vesuvio and Gran Cono. The comparison with the (simplified) geological map clearly shows the presence in these two areas of volcanic products of different age. The presented fractal dimension map analysis demonstrates the ability to get a figure about the evolution degree of the monitored volcanic edifice and can be profitably extended in the future to other volcanic systems with

  17. “Excess gooD can be Dangerous”. A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D

    PubMed Central

    Pandita, Kamal Kishore; Razdan, Sushil; Kudyar, Rattan Parkash; Beigh, Aadil; Kuchay, Shafi; Banday, Tanveer

    2012-01-01

    Summary Vitamin D is increasingly recognized to have several beneficial effects. Its toxicity, causing hypercalcemia, is considered as extremely rare. We report case series of 15 patients (most of them being elderly subjects) with iatrogenic symptomatic hypercalcemia in whom toxicity occurred due to empirical excessive administration of vitamin D by oral and parenteral route. PMID:23087723

  18. Therapeutic Assessment for Preadolescent Boys with Oppositional Defiant Disorder: A Replicated Single-Case Time-Series Design

    ERIC Educational Resources Information Center

    Smith, Justin D.; Handler, Leonard; Nash, Michael R.

    2010-01-01

    The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to…

  19. Clinical Practice as Natural Laboratory for Psychotherapy Research: A Guide to Case-Based Time-Series Analysis

    ERIC Educational Resources Information Center

    Borckardt, Jeffrey J.; Nash, Michael R.; Murphy, Martin D.; Moore, Mark; Shaw, Darlene; O'Neil, Patrick

    2008-01-01

    Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice…

  20. Variations in Clinical Presentation of Ocular Syphilis: Case Series Reported From a Growing Epidemic in the United States.

    PubMed

    Marx, Grace E; Dhanireddy, Shireesha; Marrazzo, Jeanne M; Tuddenham, Susan A; Rompalo, Anne M; Leone, Peter A; Gaydos, Charlotte A; Rietmeijer, Cornelis A

    2016-08-01

    Ocular syphilis, a form of neurosyphilis, has been increasingly diagnosed in the United States. This case series summarizes the course of 6 patients recently diagnosed with ocular syphilis, emphasizing the varied sociodemographic factors and the wide range of symptoms and outcomes that are seen in patients with this disease. PMID:27419818